• Taking in
• Taking hold
• Letting go (taking over)

• Focus on self (not infant)
• Depends on others for help 
• Needs assistance
• Difficulty making deicions
• Comfort-rest-food--> paramount !
• Relives delivery experience (talk, pictures, etc.)
• Lasts several hours or 2-3 days

• Move from dependent to independent
• Increased energy
• Increased focus on infant
• Self care, focus on bowels, bladder, breastfeeding
• Responds to instruction and praise
• Lasts 2 days - 1 week

• Giving up previous role (new mom !)
• Sees self as separate from infant
• Gives up fantasy delivery and fantasy baby
• Readjusts to change in roles
• Depression and grief work (if needed)
• From week 1 onwards !

Sensitive period in first few minutes to hours when parents must have close contact with infant for later development to be optimal 

Depends on situation; NICU babies will not necessarily be impacted negatively

Physical and emotional experience of the parents being close to their infant

Infant can see face when 12 inches or closer away from parent

• Refusal to interact/ care for baby
• Disappointment expressed over baby's sex
• Sees baby as messy or unattractive
• Baby reminds mom of someone she doesn't like
• Doesn't incorporate infant into her life

• Sleepy, eyes closed most of the time
• Crying constantly (colicky)
• Feeds poorly, vomits often
• Resists holding/ cuddling by stiffening body (due to pain, brain injury, withdrawl)
• Unresponsive to parents' approaches

• Experienced by up to 80% of women
• Hormones and exhaustion may be causes
• Assure mom that this is normal and explain to her that it may occur before discharge

• Return of uterus to normal size and condition (returns to prepregnant state)
• Starts immediately after birth of placenta
• Due to uterine contractions

• Immediately after birth: halfway b/w umbilicus and symphysis pubis
• One hour after birth: 1 cm above umbilicus
• 24 hours: at level of umbilicus
• Each day thereafter: decreases 1 cm each day
• 10th-14th day PP: no longer palpable; withdrawn into pelvis

• At birth: 1000 g
• End of 1st week: 500 g
• End of PP: 50 g

• Cramp-like pains due to contractions after birth
• More acute with:
• Pitcoin or breastfeeding
• More common with:
• Multipara, large baby, or multi-gestation (twins)

• Pitocin (most common !)
• Methergine
• Prostaglandins

• Exfoliation--growth of endometrium from bottom to top
• Scars prevented to help with future gestations
• Returns to normal by 6 weeks PP

• Not breastfeeding:
• 1 month (27 days)
• Breastfeeding:
• 6-8 weeks or more

Blood flow postpartum

Made of blood, fragments of the decidua (mucous layer in uterus in pregnancy), WBCs, mucus, and some bacteria

Bright red, fading to pinkish over time

Lasts 3-4 days

4th day PP through 10th-14th day

Pinkish brown, becoming whiter as time goes on

From 10th/14th day through 4th-8th week PP

Becomes colorless with time

• Scant: 1-2" stain on pad
• Light: 3-4" stain
• Moderate: 4-6" stain
• Heavy: saturated

• Lochial:
• Trickles from vaginal opening (introitus)
• Steady flow, increases with uterine contractions
• Non Lochial:
• Bloody discharge spurting from the vagina
• Indicates cervical or vaginal tears 

• Ambulation
• Gush upon standing up after pooled in vagina (not hemorrhage !)

• Breastfeeding
• Pitocin administration
• After C-section birth (due to suctioning of uterus during surgery)

External os--size of a pencil and firm by 7th day PP (never completely closes and becomes slit-like, not round)

Internal os--closes completely by 5th day PP

Takes entire PP period (6 weeks) to return to pre-pregnancy state

Kegal exercises speed up this process

Encourage use of water-soluble lube during sex (may experience dryness)

Slightly change but never fully return to pre-pregnant state

Remain atrophic and softened

Hygiene is top priority !!

Instruct mom NOT to scratch ! (will feel itchy)

Often occur during delivery

Witch hazel wipes, creams, etc. will help ease pain

• Pain relief (administer meds as ordered)
• Ice packs--first 24 hours at least
• Promote perineal cleansing and exercises
• Cold and hot therapy
• Sitz baths

• Breastfeeding:
• Soft--> firm--> engorged in 2-3 days
• Colostrum--> milk in 2-3 days
• Non-breastfeeding:
• Colstrum lasts 2-3 days
• Engorgement possible, decreases in 24-36 hours
• Avoid nipple stimulation (will produce more milk)

• hCG and HPL undetectable by 24 hours PP
• Estrone and estradiol at pre-pregnancy level by 1 week PP
• FSH low for about 12 days then rises to initiate menstrual cycle
• Faster in non-breastfeeding moms

• Continues to rise during pregnancy, peaks when breastfeeding
• Highest in 1st month PP, elevated during breastfeeding

• Decreased sensation to void (encourage q2h)
• Ureters larger--> return to normal 4 weeks PP
• Urinary stasis and UTIs more common !

• Blood volume--> returns to normal 1-2 weeks PP
• H&H return by 6 weeks PP
• Plasma fibrinogen remains elevated during PP period
• Increased WBCs
• Varicosities recede slightly
• CO remains elevated for 48 hours

• Immediately after birth--> very hungry and thirsty !
• Hemorrhoids common
• Decreased bowel activity (due to relaxin)
• Painful BMs due to lacerations or hemorrhoids

• Chloasma disappears
• Striae get smaller and lighter but do not disappear
• Pigmentation of areola and linea nigra may decrease but not disappear
• Hair growth slows, can cause hair loss 

• Temperature elevated right after birth
• 100.4 or greater indicates infection, less is normal
• Pulse slightly decreased
• BP returns to normal baseline

• Colostrum produced for first 2 days
• 3rd day, milk forms
• Primary engorgement
• Continuation depends on nipple stimulation

• Vital signs
• Bladder palpation
• Urinary output: color, odor (may be pink tinged from lochia)
• Incision
• Lochia: amount, odor, color, clots

• Normal due to excitement, reversal of events, tension, hormonal shift, internal temperature higher than external b/c of exertion
• Provide warmed blankets !
• If last longer than 10 minutes, consider other causes

• Every 15 min for 1st hour PP
• Use side of your hand while supporting base at symphysis pubis
• Document position and consistency
• If off midline, have patient void then reassess

• General aches and pains
• Tylenol or analgesics
• Lacerations
• Ice
• Medication

• Handwashing
• Cleaning perineal area regularly (use peri bottle)
• Sitz baths

• Discuss bleeding, infection
• Emotional response
• Support systems necessary
• Normal to feel overwhelmed
• Discuss PP blues

• Recommended that women wait 6 weeks
• Risk of hemorrhage and infection minimal at 2 weeks
• Contraception 
• May be ovulating before they get a period
• If they do not want to get pregnant again, must use contraceptive immediately !

• What they are
• What they're for
• Possible side effects

• Vaginal delivery--> 6 weeks
• C-section--> 2 weeks
• Newborn first visit--> 2 weeks

• Promote:
• Rest (sleep when the baby sleeps !)
• Fluid intake (increase if breastfeeding)
• Urinary elimination (try at least q2h)
• Prevent constipation and hemorrhoids
• Fiber-rich foods
• Witch hazel pads, creams

• Breast
• Uterus
• Bladder
• Bowels
• Lochia
• Episiotomy
• Hormones
• Emotions/ Bonding

• Give PP to non-immune women
• If titer < 1:8 or EIA level < 0.8
• If titer is positive, warn her against pregnancy for at least 3 months