Nursing Care for the Postpartum Woman

The postpartum period, also known as the puerperium, or the fourth trimester of pregnancy, occurs during the first six weeks after delivery. During this period, physiological adaptations occur to return the patient’s body to its pre-pregnancy state, including changes to the uterus, perineum, and cardiovascular system.

Following delivery, the uterus begins the process of involution, meaning it returns to pre-pregnancy size and position. As soon as the placenta is delivered, uterine muscle fibers constrict around blood vessels at the placental attachment site and intermittent uterine contractions occur to control bleeding and promote involution. The fundus, or top of the uterus, is located midway between the umbilicus and the symphysis pubis immediately after the delivery of the placenta.

Then, about 12 hours after delivery, it will rise to the level of the umbilicus. After that, the fundal height continues to descend by about one centimeter, or one fingerbreadth, per day, until it reaches the pelvic cavity by around day ten.

Along with uterine involution, the quantity and characteristics of the lochia, or vaginal discharge after delivery, is monitored. Lochia should decrease in amount and lighten in color over time.

When caring for your postpartum patient, monitor closely for signs of inadequate uterine involution, which can increase the risk of hemorrhage. Signs to watch for include a soft, or boggy uterus; a fundus that’s above the expected level or deviated away from midline; increasing amounts of lochia, return of a bright red color, or large clots. If the uterus is boggy, gently massage it until it’s firm; and if it’s not at midline, assist your patient to empty their bladder, since a full bladder can interfere with uterine involution. If you suspect postpartum hemorrhage, contact the registered nurse immediately.

Following a vaginal delivery, the perineum can be swollen and tender, and may have stitches present from repaired lacerations or an episiotomy, where an incision is made to enlarge the vaginal opening. In some cases, hematomas, bruising, or hemorrhoids can also be present.