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Role Transition: Labor & Delivery (L&D): Postpartum Care

The postpartum period begins with the expulsion of the placenta and continues until the maternal reproductive organs have returned to their normal, nonpregnant stateThis period varies for each patient as the maternal systems continue to change during the first 6 weeks after birth.

During the postpartum period, the uterus undergoes involution and other maternal reproductive organs return to their nonpregnant state. In addition, the breasts and the cardiovascular, respiratory, endocrine, urinary, gastrointestinal, integumentary, musculoskeletal, neurologic, and immune systems also must go through multiple changes.

Assessment: Postpartum Patients

Postpartum Assessment Video

Postpartum Mood and Anxiety Disorders (PMAD)

While all postpartum complications can result in psychosocial implications, some have more psychosocial impact than physical alterations. Postpartum mood and anxiety disorders (PMAD) that occur after birth can have a significant impact on the postpartum patient, their family, and infant attachment. People with a previous mental health condition are at greater risk to develop a PMAD and need close monitoring and additional support during the postpartum period.
Fast Facts for the Antepartum and Postpartum Nurse

The APA proposes that postpartum psychiatric disorders be considered as one condition with three subclasses:

  • adjustment reaction with depressed mood
  • postpartum major mood episodes (also known as Postpartum Depression / PPD)
  • postpartum mood episodes with psychotic features.

According to the National Institute of Mental Health, signs and symptoms of PPD include:

  • hopelessness, sadness, and mood swings
  • irritability, anger, and feelings of being overwhelmed
  • isolation
  • sleep impairment
  • poor appetite
  • inability to concentrate or make decisions
  • loss of interest in pleasurable activities
  • disinterest in caring for the baby
  • difficulty maintaining relationships
  • physical pain and muscle aches.

Mothers experiencing PPD frequently question their ability to care for their babies. In extreme circumstances, they can have thoughts of harming themselves and/or their babies.

Nursing interventions can include:

  • Provide anticipatory guidance regarding the realistic demands and lifestyle changes associated with parenthood.
  • Encourage patient to identify personal support systems.
  • Educate patient about signs and symptoms of PPD.
  • Teach them how to recognize suicidal ideation.
  • Instruct them about the prescribed medication regime.
  • Provide emotional support for patient and their family.
  • Make a referral for home visits and individual or group therapy.
  • Maintain communication through regularly scheduled phone calls.

Nursing Made Incredibly Easy

Postpartum Complications

Postpartum care general concerns

  • Vaginal soreness
  • Vaginal discharge
  • Contractions
  • Incontinence
  • Hemorrhoids and bowel movements
  • Tender breasts
  • Hair loss and skin changes
  • Mood changes
  • Weight loss

According to the CDC, from 2011 to 2014 the most common causes of pregnancy-related deaths were:

  • Cardiovascular diseases
  • Other medical conditions often reflecting pre-existing illnesses
  • Infection or sepsis
  • Excessive bleeding after giving birth (hemorrhage)
  • A disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body (cardiomyopathy)
  • A blockage in one of the pulmonary arteries in the lungs often caused by blood clots that travel to the lungs from the legs (thrombotic pulmonary embolism)
  • Stroke
  • High blood pressure (hypertensive) disorders of pregnancy
  • A rare but serious condition that occurs when amniotic fluid or fetal material, such as fetal cells, enters the mother's bloodstream (amniotic fluid embolism)
  • Anesthesia complications

Breastfeeding

Additional Postpartum Resources