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Postpartum Care

Postpartum

Postpartum Assessment: BUBBLE-EE

  • Breasts: Engorgement, nipple condition
  • Uterus: Fundal height, consistency (firm/boggy)
  • Bladder: Voiding pattern, distention
  • Bowel: Bowel sounds, constipation
  • Lochia: Amount, color, odor, clots
  • Episiotomy/perineum: REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation)
  • Emotional status: Bonding, mood, "baby blues" signs

Lochia Stages

  • Lochia rubra: Days 1-3; bright red, bloody
  • Lochia serosa: Days 4-10; pinkish-brown, serosanguineous
  • Lochia alba: Days 11-21; yellowish-white, leukocytes

Fundal Assessment

  • Immediately postpartum: firm, midline at umbilicus
  • First 12 hours: remains at umbilicus
  • Descends 1 cm (1 fingerbreadth) per day
  • Non-palpable by 10-14 days
  • If fundus is boggy: massage gently until firm
  • If fundus deviated to right: empty bladder

Postpartum Vital Signs

  • Temperature: slight elevation (100.4°F/38°C) first 24 hours due to dehydration
  • Pulse: bradycardia (50-70 bpm) normal first 6-8 days
  • Blood pressure: return to pre-pregnancy baseline

Postpartum Hemorrhage

  • Blood loss >500 ml vaginal delivery; >1000 ml cesarean
  • Leading cause: uterine atony (failure of uterus to contract)
  • Other causes: lacerations, retained placental fragments, hematomas
  • Signs: boggy fundus, excessive bleeding, tachycardia, hypotension
  • Interventions: fundal massage, oxytocin administration, bladder emptying

Breastfeeding

  • Initiate within first hour of life
  • Feed on demand (8-12 times/day first month)
  • Signs of adequate milk supply: content infant, good weight gain, 6-8 wet diapers/day
  • Proper latch: mouth wide, lips flanged, nose and chin touching breast
  • Break suction by inserting finger at corner of infant's mouth
  • Nipple care: air dry, express breast milk, emollient cream
  • Maternal fluid intake: 2500-3000 ml daily

📝 NCLEX Priority Points

  • BUBBLE-EE: Breast, Uterus, Bladder, Bowel, Lochia, Episiotomy, Emotional status
  • Fundus should be firm and midline; if boggy → massage and notify provider
  • Lochia: rubra (1-3 days), serosa (4-10 days), alba (11-21 days)
  • Postpartum hemorrhage: >500 mL vaginal, >1000 mL cesarean

💊 Key Medications & Interventions

  • Oxytocin: Given after delivery to promote uterine contraction
  • NSAIDs: For postpartum pain; safe for breastfeeding
  • Stool softeners: Prevent constipation after delivery

Source: AWHONN, ACOG Guidelines. For educational purposes only. Always follow facility protocols and current clinical guidelines.