Reproductive Health Nursing NUR 324 Postpartum Care Lecture 4

Postpartum Care *Essential concepts,,, -Postpartum care refers to the medical and nursing care given to woman during the puerperium ,which is 6-weeks period after delivery, beginning with termination of labor and ending with the return of the productive organs to the non-pregnant state. -This period constitutes a physical and psychological adjustment to the process of childbearing and is sometimes referred to as the fourth trimester of pregnancy.

Cont. -During this stage period ,the uterus undergoes involution – the progressive changes in the uterus after delivery ,leading to its return to near prepregnant size and condition. *Goals of postpartum care.. 1-promote normal uterine involution . 2-prevent or minimize postpartum complications. 3-promote comfort and healing of pelvis, perianal, perineal tissue. 4-assist in restoration of normal body functions.

Cont. 5-increase understanding of physiologic and psychological changes. 6-facilitate newborn care and self care by the new mother. 7-promote the newborns successful integration into the family unit. 8-support parenting skills and parent-newborn attachment. 9-provide effective discharge planning including appropriate referral for home care follow up.

Factors affecting the postpartum care 1-the nature of labor and delivery and birth outcome. 2-preparation of labor ,delivery and parenting. 3-the family's individual and collective experiences with childbearing. 4-sensitivity and effectiveness of nursing and other professional care. 5-risk factors for postpartum complications (ex: DM, Cardiac problem,….)

Postpartum biophysical changes A-Reproductive system: 1-the uterus. -lochia: Discharge from the uterus during the first 3 weeks after delivery. 2- cervix, become thicker and firmer. 3-the vagina , become smooth and swollen. 4-the perineum-edematous and bruised after delivery. 5-the abdomen-remains soft and flabby. Striae remains. 6-breast-primary engorgement

B-Endocrine system changes. Cont. B-Endocrine system changes. -estrogen and progesterone levels decrease rapidly after delivery. -ovulation and menstruation C-Cardiovascular system changes -transient bradycardia (50-70)-persist for 6-8 days. -blood volume decreases. -Hematocrite rises -leukocytosis (WBC: 20-30 thousand) -blood pressure remain stable.

D-Immune system changes. -maternal body temperature increase E-Respiratory system changes Return to non pregnant status within 6 weeks. F-Renal and urinary system changes. - Bladder distention can lead to urinary retention (increase bladder capacity).

Cont. G-Gastrointestinal system changes. -Hunger, thirst, constipation -Weight return to non pregnant weight within 6-8 weeks H- Musculoskeletal system changes. -early ambulation is encouraged. I- Integumentary system changes. -melanin decrease gradually.

Postpartum psychological adaptation -the post partum period represents a time of emotional stress for the new mother made even more difficult by the physiological changes that occur. -factors affecting: Response and support of family and friends. Experience. Cultural influences.

-postpartum depression. Psychological adaptation during Postpartum period occurring in three stages: *”Taking-in” period *Taking-hold” period *Letting go” period -postpartum depression.