Management of puerperium
for the woman, her newborn baby and her family after a normal delivery creates
a happy, exciting and rewarding experience. It is a time when the midwife
exercises her ability of observation and sensitivity to provide excellent
nursing care. The puerperal woman is no more treated as ignorant, idle, ill
woman, confined to bed. Today the puerperal woman is regarded to be healthy,
intelligent, who is anxious to see, touch and care for her baby. The first ten
days is regarded as the “lying- in-period” when close observation and adequate
care should be given to the patient.
physical well being
of client by
correcting anaemia, providing comfort, cleanliness
and promoting sufficient physical activity to ensure good muscle tone and
involution of the pelvic organs.
Establish emotional well being, quietness, freedom
from worry and exicitment and proper phychological approach.
promote breast feeding
provide education on the proper care of her baby
care is divided into two phases; immediate and subsequent.
Immediate care: covers the first 24 hours after
birth. The first 1hour is most critical is regarded as the 4th stage
of labour. Ideally it should be spent in the labour ward. It is the time most
Post – Partum Hemorrhage (PPH) occur, shock or sudden collapse.
observation is needed. Pulse, BP, involution, Lochia, perineum, could be done
every 15minutes. It includes condition of the uterus, condition of the
perineum, bladder and voiding.
sedation may be
served. If B/P
is high , sedation should be
given orally or
intraveinously to prevent
postpartum eclampsia. She is made comfortable and allowed to rest. At
the end of one hour, she is observed again, cleaned up and offered a drink- encourage to
pass urine and
uterus should be
emptied. Uterus should be well
Rest and Sleep: very essential calm atmosphere
should be provided. No strenuous activities
Ambulation: 6 –12 hours after delivery- promote fee
ling of well-being, good circulation and drainage of Lochia. She can now
participate in the management and care of her baby.
Diet, fluids and vitamins: a protein diet, vitamins
and minerals to promote good lactation. Adequate fluids – milk, fruit
supplementary vitamins , iron, folic acid to prevent anemia
Care of bladder and bowel: encourage to empty
bladder regularly to prevent Post –Partum Hemorrhage (PPH), sub-involution and
Urinary Tract Infection. Catheterize if necessary to prevent constipation.
dulcolax suppository or magnesium hydroxide (30mls). May begin to take food
rich in roughage.
and cleanliness –
vulval toilet re gular perineal care and changing of pad,
sanitary towel should be discarded
involution – encourage
early ambulation good health , prevent infection , breast feeding
,postnatal exercises and estimate fundal height daily Postnatal exercises: this
should be done daily in puerperium.
Promotion of breastfeeding: this should be
encouraged most mothers are eager. Empty breast at each feed nipples must be
free from infections cracks and engorgement. Mother must be free from
Prevention of infection: reduce visitors,
antisepsis and asepsis should be observed when caring for the vulva. On
suspicion of infection, patient should be isolated or barrier nursed.
Records: all observation vital signs abdomen,
uterine tenderness or full bladder. Involution, breast examination, Lochia
color , odor amount and consistency , wound for healing or removal of stitches.
of the mother – mother must be educated on care of the baby and the need for
post natal visit and family planning be emphasized
Done by the same person , same time using same
should empty her bladder
Palpate the abdomen and locate the fundus uteri and
upper border of the symphysis pubis. using a flat graduated rule estimate the
distance between the symphysis pubis and the uterine fundus
Post natal examination:
conducted 6weeks later to ensure
organs affected by pregnancy return to their
lactation : assess if the breast is lactating well
good condition generally –medically and gynecologic
Urine testing, vital signs and blood clot
Examination –generally, abdomen, breast
Vaginal Examination (by doctor) to assess if the
cervix is closed or still open
Perineal examination – laceration ,cough to exude
return of menses
Baby examination- general condition sleep
elimination, circumcision, feeding general appearance etc.
Ask questions on her wellbeing and that of the baby
Vaginal discharge – infection
Backache- (poor feeding and work)