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5. Anatomical Changes in the Postpartum Woman

a. Return of blood volume to prepregnant state.

1) The blood volume of the pregnant woman increases by at least 40% to allow her to tolerate the blood loss of delivery.

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 problems.

b. Genital tract
1) The cervix may be bruised and have some small lacerations.

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 delivery).

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.

c. Urinary tract
1) Increased urination should begin within 12 hours after delivery to allow for elimination of excess tissue fluid accumulated in pregnancy.

2) Pelvic soreness due to labor, vaginal lacerations, or episiotomy may be reduced after voiding.

d. Gastrointestinal tract
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 genital structures.

2) For some women, bowel habits must be reestablished through special attention to diet and fluid intake.

e. Breasts
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," colostrum, 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.

f. Abdomen
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).

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