ob chapter 17

Question 1

What is the postpartum period (puerperium)?

Answer 1

The 6-week period after childbirth involving maternal physical and psychological changes.

Question 2

What are the two types of changes during the postpartum period?

Answer 2

Retrogressive: Involution of the uterus and vagina. Progressive: Lactation, menstrual cycle restoration, and beginning the parenting role.

Question 3

How can postpartum physical care impact a birthing parent?

Answer 3

It can influence their long-term health and recovery.

Question 4

What is the Baby-Friendly Initiative, and how does it relate to postpartum care?

Answer 4

A set of strategies promoting breastfeeding and infant-parent bonding, such as skin-to-skin contact and rooming-in.

Question 5

What is parental attachment bonding?

Answer 5

A process where a parent successfully links with their newborn, facilitated by early skin-to-skin contact.

Question 6

When should skin-to-skin contact occur after birth?

Answer 6

Ideally within the first hour, even after cesarean delivery, as long as the parent and baby are stable.

Question 7

What is the en face position, and why is it important?

Answer 7

When a parent looks directly at their newborn’s face with eye contact, signaling the beginning of effective attachment.

Question 8

What is engrossment in parental bonding?

Answer 8

A sign of active parental bonding where the parent is highly focused on their newborn.

Question 9

How can nurses support family bonding postpartum?

Answer 9

Encourage skin-to-skin contact, rooming-in, and sibling/family visitation.

Question 10

Why might a birthing parent feel overlooked or forgotten postpartum?

Answer 10

They may feel less important after birth compared to the attention received during pregnancy and labor.

Question 11

What is disillusionment in new parents?

Answer 11

The realization that parenting is different from expectations; nurses should reassure parents that this is normal.

Question 12

What are postpartum blues, and how common are they?

Answer 12

Temporary feelings of sadness, tearfulness, irritability, or feeling let down, affecting up to 50% of postpartum individuals.

Question 13

What is a possible cause of postpartum blues?

Answer 13

Hormonal changes.

Question 14

How can postpartum blues be alleviated?

Answer 14

Breastfeeding can help counteract mood changes.

Question 15

What is involution of the uterus?

Answer 15

A process where the uterus returns to its pregestational size and seals off the placental site to prevent bleeding.

Question 16

How long does uterine involution take?

Answer 16

Approximately 6 weeks.

Question 17

Where is the fundus located immediately after birth?

Answer 17

Halfway between the umbilicus and the symphysis pubis.

Question 18

Where is the fundus one hour after birth?

Answer 18

It rises to the level of the umbilicus and remains there for about 24 hours.

Question 19

How much does the fundus decrease in height daily?

Answer 19

1 cm (or one fingerbreadth) per day.

Question 20

How does breastfeeding affect uterine involution?

Answer 20

It accelerates involution because oxytocin, released during breastfeeding, stimulates uterine contractions.

Question 21

What is a boggy uterus, and why is it a concern?

Answer 21

A soft, relaxed uterus that increases the risk of postpartum hemorrhage.

Question 22

What is uterine atony, and when is the highest risk?

Answer 22

When the uterus fails to contract properly, leading to rapid blood loss; highest risk is within the first hour postpartum.

Question 23

How should the fundus be assessed?

Answer 23

Assess fundal height after bladder emptying for accuracy. A full bladder can push the uterus upward, increasing bleeding risk.

Question 24

How should a well-contracted uterus feel?

Answer 24

Firm and grapefruit-like in size and tenseness.

Question 25

What is lochia?

Answer 25

A vaginal discharge consisting of blood, fragments of decidua, WBCs, mucus, and bacteria, similar to menstrual flow.

Question 26

Why does lochia occur?

Answer 26

The necrotic uterine lining is shed following birth.

Question 27

How does the cervix change after birth?

Answer 27

The internal os closes, but the external os remains slightly open and appears slitlike or stellate (star-shaped) instead of round.

Question 28

How does the vagina change postpartum?

Answer 28

It becomes soft, with few rugae, and its diameter is wider than normal.

Question 29

How does the perineum change after birth?

Answer 29

It becomes edematous and tender due to birth pressure.

Question 30

What comfort measures can help with perineal discomfort?

Answer 30

Ice packs, warm packs, a gentle pillow, or a doughnut pad for sitting.

Question 31

What medications can be used for perineal pain?

Answer 31

Acetaminophen or ibuprofen, as discussed with

Question 32

Why do postpartum patients experience diaphoresis and diuresis?

Answer 32

To rid the body of excess fluid from pregnancy.

Question 33

How does the bladder change postpartum?

Answer 33

It has a transient loss of tone, making it harder for the patient to sense when they need to void.

Question 34

Why is it important to assess the abdomen for bladder distention postpartum?

Answer 34

A full bladder can displace the uterus, preventing contractions and increasing the risk of postpartum hemorrhage.

Question 35

How can the uterine position help determine bladder fullness?

Answer 35

If the uterus is displaced and not contracting well, the bladder may be full.

Question 36

When does blood volume return to prepregnancy levels?

Answer 36

By the first or second week postpartum due to diuresis and blood loss.

Question 37

How does pregnancy-related varicosities change postpartum?

Answer 37

Varicose veins usually recede after birth.

Question 38

Is bilateral ankle edema normal postpartum?

Answer 38

Yes, but it should not progress above the knees.

Question 39

What dietary recommendations help with postpartum constipation?

Answer 39

High-fiber foods, fruits, and adequate fluids.

Question 40

Why might stool softeners be needed postpartum?

Answer 40

Because bowel movements may be slow due to relaxin, and hemorrhoids/episiotomy sutures can make passing stool painful.

Question 41

What skin change is common postpartum?

Answer 41

Striae gravidarum (stretch marks) on the abdomen.

Question 42

What is diastasis recti, and how can it be treated?

Answer 42

Separation of the abdominal muscles due to overstretching; can be treated with modified abdominal exercises or surgery if severe.

Question 43

What triggers Lactogenesis II at birth?

Answer 43

The delivery of the placenta, which causes a drop in progesterone and pregnancy hormones.

Question 44

What is Lactogenesis II also known as?

Answer 44

Engorgement or when the “milk has come in.”

Question 45

When does Lactogenesis II occur?

Answer 45

From birth to 5–10 days postpartum.

Question 46

What is the milk called during Lactogenesis II?

Answer 46

Transitional milk.

Question 47

What happens to the breasts in the first 2 days postpartum?

Answer 47

They show little change from pregnancy because colostrum may have already been secreted.

Question 48

What happens to the breasts on day 3 postpartum?

Answer 48

They become full, tense, or tender as milk forms.

Question 49

When does menstrual flow return for a non-breastfeeding parent?

Answer 49

6 to 10 weeks postpartum.

Question 50

When does menstrual flow return for a breastfeeding parent?

Answer 50

3 to 4 months or more (or sometimes not until after lactation ends).

Question 51

Can a breastfeeding person ovulate before their period returns?

Answer 51

Yes, ovulation can occur before menstruation returns, meaning pregnancy is still possible.

Question 52

What are the postpartum warning signs for respiratory issues?

Answer 52

Chest pain or difficulty breathing.

Question 53

What are the neurologic postpartum warning signs?

Answer 53

Seizures, persistent headaches, or visual changes.

Question 54

What are the mental health postpartum warning signs?

Answer 54

Thoughts of self-harm or harming others.

Question 55

What are the infection-related postpartum warning signs?

Answer 55

Fever (100.4°F or higher), redness/edema of lower extremities, or poor incision healing.

Question 56

What are the postpartum hemorrhage warning signs?

Answer 56

Soaking through one pad/hour or passing clots larger than a quarter.

Question 57

When should a postpartum patient call 911?

Answer 57

Chest pain, difficulty breathing, seizures, or thoughts of harming self/others.

Question 58

When should a postpartum patient call their healthcare provider?

Answer 58

Persistent headache, fever, excessive bleeding, swelling/redness in legs, or incision not healing.