Post-partum Care - lying flat on her back with knees bent, a
 Postpartum exercises
 Initiation of Lactation
 Relief of Discomforts
 Hygienic measures
 Maintaining adequate nutrition
MUSCLE STRENGTHENING EXERCISES
1. Abdominal breathing
- started on first day after birth
- lying flat on her back or sitting, a woman
should breathe slowly and deeply in and
out 5 times, using her abdominal
muscles
- check: watching her abdominal wall rise
2. Chin-to-chest
- excellent for the second day
- lying on her back with no pillow, a
woman raises her head and bends her
chin forward on her chest without
moving any other part of her body while
exhaling
- should start gradually, repeat no more
than 5 times the first time and then
increasing it to 10-15 times in
succession
- can be done 3-4 times a day
- check: woman will feel her abdominal
muscle pull and tighten
3. Perineal contraction (Kegel exercises)
- add on the third day
- woman tightens and relaxes her
perineal muscles 10-25 times in
succession as if she were trying to stop
voiding
- check: will feel her perineal muscles
working
4. Arm raising
- helps both breast and abdomen return
to good tone
- add on the fourth day
- lying on her back, arms at her sides, a
woman moves her arms out from her
sides until they are perpendicular to her
body. She then raises them over her
body until her hands touch and lowers
them slowly to her sides
- should rest a moment, then repeat 5
times
5. Abdominal crunches
- advisable to wait until 10th or 12th day
after birth
woman folds her arms across her chest
and raises herself to a sitting position
- expends a great deal of effort/tires a
postpartal woman easily
- begin gradually and work up slowly to
doing 10 times in a row
Physiology of Breastfeeding
 delivery of placenta causes decrease in
progesterone level, stimulating production
of prolactin
 breast milk formed in acinar and alveolar
cells
 Colostrum - 4th month of pregnancy
 Transitional breast milk - 2nd-4th day
 True or mature breast milk - 10th day
 Milk flows from alveolar cells, where it is
produced, through small tubules to
resevoirs for milk, the lactiferous sinuses.
This constantly forming milk is called
foremilk. Its availability depends very little
on the infant's sucking of the breast. As the
infant sucks at the breast, oxytocin causes
the collecting sinuses of the mammary
gland to contract, forcing milk forward
through the nipples. This is called the let-
down reflex.
 A let-down reflex is also triggered by the
sound of a baby crying or by thinking about
the baby. New milk, called hind milk, is
formed after the let-down reflex.
Advantages of breastfeeding for the mother
 preventing breast cancer
 uterine involution
 empowering effect
 reduces cost of feeding and preparation
time
 bonding between mother and child
Advantages of breastfeeding to the infant
 breast milk contains IgA, which prevents
the absorption of bacteria and viruses by
the GI tract
 Lactoferrin - interferes with the growth of
bacteria
 Lysosyme - enzyme that destroys bacteria
 L-bifidus - prevents diarrhea
 ideal electrolyte and mineral composition
 Lactose - rapid brain growth
 Protein in milk is easily digested-rapid brain
growth
 nutrients enough to supply infant's needs
 avoid exposure to cow's milk (allergy)
 formation of dental arch
Beginning Breastfeeding
 should begin as soon after birth as
possible, inside the birthing room
 stimulates release of oxytocin
 let-down of milk
 uterine contraction
 important for infants to open their mouths
wide enough to grasp both nipple and
areola
 effective sucking
 emptying of collecting sinuses
 woman should place her infant first at the
breast at which the infant fed last in the
previous feeding
 ensure breast is completely emptied at
every other feeding
 do not offer bottles of breast milk until 4-
6 weeks of age
 it takes less energy for an infant to suck
a bottle
 Milk looks like nonfat milk, thin and almost
blue-tinged in appearance.
 before breastfeeding - wash hands

Position: Promote Adequate Sucking

 lying on her side with a pillow under her
head- relieves fatigue as it allows her to
rest on the bed
 football hold - with the baby supported on
a pillow
 brushing infant's cheek - rooting reflex
 if woman has large breasts - grasp the
areolar margin between thumb and
forefinger, holding the bulk of the breast
First Few Days
 babies fed every 2-3 hours
 frequent feeding
 colostrum
 the more the breasts are emptied, the
more efficiently they fill
After Feeding:
 TEACH mother to insert a finger in the
corner of the infant’s mouth or pull down
infant’s chin to release suction
foremilk hindmilk
 To stimulate milk production and ensure
adequate fluid intake
 keep infant awake – stroke the back,
change baby’s position, rub the arms
and chest, change diapers, tick baby’s
feet
 urge infant to suck
 If not sucking well
 use breast massage
 Provide immediate support if problems
arise
 Provide information regarding techniques
for burping the breastfed baby
 infants swallow air when breastfed
 placing baby over one shoulder and
gently patting or stroking the back
 holding the baby in sitting position on
the lap, leaning the child forward against
one hand, with the index finger and
thumb supporting the head. The other
hand pat's the babies back
Breast Engorgement
 3rd or 4th day after birth, breast milk forms
 breast distention
 hardness
 tenderness
 heat in the breasts
 skin appears red, tense and shiny
 vascular and lymphatic congestion arising
from increased blood and lymph supply
 infants have difficulty sucking on engorged
breasts because areola is too hard to grasp
Prevent/Relieve Engorgement
 empty breasts of milk - allow infant to suck
often
 firm-fitting bra
 if infant cannot grasp a nipple - warm packs
or standing in warm shower minutes before
feeding combined with massage
 manual expression or the use of breast
pump after breastfeeding
 symptom of engorgement is healthy, an
announcement her breasts are producing
milk
 subsides 24 hours
Sore Nipples
 strong sucking action of newborn
 worsened by:
 improper positioning of infant
 forcefully pulling an infant from a breast
 allowing an infant to suck too long at a
breast after the breast is emptied
 permitting a nipple to remain wet from
leaking milk
 nipples are kept supple from the secretions
of the Montgomery's tubercles
 soreness - excessively dry or wet nipples
1. position baby slightly differently for each
feeding
prevent same area of nipple from receiving
pressure
2. expose nipples to air 10-15 minutes after
feeding
3. discourage the use of plastic liners that
come with nursing bras
4. apply vitamin E lotion
5. apply a few drops of breast milk to nipples
after feeding then massage into areola
Montgomery’s tubercles
6. avoid use of hand pump
 pressure can cause fissures
 use electric or batter-operated pump
instead
Sore nipples are not a contraindication to
breastfeeding
Hygienic Measures
 include perineal care as part of her daily
bath and after every voiding or bowel
movement
Perineal care
 Wash hands
 Put on clean gloves
 Place a plastic -covered pad under the
woman's buttocks to protect the bed during
the procedure.
 With the woman in supine position, remove
the perineal pad from front to back, the
direction is important to prevent the portion
of the pad that was over her rectal area
from sliding forward to contaminate the
vaginal opening.
 If actual washing is to be done, use a clean
gauze square or a clean portion of a
washcloth with soap and water to each
stroke, always washing from front to back,
from the pubis to the rectum. Rinse the
area in the same manner and dry it.
Post-partal menu
 2200-2300 calories daily
 high in protein, vitamins and minerals
needed for good tissue repair
 Roughage - peristaltic movement
 Breastfeeding - additional 500 calories and
500 ml fluid
Promote Adequate Fluid Intake
 The rapid diuresis and diaphoresis that
occur during the 2nd to 5th postpartal days
result in a weight loss of 5 lb in addition to
12 lb lost at childbirth.
 Women feel thirsty during this period of
rapid fluid loss and want additional fluid.
woman needs to increase her fluid intake to
rid her body of wastes (catabolized uterine
cells)