CHAPTER 20 POSTPARTUM ADAPTATIONS C Lutkenhaus MSN RNCOB

CHAPTER 20 – POSTPARTUM ADAPTATIONS C. Lutkenhaus, MSN, RNC-OB, C-EFM Updated 8/2015

Reproductive System • Uterus • Involution • After-pains – worse in multiparous women, increased with breast stimulation/feeding. • Lochia (rubra, serosa, alba) • Cervix • Vagina • Perineum • All can take 6 weeks to return to prepregnant size

Cardiovascular System • Blood from the uterus and placenta returns to the central circulation. • Extracellular fluid moves into the vascular compartment. • Cardiac output increases, and excess fluid is excreted by diuresis and diaphoresis. • Increased clotting factors predispose the postpartum woman to clot formation.

Urinary System Increased bladder capacity and decreased sense to fluid pressure may result in urinary retention. • Stasis of urine allows time for bacteria to grow and can lead to urinary tract infection. • The distended bladder displaces the uterus and can interfere with uterine contraction and cause excessive bleeding.

Signs of Bladder Distention • Location of fundus above baseline level (determine with empty bladder) • Fundus displaced from midline • Excessive lochia • Bladder discomfort • Bulge of bladder above symphysis • Frequent voidings of less than 150 m. L each time

Musculoskeletal System • Muscles and joints • First 1 -2 days after childbirth, muscle fatigue and aches • Abdominal wall • Diastasis recti • Reduction in musculoskeletal discomfort • Exercises to strengthen the abdominal muscles • Good posture • Body mechanics

Neurologic System Endocrine System • Assess c/o headache • Ovulation resumes • May result from epidural or spinal • Headaches, vision changes, photophobia, abdominal pain can be indicative of worsening gestational hypertension • Pain continues, but becomes less • Can become pregnant during breastfeeding even with no menses • Lactation occurs • Prolactin produces milk • Oxytocin lets milk out • Weight loss • 12 -13 pounds from fetus, fluid, blood, and placenta • 9 pounds from diaphoresis, diuresis, and involution • Pre-pregnant weight by 6 months www. e-forwards. com

Postpartum Assessments • 5 B’s • Bladder • Bottom • Breasts • Engorgement before • Perineum feeding, soften after • Clean, dry, intact feeding • No hematomas • Belly (Fundus) • Rectal area • Massage if boggy • Hemorrhoids • Blood (Lochia) • Continuous trickle is laceration • VS, orthostatic hypotension, • Hemorrhage saturates one Pain? pad in one hour or less • Homan’s Sign • May be scant after • DTR cesarean • Edema

Care in the Immediate Postpartum • Comfort measures after Vag Del • Care after Cesarean • Ice to perineum • ICE is NICE! X 24 hrs • Sitz bath after first 24 hrs • Prn pain meds • Local Anesthetic Spray • Promote urination • Cath prn • Provide food and fluids • Prevent clots • Early ambulation dermoplast. com mancpubs. info • First 24 hrs • VS • Pain relief • TCDB • ROM • Comfort and hygiene • After 24 hrs • Promote voiding • Assist ambulation • Assist infant feeding/care • Prevent ABD distention • Teaching

• Becoming acquainted • Bonding- initial • Attachment- rarely instantaneous • Maternal touch • Maternal role adaptation • Taking-in- her own needs • Taking hold- assumes responsibility for her own care • Letting go to father keishaksp. wordpress. com • Other Maternal Concerns & Feelings during Postpartum: • ABANDONMENT – During labor they were the center of attention, with everyone asking them. Now suddenly, the baby is the main interest. Sharing responsibility for infant care can help to make both partners feel equally involved in the baby’s care. • DISAPPOINTMENT - It can be difficult for parents to feel positive immediately about a child who may not have met their expectations. Comment on the child good points. • POSTPARTUM BLUES (Baby blues)- 50% of women experience some feelings of overwhelming sadness. The mother burst into tears easily or may feel let down or be irritable. Likely due to (decrease estrogen & progesterone), but also worsened by low self-esteem, exhaustion and pain. A woman needs assurance that sudden crying episodes are normal. Allow to Verbalize feelings. Discuss when she needs to seek help. • BODY IMAGE