Unit 5

Topic 5.1

Postpartum Health and Nursing Care

Topic 5.1 Postpartum Nursing Care

• Reproductive and other systemic Changes

• Nursing care the first 24 hours postpartum
• Nursing care following vaginal and caesarean birth
Unit 5 – Postpartum Physiologic Changes
Reproductive Changes: Other Systemic Changes:
- Involution * EXAM • Hormonal system
• Uterus • Urinary system
• After Pains • Cardiovascular system
• Lochia • Lactation
• Ovulation & menstruation
• Cervix
• Vagina
• Perineum
 What is involution?
• Uterus - 2 main processes. What are they?
• Seal off site of placental implantation to prevent bleeding
• Return to the pre-pregnancy state
• Fundus:
– Location of fundus (1 hour post-partum at level of umbilicus)
– Decreases by approx. 1 finger breadth per day (approx. 1 cm)
– By day 9 or 10 has returned back into pelvis and can no longer be felt
– Bladder can displace uterus and prevent involution
– Consistency after birth (firm, boggy-massage)
– Type of birth (vaginal, c/s)
• Afterpains: intermittent cramping
• Felt more by women with bigger babies or Multiparity as the uterus has to work harder
Descent of the uterine fundus
A full bladder displaces the uterus
Reproductive changes continued

• Cervix initially open and then contracts to close; by end of day 7 be firm and
back to non-pregnant state
• Vagina: takes 6 weeks to return to approximate pre-pregnancy state
• Good time to perform kegel exercises; will help strengthen and tone the vaginal muscles
• Perineum: can feel edematous and tender after birth
• Interventions?
Lochia – Lasts 2 -6 weeks

• Discharge from vagina in the postpartum period. Goes through 3 phases.

• Rubra: Red – mostly blood. Lasts for approx. 3 days

• Serosa: Pink – blood and mucous. Days 3 – 10 approx.

• Alba: Mostly mucous – whitish or colorless. Can last up to 6 weeks.

More Physiological Changes

• Diuresis • Lactation
• Let-down reflex
• Diaphoresis & chills • Latch-on (latch)
• Cardiovascular • Engorgement
•
• Gastrointestinal system Erect nipple
• Inverted nipple
• Integumentary system • Flat nipple
• Weight loss • Colostrum

• Ovulation/menstruation
Post partum Assessment- first 24 hours
The first hour:
• Fundus/lochia – important because of PPH
• Perineum
• Vital signs
• IV
• Foley if there is one/ assess bladder
• Nutrition needs (drink/food)
• Shower
• Nurse Baby
Postpartum Assessment first 24 hours

• Health history
– If this was not completed prior to admission for labor and delivery
– It should include information regarding labor and delivery as well as infant data
• Physical assessment
– We use BUBBLE HER to guide our assessment
• Laboratory data
– Hemoglobin usually measured first 12-24 hours
– Syphilis screen prior to discharge
PP Assessment – focussed assessment (first 24 hours
and beyond)

• BUBBLE Her Vitals

• B - Breasts
• U - Uterus
• B - Bladder
• B - Bowel
• L - Lochia
• E - Episiotomy(Perineum)
• H - Homan’s (Passive stretch only)
• E - Emotional
• R - Rest and Activity

• Vitals
• WE DO NOT DO HOMAN’S but this was part of the acronym
for the focused assessment
• If your patient has had an epidural or spinal, you will need to
check the site.
Palpating the Fundus after Birth
Postpartum Care Routine

• First hour PP checking every 15 min.

• Frequency of ongoing PP Assessment
• Check unit protocol
• Could be q shift if stable
• Could be q 4 hrly if new admission or complications

• See Vaginal Delivery Care map on Moodle

Postpartum and Oxytocin

• Some patients are admitted to Postpartum and have

Oxytocin/Syntocinon running (bc of boggy uterus, if bleeding bad
(ruba)). Doctor’s orders may read to discontinue when fundus
and lochia satisfactory.

• How do you deal with this?

Postpartum care education

• How might the lochia change if the client does the following:
• Ambulates
• Climbs stairs
• Breast feeds
• 24 hours following a caesarean birth
Postpartum care education

• How would you manage your patient if she is complaining of perineal pain?
What would your assessment include?

• What would care of the perineal area involve? What would you teach your
patient?
Postpartum care education

• Your patient is concerned about becoming constipated. What teaching

could you do in order to assist her in this?

• Your patient wants to know when her “milk” will come in. What do you
say? How might she feel that day?
Postpartum care education

• Third and Fourth degree tears:

• Mothers are put on bowel routine to facilitate a soft bowel movement. (Check unit
protocol for this.)

• NO ENEMAS/SUPPOSITORIES – nothing should be inserted in through the anal

sphincter in case there is a disruption of the sutures and then subsequent bleeding
or infection.

• NOthing
Postpartum care education

• WHY assess the fundus and the lochia?

• WHAT is the FIRST thing you would do if the lochia was very heavy and/or there
were clots?
• WHAT would you do if the lochia was heavy and you could palpate bladder?
• WHAT would you do if the fundus was boggy/soft?
New Admission – C/Section

• Use the acronym REEDA to describe assessment of the incision. Can also use
this for assessment of episiotomy site.
• R - Redness
• E - Edema
• E - Echymosis
• D - Discharge
• A - Approximation
Nursing Care for Cesarean

• Treat as post-op
• Vitals, IV, Foley, Incision, Lochia, O2,
• PLUS “Bubble her Vitals”

• If your patient has had an epidural or spinal, you will need to check the site.