POSTPARTUM

The postpartum period, or puerperium,

refers to the 6-to-8-week period after delivery during which the mothers body returns to its prepregnant state. Some people refer to this period as the fourth trimester of pregnancy. Many physiologic and psychological changes occur in the mother during this time. Nursing care should focus on helping the mother and her family adjust to these changes and on easing the transition to the parenting role.

Hyperfibrinogenia
prone to thrombus formation early ambulation Puerperium covers 1st 6 -8wks wks post partum Involution return of reproductive organ to its non pregnant state.

Physiologic changes:
Two types of physiologic changes occur during the postpartum period: retrogressive and progressive changes. Getting back to normal: Retrogressive changes involve returning the body to its prepregnant state. Retrogressive changes include: Shrinkage and descent of the uterus into its prepregnancy position in the pelvis Sloughing of the uterine lining and development of lochia Contraction of the cervix & vagina Recovery of vaginal and pelvic floor muscle tone.

Postpartum care
should respond to the special needs of the mother and baby and should include Prevention and early detection and treatment of complications and disease. Provision of advice and services on breastfeeding, birth spacing, immunization and maternal nutrition.

Psychological Responses:
Taking in phase dependent phase (1st three days) mom passive, cant make decisions, activity is to tell child birth experiences. During this time, the womans attention is focused on her own needs for sleep, rest and she is dependent on others. Nursing Care: - proper hygiene

 should respond to the special needs of the mother and baby and should include Prevention and early detection and treatment of complications and disease. Provision of advice and services on breastfeeding, birth spacing, immunization and maternal nutrition.

Taking hold phase

dependent to independent phase (4 to 7 days). Mom is active, can make decisions, The concern of the mother at this time is focused on her ability to control body function and her ability to assume the mothering role. She prefers to do things by herself. As she is not yet completely recovered, she feels impatient that shes not strong enough to do everything she wishes to accomplish. Because of the tendency of the woman to overwork herself, fatigue and exhaustion is common at this stage.

 HT: Begins to take a strong interest for her child - Give the woman brief demonstration of baby care - Allow her to care for the child herself with watchful guidance common post partum blues/ baby blues present 4 5 days 50-80% moms overwhelming feeling of depression characterized by crying, despondence- inability to sleep & lack of appetite. let mom cry therapeutic.

Letting go
interdependent phase 7 days & above. Mom redefines new roles may extend until child grows. Letting-Go the act of ending old ways of thinking or believing - The woman finally redefines her new role - Gives up fantasized image of her child and accepts the real one - Gives up her old role of being childless or the mother of only one or two - Extended and continues during the childs growing years

Maternal Concerns & Feelings during Postpartum:

ABANDONMENT
- Only hours before, they were the center of attention, with everyone asking about their health and well-being. Now suddenly, the baby is the chief interest. The woman may feel confused by a sensation very close to jealousy. Father may have much same feelings Shared responsibility for infant care can help to make both partners feel equally involved in the babys care and can help alleviate these feelings

DISAPPOINTMENT
It can be difficult for parents to feel positive immediately about a child who does not meet their expectations. Handle the child warmly. 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. Maybe due to hormonal changes (decrease estrogen & progesterone). It maybe a response to dependence and low selfesteem caused by exhaustion, being away from home, physical discomfort, and the tension endangered by assuming a new role. A woman needs assurance that sudden crying episodes are normal. Allow to Verbalize feelings

Physiologic Changes of Postpartum Period

CARDIOVASCULAR SYSTEM
1st or 2nd week postpartum, the blood volume has returned to its normal prepregnancy level Blood Volume Hemorrhage bleeding of > 500cc CS 600 800 cc normal NSD 500 cc

Early postpartum hemorrhage

uterine atony - bleeding within 1st 24 hrs. Baggy or relaxed uterus & profuse bleeding Complications: hypovolemic shock. Management massage uterus until contracted cold compress modified trendelenberg IV fast drip/ oxytocin IV drip

gravidocardiacs
The 40% increase in blood volume during pregnancy enters the maternal circulation within 5 to 10 minutes after placental delivery making this period very critical to gravidocardiacs because their damaged heart may not be able to handle this sudden increase in cardiac workload. Blood volume returns to nonpregnant levels 1-2 weeks after delivery resulting in a decline in cardiac output by 30%.

Blood Components
Hct rises in the first 3 to 7 days due to hemoconcentration caused by excretion of large amounts of fluids in the urine (diuresis during the first few days after delivery). Hct level returns to normal on the fourth to fifth postpartum week. Leukocytosis of 20,000 to 30,000 (normal is 5000 to 10000) during the first 12 days characterized by increased neutrophils and easinophils and decreased lymphocytes. Fibrinogen and thromboplastin remains elevated until the 3rd postpartum week. Increased leukocyte sedimentation rate.

 After the birth of their child, many woman worry about caring for their perineal area while it heals. Childbirth is a very traumatic event for a woman's body, often resulting in reduced strength in pelvic floor muscles, a torn or cut perineum, and even hemorrhoids. Another problem in the perineal area after childbirth is lochia, or the bloody discharge a woman may experience for up to six weeks after the birth of her child. Proper perinealcare can make these problems more manageable and help to encourage healing. Initial perineal care, after the stitches have been put in and the new mother has been cleaned up, is focused on treating the pain and swelling associated with child birth. Nurses will apply cooling packs to the area, and offer pain relievers if they are necessary. After the swelling has gone down, heat will be applied to the area, to stimulate healing. Sitz baths, using special tubs that fit onto a toilet bowl, allow the woman to easily and comfortably soak in warm water.

Perineal care male and female as part of bed bath

Purposes To remove perineal secretions and odor To prevent infection( when an indwelling catheter is present To promote client comfort Materials bath towel,bath blanket, disposable gloves,basin soap, disposable gloves Introduce to yourself, verify your clients identity,explain what are youre to do,why and how the client can cooperate Provide the clients privacy, by drawing the curtain or by close the door