1. POSTPARTUM /
PUERPERIUM

2. POSTPARTUM /
PUERPERIUM
 Refers to the six-week period after delivery of
the baby
 Principles:
 Promote healing and involution of different parts
of the body
 Provide emotional support
 Establish a successful lactation
 Prevent postpartum complications

3. Promote healing and

involution of different parts
of the body

4. Vascular changes
 The 30% - 50% increase in total cardiac
volume during pregnancy will be reabsorb into
the general circulation
 WBC count increases to 20,000 – 30,000/mm3
 There is extensive activation of clotting factors,
which encourages thromboembolization.
 All blood values are back to prenatal levels by
the 3rd and 4th week postpartum

5. Genital Changes
 Uterus
 Sealing of the placenta site
 Reduced to its approximate pregestational size
 Assessed by measuring the fundus by
fingerbreadth
 In some women, causes afterpains
 Nursing Management:
 Never apply heat on abdomen
 Give analgesics as ordered
 Advise knee-chest position when perineum has healed

6. Lochia
TYPE COLOR DURATION COMPOSITI
ON
Rubra Red 1-3 days Blood,
fragments of
decidua, and
mucus
Serosa Pink 3-10 days Blood,
mucus, and
invading
leukocytes
Alba White 10-14 days Largely
mucus;
Leukocyte

7. Genital Changes
 Characteristics of Lochia
 Pattern should not reverse
 It should approximate menstrual flow. However, it
increases with activity and decreases with
breastfeeding
 It should not have any offensive odor
 It should not contain large clots
 It should never be absent, regardless of the
method of delivery

8. Genital Changes
 Vagina
 Involutionfrom soft and with greater diameter
than normal until its approximate pregestational
state takes the entire postpartal period
 Nursing Management:
 Encourage Kegel Exercise

9. Genital Changes
 Perineum
 Develops edema and generalized tenderness
 Labia majora and minora typically remain
softened

10. Sexual Activity
 Maybe resumed by the 3rd or 4th week
postpartum if bleeding has stopped and
episiorrhaphy has healed

11. Menstruation
 If not breastfeeding, return of menstrual flow is
expected within 8 weeks after delivery
 If breastfeeding, menstrual return is expected
in 3-4 months. In some women, no
menstruation occurs during the entire lactation
period.

12. Urinary Changes
 There is marked diuresis within 12 hours
postpartum
 Common complaints are frequent urination in
small amounts and difficulty voiding
 Nursing management:
 Initiate
voiding
 If measures fail, catheterization as ordered.

13. Gastrointestinal Changes
 There is delayed bowel evacuation
postpartally which maybe due to:
 Decreased muscle tone
 Lack of food and enema during labor
 Dehydration
 Perineal tenderness
 Almost immediately, the woman feels hungry
and thirsty. She can eat unless she has the
after effects of general anesthesia.

14. Vital Signs
 Temperature may increase
 Bradycardia is common for the 6-8 days
postpartum
 Orthostatic hypotension and dizziness is
common

15. Weight
 There is an immediate weight loss of 10-12
pounds

16. Provide

emotional
support

17. The Psychological Phases during
the Postpartum
 Taking – In Phase
 Taking – Hold Phase
 Letting – Go Phase

18. Establish
a
successful
lactation

19. Physiology of Breastmilk
Production
Delivery of the
placenta
Anterior
Pituitary Gland
Prolactin
Acinar Cells
Production of Milk

20. Physiology of Breastmilk
Excretion
1.Crying of the baby / Thinking of the
baby
2.Posterior Pituitary Gland
3.Oxytocin
4.Let-down reflex

21. Advantages of Breastfeeding
 For the mother:
 Economical in terms of time, money, and effort
 More rapid involution
 Less incidence of cancer of the breast
 For the baby:
 Closer mother-infant relationship
 Contains antibodies
 Fewer incidence of GI diseases
 Always available at the right temperature

22. Health Teachings
 Hygiene:
 Wash breast daily
 Soap or alcohol should never be used
 Wash hands before and after feeding
 Insert clean OS squares or piece of cloth in the
brassiere to absorb moisture

23. Health Teachings
 Method:
 Stimulate the baby to open the mouth by means of
rooting reflex
 Infant should grasp not only the nipple but also the
areola
 Infant should be introduced to breast gradually
 Infant should be placed first on the breast he fed
last in the previous feeding
 Feed by demand
 Advise the mother how to relax during feedings

24. Associated Problems and
Management
 Engorgement: tension of the breast during 3rd
to 4th days. It fades after the infant begins
sucking
 Advise use of firm-fitting brassiere for good
support
 Cold compress / warm compress depending if the
mother will breastfeed or not

25. Associated Problems and
Management
 Sore Nipples
 Expose nipple to air
 If normal air-drying is not effective, exposure to a
20-watt bulb placed 12-18inches away

26. Associated Problems and
Management
 Mastitis
 Antibiotics
as ordered
 Ice compress
 Proper breast support
 Discontinue breastfeeding in affected breast

27. THE NEONATE-The first 28 days
after delivery

28. Principles of Newborn Care
 Establish and maintain a patent airway
 Maintain appropriate body temperature
 Immediate assessment of the newborn
 Proper identification of the newborn
 Nursery care

29. Establish and maintain a patent
airway

30. Establish and maintain a patent
airway
• Never stimulate crying unless secretions have
been drained out
• Position the head lower than the rest of the
body except if there are signs of increased ICP
• Suction the baby properly
– Turn the head to one side
– Suction gently but quickly
– Suction the mouth first before the nose
– Test the patency of airway

31. Maintain
appropriate body
temperature

32. Maintain appropriate body
temperature
 Important as it may lead to cold stress
 Heat loss in newborn occurs in 4 ways
 Conduction
 Convection
 Evaporation
 Radiation

33. • The newborn suffers large losses of body
heat (cold stress) because:
– he is wet at birth
– the delivery room is cold
– he does not have enough
subcutaneous fats/adipose tissues
– shivering mechanism is not
functioning
– thermoregulatory center is
underdeveloped

34. Immediate assessment of the
newborn

35. • APGAR scoring – a standardized evaluation
of the newborn’s condition/stability
– Done 1 minute afterbirth then 5 minutes after

36. SIGN 0 1 2
HEART Absent <100/min >100/min
RATE
MUSCLE Limp, Some Well-flexed
TONE flaccid flexion of extremities
extremities
RESPIRAT Absent Weak cry Good,
ORY strong cry
EFFORT
REFLEX No Grimace, Sneeze;
IRRITABILI response weak cry good,
TY strong cry

37.  APGAR interpretation of
results:
0-3 (the baby is in serious
danger)
4-6 (condition is guarded)
7-10 (baby is in the best
possible health)

38.  Assessment of gestational age
Naegel’s Rule
Mc Donald’s Rule
Bartholomew’s Rule
UTZ

39. Proper identification of the
newborn

40. • Must be done in the delivery room before
bringing the newborn to the nursery
 Identification bands
 Footprints

43.  NURSERY CARE

44.  Check the identification band
 Take anthropometric measurements:
 Length = (Ave) 50cm / 20 inches
= (Normal range) 47.5 – 53.75 cm /
19-21 ½ in
- Head circumference = 33-35 cm
- Chest circumference = 31-33 cm
- Abdominal circumference = 31-33cm

45.  Take the temperature
 At birth 37.2 degrees Celsius but will stabilize in 8
hrs.
 (Before) rectal route is preferred
 Give initial oil bath
 Dress the umbilical cord
 Crede’s prophylaxis
 Vitamin K administration

46.  Weight taking
 5.5 – 6.5 lbs. (2.5 – 3.5 kg)
 Feeding
 Initial
feeding with an ounce of sterile water
 Subsequent feedings given by demand

47. Nursery Care
Physical Assessment
• Vital Signs
o Pulse - Apical pulse recommended
- 120-140 bpm, irregular
o Respirations – largely abdominal
- Gentle, quiet, rapid but shalow
- 30-60cpm
o Blood pressure – not routinely measured unless
Coartation of the Aorta is suspected

48. • Skin
– Normally ruddy
– Acrocyanosis during the first 24-48 hours of life
– General mottling is common
– Physiologic Jaundice from 2-7 days of life
– Harlequin sign is normal first few days of life
– Mongolian spots normal but disappear by school age
– Lanugo disappears within 2 weeks
– Desquamation normal within 24 hours of life
– Milia disappear by 2-4weeks
– Deviation from normal: Pallor , Gray color

53.  Head
Largest part of the body
Fontanelles are neither sunken nor
prematurely closed
Craniotabes present
Caput succedaneum or
Cephalhematoma may be present

55. CEPHALHEMATOMA

56. • Eyes
– Cry tearlessly during the first 2 months
• Nose
– There should be no septal deviation
• Mouth
– Should open evenly when crying
– Palate should be intact
– Epstein’s pearls may be present
– Natal teeth may be seen

57. Cleft palate

58. Epstein pearls

59. Natal tooth

60.  Neck
 Headrotate freely on the neck and flex forward
and back
 Chest
 Smaller or as large as the head
 Breast may be engorged
 Witch’s milk may be present

62.  Abdomen
Liver, spleen, and kidneys may be
palpable at birth
Dome-shaped
Umbilical cord breaks free at 6th –
10th day after birth

63.  Anogenital area
 Inspect anus to ensure presence and patency
 Female genitalia: may have swollen labia and
pseudomenstruation
 Male genitalia: Scrotum may be edematous
Testes should be present
Cremasteric reflex should be
elicited

64.  Extremities
 Hands are clenched into fist
 Note for polydactyly or unusual spacing of toes

65.  Cardiovascular System
 As soon as breathing has been initiated,
oxygenation takes place in lungs
 Increased pressure on the left side of
the heart results in:
Closure of the foramen ovale
Change of Ductus arteriosus into
Ligamentum arteriosum
Ductus venosus becomes
Ligamentum venosum
- Blood volume: Ave = 300ml or 80-

66.  Gastrointestinal Tract
Meconium should be present within
24-48 hours after birth
Transitional stool present on the 2nd
– 10th day of life
Milk stool (Breastfed / Bottlefed)
Deviation from normal: Clay-
colored, blood-flecked, black tarry
stool

68.  Urinary system
 Urine is less concentrated
 Female: strong stream voiding
 Male: projected arc voiding
 Autoimmune system
 Have difficulty forming antibodies until 2 months
 Passive natural immunity

69.  Senses
 Sight:Can only see within 9 inches away from the
eyes on the first 6-8weeks
 Hearing: As soon as amniotic fluid has been
absorbed
 Taste and Smell: As soon as mucus and fluid
have been cleared
 Touch: Most develop of all senses

70.  Neuromuscular System
Blink reflex (always present)
Sucking reflex (disappears at 6 mos)
Swallowing reflex (always present)
Extrusion reflex (disappears by 4 months)

71.  Neuromuscular System
Rooting reflex (disappears by 6 weeks)

72. Neuromuscular System
Tonic neck reflex (disappears by 2-
3 mos)

73. Neuromuscular System
Babinski reflex (disappears at 3
mos)

74.  Neuromuscular System
Moro reflex (disappears by 4-5 mos)

75.  Neuromuscular System
Palmar grasp reflex (disappears at 3 mos)

76.  Neuromuscular System
Plantar grasp reflex

77. Neuromuscular System
Step/Walk-in place reflex (disappears by 3 mos)

78.  Neuromuscular System
Placing reflex

79. Discharge Instructions
• Bathing
– Maybe given anytime but not within 30 minutes
after feeding
– Sponge baths are done until cord falls off
• Cord care
– Always maintain the cord dry
– Dub 70% alcohol once or twice a day
– If it remains moist for a week, advise to see the
doctor

80. • Nutrition
– Encourage breastfeeding
NUTRIENTS HUMAN MILK COW’S MILK
Proteins 8% 20%
Fats 50% 50%
Carbohydrates 42% 30%
Minerals Lesser Greater
– Should feed by demand
– Should be burp at least twice during feeding

81. Discharge Instructions
 Clothing the newborn
 Rule of thumb
 Sleep pattern
 Usually sleeps 16-20 hours a day

82. Management for the Common
Health Problems
 Constipation
 Encourage breastfeeding
 Add more fluids, carbohydrates, sugar
 Colic
 Feed by demand
 Burp at least twice during feeding
 May need to change formula as per doctor’s order

83. Management for the Common
Health Problems
 Spitting up
 Feed in upright position
 Position on right side after feeding
 Burp more frequently
 Diaper rash
 Expose to air
 Careful washing and rinsing

84.  Miliaria
 Starch bath
 Seborrhic dermatitis
 Apply mineral oil or petroleum jelly on scalp at
night before giving shampoo in the morning

87.  GOD BLESS ON YOUR FINALS!
 Aim to top your finals! Break a neck…
Sir cj