CHAPTER

19

Nursing Care of the Family During

the
Postpartum Period

ch 19 Care of family during PP

NURSING C ARE OF THE
POSTPARTUM WOMAN
• Components of nursing care
• Assist mother with rest and recovery after
birth
• Assessment of physiologic and
psychologic adaptation
• Prevention of complications
• Education regarding self-management and
infant care
• Support of mother and her partner during
transition to parenthood
TRANSFER FROM RECOVERY
AREA
• In traditional setting, woman is moved to
postpartum room after recovery
• In labor, delivery, recovery, and postpartum
(LDRP) setting, woman and infant remain
together in room where birth occurred
• Postanesthesia recovery
• Regardless of obstetric status, no woman
should be discharged from recovery area
until completely recovered from anesthesia
 PLANNING FOR DISCHARGE

• Length of stay is dependent upon:

• Physical condition of the mother and newborn
• Mental and emotional status of the mother
• Social support at home
• Educational needs for self-management
• Financial constraints
• Low risk vaginal delivery – discharged within 24-36 hours
• Newborns’ and Mothers’ Health Protection Act of 1996
• Allows for a minimum of ____ hours stay after a vaginal birth and ____ hours after cesarean
birth
• Criteria for discharge
• American Academy of Pediatrics recommendations
 CARE MANAGEMENT: PHYSICAL NEEDS
 Couplet or mother-baby care
 Ongoing physical assessment
 Review TABLE 19-1 Carefully!!!!
 Routine lab tests: H&H & Rh status
 Nursing interventions
 Physical assessment for deviations from
normal, pain, safety, infection prevention,
teaching
 Infant security
 Prevention of infant abduction
 Prevention of infection: Linens, frequent pad
change, shoes; Avoid sick; Perineal care
 Prevention of excessive bleeding
 Uterine atony
 Interventions:
 Causes:
 Immediate attention: Saturation of pad ___ or
pooling of blood under buttocks
 Scant, light, moderate, heavy (time factor)
 Excessive bleeding: BP not reliable indicator of
shock; respirations, pulse, skin, urinary output,
LOC more sensitive
 Maintenance of uterine tone
 Fundal massage
 C ARE MANAGEMENT: PHYSIC AL NEEDS (CONT.)

 Prevention of bladder distention

 Displaces uterus  Promotion of rest
 Risk of distention  Postpartum fatigue (complex)
 Help void spontaneously ASAP  Hospital routines, infant care, anemia
 Promotion of comfort (from afterpains, lacerations,  Depressive symptoms can affect fatigue
epis, hemorrhoids, sore nipples, engorgement)  Resources available
 Nonpharmacologic interventions: Position on side,  Screening (pediatric office)
ice pack, topical meds, sitz baths; Position changes  Promotion of ambulation
for feeding, lanolin, ice/support bra  Reduction of :
 Pharmacologic interventions: Opioids, Non-opioids,  Orthostatic hypotension
NSAIDS, topical, PCA, epidural; Opioids – always  Risk of falls
monitor ; Always reassess pain within ______  Promotion of exercise
of medication; Breastfeeding: can adjust timing to  Start simple and progress
decrease infant exposure  Kegels
 CARE MANAGEMENT: PHYSICAL NEEDS
(CONT.) Planning Future Pregnancies
 Promotion of nutrition  Rubella vaccination
 PNVs, iron supplements (continue ___ weeks); Non-  If woman is not immune, vaccination is
lactating ______ kcal/day; Lactating ______ recommended
kcal/day  Avoid immunocompromised; teratogenic
 Promotion of normal bladder function  Varicella vaccination
 Void spontaneously within  Teratogenic
 Measure first several (>_________________ each)  Tetanus-diphtheria-acellular pertussis (Tdap)
 Promotion of normal bowel function  Protect woman and infant from pertussis
 Promotion of breastfeeding  Rh isoimmunization
 Baby-Friendly Hospital Initiative  Rh immune globulin should be given within
 Within _____________________ after birth _____ hours for Rh-_____________ women
 Lactation suppression who deliver an Rh-______________ infant
 Well-fitted support bra/binder continuously; Avoid  Kleihauer-Betke test
stimulation; Ice packs for engorgement; Cabbage  Made from human plasma
leaves; Mild analgesics
CARE MANAGEMENT: PSYCHOSOCIAL NEEDS
 Effect of the birth experience
 Mourn loss of expectations if birth experience didn’t
go as planned
 Maternal self-image
 Sexual adjustment is often a concern
 Include in routine discharge teaching
 Adaptation to parenthood and parent-infant interactions 
 Signs:
 If no indicators:
 Family structure and functioning
 Woman’s adjustment affected by other relationships
 Strategize
 Impact of cultural diversity
DISCHARGE TEACHING
 Self-management and signs of complications
 Cultural differences
 Discharge teaching begins
 Nutrition, exercise, family planning, sexual
intercourse, prescribed medications, follow-up care
 Sexual activity/contraception
 Time to heal and reduce risk of infection
 Contraception discussed
Prescribed medications
 PNVs, Iron, Stool softeners, Pain meds
 Routine mother and baby checkups
 Mother (________ weeks)
 Newborn (___hours after discharge)
 Follow-up after discharge
 Home visits
 Telephone follow-up
 Warm lines
 Support groups
 Referral to community resources
 C ASE STUDY

• Ms. Roth is a 19-year-old at 28 weeks with an unexpected pregnancy. She began prenatal care at 20 weeks
and presented to labor and delivery triage yesterday c/o abdominal pain and vaginal bleeding. On
examination she was found to be 7 cm dilated, 100% effaced with bulging membranes. On US the fetus was
found to be breech and fetal heart monitoring revealed persistent decelerations with contraction. Plans were
made to prepare for an emergent cesarean birth.
• A female infant was delivered 24 hours ago. Apgar scores were 3/5/8. NCCC team was present at birth and
baby is in stable condition on oxygen tent in NCCC. Ms. Roth is also in stable condition. The surgery was
uncomplicated and she is now getting up with assistance to go to the bathroom with saline lock. Her pain is
managed with PO medications. Her mother spent the night with her last night, but has gone home to get
ready for work. The father of the baby (FOB) is not involved at this time. In report the night nurse notes that
the patient has had a “flat affect.” You are now assuming care for Ms. Roth on the mother-baby unit.
• Based on the report, what are some of the priorities of care?
 QUESTION

Childbirth may result in injuries to the vagina and uterus. Pelvic floor
exercises also known as Kegel exercises will help to strengthen the perineal
muscles and encourage healing. The nurse knows that the client
understands the correct process for completing these conditioning exercises
when she reports:
a)“I contract my thighs, buttocks, and abdomen.”
b)“I do 10 of these exercises every day.”
c) “I stand while practicing this new exercise routine.”
d)“I pretend that I am trying to stop the flow of urine midstream.”