When palpating the fundal height on a postpartum woman which technique is preferable?

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After the very exhausting phase of giving birth, the newborn is not the only one who needs to be taken care of. It is also essential to make sure that the woman is in a stable condition because the immediate postpartum is a critical stage for both the woman and her baby.

• Care within the First 24 Hours
• Care in Preparation for Discharge
• Care after Discharge
• Practice Quiz: Postpartum Care

Care within the First 24 Hours

Providing nursing care to a postpartum woman during the first 24 hours entails the following:

• Assess the woman’s family profile to determine the impact that the newborn would give to the family and to the woman.
• Assess the woman’s pregnancy history, especially if the pregnancy was planned or unplanned as it will determine the ability of the woman to bond with the newborn.
• Assess the labor and birth history such as the length of labor and if any analgesia or anesthesia was used to determine any necessary procedures to be done.
• Determine the infant’s data and profile to help with planning the care of the newborn and promote bonding between the parents.
• The woman would also need a postpartum course such as her activity level after birth, any difficulties or pain felt, and if she is successful with infant feeding to determine any need for anticipatory guidance in home care.
• Assess any laboratory data of the woman to be certain that she is recovering well and if any procedures or additional diagnostic tests need to be performed.
• Assess the woman’s general appearance because it is a reflection of how well the woman is moving into the taking hold phase of recovery.
• Assure the woman that losing a quantity of her hair is not a sign of illness but because she is returning to her nonpregnant state, as hair grows rapidly during pregnancy because of increased metabolism.
• Assess for facial edema, especially for a woman with pregnancy-induced hypertension.
• Advise the woman to purchase a nursing bra that is one to two sizes larger than her pregnancy size to allow for increase.
• Assess the woman’s breast for any cracks or fissures, and avoid squeezing the nipple. Also, assess for signs of mastitis such as inflammation of a certain part of the breast.
• Assess the location, consistency, and height of the fundus through palpation.
• If the uterus is not firm upon palpation, massage it gently. Placing the infant on the mother’s breast also aids in stimulating contractions.
• Lochia is expected in a postpartum woman for 2 to 6 weeks, so assessment of its characteristics is necessary to determine if it is the normal lochia or not.
• Observe the perineum for ecchymosis, hematoma. Edema or any drainage and bleeding from the stitches.

Care in Preparation for Discharge

Before the woman is discharged, she must be educated properly regarding the care of the newborn and herself at home.

• Assess first the ability of the mother to absorb new instructions and to listen.
• Conducting group classes regarding newborn care could greatly help mothers learn not only what the instructors teach but also from the experiences that some mothers could share to the group.
• It is also recommended for fathers to attend such classes so the mother would have someone she can rely on with the newborn care.
• Individual instruction is also sought after postpartum, as the family will need to know how to care for the woman and the newborn after discharge.
• Teaching should not always be formal; it may come in the form of comments during classes or procedures.
• Instruct the woman to avoid lifting heavy objects for the first three weeks after birth.
• Advise the woman to allot a rest period every day, or to rest and sleep while her newborn is also asleep so she can regain her energy.
• Be certain that the woman is aware that she must return to the healthcare facility after 4 to 6 weeks for examination and that she must arrange an appointment for her baby to be examined by a pediatrician at 2 to 4 weeks of age.
• Make sure that the woman and the family understood the discharge instructions amidst all the frenzy of the new baby; review instructions with parents before they leave.
• Calling or visiting 24 hours after discharge is the best way to evaluate whether the family has been able to grasp all instructions and integrate the newborn into the family.

Care after Discharge

Discharge from the healthcare facility usually occurs after 2 to 3 days after birth.

• The woman can rest better at home and may eat better if she has cultural preferences regarding food.
• The newborn can also be exposed earlier to the routines of the family, and make it easier for her to adjust to extrauterine environment.
• A home visit after the discharge is usually recommended to check on how the family is doing now that they have a newborn in the house.
• High-risk newborns, newborns born to adolescent mothers, and newborns with mothers who have abused drugs during pregnancy need to have a specially planned discharge and home visit.
• Pregnancy history is assessed during the postpartum visit and if there are any difficulty with the bonding between the mother and the baby, and allow the woman to relate her labor and birth experiences.
• Assess the newborn history and if there are any concerns about the newborn that the woman has noticed.
• Assess the woman’s future plans, whether she is going back to work outside home and if she had already arranged the care of her newborn while she is away.
• Conduct a family assessment and ask if other members of the family are adapting well with a newborn in the house.
• Examine both the mother and the newborn physically to note any signs of postpartum complications or defects.
• Remind the mother about the health maintenance visit of the newborn once she reaches 2 to 4 weeks old, and her return checkup 4 to 6 weeks after birth.

Practice Quiz: Postpartum Care

Quiz time! Here’s a 5-item practice exam for this topic.

1. When should assessment of labor and birth begin?

A. An hour after delivery.
B. On the first home visit.
C. On the first 24 hours after birth.
D. During discharge planning.

2. A postpartum woman complained that she is losing too much hair. What would be the most appropriate explanation?

A. The hair that the woman grew during pregnancy is slowly falling off.
B. The woman needs to consult a cancer specialist.
C. The woman used commercial hair dyes during pregnancy.
D. The hair will start to grow again after 24 hours.

3. What is the most important part of discharge planning?

A. Evaluation
B. Saying goodbye to the health care providers
C. Paying the hospital bills
D. Going home instructions and newborn care

4. When is the best time for a postpartum visit?

A. A week after discharge
B. A month after discharge
C. A day after discharge
D. Whenever the healthcare provider is available

5. When should a newborn be examined by her primary care provider?

A. On her first year
B. After 24 hours
C. After 1 week
D. 2 to 4 weeks after birth

Answers and Rationale

1. Answer: C. On the first 24 hours after birth.

The woman is still focused on herself so asking questions about her experiences during labor and birth would encourage her to vent out her feelings.

2. Answer: A. The hair that the woman grew during pregnancy is slowly falling off.

The woman’s metabolism during pregnancy is increased, therefore, hair growth also increased.

3. Answer: D. Going home instructions and newborn care

Education is important for the woman and family members so they can easily integrate the newborn into their life.

4. Answer: C. A day after discharge

Home visit of the postpartum woman typically occurs after 24 hours after discharge.

5. Answer: D. 2 to 4 weeks after birth

The newborn must have her health maintenance when she turns 2 to 4 weeks old.

The care of the postpartal woman should always be integrated into the discharge planning. It is important to make sure that the woman is well taken cared of, for she would also be responsible for the welfare of her newborn. A healthy mother will be able to raise a healthy newborn without any difficulty.

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