POSTPARTUM CARE

➡️ Postpartum period

Postpartum period/ post natal period is the period begins immediately after childbirth; during this time, the nurse assists the new mother in learning how to care for herself and her baby. This 6-week period of time, also known as the puerperium.

Begins as soon as the placenta and membranes are completely expelled.The first check up of a postnatal woman should be as soon as the delivery of the placenta and its membranes.

The subsequent visits should be

After 7 days

10-14 days

After 6 weeks

Check up within 24 hrs of delivery;

All postpartum women should have regular assessment of vaginal bleeding, uterine, contraction, fundal height, temperature and heart rate (pulse) routinely during the first 24 hours starting from the first hour after birth.

Blood pressure should be measured shortly after birth. If normal, the second blood pressure measurement should be taken within six hours.

Urine void should be documented within six hours.

Check up on cont visits;

At each subsequent postnatal contact, enquiries should continue to be made about

general well-being and assessments made regarding the following:

breast feeding and any breast complication

Lochia(the term used to describe the discharges from the uterus during the pueperium)

Micturition, urinary incontinence and bowel function

healing of any perineal wound and perineal hygiene,

headache, fatigue, back pain

uterine tenderness and subinvolution

Counseling on various matters including;

Balance diet, iron and folic acid supplements provided for at least 3 months

General hygiene and child’s hygiene

Cord care, STRICTLY not putting anything to the

cord for any reasons

Breastfeeding exclusively for six months

Family planning and child spacing

Safe sexual activities

Gentle exercise and resting

Use of ITN’s

🔻Danger signs of the mother includes;

1.Fever

2. Severe headache

3. Foul smell discharge

4. Heavy bleeding

5. Convulsion

🔻Danger sign of the baby includes

1. Fever

2. Jaundice

3. Not able to breast feed

4. Sunken and swelling of fontanel

5. Diarrhea and vomiting

6. Continously cry

7. Foul smell of the cord or colour change(mainly green or yellow)

8. Convulsion

At each postnatal contact, women should be asked about their emotional well-being, what family and social support they have and their usual coping strategies for dealing with day-to-day matters

To the new born;

Immediately newborn check up Include head to toe assessment importantly on

-HEAD

Normal head circumference is 33-35 cm below indicates microcephaly and above that indicates hydrocephaly.

Also we look one sutures and the fontanells

Followed by ears, nose, eyes and mouth(exclude tongue tie

NECK

Exclude any swelling or abnormality

-CHEST AND ABDOMEN

Examine for normal breathing patterns and exclude enlargement of organs or any abnormality

BACK

Exclude the spinal bifida and other abnormality

GENITALIA

Confirm the sex of the baby and the opening of the anus and the urethra

Exclude any abnormality, confirm the descent of testes for the baby boy.

LIMBS

Exclude six digits or any other malformation

REFLEXES

Confirm the presence of reflex such as rooting, sucking and stretching reflex.

Continously check up within 24 hrs

Cord, checking if it bleeds or well tied

Breathing

Ability to suck

Temperature of the newborn

Well covered with dry and warm clothes, if possible skin to skin contact btn mother and the child

Immunization per WHO guide

Check up on Continous visits;

Ability to breastfeed nicely

Any sign of umbilical cord infection

Ability to pass urine and stool

Body colour to exclude jaundice or yellow palms and soles at any age

fever >37.5° C

low body temperature <35.5° C

history of convulsions

breathing > 60 per minute

severe chest in-drawing

Breastfeeding progress should be assessed at each postnatal contact.

All women and their families/partners should be encouraged to tell their health care professional about any changes in mood, emotional state and behaviour that are outside of the woman’s normal pattern.

Note;

At 10–14 days after birth, all women should be asked about resolution of mild, transitory postpartum depression (“maternal blues”).

If symptoms have not resolved, the woman’s psychological well-being should continue to be assessed for postnatal depression, and if symptoms persist, evaluated women should be observed for any risks, signs and symptoms of domestic abuse.

Sequential changes of lochia:

Names are given according to the sequential changes:

(TYPES OF LOCHIA)

1).RED LOCHIA: (RUBRA LOCHIA) : (1st week)

The name given to the first 3-4 days of pueperium. Its red in colour and consist of blood from placental site ,debris arising from decidua and chorion.

Cont: lochia:

2 ). SEROUSA LOCHIA: (SEROSA LOCHIA):

2nd week

From 5th -9th day, it’s pink in colour.

Lochia has less blood but more serum and contain leucocytes from the placental site.

Cont: lochia:

3). WHITE LOCHIA: (LOCHIA ALBA): (3rd week):

Discharges are pale ,creamy ,brown in color .

Contains leukocytes ,cervical mucus and debrits from healing tissues.

Some evidence of blood may continue to be seen for 2-3 weeks.

Cont: lochia:

The quantity ,colour, or odour are significant:

Scanty lochia may suggest infection.

Offensive lochia may suggest poor vulva hygiene and contamination of debris.

But if condition persists ,despite of hygienic management it may indicate genital tract infection.

PHISIOLOGY OF LACTATION

Prolactin hormone

Fall of ostrogen allows prolactin secreted by anterior pituitary gland to act upon the alveoli of the breast to stimulate production of the milk.

In mother who feed ,the level of prolactin remains high and ovulation is prevented due to resumption of follicle stimulating in the ovary is suppressed.

Cont: prolactin:

For mothers who do not breast feed, the level of prolactin falls within 14 -21 days after delivery and this allows the follicle stimulating hormone to be secreted by the anterior pituitary gland to act upon the ovary, leading to establishment of normal pattern of oestrogen and progesterone production. Follicle growth, ovulation and menstruation.

Cont: prolactin:

In the breast prolactin acts upon alveoli and stimulates production of the milk as a result the fist 4 days the breast becomes heavy and engorged.

There tender and must be handled gently and supported welley.

Cont: prolactin

In mothers who do not breast feed engorgement is gradually reduced by the fall in prolactin which occurs when secretion is no longer stimulated by suckling.

Oxytocin:

Oxytocin is secreted by the posterior pituitary gland.(endocrine activity)

It acts upon the uterine muscles and the breast tissue.

During the 3rd stage the action of the oxytocin: aids in separation of the placenta.

maintains contraction of the uterine muscle.

Cont: Oxytocin:

reduces the placental site.

Prevents hemorrhage.

In mothers who choose to breast feed their babies ,sucking reflex stimulates further secretion of oxytocin,which aids contraction of the uterus (involution).

Thus expulsion of milk occurs continuously.

The involution of the uterus:

At the completion of labour the uterus weighs approximately 1kg.

By the end of pueperium it has returned to its non pregnant weight of 50g.

The marked reduction of size uterus takes place during the first 10 days.

Involution is not completely until the end of 6-8 weeks.