Postpartum Nursing [+ Free Cheat Sheet] | Lecturio Nursing (2024)

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Video: How the body changes after pregnancy

Endocrine postpartum changes

• Prolactin levels remain elevated in breastfeeding clients. Non-lactating clients’ levels return to normal by 3 weeks.
• Ovulation may occur as soon as 45 days (non-lactating clients) or be delayed until 6 months (breastfeeding clients).

Hematologic postpartum changes

• Hematocrit levels drop up to 4 days postpartum, stabilizes by 8 weeks.
• WBC count up to 30,000/mm³ can be normal.
• Coagulation and fibrinogen levels remain increased 2–3 weeks postpartum.

Musculoskeletal postpartum changes

• Rectus abdominal muscles return to normal by 6 weeks postpartum.
• Pelvic floor muscle returns to normal by 6 weeks postpartum.

Gastrointestinal postpartum changes

• Increased appetite after delivery
• Bowel movement may be delayed 2–3 days.
• Breastfeeding clients need an additional 300–500 calories per day to support lactation.

Reproductive postpartum changes

• Breasts: colostrum present first 3 days, then changes to mature milk stimulated by breastfeeding
• Non-breastfeeding clients should avoid any breast stimulation. Milk production may take several days, up to several weeks, to stop.
• While breast engorgement can be normal postpartum, signs of mastitis require further evaluation and treatment.
• Uterus involutes 1 cm/day (non-palpable by 2 weeks postpartum).
• Cramping may be stronger in multiparous and breastfeeding clients.
• Cervix: os appears slit-like instead of circular, returns to 1 cm dilation by 1 week postpartum.
• Lochia is normal discharge that contains blood, mucus, and uterine tissue and may last up to 6 weeks postpartum.
  • Lochia rubra: bright red, days 1–3
  • Lochia serosa: pink, days 4–10
  • Lochia alba: white/yellow, days 11–6 weeks

Psychological postpartum changes

Transient moments of feeling anxious or overwhelmed are normal. Symptoms should resolve by 2 weeks postpartum. After this, evaluation for postpartum depression is needed.

Stages of adaptation:

• Taking in:
  • Typically occurs 1–3 days postpartum
  • Client focused on their own needs
  • Needs assistance from others, may be passive and dependent
• Taking hold:
  • Typically occurs 2–4 days postpartum
  • Client orients to taking care of infant
  • Client strives for independence and autonomy
• Letting go:
  • Typically occurs after day 4 postpartum
  • Client accepts infant’s dependence
  • Client releases previous identity as a childless person or parent of fewer children; feels hopeful
  • Risk for postpartum depression during this stage

Cardiovascular postpartum changes

• Plasma volume decreases by 1,000 mL.
• Bradycardia down to 40 bpm may be noted postpartum.

Renal postpartum changes

• Diuresis occurs after first 12 hours postpartum, up to 3,000 mL/day.
• Dilated ureters and renal pelvis returns to normal by 6–8 weeks postpartum.

Postpartum nursing diagnosis

Potential postpartum nursing diagnoses include:

• Acute pain related to perineal trauma, episiotomy, C-section, post-birth contractions
• Fatigue related to childbirth, body changes and new responsibilities
• Impaired urinary elimination related to trauma/swelling or anesthesia effects
• Risk for constipation related to hormonal changes, fear of pain with defecation, medications or anesthesia effects
• Postpartum depression
• Disturbed sleep pattern
• Impaired physical mobility
• Risk for hemorrhage
• Risk for infection
• Risk for impaired parent/infant attachment
• Risk for ineffective breastfeeding