Chapter 17

Nursing
Care of a
Postpartal
Family

1
 Objectives:
1. Describe the psychological and physiologic changes
that occur in a postpartal woman and her family.
2. Assess the physiologic and psychological changes of the
postpartal woman and her family.
3. Formulate nursing diagnoses related to physiologic and
psychological transitions of the postpartal period.
4. Develop expected outcomes for a postpartal woman
and family related to the changes during this period as
well as manage seamless transitions across differing
healthcare settings.

Copyright © 2018 Wolters Kluwer · All Rights Reserved

 Objectives:
5. Using the nursing process, plan nursing care.
6. Implement nursing care to aid the progression of
physiologic and psychological transitions
occurring in a postpartal woman and family.
7. Evaluate outcome criteria for achievement and
effectiveness of care.
8. Integrate knowledge of postpartal women and
families with the interplay of nursing process to
promote quality maternal and child health
nursing care.

Copyright © 2018 Wolters Kluwer · All Rights Reserved

 Postpartum or Puerperium
• Period of 6 wks after delivery during
which the reproductive system and
the body returns to normal
immediate--first 24 hrs
early--first week
late--2nd to 6th week
• 4th Trimester of Pregnancy

4
 Postpartum or Puerperium
It is a time of maternal changes that are
both retrogressive (involution of the
uterus and vagina) and progressive
(production of milk for lactation,
restoration of the normal menstrual cycle,
and beginning of a parenting role).

5
Psychological Changes

The new mother must move from dependent

to independent in a short time
Reva Rubins three stages of the
Postpartum (Puerperium):
Taking in
Taking hold
Letting go (taking over)

6
Taking in phase

Focused on self (not infant)

dependent on others for help in care
needs assistance
decision making difficult
comfort-rest-food needs paramount
relives delivery experience
Usually occurs 2 – 3 days PP
7
Taking Hold Phase
Moving from dependence to
independence
 energy level
 focus on infant
self care, focus on bowels, bladder,
breastfeeding
responds to instruction, praise
Lasts from 3rd day to 2 weeks PP
8
Letting Go Phase

Giving up previous role (role transition)

See self as separate from infant
Give up fantasy delivery and baby
Readjustment of relationships necessary
from 2wk →

9
Letting Go Phase

She gives up the fantasized image of her child and

accepts the real one;
she gives up her old role of being childless or the mother
of only one or two (or however many children she had
before this birth).
This process requires some grief work and readjustment
of relationships, similar to what occurred during
pregnancy.
10
Postpartum Psychological Adaptations,
Maternal Concerns

Maternal concerns and feelings

Typical issues identified by postpartal
women that they would like to hear
discussed are:
breast soreness; regaining their figure;
regulating the demands of a job, housework,
their partner, and their children; coping with
emotional tension and sibling jealousy; and
how to combat fatigue.

11/16/2022 POSTPARTUM PHASE 11

Postpartum Psychological Adaptations,
Maternal Concerns

Abandonment
Disappointment
Postpartal blues
Postpartum depression

11/16/2022 POSTPARTUM PHASE 12

 Psychological Changes of
the Postpartal Period
Maternal concerns and feelings
Abandonment
➢Examination of these competitive feelings can help a
couple realize that parenthood involves some
compromise in favor of the baby’s interests.
➢Making infant care a shared responsibility can help
alleviate these feelings and make both partners feel
equally involved in the baby’s care.
• You can help parents or partners move past this competitive
stage by pointing out positive parenting behaviors, positive
self-care behaviors, and the warm infant response to their
behaviors.
Abandonment
Mother feels less important and abandoned
the baby becomes everyone’s chief interest.

The father may express the same feeling

Bec. mother spends more time with their
infant.

14
Psychological Changes of
the Postpartal Period
Maternal concerns and feelings
Disappointment
All during pregnancy, they pictured a chubby-cheeked,
curly-haired, smiling girl or boy.
They may have instead a thinner baby, without any
hair, who seems to cry constantly, or may have a
congenital condition.
This can make it difficult to feel positive immediately
toward a child who does not meet their expectations.
Psychological Changes of
the Postpartal Period
Maternal concerns and feelings
Disappointment
You can never change the sex, size, or look of a child,
but in the short time you care for a postpartal family, it
is possible for a key person such as a nurse to tip a
scale toward acceptance or at least help a person
involved to take a clearer look at his or her situation
and begin to cope with the new circumstances.
• Handle the child warmly, to show you find the infant
satisfactory or even special.
• Comment on the child’s good points, such as long fingers,
lovely eyes, and healthy appetite.
 Psychological Changes of
the Postpartal Period
Maternal concerns and feelings
Postpartal blues
During the postpartal period, as many as
50% of women experience some feelings of
overwhelming sadness or “baby blues”
(Baselice & Lawson, 2012).
• They may burst into tears easily or feel let
down and irritable.
This phenomenon may be caused by
hormonal changes, particularly the
decrease in estrogen and progesterone that
occurred with delivery of the placenta.
 Postpartal blues
Described as overwhelming sadness that
occurs in most women during the first
week or two after birth.

May be manifested by mood swings, anger,

weepiness, anorexia, difficulty sleeping, and
a feeling of letdown.

Hormonal changes and psychological

adjustments are thought to be the main
causes.
11/16/2022 POSTPARTUM PHASE 18
Postpartum blues
Reduction of progesterone, delayed
prolactin release and changes in other
placental hormones may trigger emotional
instability.

Body image changes and dependency

needs may contribute.

19
 Postpartum blues

Overconcern re: infant and self, and

emotional lability are “normal” during the
first 5-10 days after delivery

Usually resolve naturally in 2 to 3 weeks

with support and reassurance. If symptoms
persist, the client should be evaluated for
postpartum depression.

11/16/2022 POSTPARTUM PHASE 20

Psychological Changes of
the Postpartal Period
Maternal concerns and feelings
Postpartal blues
Severe psychosis also can occur in women during this
time (Heron, Gilbert, Dolman, et al., 2012).
If a mother appears to have a level of depression that
is beyond baby blues and/or has a history of previous
postpartal depression (PPD), closer observation and
referral is indicated immediately.
Psychological Changes of
the Postpartal Period
Maternal concerns and feelings
Postpartal blues
Breastfeeding has been shown to help elevate baby
blues and counteract the effects of the hormonal drop
that occurs after childbirth.
For some women, it may be a response to
dependence and low self-esteem caused by
exhaustion, being away from home, physical
discomfort, and the tension engendered by assuming a
new role, especially if a woman is not receiving
support from her partner.
Psychological Changes of
the Postpartal Period
Maternal concerns and feelings
Postpartal blues
In addition to crying, the syndrome is evidenced by
feelings of inadequacy, mood lability, anorexia, and
sleep disturbance.
Anticipatory guidance and individualized support from
healthcare personnel are important to help the parents
understand that this unexpected response is normal.
Be certain support persons also receive assurance of
this type, or they can think the woman is unhappy with
them or the new baby or is keeping some terrible news
about the baby secret.
Psychological Changes of
the Postpartal Period
Maternal concerns and feelings
Postpartal blues
Give the woman a chance to verbalize her feelings and
make as many decisions as she wants to help her gain
a sense of control and move past this strange
postpartal emotion.
Women are at greater risk (19% to 48%) for moderate
to severe depression after childbirth requiring formal
counseling, especially if they are economically
stressed or have a comorbid condition such as
diabetes (Farr, Dietz, Williams, et al., 2011).
Postpartum Depression

Rejection of infant, or fears that she may harm infant call

for immediate intervention.
Remind mom during postpartum teaching that these
feelings sometimes occur and help is available

25
 MANIFESTATIONS OF POSTPARTUM
DEPRESSION
◼  interest in surroundings
◼  interest in food
◼ unable to feel pleasure
◼ fatigue
◼ sleep disturbance
◼ panic attacks
◼ obsessive thinking
◼  hygiene
◼  ability to concentrate
◼ odd food cravings
◼ irritability
◼ rejection of infant
Postpartum Depression
PPD: Teaching
◼ relaxation therapy
◼ rest & nutrition
◼ frequent contact with other adults

Resource:
The Post Partum Resource Center of New
York, Inc.
631-422-2255 www.postpartumNY.org

27
Disappointment
May be experienced by the parents when
their baby does not meet their expectations.

Handle the child warmly

Comment on the child’s good points

28
 PHYSIOLOGIC CHANGES PPP
❖Retrogressive Changes
▪ Include those physiologic changes related
specifically to the reproductive system as well as
other systemic changes
❖THE UTERUS
▪ Involution of the uterus involves two
processes:
1) The area where the placenta was implanted is
sealed off to prevent bleeding.
2) The organ is reduced to its approximate
pregestational size.
29
 PHYSIOLOGIC CHANGES PPP
❖THE UTERUS
▪ Involution of the uterus involves two
processes:
1) The area where the placenta was implanted is
sealed off to prevent bleeding.
➢ is accomplished by rapid contraction of the uterus
immediately after delivery of the placenta.
➢ With time, thrombi form within the uterine sinuses
and permanently seal the area.

30
 PHYSIOLOGIC CHANGES PPP
❖THE UTERUS
▪ Involution of the uterus involves two
processes:
2) The organ is reduced to its approximate
pregestational size.

31
 PHYSIOLOGIC CHANGES PPP

❖UTERUS
Estrogen & progesterone

Atrophy of myometrial cells

Decrease in uterine size & weight

32
 PHYSIOLOGIC CHANGES PPP
❖THE UTERUS
▪ INVOLUTION
▪ Reproductive organs return to their non-pregnant
state.
▪ Woman is in danger of hemorrhage until involution
is complete (6 weeks).
▪ Healing of placental site.

33
PHYSIOLOGIC CHANGES PPP
❖UTERUS
▪ Factor that promote uterine involution:
1) Breastfeeding
➢ Release of oxytocin stimulates uterine contractions.
2) Factors that delay uterine involution:
a) Over distention of uterus from hydramnios and
multiple fetuses.
b) Use of analgesia during labor
c) Exhaustion due to prolonged & difficult labor.
d) Multiparity

34
PHYSIOLOGIC CHANGES PP
❖UTERUS
▪ Progressive reduction in uterine weight:
▪ Right after delivery: 1,000 g
▪ 1 week after delivery: 500 g
▪ 2 weeks after delivery: 300 g
▪ 6 weeks after delivery: 50 g

35
PHYSIOLOGIC CHANGES PPP
❖Retrogressive Changes
❖UTERUS
▪ uterine contraction begins immediately
after placental delivery.
▪ Within a few minutes after birth
▪ the fundus of the uterus is palpable through
the abdominal wall, halfway between the
umbilicus and the symphysis pubis,.
▪ One hour later
▪ it will rise to the level of the umbilicus, where it
remains for approximately the next 24 hours.
36
PHYSIOLOGIC CHANGES PPP
❖Retrogressive Changes
❖UTERUS
▪ From then on, it decreases by one
fingerbreadth, or 1 cm, per day;
▪ for example, on the first postpartal day, it will
be palpable 1 cm below the umbilicus.
▪ By the 9th or 10th day
▪ can no longer be detected by abdominal
palpation

37
38
PHYSIOLOGIC CHANGES PPP
❖Retrogressive Changes
❖UTERUS
▪ Fundus
➢Palpate the uterus and assess for:
1) Firmness
2) Position
3) Height
✓Empty the bladder first.

39
Palpating the Uterus
Nursing care r/t uterine changes

Palpate fundus at frequent intervals

q. 15” X 1hr
q. 1hr X 2
q. 2hr X 2
q. 4 hrs up to 24-48 hrs. post delivery
Massage if not firm
Deviation to the sides and above umb. may signal full
bladder
41
Nursing care r/t uterine changes
Occasionally, the fundus can be felt slightly
to the right
➢because the bulk of the sigmoid colon forced it
to that side during pregnancy and it tends to
remain in that position.
Assess fundal height shortly after a woman
has emptied her bladder for most accurate
results
➢because a full bladder can keep the uterus from
contracting, pushing it upward and increasing
the risk of excess bleeding. 42
PHYSIOLOGIC CHANGES PPP
❖UTERUS
▪ Afterpains
▪ Strong uterine contractions that cause uncomfortable
cramps.
▪ Uterine contractions prevent bleeding.
▪ Present 2 – 3 days after childbirth.
▪ Nursing measures to relieve afterpains:
1) Explain the cause & purpose of afterpains
2) Keep bladder empty
3) Instruct woman to assume PRONE POSITION.
4) NEVER APPLY HEAT on abdomen
✓ Relaxes uterus leading to hemorrhage
5) Administer analgesics as ordered (NO ASPIRIN). 43
 Cramping or “Afterpains”
Primiparas
➢uterus tonically contracted unless clots or tissue
remain in uterus.
Multipara
➢uterus contracts and relaxes at intervals causing
“afterpains”.
➢Afterpains tend to be noticed most by
multiparas than by primiparas and by women
who have given birth to large babies or multiple
births.
More severe when breasfeeding in both
primiparas and multiparas. 44
PHYSIOLOGIC CHANGES PPP
LOCHIA
▪ Uterine discharge after delivery consisting of
blood, fragments of decidua, white blood cells,
mucus, and some bacteria
▪ LOCHIA RUBRA
▪ From delivery up to 3rd day.
▪ Bright red and may contain small clots.
▪ Consists of blood, fragments of decidua, and mucus
▪ LOCHIA SEROSA
▪ 4th to 10th day
▪ Pinkish to brownish in color
▪ Consists of blood, mucus, and invading leukocytes
45
PHYSIOLOGIC CHANGES PPP
LOCHIA

▪ 10–14 day (may last 6 weeks pp)

▪ White or Cream to yellowish in color
▪ Largely mucus; leukocyte count high

46
Scant amount Light amount Moderate Heavy amnt
• Blood only • < 4 inch (10 amnt • Saturated
on tissue cm) stain on • < 6 inch peripad
when wiped peripad (15.2 cm) within 1 hr.
• < 1 inch stain on
stain on peripad
peripad 47
Physiologic Changes
❖CERVIX

▪ Soft, edematous and relaxed

▪ By end of 7 days, external os has narrowed

to size of a pencil opening, appears slit-like,
feels firm and non-gravid.

48
Physiologic Changes
❖VAGINA
▪ Right after childbirth, vagina is smooth &
swollen
▪ Lacerations and episiotomy are usually healed
after 2 weeks.
▪ After 3 – 4 weeks, rugae reappear, but not as
numerous as before pregnancy.
▪ Returns to prepregnant condition after 6 – 8
weeks.
▪ Kegel exercise help improve circulation to
reduce edema and hasten return of vaginal
muscle tone. 49
Physiologic Changes
❖PERINEUM
▪ Swollen, ecchymosis from ruptured
capillaries, painful immediately after
delivery.
▪ Perineal muscle tone is regained by 6
weeks.
▪ Instruct woman on the following:
1) Perineal care
2) Perineal hygiene
50
Evaluate Episiotomy or
Perineal lac. for REEDA

Redness
Edema
Ecchymosis
Drainage
Approximation

51
Physiologic Changes
❖PERINEUM
▪ Perineal Care:
1) Ice packs
✓Applied on the perineum for the 1st 24 hrs. for
20 min.
2) Sitz Bath
✓Done after 24 hrs. following delivery to
promote circulation by vasodilation.
✓Done 3 – 4x/day for 20 min.

52
Physiologic Changes

❖PERINEUM
▪ Perineal Care:
3) Perilite exposure
✓Place woman in dorsal recumbent position, drape
thighs, and place lamp between legs.
✓Use 25 – 40 watt bulb
✓Lamp should be 12 – 18 inches away from the
perineum.
✓Use perineal heat lamp for 20 min., 3x/day.

53
Physiologic Changes
❖Progressive Changes
❖The Hormonal System
➢Pregnancy hormones decrease with
delivery of placenta.
➢Levels of human chorionic gonadotropin
(hCG) and human placental lactogen
(hPL) are almost negligible by 24 hours.
➢By week 1, progestin, and estrogen
(estradiol) are all at prepregnancy levels
(estriol may take an additional week
before it reaches prepregnancy levels).
54
 Physiologic Changes
❖Progressive Changes
❖The Hormonal System
➢4 major naturally occurring estrogens:
1) Estrone (E1)
2) Estradiol (E2)
➢ Predominant and most potent estrogen
during reproductive years.
3) Estriol (E3)
➢ During pregnancy is synthesized by the
placenta in very high quantities.
4) Estetrol (E4)
55
Physiologic Changes
❖Progressive Changes
❖The Hormonal System
➢Follicle-stimulating hormone (FSH)
remains low for about 12 days and then
begins to rise as a new menstrual cycle
is initiated.
➢Menses resumes by 6 - 10 wks. if not
Br. Fdg.

56
Physiologic Changes
❖Progressive Changes
❖MENSTRUATION & OVULATION
▪ Woman who is NOT BREASTFEEDING:
▪ Menstrual flow return 6 – 10 weeks after birth, and
ovulate by 8 – 10 weeks after delivery.
▪ A woman who BREASTFEEDS CONSISTENTLY,
and uses no supplemental feeding
▪ Menstruation and ovulation may return in 6 months
(Lactational amenorrhea)

57
Breast Changes
❖LACTATION
Estrogen and Progesterone

Stimulates prolactin production

Milk production

Breast engorgement
58
Suppression of Lactation

Avoid breast stimulation

Ice
Tight bra
Do not pump or express milk
Hormonal suppression (rarely)

59
LACTATION & BREAST FEEDING

◼ Lactation starts regardless if pt. is

breastfeeding or not.
◼ Entirely up to mother
◼ Must feel comfortable doing so.

Advantages of Breast Feeding:

◼ Promotes bonding between mother & baby.
◼ High nutritional value for infant.
◼ Promotes uterine involution thru release of
oxytocin from posterior pituitary.
◼ Reduces cost of feeding & preparation time.
Contraindications to Breast Feeding:

◼ Mother receiving meds not appropriate for

Breast fdg. [Lithium]

◼ Exposure to radioactive compounds

[thyroid testing];
➢ pump & dump breast milk x 48 hrs.
➢ Flush in toilet.

◼ Breast Cancer; HIV

 Physiology of Lactation

◼ Early pregnancy, ↑ estrogen (placenta)

stimulates growth of milk glands & size
of breasts.
◼ Colostrum: middle of pregnancy & day
1-3 PP,
◼ Thin, watery pre-lactation secretion.
Rich in antibodies; passes to baby in 1-3
days.
◼ Breasts begin to get tender; fill up w.
milk.
 Physiology of Lactation

Breast milk by 3rd to 4th day in response to:

◼ falling levels of estrogen & progesterone >
delivery of placenta.
◼ ^ production of prolactin by anterior
pituitary
◼ Milk ducts become distended & fluid turns
bluish-white
 Physiology cont.

◼ Infant suckling on breast produces

more prolactin, which in turn stimulates
more milk production.
◼ Finally, oxytocin released > delivery of
placenta causing mammary glands to
send milk to nipples [let down reflex].
◼ Progesterone, estrogen levels drop after
delivery which leads to ↑ milk
production.
The Urinary System:

◼ Loss of bladder tone d/t swelling &

anesthesia ; urinating difficult. May
not feel urge to void.
◼ Hydronephrosis [enlargement of
ureters] occurs after delivery & to 4
wks. PP. DIURESIS!
◼ ↓ bladder sensitivity - ↑ risk for
bladder infection - urinary stasis.
◼ Avoid bladder damage - assess
bladder q 1-2 hrs. til pt. voids.
The Urinary System:

◼ During preg., 2,000-3,000 ml. of

fluid accumulates in body - Client
loses 5- 10 lbs. of weight in 1st wk.
PP.
➢ extensive diaphoresis (excessive
sweating) and diuresis (excess urine
production) begin almost
immediately after birth to rid the
body of this fluid.
The Urinary System:

◼ This easily increases the daily urine

output of a postpartal woman from
a normal level of 1,500 ml to as
much as 3,000 ml/day during the
second to fifth day after birth.
◼ This marked increase in urine
production causes the bladder to fill
rapidly.
The Urinary System:

◼ Decreased woman’s ability to sense

when she has to void
➢ Because during a vaginal birth, the
fetal head exerts a great deal of
pressure on the bladder and urethra as
it passes on the bladder’s underside,
this may leave the bladder with a
transient loss of tone that, together
with the edema surrounding the
urethra.
The Urinary System:

◼ A woman who has had epidural

anesthesia can feel no sensation in
the bladder area until the anesthetic
has worn off.
 ❖ Circulatory System:
❖ Blood volume ↑30 – 50% in pregnancy.
❖ With diuresis & blood loss @ delivery,
blood volume returns to normal in 1-2
wks.
◼ Blood loss for NSVD = 300 – 500 cc.
◼ C/S = 500 – 1,000 cc.
◼ Non pregnant:
➢ HCT=37 - 47%
➢ HGB=12 - 16g/dL
◼ Pregnant:
➢ HCT=32 - 42 %
➢ HGB = 11.5 – 14g/dL
◼ HCT drops by 4 % & HGB drops by 1 g.
for every 250cc. of blood client loses.
◼ Patient should not be anemic entering
delivery
◼ Possible blood transfusion with large blood
loss.
◼ Average blood volume:
➢ pre-pregnant = 4000cc;
➢ pregnant state = 5250cc.
◼ ↑Blood volume during pregnancy:
➢ provides adequate exchange of
nutrients in placenta & compensates
for blood loss during delivery.
◼ HR remains ↑ x 24-48 hrs. PP
◼ With diuresis, HCT levels rise
➢ [↑hemoconcentration] reach pre-preg

level by 6 wks.
❖ Plasma fibrinogen
➢ ↑50% during pregnancy & remains
elevated 6 wks. PP. [↑estrogen levels]
➢ Can cause ↑thrombus formation.
➢ Assess pts. legs/calves for s/s
thrombophlebitis (Homan’s sign)
❖ Rise in leukocytes
➢ WBC ↑ protective measure to prepare
for stress of delivery. As high as 20-
25,000.
Gastrointestinal System:

◼ NSVD: bowels sounds.

◼Eat right away.

◼ C/S: bowel sounds hypoactive 1st 8 hrs.

➢ Epidural/spinal: po clear liquid after

delivery, advance diet if +BS.

◼ General anesthesia: usually NPO for 6-8

hrs.
Gastrointestinal System:

◼ BM - difficult/painful d/t lacerations/

hemorrhoids.

◼ C/S - BM 3rd - 4th day.

➢ GI activity slowed d/t surgery.

◼ Can go home without BM if + flatus.

▪ Integumentary System:
➢ Stretch marks

➢ [striae gravidarum] appear reddened

on abdomen.
✓ Fade by 3-6 months;

✓ Pearly white marks may remain in

lighter skinned pts. & darker marks
in darker skinned pts.
➢ Modified sit-ups strengthen abdomen
VITAL SIGNS PP
▪ Temperature: slightly ↑

✓ dehydration during labor 1st 24 hrs.

✓ Returns to normal within 24 hrs.
◼ T = 100.4 (38°C) or > PP infection
suspected.
◼ Temp. also rises 3rd - 4th day with filling
of breast milk (breast engorgement)
◼ Observe for s/s infection - nurse usually
1st to detect ↑ temp. [universal sign of
infection 100.4 x 2 readings, on days 2-10
PP]
VITAL SIGNS PP

Pulse: HR ↑ slightly x 1st hr.

◼ Stroke volume (vol. of blood pumped from
the left ventricle per beat) & cardiac output
also ↑ x 1st hr. then decreases
◼ 8-10 wks., returns to pre-pregnant
state.
◼ Rapid, thready pulse:
➢ sign of PP hemorrhage, infection
Blood Pressure - Monitor carefully.

1st trimester
Heart works faster to handle volume. BP remains
same.
2nd trimester
BP drops slightly d/t lowered peripheral resistance in
blood vessels as placenta expands rapidly.
Heart beats faster more efficiently d/t blood
volume.
Pre-pregnant BP 120/80. Pregnant BP 114/65.

3rd trimester
BP back to pre-pregnant value.
 BP Complications
↓ BP
[90/60 or less] with dizziness is “Orthostatic
hypotension”; could signify hemorrhage.
◼ Take BP/pulse lying/sitting/standing. Compare
values.
◼ Orthostatic: If BP drops 15-20 mmHg and pulse
increases 20 bpm or more. Caution for falls.

↑ BP
[140/90 or >] could signify PP pre-eclampsia.
◼ Notify physician. Could develop into serious
complication.
◼ Oxytocic meds [Pitocin] rapid delivery could ↑BP
 Other Changes

Exhaustion:

❖ Common
❖ Frequent rest periods
❖ RN coordinates nursing care & infant feeding
times
❖ provide maximum rest time.
 Other Changes

Average Weight Loss:

❖ 12 lb. [infant & placenta]
❖ 5 lbs. - diuresis & diaphoresis in wk. that follows.
❖ Lochial flow - 2-3 lbs.
❖ Total = approx. 19-20 lbs. {depends on total wt.
gain}
❖ At 6 wks. wt. may still be above pre-preg. weight.

Return of Menses: > after delivery FSH levels rise

causing ovulation
◼ No Breast Fdg.- menses resumes ~ 6 wks.
◼ Lactation delays menses for several months (6 mos)
NURSING MANAGEMENT OF POST
PARTUM CLIENT

Assessment – minimum of twice daily

◼ Vital signs
◼ Emotional Status
◼ Breasts
◼ Fundus, lochia, & perineum
◼ Voiding & bowel function - flatus, BM
◼ Legs [+ Homan’s sign, ankle edema ]
◼ S/S complications [PP hemorrhage,
infection, ↑ BP ]
NURSING MANAGEMENT OF POST
PARTUM CLIENT

Nursing Care
Safety
◼ Prevent hemorrhage- massage uterus on
admission and q 4 for first 8 hrs.
◼ Prevent falls – assess when getting out of
bed for 1st 8 hrs. Assist when necessary.
Check labs for low Hct & Hgb.
Bowel function (1-3 days to resume).
◼ Stool softeners, as ordered
◼ Encourage ambulation
◼ Increase dietary fiber
◼ Provide adequate fluid intake
Health teaching & discharge planning
◼ Reinforce self care -hand washing, perineal
care, Self-breast exam q month; S/S PP Depression
Comfort Measures
Ice , Sitz Baths, Topical Anesthetics
Analgesia, Kegels for NSVD; modified sit-ups for
NSVD (10th – 12th day PP), Breast Care