The newborn is not the only one who requires attention after the exhausting process of giving birth. It is also critical to ensure that the woman is in good health because the immediate postpartum period is critical for both the woman and her baby.
Within the First 24 Hours of Care
Nursing care for a postpartum woman during the first 24 hours consists of the following:
Examine the woman’s family profile to see how the newborn will affect the family and the woman.
Examine the woman’s pregnancy history, particularly whether the pregnancy was planned or unplanned, as this will determine the woman’s ability to bond with the newborn.
Examine the labor and birth history, such as the length of labor and the use of analgesia or anesthesia, to determine whether any procedures are required.
Determine the infant’s data and profile to aid newborn care planning and promote parent-child bonding.
The woman would also require a postpartum course to determine any need for anticipatory guidance in-home care, such as her activity level after birth, any difficulties or pain felt, and if she is successful with infant feeding.
Examine the woman’s laboratory data to ensure that she is recovering well and to determine whether any procedures or additional diagnostic tests are required.
Evaluate the woman’s overall appearance because it reflects how well she is progressing into the taking hold phase of recovery.
Assure the woman that losing hair is not a sign of illness but that she is returning to her pre-pregnancy state, as hair overgrows during pregnancy due to increased metabolism.
Examine for facial edema, especially if the patient has pregnancy-induced hypertension.
Recommend that the woman buy a nursing bra one to two sizes larger than her pregnancy size to allow for growth.
Look for cracks or fissures in the woman’s breast and avoid squeezing the nipple. In addition, look for signs of mastitis, such as inflammation of a specific part of the breast.
Palpation is used to determine the fundus’s location, consistency, and height.
Massage the uterus gently if it is not firm when palpated. Placing the infant on the mother’s breast stimulates contractions as well.
Lochia is expected in a postpartum woman for 2 to 6 weeks, so its characteristics must be assessed to determine whether it is normal lochia.
Examine the perineum for ecchymosis and hematoma—edema and any drainage and bleeding caused by the stitches.
Precautions in Discharge Planning
Before the woman is discharged, she must be adequately educated on caring for the newborn and herself at home.
First, assess the mother’s ability to absorb new information and listen.
Conducting newborn care group classes could greatly assist mothers in learning what the instructors teach and from the experiences that some mothers could share with the group.
It is also recommended that fathers attend such classes so the mother has someone she can rely on for newborn care.
Individual instruction is also sought following postpartum, as the family will need to know how to care for the woman and newborn after discharge.
Teaching does not always have to be formal; it can take the form of comments made during class or procedures.
For the first three weeks after birth, instruct the woman to avoid lifting heavy objects.
Advise the woman to set aside time for rest every day or to rest and sleep while her newborn sleeps so that she can regain her energy.
Ensure the woman understands that she must return to the healthcare facility for an examination after 4 to 6 weeks and that she must schedule an appointment for her baby to be examined by a pediatrician at 2 to 4 weeks.
Ensure that the woman and her family understand the discharge instructions amid the new baby’s excitement; review instructions with parents before they leave.
Calling or visiting 24 hours after discharge is the best way to determine whether the family has understood all instructions and has successfully integrated the newborn into the family.
Discharge from the hospital usually happens 2 to 3 days after birth.
If the woman has cultural food preferences, she can rest at home and eat better.
The newborn can also be exposed to family routines earlier, making it easier for her to adjust to the extrauterine environment.
After discharge, a home visit is usually recommended to see how the family is doing now that they have a newborn in the house.
High-risk newborns, newborns born to adolescent mothers, and newborns whose mothers abused drugs during pregnancy require a particular discharge and home visit.
During the postpartum visit, the woman’s pregnancy history is assessed. If there are any difficulties bonding between the mother and the baby, the woman is allowed to relate her labor and birth experiences.
Examine the newborn’s history and whether the woman has any concerns about the newborn.
Examine the woman’s plans, such as whether she plans to return to work outside the home and whether she has already made arrangements to care for her newborn while she is away.
Conduct a family assessment and inquire whether other family members are adjusting well to having a newborn in the house.
Physically examine the mother and the newborn for signs of postpartum complications or defects.
Remind the mother of the newborn’s health maintenance visit when she is 2 to 4 weeks old and her return checkup 4 to 6 weeks after birth.