Nursing Care of the Family during the postpartum period

How long does the length of stay in the hospital typically last after delivery?

The length of stay in the hospital for most patients depends on the type of delivery. For a vaginal birth, the patient typically stays no longer than 1–2 days, while for a cesarean section (C-section), the stay is usually around 2–3 days, assuming there are no complications.

What is the nature of the physical assessment for a postpartum patient?

The physical assessment of a postpartum patient is similar to that of a general medical-surgical patient, but we focus on additional areas specific to postpartum recovery. These include: Breasts, Uterus, Lochia, Perineum, Bowel and bladder function, Lower extremities. Refer to the assessment table for normal findings and potential complications.

Which lab tests are routinely assessed to monitor blood loss during birth?

Hemoglobin and Hematocrit (H&H) are routinely assessed to monitor blood loss during birth. For vaginal deliveries, H&H may not be drawn as frequently, but for C-section deliveries, it is typically drawn about one day after delivery.

What additional blood work might be done depending on prenatal care?

Depending on prenatal care, patients may also have blood work done to assess rubella immunity and Rh status.

What are key infection prevention measures for postpartum patients?

Ensure a clean environment at all times. Staff who are feeling unwell should not report to work. The perineum is a high-risk area, especially in cases of lacerations or episiotomies.

What are the instructions for proper perineal care?

Teach proper perineal care: Use a peri bottle with warm water after each use of the restroom, spraying front to back. Educate patients to wipe front to back after voiding or bowel movements. Encourage frequent peri-pad changes. Refer to Box 19.1 for additional interventions.

What are signs of excessive postpartum bleeding?

A peri pad saturated in 15 minutes or less. Blood pooling under the buttocks.

How is excessive bleeding assessed postpartum?

Visual evaluation of peri pads. Fundal (uterine) assessment to ensure the uterus is firm.

What is fundal massage and when should it be performed?

Hemostasis occurs when the uterus contracts. If the uterus is boggy (not firm), perform a fundal massage—a technique that involves kneading the uterus through the abdomen to stimulate contraction.

Why is bladder emptying important in preventing postpartum bleeding?

Bladder distention can also contribute to uterine atony and bleeding. A full bladder pushes the uterus up and off to one side, preventing proper contraction. Ensure the bladder is emptied regularly.

How is comfort promoted in postpartum patients?

Comfort can be promoted through pharmacologic and non-pharmacologic methods. Always verify if the patient is breastfeeding before administering medications.

How is rest promoted during the hospital stay?

Encourage rest as much as possible during the hospital stay. Advise patients to rest while the baby is sleeping, both in the hospital and at home. Assess fatigue during follow-up appointments, as ongoing fatigue can lead to complications.

Why is ambulation important postpartum, and what should be done if a thrombus is suspected?

Postpartum patients are at increased risk for venous thromboembolism (VTE). Encourage early and frequent ambulation. If a thrombus is suspected (e.g., warmth, redness, tenderness in a leg), notify the healthcare provider immediately. While awaiting further orders: Keep the patient in bed. Elevate legs on pillows.

When is the ideal time to initiate breastfeeding?

The ideal time to initiate breastfeeding is within the first 1–2 hours after birth. Newborns are usually most alert during this time.

What practices promote breastfeeding immediately after birth?

Encourage skin-to-skin contact immediately after birth for at least one hour to promote breastfeeding. Educate on infant feeding cues. Observe initial breastfeeding sessions to identify barriers and provide education.

What should patients who choose not to breastfeed do to suppress lactation?

Wear a well-fitted, supportive bra continuously for the first 72 hours. Avoid breast stimulation (e.g., let water hit the back during showers, not the chest). Limit all breast and nipple stimulation to prevent milk production.

When does breast engorgement typically occur, and how is it managed?

Breast engorgement may occur due to increased blood and lymph flow. This typically happens between 72–96 hours postpartum. To manage engorgement: Apply ice packs to the breasts. Avoid past medications for lactation suppression, as they are no longer recommended.

When should the rubella vaccine be administered postpartum, and what precautions should be taken?

Administer if the patient is non-immune (rubella titer <1:8). This is a live vaccine, so pregnancy should be avoided for 28 days after receiving it. Safe during breastfeeding (not transmitted in breast milk).

Who should receive the varicella vaccine postpartum, and what is the schedule?

Recommended for non-immune women before hospital discharge. It's a two-dose series: the second dose is given at the postpartum follow-up appointment.

Why is the Tdap vaccine given postpartum, and who else should be vaccinated?

Given postpartum to protect against pertussis, especially since infants cannot be vaccinated immediately. Encourage close contacts (partner, caregivers) to also get vaccinated to protect the baby.

When is Rhogam administered postpartum, and why?

Administer within 72 hours postpartum to Rh-negative mothers whose babies are Rh-positive. Prevents maternal sensitization that could harm future pregnancies. Also given antenatally during pregnancy if indicated.

What psychosocial aspects should be assessed in postpartum patients?

Assess the patient’s reaction to the birth experience, feelings about themselves, and bonding with the baby.

What education and emotional support should be provided to postpartum patients?

Provide education and emotional support to promote self-esteem, confidence in newborn care, and adjustment to the new role as a parent.