Nursing Care During and After Childbirth

The postpartum period, also known as the fourth stage of labor, begins after delivery of the fetus and placenta, and it extends through the first six weeks after birth. During this time, you’ll provide care for the newborn, the postpartum patient, and their family.

When caring for the newborn, you’ll focus on maintaining cardiopulmonary function, supporting thermoregulation, and accurately identifying the newborn.

Immediately after birth, you’ll assess cardiopulmonary function by calculating an Apgar score, which is a scoring system that assesses how the newborn is adapting to extrauterine life. The newborn's heart rate, respiratory effort, muscle tone, reflexes, and skin color are scored 0, 1, or 2 for a total of 10 possible points. You’ll calculate the Apgar score at one minute and five minutes and then every 5 minutes, as needed until the score reaches 7 or more. During this time, if the newborn shows signs of distress, such as bradycardia or a weak respiratory effort, immediate intervention should be provided.

Next, you’ll take steps to support thermoregulation. Remember that immediately after birth the newborn is covered in bodily fluids, putting them at risk for evaporative heat loss. If their temperature drops, the newborn will need to work hard to maintain their temperature, which will increase their need for oxygen and increases the risk of problems like hypoxemia and hypoglycemia. To prevent this, be sure to immediately dry them off with warm towels and provide warmth by either placing them on their parent’s chest to initiate skin-to-skin contact or by placing them on a radiant warmer. Once their temperature has stabilized, swaddle them in warm blankets, place a cap on their head, and continue to monitor their temperature.

Lastly, you’ll attach identification bands on the newborn that will match the parents’ identification bands. To ensure the newborn is always returned to their family after separation, these bands won’t be removed until they are discharged from the hospital.

The nursing care you’ll provide for the postpartum patient will include monitoring for complications and promoting comfort and safety.