Obstetric Nursing 2

Cardiovascular system
 Increase of blood volume (plasma volume) 30 - 50% - increase Stroke Volume and Cardiac Output
○ With iron treatment - increase RBC increase 30% > Physiologic anemia
 Maternal iron taken by the baby - 75%
○ No iron treatment - only increase 15% > anemia
○ Preventive: Iron is given second trimester
- Easily tired / fatigability
- Exercise is safe, but in moderation
○ Swimming but not in laps
○ Walking but not brisk walk
○ Dancing but not jog and bounce
○ Ride a bike, as long as there is balance until 5 months
○ Ride horse
- If there is chest discomfor t, there is a problem in the heart

Cardiac Problem
1. Class 1: No symptom, No restriction
a. Allowed pregnancy > full term
i. 3rd trimester:
1) Rest between activities
2) Avoid any form of strenuous activities
3) No bearing down > bradycardia
4) Forceps assisted birth
5) Do not raise legs on stir ups > pressure on the lower part
6) Is not allowed to experience pain (pain medication)
7) Placed on sitting position
ii. Postpartum: excess volume for compensation - tachycardia > monitor cardiac rate
2. Class 2: With Cardiac symptoms with Ordinary Physical Activity
a. Up the stairs > stop 5 steps
b. Problem in 3rd trimester:
 Same as cardiac 1
 1 day Complete Bed Rest per week > allow heart to rest
3. Class 3: Symptoms even with Less than Ordinary Physical Activity
a. Allowed pregnancy
 Emotional, and Physical stress
 Complete Bed Rest on 3rd trimester > hindi aabot ng term (deliver early) > Caesarian Section > epidural
anesthesia > recovery dangerous part
b. Post partum: Dangerous
4. Class 4: Symptoms even at rest
a. Dangerous for pregnancy
 Candidates for ligation
 Similar management to cardiac 3

 Use of drugs is safe but monitor the patient's response > Digitalis, Propanolol, Heparin not coumadin (teratogenic), Left Sid ed
Failure (problem of congestion) > Diuretic (Potassium Sparing)
 Penicillin all throughout the pregnancy as a prophylaxis to prevent Streptoccocal infection > serious complication of pericar ditis

 Decreased hematocrit (physiologic or pseudoanemia and hemodilution)

 Increase in WBC is normal during pregnancy body response to the stretch of uterus, all the way to postpartum to protect the
organs
 Increased coagulation - potential for thrombolytic complication
 Blood flow to the uterus and placenta improves when the patient is on left side lying position
 Supine hypotension syndrome - superior (hypotension) and inferior (fetal distress) vena cava compression
○ Left side lying, CS: wedge the right side (shoulder or hips)
 Best sexual position: woman on top, side by side
 BP decreases during 2nd trimester, return to normal during the third
 Estrogen vasodilator > decrease: normal
 Increase BP > Hypertension (2nd trimester) 20 - 24 AOG > monitor for increase BP > PIH

Respiratory System
 Diaphragm displaced causing Shortness of Breathe - raise Head of Bed

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 Diaphragm displaced causing Shortness of Breathe - raise Head of Bed
 8 months: difficulty Sleeping > semi sitting / fowler's or orthopneic
 Increased vascularity of mucus membranes (estrogen is a vasodilator) > nasal pharyngeal congestion > possible epistaxis

Renal System
 Increase Glomerular Filtration Rate 30 -50% because of increase blood volume
 Glucose thresholds drops releasing sugar in urine, thus will see an increase in insulin demand after 24 th week
○ If traces, normal
○ +1, 2 > DM (OGTT)
○ Medium for bacterial growth
 UTI: Best cleansing agent is water (2 more glasses/ day), not acidfying urine
 Risk to baby: preterm > bladder irritability
 Enlarging uterus acids pressure to the bladder - frequency, urgency
 Loose salt > RAA > Aldosterone production increases - increase in sodium and fluid retention > low salt diet - 4g - salt lang sa
karne, boiled or broiled (2g > salt free)
○ High salt > processed, preserved - tomato juice, (sauces) gravy

Integumentary System
 Increased pigmentation > Chloasma / Striae

Musculoskeletal System
 Changes on the center of gravity as pregnancy progresses
○ Center: pelvis, hips, line of gravity: longitudinal
○ Pregnancy: abdomen, line of gravity: transverse
 Lordosis - back pain > waddling gait - compensatory mechanism > Relaxin increases mobility of pelvic joints
○ wedge shape at least 1 inch heels
 Progressive softening of the cartilage
○ Pelvic tilt and rock
○ Tailor sitting > releasing pressure on back
 Cramping in calf from hypocalcemia or hypercalcemia

Neurologic System
 Pressure on sciatic nerve in the third trimester > cramps > wait for the baby to be born
 1st trimester > dorsiflexion of foot (counter action) or (mild) warm compress
 If on Stir - ups > complained of leg cramps > take off to the stir ups, then dorsiflex

Gastrointestinal System
 Bleeding gums (too much blood supply) - use a soft bristled tooth brush > no tooth extraction during the first trimester
 Morning sickness in first trimester
○ Glucose goes to the baby at night > in morning, dizzy > vomit > morning sickness > dried carbohydrate (cracker, toast,
dried cereals) > can raise blood glucose level 30 mins
 Nausea / Vomiting - hormonal change (due to increased HCG)
○ Avoid spicy, high fat, salty
 Hyperemesis gravidarum - excessive (beyond first trimester), pernicious (outside) > metabolic acidosis > keto acidosis
○ Potential for loss of pregnancy
○ Cause: H-mole, psychological (consider level of maturity - teenager > noncomplaint, high regard for body image) >
identify cause > manage cause > psychotherapy / replacement therapy
○ Cracker water combination > cracker - sips of water - cracker 1 hour interval
 Cravings (Pica) > psychological (psychotherapy) / increased appetite
 Pyrosis - heartburn > antacids (Maalox - low sodium content)
 Abdominal cramps
 Decreased peristalsis due to progesterone (gas, constipation, heartburn)

Endocrine System
 Anterior pituitary decreased FSH, increased LSH > increased oxytocin secreted during Labor and Delivery
 Ovaries secrete relaxin (increased flexibility of joints)
 Increased thyroid hormone - increased BMR
 Increased demand for insulin form pancreas
 Production of relaxin - hormone that permits relaxation of hip joints in preparation for child birth

Gestational Diabetes Mellitus

 Estrogen and progesterone - insulin antagonist
 HPL - counteracts effect of insulin
 Enzyme insulinase - hastens break down of insulin

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 Enzyme insulinase - hastens break down of insulin
○ Because of the hormones > insulin sensitivity > > Cannot metabolize glucose > hyperglycemia > goes to the fetus
through placenta > fetus is secreting increase insulin of the pancreas that is immature:
○ Macrosomia with (visceral organs) organomegaly
○ Respiratory Distress Syndrome
○ Preterm > diminished amount of blood volume > placental degenaration > Ultrasound - amount of calcification of the
placenta
 More calcified - aged
 Mature - 36 -38 weeks grade 3
 Delivery in Caesarian Section
○ Neonatal hypoglcemia
○ Maternal effects: PIH, Recurrent UTI, Moniliasis, Dystocia (difficulty in labor), Atony
○ Insulin Treatment, No OHA > teratogenic, stimulates pancreas to produce insulin
○ Diagnosed: Second Trimester, stress increases demand > increase insulin on the third trimester
○ Postpartum: hypoglycemia > normal in 6 weeks > if not normal, DM 2

Psychosocial Task- Situational (change situation for the baby), maturational crisis
 Coping > husband, child > give up the order > allow in decision making > clothes
First Trimester
a. Acceptance of pregnancy (Age > culture)
Second Trimester
a. Quickening - multpara (4th), primipara (5th) - 5 months
b. Fetal embodiment (accepts the baby as separate from self) > ultrasound
c. Fantasy, maternal impression
Third Trimester
a. Preparing for fetal separation (preparing for childbirth)

Child Birth Classes

1. La Maze - conditioned response, psycho prophylaxis, mind controls body, gate control
- Breathing techniques, massage, positional changes
2. Deep Reed - hypnosis
3. Bradley - home birth, natural, father assisted, no use of medications / surgery

Fatherhood
1. Mittleiden - to hatch observes behaviors and taboos associated with pregnancy
2. Couvade - means suffering alone (psuedocyesis)
*Psychosomatic symptoms felt by the husband while woman is free from the same

Complications of Pregnancy
First Trimester
1. Abortion
2. Ectopic Pregnancy
Second Trimester
1. H - Mole
Third Trimester
1. Placenta Previa
2. Abruptio Placenta

Abortion
- Termination before age of viability
Early Abortion Causes
- Before 16 weeks - Genetic Factor (60% )
Late Abortion - Endocrine factors (Hormonal imbalance)
- Between 16 - 24 weeks - Infections (TORCH)
- Systemic disorder
- Psychological factors
- Incompetent cervix
Types
1. Spontaneous / Natural
a. Threatened (Spotting) - painless closed cervix
b. Inevitable (imminent - profuse bleeding with clotted blood, painful, cervix is dilated)
Outcomes of Abortion:
i. Incomplete - fetus expelled, placenta retained

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 i. Incomplete - fetus expelled, placenta retained
1) D and C
2) Tissues never thrown away > Histopath
3) Risk: Placenta Previa
ii. Complete - all products of conception expelled
1) Involution of uterus (methergin)
iii. Missed - fetus dies in the utero and is retained
1) At risk for: DIC
2) Induction of labor (Oxytocin)
3) Misoprostol (Prostaglandin) -16 - 38 weeks - chemical induces premature labor is given as suppositories
or an injection
Stages of death
1) Maceration - generalized softening of skin
2) Mummified - no skin, only muscles and bones
3) Lithopedion - stone hard, calcified
a) DIC
b) Hazards include convulsion, vomiting and cardiac arrest
2. Induced
a. Therapeutic - to save the life of the mother > in cases of ectopic pregnancy
 Pain at uteral area, bright red bleeding

Ectopic Pregnancy
- Any gestation outside uterus
Location: Signs /Symptoms
1. Fallopian tube (70% -90) 1. Lower abdominal pain (unilateral, knifelike)
a. Isthmus - vascular, closest to uterus (acute 2. Cullen's sign - bluish umbilicus (hematoma)
rupture) 3. Cul de sac mass - (pouch near the uterus)
b. Ampulla - 2 /3 of the tube > blood will blood accumulation
accumulate in some spaces 4. Dark red bleeding
2. Cervix - hypermotility, presence of IUD, Pelvic 5. Shoulder pain - compression of phrenic nerve
Inflammatory Disease 6. Shock
3. Ovary - obstruction of fallopian tube
4. Abdomen - push outside, placenta attached liver >
do not remove, hasten composition of placenta
(methotrexate) > body will absorbed degenerated
tissues
Management:
• Salphingectomy
• Laparoscopic surgery

Hyaditiform mole
- Benign growth
- Gestational trophoblastic disease, no amnion
- Proliferation noted as a grape like cluster of vesicles > choriocarcinoma
- Snow storm pattern in ultrasound
Predisposing Signs / Symptoms
1. Oriental 1. Dark red bleeding after 12th week
2. Clomiphene (Clomid) 2. Disproportionate uterine size
3. Age (<18 - >35) 3. (-) fetal heart, outline, quickening
4. Protein Deficiency 4. Hyperemesis
5. Passage of vesicles
6. Anemia
Management:
1. Suction
2. D and C
a. Monitor HCG for 1 year (No pregnancy)
b. Oral contraception to prevent another pregnancy and to suppress endogenous pituitary LH
c. Continued increase titer is pathologic > (methotrexate)
d. Chest X - ray (for metastasis) every month until HCG titers are negative then every 2 months for 1 year
e. Change of pregnancy after H - mole is 30%

Placenta Previa

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 Placenta Previa
- Low implantation that it overlays some or all of the internal os
Types: Etiology Signs / Symptoms
1. Low lying - near os > double set up 1. Decreased vascularity of the upper 1. Painless bright red bleeding
2. Incomplete / Partial - covers 50% > segment 2. Soft uterus
CS 2. Previous scar from D&C or CS
3. Complete / Total - entire cervix 3. Tumor
covered > CS 4. Multiple gestation (fraternal)
5. High Parity
6. Smoking
7. High Altitude

Abruptio Placenta
- Sudden separation of a normally implanted placenta (partial / complete)
Types: Signs / Symptoms: Causes:
1. Concealed - hidden bleeding (Schulze's 1. Painful 1. Decrease in uterine size (ROM)
seaparation - center before edges going out) - 2. Dark red bleeding 2. Vascular engorgement
Couvelaire - Copper colored 3. Couvelaire - Rigid uterus 3. Abdominal trauma
2. Apparent (revealed) - seen Duncan (edges then 4. Short cord (less than 40 cm)
center) red white color of amniotic fluid 5. PIH
Management:
1. Position: minimal > side lying; profuse > modified trendelenburg
2. Star IV line (gauge 19 > blood transfusion)
3. Keep warm > blankets
4. In fetal distress, oxygen > 2 -3L/min via face mask
5. NPO
6. Assessment: estimate blood loss > saturated pad: 30 mL, weigh: pad saturation
1 gram = 1 mL
7. Determine level of consciousness
8. Emotional / psychological support
9. Grieving Crisis intervention - Acceptance

PIH (Pregnancy Induced Hypertension)

- Not toxemia
PIH Chronic
Onset is 20 - 24 weeks AOG Earlier
Accompanying symptoms: Proteinuria, Edema Edema
Convulsion > Ecclampsia Potential for CVA
Postpartum BP: 6 weeks normal Elevated BP
Etiology: hormone imbalance of estrogen and progesterone; prostacyclin, thromboxane imbalance > generalized arterio spasm /
vasoconstriction > decreased perfusion > uteroplacental insufficieny > IUGR, stillborn or premature
 Diminished perfusion of kidney > diminished output > oliguria > anuria (renal shut down)
 Kidney is semi permeable (filter) > protein > hypoalbunemia > fluid shift > edema > legs (dependent) > progresses anasarca
(third spacing) > pulmonary, congestive heart failure, cerebral edema > headache, Vomiting , blurring of vision, irritability of
CNS > convulsion
 No plasma > Thick and viscous blood > hemodilution > clotting
 Liver > increase in portal system > HEELP (hemolysis, elevated liver enzymes, low platelet) / Disseminated Intravascular
Coagulopathy > 20% death
 Treatment of choice: delivery

Low risk: Schedule of visit

1 - 7 months - once a month
8 month - every 2 weeks
9 months - every week

Pre ecclamspia
Mild Severe
• BP: 140/90 • Risk for convulsion
• Edema is finger and face • BP: 160 /110

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 • Edema is finger and face • BP: 160 /110
• Less than 2 g/L in a 24 hour collection • Edema is generalized (anasarca)
• Home care (rest) avoid strenuous activity • Greater than 2 g/L
• Diet low in salt, fat, high in protein
• Non compliance - knowledge deficit
• Multiply normal schedule to 2
Management:
1. Non stimulating environment: not too far, not too near, limit visitors > visiting time (lunch time, dinner time)
2. Provide with some assurance (factual)
3. Mg SO4 - CNS depressant - prevent convulsion / vasodilator (given bolus)
○ Serum Therapeutic Level: 4 - 8 mg/dL; > 8 - toxicity
4. Baseline data: DTR, HR, urine output (determine renal function - toxicity might occur), BP - pulse pressure (Widened - circulatory
collapse), (RR) Decrease, < 14 hold, if 12, antidote, fetal heart rate maintain at120 - 160 bpm
○ Antidote: Calcium Gluconate
5. CS, Epidural anesthesia, Forceps assisted, no pain > increase BP

Ecclampsia
- Grand mal (tonic clonic)

Stage 1: Invasion - changes in maternal VS

Stage 2: Aura - warning, immediately precceding convulsion > epigastric pain
a. Position - side lying, turn head to side
b. Mouth gag to protect tongue
Stage 3: Tonic clonic - alternate contraction and relaxation of muscle
a. Bruising, hematoma
i. Cushioning, put pads around rails
ii. No restrains, do not touch
iii. Time duration of seizure (20 secs at most) > no oxygen to the brain
Stage 4: Post Ictal
a. Assist to resuscitate
b. Reorient
 Status Epilepticus

Labor and Delivery

Usual Position: Anterior (LOA: 90% ) > not to compress the vena cava
Labor
- A series of processes whereby the products of conception are expelled

First Stage - cervical dilation (opening) / effacement (thinning)

• Primipara - 12 - 18 hours; effacement then dilation
• Multipara - 6 -8 hours; as cervix effaced it also dilates
 At risk: Precipitate Delivery - less than 3 hours of labor
□ Unattended birth > subdural hematoma, shoulder injury
□ Vaginal Laceration
 Grand multiparity
 Premature
 Large pelvis
 Unresistant soft tissues
 Overuse of oxytocin
◊ Morphine - to relax body (depresses RR)

Second Stage - Fetal expulsion

• Primipara - 1 1/2 - 2 hours
 2 hours - Arrest of second stage - dry vagina (early ROM) > forceps delivery
• Multipara - 30 - 45 mins

Third Stage - Placenta

• 5 - 30 minutes
 Placenta Accreta (adhere) - never separate / increta (deep) / percreta (perimetrium)
- Deep attachment of the placenta into the myometrium
- Methotrexate

Forth Stage - Puerperium

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 Forth Stage - Puerperium
1. Early - first 24 hours
2. Late - second day to 6 weeks

Factors involved:
Power: forces of labor
Primary - uterine contraction
Secondary - intra - abdominal pressure

Best Position in Labor: walking, upright, squatting

Increment, acme, decrement
• Duration, Interval , Frequency
- As labor increase, increase duration and frequency, decrease interval
Latent Active Transition
Cervical dilation: 0 -3 cm 4 -7 cm 8 -10 cm
Interval: 5 - 30 minutes 3 - 5 minutes 2 - 3 minutes
Duration: 30 seconds 45 - 60 seconds 60 - 90 seconds
Behavior: Calm, walking > cooperative Irritable, Narcissistic Behavioral change, may lose control
BP: Every hour Every 30 minutes
• Knowledge deficit  Take a full bath > immersing > - In between first and second stage
• Anxiety soothing
- Provide information regarding - They want to maintain control
progress of labor - Only concerned with herself
- Intact membranes - upright - Give medication for pain to relax
(ambulate) (5cm) Narcotic Analgesic
- If ROM, bed rest ○ Demerol
- General liquids ○ Nubain
- Breathing techniques ○ Never give unless
○ Deep Breathing (best) depress RR, normal FHT
○ Accelerated ○ Antidote: Narcan
○ Pant and blow
Stir ups - simultaneously - to prevent tearing of ligament or changes / prevent change in pressure
Do not shave the pubic hair; partial shaving > episiotomy
CS - abdomen - 2 /3 thirds of thigh
OR instruments:
4 sterile drapes
Needle holder
Clamp
Sterile solution Sharp - added > rinse first
Kidney Basin > placenta

Hypotonic Hypertonic
- Decreasing intensity - Tetanic contraction
- Lose of muscle tone - Increased duration with short interval during latent
- Longer intervals during active - Pacemaker of the uterus: fundus - 2
 Oxytocin - improves contraction  Morphine - to relax uterus
- Every hour - cervix should dilate 1 cm - At risk: Primiparity
- Retain sodium > Assess uterine contraction > fetal
heart rate > maternal vital signs > urine output every
hour > watch out for signs and symptoms of water
intoxication
- No antidote: Administer on side bottle > Never given
in main line
 Rupture the membrane > amniotomy
 CS
- At risk: Multiparity

Passage > Where baby will pass

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 Passage > Where baby will pass
- Soft tissue - include cervix, vaginal canal, introitus
- Pelvis - made up of true pelvis and false pelvis
Bones:
1. Inominate - ileum (anterior), ischium (posterior), pubis (hip bone)
2. Sacrum - fused of the vertebrae, tip is coccyx
• False pelvis - directs to the true pelvis
• True pelvis - narrower
• Linea terminalis - line separates the upper and lower pelvis
• Pelvimetry - to determine the adequacy of pelvic diameter done during labor

1. Gynecoid - anterior to posterior diameter (wide);Transverse {pelvic inlet} (wide) > round
2. Anthropoid - shape of monkeys and apes, anterior posterior diameter (wide) Narrowed transverse > diamond
 NSD - but forcep assisted
3. Platypeloid - oval (flat), narrow anterior - posterior , wide transverse
 CS
4. Android - male pelvis, narrow anterior posterior and transverse, contracted pelvis

CPD - Cephalopelvis Disproportion - problem of passageway

Fetopelvic Disproportion - problem of passenger

Passenger
- Fetus - most important
- Placenta - location of the placenta determines how the baby will pass
- Bipareital, bitemporal, bi mastoid

Presentation
 Occiput - vertex presentation
 Brow - brow presentation
 Face - face presentation
○ Occipitomentum - 13.5 cm
○ Occipitofrontal - 12 cm
○ Occipitobregmatic - 9.5 cm (vertex)

Pelvic diameter
○ Pelvic inlet - Diagonal conjugate - 11.5 - 12 .5 cm
○ Conjugate Vera - mid pelvis - 1. 5 less than the diagonal conjugate
 Smaller diameter of the pelvis, the baby will definitely pass
○ Bi- ischial diameter - Pelvic outlet - 8 cm

Breech Presentation
1. Full breech - buttocks (buttocks same as head) and legs full flex compound> CS
2. Frank - leg is flex to the thigh, extended knees, buttocks > Mariceu' s maneuver , Piper's forceps (to flex the head)
3. Footling - cannot dilate cervix fully
4. Shoulder

Fetal lie - relationship between fetal long axis and maternal long axis
Podalic version > Uterine rupture
Position - relationship between the relation of the point of reference (denominator) to the quadrants of the pelvic inlet
Shoulder > acriomion > shoulder blade
Occiput < cephalic
Sacrum < Breech

LOA - rotates 45 degrees

Persistent Left Occipitoposterior (POP)
- Fetus must turn 135 degrees to be born
- If fetus turns 45 degrees only, transverse arrest will result
- Back labor (pain on back)
- Do not allow to sit > side lying
- Effleurage - light pressure in the abdomen
- Counter pressure - steady pressure applied by a support person to the sacral area w/ the fist or heel of the hand when baby is in
posterior position > release of pressure on sacral nerves
 Side lying during delivery

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 Station - degree of descent to the level of ischial spine
- Engagement is Station 0
- Crowning is Station 3

Cardinal movements
1. Descent > Perineal support > Reitgen's maneuver
a. Episiotomy
i. Local infiltration
ii. Pudendal nerve block - will not feel her baby crown
1) Give instructions
2. Flexion
3. Internal rotation
4. Extension
a. Cord coil or nuchal cord - asphyxiation, strangulated, (single or multiple) put 2 clamps > cut > immediately resuscitate
5. External rotation
a. Down - up - shoulder
b. Suction / Placed on breast / abdomen > for temperature regulation
6. Expulsion

• Kangaroo hold - keep baby warm

• Clean the eyes - eye contact (initial phase of bonding)
• Maintain > rooming in
• If with defect, tell immediately the better features then the defect
• Start breastfeeding, as soon as there is clear airway > cry
○ Initiate - rub the feet (mild stimulation), most well developed sensory organ is the skin
• Do not milk > destroy RBC > jaundice , wait for the pulsation to stop for 1 -5 minutes
• Initiate > circulation system is clamping of the cord; cry > cut
• Do not stimulate > if premature

Third Stage
Signs of separation
• Uterine fundus rises in abdomen > Globular - shaped (Culkin's)
• Sudden trickle or gush of blood
• Umbilical cord lengthens

Battledore Placenta
- cord is inserted marginally not centrally; it does not effect circulation
• Risk: Detach cord

Succenturiata
- One or more accessory lobes connected to the main placenta by blood vessel
- Lobes may be retained in the uterus after birth, leading to severe maternal hemorrhage
- The remaining lobes must be removed from the uterus manually to prevent maternal hemorrhage from poor uterine contraction

Puerperium
1. Assess uterus > contract > to close blood vessels
- Bleeding > Atony
2. If contracted, but bleeding continues > Laceration
○ Superficial - vaginal
○ Cervical - arterial source (dangerous) > repair
3. Monitor VS (15 minutes)
4. Check estimate blood loss
○ Normal > 500 ml; excess in 500 ml > hemorrhage
○ CS > 1000 ml > needs blood transfusion
5. Assess bladder > 3 -4 hrs can push uterus out of place

8 Point Assessment Criteria of Postpartum

1. Breast
- Colostrum only for 3 day
- Mastitis (localize inflammation of the breast): can breast milk within 30 minutes if treated with antibiotics, encourage hydr ation
- Abscess
2. Uterus - 10th day > not palpable in the abdomen

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2. Uterus - 10th day > not palpable in the abdomen
3. Bladder
4. Bowels > Constipation
Normal: return immediately of peristalsis Day 2 > force fluids
5. Lochia
Rubra
Serosa
Alba
6. Episiotomy
7. Homan's sign
- Thrombophlebitis
8. Emotions
- Postpartum Blues: peaks on the 5th day, for only 1 week
a. Taking in - passive (1 - 2days)
- Want to talk about labor experience
- Dependent on the nurse
b. Taking hold - independent
- Concern for bodily (bladder and bowel)
- Strong interest in infant care
c. Letting Go
- Acceptance of new role
- Acceptance of baby, give up fantasies

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