{"id":1812,"date":"2019-11-15T21:06:00","date_gmt":"2019-11-15T21:06:00","guid":{"rendered":"https:\/\/wimetest.com\/blog\/?p=1812"},"modified":"2022-04-28T14:28:23","modified_gmt":"2022-04-28T21:28:23","slug":"postpartum-care","status":"publish","type":"post","link":"https:\/\/wildirismedicaleducation.com\/blog\/postpartum-care","title":{"rendered":"Postpartum Care and Complications"},"content":{"rendered":"\n

By Heidi Crean, DC, MSN, RN, CNL<\/strong> and Bethany Derricott, MSN, RN<\/a><\/strong><\/p>\n\n\n\n

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The postpartum recovery period covers the time period from birth until approximately six to eight weeks after delivery. This is a time of healing and rejuvenation as the mother\u2019s body returns to prepregnancy states. Nurses and other healthcare professionals need to be aware of the normal physiologic and psychological changes that take place in women\u2019s bodies and minds after delivery in order to provide comprehensive care during this period. In addition to patient and family teaching, one of the most significant responsibilities of the postpartum nurse is to recognize potential medical complications after delivery.
Detailed information on obstetric and labor and delivery problems can be found in the Nursing CEU course Pregnancy Complications<\/a>.<\/p>\n\n\n\n

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Postpartum Physiologic Changes<\/h3>\n\n\n\n
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Immediately after delivering, women experience massive shifting as the body returns to its pre-pregnant state. Some of the physiologic adaptations to the reproductive system are described below:
The uterus begins a process known as involution<\/strong> immediately after the delivery of the placenta. The uterus, with the assistance of the uterine muscles, contracts the uterine vessels and impedes blood flow. Large vessels at the site of placental attachment thrombose to control bleeding.<\/p>\n\n\n\n

Exfoliation<\/strong> also occurs at this time. Exfoliation is the sloughing off of dead tissue at the site where the placenta is attached to the uterine wall.
The uterus continues to contract after delivery, and its size decreases rapidly as estrogen and progesterone levels diminish. Immediately after delivery, the upper portion of the uterus, known as the fundus, is midline and palpable halfway between the symphysis pubis and the umbilicus. By approximately one hour post delivery, the fundus is firm and at the level of the umbilicus. The fundus<\/strong> continues to descend into the pelvis at the rate of approximately one centimeter (finger-breadth) per day and should be nonpalpable by two weeks postpartum.<\/p>\n\n\n\n

Afterpains<\/strong>, or intermittent uterine contractions, are a normal occurrence during the postpartum period.
After delivery, the endometrial surface of the uterus is shed via the vagina. The shedding endometrium is known as lochia<\/strong>.<\/p>\n\n\n\n

As with all other reproductive organs and structures, the cervix<\/strong> also changes as the body returns to a prepregnancy state. The internal os closes almost completely within three to four months of delivery.
The vaginal walls are smooth after delivery, and the vaginal folds, known as rugae<\/strong>, do not return until approximately 3 weeks postpartum.
Vaginal dryness and painful intercourse, known as dyspareunia<\/strong>, may be noted during the postpartum period due to decreased estrogen levels.<\/p>\n\n\n\n

After delivery there is a significant decrease in estrogen and progesterone levels. Prolactin initiates milk production, and the breasts become engorged, as well as warm and tender, between postpartum days 3 and 4. Mothers often refer to this as having their milk \u201ccome in.\u201d
Menstruation<\/strong> does not typically return until 12 weeks or later. However ovulation can return prior to menses, and it is important for healthcare providers to discuss family planning with patients during the early postpartum period in order to prevent undesired pregnancies.<\/p>\n\n\n\n

The postpartum body removes excess fluid accumulated during pregnancy by diuresis<\/strong>. In addition, women frequently experience excessive perspiration (diaphoresis)<\/strong>, which also releases accumulated fluid during the postpartum period. After delivery, the diaphragm descends and postpartum women\u2019s respirations<\/strong> normally return to the prepregnant state. After delivery, relaxin levels subside and the pelvic<\/strong> ligaments and joints return to their prepregnant state. However, the joints of the feet remain altered, and many women notice a permanent increase in shoe size. The abdominal wall is weakened and the muscle tone of the abdomen<\/strong> is diminished after pregnancy. Patients should be instructed to begin abdominal exercises anytime following a vaginal delivery and after abdominal tenderness resolves following a cesarean section, generally in four weeks.<\/p>\n\n\n\n

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Postpartum Psychological Changes<\/h3>\n\n\n\n
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Bonding<\/strong>, sometimes referred to as attachment, between mothers and infants is affected by a multitude of factors, including socioeconomic status, family history, role models, support systems, disturbed sleep, cultural factors, and birth experiences.
Nurses can assess for attachment behaviors by observing the interactions between mothers and their infants. Behaviors exhibited by mothers that indicate positive attachment<\/strong> include:<\/p>\n\n\n\n