NSPN 7100: Module 8- Postpartum and
Transition to Parenthood
The responses of new mothers to this period vary and will depend on a number of factors. What
factors may be considered? - ANS her antepartum experiences, her expectations for childbirth,
the length of her labour, the difficulty of her birth, pain experienced during labour, and whether
birth was normal, assisted, or operative. Responses will also be affected by her age, past
experiences including abuse and trauma, social supports, culture, and whether the pregnancy
was planned or unexpected.
Why is providing women with the opportunity to share their birth stories a significant nursing
intervention? - ANS It may foster self-actualization, promote maternal role attainment, enhance
the couple's relationship, and enrich the family's perspective.
What kind of questions could you ask new parents to assess their initial adaptation to
parenting? - ANS A good opening question could be "tell me about your labour and birth? Was
it what you expected? Do you have any questions about the experience?" It can also be helpful
to specifically ask the father, "and how was it for you?" This may open up the conversation for
the couple to express concerns or seek clarity about why something happened.
In the first 24 hours postpartum, what are the maternal assessments? - ANS - vital signs
- fundus- position and tone
- flow- amount, color, consistency
- perineum- swelling, pain, stitches
- bladder- voiding
- bowel- last BM, does she need stool softener?
- breasts
- pain- perineal pain? Incisional pain post C/S
- legs (for thrombosis)
- nutrition and hydration
- support systems
- emotional status
- readiness for self-care
- readiness for baby care
Some nurses like to use the acronym BUBBLES when performing their assessment. What does
this acronym stand for? - ANS Breast, Uterus, Bowel, Bladder, Lochia, Episiotomy, and
Supports
What is the average blood loss for vaginal birth? - ANS 300-500 ml
, What is the average blood loss for caesarean birth? - ANS 500-1000 ml
Vital signs may have slight variations in the immediate postpartum period. What slight variations
may be seen? - ANS heart rate elevation in the first hour, transient increase in blood pressure
in the first few days' postpartum, and slight increase in temperature during the first 24 hours.
How is involution (the return of the uterus to pre-pregnant state) assessed? - ANS palpating the
fundus and monitoring the vaginal flow
Fill in the blanks:
At the end of the third stage of labour, the fundus should be approximately ___cm below the
umbilicus and midline. By 12 hours postpartum it can rise to ___cm above the umbilicus then by
24 hours it should be at or just below the umbilicus. It should descend by _____cm every 24
hours - ANS At the end of the third stage of labour, the fundus should be approximately 2cm
below the umbilicus and midline. By 12 hours postpartum it can rise to 1cm above the umbilicus
then by 24 hours it should be at or just below the umbilicus. It should descend by 1-2 cm every
24 hours
When the fundus is above the umbilicus and/or deviated to the right, what may this indicate? -
ANS it may indicate a full bladder.
How does a full bladder increase the risk of PPH? - ANS A full bladder increases the risk of
postpartum hemorrhage (PPH) as the uterus is not able to contract efficiently
Uterine discharge is known as lochia and the amount and color changes over time. Describe the
colour and time frame for each of the following to appear?
Lochia rubra
Lochia serosa
Lochia alba - ANS Lochia rubra: is dark red and lasts for 3-4 days
Lochia serosa: is pink or brown and lasts for 10-14 days
Lochia alba: is yellow to white and may last up to 4-8 weeks
Fill in the blanks:
a first degree perineum tear involves ______________, while a 4th degree tear extends
_______________. - ANS a first degree tear involves skin and vaginal mucous membrane only,
a 4th degree tear extends completely through the rectal mucosa
What are factors that are associated with perineal trauma ? - ANS poor maternal nutritional
status, birth position, pelvic anatomy, fetal malpresentation and position, large infant, use of
forceps or vacuum, prolonged second stage, or precipitate birth
