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POSTPARTUM, After labor, a woman's body goes through many changes to…
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After labor, a woman's body goes through many changes to return back to the nonpregnant state
Changes to the Uterus
Involution: rapid reduction in size of the uterus
- the outermost layer turns necrotic and is sloughed off
Lochia - uterine discharge of the debris remaining after birth
- The placenta site will heal gradually 6 weeks via exfoliation and growth of new tissue
- changes in hormone levels cause the uterine cells to atrophy and the hyperplasia of pregnancy will begin to reverse
Afterpains - cramp like pains caused by intermittent contractions that can occur for 2-3 days post birth
Lochia
- Discharge of uterine debris
- Lochia rubra: dark red, first 2-3 days, small clots are common
- Lochia serosa: pinkish color, 3-10 days
Lochia alba: less color, more similar to normal discharge
- Average volume is 225 mL
Cervical Changes
- Post birth is flabby, formless, and may appear bruised
- Will slowly close and return to normal size
- First childbearing will forever alter
Breasts and Lactogenesis
- increased levels of estrogen and progesterone prepare the body for lactation
- stimulated by prolactin
- colostrum: initial milk that is secreted and immediately available to the baby at birth
- Foremilk: watery milk high in protein and low in fat, flows at the start of feeding
- hindmilk: rich in fat, flows during the "let down"
Maternal role attainment:
- Process for a woman to learn mothering behaviors
- have to find themselves in this process
Development of family attachment
- giving the partner or other family members guidance in interacting/caring for the newborn
Utilizing the en face position
- helping the new mother familirize herself with the newborn
- helping with progressive touching and face to face contact between mother and child
Assisting in bonding
- helping to facilitate activities that strengthen bond
- feeding, bathing, recognizing cues, sleeping, etc.
Postpartum weight and nutrition
- Monitoring in motherly weight loss to make sure is following a healthy curve
- monitoring dietary intake and eating habits and working with a dietitian to make sure all is healthy and balanced
Adolescent Mother
- May need special postpartum care depending on maturity and support
- contraception education to avoid repeat pregnancy
- teaching about the newborn and newborn care
- assessing roles of support people, plan for discharge, and plans for follow up care
- providing positive feedback
- connecting with supportive resources
Mother over Age 35
- special postpartum needs based on birth experience, personal expectation, and lifestyle
- aware of how the newborn will alter life
- potential for additional follow up care
Postpartum Physical Examination
- Used to identify individuals needs or potential problems
- Vital signs (BP, HR, RR, Temp), looking at breasts, listening to lungs, looking at abdomen, looking at lochia, looking at perineum,
- remember to void urine before fundal assessment
- ensure patient is relaxed; do what you can to ease anxieties
- use this time to educate and teach
Psychologic Assessment Risk Factors
- If the mother has little or no experince with newborns, this is to ease anxities
- asking questions and accepting answers in a supportive, nonjudgmental way so the patient is open
- looking for signs of depression or inability to care for the child
Assessment of Early Attachment
- Observe and note progress of attachment between baby and mother
- looking at their behaviors
Skin Integrity
- The perineal area had lots of skin damage
- could be risk for infection
- providing education for care of this are
Mental well being
- patient may be exhausted post labor
- patient may be anxious to see her child
- influx of hormones may cause numerous reactions
- helping to ease mother
Education
- Patient is not in postpartum sector for very long
-providing key education when possible
- keeping family involved in process
- keeping cultural norms in mind during education
- education on perineal care
Promoting comfort and well-being
- promoting and restoring maternal physical well being
- monitoring health status and providing aid when needed
- administering pain medications when needed
- doing all you can do promote their comfort and relieve stress
Mobility
- postpartum immobility is not uncommon due to exhaustion and strain that labor causes
- helping with early ambulation
Relieve emotional stress
- Non Judgmental listening to the mother as she expresses stresses and concerns of becoming a mother
- helping to answer any questions
- providing reassurance as needed
- promoting rest!!!!
Promote well being post cesarean birth
- monitoring for pulmonary infection
- encouraging leg exercises
- monitoring and aiding with pain as needed
CBC
- See if there are any infections presents
- could be a sign of excessive blood loss
QBL
- Monitored around the perineal area to look for any signs of excessive postpartum hemorrhaging