Unit V Postpartum

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Unit V - Postpartum
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Puerperium

• 6 weeks following delivery
• 4th trimester 3 months after delivery
• Psychological adjustment
• Dependent phase
• Dependent independent
• Interdependent

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Attachment fathers

• Engrossment
• Fathers spend less time with infants than mothers
• Fathers interactions characterized by social play
  rather than care taking
• Fathers knowledge related to competent parenting
• More research is needed

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Attachment

• Steps
• Interactive process continually assess
• Model behaviors
• Loss of the perfect child

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Psychological adjustment

• Baby blues 50-70 women experience
• Postpartum depression
• Postpartum psychosis

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Assessment parameters

• Vital signs every 15 min x 1hr, then every 30min
  x 1 hr, then every 4 hrs x until 12hrs post
  partum
• Postpartum assessment as above

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Physiological changes

• Uterus fundal height positioning, first
  hours, uterine atony, afterpains
• Lochia stages, lasts 3-6 weeks, teach signs of
  infection
• Menstrual cycle 6-8 weeks nonlactating,
  12wks-6mos lactating
• Immune system Rhogam and Rubella

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Physiologic changes

• Vital signs
• BP same
• Temp slight elevation due to dehydration, 100.4
  after 24hrs suggests infection
• Pulse bradycardia early postpartum period
  (40-80)
• Urinary void within 6-8hrs, 100cc
• Diuresis
• Diaphoresis
• Bowel

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Lactation

• Physiology elevated estrogen and progestin
  levels stimulate breast changes in pregnancy.
  Levels drop after delivery allowing prolactin to
  take effect (anterior pituitary).
• Prolactin milk production
• Oxytocin stimulates milk let-down

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Advantages for baby

• Antibodies cell mediated immunologic factors
• Enhances maturation of GI tract
• Lower incidence of allergies
• Lower incidence of SIDS
• May have protective benefit against childhood
  lymphoma and insulin dependent diabetes
• May enhance cognitive development

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Advantages for Mom

• Decreased risk of ovarian, uterine and breast CA
• Promotes uterine involution
• Return to prepregnant weight
• Some protection against osteoporosis
• Bonding
• Convenient
• Saves money

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Disadvantages???
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Assessment

• Infant readiness
• Nipples
• Latch-on, positioning, sucking swallowing
• Frequency - encourage nursing every 2-3 hours, no
  strict schedule, need 8-12 feedings per 24hrs
• Length of time? 10-20 minutes-foremilk, hindmilk

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Infant Assessment

• Day 3 3-4 wet diapers, and 1-2 stools that are
  changing
• Day 4 milk supply established, 6-10 wet diapers
  and 3 stools in 24hrs
• By 10-14 days regain of birth weight

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Special considerations

• Engorgement
• Sore nipples
• Monilial infections
• Plugged milk ducts
• Mastitis
• Storage