ATI/ OB | Postpartum Period
STAT Stitch Deep Dive Podcast Beyond The Bedside · Regular Guy
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Show Notes
The postpartum period is an ongoing process lasting at least 12 weeks, involving rapid physiological and emotional changes.
Uterus & Hemorrhage Prevention Postpartum hemorrhage is a critical risk, defined as greater than 1,000 mL of blood loss. To prevent excessive bleeding, the uterine fundus must remain firm, well-contracted, and at or below the umbilicus. If the fundus is not firm, nurses must immediately perform fundal massage and ensure the client empties their bladder. A distended bladder displaces the uterus, severely impairing its ability to contract. Lochia progresses in three stages: dark red rubra (days 1-4), pink/brown serosa (days 4-10), and white/yellow alba (days 10-14). Saturating a pad in under an hour, foul odors, or passing clots larger than an egg are priority danger signs.
Cardiovascular & Hematologic Shifts Immediately after birth, cardiac output spikes by 60% to 80%. The body eliminates excess fluid via rapid diuresis (up to 3,000 mL/day) and diaphoresis. White blood cells can normally elevate to 25,000/mm³ due to labor stress. Crucially, clotting factors remain highly elevated for weeks, putting the client at a severe risk for deep vein thrombosis (DVT). Nurses must routinely assess lower extremities for unilateral swelling, redness, and calf pain.
Endocrine & Lactation Placental delivery causes estrogen and progesterone to plummet. This allows prolactin to trigger milk production, while oxytocin stimulates milk ejection and ongoing uterine contractions. A proper breastfeeding latch must be wide, deep, and painless. Non-lactating clients must avoid breast stimulation and use cold compresses to suppress lactation.
Vital Assessments & Systems Constipation is frequent due to fluid loss, opioids, and perineal pain; stool softeners are highly recommended. The first postpartum urinary void must occur within 6 hours. The perineum must be assessed using the REEDA scoring system (Redness, Edema, Ecchymosis, Discharge, Approximation) to evaluate healing.
Pharmacology & Immunizations Non-opioids are primary for pain, while opioids are used sparingly. Rh-negative clients with Rh-positive newborns must receive Rh immune globulin within 72 hours. Live vaccines like MMR and Varicella are strictly contraindicated during pregnancy but must be administered postpartum to clients lacking immunity. The Tdap vaccine is also vital to prevent newborn pertussis.
Psychosocial Rooming-in promotes parent-newborn bonding, increases breastfeeding success, and stabilizes newborn body temperature