ADAPTASI MASA NIFAS

NUR AFI DARTI

Postpartum Physical Adaptations

Uterine Involution
Fundal position changes ; Boggy
Lochia: Rubra, Serosa, Alba
Cervical changes
Vaginal changes
Perineal changes
Recurrence of ovulation and
menustration
Lactation

Cont.

Gastrointestinal System
Urinary tract
Vital signs
Weight loss
Postpartum chill
Postpartal diaphoresis
Afterpains or Afterbirth pains

Uterine Involution
The rapid reduction in size of the
uterus and its return to a condition
similar to its pre-pregnancy state.
The uterus remains slightly larger
than it was before the first
pregnancy.
Process is complete at 3 weeks
Subinvolution may be caused by an
infection or retained placenta
fragments.

Fundal position changes

After birth the top of the fundus
remains at the level of the umbilicus
for 12 to 24 hours.
The first postpartum day it is located
1 cm or fingerbreadth below the
umbilicus.
May be displaced to the left or right
by a distended bladder.
Becomes boggy with uterine atony

Lochia: Rubra, Serosa, Alba

Rubra
dark red in color, present the first 2-3 days
postpartum, should not contain clots, a
few small clots are considered normal.

Serosa
pinkish to brownish in color, from the 3rd
to the 10th day post delivery.

Alba
creamy or yellowish in color, persists for a
week or two after serosa, may be later in
breastfeeding clients.

Cervical Changes
Following birth it is spongy and
flabby and formless and may appear
bruised.
Original form is regained in a few
hours
The shape is permanently changed
by the first childbearing.
Goes from dimple like to a lateral slit
(fish mouth)

Vaginal Changes
Following birth appears edematous
May be bruised
Small superficial lacerations may be
present
Size and rugae return to pre
pregnancy in 3 weeks By 6 weeks
appears normal

Perineal Changes
May appear edematous with some
bruising
Episiotomy edges should be
approximated
Ecchymosis may occur and delay
healing

Recurrence of Ovulation and

Menustration
Varies for each postpartum client
Generally returns to non-nursing
mothers between 7 and 9 weeks after
birth
The first cycle is non-ovulatory
Breastfeeding clients may experience
menustration and ovulation based on the
amount of time nursingmay occur from
2nd to18th month

Lactation
During pregnancy, the breasts
develop in preparation for lactation
as a result of both estrogen and
progesterone.
After birth, the interplay of maternal
hormones leads to the establishment
of milk production.

Gastrointestinal System
May have a regular diet
Bowels tend to be sluggish
Episiotomy clients may delay bowel
movement for fear of pain
Cesarean birth clients may receive
clear liquids and progress to a
regular diet
Stool softeners may be used

Urinary Tract
The postpartum client has an increased
bladder capacity, swelling and bruising
of tissue, decreased sensitivity to fluid
pressure, and decreased sensation of
bladder filling.
At risk for over-distention, incomplete
emptying, and buildup of residual urine.
Urinary output increases 1rst 24 hours
post delivery (puerperal diuresis)
Urine specimens should be obtained as
a catheterized specimen.

Vital Signs
Client should be afebrile after the
first 24 hours.
A temperature up to 100.4 may be
due to dehydration and/or exertion in
the first 24 hours.
BP WNL, a decrease may occur. An ?
BP may indicate toxemia, PIH.
Pulse rate may decrease to 50-70.
Tachycardia should alert the nurse to
blood loss/difficult birth.

Blood Values
Blood values should return to the prepregnant
state by the end of the postpartum period.
Predisposed to the development of
thromboembolism
Leukocytosis with white blood cell (WBC)
counts up to 30,000 per mL may occur early
postpartum.
Treat the symptoms, not the lab work.
Convenient rule of thumb is a 2 point drop in
hematocrit equals a blood loss of 500 mL.

Weight Loss
An initial weight loss of 10 to 12 lbs
occurs as a result of the birth of the
infant, placenta and amniotic fluid.
Puerperal diuresis accounts for loss
of an additional 5 lbs during the early
postpartum period.
Normally return to pre-pregnant
weight by 6 weeks postpartum.

Postpartum Chill and

Postpartal Diaphoresis
Most clients experience a shaking chill
or tremor after delivery. Warm blankets
usually relieve this tremor or chill.
Chills and fever late in the postpartum
period may indicate sepsis.
Diaphoretic episodes may occur at
night, a normal occurrence as the body
rids itself of waste products.

Afterpains or Afterbirth pains

Occur more commonly in multiparas
than the primiparas.
Caused by intermittent contractions.
May cause severe discomfort for the
first 2-3 days.
Breastfeeding may increase the severity.
Oxytocins may increase severity.
(Pitocin, Methergine, Ergotrate)

Perubahan pada Sistem

Muskuloskeletal
Selama beberapa hari level hormon relaxin
menurun, dan ligamen dan kartilago pelvis
mulai kembali kekeadaan sebelum hamil.
Tonus otot rectus abdominis dan
pubococcygeal melemah. Kelemahan otot ini
mempengaruhi kontrol bowel dan (terutama)
bladder.
Otot abdomen, meliputi otot rectus abdominis,
sering terpisah dan terjadi diastasis recti 24cm
Hal ini mempengaruhi resiko konstipasi.

Ekstremitas bawah

Trombofeblitis akibat statis vena dapat

dicegah dengan mobilisasi dini setelah
persalinan.
Jika terdapat varises pada tungkai
bawah, penggunaan stoking elastis yang
disertai mobilisasi dini dan intake cairan
yang adekuat setelah persalinan dapat
mencegah statis vena.
Trombofeblitis pada tungkai bawah dapat
diketahui dengan mengkaji tanda
homan/Homans sign

Cont.

Keluhan nyeri pada peregangan tendo

archiles juga dapat disebabkan oleh
trauma persalinan seperti penempatan
tungkai bawah tidak tepat pada
penyangga

Postpartum Psychological

Adaptations
Maternal Role
Postpartum blues
Development of Parent -Infant
attachment
Initial attachment Behavior
Father-Infant Interactions
Cultural Influences

Maternal Role
Time of readjustment and adaptation
During the first day or two, the client tends
to be passive and somewhat dependent
Hesitant about making decisions
Food or sleep are of major importance, May
feel a great need to talk Taking In phase
according to Rubin
By second or third day, client is ready to
resume control. Taking Hold phase
occurs during this time.
Todays client adjust more rapidly as LOS has
shortened.
Maternal role attainment: process by which a
woman learns mothering behaviors.
(anticipatory, formal, informal, and personal)

Postpartum blues
Describes a transient period of depression
that occurs in most women during the first
week or two after birth.
May be manifested by mood swings, anger,
weepiness, anorexia, difficulty sleeping,
and a feeling of letdown.
Hormonal changes and psychological
adjustments are thought to be main
causes.
Usually resolve naturally in 2 to 3 weeks
with support and reassurance. If symptoms
persist, the client should be evaluated for
postpartum depression.

Initial attachment Behavior

Progression of touching activities
En face position dominates
Relies heavily on senses of sight, touch,
hearing in getting to know the baby
Emotional distance may be occur.
The acquaintance phase, the phase of
mutual regulation
Some negative feelings may occur; be
understanding not condescending
Reciprocity is an interactional cycle that
occurs simultaneously between mother and
infant. (mutual cueing behaviors,
expectancy,
delight in each others company when
synchronous)

Father-Infant Interactions
Primary role has been supporting role
Engrossment (the characteristic
sense of absorption, preoccupation,
and interest in the infant
demonstrated by fathers during early
contact with the newborn.

Cultural Influences
Postpartum care my be affected by
cultural beliefs : No shower, no
breastfeeding for the first three days,
hot and cold foods
Do not make generalizations
Extended family may play an
important role in care