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.

Start by monitoring your patient’s blood loss by frequently checking the amount of vaginal discharge, called lochia, and ensuring their fundus, or the uppermost part of the uterus, is firmly contracted, which will help compress the blood vessels where the placenta was attached.

If the fundus feels soft or boggy or if there’s heavy bleeding, massage the fundus until it becomes firm. Keep in mind that a full bladder can interfere with the ability of the uterus to contract, increasing the risk of hemorrhage; so be sure to closely monitor your patient’s urine output and monitor them for a distended bladder.

Lastly, monitor your patient’s vital signs closely to watch for indications of excessive bleeding, such as a rise in their baseline heart rate or decrease in blood pressure.

You’ll also promote your patient’s comfort by assessing and managing their pain. Administer the prescribed analgesics and if your patient had a vaginal delivery apply ice packs to their perineum to reduce swelling and pain.

Also, remember your postpartum patient is at risk for falling due to orthostatic hypotension from blood loss and the rapid decrease in intraabdominal pressure that occurs after birth.

If your patient had epidural anesthesia, it may take longer for motor function to return to their legs. So, to keep your patient safe, have your patient sit on the side of the bed for a few minutes before standing, and assist them with ambulation.

During the postpartum period, you’ll also provide family-centered care. Because the newborn is typically alert in the first hour after birth, this is a good time to promote family bonding and attachment.

Observe how the family interacts with the newborn and watch for positive attachment behaviors such as holding their newborn, making eye contact, talking to them, and involvement in their care.

Keep an eye out for behaviors that may signal impaired attachment such as emotional lability or disinterest in the newborn, and assess for risk factors for impaired parenting, such as a lack of social support or resources.

Alright, as a quick recap... 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.

Nursing care for the newborn includes maintaining cardiopulmonary function, supporting thermoregulation, and accurate identification; caring for the postpartum patient includes monitoring for complications, promoting comfort and safety; and care for the family, will focus on promoting bonding and attachment.

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