More than 60% of
maternal deaths take place during postpartum period. The first 48 hours are
most crucial because Most maternal and neonatal complications are occur during
this period. The puerperium is the period beginning after delivery and ending
when the woman’s body has returned as closely as possible to its prepregnant
The period lasts
approximately 6 weeks. The postnatal care starts after the childbirth to 6 weeks
Prevention of sepsis at
Initiation of breast
Assessment. The first 1 hour after delivery of the placenta (fourth stage of
labor) is the critical period; post partum hemorrhage is most likely to occur
at this time.
Postnatal check up includes Pulse, BP, RR. Temp and Pallor.
Monitor vital signs every 4 hours during the first 24 hours, then every 8 to 12
BUBBLE-HE is a acronym used to denote the components of the
postpartum maternal nursing assessment.
• B: Breast
• U: Uterus
• B: Bladder
• B: Bowels
• L: Lochia
• E: Episiotomy and perineum
• H: Homan’s
• E: Emotional status
B- Breast: Assess for breast
engorgement and condition of nipples if breast-feeding.
Size, Shape, Firmness, Redness, Symmetry
Check the Breasts for - nodules, lumps
Check the Nipples - assess for eversion, flat, inverted, cracking,
bleeding, pain, blisters
Individualize teaching for breasts for breastfeeding
Check the breasts for signs of engorgement (swollen, tender,
tense, shiny breast tissue). If breasts are engorged and the woman is
• Allow warm to hot wet towel to cover the breasts and massage
to improve comfort.
• Express some milk manually or by breast pump to improve
comport and make nipple more available for infant feeding.
• Feeding the infant.
• A mild analgesic may be used to enhance comfort
Abdomen : Monitoring of
Check firmness of the
fundus at regular intervals.
Palpating the uterine
fundus Firm or “Boggy” – not palpable by 10 days.
Ask for “afterpains”
(the pain occurs due to uterine contraction towards involution after delivery).
Observe for the woman’s
first void within 6 to 8 hours after delivery.
Palpate the abdomen for
bladder distention if the woman is unable to void or complains of fullness after
voiding. a. Uterine displacement from the midline suggests bladder distention
Instruct the woman to void every several hours and after meals to
keep her bladder empty.
Bowels in shock just
moved into some strange positions. So plenty of fiber , fluids and Take a stool
softener- to avoid harm to the episiotomy or trauma to the C-section incision
Inspect the perineum
regularly for frank bleeding.
Note color, amount, and odor of the lochia.
Count the number of perineal pads that are saturated in each 8 hour
Calculate the amount of bleeding
Check for lochia (vaginal discharge after delivery)
incisions (episiotomy wound) for signs of infection and healing by REEDA
• R: Redness
• E: Edema
• E: Ecchymosis
• D: Discharge
• A: Approximation
Nursing Intervention Sitz Bath: A rotating
fluid that moves the water, may fit over the commode or one can be
performed with no special equipment using the bathtub other than a bathing
ring. Turn tub on and allow drain to open and use a ring for circulating water.
It’s very shallow and only bathes the perineal area.
Assess for Signs of DVT by the Homan’s Sign (Deep Vein
Inspect legs for signs of thromboembolism, and assess Homan’s sign
Positive Homan’s sign is indicative of DVT, although it’s not the
most reliable indicator
Most commonly performed with the supine position while laying in
The calf is flexed at a 90° angle
The nurse manipulates the foot in a dorsiflexion movement
If pain is felt in the calf, the Homan’s Sign is said to be positive
Fluctuations in estrogen levels are blamed for the emotional
roller-coaster that many moms experience after birth
High levels of stress, increased responsibility, and sleep deprivation
exacerbate the emotion
Bonding refers to the interactions between the mother and baby
Caregiving of self and baby is an indicator of emotional status.
Observe for elevated temperature above 38°C.
Evaluate episiotomy/perineum for redness, ecchymosis, edema,
discharge (colour, amount, odour) and approximation of the skin.
Assess for pain, burning sensation, and frequency of urination.
Administer antibiotics as ordered.
Provide a quiet and minimally disturbed environment.
Organize nursing care to keep interruptions to a minimum.
Encourage the woman to minimize visitors and phone calls.
Encourage the woman sleep while the baby is sleeping. (8-10 hours
Avoid strenuous activities for 6 weeks.
Instruct the woman to apply ice packs to the perineal area for
the first 24 hours for perineal trauma or edema.
Initiate the Sitz bath for perineal discomfort after the first 24 hours.
Educate to do three times a day for 15 to 20 minutes.
Instruct the woman to contract her buttocks before sitting
to reduce perineal discomfort.
Assist the woman in the use of positioning cushions and pillows
while sitting or lying.
Administer pain medication as indicated.
Retention of urine
Pain at site of perineum
Engorgement of breast
Treatment of Anaemia
Pelvic floor exercise
Pelvic tilting or rocking
Foot and Leg Exercise
exercises can be performed in bed.
Toe Stretch (tightens calf muscles)- While lying on your back, keep
your legs straight and point your toes away from you, then pull your legs
toward you and point your toes toward your chest. Repeat 10 times.
Pelvic floor exercise
muscles)-Contract your buttocks for the count of 5 and relax. Contract your
buttocks and press thighs together for the count of 7 and relax. Contract
buttocks, press thighs together, and draw in anus for the count of 10 and
Care of New Born
Keeping baby warm
Postpartum Care and
Advise the mother to
wash perineum daily and after passing urine and stools. Change perineal pads
every 4 - 6 hours. Wash hands frequently and take bath daily.
Increase intake of fluid
and food especially iron and protein rich foods like green leafy vegetables,
jaggery, lentils, eggs and meat. Increase intake of milk and milk products like
curd, cheese etc. Calorie need per day 2200+700 =2900 Kcal Advise adequate
Women with normal Hb are
advised to take 1 IFA tablet daily for 3 months. If Hb below 11 gm/dl, advise
her to take 2 IFA tabs daily and repeat Hb after 1 month.
Family planning advise
Counsel couple regarding
Advise the mother for
exclusive breast feeding on demand, atleast 6 to 8 times during day & 2-3
times during night. Educate that breast feeding is best and Pre-Lacteal feeds
must be avoided.
Cracked /sore nipples -Advise the mother to apply hind milk for
soothing effect, ensure correct positioning and attachment of baby.
Engorged breasts - Advise the mother to continue breast feeding
and to put warm compresses.
Registration of Birth
Emphasize the importance
of registration of birth with local panchayat.
It is a legal document
and it is required for many purposes.
Warning Signs of
Advise the mother to
report if following symptoms occur
• Fever, Convulsions
• Excessive bleeding
• Severe abdominal pain
• Difficulty in breathing
• Foul smelling lochia
Educate about the
Immunization for the child
Advise about the
importance of postnatal exercises
At 6 weeks following
delivery - Ask the mother for the following
Has vaginal bleeding
Has menstrual cycle
Is there any foul
smelling vaginal discharge?
Any problems regarding
Any other complaints?
Give relevant advice
& refer to doctor if needed.