1. Nursing Care of the Family After Birth: Care of the Postpartal Mother
Read : Introduction to Maternity & Pediatric Nursing
Leifer: Chapter 1 pp. 1-2, 6-7
Chapter 9 pp ,
Chapter 10 pp
5/20/2019
Marilyn Henderson

2. Current Trends in Obstetrics
Improved family involvement
Alternate birthing methods
Birthing chairs, stools
LDRP’s
Home delivery
Lamaze, Leboyer, Read
Midwives
Length of stay
5/20/2019
Marilyn Henderson

3. Terminology Viable – capable of surviving if born
Para – number of pregnancies to viability
Gravida- how many times pregnant
GTPAL
Puerperium
Obstetrics “care of families during pregnancy, birth and the postpartum period”
5/20/2019
Marilyn Henderson

4. Postpartum Nursing Assessment
BUBBLE HEB
Breasts - Homan’s sign, pedal edema
Uterus - Emotional attachment
Bladder (Bonding)
Bowel
Lochia
Episiotomy
5/20/2019
Marilyn Henderson

5. Post Partum Physiological Adaptations
Uterus
position & tone
involution = 1 cm/day
described by relationship to umbilicus
feels like grapefruit
5/20/2019
Marilyn Henderson

6. Lochia mucus, blood, some bacteria, WBC & debris describe amount
describe colour
lochia rubra 1-3 days
lochia serosa 3-7 days
lochia alba weeks
5/20/2019
Marilyn Henderson

7. Cervix Open 10 cm Contracts to close Closed by 7 days postpartum
5/20/2019
Marilyn Henderson

8. Perineum Episiotomy Laceration 1st degree 2nd degree 3rd degree
4th degree
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Marilyn Henderson

9. Assessment of Perineum
R redness
E edema
E ecchymosis
D discharge
A approximation
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Marilyn Henderson

10. Afterpains caused by uterine contractions
breastfeeding & massage make worse
analgesic before nursing
5/20/2019
Marilyn Henderson

11. Cardiovascular Changes
pregnancy induced hypervolemia allows mL + loss
 blood viscosity from fluid loss, in fibrinogen & platelets = risk of DVT
orthostatic hypotension
5/20/2019
Marilyn Henderson

12. Urinary Changes diaphoresis trauma to bladder @ delivery
may have urinary incontinence, lack of sensation
retention = full bladder = relaxed uterus = hemorrhage
5/20/2019
Marilyn Henderson

13. Endocrine Pregnancy hormones decrease to non pregnant levels
If not breast feeding - prolactin levels  to non pregnant levels in 1st few weeks
If nursing prolactin levels  in response to infant’s sucking
5/20/2019
Marilyn Henderson

14. Breast Changes Colostrum
contains protein, fat, vitamins, minerals, antibodies
Breast Milk by 3rd day
5/20/2019
Marilyn Henderson

15. Engorgement Non Nursing ice, tight bra,
Lactation supression – parlodel (bromocriptine) 2.5 mg bid
Nursing
manually express or pump
warm shower
nurse frequently
alternate breasts
5/20/2019
Marilyn Henderson

16. Return of Menses If bottle feeding ~ 6 -12 weeks
if nursing months or for entire lactation period
*CAN GET PREGNANT
5/20/2019
Marilyn Henderson

17. Nutrition Follow Canada’s Food Guide
if breast feeding, need more calories/day
extra fluids (not necessarily milk)
diet affects milk
5/20/2019
Marilyn Henderson

18. Exercise Abdominal crunches ~ 10th day start slowly & gradually 
Abdominal tightening – contract abdominal muscles to a count of 10, relax
Head lift – lift head & chin to chest to a count of three, relax
Pelvic tilt – flatten back against firm surface while contracting abdomen, hold to a count of three
Kegel’s –as soon after birth as possible; tighten to a count of 10,relax
Abdominal crunches ~ 10th day
Exercises include slow inhalation and exhalation
Cesarean sections will have to wait longer to do abdominal exercises
Abdominal crunches – knees bent, fold arms across chest and sit up 10x in succession
5/20/2019
Marilyn Henderson

19. Specific Groups and Cultures
Important to respect values and practices of other cultures
Dietary practices vary ie “hot vs cold” foods; “yin vs vang” foods
Adolescents may need extra teaching and support
Families with twins, triplets etc
Poor families
Sick, premature and newborns with perinatal injuries or congenital disorders
See text p
5/20/2019
Marilyn Henderson

20. Nursing Care after Surgical Birth – Caesarean Section
Repeat not always necessary - depends on why ie fetal distress, bleeding complication, fetal position, cephalo-pelvic disproportion (CPD)
VBAC
Nursing Process
Impaired skin integrity
Acute pain – analgesia, palpation of uterus
Breastfeeding
5/20/2019
Marilyn Henderson

21. Psychological Stuff Rubin: Post Partum Phases Taking In Phase
Taking Hold Phase
Letting Go Phase
5/20/2019
Marilyn Henderson

22. Depression Blues Post Partum Depression Post Partum Psychosis
% - transient
Post Partum Depression
antidepressants, support groups
Post Partum Psychosis
Crisis
5/20/2019
Marilyn Henderson

23. Adolescent Parenthood
developmental tasks of pregnancy/adolescence
often single with no partner support
denial common
< grade 12 education
delayed or little prenatal care, prenatal classes
fear of disclosure to partner, parents
higher risk for pregnancy complications & preterm labour
most keep their babies
5/20/2019
Marilyn Henderson

24. Adolescent Parenthood
Needs:
information re growth & development
to return to school
early interaction with infant
support
to verbalize feelings
5/20/2019
Marilyn Henderson

25. Adoption Myth: birth mothers forget the child they “give up” CAS
Private
International
Booklet “Given in Love”
5/20/2019
Marilyn Henderson

26. Bereaved Parents Do Don’t be available ignore
provide privacy change subject
say you’re sorry look for +
stay in touch say “I know how you feel”
5/20/2019
Marilyn Henderson

27. Homelessness Mother & Newborn
Living “on the street”, with relatives, in single rooms, in hotels etc
Nursing
Assess needs
Facilitate referrals to counseling, shelters, support services
5/20/2019
Marilyn Henderson

28. Support Groups in Peterborough
Too many to list – see me for a complete list
Five Counties Children’s Centre/Family Mediation Services
Down Syndrome Support
La Leche League
Kinark Child & Family Services
Peterborough District Childbirth Association
5/20/2019
Marilyn Henderson

29. Complications During Puerperium
Hemorrhage – blood loss > 500 mL during a 24 hr period
Causes:
Uterine atony ***
Retained placental fragments
Lacerations
Hematoma
DIC
5/20/2019
Marilyn Henderson

30. Assessment steady bright trickle vs gushes ? firm or boggy uterus
 BP,  pulse
apprehension, restlessness
Nursing/Medical Interventions
massage uterus, oxytocic meds, report
D&C for retained placenta
repair of laceration
evacuation of hematoma
5/20/2019
Marilyn Henderson

31. Puerperal Infection p. 243 Risk Factors Assessment Prevention
Nursing Interventions
5/20/2019
Marilyn Henderson

32. Infection of the Perineum
Episiotomy or laceration is portal of entry
Pain, heat, pressure
Nursing:
Culture
Packing
Antibiotics – topical, systemic
Analgesics
Handwashing
Infant care
5/20/2019
Marilyn Henderson

33. Subinvolution of the Uterus
most common causes are infection and retained placental fragments
Nursing Assessment
Medical treatment
Nursing Interventions
5/20/2019
Marilyn Henderson

34. Mastitis Portal of entry Nursing Assessment
Medical/Nursing Interventions
Health Teaching
5/20/2019
Marilyn Henderson

35. Thromboembolic Disorders
Nursing Assessment
Superficial venous thrombosis (SVT)
Deep venous thrombosis (DVT)
Pulmonary embolus (PE)
Prevention
Nursing/Medical Interventions 9
Nursing Interventions and Prevention
5/20/2019
Marilyn Henderson