ANGELES UNIVERSITYFOUNDATION

Angeles City

College of Nursing

NCM0107
CARE OF MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS)
First Semester, Academic Year 2021-2022
MODULE 6 CONTENT
POSTPARUM CARE

MODULE OVERVIEW

This self-instructional module is designed and prepared for BSN II students to

provide them with adequate knowledge and skills in preparing woman after delivery.
Postpartal period involves being certain not only that the woman and her baby are safe
but also that she knows how to maintain her health after returning home from a health
care facility. This module is all about the different aspects of care regarding involutional
changes that newly delivered woman experience and the prevention of possible
complications that may hamper normal recovery.

The postpartum period, also known as puerperium (from the Latin puer, "child,"
and parere, "to bring forth"), refers to the first six to eight weeks after delivery. This is a
time of maternal changes that are retrogressive (the involution of the uterus and vagina)
and progressive (the production of milk for lactation, the restoration of the normal
menstrual cycle, and the beginning of parenting role). Protecting the woman's health as
these changes occur is important for preserving future childbearing function and for
ensuring that she is physically well enough to help incorporate her new child into the
family. This period is popularly termed the fourth trimester of pregnancy.

The physical postpartum care a woman receives can influence her health for the
rest of her life. The emotional support she receives can influence the emotional health of
her child and family and can be felt into the next generation.

In this module you will spend 8 hours discussion and activities. Below are the details of
the content, the activities that you need to accomplish and estimated time of completion:

PART OF THE MODULE ESTIMATED TIME OF

COMPLETION
Pretest: 10 minutes
Video Conference: Reproductive System Changes 40 minutes
Video Viewing: Reproductive Changes 5 minutes
Video Conference: Systemic Changes 40 minutes

Video Conference: Psychological Changes 30 minutes

Asynchronous: Assessment Check: Concept Map 4 hours
Summative Evaluation: Quiz 30 points 30 minutes

Total learning hours: 8 hours

MODULE LEARNING OUTCOME:

1 |MODULE ON POSTPARTUM
Pursuant to the Commission on Higher Education (CHED) Memorandum Order No. 15,
the required policies, standards and guidelines in the nursing program parallels this
module’s aim to satisfactorily meet the following learning outcomes.
LO3: Assess mother, child, adolescent’s health status with the use of specific methods
and tools to address existing health needs. (PO2a)
LO5: Identify safe and quality nursing interventions addressing health needs affecting
women from pregnancy to postpartum and children from perinatal to adolescent stage.
(PO2c)
LO11: List appropriate evidence-based nursing care using a participatory approach
based on mother, child, adolescent preferences. (PO3a4)
LO12: Identify appropriate evidence-based nursing care using a participatory approach
based on mother, child, adolescent, and staff safety. (PO3a5)

Learning Objectives:

Upon completion of this module, the learner should be able to:

⮚ Identify changes that will happen in the reproductive system postpartum
⮚ Identify systemic changes that will happen postpartum
⮚ Identify nursing interventions specific for these postpartum changes
⮚ Identify nursing management for postpartum mothers
⮚ Identify psychological changes that happen postpartum
⮚ Differentiate post-partum blues, depression, and psychosis
⮚ Identify Nursing interventions for these psychological changes

This program is intended primarily for nursing students who already have background
knowledge in caring for the pregnant woman and the woman in labor and delivery. It may
also be used by graduate nurses and other health workers who may find the subject
matter relevant in their work. The reader is advised to read on Anatomical changes and
clinical manifestation in the postpartum woman before reading this module

PRETEST:
1. Return of reproductive organs to prepregnant state.
A. After pains
B. Puerperium
C. Involution
D. Taking-in phase

2. Cramp like pains due to postpartum uterine contractions

A. Afterpains
B. Involution
C. Postpartum blues
D. Puerperium

3. Tension in the breasts on the third postpartum day

A. Lactation
B. Engorgement
C. Milk fever
D. Taking-in

4. An overwhelming feeling of sadness that cannot be accounted for:

A. Puerperium
B. Postpartum blues
C. Postpartum Psychosis

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 D. Puerperium

5. Uterine discharge on the 1st 3 days postpartum

A. Lochia rubra
B. Lochia serosa
C. Lochia alba
D. Involution

6. Brownish/ pinkish uterine discharge from the 4 th to the 9th day postpartum:
A. Lochia rubra
B. Lochia serosa
C. Lochia alba
D. Involution

7. Whitish uterine discharge from the 10th day to the 3rd week postpartum:
A. Lochia rubra
B. Lochia serosa
C. Lochia alba
D. Involution

8. It is the 6-8 weeks after delivery:

A. Postpartum psychosis
B. Puerperium
C. Involution
D. Taking-In

9. Psychological phase during puerperium where the mother becomes concerned

with her own needs rather than the baby.
A. Taking-In
B. Taking hold
C. Letting Go
D. Involution

10. Psychological phase during puerperium is when the mother begins to develop a
strong interest in caring for her baby.
A. Taking-In
B. Taking hold
C. Letting Go
D. Involution
Note: If your score is 6 or higher, your understanding of postpartum is satisfactory. You
can continue with reading this module.

KEY TERMS: Please familiarize yourself with the following terms which will guide you in
understanding as you read the module for POSTPARTUM.

Puerperium
Involution
Lochia (rubra, serosa, alba)
Homan's sign
Engorgement
Taking-in phase
Taking-hold phase
Letting-go phase

DISCUSSION:

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 PHYSIOLOGIC CHANGES OF THE POSTPARTAL PERIOD

This section deals with the care of the newly- delivered woman as her
baby goes through the various involutional changes, using the following
goals of physical postpartum care as guidelines:

1. Promotion of healing and return to normal of the perineum and pelvic

structures.
2. Providing comfort and relief of pain
3. Prevention of infection of the bladder, the breasts, the uterus, and other body parts.
4. Establishment of successful lactation if the mother so desires.
5. Provision of emotional support.
6. Changes during involution may relate to the circulatory and renal systems,
gastrointestinal adaptation, nutritional demands, genital and breast modifications,
emotional concerns, and physical tolerance.

A. Reproductive System Changes

Involution - is the process whereby the reproductive organs

return to their non-pregnant state. The most dramatic changes during the postpartum
period are observed in the genital organs:

1. UTERUS - the organ is gradually reduced to its approximate pregestational size.

2 main processes:

a. The organ is reduced to its approximate pregestational stage:

Uterine involution is measured by finger breadths. On the first day postpartum
the fundus is one finger-breadth (1 cm.) below the umbilicus; on the second day,
2 fingerbreadths (2 cm.) below the umbilicus; on the third day, three finger-
breadths (3 cm.) below the umbilicus and so on and so forth until on the tenth
postpartum day it can no longer be palpated because it is already behind the
symphysis pubis. A sub-involuted uterus implied the presence of blood clots,
which are good culture media for bacteria, it is, therefore, a sign of puerperal
sepsis.
Weight of the uterus:
✔ Right after delivery: 1000 gms
✔ One week after delivery: 500 gms
✔ Two weeks after delivery: 300 gms
✔ Six weeks after delivery: 50-60 gms

Fundus:
✔ Assessed frequently for firmness, position, and height. It should be
checked after the bladder is emptied
✔ Palpate the fundus: Place the woman in a supine position with a small pillow
under her head and knees flexed to relaxed abdominal muscles. Palpate
by placing a hand at the umbilicus and pressing it down while the
another hand is placed just above the symphysis to support the lower
uterine segment.
If boggy:
a. Massage gently in a circular motion, the first action
b. Place the infant on the mother’s breast to stimulate uterine
contraction (released of oxytocin)
c. Administer oxytocin or increase infusion if BP is not above
140/90 mmHg
✔ Height of the fundus: Measure the position or height by using the umbilicus as a
landmark. Place fingers on the abdomen of the woman just below the umbilicus
and count the number of fingerbreadths that fit between the top of the fundus and
umbilicus. It descends one fingerbreadth per day.

4 |MODULE ON POSTPARTUM
b. The area where the placenta used to be implanted is sealed off, which is accomplished
by a rapid contraction of the uterus following placental delivery. These uterine
contractions cause cramp-like pains, which are called afterpains. Afterpains occur more
frequently in multiparas and in those who delivered large babies and twins because of the
over-distention of the uterus. It is also common among breastfeeding women because of
the release of oxytocin when the infant sucks. It is necessary for the nurse to explain that
afterpains are normal and rarely last for more than three days.

Nursing Management for AFTERPAINS:

1. Explain the cause and purpose
2. Keep bladder empty
3. Instruct to assume a prone position
4. Massage uterus gently
5. Administer analgesics

c. Immediately after delivery, the uterus casts off fragments of the decidua basalis, white
blood cells, mucus and blood and becomes fully cleaned by this sloughing process. This
uterine flow is called lochia.

Types of lochia Color Duration Composition

Lochia rubra Red 1-3 days - Blood, fragments of decidua, and mucus (first
our-may contain small clots)

Lochia serosa Pink or Brown 4-9 days - Blood, mucus, and invading
leukocytes

Lochia alba White 10 days- Largely mucus, high leukocytes (decreased

may last for the amount of lochia) 6 weeks
Estimation of blood loss:
✔ 1-inch stain after one hour: scant amount
✔ 2-4 inch stain after one hour: light amount
✔ 4-6 inch stain after one hour: moderate amount
✔ Fully saturated after one hour: heavy amount
Smell:
Like menstrual discharges

d. If the postpartum woman is not breastfeeding, menstrual flow may return within 8
weeks after delivery. If she is breastfeeding, menstrual flow may return in 3-4 months
time or, in some women may take the entire lactation period before menstruation
resumes. The absence of menstruation, though, is not a guarantee that she is not
capable of getting pregnant because although she is not menstruating, she may be
ovulating the absence of menstruation maybe her body's own way of conserving fluid for
lactation.

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 NURSING MANAGEMENT

a. Assess for the fundic height every 15 minutes for the first hour postpartum.
a.1. Be certain the bed is flat for uterine assessment, so the height of the uterus
is not influenced by an
elevated position.

a.2. Palpate the fundus of the uterus by placing a hand on the base of the uterus
just above the symphysis pubic and the other at the umbilicus.

a.3. Press in and downward with the hand on the umbilicus until you bump
against a firm globular mass in the abdomen - the uterus fundus.

a.4. Assess the fundic height and measure in finger breadths.

a.5. Never palpate the uterus without supporting the lower segment, as the
uterus potentially can invert if not supported this way and may lead to massive
hemorrhage.
b. Assess the fundus for consistency (firm, soft or boggy) and whether it is in the midline.

c. Palpate the fundus gently so as not to cause pain.

d. If the uterus is not firm on palpating, massage it gently with the examining hand.
Massage in a gentle rotating motion of the hand. It should never be hard or forceful. This
causes it to contract and become firm immediately.

e. Evaluate the uterus for height and consistency less frequently following the first hour
after delivery such as every hour for the next 8 hours, then once each shift.

f. Assess for lochia discharge every 15 minutes for the first hour, then once every hour
for the first 8 hours then every 8 hours. Observe for the character, amount, color, smell,
and presence of any clots by checking the perineal pad.

g. Upon discharge 3 days after delivery, provide the mother with teachings on how to
perform uterine assessment herself.

To further understand the local changes that happen postpartum

watch this 3-minute video:

Postpartum Care: Changes in Your Body After Delivery

2. CERVIX

a. Immediately following delivery, the cervix is soft and malleable.

b. Both the internal os and external os are well open.

c. Retraction of the cervix begins at once.

d. At the end of 7 days postpartum, the external os is narrowed to the size of a pencil
opening and feels firm and non-gravid again.

e. The process of involution in the cervix involves the formation of new muscle cells.

6 |MODULE ON POSTPARTUM
f. The cervix does not return exactly to its virginal state.

g. The internal os will close as before, however, if the mother delivers through the vagina,
the external os will usually remain slightly open and appear slit-like or stellate (star
shaped) where it was round before, this suggests that childbearing has taken place.

3. VAGINA

a. After childbirth, soft and swollen, with few rugae, with a greater diameter than
normal, the hymen is permanently torn.
b. Following vaginal delivery, the vagina is soft, few rugae are present, and its
diameter is considerably greater than normal.
c. It takes the entire postpartum period for the vagina to involute by contraction until
it gradually returns approximately to its non-pregnant state.
d. Thickening of the walls also appears due to renewed estrogen production from
the ovaries.
e. With breastfeeding wherein ovulation is delayed may continue to have thin-walled
or fragile vaginal cells causing slight bleeding during sexual intercourse until about
6 weeks time.
f. The vaginal outlet remains slightly more distended than before. If the woman
practices Kegel's exercises, the strength and tone of the vagina will increase more
rapidly.

4. PERINEUM
a. Following delivery the perineum responds by the development of edema and
generalized tenderness brought about by a great deal of pressure during
delivery
b. Ecchymosis may appear due to the rupture of surface capillaries.
c. Perineal muscles tone regained by 6 weeks
d. Labia majora and labia minora typically remain atrophic and softened in a
woman who has born a child.

e. Lacerations or episiotomy incisions may be present.

NURSING MANAGEMENT

a. Perineal care - the perineum seems to be the major focus of care during the early
postpartum period and this is because of the following reasons:

a.1. Lochia which is allowed to dry and harden on the vulva not only furnishes a
bed for bacterial growth and causes infection but also results in
discomfort and emits a foul odor.
a.2. In mothers who delivered vaginally, the perineum is the area that was
subjected to a great deal of pressure. This resulted in edema and
generalized tenderness and some portions may even show ecchymosis
because of rupture of surface capillaries.

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 a.3. Perineal stitches at the episiotomy site cause much discomfort since perineal
muscles are involved in many activities such as sitting, walking,
standing, squatting, bending, voiding, and defecating.

Perineal care should be done after each voiding or bowel movement and as
part of the daily bath, or as the mother wishes for her own comfort. In cleaning
the perineal area, warm water is poured gently over the perineum while cleansing
the labia with a clean gauze square or very soft washcloth, always washing from
front to back (from the pubic to rectum). In doing perineal care during the
postpartum period, the labia should not be extremely separated as this can cause
the solution to enter the vagina and could be a source of contamination. After
having dried the perineal area, the anal region is washed separately by turning the
mother onto her side. If the patient does the perineal care herself, she should be
told to wash her hands before cleansing the perineum.

b. Care of the Episiorrhaphy. This perineal discomfort when aggravated by the

presence of sutures from the episiorrhaphy causes a tugging sharp pain which
may interfere with rest and sleep, eating, and even in caring for the newborn.
Several nursing measures may be utilized to relieve pain and discomfort such as:

b.1. An ice bag applied to the perineum for the first 24 hours after delivery does a
great deal to reduce edema by means of vasoconstriction and thus
decrease tension on the suture line.
b.2. Exposing the perineum to a heat lamp after the first postpartum day helps
reduce edema by vasodilatation, promoting healing and providing comfort.
With the woman supine on the bed (in dorsal recumbent position) with
knees flexed and properly covered with linen, the heat lamp is placed
between her legs, about 12-16 inches away from the perineum, and left
in place for 20 minutes. This is done 3-4 times daily until healing has
taken place.
b.3. Place the patient in Sim's position to minimize perineal discomfort because it
reduces tension on the suture line.
b.4. Teach post-partum patients to contract the muscles of the perineal floor before
sitting down or standing up, to prevent tissues from being pulled apart.
b.5. Advise patients to use foam rubber rings to sit on to relieve perineal
discomfort.

c. Sexual Activity. In order to prevent infection and trauma to areas that have just
healed, sexual activity should be resumed only when lochia has stopped and
healing of the perineal area has occurred, which is about 4-6 weeks after delivery.
d. Post-natal clinic follow-up. The woman should go to a health center or see a
physician for an examination 6 weeks after delivery to assure herself that she is in
good health and has no problems from childbearing.

e. NSD mothers are allowed to ambulate 4-8 hrs after childbirth

reasons for early ambulation:
e.1. prevent constipation
e.2. Prevent circulatory problems e.g. thrombophlebitis
e.3. Prevent urinary problems
e.4. promote rapid recovery
e.5. hastens drainage of lochia
e.6. improves GI and urinary function
e.7. provide a sense of well being
f. Exercise:
Purpose:
f.2. promotes psychological well being
f.3. rapid return of woman’s figure
f.4. strengthen the muscle of the back, pelvic floor, abdomen
Exercises:
f.1. abdominal breathing: tighten abdominal muscles
f.2. Kegel: tighten the perineal muscle
f.3. Chin to chest: strengthen abdominal muscles

8 |MODULE ON POSTPARTUM
 f.4. Arm raising: return breast and abdominal muscle tone
f.5 Leg raising: tighten abdominal muscles
f.6. Sit-ups: tighten abdominal muscles

g. Nutrition:
g.1. high CHON, CHO, iron, Fiber, Calcium, and vitamins to promote wound
healing
g.2. For lactating additional 500 calories
g.3. daily intake of vitamins and iron supplements for 4-6 weeks postpartum is
recommended for breastfeeding mothers to ensure nutritious milk supply to the
infant

B. SYSTEMATIC CHANGES
1. Hormonal System
a. Pregnancy hormones begin to decrease as soon as the placenta is no
longer present.
b. HCG in urine is almost negligible by 24 hours.
c. Progestin, Estrone, and Estrodiol are at pre-pregnancy levels by one
week.
2. Urinary System
a. Pressure on the bladder and urethra as the fetus passes may leave
the bladder with a transient loss of tone and such edema surrounding the
urethra that results in difficult voiding.

b. A full bladder puts pressure on the uterus and may interfere with effective
uterine contractions.
c. Women who had epidural, spinal, or general anesthesia for delivery can feel
no sensation in the bladder area until the anesthesia has worn off.
d. In cases of poor bladder tone, some women retain a large amount of
residual urine following voiding which may result in bladder infection
since urine harbors bacteria.
e. Urinary volume rises from a normal level of 1,500 ml. to about 3,000 ml.
during the 2nd to 5th day after delivery, thus causes the bladder to fill
rapidly. This extensive diuresis begins to take place almost immediately
following delivery to get rid of the body fluid that accumulates
excessively during pregnancy.
f. The mother also experiences diaphoresis (excessive sweating), another way
by which the body gets rid of excess fluid.

NURSING MANAGEMENT

a. Assess the woman's abdomen frequently in the immediate postpartum

period to see where bladder distention is developing by:
a.1. Palpating a hard or firm area just above the symphysis pubis.
a.2. The uterine position is a good gauge of whether the bladder is full or
empty since a full bladder displaces the uterus.
a.3. On percussion, a full bladder sounds resonant in contrast to the dull
thudding sound of non-fluid-filled tissue.
b. Offer a bedpan or assist in a commode at intervals of 2-3 hours and
measure the amount of urine at each voiding until it has been established
that she is emptying her bladder completely.
c. If voiding is difficult, provide measures to encourage voiding such as
alternately pouring warm and cold water over the perineum, helping the
woman use the toilet seat, making her hear the sound of running water.
d. The first voiding after delivery should be measured to detect urinary retention.
If the woman is voiding less than 100 ml. at a time or has a displaced
uterus or palpable bladder, the physician usually orders catheterization
for residual urine. If the residual urine is over 150 ml. the catheter is left

9 |MODULE ON POSTPARTUM
 in place for 12-24 hours to give the bladder time to regain its normal tone
and to begin to function efficiently.

3. Circulatory System

a. The 30-50% increase in the total cardiac volume during pregnancy will be
reabsorbed into the general circulation within 5-10 minutes following
placental delivery, which implies a sudden increase in cardiac
workload.
b. The usual high level of circulating fibrinogen during the pregnancy
continues to be so during the first postpartum week, this is a protective
measure against hemorrhage; however this same condition encourages
thromboembolization.

c. All blood values of newly-delivered women are back to their prepregnant levels
by the third or fourth postpartum week.

d. Increased in the white blood cells count up to 30,000/mm

e. The woman continue to have increase level of plasma fibrinogen during the first
postpartal weeks.
f. Varicosities will recede but rarely will return to complete prepregnant
appearance.
g. Vascular blemishes, such as spider angina may fade slightly, in case may
remain.

NURSING MANAGEMENT

a. Monitor vital signs every hour during the first 4 hours postpartum, then every
four hours when stable.
b. Assess for adequate peripheral circulation by:

b.1. assessing the thigh for skin turgor.

b.2. assessing the presence of ankle edema and over the tibia on the
lower leg, observer for pitting edema.
b.3. assess for Homan's sign - it is done by dorsiflexing the foot and asking
her if she notices any pain in her calf. If there is pain in the calf
of her leg, it indicates that thrombophlebitis is beginning. DO NOT
MASSAGE THE AREA, it may cause circulatory emboli. This test
is done every shift or every 8 hours.

c. Encourage early ambulation (4-6 hours after delivery) to prevent bowel, bladder
or circulatory complication. Allow to dangle her legs on the edge of bed
for a few minutes the first time she is up to prevent feeling dizzy and assist
her in ambulating.

d. Encourage postpartum exercises like abdominal breathing and arm raising to

help strengthen the abdominal muscles, promote involution and a general
sense of well-being.
10 |MODULE ON POSTPARTUM
4. Gastrointestinal System

a. Digestion and absorption begins to be active soon after delivery.

b. Postpartum woman may feel thirsty and hungry from glucose used during labor.
c. There is delayed bowel evacuation during the immediate post-partum period
because of the following reasons:
- decreased muscles tone of the abdomen and intestines
- lack of food during labor and delivery
- dehydrating effects of labor and delivery
- fear of pain due to perineal tenderness (episiotomy) and presence of
hemorrhoids.
- enema administration during the first stage of labor.

NURSING MANAGEMENT

a. Provide a meal and encourage a postpartum woman to eat provided she is

not nauseated. Ideally, a postpartum diet should contain 2,500 to 2,600
calories per day and should be high in proteins, vitamins and minerals
needed for good tissue repair.

b. Encourage to increase fluid intake and roughage in her diet.

c. Administer mild laxatives or cathartic as prescribed if no bowel movement on
the third postpartum day.
d. Provide relief from hemorrhoid discomforts like:
- hot sitz bath, anesthetic sprays, witch hazel.
- gentle manual replacing of hemorrhoidal tissue.
- assuming Sim's position several times a day to provide good venous
return of the rectal area and to reduce discomfort.

5. Integumentary System
a. The stretch marks on the abdomen still appears reddened post-partum
and maybe even more prominent than during pregnancy.
b. Striae gravidarum may fade to become striae albicans over the next 3-6
months.
c. Chloasma over the face and neck, and linea nigra will be barely undetectable
in 6 weeks.
d. Abdominal wall and uterine ligaments are stretched and pouches forward
following delivery, making the woman feel overweight and unattractive
and usually require the full 6 weeks of the puerperium to return to their
former state.

NURSING MANAGEMENT

a. Provide abdominal binder or girdle during the first few weeks postpartum to
make her more comfortable, but does not aid in strengthening
abdominal tone.
b. Encourage the woman to perform postpartal exercises such as sit-ups,
abdominal breathing, chin to chest or head raising, Kegel's arm and leg
raising that give support to abdominal muscle, and aids involution, return
of abdominal tone, and strengthen abdominal and pelvis muscle.
c. Encourage good posture, proper body mechanics, and adequate rest.

6. Breast Modifications

For the first 2 days postpartum, the average women notices little change in her
breasts from the way they were during pregnancy. But on the third postpartum
day, the breasts tend to become full, feel tense and hot, with a throbbing pain.
Breast tissues appear reddened, simulating an acute inflammatory or infectious
process. This feeling of tension in the breasts on the third postpartum day is
called engorgement. Sometimes, body temperature may increase and this is
referred to as milk fever.

11 |MODULE ON POSTPARTUM
 NURSING MANAGEMENT

a. Advise mother to use firm-fitting brassiere or breast binder for good support
of the breasts. The brassiere or breast binder will not only reduce discomfort
from breast engorgement but also prevent contamination of the nipples and the
areola.

b. Cold compress application on the breasts if the mother does not intend to
breastfeed, or warm compress application if the woman desires to
breastfeed. Cold causes vasoconstriction and will therefore, inhibit breast milk
production, while heat causes vasodilatation and will, therefore, encourage breast
milk production.
c. Breast massage or the use of the breast pump if the woman will breastfeed.

II. PSYCHOLOGICAL CHANGES

A. Emotional concerns

Psychologically, puerperium may be divided into these separate phases

namely:

1. Taking-in phase
The first 2 or 3 days following delivery is a time of reflection for the
woman. She is so passive that she relies on the nurse or family members to do things
for her, even make decisions for her rather than doing things for herself. The mother
focuses upon her own needs rather than the baby's and her verbalizations center on her
reactions to the recent delivery in an effort to integrate the experience into herself.

2. Taking-hold phase

The next days following the first phase the woman is beginning to do things for
herself and make decisions on her own. This is about the time when she begins to
develop strong interest in caring for her baby. Some women become overly concerned
with their bodily functions such as bladder and bowel control, since these are necessary
for independence. Health teachings regarding self-care, newborn care and family
planning can be discussed with the mother at this time. However, this may also be
the time when the newly delivered woman may experience an overwhelming
feeling of sadness that cannot be accounted for. This is called postpartum blues. These
are believed to be the result of hormonal changes, or a response to dependency
or exhaustive, being away from home or sheer anxiety over the newly-acquired role.
The nurse should provide privacy at this time and reassure the mother that this is quite
normal and should not be a cause for alarm. Postpartum blues, however, should not
be confused with postpartum psychosis, the latter being more or less an indication of
an emotionally unstable neurotic
personality.

3. Letting-Go Phase

In the third phase, the woman finally redefines her new role. She gives up the
fantasized image of her child and accepts the real one; she gives up her old role of
being childless or the mother of only one. This process requires some grief work and
readjustment of relationships similar to what occurred during pregnancy. It is
extended and continues during the child growing years.

POSTPARTUM BLUES:

⮚ Are frequent the normal experiences of mother after the birth of the newborn.
⮚ They are characterized by labile mood and affect, crying spells, sadness,
insomnia (unable to sleep), and anxiety.

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 ⮚ Symptoms begin approximately 1 day after delivery, usually its peak is 3-7 days,
and subside rapidly with no any medical treatments.

POSTPARTUM DEPRESSION:
● Meets all the criteria for a major depressive episode, with onset within 4weeks or
1month of delivery.
● Symptoms are: anxiety, appetite changes, difficulty concentrating or making
decisions, fatigue, unable to sleep, feeling of guilt, irritability and agitation, lack of
energy, less responsive to the need of the infant, loss of pleasure in normal
activities, and suicidal thoughts.
● Is a psychotic episode developing within 3 weeks of delivery and beginning with
fatigue, sadness, emotional lability, poor memory, and confusion and
progressing to delusion(false belief with stimuli), hallucination(false perception
occurring without any true sensory stimuli), poor insight and judgment, and
loss of contact with reality. This requires an immediate treatment.

To further understand postpartum depression watch this 5-minute video

Postpartum Depression

Knowledge CHECK

Watch this video about postpartum depression.

https://www.youtube.com/watch?v=WDejffGbtn0&t=10s
After watching, explain the possible reasons for its occurrence postpartum. What are its
signs and symptoms and what interventions or health teachings can we make to
prevent its complications. Explain the rationale for each intervention. This activity will be
posted in the discussion tab of MyClass.

ASSESSMENT
CHECK

CONCEPT MAP: Graded Activity

A concept map is a diagram or graphical tool that visually represents relationships

between concepts and ideas. Most concept maps depict ideas as boxes or circles (also
called nodes), which are structured hierarchically and connected with lines or arrows
(also called arcs).

A concept map is a visual organization and representation of knowledge. It shows concepts

and ideas and the relationships among them. You create a concept map by writing keywords
(sometimes enclosed in shapes such as circles, boxes, triangles, etc.) and then drawing arrows
between the ideas that are related. Then you add a short explanation by the arrow to explain
how the concepts are related

When new knowledge is integrated with and connected to existing knowledge that new
knowledge is easier to understand and to remember. A professor’s job is to build

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 scaffolding from existing knowledge on which to hang incoming new knowledge. Using
a concept map is one way to build that scaffolding.

In this activity, you will summarize what you have learned from this module by making a
diagram of the changes that happen during the postpartum period. Changes will include,
local changes, systemic changes, and psychological changes postpartum. Nursing
interventions for these changes must also be incorporated in the diagram. Activity
instructions and rubrics will be provided in the assignment tab in My Class.

ANSWER TO PRETEST:
1. C 3. B 5.A 7.C 9.A
2. A 4.B 6.B 8.B 10.B

REFERENCES:

Adopted From:
The Self – Instructional Modules in Maternal and Child Health Nursing
Author: Dr. Zenaida S. Fernandez

PRESCRIBED TEXT:

Silbert-Flagg, J. and Pilliteri, A. (2018). Maternal child health nursing: Care of the
childbearing and childrearing family. Volume 1 and 2 (Philippine edition); 8 th edition.
Philadelphia: Lippincott
Books:
Leap, N. (2016). Supporting women for labour and birth: a thoughtful guide. London: Routledge/Taylor and Francis
Group.

Leifer, G. (2015). Introduction to maternity and pediatric nursing. Boston: Pearson

Mattson, S. (2016). Core curriculum for maternal-newborn nursing. (5th edition). Saint Louis, MO: Elsevier

Ricci, S. (2017). Essentials of maternity, newborn, and women’s health nursing. 4th edition. Philadelphia:
Wolters Kluwer

Ward, S. (2016). Maternal-child nursing care: optimizing outcomes for mothers, children, families.
(2nd edition). Philadelphia: Davis Company.

PREPARED BY:

BRENDA B. POLICARPIO RN, RM, MN Commented [1]: Signed

NCM 0107 Instructor

Peer Evaluator/s:
DRA. ANGELA MARIE GONZALES Commented [2]: Signed
NCM 0107 Instructor

Reviewed By:

Jennie C. Junio, RN, MAN Commented [3]: Signed

Level II Academic Coordinator

Debbie Q. Ramirez, RN, PhD Commented [4]: signed

Assistant Dean, College of Nursing

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APPROVED BY:

Zenaida S. Fernandez, RN, PhD Commented [5]: signed

Dean, College of Nursing

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