Section I. CHANGES OF THE POSTPARTAL PATIENT
The first six weeks following the birth of a baby is known as the postpartum
period. During this period the reproductive organs of the mother return to their
prepregnant state. There are marked anatomic and physiologic changes as the
physiologic processes that are designed to accommodate pregnancy are revised. In
caring for a patient during the postpartal period, the nurse must have a good
understanding of the physiologic and psychological adaptations that occur during this
time. With this knowledge and understanding the nurse is able to recognize any
abnormal findings and to intervene as necessary.
CHANGES IN THE REPRODUCTIVE SYSTEM FOLLOWING DELIVERY
a. The Uterus.
(1) Major changes in the uterus. Immediately after the placenta and
membranes are delivered, the placenta site is elevated, irregular, and partially
obliterated by vascular constriction and thrombosis. In other words, the placental
attachment site is sealed in order to prevent bleeding. The uterus gradually returns to
its approximate prepregnant size. This is accomplished by a decrease in the size of the
individual myometrial cells and is usually accomplished by 4 to 6 weeks postpartum.
The process is referred to as uterine involution. The uterine size usually increases
slightly after each pregnancy. A soft and boggy uterus, due to relaxation, requires
immediate massage until it is contracted again. This is done to stop bleeding. The
height of the uterus after delivery can be used to measure the process of uterine
involution while the mother is hospitalized. See figure 6-1 to view the following changes
of the uterus:
(a) Immediately after delivery- idway between the umbilicus and
(b) Twelve hours after delivery-above the umbilicus.
After that - the fundus descends about one fingerbreadth every 24
(d) After the tenth day of postpartum--the uterus should not be