Decreased estrogen levels

Snug bra, binder, ice, cabbage leaves

Do not express milk or stimulate the nipples

If pain is bad can use OTC pain relievers

• Temp- may increase to 38^o C (100.4^o F)
• Pulse- will return to normal with in a few days post partum
• Respiration- return to normal 6 to 8 weeks after birth
• BP- Orthostatic hypotension with in first 48 hours possible; may be slightly altered after birth but not always

• Uncomplicated pregnancy, labor, vaginal birth, and postpartum course
• No evidence of premature rupture of membranes
• Blood pressure and temperature stable and within normal limits
• Ambulating unassisted
• Voiding adequate amounts without difficulty
• Hemoglobin greater than 10
• No significant vaginal bleeding:  perineum intact or no more than second degree episiotomy or laceration repair; uterus is firm
• Received instructions on postpartum self management

• Term infant (38 to 42 weeks) with weight appropriate for gestational age
• Normal findings on physical assessment
• Temperature, respiration's, and heart rate within normal limits and stable for the 12 hours preceding discharge
• At least two successful feedings completed (normal sucking and swallowing)
• Urination and stooling have occurred at least once
• No evidence of significant jaundice in the first 24 hours after birth
• No excessive bleeding at the circumcision site for at least 2 hours
• Screening tests performed according to state regulations, test to be repeated at follow up visit id done before the infant is 24 hours old
• Initial hep B vaccine given or scheduled for first follow up visit
• Laboratory data reviewed;  maternal syphilis and hep B status; infant or Cord blood type an Coombs' test results if indicated

• No social, family, or environmental risk factors identified
• Family or support person available to assist mother and infant at home
• Follow up scheduled within 1 week if discharged before 48 hours after birth
• Documentation of skill of mother in feeding (breastfeeding or bottle feeding), cord care, skin care, perineal care, infant safety, and recognizing signs of illness and common infant problems

Breasts

Uterus

Bowels

Bladder

Lohia

Episiotomy/Laceration/Incision

-

Extremeties

Emotions

• Days 1-2: soft
• Days 2-3: filling
• Days 3-5: full, soften with breastfeeding (milk is "in")

Days 1-2: Firmness, heat, pain: engorgement

Days 3-5: Redness of breast tissue, heat, pain, fever, body aches: mastitis

Abdomen soft, active bowel sounds in all quadrants; Bowel movement by day 2 or 3 after birth

Cesarean; incision dressing clean and dry; suture line intact

No bowel movement by day 3 or 4; constipation; diarrhea

Abdominal incision (cesarean)- redness, edema, warmth, drainage; infection

Able to void spontaneously; no distention; able to empty completely; no dysuria

Diuresis begins ~12 hours after birth; may void 3000 ml/day

Overdistended bladder possibly causing uterine atony, excessive lochia

Dysuria, frequency, urgency; infection

Minimal edema

Laceration or episiotomy; edges approximated

Pain minimal to moderate; controlled by analgesics, nonpharmacologic techniques or both

Pronounced edema

Bruising

Heamtoma

Redness, warmth, drainage; Infection

Excessive discomfort first 1-2 days; hematoma; after day 3: infection

Always wipe from front to back

Change peri pad from front to back every time visiting the restroom

Proper education on sqeeze bottle use

• Respirations
• Pulse
• Skin Condition
• Urinary output
• LOC

• Epidural anesthesia
• Episiotomy
• Extensive vaginal or perineal lacerations
• Instrument assisted birth
• Prolonged labor 

Injections of Rh immune globulin would be given within 72 hours after birth to prevent sensitization in the Rh-negative woman who had a fetomaternal transfusion of Rh-positive fetal red blood cells.  Rh immune globulin promotes lysis of fetal Rh-positive blood cells before the mother forms her own antibodies against them

• Pelvic rest
• Limit stair climbing for two weeks
• May shower or bathe
• Lift nothing heavier than baby for 6 weeks
• Provide education about contraceptives

Greater than 500 ml of blood loss in a vaginal delivery or greater than 1000 ml of blood loss in a cesarean birth.

Also a 10% change in hct levels between admission for labor and pp or the need for erythrocyte transsfusion alo has been used to define PPH.

• Uterine Atony
• Anesthesia and analgesia
• Previous history of uterin atony
• High parity
• Prolonged labor, oxytocin induced labor
• Trauma during labor and birth
• Unrepaired lacerations of the birth canal
• Retained placental fragments
• Ruptured uterus
• Inversion of the uterus
• Placenta accreta, increta, perreta
• Coagulation disorders
• Placental abruption
• Placental previa
• Manual removal of retained placenta
• Mag Sulfate admin during labor or the pp period
• Choriamnionitis
• Uterine subinvolution

Laceration that extends through musxles of the perineal body

If the uterus fails to respont to oxytocin, a 0.2 mg dose of ergonovine (Ergotrate) or methylergonovine (Methergine) mayu be given IM to produce sustained uterine contractions.  More commonly though 0.25 mg dose of a derivatie os prostaglandin

F₂ α (carboprost tromethamine [Carboprost; Hemabate]) IM is given.  It can also be given intramyometrially at cesarean birth or intraabdominally after vainal birth.  Prostaglandin E₂ (Dinoprostone) 20 mg vaginal or rectal suppository and rectal (80 to 1000 mcg) administration of misoprostol (Cytotec) also are used.