Postpartum Care and Safety Quiz

Postpartum Period

• Postpartum: The 6-week period after childbirth. The first 4 hours are considered the 4th stage of labor.
• Hemorrhage and infection are the most common complications.
• Bonding, adjustment to parenthood, and postpartum depression (PPD) are essential psychosocial elements.
• Patient education is a crucial component of postpartum care.
• Insurance generally covers a minimum of 48 hours for vaginal deliveries and 96 hours for cesarean births.

Safety for Mother and Infant

• Security protocols are vital in mother/baby units.
• The Joint Commission (JCAHO) mandates security systems for all hospitals.
• Misidentification of newborns is a serious risk.
  • Verify identification bracelets.
• Infant abduction prevention measures are essential.

Early Maternal Assessment

• Vital signs:
  • Temperature below 100.4°F (38°C).
  • Decreased pulse (50-70 bpm) is common.
  • Blood pressure: Compared to first trimester.
  • Respirations: Normal range of 12-20 breaths per minute.
  • Pain: Considered the "fifth vital sign".
    • Maximal pain level should be around 4/10.
    • See Table 11-1 on page 372 for details.
  • White blood cell count (WBC): Expected to be around 13-14,000 due to the stress of delivery.
• Medications:
  • Ibuprofen and Aleve can be used after delivery.

Concise Postpartum Assessment Guide

• BUBBLE-HE:
  • Breasts: Assess for engorgement, milk production, and any discomfort.
  • Uterus: Assess for location (typically at the umbilicus or below), consistency (firm or boggy), and midline position.
  • Bladder: Assess for voiding pattern, bladder distention, and difficulty urinating.
  • Bowel: Assess for constipation, bowel movements, and concerns about elimination.
  • Lochia: Assess for color, amount, and odor.
  • Episiotomy or perineum: Assess for redness, swelling, pain, and signs of infection.
  • Homan’s sign: Assess for pain or tenderness in the calf.
  • Emotions: Assess for emotional well-being, mood changes, and potential signs of PPD.

Common Terms

• Fundal Check: Assessing the location and consistency of the uterus in the abdominal cavity. The umbilicus is the landmark.
• Uterine Atony: Decreased tone of the uterine muscle. The primary cause of postpartum hemorrhage.
  • Uterine tone is classified as “boggy” (loose) or “firm”.
• Involution: The process by which the uterus returns to its pre-pregnant size, shape, and location. This includes the healing of the placental site.
• Sub-involution: The uterus does not return to its pre-pregnant size or shape.
  • The fundus remains above the umbilicus after delivery.

Uterus

• Fundal checks are essential.
• The umbilicus is the baseline marker for fundus placement.
• Assess for fundal firmness or bogginess.
• Position the fundus in the midline or on either side.

Bladder

• Increased risk for urinary retention after delivery.
  • Significant fluid movement and diuresis are expected.
• IV fluids lead to increased urine output.
• Postpartum numbness can interfere with normal bladder function.
• Encourage frequent voiding and adequate fluid intake.
• While edema is expected, it should not be present in the face or hands.

Bowel

• Constipation is common postpartum.
  • Compression from the baby's head during labor.
  • Poor intake before or during labor.
  • Fear, pain, or lacerations can decrease bowel urgency.
• Encourage ambulation, fiber, and fluids.
• Stool softeners are often recommended.

Maternal Physiological Adaptations and Continued Assessment

• Hematological:
  • The body can compensate for a blood loss of 500-1000 mL.
  • Decrease in hemoglobin and increase in hematocrit are expected.
    • Hematocrit increases due to fluid loss.
    • An increase greater than 10% is concerning.
  • Patient education should focus on hydration and iron-rich foods.
  • Elevated WBC is normal in the first few days.
• Metabolic systems:
  • Loss of the placenta and the fetus leads to decreased glucose needs.
  • Gestational diabetes mellitus (GDM) usually resolves.
  • Type 1 and 2 diabetes may require less insulin or none.
    • Risk of postpartum hypoglycemia is higher than hyperglycemia.
• Neurological system:
  • Headaches require thorough assessment.
    • Preeclampsia can still be active.
  • Spinal or epidural headaches are characterized by pain in the front of the head, relieved by lying down.
    • Preeclampsia headaches are not relieved by position changes.
  • Always assess for blood pressure, visual disturbances, and epigastric pain.
• Renal system, fluids, and electrolytes:
  • Diuresis is expected.
• Respiratory system:
  • Generally no issues; respiratory rate should return to normal.
  • Problems may indicate complications (tachypnea and elevated heart rate).
• Cardiovascular system:
  • Increased cardiac output (due to fluids).
  • Risk of cardiac compromise is highest in the immediate postpartum period due to rapid physiological changes.
• RhoGAM:
  • Administer only if the infant is Rh-positive.
  • Must be given within 72 hours of delivery.
• Ovulation:
  • Returns shortly after delivery.
  • Pregnancy is possible.
  • Contraception counseling is crucial.
  • Breastfeeding is not a reliable form of contraception.
• Gastrointestinal system:
  • Constipation is common.
  • Cesarean birth (C-section) patients may experience nausea and vomiting (1-2 hours after delivery).
    • Clear liquids should be progressed to solid foods.
    • If nausea and vomiting persist beyond 1-2 hours, an ileus may be present.
  • Vaginal delivery (SVD) patients will likely be hungry; encourage adequate nutrition.
• Musculoskeletal system:
  • Expect aches and pains.
  • Joint laxity is common.
  • Avoid strenuous exercise.
  • Abdominal strain should be minimized.

Cultural Sensitivity

• Develop cultural awareness and sensitivity to provide culturally-appropriate care.
• Recognize and respect diverse beliefs and practices that may influence healthcare preferences.

Patient Education

• Activity and rest: Encourage appropriate activity levels and rest periods.
• Nourishment: Teach about dietary needs and encourage a balanced diet.
• Elimination: Discuss bowel and bladder function, encouraging regular bowel movements and voiding.
• Perineal care: Provide instructions on proper perineal hygiene.

Postpartum Surgical Patient

• Care after cesarean birth:
  • Follow the same protocols as any patient with abdominal surgery.
  • Include assessment of BUBBLE-HE elements.
• Recovery from anesthesia: Monitor for signs of recovery.
• Abdominal distention: Manage gas build-up.
• Nausea and vomiting: Assess and manage.
• Urinary system:
  • Monitor urine output; expect to see urine within 4-6 hours postpartum.
  • Remove the urinary catheter after 12-16 hours postpartum.

Breasts

• Primary Engorgement:
  • A common experience, occurring around day three postpartum (possibly earlier in multiparous women).
  • Occurs regardless of feeding method (breast or bottle).
  • Caused by oxytocin, a hormone that stimulates milk production.
• Colostrum:
  • The first milk a mother produces, thin, yellowish, and sticky.
  • Rich in antibodies and nutrients.
• Lactation:
  • The production of milk from the mammary glands.
  • Producing milk and breastfeeding are often used interchangeably.

Breastfeeding Info

• Positions:
  • Encourage mothers to try various positions to find what works best.
  • For new mothers, it’s recommended to try different positions.
  • The baby's head should be midline.
  • Safety during breastfeeding:
    • Do not sleep with the infant.
    • Side-lying breastfeeding is difficult to do while staying awake.
• Breast shells:
  • May be helpful for flat, inverted, or sore nipples.
• Donor breast milk:
  • Provide information about donor breast milk resources.
• Tobacco, alcohol, medications, caffeine:
  • Discuss the impact of these substances on breastfeeding and the infant.

Breasts Complications

• Clogged milk duct:
  • Characterized by a palpable nodule.
  • Warm compresses can help.
  • Massage the area to encourage milk flow.
  • Pumping or hand-expressing can also help.
• Abnormal engorgement:
  • Provide information about relieving engorgement.
• Cracked nipples:
  • Discuss prevention and treatment strategies.
• Mastitis:
  • A common complication of clogged milk ducts and engorgement.
  • Often associated with inflammation and pain in the breast.

Visual Cues for Mastitis

• Redness and swelling
• Flu-like symptoms
• Chills and fever

Family and Infant Bonding

• Attachment: The bond between parent and infant.
• Bonding: Starts from the moment of pregnancy confirmation and continues through early childhood.
  • This includes the birth experience, postpartum period, and beyond.

This quiz covers essential aspects of the postpartum period, including the six-week recovery timeline post-childbirth, complications such as hemorrhage and infection, and the importance of maternal bonding and education. It also addresses safety protocols in mother/baby units, including identification and abduction prevention measures.