Postpartum Care and Newborn Adaptation
What this domain tests
Postpartum questions test detection of haemorrhage and sepsis, normal involution, breastfeeding support, and recognition of the newborn's transition to extrauterine life. You must distinguish normal adaptation from deterioration.
Core rules
- After birth, assess the uterus, blood loss, perineum, vital signs, and bladder. A boggy uterus with heavy bleeding is uterine atony until proven otherwise.
- Lochia changes from red (rubra) for 3–4 days, to brown-pink (serosa), then white-yellow (alba). Offensive odour, fever, or a return to bright red bleeding suggests infection or haemorrhage.
- Encourage skin-to-skin contact and breastfeeding within the first hour for stable mother and baby. Support rooming-in and on-demand feeding.
- Newborn adaptation includes breathing, circulation, thermoregulation, and glucose homeostasis. Dry the baby, place skin-to-skin, cover the head, and monitor temperature.
- Assign Apgar scores at 1 and 5 minutes: heart rate, respiratory effort, muscle tone, reflex irritability, and colour. Apgar guides assessment, not resuscitation decisions.
- Give vitamin K 1 mg intramuscularly to the newborn and follow local eye-prophylaxis and screening schedules.
Worked example
At 1 minute a term newborn has a heart rate of 120, slow irregular breathing, some flexion, grimacing, and blue extremities. Scores: heart rate 2, breathing 1, tone 1, reflex 1, colour 1, total 6. Dry, stimulate, and keep warm; reassess at 5 minutes. A score of 6 is not itself an indication for resuscitation, but the breathing pattern and tone require close observation.
Traps that cost marks
Do not use Apgar to decide whether to start positive-pressure ventilation. Do not assume lochia is always normal: bleeding that soaks a pad in an hour needs review. Do not delay breastfeeding for routine procedures in a stable baby. A newborn's hands and feet may be blue normally; central cyanosis is not normal.
Key points
- Lochia rubra lasts about 3–4 days; offensive lochia suggests infection.
- A boggy uterus with heavy bleeding indicates uterine atony.
- Apgar is scored at 1 and 5 minutes and is not a resuscitation tool.
- Skin-to-skin contact supports thermoregulation and breastfeeding.
- Vitamin K 1 mg IM is given to the newborn.
- Return to bright red bleeding after lochia has lightened requires assessment.