The most important need for a healthy postpartum woman is education. Women and their partners have expressed their desire to learn competence in caring for their babies.4 Newborn care is the major education point, especially for first-time mothers. These new moms need reassurance that they can care for their babies. This education must include basic newborn care such as bathing and circumcision care to more complex education such as when to call the doctor. Education should also include information about safe sleep practices and about shaken baby syndrome. There is a lot of information and it can be overwhelming. Giving resources for the woman to refer to at home may be useful.
It is also important to teach the mom about self-care. The woman should be taught to rest when she can because sleep is difficult with a new baby. It is also important to teach the woman to walk in order to prevent VTE. The nurse must teach the patient about the signs and symptoms of complications that can occur in the postpartum period. Maternal morbidity and mortality rates are too high in the United States. Over half of maternal deaths occur within the first year after childbirth and the most common causes of maternal mortality include5:
- cardiovascular and coronary conditions
- venous thromboembolism
- mental health conditions
- pre-eclampsia and eclampsia.
The Association for Women’s Health, Obstetric, and Neonatal Nursing (AWHONN) has a program that provides hand-outs that can be used to teach women about signs and symptoms. It is important that nurses educate these women about the importance of making a postpartum follow-up appointment with their obstetric provider because follow up care is important.6 There is new research looking at the “4th Trimester” which is the 12 weeks following delivery. During this time, a woman must recover, adapt to changing hormones, and learn to feed and care for her newborn. During this “4th Trimester,” many women experience challenges, including fatigue, pain, breastfeeding difficulties, depression, lack of sexual desire and incontinence and may consider this normal and not seek care.7 Women should not suffer during this time and should receive appropriate care.
Pain is another problem that postpartum women may experience and can interfere with the woman’s ability to care for herself and the baby. Women who have had a vaginal birth may experience uterine cramping, which can increase with each delivery and perineal pain which can be severe with a laceration or episiotomy. These women may also have hemorrhoids. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually effective at treating cramp pain. Ice packs and topical sprays or creams can help with perineal and hemorrhoidal pain. Women who have had a c-section will have abdominal pain. Multimodal pain management including nonpharmacologic and pharmacologic therapies is important to consider. There is a variation in types and intensity of pain women experience during the early postpartum period. There is also a concern that 1 in 300 opioid-naive patients exposed to opioids after cesarean birth will become persistent users of opioids. For postoperative cesarean pain, standard oral and parenteral analgesic adjuvants include acetaminophen, NSAIDs, and mild opioids should be used first.8 Stronger opioids should be reserved for use when the other medications do not relieve pain. It is also important to educate the woman that opioids can pass through breastmilk and sedate the baby.