Chapter 9: The Family After Birth

Known as postpartum period6 weeks following childbirth, sometimes refereed as the 4th trimester of pregnancy

AdolescentsSingle WomanFamilies at or below the poverty levelFamilies who have twins or more

The nurse must adapt care to fit health beliefs Values PracticesUse an interpreter where appropriate:This should not be a family member or in cultural religious conflict with the patient family practice

Uterus: involutionLochia : Rubra, Serosa, AlbaCervixVagina: when to resume vaginal intercourse postpartum discussing this issue with her health care providerPerineum: Episiotomy :REEDA assessment: Nursing care and patient teaching: cold packs, topical and systemic, medications, nonpharmalcologic, pain relief methods

Typically resumes in 6 to 8 weeks, if not breastfeeding. Return of ovulation is delayed if breastfeeding, however it can occur at any time after birth and pregnancy is possible.
Breast: engorgement and nursing care

Cardiac output and blood volumecoagulationblood valueschillsorthostatic hypotensionnursing care

A full bladder can displace the uterus and lead to postpartum hemorrhagethe woman who voids frequent, small amounts of urine many have increased residual urine because her bladder does not fully emptyresidual urine in the bladder may promote the growth of microorganisms

Constipation: help alleviate this problem, encourage women to increase fluid and fiber intake, increase activity suck as walking

Hyperpigmentation of the skin changes as hormone levels decrease: linea nigra disappears, striae fade to silver

Diastasis recti, hypermobility of the joints, exercises : abdominal muscle tightening, head life, pelvic tilt, kegel

Prenent blood incompatibilities and inflection: RhoGAM if women is Rh negative and baby is Rh positive, Give mother immunization for Rubella if not immune

Same as with normal vaginal delivery except:monitoring of abdominal dressing, urinary catheter, respiratory care, prevention of thrombophlebitis, interventions for pain

The birth of an infant brings about physical changes in the mother but also causes many emotional and relationship changes in all family members

Pubin's Psychological changes of the Puerperium pg. 211: phase 1: taking in, phase 2: taking hold, phase 3: letting go. Postpartum blues, postpartum depression, fatigue

Engrossment, 4 phases of adjustment, having expectations and personal intentions, confronting reality and overcoming frustrations, creating one's own personal father role, reaping rewards of fatherhood