POSTPARTUM HEALTH TEACHING

BREAST
Breast development in preparation for lactation results from the influence of both estrogen and progesterone. Adecrease in estrogen
and progesterone levels after delivery stimulates increased prolactin levels, which promote breast milk production. Breasts become
distended with milk on the third day. Engorgement occurs in 48 to 72 hours in non breast feeding mothers.
PATIENT TEACHING:

Wash breast daily at bath or shower time

Wear Supportive bra
Wash hands before and after every feeding
Insert clean OS squares or piece of cloth in the brassiere to absorb moisture when there is considerable breast
discharges.

Breast Dicomforts/ Engorgement:

Breastfeed frequently
Apply warm packs before feeding
Apply ice packs between feedings
Pumping or manually expressing breast milk
Chilled cabbage leaves (placed on breast with nipple exposed)
Changing position with each nursing so that different areas of the nipples receive thegreatest stress from nursing and
avoiding breast engorgement..
Acetaminophen or ibuprofen for pain

APPLYING ICE and LANOLIN DOES NOT RELIEVE BREAST ENGORGEMENT.

Care for Cracked nipples:
1. Expose nipples to air for 10 to 20 minutes after feeding
2. Rotate the position of the baby for each feeding
3. be sure that the baby is latched on to the areola, not just the nipple
NOTE: Do not use soap on the breasts, as it tends to remove natural oils, which increases the chance of cracked nipples
UTERUS
Process of involution takes 4-6 weeks to complete. Fundus steadily descends into true pelvis; Fundal height decreases about 1
fingerbreadth (1 cm)/day; by 10-14 days postpartum, cannot be palpated abdominally.
PATIENT TEACHING:

By 10-14 days postpartum, cannot be palpated abdominally.

Breast feeding hastens involution of the uterus
The Fundus must be firm, if it is not firm, lightly massage the abdomen until fundus isfirm
Gently massage fundus to determine firmess; it is important to support the bottom of theuterus

Empty bladder frequently, it delays involution of the Uterus

CESAREAN:

Notify Health care provider if ther is bleeding,drainage,foul odor,edema and redness

BLADDER
o VOIDING is difficult because of the pressure on the bladder and urethra making it edematous.
o The bladder and urethra are traumatized by the pressure exerted by the fetal head as it passes through
the birth canal.
o Trauma to bladder results in loss of bladder tone, edema and hyperemia.
o As a result, the woman experiences decreased bladder tone that results in increased bladder capacity.
o Decreased bladder tone causes decreased sensation to the filling and distention of the bladder, the
woman may not experience the urge to void even if her bladder is already distended with urine w/c
predisposes to infection.
o Urinary retention as a result of decreased bladder tone and emptying can lead to urinary tract.
o Urinary output increases 1rst 24 hours post delivery (puerperal diuresis)
PATIENT TEACHING:
o May complain of frequent urination in small amounts: explain that this is due to urinary retention with
overflow
o May have difficulty voiding because of abdominal pressure or trauma to the trigone of the Bladder
o Voiding may be initiated by Pouring warm and cool water alternately over the vulva
o Encourage the client to go to the comfort room for every 4 to
o Let her listen to the sound of running water
o If these measures fail, catheterization, done gently and aseptically, is the last resort on doctors order.
o Instruct to avoid garters or constricting clothing that can impair circulation
o Do Kegel exercises. You perform Kegels by simply tightening your pelvic floor muscles. Pretend as if
you are trying to stop a stream of urine. Do 10 to 12 Kegels every time you feed the baby to help
tighten your pelvic floor muscles and increase blood flow to the perineum. to perform Kegel exercises
as soon as is they can comfortably do so.
BOWEL MOVEMENT
Bowel movement maybe delayed for days after delivery resulting in constipation. This is caused by:
Decreased muscle tone during labor and puerperium
Lack of food during labor
Dehydration
Fear of pain from perineal tenderness due to episiotomy, lacerations or hemorrhoid
Bowel sounds are active, but passage of stool through the bowel may be slow
Spontaneous bowel movement may not occur for 2 to 3 days after childbirth because of the lingering effects of progestone
PATIENT TEACHING:

Demonstrate how to clean the perineum after each voiding and defecation (wiping from front to back), washing the
hands and applying a perineal pad from front to back
Instruct to avoid garters or constricting clothing that can impair circulation

Teach the importance of adequate fluid intake, exercise, proper diet and a regular defecation time
Instruct to wear perineal pads loosely and to lie in sims position
Encourage client to shower as soon as she can ambulate and to take tub baths if desired after two weeks.
Recommended daily shower to promote comfort and a sense of well-being/
Provide adequate dietary fiber and fluids to promote bowel movements; if necessary administer stool softeners, laxatives,
suppositories or enema

LOCHIA
-Discharge from the uterus during the first 3 weeks after delivery. Increasing Lochia as the day passes by may
indicate Heparin Intoxicity
LOCHIAL CHANGES
LOCHIA RUBRA
Dark red discharge occurring in the first 1-3 days.
Contains epithelial cells, erythrocytes and decidua.
Characteristic human odor.
LOCHIA SEROSA
Pinkish to brownish discharge occurring 3-10 days after delivery.
Serosanguineous discharge containing decidua, erythrocytes, leukocytes, cervical mucus and
microorganisms.
Has a strong odor
LOCHIA ALBA
Almost colorless to creamy yellowish discharge occurring from 10 days to 3 weeks after delivery.
Contains leukocytes, decidua,epithelial cells, fat, cervical mucus, cholesterol crystals, and bacteria.
Has no odor.
PATIENT TEACHING
Instruct discharged patients to report any abnormal progressions of lochia,excessive bleeding, foulsmelling lochia, or large blood clots to their physician immediately. Instruct patients to avoid sexual
activity until lochial flow has ceased.
Lochia should never exceed a moderate amount, such as 4 to 8 saturated perineal pads daily with an
average of 6.
EPISIOTOMY
-Is a surgical incision through the perineum made to enlarge the vagina and assist child birth. The incision can
be midline or at an angle from the posterior end of the vulva,is performed under local anaesthetic (pudendal
anaesthesia) and is sutured closed after delivery.
PATIENT TEACHING:

Sims position- minimizes strain on the suture line

Perineal heat lamp or warm sitz baths twice a day- vasodilation increases blood supply and therefore,
promotes healing
Apply ice or cold therapy to the episiotomy or laceration immediately afterdeliveryto decrease edema
and provide anesthesia; thereafter apply moist or dryheattherapy to promote comfort and healing
Application of topical analgesics or administration of mild oral analgesics asordered
Instruct the client on sitting properly to relieve pain (squeeze the buttockstogether and contract pelvic
floor muscles before sitting)
During Perineal Care Flush with warm water.

SKIN
PATIENT TEACHING:

Chloasma, palmar erythema, linea nigra and other skin changes during pregnancy gradually disappear
during the postpartum period.
Striae gravidarum do not disappearand assumes a silvery white appearance.
Hyperpigmentation of the areola may not disappear completely. Some women areleft with a wider and
darker areola after pregnancy.
Linea nigra will be barely detectable in 6 weeks time
Mask of pregnancy (chloasma) usually disappears, while stretch marks (striae gravidarum) and
Linea nigra fade but generally do not disappear.

HOMANS SIGN
-Pain in the calf and popliteal area on passive dorsiflexion of the foot, indicatingdeep venous thrombosis of
the calf.
-Also known as dorsiflexion sign.
-Relative inactivity/prolonged time in stirrups leads to stasis of blood andpromotes clotting of blood in the
lower extremities
PATIENT TEACHING:

Get patients to ambulate as soon as possible after delivery to improve circulation and prevent the
development of thrombi.
Teach them not to cross their legs for long periods of time and to keep the legs elevated while sitting.

EMOTIONAL STATUS
TAKING-IN PHASE -1st 2- 7 days postpartum
Need for sleep and rest
TAKING-HOLD PHASE - 3rd day to 2 weeks postpartum
Control body function
Ability to assume the mother role
LETTING GO

 Realize that the infant is a separate individual and not a partof herself
Feeling of loss
Adjustment phase
OTHER CONCERNS
EXERCISES

Kegels and abdominal breathing on postpartum day one

Chin-to-chest on postpartum day 2 to tighten and firm up abdominal muscles
Knee-to-abdomen when perineum has healed, to strengthen abdominal and gluteal muscle

MENSTRUATION

If not breastfeeding- return in6-8 weeks after birth

If breastfeeding, in 3-4 months (lactational amenorrhea) or entire lactation period

SEXUAL ACTIVITIES

abstain from intercourse until episiotomy is healed and lochia ceased

Around 3-4 weeks. Remind that Assess height, consistency, and location of the fundus breastfeeding
does not give adequate protection
Cesarean -2 weeks

WEIGHT LOSS

An initial weight loss of 10 to 12 lbs occurs as a result of the birth of the infant, placentaand amniotic fluid

NIGHT SWEATS

Puerperal diuresis accounts for loss of an additional 5 lbs during the early postpartum period
Normally return to pre-pregnant weight by 6 weeks postpartum
Diaphoretic episodes may occur at night, a normal occurrence as the body rids itself of waste products

GUSH OF BLOOD THAT SOMETIMES OCCURS WHEN SHE FIRST RISES

Due to normal pooling in vagina when the woman lies down to rest or sleep; gravitycauses blood to flow out when she
stands

AFTER PAINS/ AFTER BIRTH PAINS

Intermittent cramping of the uterus

Common in multiparas, and those who have given birth to large babies
Uterus contracts more forcefully
Intense with breastfeeding (because of oxytocin)
Strong uterine contractions felt more particularly by multis, those who delivered larger babies or twins and those who
breastfeed. It is normal and rarely last for more than 3 day.