POSTPARTUM HEALTH TEACHING BREAST Breast development in preparation for lactation results from the influence of both estrogen

and progesterone. A decrease in estrogen and progesterone levels after delivery stimulates increased prolactin levels, which promote breast milk production. Breasts become distended with milk on the third day. Engorgement occurs in 48 to 72 hours in non breast feeding mothers. PATIENT TEACHING:  Wash breast daily at bath or shower time  Wear Supportive bra  Wash hands before and after every feeding  Insert clean OS squares or piece of cloth in the brassiere to absorb moisture when there is considerable breast discharges. Breast Dicomforts/ Engorgement: y Breastfeed frequently y Apply warm packs before feeding y Apply ice packs between feedings y Pumping or manually expressing breast milk y Chilled cabbage leaves (placed on breast with nipple exposed) y Changing position with each nursing so that different areas of the nipples receive the greatest stress from nursing and avoiding breast engorgement.. y Acetaminophen or ibuprofen for pain APPLYING ICE and LANOLIN DOES NOT RELIEVE BREAST ENGORGEMENT. Care for Cracked nipples: 1. Expose nipples to air for 10 to 20 minutes after feeding 2. Rotate the position of the baby for each feeding 3. Be sure that the baby is latched on to the areola, not just the nipple NOTE: Do not use soap on the breasts, as it tends to remove natural oils, which increases the chance of cracked nipples. BLADDER VOIDING is difficult because of the pressure on the bladder and urethra making it edematous. The bladder and urethra are traumatized by the pressure exerted by the fetal head as it passes through the birth canal. Trauma to bladder results in loss of bladder tone, edema and

hyperemia. As a result, the woman experiences decreased bladder tone that results in increased bladder capacity. Decreased bladder tone causes decreased sensation to the filling and distention of the bladder, the woman may not experience the urge to void even if her bladder is already distended with urine w/c predisposes to infection. Urinary retention as a result of decreased bladder tone and emptying can lead to Urinary Tract Infections Urinary output increases 1rst 24 hours post delivery (puerperal diuresis) PATIENT TEACHING:  May complain of frequent urination in small amounts: explain that this is due to urinary retention with overflow.  May have difficulty voiding because of abdominal pressure or trauma to the trigone of the Bladder  Voiding may be initiated by Pouring warm and cool water alternately over the vulva  Encourage the client to go to the comfort room for every 4 to 6 hours  Let her listen to the sound of running water  If these measures fail, catheterization, done gently and aseptically, is the last resort on doctors order.  Instruct to avoid garters or constricting clothing that can impair circulation  Do Kegel exercises. You perform Kegels by simply tightening your pelvic floor muscles. Pretend as if you are trying to stop a stream of urine. Do 10 to 12 Kegels every time you feed the baby to help tighten your pelvic floor muscles and increase blood flow to the perineum. to perform Kegel exercises as soon as is they can comfortably do so. BOWEL MOVEMENT Bowel movement maybe delayed for days after delivery resulting in constipation. This is caused by decreased muscle tone during labor and puerperium. Lack of food during labor Dehydration Fear of pain from perineal tenderness due to episiotomy, lacerations or hemorrhoid Bowel sounds are active, but passage of stool through the bowel may be slow Spontaneous bowel movement may not occur for 2 to 3 days after childbirth because of the lingering effects of progestone

PATIENT TEACHING:  Demonstrate how to clean the perineum after each voiding and defecation (wiping form

front to back), washing the hands and applying a perineal pad from front to back  Instruct to avoid garters or constricting clothing that can impair circulation  Teach the importance of adequate fluid intake, exercise, proper diet and a regular defecation time  Instruct to wear perineal pads loosely and to lie in sims position  Encourage client to shower as soon as she can ambulate and to take tub baths if desired after two weeks.  Recommended daily shower to promote comfort and a sense of well-being  Provide adequate dietary fiber and fluids to promote bowel movements; if necessary administer stool softeners, laxatives, suppositories or enema EPISIOTOMY Is a surgical incision through the perineum made to enlarge the vagina and assist childbirth. The incision can be midline or at an angle from the posterior end of the vulva, It is performed under local anaesthetic (pudendal anesthesia) and is sutured closed afterdelivery.

PATIENT TEACHING o Sims position- minimizes strain on the suture line o Perineal heat lamp or warm sitz baths twice a day- vasodilation increases blood supply and therefore, promotes healing. o Apply ice or cold therapy to the episiotomy or laceration immediately after delivery to decrease edema and provide anesthesia; thereafter apply moist or dry heat therapy to promote comfort and healing. o Application of topical analgesics or administration of mild oral analgesics as ordered o Instruct the client on sitting properly to relieve pain (squeeze the buttocks together and contract pelvic floor muscles before sitting) o During Perineal Care Flush with warm water.