Symptoms typically include changes in sleep, energy, appetite, weight, and libido. Symptoms are generally noted within the first three months but may occur up to a year after delivery. Postpartum depression occurs in 8% to 15% of women after delivery. Postpartum depression is a serious and debilitating depression that affects many women throughout the world. If malattachment is noted, providers should immediately report the observation and continue to monitor both the mother and infant. Refusing to respond or responding negatively to infant cues (e.g., crying, smiling).Malattachment behaviors vary and can include: However, there are some who do not form attachments appropriately. Most women positively attach to their newborn infants. Postpartum assessment of attachment should begin immediately after delivery and continue throughout the infant’s first year of life. Choosing the “en face” position (face-to-face, approximately 8 inches apart).Behaviors exhibited by mothers that indicate positive attachment include: Nurses can assess for attachment behaviors by observing the interactions between mothers and their infants. Patients should be instructed to begin abdominal exercises anytime following a vaginal delivery and after abdominal tenderness resolves following a cesarean section, generally in four weeks.īonding, sometimes referred to as attachment, between mothers and infants is affected by a multitude of factors, including socioeconomic status, family history, role models, support systems, disturbed sleep, cultural factors, and birth experiences. The abdominal wall is weakened and the muscle tone of the abdomen is diminished after pregnancy. However, the joints of the feet remain altered, and many women notice a permanent increase in shoe size. After delivery, relaxin levels subside and the pelvic ligaments and joints return to their prepregnant state. After delivery, the diaphragm descends and postpartum women’s respirations normally return to the prepregnant state. In addition, women frequently experience excessive perspiration (diaphoresis), which also releases accumulated fluid during the postpartum period. The postpartum body removes excess fluid accumulated during pregnancy by diuresis. However ovulation can return prior to menses, and it is important for healthcare providers to discuss family planning with patients during the early postpartum period in order to prevent undesired pregnancies. Menstruation does not typically return until 12 weeks or later. Mothers often refer to this as having their milk “come in.” Prolactin initiates milk production, and the breasts become engorged, as well as warm and tender, between postpartum days 3 and 4. Vaginal dryness and painful intercourse, known as dyspareunia, may be noted during the postpartum period due to decreased estrogen levels.Īfter delivery there is a significant decrease in estrogen and progesterone levels. ![]() The vaginal walls are smooth after delivery, and the vaginal folds, known as rugae, do not return until approximately 3 weeks postpartum. The internal os closes almost completely within three to four months of delivery. The shedding endometrium is known as lochia.Īs with all other reproductive organs and structures, the cervix also changes as the body returns to a prepregnancy state. The fundus continues to descend into the pelvis at the rate of approximately one centimeter (finger-breadth) per day and should be nonpalpable by two weeks postpartum.Īfterpains, or intermittent uterine contractions, are a normal occurrence during the postpartum period.Īfter delivery, the endometrial surface of the uterus is shed via the vagina. By approximately one hour post delivery, the fundus is firm and at the level of the umbilicus. ![]() Immediately after delivery, the upper portion of the uterus, known as the fundus, is midline and palpable halfway between the symphysis pubis and the umbilicus. ![]() The uterus continues to contract after delivery, and its size decreases rapidly as estrogen and progesterone levels diminish. Exfoliation is the sloughing off of dead tissue at the site where the placenta is attached to the uterine wall. Large vessels at the site of placental attachment thrombose to control bleeding.Įxfoliation also occurs at this time. The uterus, with the assistance of the uterine muscles, contracts the uterine vessels and impedes blood flow. The uterus begins a process known as involution immediately after the delivery of the placenta. Some of the physiologic adaptations to the reproductive system are described below: Immediately after delivering, women experience massive shifting as the body returns to its pre-pregnant state.
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