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Postpartum care involves supporting the woman's recovery to her pre-pregnant state over 6 weeks. The main goals are assisting recovery, identifying deviations, and educating on self and infant care. Physiologically, the uterus involutes, lochia occurs, and systems like urinary, circulatory, and endocrine adjust. Psychosocially, the mother progresses through dependent, independent, and letting-go phases while the family adapts to the new baby through bonding and adjusting roles and relationships.
Postpartum care involves supporting the woman's recovery to her pre-pregnant state over 6 weeks. The main goals are assisting recovery, identifying deviations, and educating on self and infant care. Physiologically, the uterus involutes, lochia occurs, and systems like urinary, circulatory, and endocrine adjust. Psychosocially, the mother progresses through dependent, independent, and letting-go phases while the family adapts to the new baby through bonding and adjusting roles and relationships.
Postpartum care involves supporting the woman's recovery to her pre-pregnant state over 6 weeks. The main goals are assisting recovery, identifying deviations, and educating on self and infant care. Physiologically, the uterus involutes, lochia occurs, and systems like urinary, circulatory, and endocrine adjust. Psychosocially, the mother progresses through dependent, independent, and letting-go phases while the family adapts to the new baby through bonding and adjusting roles and relationships.
• Postpartum Period (Puerperium / Nifas) Is the interval (lasting 6 weeks) from child birth. Puerperium = fourth trimester. Divides into : # immediate pp (first 24 hours) # early pp (first week) # Late pp • Main goals : To assist and support the woman recovery to the prepregnant state. Assess and identify deviation from to norm, and Educate the mother about her own self care and infant care. Maternal Physiologic changes 1. Involution of the uterus (1000 gr 60 gr) • Exfoliation ( a unique healing processthe placental site to heal without scarring most important aspects of involution = 6 weeks. • Endometrial regeneration = 3 weeks. • Descent of the uterine fundus : after birth (12 hours) umbilicus. average : 1 cm / day. no palpable abdominally by day 10. Afterpains ( multiparas, breastfeeding ) TABLE 1. Factors That Retard Uterine Involution Factors Rationale
Prolonged labor Muscles relax due to prolonged
time of contraction during labor. Anasthesia Muscles relax. Difficult birth The uterus is manipulated excessively. Grandmultiparity Repeated distension of uterus during pregnancy and labor leads to muscles stretching, diminished tone, and muscles relaxtation. Incompelete The presence of even small expulsion of amount of tissue interferrse with placenta and/or ability of uterus to remain family membranes. contracted. Infections. Imflammation interferres with uterus muscle’s ability to contract effectively. Lochia : • rubra = the first 3 days • serosa = 4 - 9 days. • alba = 10 – 20 days (3 weeks) • Total volume = 240 – 270 ml. After pains : multiparas > primiparas (2 – 3 days), caused by intermittens uterine contraction. Cervix, vaginal, and perineal • Cervix is spongy, flabby, and formless and may appear bruised. • Vagina edema + bruised, laceration, rugae return by 3 weeks. • Perineum = edema, bruised, ruptur / epis. 2. Urinary System • The bladder fills rapidly because of the diuresis that follows childbirth the mother is at risk for overdistention of the bladder, incomplete emptying of the bladder and retention of residual urine UTI (urinary stasis allows time for bacteria to multiply) + risk of postpartum hemorrhage ( uterine atony). • Signs of a distended bladder: • Locations of fundus above baseline level (bladder is empty) • Fundus displaced from midline • Excessive lochia • Bladder discomfort • Bulge of bladder above symphisis • Frequent voidings of less than 150 ml of urine (indicates urinary retention) 3. Circulatory System. • Pregnancy hypervolemia (Inc. blood volume ± 50%). • Excess blood volume disposed in two ways : by diuresis 2000 – 3000 ml/day and by diaphoresis. Vital Signs : • Temperature : The first 24 hours, increase 100.4° F dehidration + exertion labor. • > 24 hours, temp ≥ 38° C, infection? • Blood pressure : stable decrease excessive blood loss. increase PIH (especially + headache) pulse = bradycardi 50 – 70 bpm (first week) elevated blood loss, infection, pain, cardiac disease. 4. Gastrointestinal System • Hungry + thirsty • Constipation > 3 days • Haemorhoid. 5. Abdominal wall • Return 6 weeks. • RDA (DRA) diastasis rectus abdominis (separated), over distension (twin, large baby) • Weight loss(Cunningham et al,1997): • Immediate weihgt loss (12-13 lbs) • 2 weeks postpartum (+ 8-9 lbs) • 6 months to return to their prepregnant weight. • Endocrine system: • Lactation (2-3 days after birth) • Menstrual cycle ( Bowes, 1996 ): =Nonbreastfeeding mothers, prolactin level returns to the prepregnant level within 2 weeks, > ovulation (27 days-2 months).The return of menstruations > 3 months. = Breastfeeding mothers; the average time for ovulation (190 days). 25% > ovulates before their menstrual periods return ( Zlatnik, 1999 ). • Maternal Psychosocial Changes • Rubin (1961): takes place in three phases a. “Taking-in phase” /Dependent = 2-3 days Mother’s passive and dependent, Mother need to talk about labor and delivery experience to integrate them into fabric of her life. Mother may need help with everyday activities, as well as child care Food, fluid and sleep (focus) Studies by Ament (1990) and Wrasper (1996) taking-in phase = 24 hours after birth. b“Taking-Hold”/Dependent-independent =The mother more independent, interest+responsibility (her self care, infant care) Health education!!! = Some emotional lability, may cry” for no reason “ = Mother requires reassurance that she can perform tasks of motherhood. c.”Letting-Go”/Independent=5-6weeks. Reestablishment of father-mother bond. They must let go of their expectations and accept the reality of their infant. Mother may still feel tired+overwhelmed by responsibility and conflicting demands on her time and energies. • Family Adaptation: • Family roles and relationship must be reorganized with the birth of a baby. • Bonding and Attachment • Bonding = rapid process of attachment, parent to child only, (sensitive periode = 30 – 60 minute after the birth. • Attachment, a long-term process that begins during pregnancy and intensifies during the postpartum periode. • Methods; touching, exploring, talking to, and eye contact. Family Adaptation Siblings’ Adaptation to Neonate • Respons ? Depends on age and developmental level of the older sibling, exp.Toddler probably most difficult • competition negative behavioral changes. Factors Affecting Family Adaptation • Parental fatique • Previous experience with a newborn • Parental expectations of the newborn • Knowledge of and confidence in providing for newborn needs • Temperament of the newborn • Temperament of parents • Age of parents • Available support system • Unexpected events; cesarean birth, infection.