Postpartum Monitoring and Care

Key Areas of Focus:

• Infections, Bleeding, and Thrombotic Issues: Always monitor for these, even in healthy moms.
• Hemorrhoid Management: Use ice, Tux pads, and witch hazel; avoid donuts.
• Perineum and Incisions: Check for redness, swelling, foul smells, excessive bleeding, or large clots.

Incisions and Lacerations:

• Types of Lacerations:
  • 1st Degree: Superficial, involves vaginal mucosa or perianal skin.
  • 2nd Degree: Includes vaginal mucosa, perianal skin, deeper tissues.
  • 3rd Degree: Extends into anal sphincter.
  • 4th Degree: Extends through anal sphincter into rectal mucosa.
• Healing Process: May take 4-6 months.
• Pain Management: Sitz baths, heat for healing, ice for swelling.

Postpartum Assessments:

• Vitals:
  • Normal slight temperature elevation (<100.4°F) for 24 hours.
  • Monitor pulse for blood loss, pain, dehydration.
  • Blood pressure returning to first trimester levels.
• Respiratory: Auscultate, especially in C-section patients.

Breast and Uterus Assessment:

• Breasts: Check for symmetry, redness, or cracks (indication of poor latch).
• Uterus: Assess fundus location, firmness, and bladder distention.
• Lochia Monitoring: Amount, color, odor, and pad usage.

Teaching and Emotional Support:

• Bonding and Attachment:
  • Initial bonding in first 30-60 minutes.
  • Stages include proximity, reciprocity, and commitment.
• Emotional Health: Watch for mood swings, postpartum depression signs.

Pain and Medication:

• Afterpains: More severe with multiple pregnancies.
• Analgesics: Tylenol, ibuprofen; use caution with stronger medications.

Infant Safety:

• Security Measures: Use ID bands, security alarms, and educate parents about safety protocols.

Breastfeeding Guidance:

• Engorgement Relief: Warm showers, cold compresses, cabbage leaves.
• Feeding Frequency: Encouraged to promote supply.

Mobility and Ambulation:

• Initial Movement: Monitor for orthostatic hypotension and dizziness.

Discharge Preparation:

• Criteria: No fever, normal vitals, ambulation ability, proper wound healing, educational understanding.
• Vaccinations: Rubella, RhoGAM (consent required).

Additional Considerations:

• Fluid Intake: Recommend 2500 ml/day.
• Weight Loss Expectation: Steady loss over 3-6 months.