Processes Of Post Partum Care Nursing Essay

Postpartum care presents a special challenge, as it concerns two i.e. mother and her baby people with very distinct needs. However it is believed that contribution to good quality care ensure to balance the challenge. The major maternal and neonatal health challenges include nutrition and breastfeeding, birth spacing, immunization and HIV/AIDS, therefore Post partum care is pre-eminently about the provision of a supportive environment in which a woman, her baby and the wider family can begin their new life together. Therefore this guideline aims to identify the essential core (routine) care that every woman and her baby should receive in the first 6-8 weeks after birth, based on the best evidence available.

This guideline has been written within a conceptual framework which places the woman and her baby at the centre of care, appreciating that all post partum care should be delivered in partnership with the woman and should be individualized to meet the needs of each mother-infant dyad. Thus this clinical guideline of post partum is to offer information to support midwives to increase the knowledge and skills that enable them to handle mothers and their neonates and management of postpartum complication, and referral.

Objectives:

Perform postpartum examination on mother and baby and provide care to ensure safe post partum.

Provide first line EmONC or referral for the complication occurring during postpartum period

Facilitate the process of lactation and infant bounding.

Support of the mother and her family in the transition to a new family constellation, and response to their needs prevention, early diagnosis and treatment of complications of mother and infant, including the prevention of vertical transmission of diseases from mother to infant

Counsel the couple for:

resumption of sexual activity and birth spacing regular contraception service, emergency contraceptive methods,

dispelling myths and birth spacing in special situation.

maternal nutrition, and supplementation if necessary

baby care support of breastfeeding

Immunization of the infant and mother.

Referral of mother and infant for specialist care when necessary

CLINICAL PLACEMENT

Out Patient Department

Postnatal wards

Well baby room

Community Primary Health Care centers

POST PARTUM VISIT SCHEDULE

AFTER 3rd STAGE OF LABOUR TILL 2 HOURS

AFTER 2 HOURS TILL 24 Hours

First visit (within the first week, preferably within 2-3 days)

Second visit (4-6 weeks)

More frequent visits or different schedules may be required according to client need and or hospital policy. Encourage the woman to bring her partner or family member to at least 1 visit.

KEY ELEMENTS OF POSTPARTUM CARE:

6-12 hours

3- 6 days

6 weeks

blood loss

pain

BP

advice/

warning signs

breast care

temperature/infection

lochia

mood

recovery

anaemia

contraception

IMMEDIATE POST PARTUM CARE (After 3rd stage of labor till 2 hrs)

Initial Postpartum Recovery Assessment: special

attention to: Monitoring and assessment of maternal well being, prevention and detection of complications (e.g. bleeding, hypertension, and infections)

Determine;

Assess amount and the character of BLEEDING ,

Measure and document vital sign (BLOOD PRESSURE, pulse rate and temperature

Other warning sign like fever, uterine involution, pain etc

Status of the perineum, (tears laceration)

Status of the fundus; position and firmness

Document urine void within 6 hours.

Ensure emptiness of urinary bladder

Monitor for signs of bladder distension.

After delivery IV fluids infusing type and amount

Response of the woman and her partner to the newborn

Give woman time with baby and family to facilitate bonding and celebrate the occasion.

Status of the breasts once immediately after delivery and then again just before transfer to postpartum

Allow women to rest

Pain assessment; if the woman is experiencing any pain;

Determine the characteristics, quality, timing, and relief after comfort measures,

Investigate the source (e.g., after pains, episiotomy, painful urination, pain in the calves).

If the woman had a cesarean delivery;

check the incision dressing for intactness and determine incision bleeding

if any complain for pain type, and success of analgesics and comfort measures to control the pain;

toleration of ambulation

status of the bladder;

Provide hygiene care.

Help woman to re – dress

Establishments of breastfeeding/

ROUTINE PROGRESSIVE POST PARTUM CARE (After 2hrs till 24 hrs)

Take medical and pregnancy histories and perform physical examination that are important to alert for postpartum risk such as postpartum Hemorrhage, infection, and lead to normal healing

First Visit

HISTORY (should include significant pregnancy, labor and birth newborn history

Review of Ante Partum chart and labs, problems which may need follow up

Review of Intra Partum course and labs

Check records:

any complications during delivery

Receiving any treatments

Review of status since birth to postpartum period

Review if patient is Tdap immunization status

Obtains information about cultural factors influencing client’s health and

compliance

Assesses clients and significant other’s feelings and level of understanding of

sexuality, post partum.

Observe the gravid woman for verbal and non-verbal clues to exclude post partum

bluesdepression

HIV status

CONTINOUS POST PARTUM ASSESSMENT (ONCE PER SHIFT)

Take the vital signs including of

Respiratory characteristic s and

Rule out labour breathing shortness of breath and chest pain.

Regular Heart rate

Height, And Weight

Performs review of systems appropriate to POSTPARTUM

Body parts

Assessment and Probable findings

Breasts

Inspect the:

Colostrum excretion

breasts for signs of engorgement,

nipples aversion/ redness, or

cracks, then

Palpate the breasts gently to determine

if they are soft, filling, or engorged with milk

Note if there is pain/ oedema/ swelling

Abdomen

Inspect the abdomen and note:

striae, scars,

shape and size of the abdomen

Any organs enlargement and any masses.

Palpate the abdomen to assess

uterus involution (by height of fundas)

determine consistency, tone, position,

size/height in relation to the umbilicus

Genitalia

Inspect

Vulva and perineum for: tear, swelling, pus.

Observe external genitalia for

color of skin, varicosities, and

laceration, episiotomy stitches healing.

vaginal opening for cystocele or rectocele.

Vaginal discharge (lochia); special attention to color, amount and odor

Bladder and bowel;

Assess voiding amounts (more than 100 mL per each voiding) frequency

If amounts smaller than 100 mL check for urinary retention, i.e. suprapubic distention

Auscultate for bowel sounds in each quaderant.

Ask the woman if she has had a bowel movement after delivery.

Peripheral vascular

Inspect the extremities for edema equality of pulses, and capillary refill.

Check for Homans’ sign when the feet are dorsiflexed or woman is walking.

Hemoglobin and hematocrit (h&h).

Compare the H&H before delivery.

Note the blood type and Rh. If the woman is Rh-negative, arrange for RhoGAM

MEDICATION

For pain relief advise:

Topical cold therapy

Paracetamol

NSAIDs if not contraindicated

In areas of high prevalence of iron deficiency anaemia, 400 mg ferrous sulphate (2 tablets) per day or once a week, with 250 μg folate for 4 months is recommended for pregnant and lactating women. In areas of low prevalence 1 tablet of ferrous sulphate daily may be sufficient.

IMMUNIZATION

Offer Anti-D immunoglobulin within 72 hours to every non-sensitized Rh-D-negative woman following the delivery of an RhD-positive baby.

Complete TT vaccination for woman according to given schedule if required

Offered an MMR (measles, mumps, rubella) vaccination following birth and before discharge from the maternity unit if they are in hospital if on antenatal screening women found to be sero-negative for rubella following the safety protocol

Health Education for mother

All women should be given information about the physiological process of recovery after birth, and that some health problems are common, with advice to report any health concerns to healthcare professional, in particular:

Signs and symptoms of PPH: sudden and profuse blood loss or persistent increased blood loss; faintness; dizziness; palpitations/tachycardia.

Signs and symptoms of infection: fever; shaking; abdominal pain and/or offensive vaginal loss.

Signs and symptoms of thromboembolism: unilateral calf pain; redness or swelling of calves; shortness of breath or chest pain.

Signs and symptoms of pre-eclampsia: headaches accompanied by one or more of the symptoms of visual disturbances, nausea, vomiting, feeling faint.

Women who have had an epidural or spinal anesthesia should be advised to report any severe headache, particularly when sitting or standing

Diet during post partum

Caring breast while breast feeding

Fundal Massage

Perineum and Vaginal Care

Pain Management: explain the non- medicinal ways of easing pain, such as applying warmth to the abdomen to help soothe after pains.

Activities contribute to or prevent constipation.

If non immune for rubella educate for rubella immunization

SECOND VISIT (4-6 weeks)

HISTORY

Follow the guideline of ROUTINE POST PARTUM CARE (After 2hrs till 6hrs)

CONTINOUS POST PARTUM ASSESSMENT follow the guideline of (After 2hrs till

6hrs)

MEDICATION

Follow the guideline of ROUTINE POST PARTUM CARE (After 2hrs till 6hrs)

VACCINATION

Follow the guideline of ROUTINE POST PARTUM CARE (After 2hrs till 6hrs)

HEALTH EDUCATION

Follow the guideline of ROUTINE POST PARTUM CARE (After 2hrs till 6 hrs)

Postpartum Discharge

Plan and complete all necessary assessment and care as per hospital policy by consider

maternal and infant health and financial status.

HISTORY

Review of the woman’s physical, emotional and social well-being at taking in account the routine examinations

Counsel mother & family on baby care.

ASSESSMENT OR EXAMINATION

Follow the guideline of ROUTINE POST PARTUM CARE (After 2hrs till 6hrs)

HEALTH EDUCATION

Explain all take home medication with their effects and side effects.

Allow them to resolve their queries.

Educate mother about

danger signs,

personal hygiene,

perineal care,

postpartum exercises,

follow-up visit

baby care,

baby & mother immunization,

breast feeding,

Postpartum COMPLICATION MANAGEMENT

essentc

Hypertension during postnatal period

Continue to assess patients for signs and symptoms or worsening of preeclampsia in the postpartum period.

For postpartum patients on magnesium sulfate:

In general the magnesium sulfate is continued for 24 hours postpartum

Strict I&O in the initial 24 hours postpartum

Evaluation between 4 and 8 hours postpartum for vital signs especially BP, I&O, signs of magnesium toxicity, evaluation

for further information Refer:

World Health Organization, International Confederation of Midwifery (ICM) (2008). Midwifery education modules – second edition Managing Eclampsia Available: http://whqlibdoc.who.int/publications/2008

Baby Blues/ Post Partum Depression

Definition: A transient period of depression that occurs during the first week or two after birth

Causes: hormonal changes, fatigue

Sign and symptoms: mood swings, anger, weepiness, anorexia, insomnia

Intervention

Usually will resolve naturally

Should receive social support

Needs plenty of rest

Anemia

(Refer PHRplus/Albania (2005) Toolkits for Strengthening Primary Health Care Clinical Practice Guideline for Family Doctors; Quick References Partners for Health Reforms, & USAID) Available: http://www.who.int/management/ToolkitsforStrengtheningPHCAlbaniaPHC.pdf

Postpartum Hemorrhage

Refer: World Health Organization, International Confederation of Midwifery (ICM) (2008). Midwifery education modules – second edition Managing postpartum hemorrhage Available: http://whqlibdoc.who.int/publications/2008

Puerperal Sepsis

Refer: World Health Organization, International Confederation of Midwifery (ICM) (2008). Midwifery education

modules – second edition Managing Puerperal Sepsis Available: http://whqlibdoc.who.int/publications/2008

Diabetes in postpartum period

Refer: World Health Organization Reproductive Health AND Research (2005). A pocket guide for essential practice Sexually Transmitted and Other Reproductive Tract Infections integrating STI/RTI, HIV Care for Reproductive Health