Postpartum Adaptations - Chapter 15

The Fourth Trimester

• Definition: Time from birth of the baby until six weeks postpartum.
• Importance: Critical transition period for the mother, baby, and family.
• Adjustments: Necessary for all family members including siblings.

Reproductive System Adaptations

• Involution: Gradual change and contraction of the uterus post-delivery of the placenta.
  • Subinvolution: When uterus does not undergo involution.
• Lochia: Post-birth vaginal discharge.
  • Stages of Lochia:
    • Rubra: Day 1-4, mostly blood, red/dark brown.
    • Serosa: Day 3-10, lighter, pink/brown.
    • Alba: Day 10-21, lighter, white/cream/light yellow.
• Checking Lochia: Monitor pads for possible hemorrhaging.
• Fundus Assessment:
  • Should be firm and near the umbilicus.
  • Descends 1 cm per day, back to pelvic cavity by day 14.

Cardiovascular Adaptations

• Blood Volume: Increased during pregnancy to accommodate delivery.
• Cardiac Output: Increases initially, back to normal after weeks.
• WBC and Pulse: WBC elevated, pulse stable/slower, tachycardia not normal.
• Hypercoagulation: Risk for thrombolytic events remains for 2-3 weeks.

Urinary System

• Bladder Function: Must void within 6-8 hours post-delivery.
  • Techniques to encourage voiding include running water, warm water, and sitz baths.
• Postpartum Diuresis: Up to 3000 mL/day on days 2-5.
• Risk of Retention: Can lead to increased bleeding if bladder is full.

GI System Adaptations

• Return to Normal: Quickly post delivery.
• Common Issues: Constipation due to decreased bowel tone and peristalsis.
  • Solutions: Stool softeners, laxatives, and ample PO fluids.

Musculoskeletal System

• Recovery: Joints return to pre-pregnancy state, except feet.
• Common Complaints: Fatigue, activity intolerance, muscle and joint pain.

Integumentary System

• Hormonal Changes: Cause changes like linea nigra, melasma, and stretch marks.
• Diaphoresis: Common for about a week postpartum.

Respiratory and Endocrine System

• Ovulation and Menstruation: Returns 7-9 weeks postpartum for non-breastfeeding, delayed with breastfeeding.
• Hormonal Changes: Estrogen and progesterone drop, prolactin for lactation.

Lactation

• Process: Begins as hormone levels drop post-delivery.
• Engorgement Relief: Frequent breastfeeding, warm compresses before, cold compresses after.

Maternal Adaptation

• Phases:
  • Taking-in Phase: Focus on self, recounting birth experience.
  • Taking-hold Phase: Independence grows, focus on infant care.
  • Letting-go Phase: Adjust to new role, realistic expectations.

Bonding and Attachment

• Process: Begins at pregnancy confirmation.
• Erikson's Theory: Trust vs. mistrust based on early bonding.

Cultural Considerations

• Importance: Understand different cultural practices regarding pregnancy and postpartum.

Key Psychological Changes

• BAM: Becoming a Mother - commitment, attachment, and identity.
• Engrossment: Father's psychological adaptation.
• Stages of Role Development: From expectations to mastery despite challenges.

Please review associated textbook pages (512-513) for a detailed understanding of cultural considerations in postpartum care.