00:01
So let's talk about emotions.
00:03
This is one of the areas in the
postpartum period that up until recently,
we just weren't asking
enough questions.
00:09
So we absolutely want to
look for signs of depression.
00:12
And this is, I just can't stress
enough how important this is.
00:17
Because what we have found is
that when we don't take care
of the patient's
emotional status,
that can have long
term effects for them,
it can have long term
effects for the child
and for everyone else
that they're around.
00:30
So it's very important that
we begin the assessment here,
it doesn't end
with the hospital.
00:35
But we definitely need to
make sure that we start.
00:38
So if a client has had
a history of depression,
or they've been
treated for depression,
during their antepartum period,
then we definitely know their increased
risk for postpartum depression.
00:49
And one of the biggest things we
can do to help prevent depression
is to make sure that the
client is getting enough rest.
00:56
Oh I know, rest and new baby
don't exactly go together.
01:00
But there are ways that
we can help promote that.
01:04
Now, baby blues is just that
feeling of maybe overwhelm, anxiety
that's very typical and it may
last up until 2 weeks postpartum.
01:13
Think about all the hormones that
are floating around in the system
that are trying to find their
way back to a normal level.
01:18
And that might cause
some teary moments.
01:21
And being a little
tired may make you teary
and things hurting sometimes
may make you feel not so great.
01:28
That's normal,
about 80% of clients can expect
that they will have
that as a symptom.
01:34
But they need to understand that if
it progresses longer than 2 weeks,
that's not baby blues,
and they need to come in and
they need to talk to someone.
01:42
So we can not only promote
rest, but also support.
01:46
So while we're in there with the
client, who's coming to visit?
Who's there? Who can they identify to
give them a break when they need it?
Or let them sleep and watch the
baby so they can do something else.
01:57
This is so so so important.
02:01
We have a scale called
Edinburg depression scale.
02:03
And I'm going to talk a
little bit more about that
a little bit later
in this slide deck.
02:07
But I want to make sure
that you think about this
because we don't do enough of
assessment with this scale.
02:14
Thinking about bonding.
02:16
So this is our final
end of our pneumonic.
02:18
We want to see how the client
is interacting with the infant.
02:22
Are they together?
Where is the infant?
Every time the nurse comes in the
room, is the baby on the other side?
Is someone else
holding the baby?
Does the client seem not very
interested in the newborn?
That is a sign that something
may not be going as it should be.
02:37
If they're not interested
in taking care of the baby,
if they're not interested
in changing the diaper
or knowing that the
feeding is going okay,
then again,
there may be an issue.
02:48
Now I want to put
this in context.
02:49
If this is baby number 8, this may be
the only break that the patient gets.
02:54
And their desire to maybe have
some time away from the baby
might be completely
understandable.
02:59
But definitely check in on this.
03:02
And you want to make sure that maybe
the parents are proud of the baby
like this should be
a wonderful thing
or they're making fun of the baby or
not talking about the baby in a way
that exudes sort of positivity,
that could also be a sign that
the bonding has been impaired.
03:17
Now Reva Rubin performed this
experiment many, many years ago,
believe it or not, I learned about
this when I was in nursing school,
I don't even want to tell
you how many years ago,
but this is about attachment.
03:30
And there are 3
phases of attachment.
03:32
They're called taking in,
taking hold and letting go.
03:37
So in the taking in phase,
this usually happens
for about the first
24 hours up to day 2.
03:44
And in this particular phase,
then the client is really dependent.
03:49
So they may need help, they may be
preoccupied with the labor and how it went.
03:54
And so they are really
focused on themselves
and maybe need some extra
help with changing diaper
or getting the baby to breast
or any of those things.
04:03
After we move past day 2,
the phase of taking hold comes in.
04:08
And the interest about taking
care of the infant should pop in.
04:11
And they should be eager to
learn about what they need to do
to make sure the baby
is safe and happy.
04:16
They're still reliant on a little
bit of support from everybody else,
but they're not as
focused on themselves.
04:23
The final phase of
attachment is letting go.
04:26
Now, this letting go phase
means that they've really
integrated this baby
into their whole life.
04:31
So they're thinking about, "Oh,
I'm going to take the baby to the store,
I'm going to be with the baby
while I'm doing my daily tasks",
and they've just sort of gone
back to their new normal.
04:42
Now, letting go with someone who's had 2
or 3 babies before may happen really soon.
04:48
But if you find that this
particular stage is delayed,
and this is something you might want to
talk to the support and the family about
because usually
they're going to notice
if we find that the client
is still very dependent
and we're 2 weeks out,
something is going on with attachment
and we need to assess
that a little bit further.
05:05
So this is Reva Rubin and
her stages of attachment.
05:09
So let's go back
through that pneumonic,
so that you remember BUBBLE DEB.
05:14
B for breast, U for uterus, B for
bladder, B for bowel, L for lochia,
E for episiotomy and that
includes cesarean incision,
D for DVT, E for emotion,
and the last B for bonding.
05:28
Now, there's some other things that we
need to do during the postpartum period.
05:33
So maybe you'll remember that
back when we discuss antepartum.
05:36
We talked about RhoGAM.
05:38
And RhoGAM being an injection, and that's
given for clients who are Rh-negative.
05:43
In cases where they may have
a fetus that's Rh-positive,
and we want to decrease the
possibility of sensitization.
05:49
So this issue is going to come back
up again, after the baby is delivered.
05:53
So if the client is Rh-negative
and the infant is Rh-negative,
then we don't have to
give any RhoGAM, okay?
But if the client is Rh-negative,
and the fetus is Rh-positive,
then there is a possibility
of sensitization
and so we will need to give
RhoGAM within 72 hours, okay.
06:13
So the good thing is,
is that now that the baby is outside,
we can actually get a blood type for the
fetus, or now the baby, and we'll know.
06:23
Vaccinations.
06:24
So again, thinking about
the antepartum period,
rubella injections
were contraindicated,
because we can transmit the
rubella it's a live vaccine,
and that can be
transmitted to the fetus.
06:36
While once the baby's out,
then it's safe for the mother or
the patient to receive rubella.
06:42
So if they are
rubella nonimmune,
this may be an opportunity
to correct that.
06:47
Also, if we're in the
middle of flu season,
if the client has not
already gotten the flu shot,
now would be a
wonderful time to do so.
06:56
What other things do we need to think
about during the postpartum period?
Well, comfort, because again,
there's a lot of reasons why the patient
might not be comfortable after all
those things that have happened.
07:06
So we can offer
some suggestions.
07:09
If the client is
feeling contractions,
then remember,
the uterus has to stay firm in order to
diminish the possibility of
a uterine hemorrhage, right.
07:19
So if we do that,
then thinking about
how hard the uterus has
to contract to stay firm,
it's going to be pretty
uncomfortable.
07:26
And the more babies you have, the more
outstretched the uterus is going to be,
and the stronger those
contractions are going to be.
07:34
So if that happens, and this is
a complaint that the client has,
we can use non-steroidal
anti-inflammatories to help with that.
07:42
Other things that are non-pharmacological
for clients who really don't want that
would be things like a
heating pad or lying prone.
07:50
So applying pressure
to the abdomen
sometimes will alleviate
some of that discomfort.
07:55
If you think about it that the
uterus is sort of flopping,
it's going to contract more.
07:58
So if we keep it tight,
then it will contract less
and then we'll have less pain.
08:04
If the client has experienced
any lacerations at all,
so whether they be vaginal,
whether they've had an episiotomy,
or they have a uterine incision,
they may have some discomfort.
08:15
If the lacerations are
in the vaginal area,
we can use an ice pack
for the first 24 hours.
08:20
Only 20 minutes though,
if we keep the ice pack on
longer than 20 minutes, we can necrose the
skin tissue so we don't want to do that.
08:28
So ice the first 24 hours,
we can use a sitz bath where
they sit in warm or cool water
to help alleviate some
of that discomfort.
08:37
Or there may be a topical anesthetic
spray or foam that might be prescribed
that they can use to help
alleviate some of that discomfort.
08:46
Remember those hemorrhoids we
were looking at or looking for.
08:49
We want to see if they're there
because they can be very uncomfortable.
08:53
Again, ice packs work wonders.
08:55
We can do sitz baths
for that as well,
tucks pad and they have witch hazel sort
of on a nice big round pad that we can use.
09:03
We can use gel.
09:05
There are other sort of topical
applications that can be used
to help alleviate
discomfort from hemorrhoids.
09:11
If we have sore nipples.
09:13
Often sore nipples are an
indication of poor latch.
09:16
So one of the things you can do as the
nurse is to really check and make sure
that the latch while the baby is
breastfeeding is actually secure
that we're not getting
a lot of smacking.
09:26
So yes, smacking when you eat
indicates that something is good.
09:30
However, smacking when you're breastfeeding
indicates that the latch is not good
and that will lead to things like bruising
and blistering and things like that.
09:39
So if that occurs,
then we can do things like
check the latch, we can call the
lactation consultant for help with latch.
09:49
We can also place things like
ice or believe it or not teabags.
09:55
If the breasts are engorged, so let's
say the milk is starting to come in.
09:59
Check this out.
10:00
Cabbage leaves, right?
There is something in cabbage leaves
that help with breast engorgement.
10:05
Really strange, but it works.
10:08
And one of the best advice that I
can give clients when they go home
is to take the cabbage
and separate the leaves,
put it in the freezer,
and then you can go to the store,
like with cabbage leaves on
and they're the perfect shape
and they help with engorgement.
10:21
It's awesome.
10:23
Okay.
10:24
If the client is tired,
which absolutely makes sense,
then we want to encourage them to rest
when the baby's resting and ask for help.
10:33
If someone says,
"Is there something I can do?"
The answer is always yes.
10:37
Always yes.
10:38
Always yes.
10:40
So I told you we would talk about
the Edinburgh depression scale.
10:44
So now we're going
to talk about it.
10:45
So the Edinburgh depression scale
is a series of 10 questions.
10:49
And the client will
answer these questions.
10:51
Hopefully they did it during
the antepartum period.
10:54
But definitely during
the postpartum period.
10:57
If they have a score
that is greater than 10,
that is an indication that they may
be experiencing postpartum depression,
not just blues,
but postpartum depression.
11:06
Question number 10 asked
specifically about self harm.
11:10
If they answered that
question in the affirmative,
it doesn't matter what
else the scale says,
then we know that we're
going to refer them for care.
11:17
So this is the Edinburgh
depression scale.
11:21
Before the client leaves the hospital,
we have some teaching that we need to do.
11:25
They need to know what might
happen when they go home.
11:28
And when they might need
to call their provider
because something
serious is going on.
11:33
If they have a fever that's
over 38°C or 100.4°F,
then we need to know because
there may be an infection brewing.
11:41
If they have extreme engorgement in the
breast so that they are uncomfortable,
especially if it's unilateral so 1
breast more engorge than the other,
along with pain or redness
may indicate mastitis.
11:53
So we definitely want to hear from
them if they're experiencing that.
11:56
Any pelvic or abdominal pain,
especially that's not relieved
by our normal medications,
because that may be
indicative of an infection
or it may be indicative of a hematoma
that's brewing in the pelvic area.
12:09
Abnormal lochia.
12:10
So thinking about the stages,
the alba, the rubra, the serosa.
12:15
Are those occurring
in the correct order?
We have to talk to the client
and let them know what to expect.
12:20
So if something is off
there, they can call.
12:22
It may indicate again,
an infection or hemorrhage.
12:26
If they're soaking more than a pad an hour,
so if you have a maxi pad, and you use it,
and you find that you're
needing to change that
sooner than an hour,
because it's saturated,
that's too much lochia
and we need to know.
12:39
If the clots are larger
than a golf ball,
especially if it's not after a period
of lying down for a really long time,
then we need to know
that's too much bleeding.
12:49
Vaginal odor might
indicate an infection.
12:52
So a fleshy sort of
odor is pretty typical,
but something that really wrinkles,
your nose that smells foul,
that's a problem and we
need to know about that.
13:01
If they have urinary
frequency, urgency, burning
that may be indicative of
a urinary tract infection.
13:08
So we need to hear about that.
13:11
If they've not had any bowel
movement, 2-3 days postpartum,
especially if they had a cesarean
delivery we want to know about that.
13:18
But even if they had
a vaginal delivery,
they may be severely constipated
and that's not what we want.
13:23
So we need to hear from them
if they experience that.
13:27
Calf tenderness might indicate a
DVT so if they're feeling that,
tell them to give us a call.
13:33
If they have a depressed
mood after 14 days,
again, sign of emotional challenges,
sign of postpartum depression.
13:40
We need to know.