Maternity Nursing: Postpartum Q 22
A client is complaining of painful contractions, or after pains, on postpartum day 2. Which of the following conditions would increase the severity of afterpains?
A. Bottle-feeding
B. Diabetes
C. Multiple gestation
D. Primiparity
Correct Answer: C. Multiple gestation
Multiple gestation, multiparity, and conditions that cause overdistention of the uterus will increase the intensity of after-pains. Afterpain is a common phenomenon after vaginal delivery. Any factor that causes a delay in the process of uterus sub involution and consequently returning its size to pre-pregnancy status could affect the severity of afterpain.
Option A: There was a positive correlation between the number of pregnancies and the duration of breastfeeding with mean score of afterpain. Also, the length of ambulation decreased the afterpain intensity. However, the intensity of afterpain had no significant relationship with stimulation with oxytocin in labor, prescription of methylergonovine, and also oxytocin after delivery. Considering that a longer duration of breastfeeding and ambulation in the early postpartum period could decrease afterpain, it is suggested to encourage postpartum mothers to begin breastfeeding and ambulation as soon as possible after birth.
Option B: Diabetes has no correlation with afterpains. Afterpains (cramping) are the contractions of the uterus occurring in the days following childbirth. They are normal but can be uncomfortable. Afterpains are usually strongest on the second and third days following delivery, when the mother is breastfeeding or after she takes a uterus-contracting medication prescribed by her physician or midwife. Cramping is most noticeable after the birth of a second or third baby.
Option D: After-pains are contractions that occur after labor and delivery. These contractions signal the process of involution, the process of the uterus shrinking back down to its pre-pregnancy size and shape. While after-pains are not a reason to worry, they can cause discomfort and even pain. After-pains can vary significantly from person to person. If this is not the first baby, the pain may be worse than experienced during previous pregnancies. For pain, the mother can use comfort measures like warm packs, massage of the fundus through the abdomen, and certain medications (with a practitioner’s approval). Over-the-counter medication works well for most women.