POSTPARTUM HEALTH TEACHING

BREAST
Breast development in preparation for lactationresults from the influence of both estrogen and
progesterone. A decrease in estrogen and progesterone levels after delivery stimulates increased
prolactin levels, which promote breast milk production.Breasts become distended with milk on
the third day. Engorgement occurs in 48 to 72 hours in non breast feeding mothers.

PATIENT TEACHING:

Wash breast daily at bath or shower time

Wear Supportive bra

Wash hands before and after every feeding

Insert clean OS squares or piece of cloth in the brassiere to absorb moisture when there is
considerable breast discharges.

Breast Dicomforts/ Engorgement:

 Breastfeed frequently
 Apply warm packs before feeding
 Apply ice packs between feedings
 Pumping or manually expressing breast milk
 Chilled cabbage leaves (placed on breast with nipple exposed)
 Changing position with each nursing so that different areas of the nipples receive the
greatest stress from nursing and avoiding breastengorgement..
 Acetaminophen or ibuprofen for pain

APPLYING ICE and LANOLIN DOES NOT RELIEVE BREAST ENGORGEMENT.

Care for Cracked nipples:

1. Expose nipples to air for 10 to 20 minutes after feeding

2. Rotate the position of the baby for each feeding
3. Be sure that the baby is latched on to the areola, not just the nipple

NOTE: Do not use soap on the breasts, as it tends to remove natural oils, which increases the
chance of cracked nipples

UTERUS
Process of involution takes 4-6 weeks to complete.Fundus steadily descends into true pelvis;
Fundal height decreases about 1 fingerbreadth (1 cm)/day; by 10-14 days postpartum, cannot
be palpated abdominally.
PATIENT TEACHING:

 By 10-14 days postpartum, cannot be palpated abdominally.

 Breast feeding hastens involution of the uterus
 The Fundus must be firm, if it is not firm, lightly massage the abdomen until fundus is
firm
 Gently massage fundus to determine firmess; it is important to support the bottom of the
uterus
 Empty bladder frequently, it delays involution of the Uterus

CESAREAN:

 Notify Health care provider if ther is bleeding,drainage,foul odor,edema and redness

BLADDER
VOIDING is difficult because of the pressure on the bladder and urethra making it
edematous.

The bladder and urethra are traumatized by the pressure exerted by the fetal head as it
passes through
the birth canal. Trauma to bladderresults in loss of bladdertone, edema and
hyperemia.As a result,
the woman experiences decreased bladder tone that results inincreased bladder
capacity.

Decreased bladder tone causes decreased sensation to the filling and distention of the
bladder, the woman may not experience the urge to void even if her bladder is already
distended with urine w/c predisposes to infection.

Urinary retention as a result of decreased bladder tone and emptying can lead to urinary
tractInfections

Urinary output increases 1rst 24 hours post delivery (puerperal diuresis)

PATIENT TEACHING:

 May complain of frequent urination in small amounts: explain that this is due to
urinary
 retention with overflow
 May have difficulty voiding because of abdominal pressure or trauma to the
trigone of the
 Bladder
 Voiding may be initiated by Pouring warm and cool water alternately over the
vulva
 Encourage the client to go to the comfort room for every 4 to 6 hours
  Let her listen to the sound of running water
 If these measures fail, catheterization, done gently and aseptically, is the last
resorton doctor’s order. 
 Instruct to avoid garters or constricting clothing that can impair circulation
 Do Kegel exercises. You perform Kegels by simply tightening your pelvic floor
muscles. Pretend as if you are trying to stop a stream of urine. Do 10 to 12 Kegels
every time you feed the baby to help tighten your pelvic floor muscles and
increase blood flow to the perineum. to perform Kegel exercises as soon as is they
can comfortably do so.

BOWEL MOVEMENT
Bowel movement maybe delayed for days after delivery resulting in constipation. This is caused
by:

 Decreased muscle tone during labor and puerperium

 Lack of food during labor
 Dehydration
 Fear of pain from perineal tenderness due to episiotomy, lacerations or hemorrhoid
 Bowel sounds are active, but passage of stool through the bowel may be slow
 Spontaneous bowel movement may not occur for 2 to 3 days after childbirth because of
the lingering effects of progestone

PATIENT TEACHING:

 Demonstrate how to clean the perineum after each voiding and defecation (wiping form
front to
 back), washing the hands and applying a perineal pad from front to back
 Instruct to avoid garters or constricting clothing that can impair circulation
 Teach the importance of adequate fluid intake, exercise, proper diet and a regular
defecation time
 Instruct to wear perineal pads loosely and to lie in sim’s position
 Encourage client to shower as soon as she can ambulate and to take tub baths if desired
after
 two weeks. Recommended daily shower to promote comfort and a sense of well-being/
 Provide adequate dietary fiber and fluids to promote bowel movements; if necessary
administer
 stool softeners, laxatives, suppositories or enema

LOCHIA
Discharge from the uterus during the first 3 weeks after delivery.

Increasing Lochia as the day passes by may indicate Heparin Intoxication.

LOCHIAL CHANGES

LOCHIA RUBRA

 Dark red discharge occurring in the first 1-3 days.

 Contains epithelial cells, erythrocytes and decidua.
 Characteristic human odor.

LOCHIA SEROSA

 Pinkish to brownish discharge occurring 3-10 days after delivery.

 Serosanguineous discharge containing decidua, erythrocytes, leukocytes, cervical
mucus and microorganisms.
 Has a strong odor

LOCHIA ALBA

 Almost colorless to creamy yellowish discharge occurring from 10 days to 3 weeks

after delivery.
 Contains leukocytes, decidua,epithelial cells, fat, cervical mucus, cholesterol
crystals, and bacteria.
 Has no odor.

PATIENT TEACHING

 Instruct discharged patients to report any abnormal progressions of lochia,

excessive bleeding, foul-smelling lochia, or large blood clots to their physician
immediately. Instruct patients to avoid sexual activity until lochial flow has ceased.
 Lochia should never exceed a moderate amount, such as 4 to 8 saturated perineal
pads dailywith an average of 6.
EPISIOTOMY
Is a surgical incision through the perineum made to enlarge the vagina and assist
childbirth. The incision can be midline or at an angle from the posterior end of the vulva,
is performed under local anaesthetic (pudendal anesthesia) and is sutured closed after
delivery.

PATIENT TEACHING

 Sim’s position- minimizes strain on the suture line

 Perineal heat lamp or warm sitz baths twice a day- vasodilation increases blood
 supply and therefore, promotes healing
 Apply ice or cold therapy to the episiotomy or laceration immediately after
deliveryto decrease edema and provide anesthesia; thereafter apply moist or dry
heattherapy to promote comfort and healing
 Application of topical analgesics or administration of mild oral analgesics as
ordered
 Instruct the client on sitting properly to relieve pain (squeeze the buttocks
together and contract pelvic floor muscles before sitting)
 During Perineal Care Flush with warm water.

SKIN
PATIENT TEACHING:

 Chloasma, palmar erythema, linea nigra and other skin changes during pregnancy
gradually disappear during the postpartum period.
 Striae gravidarum do not disappearand assumes a silvery white appearance.
 Hyperpigmentation of the areola may not disappear completely. Some women are
left with a wider and darker areola after pregnancy.
 Linea nigra will be barely detectable in 6 weeks tim
 Mask of pregnancy (chloasma) usually disappears, while stretch marks (striae
gravidarum) and
 linea negra fade but generally do not disappear.

HOMAN’S SIGN
 -Pain in the calf and popliteal area on passive dorsiflexion of the foot, indicating
deep venous thrombosis of the calf.
 -Also known as dorsiflexion sign. 
 -Relative inactivity/prolonged time in stirrups leads to stasis of blood and
promotes clotting of blood in the lower extremities
PATIENT TEACHING:

 Get patients to ambulate as soon as possible after delivery to improve circulation

and prevent the development of thrombi.
 Teach them not to cross their legs for long periods of time and to keep the legs
elevated while sitting.

EMOTIONAL STATUS

TAKING-IN PHASE -1st 2- 7days postpartum

 Need for sleep and rest

TAKING-HOLD PHASE - 3rdday to 2 weeks postpartum

 Control body function

 Ability to assume the mother role

LETTING GO

 Realize that the infant is a separate individual and not a partof herself
 Feeling of loss
 Adjustment phase


OTHER CONCERNS
EXERCISES

 Kegel’s and abdominal breathing on postpartum day one

 Chin-to-chest on postpartum day 2 to tighten and firm up abdominal muscles
 Knee-to-abdomen when perineum has healed, to strengthen abdominal and gluteal
 muscle

MENSTRUATION

 If not breastfeeding- return in6-8 weeks after birth

 If breastfeeding, in 3-4 months (lactational amenorrhea) or entire lactation period

SEXUAL ACTIVITIES

 abstain from intercourse until episiotomy is healed and lochia ceased

 around 3-4 weeks. Remind that Assess height, consistency, and location of the fundus
breastfeeding
 does not give adequate protection
 Cesarean -2 weeks
WEIGHT LOSS

 An initial weight loss of 10 to 12 lbs occurs as a result of the birth of the infant, placenta
and amniotic fluid

NIGHT SWEATS

 Puerperal diuresis accounts for loss of an additional 5 lbs during the early postpartum
period
 Normally return to pre-pregnant weight by 6 weeks postpartum
 Diaphoretic episodes may occur at night, a normal occurrence as the body rids itself of
waste products

GUSH OF BLOOD THAT SOMETIMES OCCURS WHEN SHE FIRST RISES

 Due to normal pooling in vagina when the woman lies down to rest or sleep; gravity
causes blood to flow out when she stands

AFTER PAINS/ AFTER BIRTH PAINS

Intermittent cramping of the uterus

Common in multiparas, and those who have given birth to large babies
Uterus contracts more forcefully
Intense with breastfeeding (because of oxytocin)

Strong uterine contractions felt more particularly by multis, those whodelivered larger babies or
twins and those who breastfeed. It is normal andrarely last for more than 3 day