NCM107ARCE_H Module 2: OB Ward – CLMMRH jo

OB Ward Concepts

Postpartum care: What to expect after a The Uterus

vaginal birth?
Involution is the process whereby the
Assessment reproductive organs return to their nonpregnant
state.
• It is accomplished by health interview;
awareness of her prenatal, natal, and Possible problems:
medical history; physical examination;
and analysis of laboratory data. • Uterine Atony
• Afterpains
• Psychological changes
The fundus of the uterus is palpable through the
• Physical changes abdominal wall, halfway between the umbilicus
and the symphysis pubis, within a few minutes
Psychological Changes after birth. One hour later, it will rise to the level
of the umbilicus, where it remains for
Postpartum Blues/Postpartum depression approximately the next 24 hours. From then on,
(PPD) it decreases by one fingerbreadth, or 1 cm, per
• It is a mood disorder in women shortly day; for example, on the first postpartal day, it
after childbirth. will be palpable 1 cm below the umbilicus.

Lochia
• feelings of extreme sadness, anxiety,
and exhaustion that can affect the • This discharge normally has a musty,
woman's ability to care for herself or for stale odor that is not offensive
others. • Any foul odor = suggestive of infection
• Lochia is heavier in the morning than at
Birth-related post-traumatic stress disorder night
(PTSD) • The amount of lochia may also be
increased by exertion or breastfeeding
• This is a serious potentially debilitating
condition that can occur in mothers who
have experienced severe difficulty in Visual vs. Measuring
childbirth such as feeling of too much
pain, and life-threatening experience • A visual account of blood loss can vary
during delivery and or death of baby. person to person
• Weighing the pads is more accurate
• Symptoms: Re-experiencing • You must know the dry weight of the
(flashbacks, nightmares, repetitive and pad
distressing images or sensations, • Peripads can be weighed if needed: 1
physical sensations, such as pain, gram = 1 ml of blood
sweating, feeling sick or trembling

Post-partum psychosis

• the most severe form of postpartum

psychiatric illness but rare

• The onset is usually sudden, most often

within the first 2 weeks postpartum.

• Symptoms may include: delusions or

strange beliefs,hallucinations (seeing or
hearing things that aren’t there), feeling
very irritated, hyperactivity, decreased
need for or inability to sleep, paranoia
and suspiciousness, rapid mood swings
and difficulty communicating at times

Physiological Changes

(A) Reproductive System Changes

The Cervix

• Immediately after birth - soft and

malleable to palpation, both the internal
and external os are open
NCM107ARCE_H Module 2: OB Ward – CLMMRH jo

• By the end of 7 days –feels firm and during labor may have caused some
nongravid again, the external os - the trauma/edema.
size of a pencil opening
• This may cause a decreased sensation
making voiding difficult
The Vagina
Diuresis (increase production of urine)
• After delivery - swollen and has poor
occurs due to:
tone
• 4th to 6th week - regains its tone and • Decrease in estrogen which stimulated
returns to its original size. fluid retention during pregnancy
• Kegel’s exercise (perineal tightening).
Lacerations resulting from childbirth heal • Decrease in residual hypervolemia, or
completely. fluid overload

The Perineum • Reduction in venous pressure in the

lower half of the body
• After delivery - swelling and tenderness,
bruising and rupture of blood vessels • Profound diuresis can begin immediately
are usually evident. after delivery and spontaneous voiding
• 4th to 6th week - the episiotomy or usually returns within 6-8 hours post
laceration is usually evident, no more delivery
swelling and tenderness.
• Bladder fills rapidly after delivery due to
Breasts and lactation the marked increase in urine production
• Progesterone – hormone responsible for
• Urine volume should return to pre-
growth of breast tissue before birth.
pregnant levels by 2-3 days after
delivery
• Colostrum – first secretion, rich in
substances that help the newborn adjust If cystitis is suspected…
to life outside the womb.
• The nurse may need to assist the
• About two to five days after the birth the postpartum women with obtaining a
breasts begin to produce milk. "the milk urine sample. In order to not
coming in". contaminate the sample, it needs to be
obtained during midstream to avoid
• Sucking causes the pituitary gland to getting lochia in the sample
release oxytocin, which contracts the
uterus and prevents bleeding. • Then the sample is sent for microscopic
examination, culture, and sensitivity
• Cracked nipples can develop at this tests
time, which can be managed with
pharmacological and Make Sure Patient’s Know the Signs of a UTI
nonpharmacological treatment.
• Urinary frequency
(B) Systemic Changes • Dysuria
• Urgency
The Hormonal System • Hesitancy
• Dribbling
Decrease • Nocturia
• Suprapubic pain
• 24 hours after - Human chorionic
• May have gross hematuria
gonadotropin (hCG) and human
• Odor
placental lactogen (hPL)
The Circulatory System changes
• week 1- progestin, estrogen, and
estradiol are all at prepregnancy levels • The usual blood loss with a vaginal birth
is 300 to 500 ml.
• week 2 - estriol may take an additional
week before it reaches prepregnancy
levels.

• 12 days - Follicle-stimulating hormone

(FSH) remains low, begins to rise as a
new menstrual cycle is back

The Urinary System changes

• Transient loss of bladder tone or

decreased bladder tone is expected
during pregnancy due to the effect that The Gastrointestinal System changes
progesterone has on smooth muscle.
• Bowels become sluggish after birth due
• The fetal head pressing on the bladder lingering effects of progesterone
NCM107ARCE_H Module 2: OB Ward – CLMMRH jo

• decreased abdominal and intestinal While breastfeeding, women must be certain to

muscle tone drink adequate fluid daily, eat a varied nutritious
• the peptide hormone relaxin depresses diet, and check with their healthcare provider
bowel motility before ingesting medicine or alternative
• Bowel movement may not happen for 2- therapies such as herbs because most of these
3 days can be found in breast milk and their use may
not be evidence-based
To Facilitate Normal Bowel Function
Return of menstrual flow
• Drink water
• Ambulate • Not breastfeeding – 6 to 10 wks after
• Eat a high fiber diet
• Stool Softeners • Breastfeeding
• Don’t ignore it o may not return 3 to 4 months
• Medication o or the entire lactation period
• Avoid Straining o but does not guarantee that a
woman will not get pregnant
The Integumentary System changes Breastfeeding - Is the sucking of an infant at
• Striae gravidarum - the stretch marks – the mother’s breast to provide him/her with
reddened and more prominent. nourishment.
• Chloasma - Excessive pigment on the
The National Plan of Action for 2005-2010 for
face and neck will be barely detectable
after 6 weeks. Infant and Young Child Feeding:
• Linea nigra – Excessive pigment on the Goal: Reduce Child Mortality Rate by ⅔ by 2015
abdomen up to 6 weeks
Objective: To improve the health and nutrition
Let Your Patients Know… status of infants and young children.
• After delivery the soft tissue in and Outcome: To improve exclusive and extended
around the perineum may be swollen breastfeeding and complementary feeding.
and bruised
• Initial healing of the episiotomy occurs Exclusive Breastfeeding - giving a baby only
within 2 to 3 weeks breastmilk and no other liquids or solids, not
• Supportive tissue of the pelvic floor is even water
stretched and during birth and complete
healing may take 4 to 6 months Importance of Breastfeeding - psychological
benefits to children and mothers as well as
Signs of infection of the episiotomy or repaired economic benefits for families and societies
laceration of the perineum may include:
Key Messages on Infant and Young Child
• Redness Feeding
• Purulent drainage
• Warmth • Initiate breastfeeding within 1 hour after
• Gaping of the previously approximated birth
wound • Exclusive for the 6 months of life-only
• Edema breastmilk and nothing else
• Local pain • Complemented at 6 months with
appropriate foods, excluding milk
(3) Progressive Changes of the Puerperium supplements
• Extend breastfeeding up to 2 years and
Lactation beyond
The formation of breast milk (lactation).
Benefits of Breastfeeding to INFANTS
• First 2 days after birth - little change in
1. Provides a nutritional complete food for the
her breasts from the way they were
during pregnancy. infant
• 3rd day - breasts become full and feel 2. Strengthens the infant’s immune system,
tense or tender as milk forms within preventing many infections
breast ducts and replaces colostrum
3. Safely rehydrates and provides essential
nutrients to a sick child especially to those
suffering from diarrheal diseases

4. Reduces infant’s exposure to infection

(reduces hospitalization)

5. Increase IQ points

Benefits of Breastfeeding to MOTHER

1. Reduces woman’s risk of excessive blood

loss after birth (due to pituitary gland that
secretes oxytocin stimulating uterine
NCM107ARCE_H Module 2: OB Ward – CLMMRH jo

contractions which can reduce bleeding during

3rd stage of labor) 2. Provides natural methods
of delaying pregnancies

3. Reduces the risk of ovarian and breast

cancers and osteoporosis

Benefits of Breastfeeding to HOUSEHOLD

and COMMUNITY

1. Conserve funds and otherwise would be spent

on breastmilk substitute supplies and fuel to
prepare them

2. Saves medical cost to families and the

government by preventing illnesses and by
providing immediate postpartum and
contraception

Breastmilk and Breastfeeding

1. Breastmilk is the best food for the baby from

birth up to 6 months

a. Meets all food and fluid needs (birth - 6 G (Gravida) – number of times a woman has
months) conceived, including any current pregnancy
b. Protection from diseases and
malnutrition T (Term births) – number of times a woman has
c. Giving of food and drinks-digestion carried a pregnancy to at least 37 weeks
problems and infection gestation.
d. Decrease milk production
P (Preterm births) – number of times a woman
2. Give colostrum to the baby has delivered after 20 weeks but before 37
weeks gestation.
a. Prepares baby’s stomach against
infection A (Abortions) – number of times a woman has
b. No tummy ache or diarrhea lost a pregnancy, whether it was elective or
c. 45-50 mL because it can cater to the spontaneous, miscarriage, before 20 weeks
baby’s stomach size gestation.

3. Breastfeeding as often as the baby wants, day L (Live births) – living children
and night

a. Breastfeeding per demand ensures

sufficient nutrients BENEFITS OF BREASTFEEDING
b. Stimulus for continued milk production
B – est for baby
4. Use both breasts alternately at each feeding R – educed allergic reaction
a. This will prevent engorgement and E – conomical
infection
A – ntibodies present

Laws that protect infants and young child S – afe

feeding
T – emperature is always right
1. Milk code (EO 51) - products covered by Milk
Code consist of breastmilk substitutes including F – resh
infant formula; other milk products, foods, and E – motional bonding between mother and child
beverages, including bottle-fed complementary is ensured
foods
E – asily established
The Rooming-in and Breastfeeding Act of 1992
D – igestible
• Requires both public and private health
institutions promoting rooming-in to I – mmediately available
encourage, protect, and support the
practice of breastfeeding N – utritionaly optimal
• “An environment where basic physical,
G – IT problems greatly reduced
emotional and psychological needs of
others and infants are fulfilled through
the practice of rooming-in and
breastfeeding.
• Human milk bank to ensure collection,
storage, and utilization of breastmilk.
NCM107ARCE_H Module 2: OB Ward – CLMMRH jo

Common abbreviations used in medication

timing