maternity

AKA puerperium

4th trimester of pregnancy

6 weeks following childbirth

Placental hormones decline  body return to the pre pregnant state

Involution process begins following delivery

Involution is a reduction in uterine size after delivery to the pre-pregnant state

caused by uterine contractions that constrict & occlude underlying bld vessels at the placental site;

Rapid reduction in size and weight after birth

within 5-6 weeks after delivery

endometrium when not preg

dicidua during pregnancy

6-7 weeks

At end of 3rd stage of labor

uterus is midline & 2cm below umbilicus

12hrs.-fundus rises to level of umbilicus

1-2 cm

is halfway b/t umbilicus & symphysis pubis

Pitocin

Failure of the uterus to return to a non-pregnant state

retained placental fragments & infection

boggy

massaged until firm to prevent hemorrhage

Oxytocin (Pitocin): routinely given following delivery
Methergine: given IM or PO to decrease bleeding
Hemabate: given IM to decrease bleeding

decrease hemorrhage

displaces the uterus

increasing the risk of uterine atony and postpartum hemorrhage

lay mother down with head flat for the most accurate findings

Mom may be encouraged to breastfeed immediately following delivery

Intermittent uterine contractions cause “afterpain” similar to menstrual cramps

Motrin

Worsens with multiparous & breastfeeding moms

Breastfeeding or Nipple stimulation à leads to release of endogenous oxytocin from the posterior pituitary à causing the uterus to contract à cramping

Vaginal discharge after delivery
Composed of endometrial tissue, blood, and lymph

Color
Quantity
Odor

Should be fleshy or menstrual odor

composed mostly of blood
lasts approximately 3 days following delivery

composed of blood and mucus

lasts 4-10 day

composed of mostly mucus
may be yellow to white
lasts 11-21 day

Scant: less than 2 inch stain Light: less than 4 inch stain Moderate: less than 6 inch Large or Heavy:larger than 6 in stain/1 saturated pad in 2 hrs
Excessive: saturation of pad within 15 minutes

Check and apply new pad every 15 minutes
Count and weigh each pad
Note: 1 gram = 1 mL of blood

never closes as tight as it was before pregnancy

a cervical laceration especially if the fundus remains firm

regained most of its form, but never returns fully to the size it was prior to pregnancy

Often edematous, tender, and bruised

incisional site to enlarge the vaginal opening during delivery

tearing of the perineum during birth

Monitor Vital Signs
Observe Lochia character, color, amount, odor, and presence of clots
Evaluate firmness, height, and location of fundus
Document: Fundus firm, midline, located 1 FB below the umbilicus

Observe perineum for hematoma, edema, and episiotomy using REEDA acronym
Redness
Edema
Ecchymosis
Discharge
Approximation

Wash hands prior to cleansing or changing pads
Wash perineum with mild soap & warm water once daily
Clean & apply pad from front to back
Change pad ea void/ defecation
Ice pack first 24 hours
Squeeze bottle & blot dry after voiding
Sitz bath 2X qd for 20 minutes
Anesthetic cream or spray
Witch hazel pads

Observe bladder for fullness, pain, or inability to void
Observe breast for engorgement, nipple tenderness, and breastfeeding
Pain: determine location, character, and severity

Evaluate family interaction, family support, and signs of postpartum depression
Observe for interest in the newborn

Do they make eye contact with the newborn, do they touch and console the baby

estrogen and progesterone

6-8 weeks

breastfeeding is not considered a reliable method of birth control

Menstruation