Postnatal assessment

Taking-In Phase
It takes 2-3 days, during which time the mother’s first concern is with her own needs (sleep and food).

The woman reacts passively, mostly dependent on others to meet her needs.

She is quite talkative during this phase about every detail of her labor and delivery experience
Taking-Hold Phase (Taking Responsibility as a Mother)
It starts the 3rd day postpartum
She progresses from the passive individual to the one who is in command of the situation.
This phase lasts about 10 days.
Once the mother has taken control of her physical being and accepted her role as a mother, she is able to extend her energies to her mate and other children.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Physical Assessment is necessary to identify individual needs or potential problems
Explain to pt purposes of the examination.
Obtain her consent.
Record your findings and report results to the mother.
Ensure privacy and environment where the mother can lie on her back with her head supported.
Ensure bladder is empty & lay patient supine with legs flexed.
The midwives hands should be clean and warm

1. POSTNATAL ASSESSMENT PRANATI PATRA

2. PHASES OF PUERPERIUM Taking-In Phase It takes 2-3 days, during which time the mother’s first concern is with her own needs (sleep and food). The woman reacts passively, mostly dependent on others to meet her needs. She is quite talkative during this phase about every detail of her labor and delivery experience.

3. Taking-Hold Phase (Taking Responsibility as a Mother) It starts the 3rd day postpartum She progresses from the passive individual to the one who is in command of the situation. This phase lasts about 10 days. Once the mother has taken control of her physical being and accepted her role as a mother, she is able to extend her energies to her mate and other children. PHASES OF PUERPERIUM

4. Letting-go Phase This generally occurs when the mother returns home. In this phase there are two separations that the mother must accomplish. One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation. PHASES OF PUERPERIUM

5. PHYSICAL ASSESSMENT Physical Assessment is necessary to identify individual needs or potential problems Explain to pt purposes of the examination. Obtain her consent. Record your findings and report results to the mother.

6. Ensure privacy and environment where the mother can lie on her back with her head supported. Ensure bladder is empty & lay patient supine with legs flexed. The midwives hands should be clean and warm

7. POSTPARTUM MATERNAL PHYSICAL ASSESSMENT A good method to remember how to check the postpartum changes is the use of the acronym ‘ BUBBLERS’ B : Breast . U : Uterus. B : Bladder . B : Bowel. L : Lochia . E : Episiotomy . H : Homans ' sign E : Emotional response.

8. B: ASSESSMENT OF BREASTS Inspect for redness & engorgement. Palpate breasts to determine if they are soft or filling, warm, engorged or tender. Teach to promote milk production & let down, and methods to prevent and treat engorgement. Advice to use proper bra. Nipples should be soft, pliable, intact { * If mother is NOT breast feeding - DO NOT palpate breasts or assess nipples } Abnormal Findings (Breasts)- Redness, heat, pain, cracked, and fissured nipples, inverted nipples, palpable mass, painful, bleeding, bruised, blistered, cracked nipples.

9. U- ASSESSMENT OF THE UTERUS Placement and Size (location) • Tone • Lochia

10. Fundal height is measured in cm above or below the umbilicus Note: * fundus is 2 cm below the level of the umbilicus immediately after birth fundus descends approximately 1 cm per day; by the 10th day the fundus should no longer be palpated

11. B: BLADDER Marked diuresis is expected for 2-3 days following delivery: voiding should be encouraged within 6-8 hrs after labor . Ambulate the pt

12. B: BOWEL Bowel: there may be no bowel action for a couple of days because the bowel has probably been emptied during labor . Glycerin suppository may be used to relieve constipation

13. The acronym ‘ REEDA’ is often used to assess an episiotomy or laceration of the perineum. E: EPISIOTOMY .

14. Redness is considered normal with episiotomies and lacerations however, if there is significant pain present, further assessment is necessary . Excessive edema can delay wound healing and the use of ice packs during the immediate postpartum period is generally indicated.

15. Inspect and observe for presence of episiotomy lacerations, edema , pain or ulceration. Only sterile vaginal pads should be used Keep the area clean and dry by employing perineal care. use a sitz bath to aid in perineal healing.To avoid infection Teach the mother principals of selfcare .

16. H: Homans ' sign Homan's sign, is indicative of a deep vein thrombosis (DVT) Negative Homan’s Sign is with No PAIN If there is pain then it is positive (+) and the nurse needs to report this finding immediately to the health care provider. Press down gently on the patient’s knee (legs extended flat on bed) ask her to flex her foot ( dorsiflex )

17. E: Emotional response • sleep deprivation • ability to rest • energy level • comfort level • anxiety level • Appetite • bonding behaviours • support system (family, husband, self supported)

18. IMMUNIZATION Administration of anti–D–gamma globulin{ RhoGAM } to unimmunized Rh-negative mother bearing Rh-positive baby. Women who are susceptible to rubella can be vaccinated safely with live attenuated rubella virus. The booster dose of tetanus toxoid , HepB,should be given at the time of discharge, if it is not given during pregnancy