Maintenance of Safety

Activity and Exercise

Recovery Stage

Monitor vital signs every 15 minutes for the first hour and then hourly for the next 4 hours during the recovery stage (Table 27-2). Ensure the mother is settled comfortably in bed. A patient who has just given birth may need to remain in bed for a time to allow her body systems to adjust to fluid volume changes. Early ambulation is key in the prevention of complications. The nurse should take into account the baseline blood pressure, amount of blood lost, type and amount of analgesic or anesthetic medications administered during labor and birth, and level of pain when preparing to assist the woman to ambulate for the first time.

Table 27-2 Vital Signs and Blood Pressure After Delivery

The rapid decrease in intraabdominal pressure after birth results in a dilation of the blood vessels that supply the intestines (known as splanchnic engorgement), which causes blood to pool in the viscera. This contributes to orthostatic hypotension; when a woman who has recently given birth stands up, she may faint or feel lightheaded.

Instruct the patient to use her call bell to summon help before she attempts to get out of bed. Assess her color, pulse, and level of consciousness (LOC) in response to conversation and then assist her in ambulating to the bathroom. Once the woman has reached the bathroom, remain close with frequent inquiries as to her well-being. Have a wheelchair available in the room or just outside in case the woman is too weak to walk back to bed. Encourage her to rest after the ambulation so that she can regain her strength. Keep aromatic ammonia ampules on hand; these can be easily broken if necessary to revive the patient who is ambulating for the first time.

The patient who received conduction anesthesia (epidural block) is kept in bed until she can fully move, feels sensation in her legs, and has blood pressure and pulse within normal limits. Assess her ability to communicate, her LOC, and her vital signs for stability (within normal limits) before allowing her to get out of bed. The patient should wear slippers when ambulating to prevent slipping or sliding.

The patient who has received analgesics needs to be observed closely until she is fully recovered from the medication (i.e., vital signs are stable within her normal range and she is fully awake).

During the first 24 hours after giving birth, the woman’s temperature may be slightly elevated if she is dehydrated. Elevations noted after the first 24 hours may signal the onset of an infection, and temperatures higher than 100.4° F (38° C) are significant and should be reported. Many women feel chilled after giving birth and appreciate an extra blanket or one that has been warmed. Sometimes a beverage such as hot tea or warm milk provides comfort. Tell the patient this chilling is a normal reaction to the stress of labor.

Slight bradycardia, 50 to 70 bpm, is sometimes observed and is not considered abnormal if the other vital signs are within normal limits. Tachycardia may also occur in response to increased blood loss or physical exertion.

Blood pressure may be slightly elevated from exertion, from excitement, and possibly from the oxytocic medications. If the blood pressure is consistently elevated, or if the patient also reports headache or visual disturbances, complications related to gestational hypertension could be occurring. These often persist even after delivery. Notify the physician immediately. A decrease in blood pressure could be caused by altered intraabdominal pressure or hemorrhage. Watch changes closely and report them.

Later Postpartum Stage

Vital signs normally stabilize within the first 2 hours after delivery; report immediately any abnormality that persists longer than this. If vital signs have not stabilized within this time, continue to monitor them every 15 minutes to 1 hour and report significant changes.

A temperature of 100.4° F (38° C) or higher on 2 successive days during the first 10 days after delivery (not including the first 24 hours) is considered indicative of puerperal infection. Closely monitor any signs and symptoms of infection during the postpartum stage. Use good aseptic technique when caring for the postpartum patient. Review the signs and symptoms of infection with the new mother before discharge, and stress the importance of contacting the physician promptly if any of these occur (see Box 27-3).

Also assess pulse and blood pressure. Bradycardia may persist up to 10 days after delivery. Elevated blood pressure readings or a continued decrease in blood pressure may be significant and should be reported promptly.

Thrombophlebitis is a potential complication of the postpartum period. Early and frequent ambulation is the key to preventing this problem. Encourage new mothers to get out of bed and move about in the room. If the baby is kept in a nursery away from the mother’s room, this is a good target for ambulation. If the perineum is uncomfortable, teach the woman to stand using the muscles of the legs while squeezing the buttocks together. This technique also helps when she attempts to sit. If she appears unsteady, accompany her when she ambulates. Ambulation is important for women who delivered via cesarean birth and may be initiated as early as the same day of surgery. Remember that inactivity predisposes patients to development of thrombophlebitis.

The flow of lochia may increase suddenly when the patient gets out of bed; secretions that pooled in the vagina drain out of the body when she stands. Once the lochia has changed to serosa or alba, excessive exercise or activity may result in the lochia changing back to rubra. This is a sign to slow down and increase activity gradually.

The physician indicates when postpartum exercises are suitable for the new mother, whether she delivered vaginally or via cesarean. The woman should begin gradually and avoid vigorous exercise until after the examination at 6 weeks, when the physician releases her to do so. Teach her isometric exercises that help toning without causing undue exertion.

Rest and Sleep

Rest and sleep are important through the postpartum period. After the difficulties most women encounter at the end of pregnancy, it is a pleasure to sleep in any position desired. Many women report that the night 

after delivery, they get the best sleep they have experienced in weeks.

Hospital noises interrupt the sleep of many new mothers. Keeping environmental noise to a minimum to promote rest and sleep is helpful. Do not disturb the patient’s sleep unless it is necessary to protect her well-being.

If she is breastfeeding, the new mother nurses her baby at 2- to 3-hour intervals during the night. This interrupted sleep pattern may persist for weeks until the infant is capable of sleeping for 5 or 6 hours without a feeding. Encourage the patient to take advantage of periods during the day when the baby is sleeping to rest and nap to compensate for lost sleep. If sleep deprivation is prolonged, it may interfere with milk production and the let-down reflex.