Postpartum FH 2/11/2026

Postpartum Overview

Objectives

  • Maternal Behavior Characteristics during Postpartum:

    • Understand the psychological adaptive phases:

    • Taking-In: Initial phase where the mother may be focused on her own needs and the experience of childbirth.

    • Taking-Hold: The mother begins to take charge of her own care and that of the baby, seeking independence and developing confidence.

    • Letting-Go: The mother adjusts to her new role, letting go of previous ways of life and adapting to motherhood.

    • Postpartum Blues: Common, temporary feelings of sadness or mood swings experienced by many postpartum women.

  • Normal vs. Abnormal Physiological Changes in Postpartum:

    • Monitor changes in the uterus, lochia, perineum, urinary system, breasts, anus, and circulatory system.

  • Postpartum Client Assessment:

    • Methods for assessing a postpartum client effectively.

MOTHER/BABY SBAR FORM

  • Time & ROM: Documenting the time and rupture of membranes.

  • Delivery Information:

    • Type: Vaginal or C-Section (C/S)

    • Delivery Day

  • Patient Allergies: List any known allergies.

  • S: Blood Type, Rubella Status, Group B Streptococcus (GBS) status (± ATB), and last dose of Hepatitis G.

  • P: Details of the delivery (e.g., Vaginal, VAC/Forceps, C/S - Right or Left Mediolateral, Reason for the procedure).

  • Epis/Lac: Condition of perineal area (intact; presence of hemorrhoids).

  • Medication: Last dosing of medications, such as TDAP, flu vaccine, COVID boosters.

  • B: Social History, including publications and assessments of neurological checks and urinary function post-delivery.

Postpartum Adaptations
Vital Signs & Lab Values

  • Vital Signs (VS):

    • Changes and stability in maternal vital signs postpartum, including factors that may cause fluctuations.

    • Hematocrit (H) and Hemoglobin (H) levels normal values:

    • Hemoglobin: 12 - 16 g/dL

    • Hematocrit: 37 - 47%

    • White blood cell count may increase and stay elevated for 4 - 6 days postpartum.

Neurologic System Assessment

  • Assessment Questions: Inquiry on neurological status.

  • Postpartum Headaches: Potential causes and implications, especially concerning an epidural during delivery.

  • Interventions Before Calling Anesthesia: Nursing staff responsibilities and interventions.

  • Treatment Options: Addressing headache treatment.

  • Nursing Diagnoses for patients with epidurals.

Emotions

  • Psychological Skills in OB:

    • Differentiation between Baby Blues and Postpartum Depression.

    • Personal anecdotes on mood variations during postpartum.

Cardiovascular System

  • Maternal Hypervolemia: Explanation for increased blood volume postpartum.

  • Cardiac Output Recovery: Timing when maternal cardiac output returns to baseline.

  • Abnormal Findings: Identifying potential cardiovascular issues during patient assessments.

  • Average Blood Loss:

    • Vaginal and C-Section delivery statistics.

    • Hypercoagulability implications and recovery timeline for normal coagulation levels.

Breast and Breastfeeding

  • Breast Assessment: Checking for engorgement, cracks, blisters, redness, and how the baby is latching (LATCH score).

  • Brain Response During Breastfeeding: Hormonal responses and common complaints.

  • Interventions for Complaints: Nursing strategies to alleviate discomfort.

Bottle Feeding Management

  • Techniques to reduce discomfort during bottle feeding:

    • Breast compression, decrease stimulation, use of cabbage leaves, ice packs, and analgesics.

Urinary System Changes

  • Postpartum Changes in bladder function and urinary retention.

  • Risk for Urinary Tract Infections (UTI).

  • Postpartum Diuresis: Role of aldosterone and client education on early postpartum bodily changes.

Gastrointestinal System Changes

  • Postpartum Bowel Function: Understanding of decreased peristalsis and recovery timeline.

Integumentary System Changes

  • Observations of skin changes including:

    • Melasma fading, hair loss, stretch marks (Striae gravidarum), postpartum diaphoresis and Linea Nigra.

Musculoskeletal System Changes

  • Diastasis Recti: Potential separation of abdominal muscles (2-4 cm) and recommendations for postpartum exercise.

Fundus Assessment

  • Assessing the firmness of the fundus and appropriate massage techniques.

    • Measurement Protocols: Positioning concerning midline standard.

Lochia Assessment

  • Types of Lochia:

    • Rubra: Red discharge (3-4 days postpartum).

    • Serosa: Pinkish/brown discharge (3-10 days postpartum).

    • Alba: Yellow/white discharge (10-14 days postpartum).

  • Assessment Guidelines: Look for saturation ofpads during checks and patient education.

Episiotomy and Perineum Assessment

  • Examination Areas: Who to assess and what to look for regarding healing and interventions for comfort.

    • Care strategies for different laceration stages (1st to 4th degree).

Nursing Interventions and Medications

  • Postpartum Care Strategies: Vaginal and C-Section specific management tools such as peri bottles, sitz baths, or cold therapy for pain management.

  • Analgesics: Common medications prescribed including Oxycodone, Ibuprofen, and stool softeners.

Vaginal Changes Postpartum

  • Describe changes in the vagina immediately after birth and how it regains its pre-pregnancy state.

Reproductive System Adaptations

  • Puerperium Period: Duration and physiological changes expected within the first 6 weeks postpartum.

Cervical OS Changes After Delivery

  • Assessing cervical changes immediately postpartum and throughout recovery.

Extremities Evaluation

  • Understanding edema and reflex assessments for risk evaluation regarding hypertensive or seizure concerns.

Endocrine System Changes

  • Hormonal Adjustments: Postpartum decreases in estrogen and progesterone after delivery, with implications for breastfeeding status involving prolactin levels.

Postpartum Assessment Protocol

  • Acronym BUBBLEHE for systematic postpartum assessment:

    • B: Breasts

    • U: Uterus

    • B: Bladder

    • B: Bowels

    • L: Lochia

    • E: Episiotomy

    • E: Extremities

    • H: Emotional Status

Oxytocic Medications

  • Pitocin (Oxytocin): Uses for uterine tone post-delivery, side effects, and administration routes.

  • Methergine (Methylergonovine): Used for uterine atony and contraindications.

  • Hemabate (Carboprost): Control of hemorrhage with specified side effects and administration guidelines.

Cytotec (Misoprostol) Meds

  • Uses: Cervical ripening before labor, Stimulates contractions, Used when oxytocin not available, Used for uterine evacuation due to pregnancy loss.

  • Contraindicated: in cesarean births due to risk of uterine rupture

  • Adverse effect: vaginal bleeding, vertigo

Applying Concepts

  • Case scenarios shared with practical applications espoused for partners and mothers based on questions presented regarding role phases, vital sign fluctuations, and fundal assessments.

Lecture Questions

  • Include a series of true/false statements and fill-in-the-blank exercises focusing on postpartum care, mother-infant bonding, and nutritional needs specific to breastfeeding.