Post Partum Period

Definition :

      Post partum period starts immediately after delivery and extends upto 6 weeks following delivery.

Physiological changes occuring during postpartum period:

1. Uterus: Involution or shrinking of the uterus occurs
2. Lochia: Discharge  from the uterus
3. Cervix : Closes slowly over 1 week , after delivery
4. Vagina: May be swollen and bruised. Distension decreases gradually.
5. Ovulation and menstruation: Ovulation occurs as soon as the pituitary function is restored. Menstruation resumes within 2-3 months in non-breast feeding mothers and 4-6months in breast feeding mothers
6. Abdomen: The abdomen may appear flabby for a time, but with exercise tone should return in 2-3monts. Stretch marks should lighten to silver or white appearance
7. Breast: Secrete colostrum for the first 48-72 hrs after delivery. Increased prolactin levels due to a decrease in oestrogen and progesterone levels after delivery promote production of breast milk
8. Vital signs: Temperature may be elevated during the first 24 hrs after delivery - Bradycardia is common in the first week.Blood pressure and respiratory rate rarely changes
9. Urinary tract: May experience slight incontinence of urine due to decreased tone of voiding muscle. Kegel exercises will help strengthen these muscles and decrease leaking

Nurse's Interventions:

1. Assess pain level and monitor vital signs
2. Look for the fundus of the uterus, height, consistency and location
3. Assess the amount, color and odor of lochia
4. Monitor the episiotomy area for healing
5. Monitor perineal are for any change
6. Assess the incision in case of caesarian section for any infection, or inflammation
7. Assess breasts for engorgement or any retraction of nipples
8. Encourage frequent urination and monitor intake and output 
9. Encourage ambulation of the patient
10. Monitor for bowel movements
11. Administer Rh0(D) (Rh0GAM) immune globulin as prescribed. This should be given to an Rh negative patient who has delivered an Rh positive baby. Given with 72 hrs after delivery
12. Assess maternal bonding with the newborn baby 

Maternal  Education :

• Instruct the mother to avoid heavy lifting for atleast 3 - 4weeks 
• Demonstrate newborn care skills and feeding technique
• Instruct the mother regarding contraceptive devices
• Instruct the mother to follow rest periods between activity
• Instruct the mother regarding the need for regular followups as scheduled
• Inform the mother regarding the caloric needs and the importance of continuing the vitamins and minerals intake

Breastfeeding:

 

Advice to the mother:

1.  Assume a comfortable position
2. Brush the baby's lower lip with the nipple
3. Guide the nipple and areola into the baby's  mouth
4. Allow the baby to suck for 15- 20 mins 
5. Release the baby from the nipple and burp the baby
6. Repeat the baby with the second breast
7. Burp the baby again
8. Problems related to breast feeding -    a) Engorged breasts : Breast feed frequently.Apply warm pack before feeding. b) Cracked nipples : Expose nipple to air for 10-20minutes after feeding. Be sure that the baby is latched on the areola not just the nipple.

       The World Health Organization (WHO) recommends breastfeeding until 2 years old or longer, because the benefits continue that long. These agencies recommend starting as early as one hour after birth for the biggest benefits.

Breastfeeding benefits for baby:

1. Breast milk provides ideal nutrition for babies

   Most healthcare professionals recommend exclusive breastfeeding for at least 6 months or much longer.

  Breast milk contains everything baby needs for the first 6 months of life, in all the right proportions. Its composition even changes according to the baby’s changing needs, especially during the first month of life.

  During the first days after birth, your breasts produce a thick and yellowish fluid called colostrum. It’s high in protein, low in sugar, and loaded with beneficial compounds. It’s truly a wonder food and not replaceable by formula. Colostrum is the ideal first milk and helps the newborn’s immature digestive tract develop. After the first few days, the breasts start producing larger amounts of milk as the baby’s stomach grows.

   About the only thing that may be lacking from your magical milk supply is vitamin D. Unless you have a very high intake (and most of us don’t), your breast milk won’t provide enough. Vitamin D drops are usually recommended.

2. Breast milk contains important antibodies:

    

     Breast milk is loaded with antibodies that help your baby fight off viruses and bacteria, which is critical in those tender, early months.

   This particularly applies to colostrum, the first milk. Colostrum provides high amounts of immunoglobulin A (IgA), as well as several other antibodies.

   When you’re exposed to viruses or bacteria, you start producing antibodies that then go into the milk. It’s immunity, baby!

  IgA protects the baby from getting sick by forming a protective layer in the baby’s nose, throat, and digestive system.

3. Breastfeeding may reduce disease risk:

     

     Exclusive breastfeeding, meaning that the infant receives only breast milk, is particularly beneficial. It may reduce your baby’s risk for many illnesses and diseases, including: Middle ear infections: Breastfeeding, particularly exclusively and as long as possible, may protect against middle ear, throat, and sinus infections well beyond infancy. Respiratory tract infections: Breastfeeding can protect against multiple respiratory and gastrointestinal acute illnesses.  Colds and infections: Babies exclusively breastfed for 6 months may have a lower risk of getting serious colds and ear or throat infections. Gut infections: Breastfeeding is linked with a reduction in gut infections. Intestinal tissue damage: Feeding preterm babies breast milk is linked with a reduction in the incidence of necrotizing enterocolitis. Sudden infant death syndrome (SIDS): Breastfeeding is linked to a reduced risk of SIDS, especially when breastfeeding exclusively. Allergic diseases: Breastfeeding is linked to a reduced risk of asthma, atopic dermatitis, and eczema. Bowel diseases: Babies who are breastfed may be less likely to develop Crohn’s disease and ulcerative colitis.

   Diabetes: Breastfeeding is linked to a reduced risk of developing type 1 diabetes and non-insulin-dependent (type 2) diabetes.

  Childhood leukemia: Breastfeeding is linked to a reduction in the risk for childhood leukemia.

           Studies suggest breastfeeding has a positive long-term effect on brain and behavioral development. However, there hasn't been a study to confirm that a breastfed baby is smarter than a formula-fed baby. Feeding your baby with formula is also healthy and supports your baby's growth and development.