3. Postpartum period
• The postpartum period is a time of major
adjustments and adaptations not just for the
mother, but for all members of the family.
• It is during this time that parenting starts and
a relationship with the newborn begins.
• A positive, loving relationship between
parents and their newborn promotes the
emotional well-being of all.
4. Nursing management during the postpartum
• Nursing management during the postpartum period
focuses on assessing the woman’s ability to adapt to
the physiologic and psychological changes occurring
• Nurses need to be aware of these behaviors so they
can perform appropriate interventions. Steps to
address physiologic needs such as comfort, self-care,
nutrition, and contraception are described.
• Ways to help the woman and her family adapt to the
birth of the newborn
5. Cont...
• Once the infant is born, each system in the mother’s body
takes several weeks to return to its nonpregnant state.
• The physiologic changes in women during the postpartum
period are dramatic.
• Nurses should be aware of these changes and should be
able to make observations and assessments to validate
normal occurrences and detect any deviations.
• In addition to physical assessment and care of the woman
in the postpartum period, strong social support is vital to
help her integrate the baby into the family.
6. Goal of postpartum care
• Assist and support the woman’s recovery,
assess and identify deviations from the norm
& educate the mother about her own self care
and infant care
• During the fourth stage of labor the woman is
closely observed for hemorrhage and
hypovolemic shock
• After the initial dangers of hemorrhage and
shock have passed the primary postpartum
danger is infection
7. Postpartum assessment
Postpartum assessment typically is performed
as follows:
• During the first hour: every 15 minutes
• During the second hour: every 30 minutes
• During the first 24 hours: every 4 hours
• After 24 hours: every 8 hours
8. Postpartum assessment
• During each assessment, keep in mind risk factors
that may lead to complications, such as infection or
hemorrhage, during the recovery period
• Early identification is critical to ensure prompt
intervention.
• As with any assessment, always review the
woman’s medical record for information about her
pregnancy, labor, and birth.
• Note any preexisting conditions, any complications
that occurred during pregnancy, labor, birth, and
immediately afterward, and any treatments
provided.
9. Postpartum assessment
• Vital signs
• Pain level,
• A systematic head-to-toe review of body
systems → BUBBLEHEED
breasts, uterus, bladder, bowels, lochia,
episiotomy/ perineum, Homan sign/
extremities, emotional status, education and
diastasis reacti
10. Assessment
• Assessment of a postpartum woman includes:
Health History
Physical examination
Analysis of laboratory findings
11. Health History
• The technical aspects of a woman’s
pregnancy, labor, and birth can be learned
from her pregnancy, labor, and birth charts.
• Most of this information is best obtained from
a woman herself
12. Health Hystory → Family Profile
• Information for a family profile includes:
type of housing
and community
setting
socioeconomic
occupation
support persons
education level
other children
age
13. Pregnancy History
Information for a pregnancy history includes:
• gravida status
• expected date of birth
• whether the pregnancy was planned
• any problems or complications such as
spotting or pregnancy-induced
hypertension that occurred
14. Labor and Birth History
It is important to gather information:
• the length of labor
• position of the fetus
• type of birth
• any analgesia or anesthesia used
• problems during labor such as fetal distress
15. Infant Data
• The sex and weight of the infant
• any difficulty at birth such as the need for
resuscitation
• plans to breastfeed or formula feed
• any congenital anomalies present
16. Postpartum Course
• Ask about a woman’s general health;
• A her activity level since the birth;
• A description of lochia;
• The presence of perineal, abdominal, or
breast pain;
• Difficulty with elimination;
• Success with infant feeding;
• Response of her support person to parenting.
17. Laboratory Data
• Women routinely have their hemoglobin and
hematocrit levels measured 12 to 24 hours after birth
→ If the hemoglobin finding is lower than 10 g/100
mL, supplementary iron is usually prescribed.
• Take note of the laboratory reports on a postpartum
woman, and make certain that any abnormal finding,
such as low hemoglobin, is brought to the attention of
the woman’s physician or nurse-midwife.
• If a woman required catheterization during labor or
had a urinary tract infection during pregnancy, a
urinalysis or urine culture may be ordered in the
postpartum period.
18. RETROGRESSIVE CHANGES OF THE
PUERPERIUM
Temperature Pulse Respiration
Blood
pressure
After pain
Vital Signs
21. Physical Assessment → head to toe
HAIR
• Palpate the woman’s hair to determine its
firmness and strength; whenever a diet is full
• of nutrients, hair is firm and crisp, whereas if a
woman’s intake during pregnancy
wasdeficient in nutrients,
22. Physical Assessment → head to toe
Face
• Assess the woman’s face for evidence of
edema such as puffy eyelids or a prominent
fold of tissue inferior to the lower eyelid.
23. Physical Assessment → head to toe
Eyes
• Inspect the color and texture of the inner
conjunctiva.
• If a woman is dehydrated, the area appears
dry.
• The conjunctiva of a woman who is anemic
from poor pregnancy nutrition or excessive
blood loss is pale.
24. Breasts
➢ Palpate both breasts for engorgement/filling. Minimize palpation
for bottle feeding mother to avoid stimulation.
➢ Check nipples for pressure sores, cracks, or fissures. Evaluate
whether nipples are everted, flat, or inverted.
➢ All mothers should wear a supportive bra 24 hours a day for the
first few days postpartum.
➢ Engorgement-- usually occurs 2-3 days post-partum.
Teach mother to:
• apply warm packs or K-pad 15-20 minutes pre-nursing
• try a warm shower before nursing
• ice bags and/or binders for non-nursing mothers
25. Uterus
• The fundus is palpated for the following:
➢ Height-- Record finger widths above or below the umbilicus.
❖ Fundus descends 1 fingerbreadth each day
➢ Position-- Fundus should be midline near the umbilicus
→ A full bladder may push the fundus to the R or L of the umbilicus
and cause the pt’s flow to be heavier.
➢ Tone → Fundus should remain firm
27. Uterine involution
The uterus decreases in size at a
predictable rate during the postpartal
period.
After 10 days, it recedes
under the pubic bone and is no longer
palpable.
28. After pains
• In some women, contraction of the uterus after birth causes
intermittent cramping similar to that accompanying a
menstrual period.
• They tend to be noticed most by multiparas rather than
primiparas and by women who have given birth to large
babies or had an over distended uterus for any other reason.
• In these situations, the uterus must contract more forcefully
to regain its prepregnancy size and has difficulty maintaining
a steady contracted state.
• These sensations are noticed most intensely with breast-
feeding, when the infant's sucking causes a release of
oxytocin from the posterior pituitary, increasing the strength
of the contractions.
29. Nursing Interventions in case of After pain
• Lying in a prone position with a small pillow
under the abdomen will help decrease the
discomfort.
• Encourage the mother to empty her bladder
before she breastfeeds. An empty bladder will
allow the uterus to contract more efficiently
and decreases the discomfor
30. Diastasis Recti
• What to assess?
– Diastisis Recti
• Abdominal wall separates during pregnancy
– Have pt. do mini sit up and will palpate and visually inspect
abdomen
» Diastisis recti can be seen as a little hill in the center of the
abdomen and with palpation will feel separated
» Measured in fingerbreadths of separation
• What to teach?
– Importance of pp exercise—one link
– Responds to exercise within 2-3 months
• Chin lifts
– Separation of diastisis recti becomes less apparent
with time
31. C-SECTION
• C-SECTION: If the patient had a C-Section,
inspect the dressing or incision at this time
noting site, redness, discharge, and
approximation of the incision if uncovered.
Don't forget to check for bowel sounds.
32. Bladder
Assess the following
➢ Accompany mother and record first 2 voidings.
(More if voiding less than 150cc each time)
➢ Palpate for distention above the symphysis pubis
➢ 6-8 hours post-delivery → eliminasi
➢ How often and how much.. Is bladder distended?
(A) Assessing
bladder filling by palpation.
(B) Assessing bladder filling by
percussion.
33. Bowel
• Assess for presence of Bowel Sounds
• palpate abdomen for distension
• Spontaneous bowel movements may not occur for 2
to 3 days after giving birth because of a decrease in
muscle tone in the intestines during labor.
• Normal patterns of bowel elimination usually return
within 8 to 14 days after birth
• If no bowel movement by the second 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.
34. Lochia
Type of Lochia Color Postpartal Day Composition
Lochia rubra Blood, Red 1–3 fragments of decidua, and
mucus
Lochia serosa Pink 4–10 Blood, mucus, and invading
leukocytes
Lochia alba White 11–14 (may last 6
weeks)
Largely mucus; leukocyte
count high
➢check the lochia for color, amount, odor, and the number of
pads used
➢If the lochia has a foul odor, then be suspicious of an
infection
35. Lochia- how to esstimate amounts
The amount of lochia is described:
• Scant: a 1- to 2-inch lochia stain on the
perineal pad or approximately a 10-mL
loss
• Light or small: an approximately 4-inch
stain or a 10- to 25-mL loss
• Moderate: a 4- to 6-inch stain with an
estimated loss of 25 to 50 mL
• Large or heavy: a pad is saturated
within 1 hour after changing it
36. Episiotomy and perineum
➢Assess using REEDA every shift
R=redness
E-edema
E=ecchymosis
D=discharge
A=approximation
➢Assess for presence of
hemorrhoids
41. EDUCATION/TEACHING:
• Talk with your mom during the assessment,
and teach her the things about her care as you
go along.
• EXAMPLE: Peri care when checking the
perineum
• Rationale for sitz bath and peri light
• Use of local analgesics
• Hemorrhoid treatment,
• Rationale for ambulation especially if a C-
section, etc.
42. Physichologic Assessment
• “Postpartum blues” are a normal accompaniment to
childbirth. You can assure a woman that such feelings are
normal and offer supportive care until the emotion passes.
• Postpartum Depression (PPD) refers to mental obstacles of
delivery women after 6 week, including depression, sorrow,
irritability, or even illusion and delusion.
• The severe one even damaged children and committed
suicide.
• More than half of delivery women had instable emotions
after delivery.
• EPDS (Edinburgh Postnatal Depression Scale)
• Reva Rubin →emotional status ( Taking in, Taking Hold,
Latting Go)
43. Danger signs in the Post Partum Period
• Return of vaginal bleeding esp. > 1 pad/hour or large
clots
• Fever >38C with or without chills after 1st 24 hours
• Increased vaginal discharge, especially if foul-
smelling
• Swollen, red area on leg (thrombophlebitis)
• Swollen, red, tender area on breast (mastitis)
• Dysuria, increased frequency and pressure with
urination (UTI)
• Persistent perineal or pelvic pain (chorioamnionitis)
44. Postpartum Nursing Care
• Maintain physiologic integrity—assess vitals signs,
fundal height and firmness, lochia color and amt, etc. using
BUBBLEHED assessment technique.
• Nurture the Mother—essential nursing role is to help
her transition to motherhood smoothly
• Comfort & Rest—
– Perineal care—careful hygiene, use of sitz bath, use of
anesthetic spray and witch hazel pads, use of donut pillow
prn
45. Comfort measures (cont’d)
• Hemorrhoids—use of topical cream prn, sitz bath, donut ring
prn, avoid straining with BM, avoid sitting up for long periods.
• Afterpains—encourage massage of uterus, use of relaxation
and breathing techniques, anticipatory analgesic management
based on assessed pt. status. Know side effects of analgesics and
teach as needed.
• Rest—organize care to allow for rest periods. Encourage mom
to sleep when baby sleeps and limit visitors. Don’t lift anything
heavier than baby.
46. Other Education topics
• Perineal care
• Bowel and bladder function
• Nutrition—no fad diets, prenatal vitamins daily esp. if
breastfeeding, 6-8 glasses of water/day
• Early ambulation
• Bathing—showers only, start with breasts, no soap, then
shower as usual cleansing perineum last with clean
washcloth. Use peri-shower if available
• Exercise—see earlier link
• Breast care (will be discussed later)
47. Anticipatory Guidance
• Postpartum follow-up visits—4-6 wks for vaginal
delivery, 1 wks for C/S
• Infant development and care
• Physical recovery
• Sexuality and contraception
• Role changes
48. Postnatal Discharge Planning
• Rest when infant is sleeping
• Hygiene: A woman may take either tub baths or showers.
cleanse her perineum from front to back. Any perineal stitches
will be absorbed within 10 days.
• Avoid heaving lifting or heavy house work for 4 weeks, Limit
exercise and activities
• Sexual intercourse is avoided for 4- 6 weeks, a lubricant should
be used
• Use of a contraceptive
• Follow up with MD in about 4-6 weeks
• Exercise Beginning the second week, if her lochial discharge is
normal, she may start to increase this activity.
49. Pengabdian masyarakat
• Gerakan tanggap sehat reproduksi (taseksi)
pada masa postpartum melalui kader
posyandu di wilayah sambikerep kasihan
bantul diy
• Gerakan Peduli Sehat Reproduksi Wanita
(Gelis P-San) Di Masa Pandemi Covid-19
Sebagai Upaya Peningkatan Kesehatan Pada
Wanita Di Padukuhan Ngentak Bangunjiwo
Kasihan Bantul Yogyakarta
50. Research
• Bonding Attachment
• Faktor Determinan Parenting Self Effikasi Pada
Ibu Postpartum
• Anxiety Postpartum
• Sexsual Postpartum
• Fatigue Postpartum
51. Nursing Diagnosis
• Postpartum discomfort
• Risk Hypovolemia
• Risk for infection
• Risk for haemorhage
• Breasftfeeding
• Constipation
• Elimination
• Readiness to increase to become parents
52. Nursing Interventions
• Promoting Comfort
• Assisting With Elimination
• Promoting Activity, Rest, and Exercise
• Preventing Stress Incontinence
• Assisting With Self-Care Measures
• Promoting Nutrition
• Counseling About Sexuality
• Contraception
• Breastfeeding counseling
53. Nursing Care Plan
DIAGNOSIS
KEPERAWATAN
SLKI SIKI
EBN
Ketidaknyama
nan Pasca
Partum b.d
Trauma
perineum dan
kondisi pasca
persalinan d.d
Nyeri pasca
persalinan
Status Kenyamanan Pasca
Partum
Setelah dilakukan tindakan
keperawatan 1x24 jam
Status Kenyamanan Pasca
Partum meningkat dengan
kriteria hasil :
- Keluhan tidak nyaman
menurun
- Meringis/ merintih
menurun
- Luka episiotomi/laseerasi
membaik
- Payudara bengkak
menurun
- Frekuensi nadi membaik
Manajemen Nyeri
Observasi
- Observasi karakteristik nyeri
Terapeutik
- Berikan teknik non farmakologis untuk
mengurangi nyeri (relaksasi, aromaterapi
dan kompres dingin)
Edukasi
- Jelaskan strategi mengurangi nyeri
- Ajarkan teknik non farmakologis
mengurangi nyeri
Kolaborasi
- Kolaborasi analgetik, jika perlu
Perawatan Pasca Persalinan
Observasi
- Monitor TTV ibu
- Monitor karakteristik Lochea
- Periksa adanya laserasi perineum
- Monitor nyeri
Terapeutik
- Dukung ibu melakukan mobilisasi
Edukasi
- Ajarkan cara perawatan perineum
(selalu menjaga area genital tetap
bersih, mencuci dengan air dingin,
mengganti pembalut dan celana tiap 4
jam)
Kolaborasi
Puteri, Risa
Ersivitasari and Wahyuni,
Endah Sri and Fatmawati,
Siti (2020)
Teknik Relaksasi Nafas Dalam
dan Aromaterapi Lavender
Untuk Mengurangi Nyeri
Perineum Pada Ibu Post
Partum
Dalam jurnal tersebut
dijelaskan bahwa Hasil
penelitian menunjukkan
bahwa setelah memberikan
asuhan keperawatan dengan
memberikan teknik relaksasi
nafas dalam dan aromaterapi
didapatkan bahwa nyeri yang
dirasakan oleh dua ibu
primipara menurun dari skala
nyeri 2 menjadi 0.
Berdasarkan hasil penelitian
ini diharapkan dapat
memberikan pemahaman
bagi ibu primipara. Ibu
tentang tindakan non
farmakologis dalam
mengatasi nyeri merupakan
teknik relaksasi nafas dalam
yang efektif mengatasi
ketidaknyamanan pasca
melahirkan.
54. Nursing Care Plan
M
Menyusui Tidak
Efektif
Status Menyusui
Setelah dilakukan tindakan
keperawatan selama 2x24 jam
Status Menyusui meningkat
dengan kriteria hasil :
- Perlekatan bayi pada
payudara ibu meningkat
- Kemampuan ibu
memposisikan bayi
dengan benar meningkat
- Miksi bayi lebih dari 8x
sehari
- Pancaran ASI meningkat
Edukasi Menyusui
Observasi
- Identifikasi keinginan dan tujuan menyusui
Terapeutik
- Jadwalkan pendidikan keseahtan
- Berikan kesempatan untuk bertanya
- Dukung ibu meningkatkan keperacyaan diri
Edukasi
- Berikan konseling menyusui
- Jelaskan manfaat menyusui bagi ibu
- Ajarkan 4 posisi menyusui dan perlekatan dengan
benar
- Anjurkan perawatan payudara postpartum
(memerah ASI, pijat payudara dan pijat oksitosin
Pendampingan Proses Menyusui
Observasi
- Monitor kemampuan ibu menyusui
- Monitor kemampuan bayi menyusu
Terapeutik
- Dampingi ibu selama proses menyusui
berlangsung
- Dampingi ibu memposisikan bayi secara benar
untuk menyusui
- Diskusikan masalah selama menyusui
Edukasi
- Ajarkan ibu tanda-tanda bayi siap menyusu
- Ajarkan ibu mengolesi asi pada puting sebelum
dan sesudah menyusui
- Ajarkan ibu cara mengarahkan putih ke mulut
bayi
- Ajarkan ibu cara memposisikan bayi
- Ajarkan perlekatan dnegan benar
Evi Rinata, Tutik Rusdyati, Putri
Anjar Sari (2016)
Teknik Menyusui Posisi, Perlekatan
Dan Keefektifan Menghisap - Studi
Pada Ibu Menyusui Di Rsud
Sidoarjo.
Dalam jurnal tersebut dijelaskan
bahwa Masalah payudara ada
hubungan signifikan dengan
perlekatan (P=0,000). Usia gestasi
ada hubungan dengan perlekatan
(P=0,001) dan keefektifan
menghisap (P=0,000). Simpulan
pada penelitian ini yaitu tidak ada
hubungan antara usia ibu, dengan
teknik menyusui. Ada hubungan
antara paritas, pendidikan, status
pekerjaan, masalah payudara, usia
gestasi dengan teknik menyusui.
Diharapkan petugas kesehatan
meningkatkan pemberian
informasi, bimbingan,
pendampingan, dan dukungan
secara optimal kepada setiap ibu
menyusui, sehingga dapat
mencapai keberhasilan menyusui.
55. Readiness
to increase
to become
parents
Setelah dilakukan asuhan
keperawatan selama 1 x 24 jam
diharapkan Peran menjadi orang
tua membaik dengan kriteria
hasil :
- Keinginan meningkatkan
peran menjadi orang tua
meningkat dari yang
menginginkan dibimbing
oleh orang tua saja menjadi
ingin mendapatkan
informasi dari bidan atau
tenaga kesehatan untuk
menjadi seorang ibu.
Edukasi orang tua : Fase Bayi :
- Identifikasi pengetahuan orang
tua dan kesiapan orang tua
belajar tentang perawatan bayi
- Motivasi orang tua untuk
sering membaca buku atau
internet terkait bayi dan
menjadi orang tua yang baik.
- Jelaskan kebutuhan nutrisi
bayi
- Jelaskan keamanan dan
pencegahan cedera pada bayi
- Anjurkan menyentuh,
memeluk, mengajak bayi
berbicara , dan bermain
dengan bayi.
Ratnawati, A., &
Afiyanti, Y. (2014).
Efektivitas Edukasi
Postpartum
terhadap
Pencapaian Peran
Orangtua pada
Primipara. Jurnal
Teknologi
Kesehatan, 10(2),
63-67.
Dalam jurnal ini
mengatkan bahwa
edukasi post
partum pada ibu
sangat bermanfaat
untuk
mengembangkan
kemampuan
menjadi ibu.
56. IRK → Breasfeeding
• Para ibu hendaklah menyusukan anak-anaknya selama dua tahun penuh, yaitu
bagi yang ingin menyempurnakan penyusuan. Dan kewajiban ayah memberi
makan dan pakaian kepada para ibu dengan cara ma´ruf. Seseorang tidak dibebani
melainkan menurut kadar kesanggupannya. Janganlah seorang ibu menderita
kesengsaraan karena anaknya dan seorang ayah karena anaknya, dan warispun
berkewajiban demikian. Apabila keduanya ingin menyapih (sebelum dua tahun)
dengan kerelaan keduanya dan permusyawaratan, maka tidak ada dosa atas
keduanya. Dan jika kamu ingin anakmu disusukan oleh orang lain, maka tidak ada
dosa bagimu apabila kamu memberikan pembayaran menurut yang patut.
Bertakwalah kamu kepada Allah dan ketahuilah bahwa Allah Maha Melihat apa
yang kamu kerjakan. (Q.S.al-Baqarah :233)
57. References
• American Academy of Pediatrics and American College of Obstetricians and Gynecologists.
(2007). Guidelines for perinatal care (6th ed.). Washington, DC: Author.
• https://nursekey.com/12-postpartum-assessment-and-nursing-care/
• Cooper, M., Grywalski, M., Lamp, J., Newhouse, L., & Studlien, R. (2007). Enhancing cultural
competence: A model for nurses. Nursing for Women’s Health, 11(2), 148-159.
• Cunningham, F., Leveno, K., Bloom, S., Hauth, J., Gilstrap, L., & Wenstrom, K. (2015).
• Pilliteri, A .(2017). Maternal and child health nursing: Care of the childbearing and childbering
family 6th ed. Philadephia: Lippincott
• Reeder, Martin, Koniak – Grifin. (2003). Keperawatan Maternitas: Kesehatan wanita, bayi dan
keluarga volume 1 edisi 18. Buku terjemahan ( Afiyanti Yati, Rachmawati Imami Nur,
Djuwitaningsih Sri, Penterjemah). Jakarta: EGC buku asli di terbitkan pada tahun 1997
• Ricci, Susan Scott. (2013). Essentials of Maternity, Newborn and Women’s Health Nursing. 2nd
. China: Lippincott William & Wilkins
• Attilakos, G., & Overton, T. G. (2012). Antenatal care. In D. K. Edmonds (Ed.), Dewhurst’s
textbook of obstetrics & gynaecology (6th ed., pp. 42–52). Oxford, United Kingdom:
Wiley.http://thepoint.lww.com/Flagg8e
