5. Anatomical Changes in the Postpartum
a. Return of blood volume to prepregnant
1) The blood volume of the
pregnant woman increases by at least 40% to allow her to tolerate the blood
loss of delivery.
b. Genital tract
2) Many women lose 300 to 400 ml.
(a little less than 1/2 quart) of blood.
3) Due to increased blood clotting
factors in the blood, encourage ambulation (walking) to prevent blood clotting
1) The cervix may be bruised
and have some small lacerations.
c. Urinary tract
2) At birth, the uterus weighs 11
times its prepregnant weight; afterward, it rapidly shrinks back into the
pelvis (2.2 pounds after delivery reduces I I to 12 ounces 2 weeks after
3) Uterine size is slightly increased
after each pregnancy.
4) Vaginal structures may be bruised,
sore, and swollen due to birth trauma, episiotomy, and/or lacerations.
5) The mother will experience "bleeding"
consisting of blood tissue and mucus for about 2 weeks. It is heaviest
in the first 2 days after delivery and should decrease after this.
1) Increased urination should
begin within 12 hours after delivery to allow for elimination of excess
tissue fluid accumulated in pregnancy.
d. Gastrointestinal tract
2) Pelvic soreness due to labor, vaginal
lacerations, or episiotomy may be reduced after voiding.
1) Bowel movements may be
delayed for several days because of decreased muscle tone in intestines,
prelabor diarrhea, lack of food, dehydration, and/or tenderness of the
2) For some women, bowel habits must
be reestablished through special attention to diet and fluid intake.
1) Considerable enlargement
of the breasts occurs during pregnancy in response to changes in hormones.
2) The size of the milk ducts increases
during pregnancy, and by the sixth or seventh month small amounts of "pre-milk,"
may be expressed from the nipple.
3) Two to 3 days after delivery, a
surge of actual milk may be expected.
4) Infant suckling causes stimulation
that results in increased hormone production. Production of hormone causes
the milk ducts to contract and "let down" milk.
1) The muscles of the abdomen
are stretched; the expectant mother will have been instructed by her physician/practitioner/nurse
as to when exercises may be started.
2) Abdominal cesarean section
(a) The classical type involves
a vertical incision (up and down).
(b) A transverse incision runs across
the top of the pubic hairline ("bikini" incision).