1.
Post Partum Period
by: mae s.jagunap r.n.m.n

2.
Is the period beginning immediately after the
birth of a child and extending for about six weeks.
It is the time after birth, a time in which the
mother’s body, including hormone levels and
uterus size, returns to a non-pregnant state

3.
First 24 hours after birth
• All post partum women should have regular assessment of
vaginal bleeding, uterine contraction, fundal height,
temperature and heart rate (pulse)routinely during the first 24
hours starting from the first hour after birth.
• Blood pressure should be measured shortly after birth, If
normal the second blood pressure measurement should be
taken within six hours.
• Urine void should be documented within six hours.
Assessment of the Mother

4.
Postpartum Maternal Physical Assessment
Summary : BUBBLE HE
B- Breast
U- Uterine fundus
B- Bladder function
B- Bowel function
L- Lochia
E – Episiotomy
H- Homan’s sign
E- Emotion

5.
◦ Inspect for redness and engorgement.
◦ Palpate breasts to determine if they are soft or filling warm,
engorged or tender.
? Check nipples for pressure sores, cracks, or fissures.
Evaluate whether nipples are everted, flat or inverted.
◦ Engorgement usually occurs 2-3 days postpartum, warm
shower before nursing may help alleviate the problem.
Breast

6.
◦ Colostrum- (first milk) produce by mammary
gland,colostrum production can start as early as the
beginning of the 2nd trimester of pregnancy.
◦ Breastfeeding encourages uterine contraction due to
release of oxytocin.
◦ Normal : Nipples should be soft, pliable, intact & everted.
◦ Abnormal: Redness , heat, pain, cracked and fissured
nipples, inverted nipples, palpable mass, bruised, blistered

7.
It should be firm, if not, massage prior to palpation
and assess for any blood discharges during
massage.
Assess its location and the degree of uterine
contraction, any tenderness or pain should be
noted
Uterine Fundus

8.
Note:
Fundus of the uterus is palpable through the
abdominal wall halfway between the umbilicus and the
symphysis pubis (Approx. 2cm below the umbilicus)
within a few minutes after birth.
One hour later it will rise at the level of the umbilicus
and will stay in that level for 24 hours: fundus descends
approximately 1 cm per day: by the 10th day the fundus
should no longer be palpated.

9.
? If fundus is deviated to the left or to the right or elevated
above level of umbilicus always rule out DISTENDED
BLADDER, and cause the patient’s flow to be heavier.
? Bladder distention may displace the uterus ,
leading to a boggy uterus and increase risk for
atony.
? Always encourage mother to empty her bladder

10.
Normal findings: normal size and shape, mobile
regular, firm, in the midline, below the umbilicus and
non tender.
Abnormal: immobile, irregular, soft, tender, deviated away
from the midline or above the umbilicus after 24 hours

11.
● Patient might feel occasional contractions, sometimes
called afterpains, during the first few days after
delivery. These contractions- which often resemble
menstrual cramps – prevent excessive bleeding by
compressing the blood vessels in the uterus.
● After pains are common during breastfeeding, due to
the release of the hormone oxytocin

12.
⮚ Lochia is the vaginal discharge you have after a vaginal
delivery.
⮚ It has a stale, musty odor like menstrual discharge.
⮚ Lochia for the first 3 days after delivery is dark red in color.
⮚ A few small blood clots, no larger than a plum, are normal..
Lochia rubra – dark red discharge.
- 1- 3 days
Lochia serosa - pink or brownish serosanginous
discharge
- 4-7 days/may last up to 10 days
Lochia alba – creamy or yellowish discharge (white)
- 7 – 10 days or up
LOCHIA

13.
● When examining the lochial discharges note the
amount ,color, consistency, odor and presence of
clots
● The amount is assessed in relation to TIME
( scant, light, moderate, heavy.)
Normal: It should be odorless, with no clots and
gets less each day.
Abnormal: Heavy ,foul odor, bright red bleeding ,
clots, amount more than a period.

14.
● All postpartum mothers should void by six hours
after delivery or foley catheter removal.
● May have bruising and swelling caused by trauma
around urinary meatus.
● Increased bladder capacity, along with decreased
sensitivity to pressure leads to urinary retention.
Urinary Tract (Bladder)

15.
● Diuresis occurs during the first 2 days after
delivery.
● Bladder distention may displace the uterus ,
leading to a boggy uterus and increase risk for
atony.

16.
● Daily ask the patients if she has had a bowel
movement. If no bowel movement by the 2nd day ,
she may need a stool softener or a laxative .
● Encourage increase in fluid and juices along with
increasing intake of fruits and vegetables .
Ambulation helps too.
BOWEL

17.
● Assess using REEDA
R- redness
E- edema
E- ecchymosis
D- discharge
A- approximation
● Should have minimal tenderness with gentle palpation
● No hardened areas or hematomas
● Assess knowledge, practice and effectiveness of self
pericare
Episiotomy (Perineum)

18.
? Abnormal findings: Pronounced edema, wound
edges not intact, signs of infection, marked discomfort.
SKIN INTEGRITY
Assess for skin color, temperature,texture,
moisture, integrity and include the location of any skin
breakdown or wounds
Assess for signs of dehydration,such as dry,itchy,
dull looking and poor skin tugor.

19.
● Homan’s sign is an indicator of deep vein thrombosis
(DVT). The sign is present where pain in the calf is
produced by passive dorsiflexion of the foot.
● Assess Homan’s sign every shift
● Women are prone to thrombophlebitis post partum related
to hypercoagulability of the blood caused by
-pregnancy (hormonal change)
-anemia
-pelvic infection
-traumatic delivery
-enlarged uterus, which increases pressure on
the veins that return the blood to the heart from the lower
body.
Homans’ sign (Leg)

20.
? Assess legs daily for redness, nodular or warm
areas, discolorations, or leg varicosities and notify
the doctor.
? Assess for peripheral pulses and for the presence
of and amount of edema.

21.
pain in the calf of the leg upon dorsiflexion of the foot with the
leg extended that is diagnostic of thrombosis in the deep
veins of the area.

22.
3 Normal Phases:
1. “Taking In” - immediately after delivery till up to 2 days
postpartum.
- need rest and sleep
- self-focus
- relives events of labor and delivery
1. “TakingHold”- preoccupied with the present.
- usually encompasses days 2-5 postpartum
-interested in self care
-optimal time for teaching
-focus on caring for baby
1.
Emotional Status

23.
3. “Letting Go”- reestablishing relationships with
others with outward focus
“Postpartum Blues”- a normal temporary state
related to hormonal changes, role redefinition,
fatigue or pain. Patient may “cry for no reason”
-typically begins
first 2-3 days after delivery, and may last for up to
10-14 days.

24.
● Assess for:
◦ Sleep deprivation
◦ Ability to rest
◦ Energy level
◦ Comfort level
◦ Anxiety level
◦ Appetite
◦ Bonding behaviors
◦ Support system (family husband, self supported)
Maternal Examination

25.
● No soap on the nipples, wash with water , wear
supportive bra.
● Most important is the “latch –on”, teach the mother
on how to assist the infant getting the nipple and
areola in the mouth .
● Teach different positions to hold the baby .
● Relax to allow for “let down”
Breastfeeding Care

26.
● Rooming – In
● If the infant stays in the room of the mother rather
than in the nursery.
The more time a woman has spend with her baby,
the sooner she may feel competent in child care,
and therefore is most likely to form a sound
mother – child relationship.

27.
end