Information about Puerperium

Post partum period begins after delivery towards when reproductive tract returns to normal non-pregnant state.
Involution is the time when uterus returns to non-pregnant state.

weight of uterus reduced from 2 lbs to 2 oz
endometrium regenerates
fundus descends into pelvis; fundal height decreases about 1 cm per day; by 10th day post partumly, fundus cannot be palpated abdominally.

Other Events during Puerperium

1. Cervix and Vagina

the muscles of cervix after a week regenerates
external os remains wider
internal os is closed after a week
vaginal distention decreases
vaginal rugae reappeared by third week
lacerations or episiotomy suture line gradually heal

2. Ovarian function and Menstruation

dependent on how pituitary functions
menses returns within 8 weeks to non-breastfeeding women and 3-4 months for breastfeeding mothers
breastfeeding mothers may experience amenorrhea
woman may ovulate without menstruating

3. Breast

continue to secrete colostrum
breasts become distended with milk on third day
engorgement 48-72 hours in non-breastfeeding clients

4. Urinary Tract

urinary retention may be experienced as a result of loss of elasticity and tone and loss of sensation from drugs, trauma or loss of privacy
diuresis will be experienced within first 12 hours after delivery
kidney function returns to normal easily

5. Gastrointestinal

client will feel extremely starve after delivery
constipation is occurring due to loss of tone and perineal tenderness
hemorrhoids are common but eventually subsides

6. Vascular System

WBC increases during labor and delivery, as well as early post partum period; then return to normal after few days
Hemoglobin and RBC decreased and return to normal value after a week
elevated fibrinogen levels during first week postpartum and contribute to thrombophlebitis
blood volume is back by third week

7. Vital Signs

temperature may be elevated to 100.4 F (38 C) during first 24 hours after delivery without pathologic condition
bradycardia is usual for a week about 50-70
blood pressure must be unchanged

Rubin's Postpartum Emotional Phases
1. Taking-in phase - for 2-3 days

basic and primary needs of mothers are their own - food, water, clothing, sleep
mother becomes attention seeker: she always talk about her experience during labor and delivery. The nurse should be good listener in interpreting these events
not good time for health teachings

2. Taking-hold phase - usually for 3 days to 2 weeks but it varies in every women

mother is sensitive in doing the "mothering" role right
mother is more in control of her emotions
best time for health teachings

3. Letting-go phase - varied

mothers may grieve over the separation of the baby from her body
may display dependent-independent behaviors where she wanted to feel secure while making decisions
time when post-partum blues may develop
time when bonding process is facilitated and parenting skills are enhanced

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