POST PARTUM CARE determine any need for

anticipatory guidance in home

Care within the First 24 Hours care.
 Assess any laboratory data of the
Providing nursing care to a postpartum
woman to be certain that she is
woman during the first 24 hours entails the
recovering well and if any
following:
procedures or additional
diagnostic tests need to be
 Assess the woman’s family profile
performed.
to determine the impact that the
 Assess the woman’s general
newborn would give to the family
appearance because it is a
and to the woman.
reflection of how well the woman
 Assess the
is moving into the taking hold
woman’s pregnancy history,
phase of recovery.
especially if the pregnancy was
 Assure the woman that losing a
planned or unplanned as it will
quantity of her hair is not a sign of
determine the ability of the
illness but because she is
woman to bond with the newborn.
returning to her nonpregnant
 Assess the labor and birth history
state, as hair grows rapidly during
such as the length of labor and if
pregnancy because of increased
any analgesia or anesthesia was
metabolism.
used to determine any necessary
 Assess for facial edema, especially
procedures to be done.
for a woman with pregnancy-
 Determine the infant’s data and
induced hypertension.
profile to help with planning the
 Advise the woman to purchase a
care of the newborn and promote
nursing bra that is one to two sizes
bonding between the parents.
larger than her pregnancy size to
 The woman would also need a
allow for increase.
postpartum course such as her
 Assess the woman’s breast for any
activity level after birth, any
cracks or fissures, and avoid
difficulties or pain felt, and if she is
squeezing the nipple. Also, assess
successful with infant feeding to
for signs of mastitis such as
 inflammation of a certain part of greatly help mothers learn not
the breast. only what the instructors teach
 Assess the location, consistency, but also from the experiences that
and height of the fundus through some mothers could share to the
palpation. group.
 If the uterus is not firm upon  It is also recommended for fathers
palpation, massage it gently. to attend such classes so the
Placing the infant on the mother’s mother would have someone she
breast also aids in stimulating can rely on with the newborn care.
contractions.  Individual instruction is also
 Lochia is expected in a sought after postpartum, as the
postpartum woman for 2 to 6 family will need to know how to
weeks, so assessment of its care for the woman and the
characteristics is necessary to newborn after discharge.
determine if it is the normal lochia  Teaching should not always be
or not. formal; it may come in the form of
 Observe the perineum for comments during classes or
ecchymosis, hematoma. Edema or procedures.
any drainage and bleeding from  Instruct the woman to avoid lifting
the stitches. heavy objects for the first three
weeks after birth.
Care in Preparation for Discharge
 Advise the woman to allot a rest
period every day, or to rest
Before the woman is discharged, she must be
and sleep while her newborn is
educated properly regarding the care of the
also asleep so she can regain her
newborn and herself at home.
energy.
 Assess first the ability of the  Be certain that the woman is
mother to absorb new instructions aware that she must return to the
and to listen. healthcare facility after 4 to 6
 Conducting group classes weeks for examination and that
regarding newborn care could she must arrange an appointment
 for her baby to be examined by a how the family is doing now that
pediatrician at 2 to 4 weeks of age. they have a newborn in the house.
 Make sure that the woman and  High-risk newborns, newborns
the family understood the born to adolescent mothers, and
discharge instructions amidst all newborns with mothers who have
the frenzy of the new baby; review abused drugs during pregnancy
instructions with parents before need to have a specially planned
they leave. discharge and home visit.
 Calling or visiting 24 hours after  Pregnancy history is assessed
discharge is the best way to during the postpartum visit and if
evaluate whether the family has there are any difficulty with the
been able to grasp all instructions bonding between the mother and
and integrate the newborn into the baby, and allow the woman to
the family. relate her labor and birth
experiences.

Care after Discharge  Assess the newborn history and if

there are any concerns about the
Discharge from the healthcare facility usually newborn that the woman has
occurs after 2 to 3 days after birth. noticed.
 Assess the woman’s future plans,
 The woman can rest better at
whether she is going back to work
home and may eat better if she
outside home and if she had
has cultural preferences regarding
already arranged the care of her
food.
newborn while she is away.
 The newborn can also be exposed
 Conduct a family assessment and
earlier to the routines of the
ask if other members of the family
family, and make it easier for her
are adapting well with a newborn
to adjust to extrauterine
in the house.
environment.
 Examine both the mother and the
 A home visit after the discharge is
newborn physically to note any
usually recommended to check on
signs of postpartum
complications or defects.
  Remind the mother about the may be repeated up to every 4 hours.
health maintenance visit of the Peak concentrations are achieved at
newborn once she reaches 2 to 4 12 minutes following absorption and
weeks old, and her return checkup de-esterification to the active free
4 to 6 weeks after birth. acid, with a half-life of 21 minutes.
Vaginally, a 25-mcg insert can be
COMMON DRUGS IN
given every 3 to 6 hours up to a
THE DR
maximum of 50 mcg per dose.
Misoprostol is three times more
Drugs for Cervical Ripening
bioavailable when administered
 Dinoprostone is the only vaginally than the oral formulation.
prostaglandin currently available for  Oxytocin is still the preferred
cervical ripening in the form of both a pharmacologic agent for cervical
vaginal gel (Prepidil 0.5 mg) and a ripening or inducing labor once the
vaginal insert (Cervidil 10 mg). The cervix is favorable. It can also be used
gel needs be kept refrigerated and for labor induction after misoprostol
brought to room temperature before is administered for cervical ripening.
use and should only be administered
Pain Management Drugs
with the patient near a delivery suite.
Patients using the gel need to be kept
 Inhaled nitric oxide is a fairly effective
in the recumbent position for the first
and relatively safe option (for the
30 minutes and should be monitored
mother and fetus) for analgesia. It
for a further 30 to 120 minutes.
does not interfere with the release
Contractions typically appear within
and function of endogenous
60 minutes and peak within 4 hours.
oxytocin, and has no adverse effects
 Misoprostol (Cytotec) is a synthetic
on the normal physiology and
prostaglandin (PGE1) analogue that is
progress of labor. Patients may
a safe and inexpensive option for
experience nausea, vomiting, and
cervical ripening, albeit an unlicensed
dizziness. Since nitric oxide is rapidly
indication. It can be administered
excreted by the lungs of the newborn,
orally at a dose of 50 to 100 mcg that
it is relatively safe even though it
 crosses the placenta readily. Patients  Ropivacaine is a newer amide local
must be monitored for hypoxemia if anesthetic and a homologue of
nitric oxide is used together with bupivacaine. It is less cardiotoxic than
systemic opioids. bupivacaine but more so than
lidocaine. The cardiotoxicity of
Neuraxial analgesia provides superior pain
ropivacaine is not enhanced by
relief over systemic methods. Neuraxial labor
progesterone. It has favorable
analgesia often combines opioids as well as
sensory-motor differential block at
local anesthetics that work synergistically
low concentrations but demonstrates
and allow the use of lower doses of each
greater separation between sensory
agent, thereby minimizing side effects.
and motor blockade than
bupivacaine.
 Bupivacaine is the drug of choice for
spinal or dilute epidural solutions for
Adjuvants such as epinephrine, clonidine,
the initiation of anesthesia as well as
and neostigmine may be used to improve
maintenance of labor analgesia. It
analgesia and decrease complications
provides favorable sensory-motor
associated with a high dose of a single drug.
differential block at low
concentrations, resulting in analgesia  Epinephrine binds to the spinal cord
with motor sparing, thereby allowing alpha-adrenergic receptors,
ambulation. Bupivacaine has a long decreasing uptake of local
duration of action and does not anesthetics and opioids from the
produce tachyphylaxis. It is highly epidural space as a result of
protein bound and therefore does vasoconstriction.17 It quickens the
not cross the placenta readily. onset of analgesia and increases the
 Lidocaine has less differential block, a duration of action but cannot be used
shorter duration of action, and a for spinal analgesia.
higher association of transient
neurologic symptoms than
bupivacaine. It is usually reserved for
the rapid extension of an epidural.