Postpartum Introduction

The postpartum period (puerperium or fourth trimester) occurs after birth and lasts approximately six weeks,
when the woman’s body physically readjusts to her non-pregnant state and psychosocially adapts to her new
situation. This module will highlight important components of a comprehensive postpartum assessment to
ensure a safe recovery post delivery. This module will address the physiological and psychosocial changes a
woman may experience during the postpartum period.

Source: Michelle Hughes, 2018

Postpartum nursing focuses on women, newborns, and their families during the postpartum period. Nurses
must provide respectful, holistic care that focuses on the physical, emotional, mental, social, and spiritual well-
being of the client and family. Recognizing the impact of the social determinants of health will assist nurses to
provide safe, comprehensive care to a diverse population, actively collaborate within an interprofessional team,
and advocate for optimal health for women, newborns, and their families.
Did You Know?
In Canada ...
The average age of birthing women is 30.2 years, with the average age of a woman’s first birth at 28.5 years.
Fertility rates are increasing in the 30–34 year-old age group and decreasing among women 25–29 years of
age.
The average woman is having 1.6 children. In Ontario, that average drops to 1.52 children per woman, and
approximately 2.4 children per woman worldwide. Read more about this in Statistics Canada: Fertility Overview
2009–2011.
Nurse’s Role in a Postpartum Assessment
This unit will introduce the learner to the role of a postpartum nurse and essential care for the mother and
newborn. Competent care, therapeutic communication, and continuous critical thinking are required for a
comprehensive postpartum assessment. The nurse's role in a postpartum assessment focuses on the
following key points:
 Knowledge of the physiological and psychosocial processes during the postpartum transitional period
 Perform and document of a thorough postpartum head-to-toe assessment
 Support and assess for the postpartum client, newborn and family needs as they adjust to their new
roles
 Educate the postpartum client and family about postpartum resources and services available for the
family
 Provide safe, competent client and family-centred care to promote the well-being of the family unit
This unit will focus on the postpartum woman. The simulation game will focus on the integration of the
relationship between the postpartum woman, newborn, and family.

Module 4 Postpartum complicationsLearning Objectives

By the end of this section, you should be able to identify complications during the postpartum period and
potential nursing interventions required.
Recommended Resources
Review a chapter on maternal postpartum complications during the postpartum period in a current Maternal
Child Nursing Care textbook.
introduction to Postpartum Complications
During the postpartum period, complications can occur. Comprehensive nursing assessment and safe
competent care can help to decrease potential postpartum complications. This folder will address
complications including:
 Postpartum hemorrhage
 Thromboembolic disorders
 Postpartum infections
 Psychological complications
 Perinatal loss and grief that can occur during the postpartum period

Postpartum Hemorrhage (PPH)

The primary cause of maternal death is postpartum hemorrhage (PPH), which occurs in 5% of deliveries
(Society of Obstetricians and Gynaecologists of Canada, guidelines, Active Management of the Third Stage of
Labour: Prevention and Treatment of Postpartum Hemorrhage).
PPH is defined as excessive bleeding that occurs during the first 24 hours of the postpartum period (early
PPH). However, PPH can occur after the first 24 hours and up to six weeks after birth (late PPH) (London et.
al., 2017 and Perry et. al., 2017). Therefore, continuous assessment is required, as well as client education
regarding signs and symptoms.
Risk factors and causes of PPH include, but are not limited to:
 Uterine atony
 Trauma during delivery
 Retention of placental tissue
 Coagulation disorders
Potential signs of PPH:
 Excessive bleeding
 Boggy fundus
 Abnormally large clots
 Elevated fundus level
 Hematoma in perineal area
 Increased pulse and temperature, decreased BP
 Decreased level of consciousness
Nursing Interventions:
 Active management and ongoing assessment of PPH risk factors, signs and symptoms.
 Take measures to ensure that the placenta is delivered within 30 minutes after birth.
 Periodic assessment of vaginal bleeding. Measure blood loss if it occurs.
 Frequent assessment of fundal height and uterine tone as required.
 Firm massage of uterine fundus if atony occurs.
 Uterine stimulants may be required if massage is not effective.
 Monitor bladder and urine output. Encouraging woman to empty bladder.
 Assess perineal area for hematomas or trauma from birth.
 Monitor for signs and symptoms of hemorrhage or hypovolemic shock.
 Vital signs, circulatory status (i.e. auscultate heart and breath sounds, skin assessment), urine output,
level of consciousness and mental status.
Did You Know?
Did you know …
Most deaths from PPH are caused by ineffective management of slow, steady blood loss (London et al., 2017,
p.715)

Learning Activity 1
Test Yourself!

1. Which of the following is the priority nursing action for a postpartum hemorrhage?

Please select the correct option and then click the "Check Your Answer" button.

a. Massage the uterus until firm

b. Insert foley to empty bladder
c. Call for help
d. Insert large-bore needle for venous access
That’s correct!

2. Which of the following clients is at highest risk of postpartum hemorrhage?

Please select the correct option and then click the "Check Your Answer" button.

a. An 18 year old, nulliparity, woman who had a quick delivery

b. A 35 year old, multiparity, who had a prolonged labour
 c. A 26 year old, multiparity, who received an epidural
d. A 23 year old, nulliparity who delivered twins vaginally
That’s correct!

3. Postpartum hemorrhage rates have decreased due to advancement in technology in postpartum care.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!
Venous Thromboembolic Disorders (VTE)
Venous thromboembolism (VTE) results from blood clots obstructing blood flow in a superficial or deep vein.
Three postpartum thromboembolic disorders include: superficial venous thrombosis, deep venous thrombosis,
and pulmonary embolism (Perry et. al., 2017).
Some example of risk factors and causes of VTE include:
 Venous stasis (from prolonged bed rest or immobility)
 Hypercoagulation or coagulation deficiency
 Cesarean birth
 Trauma during birth
 Varicose veins
 Multiparity
 Personal or family history of VTE disease
 Diabetes
 Advanced maternal age (>35 years)
 Anemia
 Malignancy
 Obesity
 Cigarette smoking
 Potential signs of VTE
 Warm, red, enlarged hardened vein on legs
 Calf tenderness and swelling with pain
 Dyspnea and tachypnea, tachycardia, chest pain and apprehension with pulmonary embolism
 Nursing Interventions:
 Assess for signs of pulmonary embolism
 Emergent treatment required if pulmonary embolism is suspected
 Encourage early ambulation
 Promote activity while on bed rest
 Assess legs for peripheral pulses and skin for edema, colour, temperature, pain
 Encourage fluids
 Use TED stockings or compression device as required
 Educate client about avoiding prolonged sitting, standing, crossing legs and restrictive clothing
 Elevate legs while sitting
 Obtain lab values (i.e. PT, PTT) and diagnostic tests as required
Did You Know?
Risk of deep vein thrombosis and pulmonary embolism are higher in women diagnosed with lupus (London et
al., 2017, p.729)
Learning Activity 2
Test Yourself!

1. A pulmonary embolism obstructs blood flow to which part of the body?

Please select the correct option and then click the "Check Your Answer" button.

a. Lower legs
b. Upper arms
 c. Lungs
d. Heart
That’s correct!

2. Which medication should not be given to a woman on anticoagulants?

Please select the correct option and then click the "Check Your Answer" button.

a. Tylenol
b. Aspirin
c. Advil
d. Benadryl
That's correct!

3. Which nursing intervention would decrease the risk of thromboembolic disease in postpartum women?

Please select the correct option and then click the "Check Your Answer" button.

a. Encourage fluids to avoid dehydration

b. Limit mobility to avoid dislodging clots
c. Provide analgesics for pain as needed
d. Encourage bed rest to support flow of blood
That’s correct!
Postpartum Infections
Postpartum infections can vary depending on the site of infection and cause. Common postpartum infections
include: puerperal fever, endometritis, wound infection, mastitis, urinary tract infections, and respiratory tract
infections (London et. al., 2017 and Perry et. al., 2017). Postpartum infections are most commonly caused by
streptococcal and anaerobic organisms.
Some examples of risk factors of postpartum infections include:
 Compromised health status (i.e. concurrent medical or immunosuppressive conditions, poor nutritional
state, obesity, etc.)
 Prolonged labour or ruptured membranes
 Caesarean birth and vaginal episiotomy or lacerations
 Retained placenta tissue
 Chorioamnionitis
 Catheterization
 Multiple internal examinations
Potential signs of postpartum infections (varies according to infection site):
 Presence of fever of > 38 degrees Celsius (100.4 degrees Fahrenheit) on two consecutive days
 Increased pulse
 Chills
 Nausea
 Fatigue and lethargy
 Pain or tenderness at incision site (i.e Caesarian, laceration repair or episiotomy)
 Foul-smelling vaginal discharge
 Erythema, edema, swelling and warmth at site
 Dysuria, frequency and urgency, urinary retention, hematuria, or pyuria
Nursing Interventions (varies according to infection site):
 Frequent assessment of infection site and vital signs
 Education regarding proper hygiene technique (i.e. hand hygiene, changing perineal pads, perineal
care: wiping front to back, etc.)
 Encourage fluids to avoid dehydration
 Comfort measure depending on site of infection (i.e. sitz bath, warm compresses, analgesics as
required and ordered, etc.)
 Provide information of signs and symptoms of infection and when to contact primary healthcare
provider
 Use aseptic techniques when providing care
 Provide information sheet on postpartum infections prior to discharge
Learning Activity 3
Test Yourself!

1. Which of the following factors increases the risk of mastitis?

Please select the correct option and then click the "Check Your Answer" button.

a. Loose-fitting bra
b. Alternating breasts during feeding
c. Use of plastic-lined breast pads
d. Air-drying breasts after feeding
That’s correct!

2. What should the nurse assess when inspecting a cesarean wound?

Please select the correct option and then click the "Check Your Answer" button.

a. Pallor, soft and shiny skin texture

b. Ecchymosis, edema, and approximation
c. Cyanosis, discharge, and induration
d. Jaundice, foul smelling discharge, and pain
That’s correct.

3. A preventative measure of postpartum infection includes proper perineal care, which involves wiping the
perineum back to front.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!

ostpartum Psychological Complications

Postpartum psychological complications refers to various perinatal mood disorders including “baby blues”,
anxiety or minor and major depressive episodes, and psychosis that can occur up to 12 months after birth
(Perry et. al., 2017). It is important to assess all postpartum women for psychological complications and
educate them and their support people on the signs and symptoms of psychological complications prior to
discharge.

Source: Parentingupstream
Risk factors of the various postpartum psychological complications include but are not limited to:
 Previous personal or family mental health history
 Mood disorders during pregnancy (i.e. depression or anxiety)
 Increased stressors during perinatal period
 Lack of social support
 Age (< risk with younger women)
 Discontent with birthing experience or feeding problems
 Preterm or ill newborn
 Death of newborn
Potential signs of postpartum psychological complications (varies according to specific complication):
 Mood swings
 Anxiety
 Irritability
 Poor concentration
 Tearfulness
 Psychosomatic symptoms (i.e. trembling, nausea, palpitations, dyspnea, etc.)
 Fatigue
 Insomnia or difficulty sleeping
 Change in appetite
 Change in behaviour and interaction with newborn and others
 Inability to care for self or newborn
 Visual or auditory hallucinations
 Suicidal or homicidal ideation
Nursing Interventions (varies according to specific complication):
 Assess for signs of postpartum mood disorders. Incorporate screening tools according to protocol.
 Encourage the women to talk about her birthing experience, feelings and transition into the new role.
 Educate the postpartum woman and her support people about signs and symptoms of psychological
complications.
 Teach about the importance of self-care: balanced diet, adequate sleep, exercise, setting realistic
expectations, and seeking out support groups.
 Encourage the postpartum woman to ask for help from family and friends when needed, and to accept
help when offered.
 Provide information sheet and resources related to postpartum psychological complications prior to
discharge.
 Refer to mental health specialist or other interprofessional team members as needed.
Did You Know?
One in every seven women is affected by a postpartum psychological complication (Perry et al., 2017, p.621)
Learning Activity 4
Test Yourself!

1. A postpartum woman states she is not sleeping at night, feels restless, is fatigued and is experiencing visual
hallucinations. These are symptoms of which postpartum psychological complication?

Please select the correct option and then click the "Check Your Answer" button.

a. Postpartum anxiety disorder

b. Postpartum psychosis
c. Postpartum mood disorder
d. Postpartum depression
That’s correct!

2. Mother-infant attachment issues are a complication of perinatal mood disorders.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That is correct!

3. Approximately 80% of postpartum women experience “baby blues” after birth.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That is correct! (Perry et al., 2017, p.621)
Perinatal Loss and Grief
Perinatal loss and grief is individualized to the person experiencing the loss. It can refer to perception of the
birthing experience, the birth of a newborn that was not expected (e.g. gender, physical appearance,
congenital anomaly) or death of the mother or newborn. The nurse’s role is to provide genuine, empathetic
care to the mother and/or family and provide support through the grieving process.
Newborn death can be the result of:
 Birth defects (i.e congenital malformation, deformation and chromosomal abnormalities)
 Prematurity, short gestation and low birth weight
 Effects of maternal complication of pregnancy
 Birth trauma
 Acute illness
 Sudden infant death syndrome (SIDS)
Maternal death can be the result of:
 Disease of the circulatory system
 Obstetric embolism
 Hypertension
 Postpartum hemorrhage
 Puerperal infections
Nursing Interventions:
 Support is individualized to the client (and family), specifically depending on stage of the grieving
process.
 Use therapeutic communication to encourage client(s) to express their feelings and experience with the
loss.
 Support client(s) in the decision-making process, incorporating spiritual and cultural values, beliefs,
communication, and practices.
 Allow the opportunity for the mother (and family) to see, hold, care for and/or name the newborn. It is
an individualized decision that should not be pressured. If chosen, the nurse needs to explain what to
expect and support the mother/family during the process. Offer time alone, if requested.
 Ask if the mother/family would like mementos of the newborn. For example, card with birth information
(i.e. date, weight and height) and hand or foot imprint.
 Provide bereavement support resources to the mother/family prior to discharge.
 With maternal death, support the family with grieving, decision-making process, and new perspective of
role and family.

Learning Activity 5
Test Yourself!

1. Which of the following factors increase the risk of maternal death?

Please select the correct option and then click the "Check Your Answer" button.

a. Multiple gestations
b. Prolonged labour
c. Cesarean section delivery
d. A maternal age of 40 years and older
That’s correct! For 1996/97-2010/11, women 40 years and older had 3.6 (95% CI: 2.1-6.0) times the rate
experienced by women aged 20-24 years (Public Health Agency of Canada: Maternal Mortality in Canada,
Table 4).

2. Maternal complication during pregnancy is the leading cause of newborn deaths.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct! It is congenital malformation, deformations, and chromosomal abnormalities (Statistics
Canada: Leading causes of death, infants, by sex, Canada)

Summary
Thorough assessments can help nurses to identify postpartum risk factors, as well as signs and symptoms of
potential complications during the postpartum period.  If complications occur, it is important for nurses to
provide safe, efficient care and support the mother, newborn and family.

Module 5Focused Postpartum Assessment Prior to Discharge

Learning Objectives
By the end of this section, you should be able to apply components of a focused postpartum assessment
required prior to discharge.
Recommended Resources
Review a chapter on postpartum assessment required prior to discharge in a current Maternal Child Nursing
Care textbook.
ntroduction to Focused Postpartum Assessment Prior to Discharge
Postpartum women’s birthing experiences are diverse and personal. It is important for the nurse to regularly
assess the woman’s physical and psychosocial adaptions of her perinatal experience to ensure she is
recovering well, and to support a healthy transition into parenthood. Assessment of the postpartum woman
includes the newborn and support people (i.e. family, friends) who will be part of the transitional process.

Source: PublicDomainPictures
A thorough assessment by the nurse can:
 Help determine the postpartum woman’s and family’s needs
 Identify potential physical or psychosocial health concerns
 Assist the new mother to adjust into her new role
 Provide teaching opportunities about self-care, newborn care and resources available within her
community
Discharge Times
Most women are discharged in 24-48 hours after a vaginal birth and 48-72 hours after a Caesarean birth.
Discharge time varies relating to type of birth, physical and psychological status of the woman and newborn,
education requirements, support systems, and resources required for follow-up care. The nurse’s role is to
provide the postpartum woman with the required information in a short timeframe, prior to discharge. Nursing
care is focused on client-specific discharge needs, and the ability for the woman to provide care independently
when she returns home.
Planning for Discharge
The nurse provides ongoing assessment of the postpartum woman until discharge. Assessment is focused on
vital signs: Breasts, Uterine, Bladder, Bowel, Lochia, Legs and Episiotomy/Laceration or Caesarean incision,
Hemorrhoids and Emotional status (BUBBLLEHE):

B Breasts – firmness and nipples

U Uterine – fundus: locations, consistency, firmness

B Bladder – function, amount, frequency

B Bowel – function, passing gas, bowel movement

L Lochia – amount, colour

L Legs – peripheral edema

E Episiotomy/Laceration or Caesarean Incision – discomfort, condition of repair

 H Hemorrhoids

E Emotional status – mood, fatigue

Sources:
London, M.L., Ladewig, P.A., Davidson, M.R., Ball, J.W., Binder, R.C.M., & Cowen K.J. (2017). Maternal &
child nursing care (5th ed). Hoboken, NJ: Pearson Education, Inc.
Perry, S.E., Hockenberry, M.J., Lowdermilk, D.L., Wilson, D., Keenan-Lindsay, l., & Sams, C.A.
(2017). Maternal child nursing care in Canada (2nd Canadian ed.). Elsevier.
 
Routine lab tests may be performed to assess the hemoglobin and hematocrit values to assess blood loss
during birth. If rubella or RH statuses are unknown, they will be tested to determine if additional treatment is
required.
Postpartum nursing interventions are prioritized depending on the woman’s physical, psychological and social
needs. The nurse’s role can include providing direct care, educational support, guidance on new skills,
encouraging the woman adapting to her new roles, increasing the woman’s autonomy and self confidence in
her capabilities. Many hospitals use standardized care plans or care maps to assist the nurse during the
discharge process.
Nursing interventions that focus on physical health of the postpartum woman include:
 Prevention of:
o Postpartum infections
o Excessive or prolonged bleeding
o Uterine atony
o Distension of the bladder
 Promotion of:
o Comfort and rest
o Breastfeeding or suppression of lactation and proper bottle-feeding practices
o Ambulation and exercise
o Bladder and bowel function
o Nutrition of mother
Nursing interventions that focus on psychosocial needs of the postpartum woman include:
 Impact of the birth experience
 Maternal self-image
 Adaptation of parenthood and parent-infant interaction
 Emotional health, including postpartum blues
 Family structure and functioning
 Resources and community support
Here is a list of correct matches:
 The woman had a vaginal birth 6 hours ago and her vital signs are HR: 116bpm, BP
90/48mm/Hg, with pallor, cool, clammy skin.
Assess for postpartum hemorrhage or shock. Call for assistance. If uterus boggy, massage until firm,
reassess uterus and give medications as ordered.
 The woman had a Caesarean birth and states she feels light headed and dizzy when sitting up
Assess orthostatic hypotension and opioid effects. Monitor vital signs. Encourage exercise in bed to
promote circulation prior to standing. Inform the client to ask the nurse for assistance the first time
getting out of bed.
 The woman comments that her breasts hurt and feel like hard cannon balls.
Assess for engorgement: tenderness, firmness, warmth and enlargement. Apply warm compresses or
warmth to breast to support circulations and comfort, analgesics as needed.
 Upon examination, you notice the woman’s uterus is displaced to the left, not midline and is at a
higher than expected level.
Encourage woman to urinate if distended due to full bladder, and then reassess uterus. Uterus should
be firm, midline, and decrease in size 1-2cm/day.
 The woman states her sheets are continuously wet and she has been sweating since delivery.
 Postpartal diuresis causes increase perspiration and urinary output. Provide dry sheets and continuous
change, encourage fluids, monitor output and vital signs for potential fever.

 The woman states she has not had a bowel movement for 4 days
Assess for constipation. Encourage increase fluid and fibre intake, exercise, and movement. Could be
related to adverse effects of medication (e.g., opioids, iron supplement, magnesium sulphate).
 The woman states she expelled a large amount of lochia when she got up to go to the bathroom
after breastfeeding.
Assess for clots, characteristics, frequency and amount on pads. Teach client about lochia stages,
amount, frequency of changing pads, clot size, and impact of breastfeeding on the uterus.
 The woman states her legs feel swollen and uncomfortable to move.
Assess for peripheral edema and venous thrombosis. Assess each calf for tenderness and warmth.
Encourage exercise when in bed and promote early ambulation with assistance.
 The woman states her incision appears red, edematous, and tender when she moves in bed.
Assess for infection. Edges should be approximated, suture line intact, dressing clean and dry.
 The woman comments feeling pressure and pain when having a bowel movement.
Assess for hemorrhoids. Encourage Sitz baths to relieve discomfort of pain. Encourage increase in
fluids, fibre and roughage, and avoid sitting for long and directly on buttocks.
 The woman shared she feels teary more than usual since giving birth.
Assess for postpartum blues. Explain this occurs with 80% of postpartum woman and usually resolves
in a few days without treatment.
Learning Activity 2
Test Yourself!

1. What nursing interventions are important in the prevention of postpartum infection?

Please select the correct option and then click the "Check Your Answer" button.

a. Encouraging the woman to wipe back to front after each void

b. Maintaining a clean environment and following routine precautions
c. Changing disposal pads every four hours
d. Encouraging visitors to assist in care of woman and newborn
That's correct!

2. Which two nursing interventions are the most important to prevent excessive bleeding?

Please select the correct option and then click the "Check Your Answer" button.

a. Maintaining good uterine tone and preventing bladder distention

b. Promoting mobility and massaging uterus every four hours
c. Encouraging bedrest for 24 hours and indwelling catheter after six hours
d. Monitoring intake and output and promoting circulation with exercise
That’s correct!

3. Which factor can result in bladder distension?

Please select the correct option and then click the "Check Your Answer" button.

a. Vaginal birth
b. Oxytocin administratoin
c. Afterpains
d. Uterine atony
That’s correct!

4. Which nonpharmacological intervention is best used to reduce the discomfort of engorgement?

 Please select the correct option and then click the "Check Your Answer" button.

a. Applying ice packs or cabbage leaves

b. Massage topical application of anaesthetic ointment
c. Expressing colostrum or breast milk onto nipples
d. Encouraging sitz baths after feeding newborn
That's correct!

5. What is the rationale for administering Rh immune globulin to a Rh-negative, antibody negative (Coombs’
test) woman?

Please select the correct option and then click the "Check Your Answer" button.

a. To increase sensitization in the Rh-negative woman who has had a fetomaternal transfusion of Rh-
positive fetal RBCs
b. To increase the immune response and antibody formation of Rh after birth
c. To promote restructuring and synthesis of fetal Rh and maternal Rh factors during the postpartum
period
d. To promote lysis of fetal Rh-positive blood cells before the mother forms her own antibodies against
them
That's correct!

6. Which intervention provided by the nurse can assist the woman in her new role as a mother? Select all that
apply:

Please select the correct option and then click the "Check Your Answer" button.

a. Encourage her to ask family members for their perceptions of her role
b. Help the woman to identify possible conflicts among family members
c. Provide standardized strategies for dealing with problems once discharged
d. Assess the woman for postpartum blues and discuss strategies
That's correct!

7. Where should the fundus be on the second day postpartum?

Please select the correct option and then click the "Check Your Answer" button.

a. Above umbilicus
b. At umbilicus
c. 1 cm below umbilicus
d. 2 cm below umbilicus
That’s correct!

8. What should the lochia look like on day 1 or 2?

Please select the correct option and then click the "Check Your Answer" button.

a. Lochia rubra, small amount, 5cm or less

b. Lochia rubra, light amount, 5-10cm
c. Lochia rubra, moderate amount, 10-15cm
d. Lochia rubra, large amount, 15cm or more
That’s correct!
9. What does the Society of Obstetricians and Gynecologists of Canada suggest to screen all women for,
during the postpartum period?

Please select the correct option and then click the "Check Your Answer" button.

a. Depression
b. Influenza
c. Future pregnancies
d. Community resources
That’s correct!
Summary
Nursing care focuses on the woman’s needs and should be family-centred. Prior to discharge, the nurse
should focus of the woman’s specific health related physiological and psychosocial need and required
resources to ensure a safe discharge home.

Module 6Discharge Teaching

Learning Objectives
By the end of this section, you should be able to assess and evaluate postpartum home-care needs to assist
with discharge teaching.
Recommended Resources
Review a chapter on discharge teaching for postpartum woman in a current Maternal Child Nursing Care
textbook.

Introduction to Discharge Teaching

Discharge teaching and planning should focus on the woman’s specific needs to support independence in her
new role. Facilities will have specific requirements prior to discharging the mother and newborn. The discharge
health requirements can include:
 Laboratory results
 Prescribed medications
 Client’s self-care needs and ability
 Completed discharge teaching requirements
 Follow-up appointments for the woman and newborn

Discharge Teaching: Maternal Information

Comprehensive discharge teaching is imperative before the mother and newborn go home, to ensure that
individual needs are met and maintain continuity of care, post discharge. Thorough knowledge of postpartum
assessments and communication skills are essential to provide discharge teaching that is client centred,
addresses maternal and newborn health care needs, and promotes optimal overall well-being.
Discharge teaching can include:
 Care of self and newborn (newborn care will be discussed in more detail in the Newborn Care module)
 Breast and nipple care
 Nutrition of newborn: breastfeeding or bottle-feeding specific needs
 Perineal care, including incision or episiotomy care if required
 Vaginal bleeding and lochia patterns after birth
 Normal urine and bowel movement patterns
 Pain management and prescribed medications
 Nutrition and exercise
 Sexual activity and use of contraception
 Signs and symptoms of complications, including postpartum infections and hemorrhage
 Postpartum blues versus postpartum depressions and other psychological complications
 Adjusting to parenthood, including the importance of rest, new roles and relationships
 Routine follow-up care for mother and newborn
 Resources and community-support services
Please Note
If the client experiences any of the following symptoms, it is important they contact their primary healthcare
provider immediately:
 Heavy bleeding that soaks through a pad in one hour
 Clots larger than a loonie coin or golf ball
 A fever greater than 38˚C (100.4˚F) and chills
 Experiencing severe pain in their vagina/perineum area or Caesarean section
 Feelings or fears of wanting to hurt themselves or their newborn
Clinical Pearl of Wisdom
Follow agency policy related to car-seat safety. Be aware of the nurse’s liability regarding car-seat use.
Pause and Reflect
What are some common community resources available for new mothers in your neighborhood?

Summary
Discharge teaching should be a holistic family-centred approach and inclusive to the woman’s specific needs
related to physiological and psychosocial health; self and infant care; and supportive resources available in
their community to ensure a successful transition back home.

Module 7Family-Centred Care

Learning Objectives
By the end of this section, you should be able to apply inclusive and holistic family-centred care nursing
strategies for diverse families.
Recommended Resources
Review a chapter on family-centred care and transition to parenthood during the postpartum period in a current
Maternal Child Nursing Care textbook.

Introduction to Family-Centred Care

The arrival of a newborn brings many changes for the family. The nurse has an important role in supporting the
family during this transition. In providing this support, the nurse needs to take into account the birthing
experience, the family members involved, and their relationships with each other, and parental expectations for
life with a newborn. Teaching about what to expect regarding changes in the mother’s body after delivery, and
normal responses of newborns, can help the family deal with the challenges they may experience.

Source: Michelle Hughes, 2018

Key Components of Family-Centred Care include:
 The birthing journey is a normal healthy process.
 Family-centred care provides an opportunity for optimal holistic care and focuses on mothers,
newborns and families’ unique needs.
 Attachment between the parent and child should be encouraged to promote and strengthen bonding
and newborn development.
 Culturally sensitive care acknowledges and respects the individual’s and family’s cultural values, beliefs
and norms; and integrates these components into care in a meaningful way.
 Women and families require knowledge in maternal, newborn and family health to make informed
decisions and support successful transition into their new roles.

Transition to Parenthood
The arrival of a newborn brings many changes for the family. The nurse has an important role in supporting the
family during this transition. In providing this support, the nurse needs to take into account the birthing
experience, the family members involved, and their relationships with each other, and parental expectations for
life with a newborn. Teaching about what to expect regarding changes in the mother’s body after delivery, and
normal responses of newborns, can help the family deal with the challenges they may experience.

Learning Activity 1
Family Scenarios
Determine the priority postpartum assessments and interventions for the following scenario.
Scenario 1:
The following client arrived onto the postpartum unit:
Aanya is a 38-year-old woman, G3P1T1A2L1 who had a 42 hour, spontaneous vaginal birth, vertex
presentation, with 2nd-degree laceration. Epidural given. Vital signs stable. Breastfeeding initiated, baby skin
to skin after birth x 60 minutes. Fundus soft, midline, 1cm above umbilicus. Lochia ruba with small clots, pad
changed with large amount of blood. In-dwelling catheter. Aanya shared she is a single mother and finally
became pregnant with the help of in-vitro fertilization (IVF).
What are the top three priorities the nurse should focus on during their assessment?

Test Yourself!

1. This client is at risk of bladder distension due to epidural and prolonged labour.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That's correct!

2. Massaging the fundus does not cause pain for the woman.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!

3. In-vitro fertilization can cause multiple pregnancies and increase health problems for mother and
newborn.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!
Pause and Reflect
How can Aanya's past abortions (elective or therapeutic) impact her transition to parenthood?
Why is it important for the nurse to ask Aanya to share her birth story?
Learning Activity 2
Family Scenarios
Determine the priority postpartum assessments and interventions for the following scenario.
Scenario 2:
The nurse has been assigned to the following clients on the postpartum unit:
Fernanda is a 24-year-old woman, G1P1T1A0L1. Fernanda is a surrogate, for a couple who are first-time
parents. She had a spontaneous vaginal birth without complications. Vital signs are stable and BUBBLLEHE
assessment findings are within normal ranges. Fernanda is ready to be discharged. The newborn’s adoptive
parents are in the room when you arrive.
What are the top three priorities the nurse should focus on during their assessment?
Test Yourself!

1. The healthcare environment is heteronormative and can create unique challenges to diverse
parents.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!

2. Surrogate mothers are actively involved with newborn care for three months postpartum.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!

3. Non-birth parents need to have their pregnancy experience validated and celebrated.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!
Pause and Reflect
As a nurse on a postpartum unit, how can you create an inclusive environment for surrogate mothers, as well
as the newborn's adoptive parents?
How would the nurse assist the newborn’s adoptive parents’ transition into their new role?

Learning Activity 3
Family Scenarios
Determine the priority postpartum assessments and interventions for the following scenario.
Scenario 3:
The nurse has been assigned to the following clients on the postpartum unit:
Nour is a 32-year-old woman, G3P3T3A0L3. Nour is a new immigrant to Canada, speaks minimal English, and
has been in Canada for five months. Nour is day 2, post-Caesarean section. Vital signs stable. Epimorph
discontinued. Nour is breastfeeding and the newborn is latching well. Caesarean dressing removed, edges
approximated, no edema, no drainage, with minimal redness located where tape secured dressing. Moderate
rubra lochia. Foley discontinued and Nour is drinking fluids to promote urinary elimination. Nour stated she has
not had a BM and is not eating, because does not like the hospital food. Nour commented she is looking
forward to going home to rest and to receive support from her grandmother.
What are the top three priorities the nurse should focus on during their assessment?
Test Yourself!

1. Cultural values, beliefs and practices do not have a direct impact on the mother and newborn’s
health.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That's correct!
2. Knowledge of cultural beliefs can help the nurse make more accurate assessments and
interventions when observing mother and family behaviours.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!

3. Not all members of a cultural group adhere to traditional practices, it is important for nurses to
validate culture with the client.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!
Pause and Reflect
How can nurses learn about cultural values, beliefs and practices about childbirth and parenting, that are
meaningful for the client?
What resources can the nurse provide to mothers who have recently immigrated to Canada?
See the link below to learn more about strategies nurses can use when working with patients who are new to
Canada.
Review the Best Start: Giving Birth in a New Land, Strategies for Service Providers Working with
Newcomers (Opens PDF document)resource guide to learn more about effective strategies nurses can
implement when working with clients who are new to Canada.
Learning Activity 4
Family Scenarios
Determine the priority postpartum assessments and interventions for the following scenario.
Scenario 4:
The nurse has been assigned to the following client on the postpartum unit:
Pauline is a 17-year-old woman, G1P1T1A0L1. Pauline had a spontaneous preterm vaginal birth. Vital signs
stable. Pauline wants to breastfeed, though is finding it very painful and unsure if she will be able to continue.
Fundus is firm and midline. Moderate amount of rubra lochia. Pauline stated she is worried about the clots she
noticed the last time she voided. Pauline had a bowel movement. It was painful due to a small hemorrhoid. She
is able to ambulate without assistance. Pauline shared with the nurse that she will be moving in with her
boyfriend and his parents. Her boyfriend has a two-year-old son from a previous relationship. Pauline
commented she is worried about taking care of her newborn and her boyfriend’s son, when he has custody on
the weekends.
What are the top three priorities the nurse should focus on during their assessment?

Test Yourself!

1. Adolescent mothers are at increased risk of postpartum mood disorders associated with lack of support
and poor relations with their partners.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That's correct!

2. Mortality rates are lower among infants of adolescent mothers.

Please select the correct option and then click the "Check Your Answer" button.
 a. True
b. False
That's correct!

3. Adolescent fathers need support to discuss their feelings and perspectives of fatherhood.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!
Pause and Reflect
How should the nurse adapt postpartum care for adolescent parents, versus other parents?
How can the nurse support Pauline’s educational needs regarding self and newborn care?

earning Activity 5
Family Scenarios
Determine the priority postpartum assessments and interventions for the following scenario.
Scenario 5:
The nurse has been assigned to the following clients on the postpartum unit:
Ziv is a 28-year-old woman, G2P2T2A0L2. Ziv had a spontaneous vaginal birth, without complications, six
hours ago. Vital signs are stable, IV infusing at 30cc/hr. and intact, and newborn is breastfeeding skin to skin.
Ziv’s family has arrived and wants to begin a traditional ceremony that has been performed by traditional elders
and celebrated with each new generation. 
What are the top three priorities the nurse should focus on during their assessment?

Test yourself!

1. It is important for nurses to ask clients their about cultural practices, to ensure culturally safe care.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That's correct!

2. Families should have minimal involvement in mother and newborn care to promote the mother’s
independence.

Please select the correct option and then click the "Check Your Answer" button.

a. True
b. False
That’s correct!
Pause and Reflect
How can nurses support clients’ traditional practices, beliefs, values and communication during the postpartum
period?
How does a client’s family influence their postpartum journey?
Resources:
Cultural Competence and Cultural Safety in First Nations, Inuit and Métis Nursing Education: An Integrated
Review of the Literature
Health Professionals Working with First Nations, Inuit, and Métis Consensus Guideline
Summary
Holistic family-centred care nursing strategies are required to provide optimal care for Canada’s diverse
population. Family-centred care principles support the unique health needs of mothers, newborns and their
families.

Module 8Final Notes on Postpartum

Summary
The postpartum period consists of many changes that a woman must transition through, both physiologically
and psychologically. Physiological changes involve the cardiovascular, genitourinary, endocrine, respiratory,
neurological, musculoskeletal and integumentary systems. Comprehensive postpartum assessment enables
the nurse to promptly intervene to minimize potential risk factors and complications. Educating the postpartum
client regarding self-care, newborn care and their well-being empowers the woman to develop a healthy self-
concept as she adjusts to the new role of motherhood.
Pause & Reflect
 What knowledge have I gained from this module? What additional knowledge do I need?
 How will I maintain current knowledge in postpartum health?
 Why is it important for a nurse to thoroughly assess a woman’s physical and psychological changes
during the postpartum period?
 How can the nurse create an inclusive, welcoming, holistic approach to postpartum care?
 When determining postpartum home care needs, how can a nurse incorporate the client’s cultural
beliefs, values, and practices?
References
Aboriginal Nurses Association of Canada. (2009). Cultural Competence and Cultural Safety in First Nations,
Inuit and Métis Nursing Education. An Integrated Review of the Literature. Ottawa: Aboriginal Nurses
Association of Canada. Retrieved from
https://www.uleth.ca/dspace/bitstream/handle/10133/720/An_Integrated_Review_of_the_Literature.pdf?
sequence=1
Allan, B & Smylie, J. (2015). First Peoples, second class treatment: The role of racism in the health and well-
being of Indigenous peoples in Canada. Toronto, ON: the Wellesley Institute. Retrieved from
http://www.wellesleyinstitute.com/publications/first-peoples-second-class-treatment/
Best Start Resource Centre. (2009). Giving Birth in a New Land: Strategies for Service Providers Working with
Newcomers(Opens PDF document). Toronto: Best Start Resource Centre. Retrieved from
https://www.beststart.org/resources/rep_health/Newcomer_%20Guide_Final.pdf
Canadian Association of Schools of Nursing. (2017). Canadian Association of Schools of Nursing (CASN)
Entry-to-Practice Competencies for Nursing Care of the Childbearing Family for Undergraduate
Education(Opens PDF document). Retrieved from https://www.casn.ca/wp-content/uploads/2016/09/FINAL-
CHILDBEARING-FAMILY-COMPETENCIES-revised.pdf
College of Nurses of Ontario. (2009). Practice Guideline: Culturally Sensitive Care. Toronto, ON: Author.
Jarvis, C. (2014). Physical examination & health assessment, second Canadian edition. Toronto, ON:
Saunders/Elsevier Canada.
kineticstreaming. (2013, August 28). Postpartum Assessments and Interventions(Opens new window). [Video
file]. Retrieved from https://youtu.be/Je2r6gc7gGo
London, M.L., Ladewig, P.A., Davidson, M.R., Ball, J.W., Binder, R.C.M., & Cowen K.J. (2017). Maternal &
child nursing care (5th ed). Hoboken, NJ: Pearson Education, Inc.
McGowan, A. (2017). A Rural Registered Nurse’s Experience with Postpartum Care. [Video file].
Orton, C. (2017). Om Sweet Home Blog. Retrieved from http://omsweethomeblog.com/index.php/about/
Perry, S.E., Hockenberry, M.J., Lowdermilk, D.L., Wilson, D., Keenan-Lindsay, l., & Sams, C.A.
(2017). Maternal child nursing care in Canada (2nd Canadian ed.). Elsevier.
Perry, S.E., Hockenberry, M.J., Lowdermilk, D.L., Wilson, D., Sams, C.A. & Keenan-Lindsay, L.
(2012). Maternal child nursing care in Canada (First Canadian ed.). Elsevier.
Public Health Agency of Canada. (2013). Maternal Mortality Rate in Canada(Opens PDF document). Retrieved
from https://sogc.org/wp-content/uploads/2014/05/REVISEDMortality-EN-Final-PDF.pdf
Statistics Canada. (Date modified: 2017-03-09). Leading causes of deaths, infants, by sex, Canada. Retrieved
from http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=1020562
Wilson, D., de la Ronde, S., Brascoupé, S., Apale, A. N., Barney, L., Guthrie, B., . . . Pauktuutit Inuit Women of
Canada. (2013). Health professionals working with First Nations, Inuit, and Métis consensus guideline.(Opens
PDF document) Journal of Obstetrics and Gynaecology Canada, 35(6), 550. Retrieved from
http://old.sogc.org/wp-content/uploads/2013/06/June-JOGC-2013-CPG293_Supplement_Eng_Online-
Final_NO-cropmarks_REV-F.pdf