Midwife Licensure Exam Normal Pregnancy, Labor & Postpartum — Normal Postpartum CareConcept Map

Concept

Physiologic Changes and Involution

Sub Concepts

• Uterine Involution (fundal descent ~1 cm/day)
• Lochia Progression (rubra → serosa → alba)
• Cardiovascular Changes (diuresis, bradycardia)
• Hematologic Changes (leukocytosis, hypercoagulability)
• Gastrointestinal/Urinary Changes (constipation, retention)
• Endocrine Shifts (prolactin, estrogen/progesterone fall)
• Weight Loss (5-6 kg immediate)

Relationship To Central

Forms the foundation for understanding what is normal during the postpartum period; guides assessment and early detection of abnormalities

Concept

BUBBLE-HE Assessment Framework

Sub Concepts

• B - Breasts (filling, engorgement, nipple integrity)
• U - Uterus (firmness, height, position, involution)
• B - Bladder (distension, voiding, impact on uterine contraction)
• B - Bowel (function, constipation prevention)
• L - Lochia (amount, color, odor, clots, abnormal findings)
• E - Episiotomy/Perineum (REEDA assessment, healing)
• H - Homans' sign/Lower Extremities (DVT assessment)
• E - Emotional Status/Bonding (mood, attachment, depression screening)

Relationship To Central

Systematic assessment tool used at every postpartum encounter to evaluate all body systems and detect complications early

Concept

Postpartum Hemorrhage (PPH) Prevention

Sub Concepts

• Definition (>500 mL vaginal, >1,000 mL cesarean)
• Primary Cause: Uterine Atony (boggy uterus)
• 4 Ts Framework (Tone, Trauma, Tissue, Thrombin)
• Signs of Atony (soft fundus, excessive bleeding, clots)
• First-Line Intervention (fundal massage)
• Bladder Assessment (full bladder prevents contraction)
• Uterotonic Medications (oxytocin, methylergometrine, carboprost)
• Medication Contraindications (Methergine with hypertension, carboprost with asthma)
• Monitoring (vital signs, blood loss estimation, pad count)

Relationship To Central

Critical safety priority; PPH is the leading cause of maternal mortality; early detection and intervention save lives

Concept

Breastfeeding Support and Lactation

Sub Concepts

• Philippine Policy Framework (RA 10028, EO 51 Milk Code, Unang Yakap)
• Colostrum (antibodies, protein, laxative effect)
• Milk Physiology (prolactin for production, oxytocin for let-down)
• Stages of Milk (colostrum → transitional → mature)
• Latch Teaching (mouth wide, areola contact, chin to breast)
• Feeding Frequency (8-12 times/24 hours, demand-driven)
• Engorgement Management (frequent feeding, warm/cold compresses)
• Mastitis Recognition and Management (continue breastfeeding, antibiotics)
• Exclusive Breastfeeding for 6 Months (DOH guideline)
• Contraindications (HIV, active TB, certain drugs, infant galactosemia)

Relationship To Central

Promotes infant health, mother-infant bonding, and postpartum uterine contraction (via oxytocin release)

Concept

Maternal-Infant Bonding and Psychological Adaptation

Sub Concepts

• Rubin's Maternal Phases (taking-in, taking-hold, letting-go)
• Taking-In Phase (passive, dependent, food/rest focused, birth processing)
• Taking-Hold Phase (independent, eager to learn, best teaching time)
• Attachment Behaviors (eye contact, touching, naming, responsiveness)
• Postpartum Blues (transient, day 3-5 peak, reassurance only)
• Postpartum Depression (persistent >2 weeks, requires referral/treatment)
• Postpartum Psychosis (rare emergency, requires psychiatric care, infant safety)

Relationship To Central

Ensures safe, healthy maternal-infant relationship and identifies mental health complications requiring intervention

Concept

Discharge Planning and Follow-Up Care

Sub Concepts

• Danger Signs Requiring Report (heavy bleeding, fever, DVT signs, embolism)
• Perineal/Incision Care (sitz baths, front-to-back cleansing, pain relief)
• Activity and Rest (early ambulation, gradual return, Kegel exercises)
• Nutrition (iron continuation, balanced diet, extra calories if breastfeeding)
• Postpartum Contraception (progestin-only for breastfeeding, LAM criteria)
• Rh Immunoglobulin (anti-D within 72 hours if Rh-positive baby)
• Follow-Up Scheduling (6-week postpartum visit, newborn care coordination)
• Family Support Assessment (social determinants, postpartum depression risk)

Relationship To Central

Prepares mother and family for safe home care and identifies when to seek help; ensures continuation of care and prevention of complications

To

BUBBLE-HE Assessment Framework

From

Physiologic Changes and Involution

Strength

strong

Relationship

Understanding normal physiology (fundal descent, lochia changes, vital signs) enables accurate assessment using BUBBLE-HE; abnormalities identified through assessment indicate deviations from expected physiology

To

Postpartum Hemorrhage Prevention

From

BUBBLE-HE Assessment Framework

Strength

strong

Relationship

BUBBLE-HE assessment, particularly evaluation of uterine firmness, lochia amount, and vital signs, is the primary tool for detecting early signs of PPH; allows for timely intervention

To

Uterine Atony

From

Postpartum Hemorrhage Prevention

Strength

strong

Relationship

Uterine atony (boggy uterus) is the most common cause of PPH; recognizing atony through fundal assessment leads to immediate massage and intervention, preventing severe hemorrhage

To

Maternal-Infant Bonding and Psychological Adaptation

From

Breastfeeding Support and Lactation

Strength

strong

Relationship

Successful breastfeeding promotes oxytocin release, enhancing uterine contraction (preventing PPH), and facilitates en face contact and bonding behaviors critical for maternal-infant attachment

To

Rubin's Maternal Phases

From

Maternal-Infant Bonding and Psychological Adaptation

Strength

strong

Relationship

Rubin's phases framework explains the expected progression of maternal emotional adaptation; identifies the best time for teaching (taking-hold phase) and screens for complications (blues vs. depression)

To

Danger Signs Requiring Report

From

Discharge Planning and Follow-Up Care

Strength

strong

Relationship

Discharge teaching must include clear identification and explanation of danger signs (bleeding, fever, DVT signs, depression) so mothers know when to seek immediate help; critical safety education

To

Lochia Progression

From

Uterine Involution

Strength

strong

Relationship

As the uterus involutes and the placental site heals, lochia changes predictably from rubra to serosa to alba; the two processes are interdependent and both indicate normal healing

To

BUBBLE-HE Assessment Framework

From

Breastfeeding Support and Lactation

Strength

strong

Relationship

The Breasts component of BUBBLE-HE specifically assesses breastfeeding readiness, latch quality, and complications like engorgement and mastitis; these are essential elements of postpartum care

To

Uterotonics and Their Pharmacology

From

Postpartum Hemorrhage Prevention

Strength

strong

Relationship

Understanding when and how to administer uterotonic medications (oxytocin, methylergometrine, carboprost), including contraindications, is essential for PPH management; medication choice depends on clinical presentation and maternal history

To

Postpartum Hemorrhage Prevention

From

Cardiovascular and Hematologic Changes

Strength

moderate

Relationship

Normal postpartum cardiovascular changes (blood volume shifts, diuresis) and hypercoagulability increase the risk and significance of PPH; understanding these changes helps anticipate and recognize early signs

To

Uterine Involution

From

Bladder Assessment

Strength

strong

Relationship

A full bladder displaces the uterus and prevents effective contraction, directly impairing involution and increasing bleeding risk; emptying the bladder is a priority intervention

To

Breastfeeding Support

From

Mastitis Recognition and Management

Strength

strong

Relationship

Mastitis is a complication of breastfeeding; recognizing its signs and managing it by continuing breastfeeding plus antibiotics prevents weaning and maintains lactation success

To

Discharge Planning and Follow-Up Care

From

Postpartum Depression

Strength

strong

Relationship

Screening for postpartum depression during the postpartum period and at discharge follow-up appointments is essential; early identification allows timely referral and treatment to prevent harm

To

Postpartum Psychosis

From

Attachment Behaviors

Strength

moderate

Relationship

Presence or absence of normal attachment behaviors may indicate postpartum psychosis risk; psychosis can impair maternal ability to safely care for and bond with infant; requires emergency intervention

To

DVT Prevention

From

Activity and Rest Discharge Teaching

Strength

strong

Relationship

Early ambulation promotes venous return and prevents DVT; discharge teaching emphasizing activity is essential for thromboembolism prevention in the postpartum period when hypercoagulability persists

To

Breastfeeding and Lactation

From

Postpartum Contraception

Strength

moderate

Relationship

Contraceptive choice depends on breastfeeding status; progestin-only and non-hormonal methods are preferred for breastfeeding mothers to avoid affecting milk supply; LAM criteria apply

To

Discharge Planning

From

Rh Immunoglobulin Administration

Strength

moderate

Relationship

Anti-D immunoglobulin must be given within 72 hours postpartum if mother is Rh-negative and baby is Rh-positive; verification and administration documentation is a critical discharge responsibility

To

BUBBLE-HE Assessment and Teaching

From

Taking-Hold Phase

Strength

strong

Relationship

The taking-hold phase (days 2-10) is the optimal window for teaching mothers about self-care, infant care, and health promotion; assessment findings should guide individualized teaching priorities

To

Uterine Contraction and Afterpains

From

Prolactin and Oxytocin Release

Strength

strong

Relationship

Oxytocin released with breastfeeding and let-down reflex causes uterine contractions (afterpains) that promote involution and prevent hemorrhage; this is a beneficial physiologic response to encourage frequent feeding

To

Preventing Mastitis

From

Engorgement Management

Strength

strong

Relationship

Proper engorgement management (frequent feeding, warm compresses, expression) prevents milk stasis and subsequent mastitis; these are preventive interventions central to breastfeeding success