Postpartum emotional reactions
- baby blues
- postpartum depression (PPD)
- postpartum psychosis
- postpartum anxiety/panic disorder
- PPD with OCD
Baby Blues
- 85% of new mothers
- sadness/tearfulness
- irritablity + anxiety
- crying spells
- mood swings
- fatigue/sleep deprivation
- appetite disturbance
Postpartum Depression
- 15% of new mothers
- increased incidence with personal or family history of mood disorder, negative life event (loss, poor marital support, divorce, financial difficulty, thyroid disorder)
- intense sadness that persists past the baby’s first few weeks of life
- incidence is 50% higher among teen moms
S/S of PPD
- depressed mood
- functional impairment
- lack of bonding
- changes in sleep/eating
- psychomotor agitation
- fatigue
- feelings of worthlessness and suicidal ideation
Medical Management of PPD
- natural course = gradual improvement over 6 months
- pharmacologic: antidepressants, antianxiety agents, mood stabilizers, antipsychotics
- therapy, support groups
Postpartum Psychosis
- 1/1000 births
- occurs 1-4 weeks after birth, up to 90 days
- most severe of PP mood disorders
- emergency
- good prognosis with early detection + treatment
S/S of postpartum psychosis
- agitation
- hallucinations
- severely impaired ability
- delusions
- paranoia
- severe mood depression
Involution
return of uterus to normal state
begins immediately after delivery of placenta
Subinvolution
the failure of the uterus to return to a nonpregnant state.
common causes: infection and retained placental parts
Lochia Rubra
bright red, lasting 1-4 days
Lochia serosa
pinkish brown color, containing old blood + serum tissue debris. occurs second and lasts 3-10 days
Lochia alba
creamy white/light brown color, contains leukocytes and decidual tissue. lasts 10-14 days or up to 6 weeks
Cervical changes after birth
- internal cervix gradually closes and returns to normal after 2 weeks
- external os widens and never regains its pre pregnancy appearance. stays a jagged, slit like opening
Vaginal changes after birth
- gradually decreases in size and regains tone (4-6 wks)
- estrogen decreases which causes thinness of vaginal mucosa and absence of rugae
- estrogen defciency = decreased lubrication
Perineal Changes after birth
- edema & bruising for a few days
- episiotomy/tear can take 4-6 wks to heal
- hemorrhoids
- pelvic floor retraining, promotes healing (kegel exercises)
Cardiovascular postpartum changes
- blood volume increases during pregnancy and drops after birth
- returns to normal 4 weeks pp
- average blood loss for vaginal delivery is 300-500ml
- average blood loss for c section is 500-1000ml
Urinary changes after birth
- gradual return of bladder tone and size
- urinary retention = major cause of uterine atony (hemorrhage)
- postpartum diuresis begins within 12 hrs and continues for 1 week pp
Vital sign changes postpartum
- cardiac output returns to normal after 3 months
- tachycardia: may be from hypovolemia, dehydration, hemorrhage
- decrease in BP is an expected early finding
- increased BP may be preeclampsia
- temp of 100.4 in the first 24 hrs may be dehydration but should be normal after 1 day
- respirations WNL
Integumentary changes postpartum
- striae gravidarum (stretch marks)
- profuse diaphoresus
- linea nigra
- melasma
- hair loss is temporary
Endocrine changes postpartum
- estrogen & progesterone drop quickly
- prolactin increases due to breastfeeding
- estrogen remains low until breastfeeding decreases
- ovulation can occur before menstruation
- elevated serum prolactin suppresses ovulation
Lactation
- oxytocin is essential
- drop in estrogen + progesterone triggers release of prolactin from anterior pituitary
- prolactin is highest 10 days pp
- prolactin is produced in response to infant suckling + emptying of breasts
- oxytocin responsible for milk ejection reflex/let down reflex
Where is oxytocin produced?
the posterior pituitary is prompted by the hypothalamus
