MJ - CH.
17
Chapter 17: Nursing Care of a Postpartal Family
● Postpartal period/ puerperium
- From the latin word, puer means child and
parere means to bring forth.
A. Psychological Changes of the Postpartal Period
1. Behavioral Adjustment: Phases of Puerperium
● Reva Rubin, a nurse who divided the puerperium
into 3 separate phases
a. Taking-In Phase
- A largely time of reflection
- (1 to 3 days period) woman is largely
passive
- Prefers having a nurse attend to her needs
and make decisions for her rather than do
these things herself
b. Taking-Hold Phase
- Woman begins to initiate action
- She begins to take stronger interest in her
infant.
c. Letting-Go Phase
- Woman redefines her new role
- She gives up fantasized image of her child
and accepts real one
- Require some grief work and readjustment
of relationships
2. Development of parental Attachment, Bonding
and Positive Family relations
a. Rooming-In: occurs when infant and woman are
together 23 out of 24 hours a day
b. Sibling Visitation: Can help relieve some
impact of separation and also help to make the
baby a part of family
3. Maternal Concerns and Feelings in the Postpartal
Period
a. Abandonment
b. Dissapointment
c. Postpartal Blues
B. Physiologic Changes of the Postpartal Period
1. Reproductive System Changes
Involution: process whereby the reproductive organs
return to their nonpregnant state
a. Uterus
- weighs about 1,000 g and at the end of 1st week,
weighs 500 g then after 6 weeks (involution
complete) weigh 50 g
- Fundus: normally located in midline of abdomen
and felt the same location at pregnancy, at the right
side
- Involve 2 process:
● Area where the placenta was implanted is
sealed off to prevent bleeding
● Organ is reduced to its approximate
pregestational size
b. Lochia
- flow consist of blood, fragments of decidua, WBC,
mucus and some bacteria
● Lochia rubra: red color; 1 to 3 days;
blood, fragments of decidua and mucus
● Lochia serosa: pink or brownish; 3 to 10
days; blood,mucus and invading
leukocytes
● Lochia alba: white; 10 to 14 days; largely
mucus, leukocytes count high
c. Cervix
- Uterine cervix feels soft and malleable to palpation
- Does not return to exactly to its prepregnancy state
because of new muscles formation
d. Vagina
- Feels soft, with few rugae and diameter is greater
than normal
e. Perineum
- Edematous and tender
2. Systemic Changes
a. Hormonal System
- decrease as soon as placenta is no longer present
● HCG and hPL: negligible at 24 hours
● Progestin, estrogen and estradiol: return at
prepregnancy at 1 week
● FSH: remain low about 12 days
b. Urinary System
- Increase daily urine output from normal level of
1,500 ml as much as 3,000 ml/day during 2nd and
5th day after birth
c. Circulatory System
- The usual blood loss with vaginal birth is 300 to
500 ml.
- With cesarean delivery, 500 to 1,00 ml. A 4- point
decrease in hematocrit and a 1-g decrease in
hemoglobin value occur with each 250 ml of blood
lost
d. Gastrointestinal System
- Woman feels hungry and thirsty
- Bowel sounds are active, but passage of stool
through the blood maybe slow because of effect of
relaxin
e. Integumentary System
- Striae gravidarum: stretch marks on woman’s
abdomen
- Chloasma: excessive pigment on face and neck
- Linea nigra: excessive pigment on abdomen
- Diastasis recti: overstretching and separation of
abdominal musculature
3. Retrogressive Changes of Puerperium
a. Exhaustion
b. Weight loss (19 lb)
c. Vital sign changes
- Temperature
- Pulse
- Blood Pressure
4. Progressive Changes of the Puerperium
a. Lactation
4 Phases of Lactogenesis
- Lactogenesis I
● Begins around 16 weeks gestation as the
glandular luminal cells in the breast begin
secreting colostrum
- Lactogenesis II
● Triggered at birth by delivery of placenta,
when progesterone hormone and other
circulating pregnancy hormone suddenly
decrease and oxytocin sharply increase as
aresult of infant suckling
● Often when mothers feel that their “milk
has come in” and occurs from birth to 5 to
10 days postpartum
● Often termed as “transitional milk”
- Lactogenesis III
● Occur from day 10 until weaning
postpartum, when the mature milk supply
MJ - CH. 17
is now driven by circulating lactation
hormones oxytocin and progesterone
- Lactogenesis IV
● Occur after complete weaning and the
breast involute to their prelactation state

5. Return of Menstrual Flow

a. (Not breastfeeding) return in 6 to 10 weeks after birth
b. (Breastfeeding) Not return for 3 or 4 month

C. Nursing Care of Woman and Family During the First 24

Hours After Birth
1. Assessment
a. Health history
b. Family profile
c. Pregnancy history
d. Labor and birth history
e. Infant data
f. Postpartal course
g. Laboratory data
h. Physical assessment:
- General appearance
- Hair
- Face
- Eyes
- Breasts
- Uterus
- Lochia
- Perineum