Postpartum Nursing: Normal Changes & Nursing Diagnosis

Nursing Knowledge

Postpartum Nursing: Normal Changes & Nursing Diagnosis

Postpartum changes refer to the physical and psychological changes that occur in a woman’s body after childbirth. These changes can have a significant impact on the health and well-being of both the mother and the newborn. As such, it is important for nurses and other healthcare professionals to have a thorough understanding of these changes in order to provide appropriate care and support to postpartum women.
Last updated: December 4, 2023

Table of contents

Video: How the body changes after pregnancy

Endocrine postpartum changes

  • Prolactin levels remain elevated in breastfeeding clients. Non-lactating clients’ levels return to normal by 3 weeks.
  • Ovulation may occur as soon as 45 days (non-lactating clients) or be delayed until 6 months (breastfeeding clients).

Hematologic postpartum changes

  • Hematocrit levels drop up to 4 days postpartum, stabilizes by 8 weeks.
  • WBC count up to 30,000/mm3 can be normal.
  • Coagulation and fibrinogen levels remain increased 2–3 weeks postpartum. 

Musculoskeletal postpartum changes

  • Rectus abdominal muscles return to normal by 6 weeks postpartum.
  • Pelvic floor muscle returns to normal by 6 weeks postpartum.

Gastrointestinal postpartum changes

  • Increased appetite after delivery
  • Bowel movement may be delayed 2–3 days.
  • Breastfeeding clients need an additional 300–500 calories per day to support lactation.

Reproductive postpartum changes

  • Breasts: colostrum present first 3 days, then changes to mature milk stimulated by breastfeeding
  • Non-breastfeeding clients should avoid any breast stimulation. Milk production may take several days, up to several weeks, to stop.
  • While breast engorgement can be normal postpartum, signs of mastitis require further evaluation and treatment.
  • Uterus involutes 1 cm/day (non-palpable by 2 weeks postpartum).
  • Cramping may be stronger in multiparous and breastfeeding clients. 
  • Cervix: os appears slit-like instead of circular, returns to 1 cm dilation by 1 week postpartum. 
  • Lochia is normal discharge that contains blood, mucus, and uterine tissue and may  last up to 6 weeks postpartum.
    • Lochia rubra: bright red, days 1–3
    • Lochia serosa: pink, days 4–10
    • Lochia alba: white/yellow, days 11–6 weeks

Psychological postpartum changes

Transient moments of feeling anxious or overwhelmed are normal. Symptoms should resolve by 2 weeks postpartum. After this, evaluation for postpartum depression is needed.

Stages of adaptation: 

  • Taking in: 
    • Typically occurs 1–3 days postpartum
    • Client focused on their own needs
    • Needs assistance from others, may be passive and dependent
  • Taking hold: 
    • Typically occurs 2–4 days postpartum
    • Client orients to taking care of infant
    • Client strives for independence and autonomy
  • Letting go: 
    • Typically occurs after day 4 postpartum
    • Client accepts infant’s dependence
    • Client releases previous identity as a childless person or parent of fewer children; feels hopeful
    • Risk for postpartum depression during this stage 

Cardiovascular postpartum changes

  • Plasma volume decreases by 1,000 mL.
  • Bradycardia down to 40 bpm may be noted postpartum.  

Renal postpartum changes

  • Diuresis occurs after first 12 hours postpartum, up to 3,000 mL/day.
  • Dilated ureters and renal pelvis returns to normal by 6–8 weeks postpartum. 

Postpartum nursing diagnosis

Potential postpartum nursing diagnoses include: 

  • Acute pain related to perineal trauma, episiotomy, C-section, post-birth contractions
  • Fatigue related to childbirth, body changes and new responsibilities
  • Impaired urinary elimination related to trauma/swelling or anesthesia effects
  • Risk for constipation related to hormonal changes, fear of pain with defecation, medications or anesthesia effects
  • Postpartum depression 
  • Disturbed sleep pattern 
  • Impaired physical mobility
  • Risk for hemorrhage
  • Risk for infection
  • Risk for impaired parent/infant attachment
  • Risk for ineffective breastfeeding


Postpartum Nursing: Normal Changes & Nursing Diagnosis

Free Download

Nursing Cheat Sheet

An overview of physical and psychological postpartum changes.

Master the topic with a unique study combination of a concise summary paired with video lectures. 

User Reviews