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21.1 Postpartum Infections

Postpartum infections can occur with both vaginal and cesarean birth. The nurse assesses for signs of infection beginning in recovery directly after birth until discharge home. The nurse is aware that infection can progress quickly and cause morbidity and mortality. Education on prevention of infection is key and also begins in recovery and ends in discharge instructions.

21.2 Postpartum Hemorrhage

Postpartum hemorrhage is an emergency that is treated by a multidisciplinary team. The nurse is the first line in prevention of PPH by recognizing risk factors and close monitoring of uterine consistency and lochia, encouraging frequent voiding, and assessing the incision and perineum. Nurse monitoring often interrupts the postpartum person’s ability to rest. When a PPH occurs, the nurse monitors vital signs, performs fundal massage, calls for additional assistance, and prepares for administration of medications or blood products. The nurse assesses for a full bladder, hematoma, boggy uterus, or trauma to the reproductive tract. With the nursing interventions directed at preventing and minimizing blood loss, the nurse assists in decreasing the morbidity and mortality related to postpartum hemorrhage.

21.3 Breasts and Breast-Feeding

Breast-feeding persons need emotional and physical support while learning to breast-feed, especially when difficulties arise. The nurse provides education, support, and treatment for these difficulties. The nurse ensures a good latch, treats cracked nipples, educates regarding engorgement and mastitis, and supports the person with an infant in the NICU. The nurse also provides lactation referrals and community resources for assistance with breast-feeding.

21.4 Cesarean Birth Discomforts

Nurses are aware of the discomforts related to recovery after a cesarean birth. The nurse educates the postpartum person on common discomforts and relief measures. The nurse demonstrates how to hold the newborn to prevent incision pain. The nurse also provides discharge instructions to promote healing and rest in the postpartum period.

21.5 Postpartum Mood Disorders and Psychiatric Disorders

The nurse assesses the postpartum person for signs and symptoms of PPD and PPP. Assessment for those disorders begins during pregnancy and continues through postpartum discharge. The difference between baby blues, PPD, and PPP are explained to the postpartum person. If signs of these disorders are recognized, the nurse notifies the health-care provider and social services to begin treatment prior to discharge home. The nurse helps to prevent PPD by providing support and anticipatory guidance on the many adaptations occurring during postpartum.

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