Postpartum and newborn care

• Postpartum period

  • critical transitional time for women, newborn, and family
  • physiological and psychological adjustments
  • Begins after delivery of placenta and lasts approximately 6 - 8 weeks
• Breast

  • Can be swollen or engorged
  • assess nipple tissue and when breastfeeding for signs of trauma
  • Education on self-massage and hand expression
  • Heat - encourage milk supply and relieve discomfort
  • Cold - decrease swelling, help decrease milk supply
• Reproductive system -Uterus-

  • after birth, descends from level of umbilicus at a rate of 1 cm/day
  • fundus should be assessed for firmness, position in relation to umbilicus
• Lochia

  • vaginal discharge that occurs after birth
  • assessed for colour (rubra-serosa-alba), amount (# pads), odor and presence/absence of clots
• Perineum

  • Assessed for redness, edema or swelling, ecchymosis or bruising, discharge and approximation
  • Assessed regardless of a tear, laceration, or episiotomy has been recorded
• Cardiovascular

  • Dramatic changes after birth
  • Blood volume drops rapidly
  • Bradycardia (50-70 bpm) no longer perfusing to placenta
  • Stable blood pressure values
  • Risk for thromboembolism related to hypercoagulability combines with vessel damage during birth and immobility
• Urinary system

  • Ensure patients can void following delivery
  • Difficulty in voiding can cause urinary retention, bladder distension, UTI
  • pericare should be performed post void
  • Catheterization may be required
• Gastrointestinal

  • GI returns to normal quickly post delivery
  • decreased bowel tone, peristalsis, and sluggish bowels
  • need to replenish food and fluids following delivery
  • May experience hemorrhoids
• Musculoskeletal system

  • Fatigue and activity intolerance
  • Greater risk for DVT
  • Note any asymmetry, discomfort or pain in lower legs, Homan's sign
• Integumentary system

  • Linea Nigra (dark line down middle of abdomen)
  • Striae gravidarum (stretch marks)
  • profuse diaphoresis
  • healing tears -> episiotomy
• Respiratory System

  • Respirations remain within normal adult range
  • Respiratory effort eased following delivery
  • Risk of pulmonary embolus
• Emotional

  • Postpartum patients experience multitude of emotions
  • Hormone changes, sleep deprivation, and changing roles
  • Educate family about signs of postpartum blues and depression
• Advantages of breastfeeding

  • Provides immunologic protection
  • Infants digest and absorb components easier
  • Provide more vitamins to infant (mother's diet is adequate)
  • strengthens mother-infant attachment
  • No additional cost or extra preparation
• Disadvantages with breastfeeding

  • May not be reccomended due to medical conditions or lifestyle choices (medications)
  • partner is unable to equally participate in the feeding of infant
  • Mother may have hard time taking time away from the infant
• Breastfeeding Principles

  LATCH: latch, audible swallowing, type of nipple, hold & positioning

  Frequency: q 2 - 3 hours, once established q 3 - 4 hours

  May also use breast pump and offer expressed breast milk to baby

  may experience challenges at the beginning
• What type of breastfeeding position is this?

  Cradle position

  
• What type of breastfeeding position is this?

  Cross-cradle position

  
• What type of breastfeeding position is this?

  Football position

  
• What type of breastfeeding position is this?

  Side laying position

  
• Advantages of formula feeding

  • Provides good nutrition to infant
  • Father can participate in infant feeding patterns
• Disadvantages of formula feeding

  • May need to try different formulas before finding one that is well-tolerated by infant
  • Proper preparation
  • Expensive
• Infant Body temperature regulation

  • Significant decrease in environmental temperature after birth
  • Excessive cooling may lead to profound depression of cold stress
  • Axillary (preferred) 36.5 - 37.5 *C
• APGAR: Normal 7 - 10, Moderate 4 - 6, severe 0 - 3

  Performed at 1 minute, 5 minutes, and if abnormal values again at 10 minutes

  
• Early Newborn Period

  • Infant’s cardiovascular and respiratory system change rapidly
  • Infant is dried and stimulated to breathe
  • Infant usually alert for first hour after birth
  • Apgar score and vital signs used to assess infant’stransition
• Early Newborn: digestion and absorption and elimination

  • By birth, newborn has experienced swallowing, gastric emptying, and propulsion
  • Meconium is developed in utero
  • If amniotic fluid is not clear, meconium passed in utero
• Early Newborn: Voiding

  • 93% void by 24 hours after birth and 100% void by 48 hours after birth
  • If newborn does not void within 48 hours, nurse should assess adequacy of fluid intake, bladder distention, restlessness, and symptoms of pain
  • *Important to document voids**
• Early Newborn: Liver

  • Have immature livers
  • May have difficulty conjugating bilirubin
  • The liver plays a role in iron storage, carbohydrate metabolism (enzymes) and coagulation
  • Assessments: Jaundice test (within 24 hours and 12 hours within discharge), yellowing of skin & eyes, sleepy lethargic, decreased feedings
• Early Newborn: Immune System

  • Immune system isn’t fully activated until after birth
  • Fever not reliable indicator of infection – in newborn period, hypothermia is more reliable indicator of infections
  • Prevention: handwashing, breastfeeding, no kissing baby on face (herpes)
• Newborn Vitals

  HR: 100 (110) - 160 bpm -fluctuates with deep sleep and crying

  RR: 30 - 60 respirations/min

  Temp: 36.5 - 37.5
• Normal Newborn Measurements

  Weight: 2500 - 4000 grams (depends on maternal size and age)

  Length: 45 - 55 cm

  Head circumference: 33 - 35 cm
• Newborn Posture, Skin Hair

  Posture: Record spontaneity of motor activity and symmetry of movements

  Skin: skin texture, turgor, pigmentation variation, vernix, rash, and birthmarks

  Hair: Lanugo (soft fine hair), spina bifida, examine the texture and distribution of hair
• Assess fontanelles and structures

  Hydrocephalus: Neurological disorder caused by an abnormal buildup of cerebral spinal fluid in the ventricles of the brain

  
• Assess fontanelles and structures

  Molding: Abnormal head shape from the pressure on babies head during birth
• Assess fontanelles and structures

  Cephalohematoma: Blood that collects between the scalp and skull. Does not cross sagital sutures

  
• Early Newborn Face, Mouth, Eyes, and Ears

  Assess reflexes: Test for Moro (startle) reflex, check for presence of gag, swallowing reflexes, coordinated with sucking reflex

  Assess mouth: Check for clefts in either hard or soft palates, Check tongue for deviation, white coating (thrush)

  Eyes: PERLA and reflexes, true eyes color not determined before 6 months
• Newborn assessment of the face, mouth, ears record symmetry, assess for down syndrome, hearing screening done with parents consent
• Assess fontanelles and structuresCaput Succedaneum: Swelling of the scalp in a newborn. Caused from a long delivery and high pressure. Does cross sagital sutures.

  
• Early Newborn Heart & Lungs

  • Assess and maintain airway
  • Assess heart rate, rhythm for 1 full minute (murmur- location, timing, duration)
  • Size of chest (shape, symmetry, indrawing/ retraction)
  • Breath sounds and respiratory effort (nasal flaring)
  • Color for pallor, cyanosis, acrocyanosis
• Early Newborn Abdomen

  • Abdomen should appear large in relation to pelvis
  • Note increase/decrease peristalsis, protrusion of umbilicus
  • Measure umbilical hernia by palpating, note any discharge and # of vesicles from cord
  • Auscultate and percuss abdomen, assess for dehydration and femoral pulse
• Early newborn Genitals and anus

  • Examine Labia majora, labia minora, and clitoris. Inspect penis to determine whether urinary meatus is correctly positioned and to rule out hypospadias
  • Note discoloration and edema (common in breech births)
  • Inspect anal area and verify it is patent
  • Note passage of meconium