Postpartum

Family-centered Maternal and Newborn Care- is a philosophy that is contingent with the new paradigm of patient-family centered care, where healthcare is not only providing support for the patient but all individuals connected to the patient.  For postpartum, the partner of the patient can often be forgotten in the nursing assessment.  As a nursing student, I found that because I did not have a large workload, it was a good time to integrate assessment of family needs into practice.  Whether this is practical in the work setting, I only have one comment: if the workload is fair and equitable (the system’s responsibility), then a good grip of integrating family assessment into practice will allow assessments in a timely manner (the individual practioner’s responsibility), so that “I don’t have enough time” should not be the primary excuse of neglecting family needs.  

Interactive Resources: PERL (Patient Education Reference Library) contains many videos which can be used to educate patients.  Topics covered in the videos include episiotomies, amniocenticis, epidurals and the birthing process.  Disclaimer

Postpartum Maternal Physical Assessment Summary- BUBBLE HE

Breasts:

  • inspect: size, symmetry, shape of breast and nipples taking note of erection, flatness, redness, bruising, open wounds, presence of mastitis and colostrum
  • palpate: fullness, soft or engorged, firmness and lumps
  • pain assessment

Uterus (Fundus):

  • palpate: firmness/bogginess, location of the fundus in relation to the abdomen, determine the location of the fundus in relation to the belly button to determine amount of fundal involution
  • inspect incision site
  • check policy: in some organizations, they may not assess fundal involution by palpation due to fear of dehiscence

Bladder:

  • void amount (~30ml/hr)
  • assess for distention, incontinence, urinary retention, urinary infection especially if the patient had a foley catheter

Bowel:

  • last bowel movement/flatus
  • assess for distention, abdominal pain

Lochia:

  • amount, color, odour
  • assess for postpartum hemorrhage 

Episiotomy 

  • level of laceration
  • number of stitches, redness, edema, bruisin, discharge, approximation of wound edges
  • assess perineal area

Homan’s Sign-for DVT

  • assess for pain with dorsiflexion
  • check policy: this is sometimes not done in organizations

Emotional State:

  • assess for signs and symptoms of postpartum depression and infant-maternal bonding

At my postpartum placement, one of the nurses gave us a very helpful handout on what to look for specifically in cesarean and vaginal deliveries postpartum.  Again, the Disclaimer is that these were tips she found useful in assessing her patients, do not use this information to guide your practice, checking college standards and organizational regulations is imperative to good practice. 

Vaginal Birth

credit: nucleusanimation

Vaginal Birth Assessment

  1. VS: on admission; 2 hrs post 1st set of VS; 24hr postpartum or qshift; within 2hr of d/c
  2. Urine Output: d/c foley when patient is walking; delay foley removal if there is swelling in labia
  3. IV: d/c when patient is stable and no signs of postpartum hemorrhage  
Cesarean Section

credit: nucleusanimation

 
Cesarean Assessment
  1. VS: on admission; 1hr post 1st set of vitals; q4hrs for the next 48 hrs; qshift until d/c; within 2hrs of d/c
  2. Urine Output: d/c foley catheter 12 hrs post opt unless ordered; output for first 2 voids should match ~30ml/hr; if no void within 6-8 hrs post foley removal then do I/O catheter
  3. IV: assess for complications such as infiltration, fluid overload; d/c 24hrs or when stable VS

Neonatal Physical Assessment

  1. Check: GBS, Bloodtype, HepB, HIV and Rubella status of mother and baby
  2. VS: on admission; qshift (if GBS+ive then q4h)
  3. Head to Toe: on admission; qshift; the mother is a great resource wen you are doing vital assessments or when you are getting blood samples for the heel prick.  Have the mother hold the baby skin-skin or breast feed the baby when you assess, they cry less and will make the assessment go faster. 
  4. Blood Work: GBS+ive babies need cbc and blood culture 4hrs after birth; bilirubine and newborn screen with heel prick is done after 24hrs for Vaginal births and 48hrs for Cesarean sections
  5. Breastfeeding: skin-skin as much as possible; breask feed 12-3 hrs or when baby shows feeding cues

Heel Pricking- Newborn Blood tests

Newborn Jaundice

Breast Feeding- A great review of breastfeeding for nursing students and parents! It is good if you can during your clinical placement find the lactation consultant who works on the unit to have them go through tips on how to educate mothers on effective breast feeding. 

credit: nucleusanimation

Alternatives to Breast Feeding- Formulas should be used as only a last resort especially in the initial feeding stages.  Formulas are not the be all end all when it comes to breast feeding alternatives.  Something that stuck in my mind during my postpartum clinical is that formula is NOT EQUIVALENT to breast milk; and parents may have misconceptions that will require clarification.  For mothers who are skeptical about breast feeding for their individual reasons, give them alternatives like breast pumping shown in the following video.

Resources

http://www.parents.com/parentstv/

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