Patient Teaching:

1. Signs and Symptoms of Infections

a. Fever Anything > 100.4
b. Chills, Lethargy, SOB, Productive Cough
c. Redness, Swelling, Warmth to local area.
2. Monitoring Uterine Status
a. Presence of bogginess (softening of the uterus due to inadequate contraction
of the muscle tissue)
b. Positioning out of midline
c. Heavy lochia flow
d. Presence of clots
e. Formation of a hematoma
f. Changes of Color of Lochia Flow Red→ Serous → white
3. Perineal Care
a. Perineal care after each elimination (urination or defecation) cleanses the
perineum and helps to promote comfort
b. Use of “peri bottles" that the woman can use to squirt warm tap water over
her perineum following elimination.
c. Start at the front and proceed toward the back (area around the anus) to
prevent contamination from the anal area.
d. Perineal pad should be applied from front to back, placing the front portion
against the perineum first.
e. Perineal pads should be changed regularly to prevent infection.
4. Relief of After Pains
a. Breastfeeding women are also more likely to experience after pains than
formula-feeding women because of the release of oxytocin when the infant
suckles.
b. Lie prone with a small pillow under the lower abdomen, explaining that the
discomfort may be intensified for about 5 minutes but then will diminish
greatly.
c. The prone position applies pressure to the uterus and therefore stimulates
contractions. When the uterus maintains a constant contraction, the after
pains cease.
d. Ambulation can assist in pain relief.
5. Nutritional Support
a. Due to NPO Status mothers will be hungry postpartum. She should be allowed
to eat and drink as desired, unless complications prevent it.
b. A breastfeeding mother will require 500 kcal/day above what is ordinarily
recommended for a woman of her age.
c. Many women continue prenatal vitamin and iron supplementation until the
postpartum checkup
d. Breastfeeding mothers may continue supplementation throughout lactation.
6. Sexual Activity
a. Couples were formerly discouraged from engaging in sexual intercourse until
6 weeks postpartum.
 b. Currently, couples are advised to abstain from intercourse until the perineum
is healed and the lochial flow has stopped (usually by the third to sixth week
postpartum).
c. Alternative of Expressing Love: kissing, holding, and talking.
d. Since postpartum women often experience vaginal dryness due to hormonal
changes, the use of a water-based lubrication, such as K-Y jelly or Astroglide,
may initially be necessary during intercourse.
e. The female-superior or side-by-side positions for coitus may be preferable
because they enable the woman to control the depth of penile penetration.
f. Breastfeeding women should be forewarned that during orgasm, milk may
spurt from the nipples because of the release of oxytocin. Some couples find
this pleasurable or amusing; other couples choose to have the woman wear a
bra during sexual activity. Breastfeeding the baby before lovemaking may
reduce the chance of milk release.
g. Maternal fatigue is often a significant factor limiting the resumption of sexual
intercourse.
h. While interest and desire vary, most couples resume sexual activity within 3
months.
7. Signs and Symptoms of Complications
a. The woman should contact her caregiver if she develops any of the signs of
possible complications:
i. Sudden, persistent, or spiking fever (greater than 100.4°F) or chills
ii. Change in the character of the lochia—foul smell, return to bright red
bleeding, excessive amount (more than one pad per hour after 24
hours)
iii. Evidence of mastitis, such as breast tenderness, reddened areas,
malaise, fever, chills
iv. Evidence of thrombophlebitis, such as calf pain, tenderness, redness,
or pain with walking
v. Evidence of urinary tract infection, such as urgency, frequency,
burning on urination
vi. Evidence of infection in an incision (either episiotomy or cesarean),
such as redness, edema, pain or discomfort, discharge, or lack of
approximation
vii. Continued mood changes or signs of postpartum depression, inability
to care for self or baby, feelings of self-harm, or anxiety
viii. Severe pelvic pain or abdominal tenderness