Postpartum Care and Newborn Nursery Procedures

POSTPARTUM

The period after giving birth, usually considered to be the first few days after delivery, but technically includes the six-week period after childbirth up to the mother's postpartum checkup.

PURPOSE

Immediately following childbirth, the mother experiences profound physical and emotional changes, which can influence her for the remainder of her life.

Precautions for the Mom

The mother is at risk for infection, hemorrhage, pregnancy induced HTN, blood clot formation, breast problems, and postpartum depression (Baby Blues).

POSTPARTUM CARE - Initial assessment

Includes assessment of pain, the condition of the uterus, vaginal discharge, the condition of the perineum, and the presence/absence of bladder distension.

POSTPARTUM CARE - Assessment frequency

Assessment should be done every 15 minutes for the first hour; then generally every 30 minutes for the second hour; and every four to eight hours thereafter depending on facility policy.

Assessment of Pain

Includes complaints of pain in the calf, headache, spinal headache, and painful, swollen, and red breasts.

Condition of the Uterus

Assessed by evaluating the height and consistency of the fundus, which should be at the umbilicus or above it after the 1st hour after delivery.

Fundal height decrease

Every day the fundal height decreases by approximately the width of one finger (one cm).

VAGINAL DISCHARGE (LOCHIA)

The color and amount of lochia is assessed; an excessive amount could be a sign of infection. It changes from red on the first day after delivery to white and can continue up to 14 days, with spotting possible for another six weeks.

PERINEUM CARE

Usually assessed after an episiotomy or laceration repair, for a hematoma, and relief of discomfort using cold packs for the first 24 hours and warm packs thereafter.

BREASTFEEDING

Lactation nurses aid mothers in learning how to breastfeed and cope with any problems that arise, including positioning their baby, nursing frequency, milk supply, and common frustrations.

POSTPARTUM DEPRESSION

Moderate to severe depression in a woman after she has given birth, which may occur soon after delivery or up to a year later, most commonly within the first 4 weeks after delivery.

Apgar Score

The very first test done on a newborn right after birth to quickly evaluate a newborn's physical condition and determine any immediate need for extra medical or emergency care, done twice at 1 minute and 5 minutes after birth.

Focus On - Color

Be worried about central cyanosis; bluish coloring of hands and feet is normal at first.

Focus On - Temperature

Keep the baby dry and wrapped up; should be above 97.6 axillary.

Focus On - Feeds

Should be every 3-4 hours; can breastfeed more often, but milk doesn't come in until 3-4 days of life.

Focus On - Voiding and Stools

You want to see 6-8 wet and dirty diapers a day.

Focus On - Jaundice

Can be normal but intervention is needed usually when bilirubin levels reach above 10-12 at day two of life for normal term babies.

Focus On - S&S of Illness

Signs include temperature below 97.0 or above 100.4, projectile vomiting, diarrhea, blood in stool, skipping more than one feed, more than 6 wet diapers a day, lethargy, or irritability.

Other considerations for Nursery nurses

Nursery nurses must keep in mind other possible situations that require additional monitoring, tests, and possible admission to NICU.