Purpose of Nursing Cares during Puerperium

Subject: Midwifery III (Theory)

Overview

The usual puerperium period lasts from birth to six weeks after birth. During this period, the reproductive and other organs return to their pre-pregnancy status. The care for puerperium is divided into four categories: infection prevention, involution promotion, breastfeeding promotion, and emotional support. Although it is rare in affluent nations, puerperal infection is nevertheless a cause of maternal death. The reduction in uterine size and weight is dependent on whether involution is absent or delayed. Pregnancy is not an illness in and of itself, as we know it is a physiological shift in a woman's life. A woman requires diet, rest and sleep, exercise, and other things. Among these is emotional support, which is crucial.

The usual puerperium period lasts from birth to six weeks after birth. During this period, the reproductive and other organs return to their pre-pregnancy status. The management of puerperium is divided into four categories:

  1. Prevention of infection
  2. Promotion of involution
  3. Promotion of lactation
  4. Emotional support

Prevention of infection

Although it is rare in affluent nations, puerperal infection is nevertheless a cause of maternal death. It must be avoided by maintaining proper cleanliness. The uterus provides a favorable habitat for organism multiplication. Any level of trauma increases the likelihood of infection developing. Puerperal infection is possible if:

  • Breast infection
  • Infection of the genital tract
  • Infection of the urinary tract
  • Upper respiratory tract infection

Sources of infection

  • Autogenous: The cause of the infection is the patient's own respiratory system, as well as septic foci throughout the patient's own body.
  • Endogenous: from the organism that was already in the patient's vagina, bowel, and urine tract
  • Exogenous: from septic foci found in dust, blanket sheets, etc.

Infecting organism

  • Pyogenic Streptococcus
  • The bacteria Escherichia coli
  • Pyrogens of Staphylococcus aureus
  • Anaerobic streptococci, as well as other anaerobic organisms such as Clostridium tetani and Welch.

Promotion of involution

Involution refers to the physiological shift that occurs during the puerperium that reduces the size of the uterus. The uterus weighs around 1 kilogram at the conclusion of labor, but after the puerperium, it weighs 60 grams. During pregnancy, the uterus thickens five times and lengthens ten times with 30*22*20 cm; after the puerperium, it recovers to its natural shape and size. The uterus shrinks within 10-12 days of delivery, although other alterations do not occur within this time frame.

It can take up to 6 weeks or more. It is critical to empty the lochia in order to achieve rapid involution. Lochia is the discharge from the uterus via the vaginal canal following childbirth or abortion via the autolysis process.

The reduction in uterine size and weight is dependent on whether involution is absent or delayed.

Factors to Help in Involution

  1. Lactation
  2. Nutrition
  3. Ambulation and exercise
  4. Massaging
  5. Autolysis

Promotion of lactation

The action of the oxytocin hormone induces the separation of the placenta during the third stage of labor. Following the placental evacuation, the levels of human chorionic gonadotrophin, human placental lactogen, estrogen, and progesterone rapidly decrease, causing physiological changes in the body. The decrease in estrogen hormone encourages the anterior pituitary gland to emit prolactin hormone, which causes milk to be made.

Women who continue to breastfeed have high prolactin levels, while those who do not breastfeed have low prolactin levels 14-21 days after delivery.

The mother must learn to care for her newborn infant while still recovering from the physical stress of pregnancy, labor, and delivery. Many women have no or little experience carrying a newborn infant. Some mothers use their own breast milk while others use bottled milk, but the goal is the same: to nurture their baby. She is transmitting her love and care for her infant, which is reversed by her satisfaction with the feed. As midwives, we must understand that the mother is the most essential person in her baby's life, and we must aid and encourage the mother to breastfeed.

Emotional support

Pregnancy is not an illness in and of itself, as we know it is a physiological shift in a woman's life. A woman requires diet, rest and sleep, exercise, and other necessities both before and after an emergency. Among these is emotional support, which is crucial. A basic need, according to Maslow's hierarchy, falls under the third stage, which is love, affection, and emotional support.

Giving birth is an emotional experience since it is the culmination of many dreams and concerns, as well as the beginning of a new human existence and family relationship. Mothers need to be helped while they adjust to this experience, and the key to offering assistance is to have an encouraging attitude, demonstrate trust in the mother's competence, and not make her feel like a failure in any manner.

We can boost his mother's confidence by providing clear and detailed instructions on the following topics:

  • Feeding advice for your baby
  • How to Raise the Babies' Wind
  • Cleaning and sterilization of feeding bottles, utensils, and comforts
  • Bathing the infant, dealing with aching buttocks, skin rashes, and so on
  • Managing Crying Periods
  • Parents' emotional requirements
  • The family's requirements
  • The Health Visitor's Role
  • The Maternity and Infant Care Clinic
  • The postnatal checkup
  • Advice on Family Planning
Things to remember
  • The normal puerperium state is from delivery to six weeks after birth. Within this time the reproductive and other organs return to their pre-pregnant state.
  • The management of puerperium is headed in four areas and they are prevention of infection, promotion of involution, promotion of lactation, and emotional support.
  • Puerperal infection is still a cause of maternal death although its incidence is infrequent in developed countries. It must be prevented by the strict cleanliness.
  • The reduction in size and weight of the uterus depends on the involution is the absence or delayed involution. It takes up to 6 weeks or later.
  • It is very necessary to drain the lochia to attain quick involution.
  • Lochia is the discharge from the uterus through the vagina after childbirth or abortion by autolysis process.
  • Pregnancy itself is not a disease, as we know that it is a physiological change in women's life.
  • Before and after an emergency, a woman needs nutrition, rest and sleep, exercise, and so on.
  • Among them, emotional support is also one which is very important.
  • According to Maslow's hierarchy of basic needs, it comes under the third stage i.e. love, affection, and emotional support.
  • Lochia is the discharge from the uterus via the vaginal canal following childbirth or abortion via the autolysis process.
  • Pregnancy is not an illness in and of itself, as we know it is a physiological shift in a woman's life.
  • A woman requires diet, rest and sleep, exercise, and other necessities both before and after an emergency.
  • Among these is emotional support, which is crucial.
  • A basic need, according to Maslow's hierarchy, falls under the third stage, which is love, affection, and emotional support.
Questions and Answers

Purpose of nursing cares during puerperium

The normal puerperium state is from delivery to six weeks after birth. Within this time the reproductive and other organs return to its pre- pregnant state. The management of puerperium is headed in four areas.

  1. Prevention of infection
  2. Promotion of involution
  3. Promotion of lactation
  4. Emotional support

 

  1. Prevention of infection

Puerperal infection is still a cause of maternal death although its incidence is infrequent in the developed countries. It must be prevented by the strict cleanliness. The uterus provides an ideal environment for the multiplication of organism. Any degree of trauma will increase the tendency for development of infection. Possible of puerperal infection is:

  • Breast infection
  • Infection of the genital tract
  • Infection of urinary tract
  • Upper respiratory tract infection

 

Sources of infection

  • Autogenous: the source of infection is from patient own respiratory tract, septic foci in patients own body.
  • Endogenous: from the organism already present in the patients vagina, bowel, and urinary tract.
  • Exogenous: from the septic foci present in dust , blanket sheet , etc.

 

Infecting organism

  • Streptococcus pyogenic
  • Escherichia coli
  • Staphylococcus pyrogens
  • Anaerobic streptococci and others anaerobic organism such as clostridium tetani or welchii.

 

 

 

  1. Promotion of involution

The physiological change during the puerperium reducing the size of the uterus is called involution. At the end of the labour, the weight of the uterus is about 1 kg but after puerperium, its weight becomes 60 gram. During pregnancy, a thickness of the uterus is increased by 5 times and the length is increased by 10 times with 30*22*20 cm. after puerperium it returns to its normal shape and size. The reduction in the size of the uterus is completed within 10-12th days after delivery but other changes are not completed within this periods.

It takes up to 6 weeks or later. It is very necessary to drain the lochia to attain the quick involution . lochia is the discharge from the uterus through vagina after childbirth or abortion by autolysis process.

The reduction in size and weight of the uterus depends on upon the involution is the absence or delayed involution.

The following factors help in involution:

  1. Lactation
  2. Nutrition
  3. Ambulation and exercise
  4. Massaging
  5. Autolysis

 

  1. Promotion of lactation

During the third stage of labour, the action of oxytocin hormone stimulates the separation of the placenta. After the expulsion of the placenta, the level of human chorionic gonadotrophin, human placental lactogen, estrogen, and progesterone fall down rapidly which bring the physiological change in the body. The fall in estrogen hormone stimulates the anterior pituitary gland to secrete prolactin hormone, which produced milk.

The women who are continuing on breastfeeding, the level of prolactin remains high and who do not breastfeed, the level of prolactin fall within 14-21 days of the delivery.

The mother must learn to care for her newborn baby during the time in which she still receiving from the physical stress a pregnancy , labour and delivery. Many women have little or no experience of carrying a newborn infant. Some feed their own breast milk and some feed bottle milk but all of them have same aim that providing her baby with nourishment. She is communicating her baby, love and care to him to reversed by her satisfaction with the feed. As a midwife, we must recognize it is the mother who is the most important person in her baby's life we should provide help and encouragement to the mother for lactation.

 

  1. Emotional support

Pregnancy itself is not a disease, as we know that it is the physiological change of women's life. Before and after an emergency, a women's needs nutrition, rest and sleep, exercise and so on. Among them, the emotional support is also one which is very important. According to Maslow's hierarchy a basic needs, it comes under the third stage i.e. love, affection, and emotional support.

To give the birth to a baby is one emotional experience as it is the culmination of many hopes and fears and the beginning of a new human life and family relationship. Mother need to be supported as they adjust to this experience and the secret of providing support is to have an encouragement attitudes, showing confidence in the mother's ability and preventing her from being made to feel a failure in anyway.

We can build up he mothers confidence by giving clear and careful instruction on the following topic:

  • Advice about baby's feeding
  • How to bring up the babies wind
  • Sterilization of feedings bottles, tools, and comforts
  • Bathing baby
  • Dealing with sore buttocks, skin rashes etc
  • Coping with crying spells
  • The emotional needs of parents
  • The needs of the family
  • The role of the health visitor
  • The mother and baby clinic
  • The postnatal examination

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