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Hand-outs for Changes and Nursing Care during Postpartum and Puerperium
Period
When a woman has successfully linked with her newborn, it is termed attachment or
bonding. Looking directly at her newborns face with direct eye contact termed as en face
position is a sign a woman is beginning an effective attachment. Meanwhile, the action
that alerts caregivers to how actively the father, as well as the mothers beginning
bonding often called as engrossment.
The more time a woman has to spend with her baby is called rooming-in. It makes her
better acquainted with her child, feel more confident in her ability to care for her baby,
and more likely form a sound mother-child relationship.
When it comes to the siblings of the newborn and to the mother, separation from children
is often as painful for her a mother as it is for her children. A chance to visit the hospital
and see the new baby and their mother reduces feelings that their mother cares more
about the new baby than about them.
There are some feels that they were abandoned. Meaning after all, they were the center of
attention, with everyone asking about their health and well-being. Now, suddenly the
baby is everyones chief interest. You can help the woman move on these past feelings by
verbalizing the problem. This could also happen to the father because he feels resentful of
the time the mother spends with the infant. Making infant care a shared responsibility can
help alleviate these feelings and make both partners and feel equally involved in the
babys care.
Disappointment could also happen. All during pregnancy, they pictured a chubbycheeked, curly-haired, smiling girl or boy. They have instead a skinny baby, without any
hair, who seems to cry constantly. This can make it difficult to feel positive immediately
toward a child who does not meet their expectations. It can cause parents to remember
their adolescence, when they felt gangly and unattractive, or to experience feelings of
inadequacy. Comment on the childs good points, such as long fingers, lovely eyes, and
healthy appetite. Be aware, however, that, culturalyl, some groups are fearful for the baby
if these types of comments are made because they could draw evil influences toward the
child.
Postpartum Blues - a woman experience some feelings of overwhelming sadness or
baby blues. This is because of the hormonal changes, particularly the decrease in
estrogen and progesterone that occurred with delivery of the placenta. Encouraging the
woman to talk about their postpartal feelings helps to differentiate between problems that
can be handled best with discussion and concerned understanding and those that should
be referred to a social service department or a community health agency for additional
support.
Vagina
The vagina feels soft, with few rugae, and its diameter is considerably greater than
normal. The hymen is permanently torn and heals with small, separate tags of tissue. It
takes the entire postpartal period for the vagina to involute (by contraction, as with the
uterus) until it gradually returns to its approximate pregnancy state. If a woman practices
Kegel exercises, the strength and tone of the vagina will increase more rapidly.
Perineum
The perineum is edematous and tender immediately after birth. Ecchymosis patches from
ruptured capillaries may show on the surface. The labia majora and labia minora typically
remain atrophic and softened after birth, never returning to their prepregnancy state.
Systemic Changes
Hormonal System
Pregnancy hormones begins to decrease as soon as the placenta is no longer present.
Levels of hCG and hPL are almost negligible by 24 hrs. By week 1, progestin, estrone,
and estradiol are all at prepregnancy levels. FSH remains low for about 12 days and then
begin to rise as a a new menstrual cycle is initiated.
Urinary System
2000 to 3000 ml of excess fluid accumulates in the body so extensive diaphoresis and
diuresis begin almost immediately after birth to rid the body of this fluid. This easily
increases the daily urine output of a postpartum woman from a normal level of 1500 ml
to 3000 ml per day during the 2 nd and 5th after birth. Hydronephrosis or increased size of
ureters remains present for about 4 weeks.
Circulatory System
The usual blood loss with a vaginal birth is 300 to 500 ml. With a cesarean birth, it is 500
to 1000 ml. Women usually continue to have the same high level of plasma fibrinogen
during the first postpartum weeks as they did during pregnancy.
Gastrointestinal System
Digestion and absorption begin to be active again soon after unless a woman had a
cesarean birth. Hemorrhoids that have been pushed out of the rectum because of the effort
of pelvic-stage pushing often are present. Bowel sounds are active.
Integumentary System
Stretch marks on a womans abdomen still appear reddened and may be even more
prominent during than during pregnancy, when they were tightly stretched.
Retrogressive Changes
Exhaustion
A woman has sleep hunger meaning for the last several months, she probably
experienced difficulty in sleeping. All during labor, she worked hard with little or no
sleep. She lacks sleep.
Weight Loss
Rapid and diuresis and diaphoresis usually result in weight loss.
Progressive Changes
Lactation
A woman starts to produce breast milk. Engorgement is the feeling of tension in the
breasts on the third or fourth day after birth.
Menstrual Flow
The resulting decrease in hormone concentrations cause a rise in production of FSH by
the pituitary, which leads with only slight delay to return to ovulation. This initiates the
return of normal menstrual cycles. A woman whos not breastfeeding can expect her
menstrual flow to return in 6 to 10 weeks after birth. If shes breastfeeding, it will return
in 3 or 4 months. It is called lactational amenorrhea.
Nursing Care
During the first 24 hrs after birth, we start first with the assessment which includes
history, physical examination and analysis of laboratory findings. We also include the
health history, her family profile, pregnancy history, labor and birth history, infant data,
and postpartum course.