Postpartal Care
Postpartal Care tests monitoring of involution, bleeding, breastfeeding, perineal healing, and emotional adjustment during the first hours and weeks after birth.
Core rules
- BUBBLE-LE structures assessment: Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Legs, Emotions.
- Involution: the fundus is at the umbilicus immediately after birth, descends about 1 cm per day, and is usually not palpable abdominally by 10–14 days.
- Lochia: rubra for 1–3 days, serosa for 4–10 days, alba for 11–21 days. Foul odor, large clots, or return to bright red bleeding is abnormal.
- Postpartum hemorrhage is blood loss over 500 mL after vaginal birth or over 1000 mL after cesarean birth; uterine atony is the leading cause. Massage the uterus, empty the bladder, give oxytocin per protocol, and refer.
- Breastfeeding should start within 1 hour with skin-to-skin contact; exclusive breastfeeding is recommended for 6 months, then complementary feeding.
Worked example
Two hours after a home birth, the mother has a boggy fundus above the umbilicus and heavy bleeding. The midwife calls for help, massages the fundus, empties the bladder, gives oxytocin per protocol, starts IV access if available, and refers urgently. The reasoning is that atony is the most common cause of early postpartum hemorrhage and massage plus oxytocin addresses it while transfer addresses ongoing risk.
Traps
Do not assume a full bladder is harmless; it displaces the uterus and worsens atony. Do not treat afterpains as infection. Do not stop breastfeeding for ordinary fever without assessment. Do not ignore sadness, insomnia, or thoughts of self-harm.