The postpartum physiological changes are those expected changes that occur during the immediate postpartum and is the beginning of the return of pre-pregnancy physiology and breastfeeding. This stage lasts at least two hours after birth. Most of the time these changes are normal and can be managed with medication and comfort measures. In a few situations complications may develop. Postpartum physiological changes may be different for women delivering by cesarean section. Other postpartum changes occur over the following six week period. Other postpartum changes, signs, and symptoms may indicate developing complications.
Video Postpartum physiological changes
Breasts and lactation
The physiological changes that occurred earlier in the pregnancy that prepared the breast for lactation become altered after the birth. About 2 to 3 days (72 to 96 hours) before the birth the breasts begin to produce the fore milk or colostrum. This sometimes described as "the milk coming in". In about three days to five days the normal and expected milk forms. Engorgement of the breast is a normal development at this time. The breast changes and can become red. Tenderness can develop. Engorgement is a result of the congestion in the breast lymphatic system, veins and the filling with milk. Information can be provided to the mother before the birth to enhance the understanding of breastfeeding and the support that will be available to make it successful. The mother is encouraged to breastfeed and spend time bonding with her infant immediately after the birth. Sucking causes the pituitary to release oxytocin that to contract the uterus and prevent bleeding. The breasts will begin to fill with milk and usually become engorged. Progesterone is the hormone that influences the growth of breast tissue before the birth. The postpartum changes that occur in the endocrine system after the birth shift from hormones that prevent lactation to hormones that trigger milk production. This can be felt by the mother in the breasts. The crying of the infant can induce the release of oxytocin from the pituitary gland. Cracked nipples can develop at this time and is managed with pharmacological and nonpharmacological treatment.
Maps Postpartum physiological changes
Thermoregulation
Uncontrolled shivering and feeling of cold can occur immediately after birth. This differs from the fever associated with a developing infection.
Uterus
The most drastic change in the uterus is the contraction from a organ weighing one kilogram and a volume of about 10-L down to a 60 gram organ that only contains 5ml of fluid. Immediately after delivery, the fundus of the uterus begins to contract. In a normal and healthy response it should feel firm and not boggy. It begins to involute with contractions of the smooth muscle of the uterus. It will contract midline with the umbilicus. It begins its contractions and by twelve hours after the birth it can be felt to be at the level of the umbilicus. The uterus changes in size from one kilogram to 60 -80 grams in the space of six weeks. After birth, the fundus contracts downward into the pelvis one centimeter each day. After two weeks the uterus will have contracted and return into the pelvis. The sensation and strength of postpartum uterine contractions can be stronger in women who have previously delivered a child or children.
Lochia
This is the discharge that appears after birth consisting of three stages. These are lochia rubra, lochia serosa and lochia alba.
Cervix, vagina and perineum
The cervix remains soft after birth. It may have small lacerations and be swollen. It may also be bruised. The vagina contracts and begins to return to the size before pregnancy. The perineum can be bruised and swollen. Pain can originate from an epistemology and tears. Hemorrhoids can develop after the birth.
Immune system
Immune function is assessed immediately after the birth. Clinicians test for immunity to rubella, Hepatitis B, Rh, varicella and the presence of antibodies against tetanus, diphtheria and pertussis.
Pain control and comfort measures
Education and discussion before the birth can alleviate some of the fear of the unknown and the anxiety when treatments are experienced for the first time. Providing continuous updates on the status of the infant is beneficial.
Perineal pain after childbirth has immediate and long-term negative effects for women and their babies. These effects can interfere with breastfeeding and the care of the infant. The pain from injection sites and possible episiotomy is managed by the frequent assessment of the report of pain from the mother. Pain can come from possible lacerations, incisions, uterine contractions and sore nipples. Appropriate medications are usually administered. Routine episiotomies have not been found to reduce the level of pain after the birth. Comfort is enhanced with changing linens, urination, the cleaning of the perineum and ice packs. Privacy also in implemented to promote comfort.
Hemorrhoid pain can be managed with a variety of methods. Some recommendations for reducing the pain of hemorrhoids include: cleansing with warm water, hemorrhoid creams, increasing fluids, lying on the site and sitz baths.
Medications controlling pain will begin to wear off. This also true when an epidural or spinal block was given. Uterine contractions are sometimes painful and comfort can be promoted by suggesting that different positions can be tried. Walking around, with assistance, can decrease pain. Since uterine cramping may become more painful during breastfeeding, medications can be given a half an hour before nursing. Pain control and comfort can be managed by anticipating the return of sensation and bodily reactions to bruises, tears, incisions and puncture sites.
Management
Immediately after the birth, on going assessments are performed with recommendations from the American Academy of Pediatrics and American College of Obstetricians and Gynecologists. They have identified that vital signs, blood pressure, pulse, uterine position and bleeding should be assessed every 15 minutes for the first two hours after birth. The temperature is measured every four hours during the first eight hours after the birth. An acronym for the physical assessment is:
B for Breasts
U for Uterus
B for bowel and GI function
B for bladder function and output
L for lochia
E for episiotomy
Nutrition
The caloric needs will changed based upon the production of milk for the infant. The caloric requiremet for a nonbreastfeeding, nonpregnant woman changes from 1,00-2,00 kcal/day to 2,300 to 2500 kcal/day for the breastfeeding woman. Nutritional supplementation is often prescribed and recommended. In some instances women are encouraged to continue to take pre-natal vitamins. Increasing the intake of fluids is dicussed. The need for additional levels of minerals are mostly likely due to lactation. Calcium and iron needs increase postpartum. Calories may need to increase by 333 kcal/day during the first four to six weeks postpartum and then by 400 kcal/day 6 months postpartum.
Other foods or substances are not recommended postpartum because they may have affects on the baby. Some clinicians discourage the use of caffeine. This could produce fussiness in the baby. Alcohol use is strongly discouraged. Consuming fish is healthy and provides vitamins, minerals and proteins. Some fish consumption may need to be limited like salmon, haddock, cod, herring, sardines, grouper, shrimp, pollock tilapia and tuna.
Weight loss may have to be modified to ensure recovery. Quick weight loss can reduce milk supply. Low carb and high protein diets may not be appropriate. A realistic weight loss goal is one pound per week.
A urinary catheter is usually put in place before the cesarean section to prevent urinary retention. The abdominal incision will be another site for pain and possible infection. Moving out of bed may be delayed. As with any surgical procedure, the risk is higher for the development of blood clots in the legs. In these cases intermittent a pneumatic pressure device may be used or more simple compression stockings. Leg exercise will also be effective in promoting blood circulation in the legs. Higher levels of pain medication may be needed related to abdominal incisions. If the cesarean was not planned, some women will be disappointed and may benefit from encouraging counsel from clinicians.
References
Bibliography
- Durham, Roberta (2014). Maternal-newborn nursing : the critical components of nursing care. Philadelphia: F.A. Davis Company. ISBN 978-0803637047.
- Henry, Norma (2016). RN maternal newborn nursing : review module. Stilwell, KS: Assessment Technologies Institute. ISBN 9781565335691.
- Davidson, Michele (2014). Fast facts for the antepartum and postpartum nurse : a nursing orientation and care guide in a nutshell. New York, NY: Springer Publishing Company, LLC. ISBN 978-0-8261-6887-0.
Source of the article : Wikipedia
0 Comments