Essentials of Maternity, Newborn, and Women's Health Nursing

CHAPTER 15: Postpartum Adaptations

Case 1

You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises.

I. While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process?

Did not answer the question as askes.. this is good info but not physiology.

 After child birth, there are postpartum changes that occur in the body to return it to how it was before the pregnancy. One of those processes in contraction of the uterus so that it can return to normal. The uterus will change in size from 1kg to sixty – eighty grams for a period of six weeks. The fundus will contract down towards the pelvis for 1cm everyday. After two weeks of such contractions, the uterus will have contracted and returned into its normal place before pregnancy (Susan et al., 2016). However, sometimes the uterus may not contract as required and this can be caused by; prolonged labor, prolonged use of oxytocin, precipitous labor, chorioamnionitis, and uterine distension. 

II. Linda wants to know how long she should expect to bleed. What would you tell her?

III. Stages of Lochia/

Postpartum bleeding varies from one person to another. However, generally Linda should expect heavy bleeding to last up to ten days then after that she might experience spotting or light bleeding up to four to six weeks after the day of delivery. During this time, the body is getting rid of all the tissues and blood that it used for nourishment of the baby because it does not need them anymore. 

IV. The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role?

Linda is going through the Taking-In Phase. This is the phase where the woman reflects about her delivery experience and is also passive. The woman most of the times prefers to talk about her pregnancy, labor and childbirth experiences. Linda will still go through Taking Hold Phase where she will begin making decisions on her own, and the Letting Go Phase where she will finally accept her new role of being a mother. 

Case 2

Gretta and Sam just had their first child. Gretta is excited and talkative about her birth experience and wants to keep her baby with her constantly. She tells you his name is Joseph and they will call him “Joey” for short. Gretta is breast-feeding and is attentive to Joey’s needs. You observe that Sam does not initiate contact with the baby but when Gretta insists that he hold Joey, he picks him up slowly and awkwardly and stares at his face for a long period of time. When Joey cries, he immediately returns him to Gretta’s arms.

i. Based on your observations of Sam’s interactions with Joey, relate where Sam is developmentally in the process of paternal attachment and bonding.

Sam might be going through paternal perinatal mood and anxiety disorders. Fathers may develop this disorder after their baby is born especially if they are new dads. Sam does not have any interest in parenting not even helping his wife with the baby. He does so when forced to and whenever the baby cries, he gets worse and cannot handle a crying baby. Just like PPD in women who have just given birth, the condition can disappear with time. Sam needs therapy to help him create a bond with his child and embrace fatherhood (Segre et al., 2016). 

ii. What nursing interventions could you implement that would assist Sam in the transition to fatherhood?

As a nurse, I would enroll Sam for improved, father focused postnatal program. This will help him to deal with her current problem and learn how to bond and develop natural attachment to his baby (Susan et al., 2016). Also, I would encourage him to read materials that have father-focused postnatal content and interact with other fathers and share ideas on fatherhood. This will help him transition well to fatherhood.

References 

Segre, L. S., O'Hara, M. W., & Perkhounkova, Y. (2016). Adaptations of psychotherapy for psychopathology during pregnancy and the postpartum period.

Susan S. R., Terri, K., & Susan, C. (2016). Maternity and Pediatric Nursing, Second Edition ISBN: 978-1-60913-747-2