Postpartum Management

Normal temperature after birth

Slight elevation r/t to dehydration/diaphoresis is normal drops shortly afterward; >100.4*F (38*C) is concerning for infection

Normal HR after birth

40-80 BPM; >100 BPM is bad and can indicate hemorrhaging

Normal RR after birth

12-20 breaths/min; abnormal can indicate pulmonary edema or embolism

What does low BP after birth indicate?

Dehydration, hemorrhage, hypovolemia, or shock

What does high BP after birth indicate?

Postpartum HTN or preeclampsia

What is postpartum pain goal?

0-2/10

What does severe perineal pain that doesn’t improve indicate?

May indicate perineal hematoma

When is postpartum CBC commonly obtained after birth?

Usually 12-24 hours after birth to assess for anemia and blood loss

What does BUBBLE stand for?

Breasts, uterus, bladder, bowels, lochia, episiotomy/extremities/emotional

What should breasts be assessed for after birth?

Symmetry, engorgement, erythema, nipples, colostrum/milk

What nipple findings should be looked for?

Erect, inverted, flat, cracking, blistering, painful/tender

What do cracked or blistered nipples indicate?

Improper infant positioning or latch, which can cause nipple trauma

What are normal breast findings?

Soft nipples and firmer/fuller breasts from milk production

What are abnormal breast findings that should be reported?

Nodules/masses and hot red or painful areas; indicates plugged duct or mastitis

Why should unnecessary breast stimulation be avoided when not breastfeeding?

Stimulation increases milk production and worsens engorgement

How to assess fundus?

Top hand is on umbilicus and bottom hand support uterus

What should be done if uterus is boggy?

Massaging uterus contracts uterus and makes it form to control bleeding

What does a soft or boggy fundus indicate?

Uterine atony, increasing risk of postpartum hemorrhage

What should be done if uterus is deviated?

Assist client to empty bladder

What do we assess C/S abdominal incision for?

Well-approximated edges, bleeding/drainage, type of closure method, signs of infection

What are normal afterpains after birth?

Mild uterine cramping from uterine contractions during involution, usually 0-4/10

Is mild hematuria normal immediately after birth?

Occurs temporarily and normal, but significant or persistent hematuria should be reported

What is normal bowel movements after birth?

BM may be delayed 1-3 days postpartum

Nursing consideration for GI after birth

Don’t advance diet due to constipation to prevent straining (also give stool softeners)

When is lochia amount concerning?

When 1 pad gets saturated in 1 hour OR fist-sized clots

How to quantify blood loss from lochia?

Determine amount by weighing blood-soaked materials/pads

Why is there less lochia after a C-section?

Less vaginal bleeding due to uterus already being surgically cleared during delivery alongside with placental removal

How should patient be positioned to assess perineum?

Laterally (side-lying) with upper leg flexed upward

How long does it take for episiotomy/laceration to heal?

Within first 2-3 weeks

Peribottle

Uses warm water to gently cleanse perineal area, often after urination to reduce irritation and discomfort

When to use ice packs after birth?

During first 24 hours to decrease swelling, bruising, and pain

Types of topical treatments used for perineal discomfort or hemorrhoids

Witch hazel, creams, or topical steroids reduces swelling, itching, or discomfort

Sitz bath

Warm, shallow bath that helps improve comfort, circulation, and healing after initial swelling period

What does GAS mean in postop/cesarean care?

Gas relief, Ambulation, and Simethicone to relieve gas discomfort and promote bowel function

How to promote gas relief?

Encourage measure that move trapped gases (warm fluids, walking, avoiding carbonated drinks)

How is postpartum pain treated?

Anti-inflammatories, acetaminophen, opioids

How is pain after C/S treated?

Epidural infusion/pump or PCA depending on patients needs or orders

How should nurse prepare for ambulation?

Elevate HOB and have client sit at edge of bed for a few minutes before assessing status

How does early ambulation benefit postpartum recovery?

Prevents VTE, improves circulation and promotes BM

How long should a client stay in the hospital after vaginal delivery?

24-48 hrs

How long should a client stay in the hospital after a C/S delivery?

48-72 hrs

What if someone overexerts themselves during exercise?

Increased or bright-led lochia may occur when doing too much; stop and rest

What are expected positive behaviors for mother and infant?

Eye-to-eye contact with newborn, using en face position during holding or feeding, physical and emotional closeness

Contraindications for breastfeeding

Patients have active HSV on breast, HIV, illicit drug use, and active TB

Nursing considerations for bowel elimination

Prevent constipation due to birth trauma making BM worse; use stool softeners/laxatives when indicated

Why is RhoGAM given postpartum?

Indicated for Rh-negative birthing parent when newborn is Rh-positive to prevent Rh sensitization; given within first 72 hrs pp

What immunizations should be assessed before postpartum discharge?

Flu, Tdap, MMR

When can sexual activity continue postpartum?

Around 4-6 weeks when patient ready and healing is adequate with no bright bleeding

Education before continuing sexual activity

Advise lubricant use due to vaginal dryness AND avoid estrogen + progesterone first 3 weeks due to VTE risk

What neurologic symptoms require urgent postpartum evaluation?

Severe headache or vision changes, indicating postpartum preeclampsia

Postpartum blues

Temporary mild sadness postpartum that peaks around 3-5 days

When does postpartum phone call follow-up occur?

Around the first week after discharge

When does office postpartum follow-up occur?

Around 4-6 weeks for uncomplicated vaginal birth; around 2 weeks for C/S birth

When may a postpartum home visit occur?

May occur within first week after discharge to assess for physical and psychosocial problems