Ohio Business College 23

Overview of Postpartum Care in OB Nursing

General Responsibilities

  • A nurse's role in obstetrics (OB) is active and requires frequent monitoring of both mother and infant.

  • Continuous assessment of electronic fetal monitoring (EFM) strips and identifying patterns or concerns is essential, particularly during labor and delivery.

  • The postpartum phase involves specific duties that focus on the recovery of the mother after birth.

Postpartum Recovery Timeline

  • Duration of Recovery: The postpartum period lasts about six weeks, following the delivery of the placenta.

  • The immediate assessment and interventions begin once the placenta is delivered.

Physical and Psychological Changes in the Postpartum Period

  • Physical changes occur in several areas:

    • Uterine Involution: The uterus returns to its pre-pregnancy size. Monitoring this is crucial—if involution fails, it’s termed subinvolution.

    • Lochia Flow: Assess lochia (post-birth vaginal discharge) for color, consistency, and odor as indicators of normal recovery or potential complications.

    • Cervical Involution and Other Changes: The cervix will also return to its normal state, influencing vaginal distension and ovarian function post-delivery.

Major Risk Factors During the Postpartum Period

  • Hemorrhage: It’s vital to monitor for excessive bleeding (over 500 ml postpartum after vaginal delivery or over 1000 ml post-C-section).

  • Shock, Infection, and Potential Death: Nurses must be vigilant for signs of these conditions in the early postpartum phase.

Role of Hormones in Recovery

  • Oxytocin: Often administered as a bolus after placenta delivery, it strengthens uterine contractions to prevent hemorrhage.

  • Hormonal Changes: Post-delivery hormonal shifts affect various body functions, including breast engorgement and vaginal discharge.

Assessment Protocols

  • Postpartum Checks: Perform checks every 15 minutes for two hours post-delivery, including:

    • Vital signs and fundal checks for uterine firmness and position.

    • Assess perineum using the mnemonic BUBBLE HEAT (Redness, Edema, Bruising, Drainage, Approximation).

  • Lochia Monitoring: Monitor the amount and characteristics of lochia, noting any abnormalities or excessive bleeding.

Nursing Interventions

  • Fundal Massage: If the fundus is soft or boggy, massage is needed to encourage contraction.

  • Patient Education: Instruct on proper perineal care, signs of infection, and normal postpartum recovery expectations.

  • Emotional Support: Assess emotional well-being; conditions such as postpartum blues or depression need careful monitoring and appropriate referrals when necessary.

Nutritional Considerations

  • Encourage a diet rich in protein to promote healing and recovery.

  • Monitor hydration and overall nutritional status during hospitalization.

Complications to Watch For

  • Thromboembolic Disorders: Educate patients on the importance of ambulation to prevent deep vein thrombosis (DVT).

  • Postoperative Complications: For C-section patients, monitor for infection at incision sites and ensure appropriate postoperative care.

Educating Patients

  • Educate clients on signs of postpartum complications, proper use of medications such as pain relievers, and when to seek help.

  • Maternity classes that cover postpartum adjustments, newborn care, and family dynamics are encouraged before discharge.