Childbearing Family Nursing: Postpartum Care Quiz

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Questions and Answers

What is the term for the process by which reproductive organs return to their non-pregnant state?

Decidualization

Estrogenic change

Hyperplasia

Involution (correct)

Which hormone levels change to induce uterine contractions after delivery?

Decreased estrogen levels (correct)

Increased human chorionic gonadotropin levels

Increased progesterone levels

Decreased oxytocin levels

On which day postpartum should the fundal height be approximately 3 cm below the umbilicus?

D3 (correct)

What does a flaccid fundus indicate in a postpartum woman?

Uterine atony Signup and view all the answers

Which of the following statements about postpartum uterine involution is incorrect?

Involution can be influenced positively by increased estrogen levels. Signup and view all the answers

What is a common emotional experience for women in the first 24-48 hours after delivery?

Elevation of mood and over activity Signup and view all the answers

What percentage of women may experience postnatal blues within the first two weeks after delivery?

80% Signup and view all the answers

In which phase does a mother primarily focus on her own basic needs?

Taking-in phase Signup and view all the answers

During the taking-hold phase, a woman primarily begins to focus on what?

Learning about newborn care Signup and view all the answers

What is the primary verbal behavior a mother uses immediately following the prenatal visit?

It Signup and view all the answers

In the anticipatory stage of becoming a mother, what behavior is common?

Copying the own mother's behaviors Signup and view all the answers

What position should a mother hold her baby to establish direct eye contact?

En face position Signup and view all the answers

What is the duration of the taking-hold phase postpartum?

2-10 days Signup and view all the answers

What is a characteristic behavior of women in the taking-in phase?

Being passive and following instructions Signup and view all the answers

Which of the following factors can lead to normal psychological changes in postpartum women?

Decreased oestrogen & progesterone levels Signup and view all the answers

What percentage of postpartum women is affected by postpartum depression within six months after delivery?

13% - 19% Signup and view all the answers

What key emotion might women experience during the taking-hold phase?

Mood swings and fatigue Signup and view all the answers

What characterizes postpartum blues?

Altered mood and anxiety Signup and view all the answers

What is the typical duration of postpartum blues?

1-2 weeks Signup and view all the answers

What percentage of postpartum women may experience puerperal psychosis?

0.1% - 0.5% Signup and view all the answers

Which emotional symptoms are typically associated with postpartum blues?

Anxiety and irritability Signup and view all the answers

What is the typical heart rate range for women in the first 6-10 days postpartum?

50-70 bpm Signup and view all the answers

How much blood loss is typically expected during a vaginal birth of a single fetus?

300-500 ml Signup and view all the answers

What physiological change occurs to blood volume during pregnancy?

Expands by 40% Signup and view all the answers

When do blood cell and hemoglobin levels return to pre-pregnant levels after birth?

Within 4-6 weeks Signup and view all the answers

What contributes to the hypercoagulable state in the early puerperium?

Increased platelet count Signup and view all the answers

What causes diuresis in the first 2-5 days postpartum?

Drops in estrogen Signup and view all the answers

What is the expected blood loss range during a C-section?

500-1000 ml Signup and view all the answers

When does the hemostatic system typically return to its normal pre-pregnant status?

6-12 weeks Signup and view all the answers

What primarily triggers the onset of milk production after childbirth?

Decrease in progesterone levels Signup and view all the answers

What causes breast fullness in lactating mothers?

Venous congestion and milk accumulation Signup and view all the answers

When does breast engorgement typically occur postpartum?

Within 48-72 hours after childbirth Signup and view all the answers

What is the role of progesterone during pregnancy regarding lactation?

Promotes the development of lobules and alveoli Signup and view all the answers

What physiological change occurs in the breasts if a mother is not breastfeeding by the 3rd or 4th day postpartum?

Drop in prolactin levels Signup and view all the answers

What happens to the levels of human chorionic gonadotropin (hCG) postpartum?

They fall rapidly and should not be detectable by 10 days Signup and view all the answers

What is a common characteristic of breast engorgement?

Hard and painful, warm to touch Signup and view all the answers

What occurs to the placental hormones after the expulsion of the placenta?

Both oestrogen and progesterone levels drop significantly Signup and view all the answers

What is diastasis recti abdominis often associated with during the 3rd trimester?

Separation of rectus abdominis muscles Signup and view all the answers

What is a common consequence of muscle overexertion during labor?

Fatigue and muscle ache Signup and view all the answers

Which of the following changes to hair is common postpartum?

Permanent coarse or bristly hair remains Signup and view all the answers

What is a common cause of postpartum chill?

Sudden release of pressure on pelvic nerves Signup and view all the answers

How does the immune system change during pregnancy and postpartum?

Mildly impaired during pregnancy, then rebounds slowly Signup and view all the answers

Which psychological response may a woman experience in the postpartum period?

Adjustment to a new family role Signup and view all the answers

What is a reported effect of melasma during pregnancy?

May persist in up to 30% of women Signup and view all the answers

Postpartum hair loss is most likely to occur during which timeframe?

3-4 months after birth Signup and view all the answers

Study Notes

Course Information

Bachelor of Science (Honours) in Nursing (53455-3)
SN3180 – Childbearing Family Nursing
Postpartum Assessments and Care (Part 1)
Maternal Physiological & Psychological Changes in the Puerperium
Dr. Lo, Shirley
2024

Learning Outcomes

Describe the essential changes in puerperium
Physiological changes and adaptations
Psychological changes and adaptations
Understand relevant nursing assessments and interventions to support postpartum families
Understand and support breastfeeding of the infant
Identify and promote appropriate approaches in family planning

Outline of the Upcoming 3 Lectures

Maternal physiological and psychological changes in the puerperium
Nursing assessments and care in the puerperium
Breastfeeding and family planning

The Puerperium

Defined as the period immediately after delivery of the placenta and membranes
Continues for 6 weeks (42 days)
Also known as the postpartum period or the fourth trimester of pregnancy

Importance of the Puerperium

Considerable physiological and psychological adaptations occur towards returning to the non-pregnant state
The woman recovers from labor, which can be physically and emotionally draining
A mother undergoes a significant psycho-physiological experience – becoming a mother and caring for a newborn
Breastfeeding should be established
Appropriate contraceptive methods should be discussed with healthcare professionals

Postpartum Physiological Changes

Reproductive system
Endocrine system
Cardiovascular system
Respiratory system
Digestive system
Excretory system
Musculoskeletal system
Integumentary system
Immune system

Postpartum Physiological Changes: Detailed

Uterus (Uterine Involution):
- The process of the uterus returning to its pre-pregnancy size and condition
- Immediately after delivery, the uterine fundus should be firm and contracted—influenced by hormonal changes
- Withdrawal of placental hormones (oestrogen and progesterone), Increased oxytocin level
- Palpation of the fundus—midline, near the maternal umbilicus, during the first few hours after delivery
- Size can be larger after a C-section or in women who have had multiple births.
- Descent of the fundal height—decreases ~1cm per day
- By day 10, fundus should be in the pelvis and no longer palpable abdominally
- Involves the contraction of uterine muscle, release of proteolytic enzymes for autolysis and regeneration of uterine epithelium
Placental Site:
- Regeneration may take 6 weeks.
Afterpains (afterbirth pain):
- Intermittent uterine muscle contractions under oxytocin's effects
- More noticeable after births of large babies, multiple births, or polyhydramnios
- More intense in women who have had multiple births
- Typically resolve in 3 to 7 days
Reproductive system changes:
- Postpartum hemorrhage is a serious concern
- The cervix returns to its normal shape
- Vaginal changes, such as swelling, decrease in lubrication
Cardiovascular changes:
- Blood volume may expand up to 40% during pregnancy
- Blood volume decreases after delivery
- Return to pre-pregnancy values within a few weeks through diuresis (urine excretion), diaphoresis (sweating), and extravascular fluid excretion/perspiration
Respiratory changes:
- intra-abdominal pressure decreases after childbirth
- Chest wall compliance increases
- Pulmonary functions return to non-pregnant state in 1 to 3 weeks
- Respiratory rate returns to 12-20 breaths per minute
Gastrointestinal system:
- Full GI mobility and tone return within 2 weeks
- Constipation can be common due to slowing of the digestive system, dehydration, temporary decrease in abdominal muscle tone, opiate use, and fear of pushing
- Return to normal functioning in 8-14 days
Body weight changes:
- Initial weight loss of 10-12 lbs (delivery of the baby, placenta, and fluids)
- Additional 5 lbs may be lost through extracellular fluid loss in the first week after birth
- Common to return to pre-pregnancy weight within 6-8 weeks if a healthy, moderate diet is maintained
Urinary system:
- Increased bladder capacity
- Swelling of the urethra
- Decreased sensation of bladder filling
- Postpartum diuresis (increased urine production) with excretion of extravascular fluid lasting 12-24 hours
Musculoskeletal system:
- Muscle tone returns within 6-8 weeks dependent on previous conditions, exercise levels, prior pregnancies to pre-pregnancy levels
- Diastasis recti abdominis (separation of abdominal muscles can persist post-delivery, especially with a prior C-section delivery; proper exercise important for return to pre-pregnancy state.
Integumentary changes:
- Hyperpigmentation usually fades after delivery.
- Striae gravidarum often persists, although some fade.
- Postpartum hair loss is common.

Maternal Psychological Changes

A woman in the postpartum period experiences multiple responses as she adjusts to new roles, a new family member, delivery-related discomforts, body image changes, and the reality of no longer being pregnant
Normal emotional and psychological adaptations:
- The “pinks”
- The “blues”
Maternal Role Attainment (MRA):
- Taking-in (dependent)
- Taking-Hold (dependent-independent)
- Letting-go (interdependent)
Process of acquaintance:

Bonding and Attachment and Maternal Touch

Initially, there is a unidirectional attraction to the newborn
Bonding – mutual interactive feelings between the parent(s) and new baby, lasts from 30-60 minutes
Attachment – relatively long-lasting bond between parents and infant
Maternal touch—en-face position with infant's face aligned to mom's own, eye-to-eye contact

Postpartum Mental Health Issues

Perinatal mental illness: baby blues, postpartum depression, and postpartum psychosis can occur, impacting psychological wellbeing.

Additional Information

References to specific data and studies should be noted in this section for a more in-depth study.

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Description

Test your knowledge on the maternal physiological and psychological changes during the puerperium. This quiz covers essential nursing assessments, interventions, and family planning approaches relevant in postpartum care. Understand how to effectively support postpartum families in their transition after childbirth.