Postpartum Care Chapter 53 Angella J. Soles, RN 9/4/2019 Lois White 2nd Edition

Introduction Making the Connection Refer to following chapters to increase your understanding of postpartum care: Adult Health Nursing Reproductive System Maternal & Pediatric Nursing Prenatal Care Complications of Pregnancy The Birth Process 9/4/2019 Lois White 2nd Edition

Topics of Discussion Learning Objectives Define Key Terms Describe the various aspects of family adaptation Discuss the mother’s physiologic changes after the birth of her baby. Describe the expected and unexpected emotional/behavioral changes in the new mother. Demonstrate the postpartum assessments for every new mother and the additional assessments for a mother who has had a cesarean birth. Discuss the possible postpartum complications of hemorrhage and puerperal infection, including endometritis, mastitis, and thrombophlebitis. Explain the adcantages and disadvantages of the various methods of family planning. Plan and provide the care of a woman who has had a baby. 9/4/2019 Lois White 2nd Edition

Family Adaptation Family roles and relationships must be reorganized with the birth of a baby. Bonding and attachment are the terms used to describe this process of becoming acquainted with the neonate Bonding refers to a rapid process of attachment, parent to child only, taking place during the sensitive period, the first 20-60 minutes after the birth. Attachment, a long-term process that begins during pregnancy and intensifies during the postpartum period, establishes an enduring bond between parent and child and develops through reciprocal behaviors. This includes several groups, mom, dad, siblings & grandparents. 9/4/2019 Lois White 2nd Edition

Maternal Physiologic Changes Many are reversal of changes that occurred during pregnancy Reproductive (uterus, cervix, vagina, perineum) Uterus, involution-returns to prepregnancy size (muscle contraction, catabolism, regeneration) fundal descent-grapefruit/umbilicus for 12 hrs then descends 1cm{1 finger breadth} each day for 10 days Afterpains-contractions Lochia-bright red to pink or pinkish brown then yellowish white Cervix-within 18 hours becomes firm, shortened and regained for, 2 weeks-os is closed Vagina& perineum-6 weeks for complete involution of uterus. Perineum may have edema and bruising from stretching and thinning during labor. Look at degrees of episiotomies. First through fourth. 9/4/2019 Lois White 2nd Edition

Endocrine After expulsion of the placenta, the levels of the placental hormones estrogen, progesterone, human placental lactogen (hPL), human chorionic gonadotropin (hCG), and relaxin rapidly decline. Assess blood glucose levels Prolactin initiate milk production within 2-3 days after the infant’s birth. Oxytocin a PPH causes the milk to be expressed from the alveoli into the lactiferous ducts. (Let-Down Reflex) Menstrual Cycle-Breastfeeding mom’s-Prolactin causes ovaries not to respond to FSH and ovulation does not occur. Prolactin level is influenced by 3 factors: frequency & duration of feedings, supplemental feedings, and possibly the strength of the infant’s suckling. Ovulation of nonbreastfeeding moms occur as soon as 27 days after the birth and usually by 2 months. 9/4/2019 Lois White 2nd Edition

Breasts Colostrum the last few weeks of pregnancy Colostrum-yellowish fluid rich in antibodies and high in protein Milk production begins 2-3 days after birth Breasts feel firm, warm, may be tender By day 3 or 4 after birth ENGORGEMEN may occur; the breasts become quite distended (swollen), tender, and warm. Encourage breast feeding mom to do frequently to encourage milk production If not breastfeeding, milk should not be expressed, milk production will cease in a week 9/4/2019 Lois White 2nd Edition

What This Means Add a strong statement that summarizes how you feel or think about this topic Summarize key points you want your audience to remember 9/4/2019 Lois White 2nd Edition

Next Steps Summarize any actions required of your audience Summarize any follow up action items required of you 9/4/2019 Lois White 2nd Edition