Postpartum Care (Puerperium Period) : Postnatal Assessment Tool |

Postpartum Care (Puerperium Period)

Introduction

The postpartum period (puerperium) is the 6-week period after childbirth, during which the mother’s body undergoes physical, hormonal, and emotional changes as it returns to a non-pregnant state. This period is crucial for maternal recovery, newborn bonding, and monitoring for complications.

Nurses play an essential role in providing immediate postpartum assessment, maternal psychological support, and managing postpartum complications to ensure optimal health and well-being for both mother and baby.

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1. Immediate Postpartum Assessment

Definition

Immediate postpartum assessment refers to the first 1-2 hours after delivery, where close monitoring of the mother's vital signs, uterine contraction, bleeding, and overall recovery is conducted.

Key Components of Postpartum Assessment (BUBBLE-HE)

🔹 B - Breasts: Assess for engorgement, nipple pain, and proper breastfeeding latch.
🔹 U - Uterus: Check for fundal height, tone, and firmness (should be firm and midline).
🔹 B - Bladder: Monitor for urinary retention and encourage early voiding.
🔹 B - Bowel: Check for bowel movement and constipation prevention.
🔹 L - Lochia: Assess postpartum bleeding (lochia rubra, serosa, alba).
🔹 E - Episiotomy/C-section Incision: Check for healing, swelling, or signs of infection.
🔹 H - Homan’s Sign: Assess for deep vein thrombosis (DVT) (pain or swelling in the legs).
🔹 E - Emotional Status: Monitor for mood changes, postpartum blues, or depression.

Nursing Interventions for Immediate Postpartum Care

✅ Monitor vital signs (BP, pulse, temperature) every 15 minutes for the first hour.
✅ Check uterine fundus for contraction and position (firm, midline, at or below umbilicus).
✅ Assess for postpartum hemorrhage (PPH) – excessive bleeding may indicate uterine atony.
✅ Encourage early breastfeeding – helps uterine contraction and bonding.
✅ Monitor urine output and assist in ambulation.
✅ Pain management – provide analgesics for perineal pain or post C-section discomfort.

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2. Maternal Recovery and Psychological Well-being

A. Physical Recovery

1. Uterine Involution: The uterus returns to its normal size in 6 weeks.
2. Lochia Discharge:
• Lochia Rubra (Days 1-4) – Bright red, moderate flow.
• Lochia Serosa (Days 4-10) – Pinkish-brown, lighter flow.
• Lochia Alba (Days 10-6 weeks) – White/yellowish, minimal discharge.
3. Perineal Healing: If episiotomy or tears occurred, healing takes about 2-3 weeks.
4. C-Section Recovery: Incision healing, pain control, and mobility encouragement.

B. Psychological Well-being

• Postpartum Blues (Mild mood swings, weepiness, anxiety – resolves in 2 weeks).
• Postpartum Depression (PPD) (Persistent sadness, withdrawal, anxiety).
• Postpartum Psychosis (Severe mood swings, hallucinations – emergency condition).

Nursing Interventions for Psychological Well-being

✅ Provide emotional support and reassurance.
✅ Encourage rest, hydration, and nutrition for mental and physical healing.
✅ Teach relaxation techniques and stress management.
✅ Screen for postpartum depression using Edinburgh Postnatal Depression Scale (EPDS).
✅ Encourage partner/family involvement in newborn care.

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3. Postpartum Complications and Nursing Interventions

A. Postpartum Hemorrhage (PPH)

🔹 Definition: Blood loss of >500 mL (vaginal birth) or >1000 mL (C-section) within 24 hours.
🔹 Causes: Uterine atony, retained placenta, trauma, coagulation disorders.
🔹 Signs: Excessive vaginal bleeding, hypotension, tachycardia, dizziness.

✅ Nursing Interventions:
✔️ Fundal massage to promote uterine contraction.
✔️ Administer oxytocin (Pitocin) to control bleeding.
✔️ Monitor vital signs and signs of shock.
✔️ IV fluids and blood transfusion if needed.

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B. Infection (Endometritis, Mastitis, UTI, Wound Infection)

🔹 Definition: Infection in the uterus, perineal area, breasts, or urinary tract.
🔹 Signs: Fever, foul-smelling lochia, pain, redness, swelling, malaise.

✅ Nursing Interventions:
✔️ Administer antibiotics as prescribed.
✔️ Monitor temperature and signs of infection.
✔️ Encourage hand hygiene and perineal care.

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C. Deep Vein Thrombosis (DVT)

🔹 Definition: Blood clot in the leg veins, common after delivery due to immobility.
🔹 Signs: Swollen, red, warm, painful calf.

✅ Nursing Interventions:
✔️ Encourage early ambulation to prevent clot formation.
✔️ Monitor leg swelling and pain.
✔️ Administer anticoagulants as prescribed.

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D. Postpartum Depression (PPD)

🔹 Definition: Severe depression lasting more than 2 weeks postpartum.
🔹 Signs: Persistent sadness, anxiety, disinterest in baby, mood swings.

✅ Nursing Interventions:
✔️ Encourage counseling & therapy for emotional support.
✔️ Monitor for thoughts of self-harm or harm to baby.
✔️ Encourage partner/family support and self-care activities.

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4. Nursing Care Plan for Postpartum Care

Nursing Diagnosis	Expected Outcomes	Nursing Interventions
Risk for postpartum hemorrhage	No excessive bleeding, stable vital signs	Monitor lochia, perform fundal massage, administer oxytocin if needed
Acute pain related to perineal trauma	Pain relief achieved, comfortable ambulation	Provide analgesics, teach perineal care, apply ice packs
Risk for infection	No fever or wound complications	Monitor temperature, educate on hygiene, administer antibiotics
Risk for impaired bonding	Mother demonstrates attachment to baby	Encourage skin-to-skin contact, breastfeeding support, educate on newborn care
Risk for postpartum depression	Improved emotional well-being	Screen for depression, provide emotional support, refer to mental health services if needed

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5. Health Education for Postpartum Mothers

✅ Self-Care: Rest, hydration, and proper nutrition.
✅ Breast Care: Proper latching techniques, managing engorgement.
✅ Hygiene: Daily perineal care, change sanitary pads frequently.
✅ Activity: Gradual return to normal activities, avoid heavy lifting.
✅ Warning Signs: Seek medical help for fever, heavy bleeding, severe pain.
✅ Emotional Health: Talk about feelings, seek support if feeling overwhelmed.

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Postpartum care is essential for maternal recovery, physical healing, and emotional well-being. Nurses play a vital role in assessing postpartum changes, preventing complications, and providing emotional and educational support. Proper care and early detection of complications can ensure a smooth transition into motherhood and improve maternal health outcomes. 💖👶🏼 

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Basic Information

Days since delivery:

Type of delivery: Select... Vaginal delivery Cesarean section Assisted vaginal delivery

Physical Symptoms

Bleeding (lochia): Select... None/Minimal Light (less than period) Moderate (like period) Heavy (more than period) Excessive (soaking pad in 1 hour)

Bleeding color: Bright red Pink Brown Yellow/white

Bleeding odor: Normal/no odor Foul/unpleasant odor

Abdominal pain: None Mild (occasional) Moderate (interferes with activities) Severe (constant, intense)

Perineal pain (if vaginal delivery): None Mild Moderate Severe

Other Symptoms

Fever: No fever Low-grade (37.2°C - 38°C / 99°F - 100.4°F) High (above 38°C / 100.4°F)

Breast discomfort: None Mild fullness Moderate pain/engorgement Severe pain with redness/fever

Urination issues: Normal Painful/burning Frequent/urgent Leakage

Bowel movements: Normal Constipated Diarrhea Painful

Emotional Well-being

Mood: Generally good Easily upset Anxious/worried Sad/depressed

Sleep: Getting adequate sleep Frequently interrupted Difficulty sleeping

Appetite: Normal Reduced Increased Variable

Your Postnatal Assessment

Remember: This tool is not a substitute for professional medical advice. Always consult with your healthcare provider about any concerns.