Chapter 21: Postpartum Period

• Family centered care is most important in the postpartum period

• Nursing care is provided in the context of the family unit and focuses on
adaptation after birth (emotional, physiological)
• Approach to the postpartum care is wellness oriented

Nursing Care in the Postpartum Period:

• Assisting mother with rest and recovery from the process of labour and birth
• Assessment of physiologic and psychologic adaptation after birth
• Prevention of complications
• Educating the client with self-management and infant care
• Support of the mother and her partner during transition to parenthood

Transfer from the Recovery Area:

• Woman is transferred to a postpartum room after she is stable and recovery

period has been completed
• In facilities with Labour, Delivery, Recovery, and Postpartum (LDRP) rooms,
the nurse that provided care in the recovery room continues to provide
care in the postpartum
• Vitals are taken Q15 min for the first hour after birth, and then Q hr
afterwards

Planning for Discharge:

• Upon initial contact with the postpartum woman, nurses prepare her for
returning home with the infant
• The length of hospital stay depends on her physical condition, mental and
emotional status, condition of the newborn, social support at home, client
education needs, and financial constraints
• In birthing centers, women may be discharged within a few hours (when they
are stable)
• Low risk women and infants are usually discharged from hospital 24-36hrs
after vaginal birth (“early postpartum discharge”, “shortened stay”, or “1-
day maternity stay”)
• Shortened hospital stays are due to efforts to reduce health care costs, and
client demands for less medical intervention
• Greatest risk for early discharge: jaundice in the infant, feeding difficulties,
infection, unrecognized respiratory and cardiac problems. These conditions
do not always appear in the first 24 hours after birth
• Breastfeeding may not be well established, and mothers may not have had
sufficient time to learn to care for their newborns

Criteria for Discharge:

• Mother: uncomplicated pregnancy/birth, BP and temp stable, independent
ambulation, voiding without difficulty, Hgb normal, no significant PV,
perineum intact or no more than 2 degree repair, instructions given on
postpartum care and mgmt
• Infant: Term baby (38-42 wks), appropriate weight for gestational age,
normal physical assessment, TPR normal and stable for 12 hrs before
discharge, 2 successful feedings, voided at least once
• No jaundice, bleeding, vaccines given, lab data reviewed
Couplet Care: Also called Mother-baby care or single-room maternity care. A
variation of rooming in, in which the mother and baby room together, and
mother and nurse share care of the infant. Organization of the mother’s care
revolves around infant’s feeding and care times.

Ongoing Physical Assessments:

• Performed throughout hospitalization

• Include VS, postpartum check on mother (breasts, fundus, lochia, perineum,
bladder/bowel function, legs

Routine Lab Tests:

• Hemoglobin and hematocrit evaluated on first day postpartum to assess

blood loss, especially after a cesarean birth
• Routine urinalysis (and sometimes C&S)
• Rubella and Rh status (if unknown)

Prevention of Infection:

• Nurses in postpartum must be acutely aware of infection prevention

• Change bed linens, disposable pads, draw sheets frequently
• Women should have something on their feet when walking around,
• Hand hygiene is important, as well as standard precautions
• Perineal tears and episiotomies are high risk for infection due to skin
integrity
• Instruct women to wipe vagina from front to back is important (and peri
care)

Prevention of Excessive Bleeding:

• Moderate amount of vaginal bleeding (lochia) is expected postpartum

• Bleeding must be monitored by nurses
• Most common cause of excessive bleeding: uterine atony, which is the
failure of the uterus to contract firmly
• Blood loss is described as: scant (<2.5cm), light (<10cm), moderate
(>10cm), or heavy (saturated)
• When excessive bleeding occurs, VS are monitored closely. These include:
RR, Pulse, Skin, urinary output, and level of consciousness
• Interventions to prevent excessive bleeding: Maintenance of uterine tone
(massaging fundus) and Prevention of bladder distention (due to urinary
retention)

** Promote Comfort, Rest, Ambulation, Nutrition, and Normal

Bladder/Bowel Patterns **

• Inspect locations of pain for redness, heat, discharge, and swelling

• Postpartum fatigue (PPF) is common in the immediate postpartum period,
and gets worse over the first 6 weeks after birth
• Mother should void 6-8 hours after giving birth (should be measured and at
least 150mL)
• Early ambulation reduces incidence of Venous Thromboembolism (VTE). If
the woman must remain in bed, TED stockings should be used and
exercises done
• Caloric intake for postpartum woman = 1800-2200 calories/day and 2700
calories if lactating