Normal Postpartum Care - Concept Map
Normal Postpartum Care (Puerperium): Safe Physiologic Recovery, Hemorrhage Prevention, Successful Breastfeeding, and Maternal-Infant Bonding
Related concepts
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
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
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
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)
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
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
Concept connections
- Physiologic Changes and InvolutionBUBBLE-HE Assessment FrameworkUnderstanding normal physiology (fundal descent, lochia changes, vital signs) enables accurate assessment using BUBBLE-HE; abnormalities identified through assessment indicate deviations from expected physiology
- BUBBLE-HE Assessment FrameworkPostpartum Hemorrhage PreventionBUBBLE-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
- Postpartum Hemorrhage PreventionUterine AtonyUterine atony (boggy uterus) is the most common cause of PPH; recognizing atony through fundal assessment leads to immediate massage and intervention, preventing severe hemorrhage
- Breastfeeding Support and LactationMaternal-Infant Bonding and Psychological AdaptationSuccessful breastfeeding promotes oxytocin release, enhancing uterine contraction (preventing PPH), and facilitates en face contact and bonding behaviors critical for maternal-infant attachment
- Maternal-Infant Bonding and Psychological AdaptationRubin's Maternal PhasesRubin'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)
- Discharge Planning and Follow-Up CareDanger Signs Requiring ReportDischarge 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
- Uterine InvolutionLochia ProgressionAs 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
- Breastfeeding Support and LactationBUBBLE-HE Assessment FrameworkThe Breasts component of BUBBLE-HE specifically assesses breastfeeding readiness, latch quality, and complications like engorgement and mastitis; these are essential elements of postpartum care
- Postpartum Hemorrhage PreventionUterotonics and Their PharmacologyUnderstanding 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
- Cardiovascular and Hematologic ChangesPostpartum Hemorrhage PreventionNormal 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
- Bladder AssessmentUterine InvolutionA full bladder displaces the uterus and prevents effective contraction, directly impairing involution and increasing bleeding risk; emptying the bladder is a priority intervention
- Mastitis Recognition and ManagementBreastfeeding SupportMastitis is a complication of breastfeeding; recognizing its signs and managing it by continuing breastfeeding plus antibiotics prevents weaning and maintains lactation success
- Postpartum DepressionDischarge Planning and Follow-Up CareScreening 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
- Attachment BehaviorsPostpartum PsychosisPresence 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
- Activity and Rest Discharge TeachingDVT PreventionEarly ambulation promotes venous return and prevents DVT; discharge teaching emphasizing activity is essential for thromboembolism prevention in the postpartum period when hypercoagulability persists
- Postpartum ContraceptionBreastfeeding and LactationContraceptive choice depends on breastfeeding status; progestin-only and non-hormonal methods are preferred for breastfeeding mothers to avoid affecting milk supply; LAM criteria apply
- Rh Immunoglobulin AdministrationDischarge PlanningAnti-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
- Taking-Hold PhaseBUBBLE-HE Assessment and TeachingThe 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
- Prolactin and Oxytocin ReleaseUterine Contraction and AfterpainsOxytocin 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
- Engorgement ManagementPreventing MastitisProper engorgement management (frequent feeding, warm compresses, expression) prevents milk stasis and subsequent mastitis; these are preventive interventions central to breastfeeding success
Diagrams
Normal Postpartum Care: Comprehensive Concept Map
Postpartum Hemorrhage (PPH) Assessment and Management Algorithm
Lochia Assessment and Documentation
Breastfeeding Assessment and Support
Rubin's Maternal Phases and Emotional Adaptation
BUBBLE-HE Postpartum Assessment Framework
Timeline of Lochia Progression and Expected Duration