Postpartum Adaptations PDF

Chapter 15 Postpartum Adaptations Maternal Psychological Adaptation: Reva Rubin’s Three Phases Taking-in phase: Time immediately after birth when the client needs others to meet her needs and relives the birth process Taking-hold phase: Second phase characterized by dependent and independent...

Chapter 15 Postpartum Adaptations Maternal Psychological Adaptation: Reva Rubin’s Three Phases Taking-in phase: Time immediately after birth when the client needs others to meet her needs and relives the birth process Taking-hold phase: Second phase characterized by dependent and independent maternal behavior Letting-go phase: Third phase in which woman reestablishes relationships with others Copyright © 2021 Wolters Kluwer· All Rights Reserved Postpartum Period Critical transition period for woman, newborn, and family physiologically and psychologically Puerperium: period after delivery of placenta, lasting for 6 weeks, “fourth trimester” Possible definition: changes in all aspects of mother’s life that occur during the first year following birth of child Maternal physiologic and psychological changes Mother and family adjustment to new family member Copyright © 2021 Wolters Kluwer· All Rights Reserved Reproductive System Adaptations #1 Uterus o Involution: contraction of muscle fibers; catabolism; regeneration of uterine epithelium o Lochia: rubra, serosa, alba o Afterpains Cervix: closure; now appearing as jagged slit-like opening Vagina: eventual thickening and return of rugae Perineum Copyright © 2021 Wolters Kluwer· All Rights Reserved Reproductive System Adaptations #2 Copyright © 2021 Wolters Kluwer· All Rights Reserved Reproductive System Adaptations #3 Copyright © 2021 Wolters Kluwer· All Rights Reserved Question #1 Is the following statement true or false? After birth, the cervix returns to its prevaginal delivery birth shape. a. True b. False Copyright © 2021 Wolters Kluwer· All Rights Reserved Answer to Question #1 b. False After delivery, the cervix closes but never regains its prevaginal delivery birth appearance. It is no longer circular but appears as a jagged slit-like opening. Copyright © 2021 Wolters Kluwer· All Rights Reserved Cardiovascular System Adaptations Blood volume and cardiac output Hematocrit level Pulse rate and blood pressure Coagulation factors Red blood cell production Copyright © 2021 Wolters Kluwer· All Rights Reserved Question #2 Is the following statement true or false? The drop in maternal blood volume after birth leads to a similar drop in hematocrit. a. True b. False Copyright © 2021 Wolters Kluwer· All Rights Reserved Answer to Question #2 b. False Despite the decrease in blood volume, the hematocrit level remains relatively stable and may even increase, reflecting the predominant loss of plasma. Copyright © 2021 Wolters Kluwer· All Rights Reserved Urinary System Adaptations  Glomerular filtration rate and renal flow increase  Voiding sensation affected by: o Perineal lacerations o Generalized swelling and bruising of the perineum and tissues surrounding the urinary meatus o Hematomas o Decreased bladder tone due to regional anesthesia o Diminished sensation of bladder pressure due to swelling, poor bladder tone, and numbing effects of regional anesthesia used during labor Copyright © 2021 Wolters Kluwer· All Rights Reserved Causes of Postpartum Diuresis Large amounts of intravenous fluids given during labor Decreasing antidiuretic effect of oxytocin as its level declines Buildup and retention of extra fluids during pregnancy Decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production Copyright © 2021 Wolters Kluwer· All Rights Reserved Gastrointestinal (GI) System Adaptations The GI system quickly returns to normal; relief of pressure on organs Decreased bowel tones for several days Decreased peristalsis occurs Constipation is common due to fear of straining affecting the perineum Hunger and thirst occur due to NPO status prior to delivery Copyright © 2021 Wolters Kluwer· All Rights Reserved Musculoskeletal System Adaptations Joints return to prepregnant state except for feet Women commonly experience fatigue and activity intolerance for weeks after giving birth Abdominal muscle tone is diminished after birth and special exercises are needed to return to normal Copyright © 2021 Wolters Kluwer· All Rights Reserved Integumentary System Adaptations Pigmentation fades Stretch marks fade to silvery lines Diaphoresis is common for about a week postpartum Copyright © 2021 Wolters Kluwer· All Rights Reserved Respiratory and Endocrine System Adaptations Respiratory system o Tidal volume, minute volume, vital capacity, and functional residual capacity return to prepregnant values within 1 to 3 weeks of birth o Anatomic changes reside quickly Endocrine system o Estrogen and progesterone levels drop quickly o Placental hormones decline rapidly o Prolactin levels decline within 2 weeks if not breast-feeding Copyright © 2021 Wolters Kluwer· All Rights Reserved Lactation #1 Secretion of milk by the breasts Result of interaction of progesterone, estrogen, prolactin, and oxytocin Typically appearing 4 to 5 days after childbirth “Breast crawl” process Copyright © 2021 Wolters Kluwer· All Rights Reserved Lactation #2 Copyright © 2021 Wolters Kluwer· All Rights Reserved Engorgement Process of swelling of the breast tissue due to an increase in blood and lymph supply as a precursor to lactation Relieved by frequent emptying, warm showers and compresses before feeding, cold compresses between feedings, if breast-feeding Tight supportive bra, ice, avoidance of breast stimulation if not breast-feeding Copyright © 2021 Wolters Kluwer· All Rights Reserved Question #3 For the woman who is not breast-feeding her newborn, which measure would be most appropriate to relieve engorgement? a. Warm showers b. Nipple stimulation c. Ice to the breasts d. Manually expressing milk Copyright © 2021 Wolters Kluwer· All Rights Reserved Answer to Question #3 c. Ice to the breasts For the woman who is not breast-feeding, measures to relieve engorgement include applying ice to the breasts for 15 to 20 minutes every other hour. Warm showers promote the let-down reflex are encouraged for the woman who is breast-feeding and experiencing engorgement. Any stimulation of the breasts, such as nipple stimulation or manual milk expression, is to be avoided for the woman who is not breast-feeding. Copyright © 2021 Wolters Kluwer· All Rights Reserved Ovulation and Return of Menstruation Interplay of hormones: estrogen, progesterone, prolactin, and oxytocin Nonlactating women: return of menstruation 7 to 9 weeks after birth Lactating women: return dependent on breast- feeding frequency and duration; anywhere from 2 to 18 months Copyright © 2021 Wolters Kluwer· All Rights Reserved Maternal Psychological Adaptations Attachment: formation of a relationship between a parent and his or her newborn through a process of physical and emotional interactions Early and sustained contact between newborns and parents is vital Nurses play a crucial role in assisting with this process of attachment Factors influencing attachment include environmental circumstances, newborn health, and quality of nursing care Copyright © 2021 Wolters Kluwer· All Rights Reserved Postpartum Mood Disorders  Baby blues o Mild depressive symptoms, anxiety irritability, mood swings, tearfulness, increased sensitivity, fatigue o Usually peak at days 4 and 5 and resolve by day 10  Postpartum depression and psychosis o Symptoms last longer and are more severe and require treatment o May lead to poor bonding, alienation from loved ones, daily dysfunction, and violent thoughts/actions Copyright © 2021 Wolters Kluwer· All Rights Reserved Variables Affecting Maternal Role Attainment Maternal o Confidence, age, relationship with father, socioeconomic status, birth experience, stress, support system, personality traits, self-concept, child-rearing attitudes, role strain, health status, preparation during pregnancy, relationship with own mother, depression, and anxiety Infant o Appearance, responsiveness, temperament, health status Copyright © 2021 Wolters Kluwer· All Rights Reserved Four Stages of Becoming A Mother (BAM) Commitment, attachment to unborn baby, preparation for delivery and motherhood during pregnancy Acquaintance/attachment to infant, learning to care for infant, and physical restoration 2 to 6 weeks postbirth Moving toward a new normal Achievement of a maternal identity through redefining self to incorporate motherhood (around 4 months) Copyright © 2021 Wolters Kluwer· All Rights Reserved Engrossment: Partner Psychological Adaptation #1 Visual awareness of the newborn Tactile awareness of the newborn Perception of the newborn as perfect Strong attraction to the newborn Awareness of distinct features of the newborn Extreme elation by the father Increased sense of self-esteem Copyright © 2021 Wolters Kluwer· All Rights Reserved Engrossment: Partner Psychological Adaptation #2 Copyright © 2021 Wolters Kluwer· All Rights Reserved Engrossment: Partner Psychological Adaptation #3 Three-stage role development process o Expectations o Reality o Transition to mastery Copyright © 2021 Wolters Kluwer· All Rights Reserved Cultural Considerations Cultures vary in their postpartum beliefs, practices, and customs Nurses must be open, respectful, nonjudgmental, and willing to learn about ethnically diverse populations Understanding various cultures’ views of the postnatal period as it relates to their recovery and well-being after childbirth is important for all nurses Copyright © 2021 Wolters Kluwer· All Rights Reserved