HEAL 6024 The Puerperium

The Puerperium “ A period of approximately 6 weeks after the birth of a baby during which time the physiological changes of pregnancy are reversed and lactation is established” (Henderson & Jones, 1997)

-physical restoration of the mother. -establishing a relationship Tasks for a mother / family to accomplish in the puerperium include: -physical restoration of the mother. -establishing a relationship with the infant. -learning to care for and meet the needs of a dependant infant. -adapting lifestyle and relationships to accommodate the new family member within the family unit.

A Woman- Centred Approach to Postnatal Care Women’s expectations -continuity of care -consistent advice -accurate information -skilled help -practical, educational and emotional support

A women’s centred approach (continued) -Identifying needs and planning care. Work in partnership with the mother -Culturally sensitive care: Each woman should be asked about her beliefs and childbirth practices so that culturally sensitive care is provided.

-Fathers involvement of the father in the care of the mother and baby

Restoring and maintaining physical health. -fundus (uterine involution) -Lochia Vital signs: Temperature, pulse & blood pressure -perineum -bladder -breasts -bowels -pain -extremities (calf ….? Dvt) -emotional state -attachment -cultural variations

1. Uterine involution -evaluate firmness, height and location. -should be firm and central and reducing in size approximately 1 cm per day until no longer palpable above the symphysis pubis (10-12 days post natal) rationale -a contracted uterus minimises bleeding -significant in screening for retained products of conception or infection. -teach mother

3. Lochia -normal to have vaginal discharge from the uterus after delivery (dissolved clot and exudate serum and lymph from the uterus). -Observe the character, colour, amount, odour and presence of clots. -red (rubra) 3-4th day -serous (serosa) 4-8th day -white (alba) 10th -14th day

Rationale -persistent red lochia, clots and offensive odour are maybe significant of retained products and / or infection. -lochia may increase: first thing in the morning, when breastfeeding and / or after a lot of exercise.

-temperature: indication of infection, dehydration -pulse Physical Assessment 1. Vital signs -temperature: indication of infection, dehydration -pulse -blood pressure: assesses cardiovascular response rationale……….

4. Perineum -observe for haematoma (bruising), edema (swelling) and tears or episiotomy. -note haemorrhoids and degree of discomfort. rationale liberal blood supply….quick healing of lacerations and tears. -promote good hygiene…. -may impede passing of urine

5. Elimination. Bladder function -labour and delivery can have an adverse effect on bladder function. -retention of urine may occur after delivery due to pain from lack of sensation, tears or an epidural -promote regular emptying of the bladder. -observe for fullness, output, burning and pain.

Bowels: assess the normal passing of bowel motions -constipation may be due to fluid loss, lack of tone, pain, reflex inhibition haemorrhoids.

6. Breasts -check for engorgement, nipple tenderness and breastfeeding 6. Breasts -check for engorgement, nipple tenderness and breastfeeding. -after pains may be felt during breastfeeding Rationale: to ensure the mother is relaxed -breast engorgement may lead to infection and any breast stimulation will promote lactation

7. Legs Check for -pain -heat -colour -swelling -Increased risk of thrombosis

General wellbeing Questions to ask include: Emotional wellbeing

Post-partum Haemorrhage -a loss of blood greater than 500 mls following delivery -primary (early) -secondary (late) Cause: usually retained products (placenta or membranes) in the uterus, atonic uterus. This is an obstetric emergency

Nursing interventions. -rub the fundus Why? -get help -stay with the woman Why? -reassure -lie her down Why? -lower extremities raised Why? -take B/p , pulse (assess blood loss) -keep her warm Why? -oxygen at 4 litres per minute (if available) -put the baby to the breast if appropriate Why? -follow up the cause of the PPH Why?

A woman needs knowledge about: -exercises following child birth -safe lifting techniques LIFT techniques (refer to Nursing practice course) -where to gain assistance and information when at home.

Bonding / Attachment -the development of attachment between a parent and a child. -influenced by culture, learned communication patterns and nurturing behaviours

-aided by spending time with and doing things for the baby, Bonding / Attachment -begins during pregnancy -aided by spending time with and doing things for the baby, uses the baby’s name, eye contact, shape of the baby’s face, features of the baby, cry…………. “Learning to love your baby takes time”

Conclusion A complex series of events occurs after birth. The woman returns to a non pregnant state and begins the psychological adaptation to motherhood. The quality of postnatal care provided around the time of birth influences the experience of early parenthood and the confidence with which parenting skills are learnt.