California Baptist University NUR 325 Nursing Services with the Childbearing Family POSTPARTUM DISCHARGE TEACHING I. Involution of the Uterus and Lochia Changes after birth A. Promoting Uterine In... volution 1. Check the fundus of your uterus with the palm of your hand each day and note if it is in the midline of your abdomen. If it is displaced to one side, empty your bladder and check it again. 2. If it feels soft or spongy, massage it until it becomes firm. You should feel the fundus (top of the uterus) one fingerbreadth further below your belly button each postpartum day until day 10 when it shrinks inside the pelvis. 3. You may notice contractions of the uterus call after pains occurring if you are a multipara or if you are breastfeeding. These are normal and are due to oxytocin being released in response to the uterine muscle relaxing or the baby sucking. They usually disappear after the third postpartum day. You may find relief by lying prone with a pillow under the lower abdomen, walking, or taking Motrin or Tylenol. B. Lochia Changes and Bleeding 1. The color of the Lochia (uterine discharge) should change as follows: red (day 1-3), pinkish brown (day 4-10), creamy white or yellow (day 11-24). A return to bright red bleeding after these changes begin is a reason to notify your caregiver. 2. Numerous or large blood clots and heavy bleeding may be caused by uterine relaxation or retained placental fragments. Notify your caregiver if you continue to have many small clots, a clot bigger than a half dollar, or if you are bleeding is as much as 1 or more saturated sanitary pads/hour. 3. The daily amount of Lochia you produce decreases gradually. It is greater in the morning because it pools in the vagina while you sleep. You may notice an increase in the amount of Lochia when you breastfeed or exercise. 4. Lochia should smell similar to your menstrual period. If it has a foul odor or your saturated pads smell foul, notify your caregiver as it may indicate an infection. 5. If you suddenly have excessive amounts of bleeding immediately check your uterus. If it is not firm, massage it then call your doctor. 6. If the amount of bleeding increases evaluate if you are doing too much—the uterus is a muscle and if your body gets overly tired, it will relax and lead to more bleeding. II. Perineal Care A. Use good hygiene when you cleanse after urinating or defecating. 1. Cleanse from the front (near the pubic hair) to the back (near the anus) of the perineum. 2. Squeeze warm water over the perineum using a peri-bottle. 3. Blot (pat) the area with toilet paper rather than wiping. 4. When changing pads, remove the pad to the back and apply the new pad from the front to the back. Change pads regularly to prevent infection. 5. When placing ice packs on the perineum or applying pain relief products, always move from front to back. 6. The episiotomy should continue to heal without any redness, swelling, bruising, discharge or separation of the edges of the wound. [Show More]
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