Postpartum & Nursery

POSTPARTUM The period after giving birth. Usually considered to be the first few days after delivery. BUT technically it includes the six-week period after childbirth up to the mother's postpartum checkup.

PURPOSE Immediately following childbirth, the mother experiences profound physical and emotional changes. She may stay in the hospital for a very short time(24-48hrs) after delivery. The physical and emotional care a woman receives during the postpartum period can influence her for the remainder of her life.

Precautions for the Mom The mother is at risk for: Infection Hemorrhage Pregnancy induced HTN Blood clot formation Dehiscence Breast problems Postpartum depression

POSTPARTUM CARE Initial assessment: Pain The condition of the uterus Vaginal discharge The condition of the perineum The presence/absence of bladder distension (followed by appropriate interventions )

POSTPARTUM CARE Assessment should be done every 15 minutes for the first hour; Then generally every 30 minutes for the second hour; and every four to eight hours thereafter depending on facility policy.

Assessment of Pain Brainstorm With Your Table What is the cause of the pain??? c/o pain in the calf c/o a headache c/o of a spinal headache c/o painful, swollen and red breasts ***Other sites of pain are surgical site and muscle pain after a long labor.

Condition of the Uterus Assessed by evaluating the height and consistency of the fundus (the part of the uterus that can be palpated abdominally). – The height of the fundus after the 1 st hr. after delivery is at the umbilicus or above it. – Every day the fundal height decreases by approximately the width of one finger (one cm). Massaging the uterus promotes contraction and aides the uterus in returning to its original size.

VAGINAL DISCHARGE (LOCHIA) The color and amount of lochia is assessed. An excessive amount could be a sign of … The vaginal discharge changes from red on the first day after delivery and eventually turns white. It can continue up to 14 days. However, spotting can continue for another six weeks.

PERINEUM CARE Usually assessed… After an episiotomy or laceration repair For a hematoma Relief of discomfort… Cold packs for the 1 st 24 hrs Warm packs for after the 1 st 24 hrs Rinsing after every void and/or bm Sitting in a sitz bath

BREASTFEEDING Lactation nurses aid mothers in learning how to breastfeed and cope with any problems that arise New mothers learn about: – Positioning their baby – Nursing frequency – Milk supply – Common frustrations

POSTPARTUM DEPRESSION Moderate to severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later. Most of the time, it occurs within the first 4 weeks after delivery. There is treatment!!!

Moving on to a fun subject… The Nursery After a baby is born, a doctor or nurse will perform a series of tests to determine the baby’s physical condition. A routine evaluation, called the Apgar test, is used to identify whether a baby needs urgent medical care. After delivery, the baby will also be given a vitamin K shot, eye drops, and newborn screening tests. The baby may also receive a hearing test and a hepatitis B vaccine. I

Apgar Score The very first test done on a newborn right after birth in the delivery or birthing room. The test was designed to quickly evaluate a newborn's physical condition after delivery and to determine any immediate need for extra medical or emergency care. It is done twice – at 1 min then 5 mins after birth. See HANDOUT for scoringHANDOUT

Focus On… Important things to focus on: Color Temperature Feeds Voiding and stools Jaundice S&S of illness

Focus On… COLOR: be worried about central cyanosis; bluish coloring of hands and feet is normal at first TEMP: this is a big one!!! Keep the baby dry and wrapped up; should be above 97.6 axillary.

Focus On… FEEDS: Should be every 3-4 hours; can breastfeed more often, but milk doesn't come in until 3-4 days of life VOIDING and STOOLS: you want to see 6-8 wet and dirty diapers a day

Focus On… JAUNDICE: can be normal but intervention is needed usually when bilirubin levels reach above at day two of life (for normal term babies)

Focus On… S&S of ILLNESS: temp below 97.0 or above projectile vomiting, or diarrhea blood in stool skipping more than one feed > 6 wet diapers a day lethargy, or irritability

Other things to consider… Nursery nurses also have to keep in mind other possible situations that require additional monitoring and tests and possible admission to NICU.