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Chapter 19
Nursing Care of the Family
During the
Postpartum Period
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Nursing Care of the Postpartum
Woman
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Components of nursing care
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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
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Transfer from Recovery Area
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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
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Regardless of obstetric status, no woman should be
discharged from recovery area until completely
recovered from anesthesia
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Planning for Discharge
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Length of stay is dependent upon:
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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
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Planning for Discharge (Cont.)
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Newborns’ and Mothers’ Health Protection Act of
1996
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Allows for a minimum of 48 hours stay after a vaginal
birth and 96 hours after cesarean birth
Criteria for discharge
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American Academy of Pediatrics recommendations
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Care Management
Physical Needs
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Couplet or mother-baby care
Ongoing physical assessment
Routine lab tests
Nursing interventions
Infant security
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Prevention of infant abduction
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Care Management
Physical Needs (Cont.)
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Prevention of infection
Prevention of excessive bleeding
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Maintenance of uterine tone
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Uterine atony
Fundal massage
Prevention of bladder distention
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Care Management
Physical Needs (Cont.)
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Promotion of comfort
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Promotion of rest
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Postpartum fatigue
Promotion of ambulation
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Nonpharmacologic interventions
Pharmacologic interventions
Reduction of venous thromboembolism
Promotion of exercise
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Care Management
Physical Needs (Cont.)
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Promotion of nutrition
Promotion of normal bladder function
Promotion of normal bowel function
Promotion of breastfeeding
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Baby-Friendly Hospital Initiative
Lactation suppression
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Planning Future Pregnancies
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Rubella vaccination
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If woman is not immune, vaccination is recommended
Varicella vaccination
Tetanus-diphtheria-acellular pertussis (Tdap)
Rh isoimmunization
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Rh immune globulin should be given within 72 hours
for R-negative women who deliver an Rh-positive
infant
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Care Management
Psychosocial Needs
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Effect of the birth experience
Maternal self-image
Adaptation to parenthood and parent-infant
interactions
Family structure and functioning
Impact of cultural diversity
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Case Study
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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.
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Case Study (Cont.)
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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.
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Case Study (Cont.)
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Based on the report, what are some of the
priorities of care?
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Discharge Teaching
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Self-management and signs of complications
Sexual activity/contraception
Prescribed medications
Routine mother and baby checkups
Activities of daily living at home
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Discharge Teaching (Cont.)
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Follow-up after discharge
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Home visits
Telephone follow-up
Warm lines
Support groups
Referral to community resources
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Question
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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:
“I contract my thighs, buttocks, and abdomen.”
“I do 10 of these exercises every day.”
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Question (Cont.)
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“I stand while practicing this new exercise
routine.”
“I pretend that I am trying to stop the flow of
urine midstream.”
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