Post partum care

• Postnatal assessment involves evaluating a mother's condition after childbirth

Puerperium

• It is the period following childbirth
• Body tissues, especially pelvic organs, return to a pre-pregnant state anatomically and physiologically

Definitions of Postnatal Care

• D C Dutta defines it as a systematic examination of the mother and baby
• Appropriate advice is given to the mother during the postpartum period
• Nadine M. Jacobson defines encompasses management of the mother, newborn, and infant during postpartum
• It technically includes the six-week period after childbirth up to the mother's postpartum check-up

History Taking

• Identification data is taken
• Present obstetric history- nausea, vaginal bleeding, urine frequency should be taken
• Past obstetric history-number of children, complication of previous pregnancies, miscarriages
• Family history is taken
• Medical/surgical and Personal history is taken
• Menstrual history is taken
• Details of contraception are taken
• Patients state of psychological health is taken

Physical Examinations

• General examination includes mental status and skin condition
• Examination of the patients head, eyes, ear, nose, mouth, pharynx and throat.
• Examination of the patients neck, chest, breast & abdomen
• Examination of the Perineum, lochia, cervix, vagina and bladder.
• Examination of the patients bowel, extremities and nails

BUBBLEHE Assessment

• It is an organized method for nurses to examine postpartum clients
• It provides a consistent, quality approach to nursing care, and act as reminder

BUBBLEHE Elements

• Breasts: Assess if soft, filling, firm, and check the nipples
• Uterus: Check consistency, position, and height
• Bladder: Evaluate voiding pattern
• Bowels: Listen for bowel sounds and check for hemorrhoids
• Lochia: Assess the type, amount, clots, and odor
• Episiotomy: Check for laceration, bruising, and swelling
• Homan sign: Check if present or not
• Emotional status: Assess bonding and for postpartum blues

Breast Assessment

• After delivery, breasts are enlarged, soft, and warm, containing colostrum
• Mothers may experience breast engorgement, starting as a tingling sensation 2-4 days post-delivery
• Milk releases through infant sucking, manual expression, or pumping
• Analgesics may be given for breast pain
• Cabbage leaves can reduce pain and swelling

Uterus Assessment

• Assess size, weight, location, and firmness
• Immediately after delivery, the uterus starts involution (reduction in size)
• The uterus weighs about 100g, measuring.
• By the end of the 6th week, it weighs 50-100g
• A bulky uterus may indicate blood clots, retained placental bits, or a full rectum
• Tenderness suggests infection
• A normal uterus should be contracted, hard, and not painful if touched
• After the 1st postpartum day, the fundus involutes 1-2 cm per day

Management of Bleeding

• After placental delivery, add 20-30 units of oxytocin to intravenous solution
• Alternatively, intramuscular oxytocin can be administered (10 units)
• Initiate early breastfeeding and nipple stimulation
• For a boggy uterus despite massage and oxytocin, or if bleeding continues, start pharmacological agents
• Administer Methargin 0.25mg IM
• Give Prostaglandin if Methargin cannot stop bleeding or is contraindicated

Uterine Pain

• An empty bladder is key to relieving after birth pain
• Lying prone with a pillow under the lower abdomen keeps it contracted and eliminates after birth pain.
• Analgesics can be effective

Bladder Assessment

• Postpartum, the bladder is congested, edematous, and hypotonic due to labor
• Mothers should urinate within 4 hours, voiding at least 300 ml to completely empty the bladder
• Diuresis of up to 3000 ml per day can occur in the first 2-3 days.
• Straight catheterization may be required

Bowel Movements

• Bowel movements usually occur 2-3 days after vaginal delivery
• Constipation may occur when gastric motility does not return by 2-3 days
• Clients should drink 6-8 glasses of fluid daily and eat a high fiber diet
• Sitz baths and/or enemas may be given
• Stool softeners like dulcolax or topical ointments can be used

Lochia Assessment

• Ensure the source of bleeding is not laceration if bleeding is heavy
• Saturation of a vaginal pad within 15-30 minutes indicates heavy bleeding
• CBC may indicate a 1.0 to 1.5 g/dl decrease in hemoglobin level

Episiotomy Care

• An episiotomy is a surgical incision to enlarge the vaginal opening for delivery
• Care includes applying ice packs to the perineum for the first 24 hours
• Do not apply ice directly to the skin, wrap with an absorbent disposable cover
• After the first 24 hours, a sitz bath with warm water may be used
• Teach perineal hygiene, including daily wash with warm water and mild soap
• Clean the perineum after each voiding
• Change perineal pads frequently after each voiding, removing from front to back
• Washing hands decreases infection risk
• Perform perennial exercises such as kegel exercises to improve stregth

Homan's Sign

• Assess to check for thrombophlebitis
• Teach clients to flex and extend both legs and feet alternatively as leg exercises
• Keep the legs uncrossed while seated
• Avoid flexing the leg at the groin
• Wear support hose/antiembolism stockings
• Padding pressure points during lithotomy position

Emotional Status

• The immediate postpartum period involves varied emotions
• Mothers may be exhausted and need sleep and rest
• Mothers wish to meet their own rest and nutritional needs before focusing on newborns during the taking in phase
• Mothers want to relieve the experience by relating or recounting their labor and delivery

Guidance for Home Care

• Mothers are usually discharged 2-3 days post normal delivery.
• Midwives must evaluate the mother's needs for instruction and guidance for her care, including
  • Self care
  • Baby care
  • Self in relation to others

Self Care Instructions

• Ways to improve general health is a part of self care
• Practice perineal care
• Practice breast care
• Breast care during breast engorgement
• Postnatal exercises
• Gradual return to day to day activities
• Schedule a 6th week post partum check up

Baby Care Instructions

• Breastfeeding information
• Information on Bottle feeding care and preparation of bottles and nipples or container
• Instructions to Hold the baby during feeding
• Instructions of Baby bathing and dressing including care of genital area
• Instructions for Cord care
• Instructions and informayion for Prevention and treatment for diaper rash.
• Instructions for Checking babies temperature.
• Ways of Recognizing baby's needs
• Schedule Check-up and immunization for the baby.

Self Care in Relation to Others

• A mother requires:
  • Sibling and husband.
  • Family planning
  • Can resume sexual intercourse after six weeks

Myths and Facts Related to Postnatal Diet

• Myth: Eat bland food like khichdi during postpartum
  • Fact: Bland foods like khichdi and rice are easily digested and provide immediate energy
• Myth: Ghee (butter) helps recover faster and strengthens joints
  • Fact: Mothers have enough fat reserves from pregnancy; ghee leads to weight gain
• Myth: More milk a mother drinks, the more milk she'll make
  • Fact: A balanced diet of rich in protein, minerals, and vita increases breast milk supply
• Myth: Avoid eating spicy food
  • Fact: If baby seems uncomfortable or fussy, it's ok to eat spicy food
• Myth: Drinking carom can help to digest and speed up recovery
• Fact: There is no scientific evidence to support this claim.
• Myth: Breastfeeding moms can't have their morning coffee
  • Fact: Caffeine in moderate amounts hasn't been proven harmful
• Myth: Skip the "gassy" food like broccoli, cabbage etc.
  • Fact: Cabbage, broccoli, and vegetables are super foods
• Myth: Breastfeeding moms require special vitamin supplements
  • Fact: The best source of nutrient for the baby mother is a varied
• Myth: Eating yogurt by nursing mother causes infant diarrhea indigestion and gas
  • Fact: Yogurt is a known pro-biotic and source of calcium and it is condition like, diarrhea, indigestion and acidity