Postpartum Nursing Care

• Postpartum nursing care focuses on the mother's recovery after childbirth
• Includes monitoring for complications, pain management, education on newborn care, and emotional support

Postpartum Period Defined

• The postpartum period, also known as the puerperium, typically lasts for six weeks after delivery
• Significant physiological and psychological changes occur as the mother's body returns to its pre-pregnant state

Uterine Involution

• Involution is the process where the uterus returns to its pre-pregnancy size and condition
• After delivery, the uterus contracts strongly to control bleeding and begins to shrink
• Fundal height (the top of the uterus) decreases by approximately 1 cm per day
• After pains, or intermittent uterine contractions, are common, especially in multiparous women (women who have had multiple pregnancies) and during breastfeeding due to oxytocin release
• Lochia is the vaginal discharge after birth, containing blood, tissue, and mucus
• Lochia progresses through three stages:
  • Lochia rubra: dark red, occurs for the first 3-4 days
  • Lochia serosa: pinkish-brown, occurs from days 4-10
  • Lochia alba: whitish-yellow, occurs from days 10-14 (may last up to 6 weeks)
• Persistent bright red bleeding suggests excessive bleeding and requires immediate attention
• Subinvolution occurs when the uterus does not return to its normal size within the expected time frame
• Common causes of subinvolution include retained placental fragments or uterine infection

Cervical Changes

• The cervix gradually closes after delivery but may retain a slightly wider external os (opening) compared to its pre-pregnancy state

Vaginal Changes

• The vagina gradually regains its pre-pregnant form, but it may remain slightly more relaxed
• Kegel exercises help strengthen the pelvic floor muscles, improving vaginal tone, and preventing urinary incontinence

Cardiovascular System Changes

• Blood volume and cardiac output, which increased during pregnancy, decline after delivery
• Diuresis (increased urination) and diaphoresis (increased sweating) help eliminate excess fluid
• There is an increased risk of thromboembolism (blood clot formation) in the postpartum period due to increased clotting factors

Gastrointestinal System Changes

• Bowel movements may be delayed due to decreased intestinal motility and pain medications
• Stool softeners and increased fluid and fiber intake can help prevent constipation

Urinary System Changes

• The bladder may have decreased sensitivity due to trauma during delivery
• Urinary retention can lead to urinary tract infections (UTIs) and uterine atony (lack of uterine muscle tone)

Endocrine System Changes

• Estrogen and progesterone levels drop significantly after delivery
• Prolactin levels increase in breastfeeding mothers, stimulating milk production
• Ovulation may be delayed in breastfeeding mothers, but it is not a reliable form of contraception

Musculoskeletal System Changes

• Abdominal muscles may be stretched and weakened during pregnancy
• Diastasis recti is the separation of the abdominal muscles, and exercise can help this

Integumentary System Changes

• Skin changes such as melasma (dark patches on the face) and linea nigra (dark line down the abdomen) usually fade after delivery
• Striae gravidarum (stretch marks) may fade but usually do not disappear completely

Vital Signs Assessment

• Assess vital signs (temperature, pulse, respiration, and blood pressure) regularly to monitor for complications
• Elevated temperature may indicate infection
• Tachycardia may indicate blood loss, infection, or pain
• Hypotension may indicate blood loss or dehydration

BUBBLE-HE Assessment

• A common postpartum assessment tool is the BUBBLE-HE assessment:
  • Breasts: Assess for engorgement, tenderness, and nipple condition
  • Uterus: Assess fundal height, location, and consistency
  • Bowel: Assess for bowel sounds, distention, and bowel movements
  • Bladder: Assess for urinary output, frequency, and signs of urinary retention
  • Lochia: Assess for amount, color, odor, and consistency
  • Episiotomy/Perineum: Assess for edema, bruising, approximation, and signs of infection
  • Homan's sign/Extremities: Assess for signs of thrombophlebitis (pain, redness, swelling in the legs)
  • Emotional Status: Assess mood, affect, and bonding with the newborn

Pain Management

• Pain after delivery can be caused by uterine contractions, episiotomy, perineal tears, or cesarean incision
• Non-pharmacological methods include ice packs, sitz baths, and positioning
• Pharmacological methods include analgesics such as NSAIDs and opioids

Promoting Rest and Sleep

• Fatigue is common in the postpartum period due to labor, delivery, and newborn care
• Encourage rest and sleep
• Suggest strategies such as napping when the baby naps and limiting visitors

Nutrition

• Encourage a balanced diet with adequate calories, protein, and fluids
• Breastfeeding mothers should increase their caloric intake by approximately 500 calories per day
• Continue taking prenatal vitamins

Elimination

• Encourage adequate fluid intake and a high-fiber diet to prevent constipation
• Administer stool softeners as needed
• Monitor urinary output for signs of urinary retention or infection

Breastfeeding Support

• Breastfeeding provides numerous benefits for both mother and baby
• Encourage early and frequent breastfeeding
• Teach proper latch-on techniques and positioning
• Address common breastfeeding challenges such as engorgement, sore nipples, and mastitis

Non-Breastfeeding Mothers

• Advise non-breastfeeding mothers to wear a supportive bra
• Avoid stimulating the nipples to prevent milk production
• Ice packs and analgesics can help relieve discomfort from engorgement

Postpartum Blues

• Postpartum blues are common in the first few weeks after delivery, characterized by mood swings, tearfulness, and anxiety
• Typically resolves on its own within a few weeks

Postpartum Depression

• Postpartum depression is a more serious condition with symptoms such as persistent sadness, hopelessness, and difficulty caring for the baby
• Requires professional evaluation and treatment

Postpartum Psychosis

• Postpartum psychosis is a rare but severe psychiatric emergency with symptoms such as hallucinations, delusions, and suicidal or infanticidal thoughts
• Requires immediate medical intervention

Maternal Role Attainment

• Maternal role attainment is the process by which a woman learns to become a mother
• Encourage bonding with the newborn through skin-to-skin contact, feeding, and cuddling
• Provide education and support to help the mother develop confidence in her parenting skills

Sibling Adaptation

• Prepare siblings for the arrival of the new baby
• Encourage positive interactions between siblings
• Spend individual time with older siblings

Discharge Teaching

• Provide instructions on postpartum care, newborn care, and warning signs to report to the healthcare provider
• Schedule follow-up appointments for both mother and baby
• Discuss contraception options
• Provide information on community resources and support groups

Postpartum Hemorrhage

• Postpartum hemorrhage is excessive bleeding after delivery (more than 500 mL after vaginal delivery or 1000 mL after cesarean delivery)
• Common causes include uterine atony, lacerations, retained placental fragments, and coagulation disorders
• Nursing interventions include fundal massage, administration of uterotonic medications (oxytocin, misoprostol, methylergonovine), and fluid resuscitation

Postpartum Infection

• Postpartum infection can occur in the uterus (endometritis), perineum, or urinary tract
• Risk factors include cesarean delivery, prolonged labor, and multiple vaginal examinations
• Signs and symptoms include fever, chills, abdominal pain, and foul-smelling lochia
• Treatment includes antibiotics and supportive care

Thromboembolic Disease

• Thromboembolic disease includes deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Risk factors include cesarean delivery, obesity, and history of thromboembolism
• Signs and symptoms include leg pain, swelling, redness, and shortness of breath
• Prevention includes early ambulation, compression stockings, and anticoagulation medications