Postpartum Nursing Care

prenatal vitamins

Discharge Teaching for Home § Nutrition · Consume 1800-2200 kcal/day · Instruct lactating clints to add additional 450-500 kcal/day to pre-pregnancy diet and increase calcium · Iron supplements are good for low H/H · Continue taking _________________ until 6 weeks after birth

A. Heavy bleeding

The nurse is discharging a postpartum client to home. Which danger signs are the most important in the first week at home? Select all that apply A. Heavy bleeding B. Breast fullness C. Temperature over 99 F (no, because it should be 100.4) D. Perineal soreness E. Crying easily

A. Massage uterus B. Catheterize bladder C. Notify charge nurse

A nurse is assisting a client in the bathroom who delivered a 9 pound baby one hour ago vaginally. Which statement is the nurse most concerned about? A. "I can't go - I feel like I have to urinate, but I can't." B. "Is it normal to have clots come out?" C. "I am having some really bad cramps." **D. "I feel a little dizzy." After getting help to assist the client back to bed, what is the nurse's next action? A. Obtain VS **B. Assess fundus C. Insert catheter D. Administer ibuprofen The nurse notes pulse of 110, BP 90/60, fundus boggy, right of midline at 2 fb over umbilicus, steady red vaginal bleeding with 1 cm clots. Which actions should the nurse complete? SATA A. Massage uterus B. Catheterize bladder C. Notify charge nurse D. Ambulate client E. Offer clear liquids (no, she might need to go to OR. It would be right if it was IV)

B. Assess fundus

A nurse is assisting a client in the bathroom who delivered a 9 pound baby one hour ago vaginally. Which statement is the nurse most concerned about? A. "I can't go - I feel like I have to urinate, but I can't." B. "Is it normal to have clots come out?" C. "I am having some really bad cramps." **D. "I feel a little dizzy." After getting help to assist the client back to bed, what is the nurse's next action? A. Obtain VS B. Assess fundus C. Insert catheter D. Administer ibuprofen

D. "I feel a little dizzy."

A nurse is assisting a client in the bathroom who delivered a 9 pound baby one hour ago vaginally. Which statement is the nurse most concerned about? A. "I can't go - I feel like I have to urinate, but I can't." B. "Is it normal to have clots come out?" C. "I am having some really bad cramps." D. "I feel a little dizzy."

A. Apply cold compresses between feedings

A nurse is conducting a home visit for a client who is 1 week postpartum and breastfeeding. The client reports breast engorgement. Which of the following recommendations should the nurse make? A. Apply cold compresses between feedings B. Take a warm shower right after feedings. C. Apply breast milk to the nipples and allow them to air dry D. Use the various infant positions for feedings

C. "Pertussis, or whooping cough, is a severe infection for a newborn, and newborns can't be vaccinated. This vaccine will keep you from giving pertussis to your baby."

A nurse is discussing giving a Tdap vaccination to a day two postpartum client prior to discharge. Which explanation for administration is correct? A. "Since your rubella immunity is low, you should have this vaccination to protect the fetus from measles if you have another baby." B. "Your doctor wants to be sure you are up to date on all immunizations before you go home." C. "Pertussis, or whooping cough, is a severe infection for a newborn, and newborns can't be vaccinated. This vaccine will keep you from giving pertussis to your baby." D. "Since your immune system is weakened now, we don't want you to end up with an infection like tetanus or diphtheria."

B. A client who does not wash her hands between perineal care and breastfeeding

A nurse is providing care to four clients on the postpartum unit. Which of the following clients is at greatest risk for developing a postpartum infection? A. A client who had an episiotomy that is erythematous and has extended into a third-degree laceration. B. A client who does not wash her hands between perineal care and breastfeeding C. A client who is not breastfeeding and is using measures to suppress lactation D. A client who has a cesarean incision that is well-approximated with no drainage.

C. Sore nipple with cracks and fissures

A nurse is providing discharge instructions for a client. At 4 weeks postpartum, the client should contact her provider for which of the following client findings? A. Scant, nonporous white vaginal discharge B. Uterine cramping during breastfeeding C. Sore nipple with cracks and fissures D. Decreased responses with sexual activity

C. Kegel exercises

A nurse is providing discharge instructions to a postpartum client following a c-section. The client reports leaking urine every time she sneezes or coughs. Which of the following interventions should the nurse suggest? A. Sit-ups B. Pelvic tilt exercises C. Kegel exercises D. Abdominal crunches

A. Wear a supportive bra continuously for the first 72 hours

A nurse is providing discharge teaching for a non lactating client. Which of the following instructions should the nurse include in the teaching? A. Wear a supportive bra continuously for the first 72 hours B. Pump your breasts every 4 hours to relieve discomfort C. Use breast shells throughout the day to decrease milk supply D. Apply warm compresses until milk suppression occurs

§ CBC: Postpartum H&H (compare to admission) to assess for blood loss (especially with C-section) § Urinalysis to assess for UTI § Review Rh, blood type § Review Rubella immunity, and other viral diseases

Assessing the Postpartum Family · Couplet or mother-baby care is done together · Ongoing physical assessment: BUBBLE-HE · Check routine lab tests: 1. 2. 3. 4. · Nursing Interventions: Periodic assessments to detect changes, relieving discomfort/pain, safety measures to prevent injury and infection, education to promote self-management and infant care

2-3 days

BUBBLE-HE: Breasts, Uterus, Bowel (GI), Bladder, Lochia, Episiotomy, Vitals and teaching · Vital Signs (BP, temp, HR, RR, O2 sat) § BP: consistent with baseline, slight increase first few days, can be orthostatic for 48hr · ABNORMAL: hypertension (anxiety, preeclampsia); hypotension (bleeding) § Temperature: 97.2-100 · ABNORMAL: greater than 100.4 = infection § Pulse: 50-90 bmp · ABNORMAL: tachycardia (pain, fever, dehydration, bleeding) § RR: 16-20 · ABNORMAL: bradypnea (opioids), tachypnea (anxiety, URI) · Pain - level, where, when, etc. · Auscultate heart, lungs § Breath Sounds: clear to auscultation · ABNORMAL: crackles (fluid overload) · Breasts § Day 1-2 soft § Day 2-3 filling § Day 3-5 full or empty after breastfeeding § ABNORMAL: firmness, heat, pain (engorgement) · Nipples: skin intact with no soreness § ABNORMAL: redness, bruising, cracks, fissures, abrasions, blisters (latching problems) · Uterus § Firm, midline, non-tender § for the first 24 hours at the umbilicus and involutes ~ 1cm/day § ABNORMAL: soft, boggy, higher than normal, uterine atony · Bladder: able to void spontaneously, no distention, able to empty, no dysuria § ABNORMAL: overdistended (causes uterine atony), excessive lochia, dysuria, frequency, urgency burning, infection · Bowels/Rectum: ABD soft, active bowel sounds, BM in _____________ PP, clean incisions § ABNORMAL Rectum: discolored hemorrhoids, severe pain, thrombosed hemorrhoids § ABNORMAL ABD and bowels: no bowel movement by day 3-4, constipation, diarrhea, ABD incision is red/swollen/warm/draining · Lochia - scant-moderate amount, normal color, fleshy odor, few clots (less than 1cm): day 1-3 rubra, day 4-10 serosa, after 10 days alba § ABNORMAL: large amount of lochia, large clots, (uterine atony, lacerations), foul odor (infection) · Trauma: Perineum/incision, pain is minimal-moderate and controlled with meds § Laceration/ episiotomy with edges approximated § REEDA § Rectal area: ideally no hemorrhoids § ABNORMAL perineum: pronounced edema, bruising, hematoma, redness, warmth, drainage, excess pain, separated wounds · Hemorrhoids · Legs/extremities § DTR's 1+ or 2+ § Negative Homan's § Edema possible present § ABNORMAL: DTRs greater than 3 (preeclampsia), redness, tenderness, pain, thrombophlebitis · Energy Level: able to care for self and baby, and able to sleep § ABNORMAL: lethargy, extreme fatigue, difficulty sleeping, postpartum depression · Emotional status: excited, happy, interested in baby § ABNORMAL: sad, tearful, not interested in baby, anxiety about baby/parenting, postpartum blues/depression (usually PPD doesn't start for 2 weeks after birth, so we usually check for risk factors)

Side-lying position

Care Management: Physical Needs -Promote rest § Postpartum fatigue and lack of sleep are common complaints for new parents. § Sometimes you might have to kick family out so mom can take a nap § Help mothers with findings child support so that she can rest § _____________ while breastfeeding minimizes fatigue -Assess for fatigue after discharge during 2-week and 6-week checkups

Wipe front to back, use squeeze bottles, change pads frequently, wash hands before and after peri-care

Care Management: Physical Needs Prevent infections (where? Any wound that she has, C-sections, lacerations, UTI, URI) § Change bed linens, wear slippers when out of bed to prevent contamination on return to bed, hand hygiene, standard precautions, no ill people in contact with mom/baby -Perineal lacerations/episiotomies can increase risk for infection, so perineal care is important. ______________________

· Alternate flexion and extension of the feet · Rotate ankles in circular motion · Alternate flexion and extension of the legs · Press the back of knees to the bed surface; relax

Care Management: Physical Needs o Promoting ambulation and Exercise § Early ambulation is associated with reduction of venous thromboembolism and promotes return of strength, GI motility, reduce pain § Monitor for orthostatic BP after delivery, assess BP, blood loss, and timing of analgesics § With epidural: monitor wearing off by checking the mon's ability to bend both knees, place feet flat on bed, and lift buttocks off bed without assistance § ALWAYS help mom the first time she gets out of bed. Give her the call light § Prevent venous thromboembolism: - - - - § When exercises, mom should start with simple exercises and gradually progress. ABD exercises are postponed until 4-6 weeks after C-section Teach exercises for recovery

NSAIDS (ibuprofen, naproxen)

Care Management: Physical Needs · Pain/comfort management (moms have pain from UC, lacerations, hemorrhoids) · ** if the postpartum woman complains of extreme perineal pain, especially after having pain meds, assess the perineum. There could be a hematoma or infection (or worse, cellulitis, necrotizing fasciitis, or angioedema) § Pharmacological · ____________________, provide better relief for uterine cramping and perineal pain than acetaminophen. Ibuprofen is preferred for breastfeeding moms because it is less spread through breast milk · Topical anesthetic ointments for perineal pain · PCA/opioids or epidural for C-section Remember to always carefully monitor moms who get opioids because of respiratory depression and decreased intestinal motility

Ice Packs

Care Management: Physical Needs · Pain/comfort management (moms have pain from UC, lacerations, hemorrhoids) · ** if the postpartum woman complains of extreme perineal pain, especially after having pain meds, assess the perineum. There could be a hematoma or infection (or worse, cellulitis, necrotizing fasciitis, or angioedema) · Non-pharmacological § ICE PACKS § Distraction, imagery, therapeutic touch, relaxation, acupressure, aromatherapy, hydrotherapy, massage therapy, music therapy, TENS § For contraction pains, she can try warm heated pad or lying prone § For sore nipples, apply topical preparations like lanolin or hydrogel pads § For engorged breasts, use cabbage leaves, ice packs, wear a supportive bra § Interventions for Episiotomy, Lacerations, and Hemorrhoids: · Cleansing: wash hands before changing pads, wash perineum with mild soap and warm water daily, clean from symphysis pubis to anal area, apply peri-pad from front to back, wrap soiled pads and discard, change pads at least 4x/day, assess lochia · ________________________: apply ice pack to perineum from front to back to decrease edema/give comfort during first 24 hours of birth and provide anesthetic effect after 24 hours of birth. · Squeeze Bottle: fill bottle with 100F water and instruct mom to position nozzle between her legs so squirts of water reach the perineum as she sits on a toilet. Blot dry with toilet paper and avoid contamination of perineum. · Sitz Baths: use twice daily for 20 minutes · Topical applications: anesthetics creams, witch hazel pads, hemorrhoidal cream

D. "I pretend that I am trying to stop the flow of urine midstream."

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: A. "I contract my thighs, buttocks, and abdomen." B. "I do 10 of these exercises every day." (no, it would be 10 reps, multiple sessions/day) C. "I stand while practicing this new exercise routine." D. "I pretend that I am trying to stop the flow of urine midstream."

ovulation can occur as soon as 1 month after birth (particularly in non-breastfeeding women) · Non lactating women: menses at 4-10 weeks · Lactating women: menses at 6 months or more

Discharge Teaching for Home -Sexual activity/contraception § Clients can safety resume sexual intercourse by the 2nd-4th week after birth, when bleeding has stopped and perineum has healed. OTC lubrications may be needed, and most parents typically resume sexual intercourse 6 weeks after delivery § Physiologic reactions to sexual activity can be slower and less intense for the first 3 months following birth § Use lubrication due to decrease in vaginal lubrication § Pain free § Initiate contraceptive method before resuming sex because ____________________ - - If breastfeeding, do not take oral contraceptives until milk production is well established (usually 6 weeks).

2nd-4th week after birth, when bleeding has stopped and perineum has healed

Discharge Teaching for Home o Sexual activity/contraception § Clients can safety resume sexual intercourse by the ______________________. OTC lubrications may be needed, and most parents typically resume sexual intercourse 6 weeks after delivery § Physiologic reactions to sexual activity can be slower and less intense for the first 3 months following birth § Use lubrication due to decrease in vaginal lubrication § Pain free § Initiate contraceptive method before resuming sex because ovulation can occur as soon as 1 month after birth (particularly in non-breastfeeding women) · Non lactating women: menses at 4-10 weeks · Lactating women: menses at 6 months or more If breastfeeding, do not take oral contraceptives until milk production is well established (usually 6 weeks).

no ABD exercises for 4-6weeks and wait until 4-6 week follow-up before performing strenuous exercise, heavy lifting, or excessive stair climbing. No more than one flight of stairs once a day. No more than 10lb for first 2 weeks

Discharge Teaching for Home § Activity: · Discuss what might eb strenuous and encourage the client to be willing to accept help from others · Teach the client how to perform pelvic tilt to strengthen back muscles and relive strain on the lower back. These involve alternately arching and straightening the back · Regain pelvic floor muscles by performing Kegel exercises (same muscles as starting and stopping flow of urine) · Begin simple exercises soon after birth and progress to more strenuous activities · For C-section, ____________________________________ · Following vaginal birth, limit stair climbing for the first few weeks postpartum · Plan at least one daily rest period, usually when infant naps

8-12 times in 24hr period. Allow the infant to feed until the breast softens. Offer the second breast to the infant before completing feeding and start each feeding with a different breast

Discharge Teaching for Home § Breast Care for CLIENTS WHO WILL BREASTFEED: · Hand hygiene before breastfeeding to prevent infection · Wear a well-fitting, non-binding bra. Do not use an underwire bra, which can cause clogged milk ducts · Allow the infant to nurse on demand, which would be about ____________________________________________ · To relive engorgement, take a warm shower or apply warm compresses before breastfeeding to promote let-down and milk flow. Empty each breast completely at feedings, using a pump if needed after the infant has finished feeding. Apply cool compresses after feedings · Apply breast creams as prescribed and wear breast shells in the bra to soften the nipples if they are irritated and cracked · For flat/inverted nipples, use a breast shell between feedings · For sore nipples, apply a small amount of breast milk to the nipple and allow it to air dry after breastfeeding · Drink adequate fluids to satisfy thirst

apply cold compresses 15 min on and 45 min off. Fresh, cold cabbage leaves an be placed inside the bra. Mild analgesics can be taken

Discharge Teaching for Home § Breast Care for CLIENTS WHO WILL NOT BREASTFEED: · Suppress lactation · Wear a well-fitting, supportive bra continuously for the first 72 hours · Avoid breast stimulation and running warm water over the breasts for prolonged periods until no longer lactating · For breast engorgement (3rd-5th day) _____________________________________

· Clean perineum from front to back with warm water after each voiding and bowel movement · Blot perineal area from front to back · Remove and apply perineal pads from front to back

Discharge Teaching for Home § Perineal Care: - - -

48 hours after discharge

Discharge Teaching for Home · Prescribed medications § Pain medications: opioids (overuse, constipation) § Prenatal vitamins, iron · Routine postpartum mother & baby checkups § Postpartum checkup 6 weeks for vaginal delivery · 2 week check up after cesarean birth § Well baby check within ________________ · Activities of daily living at home § C-section restrictions: possible driving, going up and down stairs, tub baths

6 weeks for vaginal delivery

Discharge Teaching for Home · Prescribed medications § Pain medications: opioids (overuse, constipation) § Prenatal vitamins, iron · Routine postpartum mother & baby checkups § Postpartum checkup _____________________ · 2 week check up after cesarean birth § Well baby check within 48 hours after discharge · Activities of daily living at home § C-section restrictions: possible driving, going up and down stairs, tub baths

Danger Signs to Report

Discharge Teaching for Home · Self-care and danger signs § _________________________: · Fever, chills · Change in vaginal discharge: increased amount, large clots, change in lochia color (like red and foul smelling) · Foul vaginal odor · Abdominal or pelvic pain that doesn't stop with analgesics · Heavy bleeding, increases in bleeding, more than 1 pad in an hour · Postpartum depression · Episiotomy, laceration, or incisional pain that doesn't stop with analgesics, has foul smelling drainage, redness, or edema · Calves with localized pain, tenderness, redness, and swelling. · Urination with burning, pain, frequency · Breasts with localized tenderness and pain with firmness, heat, swelling; OR nipples with cracks, redness, bruising, blisters, or fissures

HYPOVOLEMIC SHOCK

Emergency: · WARNING SIGNS OF ___________________: § Persistent, significant bleeding · Pad saturated in 15 minutes · No VS changes YET (because a blood volume loss of 30-40% is needed to change mom's BP) § Feels weak, light-headed, "funny", nauseated, or seeing "stars" § Appears anxious, air hunger § Skin color: cool clammy § Pulse rate (earliest): increases § Blood pressure (late): decreases

§ ASSESS UTERUS! IF ATONIC, MASSAGE and don't stop until its firm! § CALL FOR HELP! § Notify provider § Administer uterotonic medications: oxytocin IV as prescribed § Insert indwelling catheter (why? To monitor output for kidney perfusion) § Monitor VS § IV fluid bolus of LR or NS (consider second line at least 18-16 g for rehydration and blood products. Its best to get it started early because blood loss shrinks the veins) § Administer oxygen via non-rebreather at 10L/min § Administer blood products as ordered § Tilt mother on her side and elevate legs to promote venous return § Administer emergency drugs as ordered § Prepare for possible surgeries or treatments § Document the incident

Emergency: Hypovolemic Shock · WARNING SIGNS OF HYPOVOLEMIC SHOCK: § Persistent, significant bleeding · Pad saturated in 15 minutes · No VS changes YET (because a blood volume loss of 30-40% is needed to change mom's BP) § Feels weak, light-headed, "funny", nauseated, or seeing "stars" § Appears anxious, air hunger § Skin color: cool clammy § Pulse rate (earliest): increases § Blood pressure (late): decreases · INTERVENTIONS: - - - - - -

§ Must be stable physically & emotionally § Must show ability to care for self and newborn § Depends on finances, insurance coverage, laws § Also depends on support at home

Going Home · Planning starts on admission - plans for infant & self care, previous experiences with childcare · Discharge generally, 24-48 hours after uncomplicated vaginal birth, 72-96 hours for uncomplicated cesarean birth: - - - - · You must teach mom s/s to report and indications of complications · Mom needs education on nutrition, exercise, family planning, sexual intercourse, medications, and follow-up · No medication that causes drowsiness should be administered to the mother before discharge if she is the one who will be holding the baby when they leave the hospital. In most instances, the mom is seated in a wheelchair and given the baby to hold. The newborn must be secured in a care seat for the drive home

1. completely recovered from anesthesia (need to be able to move their legs after spinals or epidurals) 2. hemodynamically and obstetrically stable, that is no excessive bleeding

Immediate Recovery, Care, Then Transfer · After the initial recovery period has been completed and provided that her condition is stable, the mother may be transferred to a postpartum room in the same or another nursing unit. In facilities with labor, delivery, recovery, and postpartum (LDRP) rooms, the woman is not moved and the nurse who provides care during recovery usually continues caring for the mom. · No woman should be discharged from recovery until: 1. 2. · When they're transferred out of recovery area, you give the Handoff REPORT on pregnancy, birth, and recovery with transfer out of recovery status to the postpartum nurse. · Planning for discharge § From the initial contact with the postpartum mother, the nurse prepares the new mother for return home. § Length of hospital stay depends on condition of mom and baby, mental/emotional status of mom, social support at home, patient education needs for self-care and infant-care, and financial restraints. § Mom's with low risk for complications may be discharged within 24-36 hours after birth (early postpartum discharge) § Newborn's and Mother's Health Protection Act of 1996 requires all health plans to allow the mom and baby to remain in the hospital for a minimum of 48 hours after uncomplicated vaginal birth and for 96 hours after C-section, unless the mom and doctor decide on early discharge. · Criteria for Discharge § Hospital stay should be long enough to identify early problems and determine that mom and family are prepared and able to care for the neonate at home § Health of mom and baby should be stable, and mom should be able/confident to provide care for baby § There should be adequate support systems in place and access to follow-up care § Most facilities use the couplet or mother/baby model of care. This involves the mom and baby rooming-in and the mom and nurse sharing infant's care.

Newborns and Mothers' Health Protection Act of 1996

Legal Aspects After Discharge · "_________________________________": Allows for a minimum of 48 hours stay after a vaginal birth and 96 hours after cesarean birth (not required to stay) · Before discharge of mother and newborn together: § Hospital stay for a mother should be enough time to identify complications § American Academy of Pediatrics recommendations: Must have screening for newborn complications completed as well (example: hyperbilirubinemia)

FUNDAL MASSAGE(maintains uterine tone) until the fundus is firm. This can cause a temporary increase in bleeding as pooled blood leaves the uterus. This can be uncomfortable for mom, so explain why it is needed to mom.

Nursing Care Priority: BLEEDING · 1. GOAL: Prevent excessive bleeding because all women who give birth are at risk for excessive bleeding that can progress to postpartum hemorrhage · 2 .Common cause of bleeding: UTERINE ATONY (the relaxed uterus distends with blood and clots, blood vessels are not clamped off, and excessive bleeding results) § Vaginal or vulvar hematomas, lacerations · 3. PRIORITY INTERVENTION FOR UTERINE ATONY: _______________________________________ · Assess vaginal bleeding with pad count. A perineal pad saturated in 15 minutes or less and pooling of blood under buttocks indicates excessive blood loss. 1G of weight in pad = 1mL of blood (remember, BP is not always reliable for blood loss cause of compensatory mechanisms that prevent drop in BP) · If bladder distention is present, empty bladder ASAP because a full bladder displaces the uterus and prevents uterine contractions that stop bleeding § Women can be at risk for bladder distention because of anesthesia, episiotomy, extensive lacerations, instrument assisted birth, or prolonged labor · Give medications to contract uterus (oxytocin) and IV fluids · Incision care - perineal trauma or cesarean incision § Assess incision, dressing for bleeding

recommended for everyone who will be around an infant. Babies cannot get this vaccine until 6 months, so it helps prevent the mom from giving the infection to her baby.

Planning For Future Health or Future Pregnancies · Rubella vaccination: This is for German measles, which can cause severe birth defects. If woman is not immune, titer 1:8 or less, vaccination is recommended · Varicella vaccination: this is for chickenpox/shingles one dose before D/C with second at PP visit · Tetanus-diphtheria-acellular pertussis (TDaP): ______________________________________ · Rh isoimmunization: RhD immune globulin should be given within 72 hours for Rh-negative women who deliver a Rh-positive infant

This is for German measles, which can cause severe birth defects. If woman is not immune, titer 1:8 or less, vaccination is recommended

Planning For Future Health or Future Pregnancies · Rubella vaccination: ______________________________ · Varicella vaccination: this is for chickenpox/shingles one dose before D/C with second at PP visit · Tetanus-diphtheria-acellular pertussis (TDaP): recommended for everyone who will be around an infant. Babies cannot get this vaccine until 6 months, so it helps prevent the mom from giving the infection to her baby. · Rh isoimmunization: RhD immune globulin should be given within 72 hours for Rh-negative women who deliver a Rh-positive infant

at least 72 hours after giving birth

Postpartum Recovery -Lactation Suppression: this is needed when a mom is not going to breastfeed or in the case of neonatal death § Snug fitting bra for ________________ § Avoid nipple and breast stimulation (don't run warm water over the breasts, newborn suckling, or express breastmilk) § Engorgement often occurs about 72-96 hours after birth and can be managed with non-pharm interventions (ice packs, cabbage leaves Lactation suppression medications no longer used. Use Cabbage leaves.

within the first 1-2 hours after birth. Place newborns in skin-skin contact with moms as soon as possible and have them remain there for at least 1hr -During the first hour, most infants are alert and ready to nurse

Postpartum Recovery -Promoting Breastfeeding § The ideal time to initiate breastfeeding is _______________________

150mL

Postpartum Recovery o Promoting Bladder Function § Should void within 6-8 hours after delivery (but its still best/normal to void in 1-2hr) § A volume of ____________ is expected with each voiding -Urinary incontinence: Kegel exercises

promote ambulation, rocking in a chair, avoiding gassy foods (legumes, beans, broccoli)

Postpartum Recovery o Promoting Bowel Function § Ambulation, increasing intake of fiber and fluids, teaching mom side effects of opioids § Stool softeners or laxatives may be needed § Rectal suppositories and enemas should not be administered to women with 3rd-4th degree perineal lacerations. They can cause bleeding or damage to the suture site and predispose the mom to infection. -For gas pains, ____________________

1800-2200 calories in non-lactating women, 2700 calories in lactating women

Postpartum Recovery · Promoting Nutrition § __________________________________ § Dietary intake for lactating women: 200-300mg of omega 3 polyunsaturated fatty acids so that there is adequate DHA in breast milk § Prenatal vitamins up to 6 weeks after birth § Iron supplements for low h/h

Reflect On The Birth Experience

Psychological Needs · To ___________________ (was it what they expected? How do they feel about it? Was there things they don't understand? Is there anything they want to talk about?) · To Create Self Image As A Parent: encourage this by treating them as a parent. Ask them before you do things with the baby. · To Become A Parent, Interact With Newborn: keep the newborn in the room as much as possible. If they aren't comfortable, keep positively reinforcing good behaviors. · To Change Family Roles And Structure: encourage moms to bring in siblings, and support them through dealing with role changes · Focus Differs In Various Cultures: § Example: Asian Cultures § Rest § Hot Vs Cold Environment, foods, water, baths · Signs of Potential Complications and Postpartum Psychosocial Concerns: § Unable or unwilling to discuss labor and birth experience § Refers to self as ugly and useless § Markedly depressed § Lacks support system § Partner or other family members react negatively to the baby § Refuses to interact with or care for baby, not naming baby, not holding or feeding baby, is upset by baby vomit or soiled diapers § Expresses disappointment over baby's sex § Sees baby as messy or unattractive § Baby reminds them of person she doesn't life § Difficulty sleeping § Loss of appetite