The postpartum period begins after the delivery of the infant and generally ends 6-8 weeks later, though can extend in certain cases. The mother’s body continues to go through changes as it returns to a prepregnancy baseline. Recovery depends on the delivery process and any complications endured. Psychological and emotional changes are expected as the parents form an attachment to their child and begin the parenting process with its many challenges.
Nursing Process
Labor and delivery, postpartum, NICU, and obstetric nurses are skilled in caring for mothers and parents through all stages of pregnancy. Patients in the postpartum period will receive education and support from these nurses as they navigate recovery from birth, bonding with their infant, and maintaining their own physical, emotional, and psychological health.
Nursing Assessment
Nursing assessments during the postpartum period involve a thorough evaluation of the mother’s physical condition, emotional state, and adaptation to motherhood. This assessment includes:
Physical Assessment
- Vital Signs: Monitor vital signs, including blood pressure, temperature, heart rate, and respiratory rate to detect any abnormalities early.
- Uterine Involution: Assess the uterus for size, position, and firmness to ensure proper involution and identify any signs of hemorrhage.
- Lochia: Evaluate the amount, color, and odor of lochia to monitor for potential infections or complications.
- Perineal Healing: Inspect the perineal area for signs of infection, hematoma, or delayed healing, providing necessary care and advice.
- Breast Examination: Examine the breasts for engorgement, proper latch during breastfeeding, and signs of mastitis.
Emotional and Psychological Assessment
- Mental Health Screening: Conduct screenings for postpartum depression, anxiety, and other mood disorders using standardized tools.
- Emotional Support: Engage in conversations to assess the mother’s emotional state, providing reassurance and identifying any signs of distress.
Adaptation to Motherhood
- Bonding and Attachment: Observe interactions between the mother and the newborn to assess bonding and attachment, offering guidance to enhance this relationship.
- Parenting Skills: Evaluate the mother’s confidence and skills in caring for the newborn, providing education and support as needed.
Nursing Interventions
Interventions in postpartum care focus on addressing identified needs and promoting overall well-being through targeted strategies.
Physical Care
- Pain Management: Provide appropriate pain relief measures, including medications and non-pharmacological techniques such as ice packs and relaxation exercises.
- Breastfeeding Support: Offer lactation support, including breastfeeding techniques, positioning, and addressing common issues like sore nipples or low milk supply.
- Perineal Care: Educate on perineal hygiene, use of sitz baths, and application of topical treatments to promote healing and comfort.
- Nutritional Support: Advise on balanced nutrition to support recovery and breastfeeding, ensuring adequate fluid intake and a nutrient-rich diet.
- Activity and Rest: Encourage appropriate physical activity and rest periods, emphasizing the importance of self-care and gradual return to daily activities.
Emotional and Psychological Support
- Counseling: Provide counseling services to address feelings of anxiety, depression, or stress, offering coping strategies and emotional support.
- Support Groups: Facilitate support group meetings for new mothers to share experiences, challenges, and solutions, fostering a sense of community.
- Partner and Family Involvement: Include partners and family members in the care plan, educating them on how to support the new mother and enhance family dynamics.
Educational Interventions
- Infant Care Education: Teach about newborn care practices, including feeding, bathing, diapering, and recognizing signs of illness.
- Postpartum Care Education: Educate on postpartum recovery processes, warning signs of complications, and when to seek medical help.
- Contraception and Family Planning: Discuss contraception options and family planning, ensuring the mother is informed and supported in her choices.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for a postpartum patient, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for postpartum care.
Acute Pain
Acute pain is common in postpartum patients and occurs in the urogenital region, breasts, and back. Pain in the perineum is common in patients who had vaginal delivery due to bruising or episiotomy. Patients who delivered via Cesarean may have pain at the incision site and may experience discomfort when moving, coughing, or breastfeeding.
Nursing Diagnosis: Acute Pain
Related to:
- Tissue damage
- Cesarean delivery
- Episiotomy repair
- Perineal lacerations
- Impaired skin integrity
- Surgical procedure
- Perineal hematoma
- Mastitis
- Engorgement
As evidenced by:
- Diaphoresis
- Distraction behavior
- Expressive behavior
- Guarding behavior
- Positioning to ease pain
- Protective behavior
- Reports pain and intensity
- Hot, swollen breasts
Expected outcomes:
- Patient will report reduced discomfort.
- Patient will demonstrate appropriate comfort measures to help alleviate pain.
Assessment:
1. Assess the location and pain characteristics.
Pain assessment is vital in ensuring optimal pain management. This will help identify the location, extent of tissue damage, the severity of discomfort, and appropriate treatment interventions.
2. Assess the patient’s abdomen and uterine contractions.
Afterpains or uterine cramping is expected after giving birth. While these contractions are normal, they can be uncomfortable. It is important to monitor this pain and ensure the uterus is contracting appropriately. Uterine atony or an uncontracted uterus can cause life-threatening bleeding.
3. Assess perineal lacerations.
Spontaneous perineal or episiotomy tears can affect about 65% of women who deliver vaginally. In some cases, while there are no visible tears, perineal pain still occurs due to trauma and developing hematoma.
4. Assess breast pain.
Breast pain is also common in postpartum patients due to breast engorgement and inadequate emptying of breast milk. If mastitis is left untreated, it can cause infection and abscess formation in the affected breast.
Interventions:
1. Administer medications as ordered.
Pain medications like ibuprofen are given to help alleviate postpartum discomfort. Antibiotic therapy may also be indicated depending on the patient’s symptoms and if there is an infection present, such as mastitis.
2. Encourage the use of relaxation techniques for pain reduction.
Relaxation techniques like deep breathing, massage, and meditation help alleviate discomfort and refocus the attention of postpartum patients.
3. Encourage early ambulation as tolerated.
Early ambulation after childbirth promotes blood flow, speeds up tissue healing and recovery, reduces constipation and gas pain, and promotes pain relief.
4. Instruct when to use hot and cold therapies.
Cold compresses are ideal for helping reduce pain and swelling in the perineal area. Warm compresses or a warm sitz bath promotes vasodilation, blood flow, and localized comfort. Utilize heating pads for back pain.
5. Encourage breastfeeding if there are no contraindications.
Continuous breastfeeding can prevent breast discomfort due to engorgement and promote continuous breast milk production. If the patient is not able to breastfeed, instruct on how to use breast pumps. Both breasts must be emptied to prevent milk stasis, as this can increase the risk of breast abscess formation.
6. Encourage the patient to eat high-fiber foods.
Perineal pain is common and can lead to constipation if the patient delays defecation for fear of pain. Intake of high-fiber foods, along with laxatives or stool softeners, can help decrease constipation and prevent straining when defecating.
Imbalanced Nutrition: Less Than Body Requirements
Adequate nutrition for postpartum patients is vital as it can help speed up post-pregnancy body recovery, boost energy levels, balance hormones, and promote breast milk production.
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements
Related to:
- Altered taste perception
- Postpartum depression
- Food aversion
- Inadequate interest in food
- Lack of sleep
- Inadequate knowledge of nutrient requirements
- Inadequate food supply
- Insufficient food intake to meet metabolic demands
As evidenced by:
- Abdominal pain
- Weight loss
- Body weight below ideal weight range for age and gender
- Constipation
- Excessive hair loss
- Hypoglycemia
- Lethargy
- Pale mucous membranes
- Food intake less than the recommended daily allowance
- Inadequate breast milk production
- Poor wound healing
Expected outcomes:
- Patient will meet nutritional needs as evidenced by prompt postpartum recovery, timely wound healing, and appropriate energy levels.
- Patient will demonstrate adequate breast milk production.
Assessment:
1. Assess laboratory values.
Laboratory tests will demonstrate alterations in nutritional status. Alterations in albumin and pre-albumin levels can indicate an inflammatory response accompanying acute malnutrition. Anemia may be present along with nutrient deficiencies in B vitamins and iron.
2. Assess the patient’s daily food intake.
Assessing the patient’s food intake can help identify deficiencies and determine if the patient is eating well-balanced, healthy meals. Nursing women need about 500 additional calories per day and other vital nutrients like protein, calcium, and fluids.
3. Assess for emotional or psychosocial factors affecting appetite.
A newborn is a significant change to routine, sleep, and relationships. Assess for symptoms of depression that may affect appetite. Lack of sleep and energy also contribute to poor dietary intake.
Interventions:
1. Discuss eating habits, food intolerances, and preferences.
Postpartum patients need adequate nutrients to ensure prompt body recovery and wound healing, especially if a C-section was performed. Protein is vital for wound healing and recovery. Assess if the patient follows a particular diet like veganism that may require individualized interventions to meet nutritional needs.
2. Encourage vitamins or supplements as necessary.
The patient may be recommended to continue prenatal or postnatal vitamins containing iron, iodine, and omega-3 fatty acids.
3. Encourage adequate rest periods.
Most postpartum patients have less opportunity to rest and adapt to postpartum changes, compromising prompt recovery. Rest periods reduce metabolic rate and ensure nutrients are utilized for healing and energy.
4. Encourage adequate fluid intake.
Adequate fluid intake in postpartum patients helps prevent dehydration and replenishes fluids to support breast milk production.
5. Refer the patient to a dietitian.
A dietitian can help patients plan appropriate and well-balanced meals to meet individual needs during the postpartum phase.
Ineffective Breastfeeding
Difficulty with infant latching, pain with breastfeeding, or poor breastfeeding experiences can lead to ineffective breastfeeding.
Nursing Diagnosis: Ineffective Breastfeeding
Related to:
- Infant prematurity
- Infant anomaly (cleft palate)
- Poor sucking reflex of infant
- Maternal anxiety or disinterest
- Knowledge deficit
- Interruptions in breastfeeding
- History of ineffective breastfeeding attempts
As evidenced by:
- Expresses or observed difficulty in breastfeeding
- Complaints of pain or nipple soreness
- Insufficient emptying of breastmilk when feeding/inadequate milk supply
- Infant displaying inadequate wet diapers or weight loss/inadequate weight gain
- Failure to latch
Expected outcomes:
- Mother will implement two techniques to improve breastfeeding.
- Infant will display effective breastfeeding as evidenced by appropriate weight gain.
Assessment:
1. Assess knowledge.
Assess the mother’s knowledge about breastfeeding as well as cultural conflicts and any myths or misunderstandings.
2. Perform physical assessment.
Perform a breast assessment for engorgement, mastitis, and inverted nipples as well as an assessment of the infant’s ability to latch and suck.
3. Assess support system.
A supportive partner is an important factor in effective breastfeeding. Supportive family members and the healthcare team can also contribute.
Interventions:
1. Provide 1:1 support.
Breastfeeding for new mothers may take time and practice. Allow 1:1 time with emotional support. Sessions can be 30 minutes or longer in the beginning.
2. Teach to recognize cues.
Educate the mother on early cues from the infant. Rooting, lip-smacking, and sucking fingers/hands signal a desire to eat. Recognizing cues for timely feeding promotes a better experience for mom and baby.
3. Prevent and treat breastfeeding complications.
If ineffective breastfeeding is related to nipple pain or engorgement, intervene accordingly. Heat or cool application and massage can ease engorgement. Apply lanolin to nipples and do not use harsh soaps. Use cotton bras or pads.
4. Coordinate with a lactation consultant.
Lactation consultants help instruct on breastfeeding positions, feeding schedules, increasing the milk supply, and using a breast pump.
Risk For Impaired Parenting
An inability to create or maintain an environment to promote growth and attachment of the parent and child.
Nursing Diagnosis: Risk For Impaired Parenting
Related to:
- Premature birth
- Multiple births
- Unwanted pregnancy
- Physical handicap of infant
- Prolonged separation from the parent
- Lack of maturity level for parenting
- Low educational level
- Low socioeconomic level
- Young maternal age
- Closely spaced pregnancies
- Difficult birthing process
- Sleep deprivation
- History of depression or mental illness
- Substance abuse
- History of familial or intimate partner abuse
- Lack of family or spousal support
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Parent will verbalize individual risk factors that increase the risk of impaired parenting.
- Parent will identify resources and personal strengths to overcome parenting barriers.
- Parent will participate in classes to promote effective parenting.
Assessment:
1. Assess family support and dynamics.
Assess if the infant’s father is involved in parenting. Assess for other family support such as the mother’s parents or other family members. Assess for additional children in the home.
2. Observe attachment between parents and infant.
Observe the parent’s attitude toward the infant. Monitor interactions when feeding and changing the infant or a reluctance or indifference in parenting.
3. Determine challenges in the parent’s capabilities.
Young parents with an unplanned or unwanted pregnancy may lack the skills and knowledge for parenting. Consider the parent’s intellectual and emotional level as well as any physical weaknesses.
Interventions:
1. Display positivity and allow time for bonding.
When interacting with the infant and parents, the nurse should display a positive attitude to model interactions. Provide plenty of time for bonding by keeping the infant in a bassinet at the bedside and educating the parents on how to feed, hold, swaddle, and bathe.
2. Encourage time for themselves.
Parental stress is linked to postnatal depression. Remind parents to identify positive outlets for themselves and to take time from parenting to reduce anxiety.
3. Perform a depression screening.
Post-partum depression can affect up to 18% of new mothers. Symptoms displayed often show a loss of sensitivity and response to their infant’s needs. This serious condition requires intervention for both mom and baby.
4. Offer community resources.
Young, single, or unprepared parents may require the support of community resources. Provide information on parenting classes and government assistance programs to aid in the safety and health of the infant.
Risk For Infection
Childbirth can carry an increased risk for infection from trauma, sepsis, and surgical procedures.
Nursing Diagnosis: Risk For Infection
Related to:
- Trauma to the abdominal wall (cesarean section)
- Trauma to the uterus, genitals, and urinary tract
- Episiotomy
- Advanced maternal age
- High BMI
- Chronic conditions (diabetes, hypertension, immunosuppression)
- Sexually transmitted diseases
- Pre-term or post-term labor
- Prolonged rupture of membranes (PROM)
- Excessive internal exams
- Endometritis
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will not develop an infection during the postpartum period.
- Patient will display surgical site healing following c-section or episiotomy without signs of redness, warmth, or drainage.
Assessment:
1. Identify risk factors.
Gestational diabetes, intrapartum infections, PROM, preeclampsia/eclampsia, and prolonged labor increase the incidence of infection.
2. Assess signs and symptoms.
Fever, uterine tenderness, bleeding, and foul-smelling lochia are signs of endometritis. Localized infections to surgical incisions include pain, erythema, and purulent drainage without approximation of wound borders.
3. Monitor lab work.
The white blood count will be elevated along with neutrophils and lactic acid. Blood cultures can also be obtained prior to starting antibiotics.
Interventions:
1. Administer antibiotics.
Broad-spectrum antibiotics should be administered until cultures or pathogens are identified. Very ill patients or serious infections require IV antibiotics. Less severe infections can be treated outpatient with oral antibiotics.
2. Decrease the risk prior to delivery.
It’s vital for the healthcare team to reduce the risk of infection through proper handwashing, NOT shaving before delivery, preoperative showering before cesarean section, maintaining glycemic control <200 mg/dL, limiting vaginal examinations, and avoiding internal fetal monitoring.
3. Provide education on symptoms.
Nurses should educate patients at discharge on signs and symptoms of infection and when to seek prompt treatment (fever, persistent pain, changes in lochia).
4. Demonstrate wound care.
Teach the patient to care for their episiotomy incision by not bearing when defecating (may need to take stool softeners), use ice packs to decrease the swelling, begin warm sitz baths 24 hours after birth, change postpartum pads every 2-4 hours, and always wipe front to back after using the bathroom and clean the area by spraying warm water over the area and patting dry with a clean towel. For a C-section incision, keep the dressing clean and dry until instructed to remove. Wash with soap and water as instructed and do not scrub.
Nursing Diagnosis and Rationale for Postpartum Care
1. Risk for Bleeding
Rationale: Postpartum hemorrhage is a significant risk following childbirth due to the possible atony of the uterus, retained placental fragments, or lacerations. Nurses should closely monitor the amount and color of lochia, assess uterine tone and position regularly, and administer uterotonic medications as ordered. Educating the patient on recognizing signs of excessive bleeding is crucial.
2. Acute Pain
Rationale: Pain is common postpartum due to perineal trauma, uterine contractions, or surgical incisions from a cesarean section. Nurses should assess pain levels using standardized pain scales, provide prescribed analgesics, and recommend non-pharmacological pain relief measures such as warm compresses or sitz baths. Patient education on proper wound care and mobility can also reduce discomfort.
3. Risk for Infection
Rationale: The postpartum period poses a risk for infections such as endometritis, urinary tract infections, and surgical site infections. Nurses should monitor for fever, foul-smelling lochia, and increased pain or redness at the surgical site. Strict adherence to aseptic techniques during catheterization and wound care, as well as advising the patient on personal hygiene, can prevent infections.
4. Impaired Urinary Elimination
Rationale: Postpartum women may experience difficulty urinating due to swelling, pain, or epidural anesthesia effects. Nurses should assess bladder function regularly, encourage fluid intake, and assist the patient to the bathroom frequently. Using techniques such as running water sounds or applying warm water over the perineum can promote urination.
5. Constipation
Rationale: Constipation is common postpartum due to decreased bowel motility, pain medications, and fear of pain during defecation. Nurses should encourage a high-fiber diet, adequate hydration, and early ambulation. Administering stool softeners or laxatives as ordered and educating the patient about gentle bowel movement techniques can help alleviate constipation.
6. Risk for Impaired Parenting
Rationale: The transition to parenthood can be overwhelming, and some parents may struggle with bonding or caring for their newborn. Nurses should assess the parents’ emotional readiness and provide education on newborn care practices. Encouraging skin-to-skin contact and breastfeeding can promote bonding. Referrals to parenting support groups or counseling services may be beneficial.
7. Anxiety
Rationale: The postpartum period can bring about anxiety related to physical recovery, newborn care, and lifestyle changes. Nurses should offer emotional support, provide accurate information about postpartum recovery and newborn care, and create a supportive environment. Referring the patient to mental health professionals if anxiety persists can be essential for their well-being.
8. Deficient Knowledge
Rationale: New mothers may lack knowledge about postpartum recovery, newborn care, and potential complications. Nurses should provide comprehensive education on topics such as breastfeeding, signs of postpartum depression, and when to seek medical attention. Using visual aids, written materials, and hands-on demonstrations can enhance understanding.
REFERENCES
- Berens, P. (2022, January). Overview of the postpartum period: Normal physiology and routine maternal care. UpToDate. https://www.uptodate.com/contents/overview-of-the-postpartum-period-normal-physiology-and-routine-maternal-care
- Boushra M, Rahman O. Postpartum Infection. [Updated 2021 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560804/
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Episiotomy – aftercare. (2020, March 31). MedlinePlus. https://medlineplus.gov/ency/patientinstructions/000483.htm
- Going home after a C-section Information. (202, October 5). Mount Sinai. https://www.mountsinai.org/health-library/discharge-instructions/going-home-after-a-c-section
- Lactation Consultant: When To See One & What To Expect. (2021, November 30). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22106-lactation-consultant
- Missler, M., van Straten, A., Denissen, J. et al. Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial. BMC Pregnancy Childbirth 20, 658 (2020). https://doi.org/10.1186/s12884-020-03341-9
- Rayce, S. B., Rasmussen, I. S., Væver, M. S., & Pontoppidan, M. (2020). Effects of parenting interventions for mothers with depressive symptoms and an infant: systematic review and meta-analysis. BJPsych open, 6(1), e9. https://doi.org/10.1192/bjo.2019.89
- Vismara, L., Rolle, L., Agostini, F., et al. Perinatal Parenting Stress, Anxiety, and Depression Outcomes in First-Time Mothers and Fathers: A 3- to 6-Months Postpartum Follow-Up Study. (2016, June 24). Frontiers. https://www.frontiersin.org/articles/10.3389/fpsyg.2016.00938/full
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