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Post Natal Care Paper








T.A 2018/2019

A. Background
Pregnancy and birth are regarded as a physiological occurrence in which most women
end up with normal and no complications (Department of Health, 1993). At the end of the
puerperium period, recovery of labor is generally considered to be complete. This view may
be optimistic. For many women, recovery is something that goes on and becoming a mother
is a normal physiological process. However, some recent studies suggest that long-term
health problems that occur after childbirth are a common problem (Hillan 1992b: glazener et
al., 1993, bick and MacArthur, 1995a), may last for a long time. A thorough knowledge of
physiological and psychological changes in puerperium times is essential if midwives
accurately assess maternal health status and ensure that recovery is in accordance with
expected standards. It is equally important to be aware of the potential for postpartum
morbidity in the long term and related factors such as obstetrics, anesthesia and social factors.


A. Penegrident
Normal puerperium or puerpurium is the period when it begins after normal labor or
delivery is completed and ends for about 6-8 weeks, but the entire genetal apparatus is
recovered as before in 3 months. Postpartum period with a history of potential episiotomy
occurs postpartum infusion and the greatest mortality rate in Indonesia is caused by infection.

The postpartum period begins after the birth of the placenta and ends when the uterus
complains like pre-pregnancy, lasting about 6 weeks. but all new genital devices recover
before pregnancy within 3 months.
The postpartum period begins after the completion of partus & ends approximately 6 weeks,
but all the new genitals recover as before pregnancy within 3 months.

Puerperal period is a period that begins from several hours after birth placenta and ends
after 6 weeks post partum.
Puerperal period is the period after childbirth until the recovery of the uterus and female
organs generally accompanied by the birth of puerperal blood, lasts for ± 6 weeks.

B. Kinds of puerperium
a. Early Puerperium
Namely the mother's restoration has been allowed to stand and walk and may work after
40 days
b. Puerperium intermedial
That is a thorough recovery of genetalia tools last 6-8 weeks
c. Remote Puerperium
That is the time it takes to recover and be perfectly healthy especially if during pregnancy
or labor time has a complication of time for perfectly healthy can be weeks, months or years.

3.The purpose of childbirth care

a. Restoring and maintaining the physical health of the mother by:

1). Mobilation gradually

2). Maintain cleanliness

3). Prevent the occurrence of anemia b. Restoring and maintaining the psychological health
of the mother by giving support and strengthening mother's belief in mother's role c. Prevent
complications during childbirth and if necessary treatment or referral d. Streamline in the
formation of breast milk e. Provide information and education counseling / IEC to mother
and her family about physical changes and signs of infection, breastfeeding, self-esteem,
balanced nutrition, sexual life and contraception so that mothers are able to care for
themselves and their infants independently during the puerperium.

4. Physiological Change of Puerperium Period

During pregnancy, changes occur in the female body system, including changes in the
reproductive system, digestive system, urinary system, musculkeletal system, endocrine
system, cardiovascular system, hematology system, and changes in vital signs. In the
postpartum the changes will again be the same as before pregnancy. The changes are as

a.Physical changes
General situation soon after childbirth is generally very weak,especially if the partus lasts
b.Reproduction system
c. Changes to the vulva, vagina and perineum
d. Digestive system
e. Urinary System
f. Muskuluskeletal System
g. Endocrine system
h. Cardiovascular System
i. Psychological changes

1. Phace honey moon There is intimidation and prolonged contact between good dad moms,
this is also called a psychic honeymoon that does not require romantic things. each name
cares for each other and creates a new relationship. (Varney 2007: 3)

2. Bonding and attachment occurs in the fourth stage of contact between mother, father and
child and remains in the bond of love. It is important for care to think about how to make it
happen. husband participation in the process of childbirth is one effort in the process of
bonding affection.

3. Phase Taking In (dependency stage) occurs on 1-2 days post partum. mother's attention
mainly to her needs, passive and dependent. ibiu does not send contact with the baby does not
mean not pay attention. in this phase to note contact with the baby, not how to care for the
baby (Hamilton, 1995: 291)

4. Phase taking hold lasting approximately 10 days from day to 2-4 post partum. paa is
currently very needed support system especially for young mother / primi para because in this
phase often happened post partum blues.
5. Phase letting go or interdependence (Manuaba, 1998). starting at 5-6 weeks of birth. the
body of ib after recovering physically the mother is able to accept the normal responsibility
no longer accept the role of illness and sexual activity has been done again.

6. Maternal reactions Positive reactions include talking to the baby, hugging, researching and
giving positive feedback about her baby.

7. Post partum blues (Obstetric Synopsis, 1983) mothers feel tired after childbirth, experience
perineal pain, swelling mamae. this is due to decreased levels of estrogen and progesterone of
the body after childbirth, often the original high emotion decreases rapidly after birth and
appears in 1-2 weeks of the partum part.

i. Hematology System During the last weeks of pregnancy, fibrinogen and plasma levels and
blood clotting factors increase.

l. Changes in Vital Signs 1. Body temperature The body temperature after the exposure may
rise from 0.5 ° C to 37.2 ° C-37 ° C, but not exceeding 38 ° C.
2. pulse Normal pulse in adults 60-80 times per minute. After childbirth there can be
puerperial brackardia whose pulse rate reaches 40-50 times / min.
3. Blood pressure Usually unchanged, the possibility of blood pressure will be lower after the
mother gave birth to katena bleeding.
4. Breathing
5. The state of breathing is always associated with the state of temperature and pulse.

5. Psychosocial aspects that occur during the puerperium

a. Phase taking in That happens fantasy, introspection, projection and rejection. Mother's
attention especially to his needs, may be passive and dependent
b. Phase taking hold That is the mimic stage and role play
c. Phase letting go That is the mother has taken responsibility in caring for her baby.

6. Basic needs of postpartum mothers

a. Nutrition and Liquids In addition to treatment in infants, which is also very important to
note is to care for maternal health. Similarly, the food intake, especially for mothers who
b. Ambulation Early ambulance is highly recommended for postpartum mothers as this will
improve blood circulation and prevent the risk of thrombophlebitis, improve peristalsis and
bladder function so as to prevent constipation and retention of urine and mothers will feel
c. Elimination CHAPTER / BAK Postpartum mothers should urinate within the first 6-8
hours at least 200cc.
d. personal hygiene Maintaining hygiene for postpartum mothers is very important because
postpartum mothers are very susceptible to infectious events so that mothers need to always
keep the cleanliness of the whole body, clothing he wore and cleanliness of the environment
e. Perineal Wound Care Perineal wound care is the fulfillment of the need for healthy
between the thighs restricted to the vulva and anus in the mother who is in the period between
the birth of the placenta to the return of the genetic organ as it was before pregnancy.
f. Break Postpartum requires adequate rest, this is important because if the mother is less rest
will affect the general health condition.
g. Sexual In the puerperium period often decreases libido in the mother. The presence of
perineal rupture and decreased steroid hormone will affect the mother's desire for sexual
h. Family planning In the postpartum period, contraceptive use is necessary because it can
improve maternal and fetal health by prolonging the interval between pregnancies, as close
proximity (3-18 months) increases the incidence of LBW, preterm delivery, small infants,
neonatal death and death fetus.
j. Gymnastics Postural gymnastics is a gymnastics consisting of a series of body movements
performed by mothers after childbirth in order to speed up the recovery of the mother's

7. Frequency of the Postpartum Visits

a. Visit I

Time 6-8 hours after delivery Aim :

1. Prevent postpartum hemorrhage due to uterine atony
2. Detect and treat other causes of bleeding, refer if bleeding continues
3. Provide counseling to mother and her family how to prevent postpartum hemorrhage due
to uterine atony
4. Early breastfeeding
5. Conducting a relationship between mother and newborn
6. Keeping the baby healthy by preventing the occurrence of hypothermia
7. Accompanying mothers and newborns for health workers who help mother deliver at least
2 hours after birth or until the condition of the mother and baby is stable

b. Visit II

Time 6 days after deliveryAim :

1. Ensure normal uterine involution is good uterine contractions, uterine fundus under
umbilicus and no abnormal bleeding or odor
2. Assess for signs of fever, infection or abnormal bleeding
3. Ensure the mother gets enough food, fluids and rest
4. Ensuring the mother is breastfeeding well and showing no signs of peyulit
5. Provide counseling to mothers about infant care include: umbilical cord care, keeping baby
warm and caring for the baby daily
c. Visit III

Time 2 weeks after delivery

The goal is the same as the purpose of the visit 6 days after delivery

d. Visit IV
Time 6 weeks after deliveryAim :
1. Identify the possibility of complications in the mother and baby
2. Provide counseling methods of contraception / family planning in advance

A. Conclusion
The puerperal period is the period of time or period in which the reproductive organs
return to a nonpregnant state, this time takes 6 weeks, during the puerperium there are many
physiological changes as well as psychological changes between physiological changes of
vital signs, during the puerperal period of signs changes vital must be done because to help
the health worker in post partum / puzzle supervision. Blood pressure should be stable, the
temperature drops slowly and steadily at 24 hours post partum, the pulse becomes normal
after delivery.

B. Suggestions
Given the danger of increasing vital signs above normal limits, it would be fatal so
important that a midwife monitor the physiological development of postpartum or puerperal
patients by monitoring vital signs. So a midwife can do next handling immediately.