How The Body Changes After Pregnancy | Postpartum Physiologic Changes

Summary

This video covers the normal physiological changes that occur during the postpartum period, detailing the body's transition from pregnancy to its new normal state. It explores eight systems, including the reproductive, cardiovascular, hematologic, endocrine, renal, gastrointestinal, musculoskeletal, and mental health systems. Key topics include uterine involution, lochia stages, hormonal shifts, breastfeeding effects, and changes in the cardiovascular and renal systems. Psychological adaptation phases, such as 'taking in,' 'taking hold,' and 'letting go,' are also discussed, highlighting the emotional changes and the process of bonding with the newborn.

Takeaways

• 😀 The postpartum period involves significant physiological changes as the body transitions from a pregnant state to a non-pregnant state, impacting various systems.
• 😀 Uterine involution is a crucial process post-delivery where the uterus shrinks from above the umbilicus to below it, and eventually returns to its non-pregnant size over about two weeks.
• 😀 Lochia, the postpartum discharge, changes in color and consistency over the first six weeks, with three stages: lochia rubra (red), lochia serosa (pink), and lochia alba (white/yellow).
• 😀 The cervix undergoes significant changes after delivery, including dilation and bruising, but gradually returns to a round shape and eventually a normal, slit-like appearance.
• 😀 Breastfeeding stimulates the release of oxytocin, helping to reduce bleeding and encourage uterine contractions, though it may make contractions more intense for multiparous clients.
• 😀 Colostrum is produced shortly after delivery, which may leak before birth and lasts up to 96 hours, transitioning into full milk production as breasts become engorged.
• 😀 Cardiovascular changes post-delivery include a reduction in plasma volume, and heart rate fluctuations, including potential bradycardia in the early postpartum period.
• 😀 Hematologic changes include a drop in hematocrit and a temporary rise in white blood cell count, both of which stabilize after a few weeks.
• 😀 Prolactin levels remain elevated during breastfeeding to support milk production, while ovulation can occur as soon as 45 days postpartum, although breastfeeding may delay it for up to six months.
• 😀 Psychological adaptation includes stages like 'taking in', 'taking hold', and 'letting go', reflecting the evolving independence and bonding process of new mothers with their babies.

Q & A

What is involution and why is it important in the postpartum period?

Involution refers to the process by which the uterus returns to its non-pregnant size after childbirth. It starts about 24 hours after delivery and progresses until the uterus is no longer palpable by two weeks. This process is important as it helps prevent complications like bleeding or infections.

What are the stages of lochia, and how do they differ over time?

Lochia is the postpartum discharge that consists of blood, mucus, and uterine tissue. It has three stages: Lochia Rubra (bright red, days 1-3), Lochia Serosa (pinkish, days 4-10), and Lochia Alba (whitish-yellow, up to six weeks). These changes in color indicate the healing process of the uterus.

How does breastfeeding affect uterine contractions postpartum?

Breastfeeding stimulates the release of oxytocin, which not only helps with milk production but also causes uterine contractions. These contractions help reduce bleeding and promote the involution of the uterus, though they can be uncomfortable, especially for multiparous clients.

What is subinvolution and how can it be identified?

Subinvolution occurs when the uterus does not shrink back to its normal size as expected after childbirth. If a healthcare provider can still palpate the uterus after two weeks, it may indicate subinvolution, which requires further assessment.

How does the cardiovascular system adjust postpartum?

After delivery, the body reduces the extra blood volume needed during pregnancy. Plasma volume decreases by about 1000 mL, and pulse rate typically decreases to normal levels. In some cases, bradycardia (a slow heart rate of 40-50 beats per minute) can occur, which is usually temporary.

What changes occur in the hematologic system after delivery?

In the first few days postpartum, the hematocrit drops due to blood loss, but it stabilizes over time. The white blood cell count may temporarily increase to 25,000 but is still considered normal. Coagulation factors like fibrinogen return to normal within two to three weeks.

How does prolactin function in the postpartum period?

Prolactin is the hormone responsible for milk production. It remains elevated as long as the client is breastfeeding. If a client is not breastfeeding, prolactin levels will normalize within about three weeks. Breastfeeding can also delay ovulation, especially if the baby is not sleeping through the night.

What is the normal urinary output postpartum?

Diuresis is common in the first 12 hours after delivery, where the body works to rid itself of excess fluid. This can lead to frequent urination or sweating. The glomerular filtration rate remains elevated for a few weeks, returning to normal afterward.

How does the gastrointestinal system change postpartum?

The body requires more calories for lactation, leading to increased appetite. Bowel movements may be delayed for two to three days due to reduced food intake during labor or narcotic pain medication. Cesarean births can also slow peristalsis, prolonging bowel recovery.

What musculoskeletal changes occur after pregnancy?

During pregnancy, hormonal changes loosen ligaments and joints to accommodate childbirth. These changes reverse over six to eight weeks postpartum. However, some women may experience permanent foot enlargement, and pelvic floor muscles may take six weeks to tighten back up.

What psychological changes are common in the postpartum period?

Many new parents experience 'baby blues,' which includes feelings of anxiety or overwhelm, affecting about 80% of individuals and typically lasting up to two weeks. However, if these feelings persist beyond two weeks, postpartum depression should be considered and assessed.

What are the phases of psychological adaptation postpartum?

There are three phases of psychological adaptation: 'Taking In' where the client focuses on their own needs and is dependent on others; 'Taking Hold' where the client seeks independence and begins to care for the baby; and 'Letting Go' where they integrate the baby into their daily life.