PP Blues PP Depression PP Psychosis

onset 1-10 days after birth 1-12 months after birth Within first month after birth
symptoms Sadness, tears Anxiety,feeling of loss,sadness Delusions or hallucinations
incidence 70% of all births 10% of all births 1% to 2% of all births
Etiology Probable hormonal Hx of previous depression,hormonalPossible activation of previous mental
(possible) changes,stress of life response,lack of social support illness family hx of bipolar d/o
changes
therapy Support, empathy Counseling,drug therapy Psychotherapy,drug therapy
Nursing Offering compassion & Referring to counseling Referring to counseling,safeguarding
Role understanding mother from injury to self or to newborn
Maternal Concerns & Feelings during Postpartum:

 ABANDONMENT - Only hours before, they were the center of attention, with everyone asking about their
health and well-being. Now suddenly, the baby is the chief interest. The woman may feel confused by a
sensation very close to jealousy. Father may have much same feelings Shared responsibility for infant care
can help to make both partners feel equally involved in the baby’s care and can help alleviate these
feelings.

 DISAPPOINTMENT - It can be difficult for parents to feel positive immediately about a child who does
not meet their expectations. Handle the child warmly. Comment on the child good points.

 POSTPARTUM BLUES (Baby blues)- 50% of women experience some feelings of overwhelming sadness.
The mother burst into tears easily or may feel let down or be irritable. Maybe due to hormonal changes
(decrease estrogen & progesterone). It maybe a response to dependence and low self-esteem caused by
exhaustion, being away from home, physical discomfort, and the tension endangered by assuming a new
role. A woman needs aasurance that sudden crying episodes are normal. Allow to Verbalize feelings

POSTPARTUM BLUES
· “baby blues”; normal part of postpartum experience but only for a few days
· Tearfulness, irritability, sometimes insomnia
· Causes: hormonal fluctuations, physical exhaustion, maternal role adjustment
o Reassure that this is normal
o Anticipatory guidance and individualized support from health care personnel are important to help
the parents understand
o Keeping lines of communication open
o Allow her to make as many decision as possible can help give her sense of control over her life
o Allow her to verbalize her feelings and concerns

POSTPARTUM DEPRESSION
· A serious & debilitating depression, occurring within first 9 months after delivery, often within the initial
weeks or months
· Sadness, crying, insomnia, decreased appetite, withdrawal and sometimes suicidal ideation or the desire
to harm the infant
· Somatic symptoms: headaches, diarrhea, constipation, severe anxiety, feeling as though they are jumping
out of their skinm and/or just not feeling like themselves

Physiologic Changes of Postpartal Period

  CARDIOVASCULAR SYSTEM – 1st or 2nd week postpartum, the blood volume has returned to its
normal pre-pregnancy level.

Blood Volume
Hemorrhage – bleeding of > 500cc
CS – 600 – 800 cc normal NSD 500 cc

Early postpartum hemorrhage– bleeding within 1st 24 hrs. Baggy or relaxed uterus & profuse bleeding –
uterine atony. Complications: hypovolemic shock.
Mgt:

1.) massage uterus until contracted

2.) cold compress
3.) modified trendelenberg
4.) IV fast drip/ oxytocin IV drip
 The 40% increase in blood volume during pregnancy enters the maternal circulation within 5 to 10
minutes after placental delivery making this period very critical to gravidocardiacs because their
damaged heart may not be able to handle this sudden increase in cardiac workload.
 Blood volume returns to nonpregnant levels 1-2 weeks after delivery resulting in a decline in cardiac
output by 30%.

Blood Components
 Hct rises in the first 3 to 7 days due to hemoconcentration caused by excretion of large amounts of
fluids in the urine (diuresis during the first few days after delivery). Hct level returns to normal on the
fourth to fifth postpartum week.
 Leukocytosis of 20,000 to 30,000 (normal is 5000 to 10000) during the first 12 days characterized by
increased neutrophils and easinophils and decreased lymphocytes.
 Fibrinogen and thromboplastin remains elevated until the 3rd postpartum week.
 Increased leukocyte sedimentation rate.

1. Cardiovascular system
· 30-50% increase in total cardiac volume during pregnancy will be reabsorbed into the general
circulation within 5-10 minutes after placental delivery
· Blood loss: vaginal birth- 300-500 ml; cesarean birth- 500-1000ml
· Blood volume decrease to non pregnant levels by fourth week after delivery
· Hematocrit rises by the 3rd-7th postpartum day
· WBC increases to 20000-30000/mm3
o Cannot be used as an indicator or signs of postpartum infection
o Part of body’s defense system against infection
o Aid to healing
· Extensive activation of the clotting factors which encourages thromboembolization:
o Ambulation is done early 4-8hours after normal vaginal delivery
When ambulating the newly-delivered patient for the first time, the nurse
should hold on to the patient’s arm.
o Massage is contraindicated.
· All blood values are back to prenatal levels by the 3rd-4th week postpartum