Which information would the nurse emphasize in the teaching plan for a postpartum woman who is reluctant to begin taking warm sitz baths?

Postpartum Pain Management

How you feel should guide your activity level. You may wish to limit your visitors in order to get the rest you need and to take advantage of the nursing care and teaching.

We support your choices and have very few routines or rules. Please tell the staff what is important to you during your hospital stay. We encourage you to ask questions and hope you feel well cared for. Taking good care of yourself is an important part of parenting. It will be some time before your body returns to how it was before you became pregnant, but there are things you can do that will assist the natural recovery phase.

Pain Management
Most women experience some degree of pain or discomfort after childbirth. The perineum (area surrounding the vaginal opening) may be bruised, or you may have had some stitches to repair a tear or episiotomy. If you had a Cesarean birth, you have pain at your incision site and it is uncomfortable to move, cough, and even laugh.

You will be asked how you feel periodically throughout your stay in the hospital. You can help by telling us on a scale of 0 to 10 how your pain feels. Having no pain is characterized by 0 (zero) and 10 is the worse possible pain you know. As the parent, you may also find it comforting to know that we have a scale to measure newborn pain that your baby may experience during a procedure such as circumcision or blood draw. We make every effort to comfort your newborn during any painful procedure and we will teach you how to do the same.

Your doctor or midwife has left orders for medications to reduce your pain and increase your comfort. Your nurse will administer any additional pain medications prescribed by your physician or midwife. Let your nurse know if you have pain as soon as you begin to feel uncomfortable. In addition to pain medication, your nurse can suggest comfort techniques such as the use of ice on sore stitches or sitting and lying positions that can help you feel more comfortable.

Bleeding and Afterpains
After delivery, uterine contractions expel blood and tissue. This vaginal flow is called lochia and continues for two to six weeks after delivery. The first several days after delivery, bleeding is usually heavy and bright to dark red in color. Some clots as large as a small tangerine are normal. If you are expelling many large clots or experiencing an unusually heavy flow (soaking through a large pad in an hour or less), call your nurse while you are in the hospital, or your physician or midwife once you are home.

Bleeding will decrease over the next few weeks, and change color from bright red to pink to brown to yellow and then clear. It should have a strong fleshy smell, not a putrid odor. A return to bright red bleeding or passing of large clots once your bleeding has slowed may signify excessive activity on your part. It is your body’s way of reminding you to rest and take it easy.

Afterpains (cramping) are the contractions of the uterus occurring in the days following childbirth. They are normal, but can be uncomfortable. Afterpains are usually strongest on the second and third days following delivery, when you are breastfeeding or after you take a uterus-contracting medication prescribed by your physician or midwife. Cramping is most noticeable after the birth of a second or third baby.

Afterpains gradually decrease in intensity, but may last seven to ten days. To help ease afterpains, try the following:

• Use ibuprofen or prescribed medication as needed.
• The same relaxation and breathing techniques used during labor can help alleviate afterpains as well.
• Start walking soon after delivery.
• Keep your bladder empty.
• Frequent breastfeeding, starting immediately after birth, can also alleviate afterpains.

Changes in Your Uterus
Immediately after delivery and for the next several days, the uterus weighs about two pounds. You can feel it just below your navel as a firm mass about the size of a grapefruit. Large blood vessels bleed into the uterine cavity where the placenta was attached to the wall of the uterus. The uterus contracts firmly to prevent the uterus from filling with blood and clots and to prevent heavy blood loss. The following activities help the uterus contract:

• You, your husband/partner, and your nurse can massage your uterus for the first few days after delivery. This is done by placing your hand on your uterus and slowly rubbing in a circular motion. This procedure will stimulate contractions and make your uterus become firm.
• If you breastfeed, the hormone oxytocin is released, which causes your uterus to contract.
• Occasionally, medication is given for several days after birth to keep your uterus firm.
• Once at home, you no longer need to massage your uterus.
• The uterus continues to decrease in size until it returns to its normal size and weight of about two ounces six weeks after delivery.

Laceration (Tear) or Episiotomy
During childbirth, the perineum stretches and occasionally tears. If the tears are small, you may experience some uncomfortable swelling and stinging. If the tear is large, you will experience more pain and will have stitches.

Occasionally, an episiotomy (a surgical incision that enlarges the vaginal opening) is performed to facilitate the birth of the baby. The amount of pain following an episiotomy or deep tear varies among individuals. It is caused by the swelling of the tissues surrounding the vagina as well as by the incision or deep tear. Swelling and discomfort usually peak on the second or third day after delivery, but it is difficult to predict how long the discomfort will persist. Some women experience little or no discomfort, while others experience dull, aching pain for some time. This is normal and eventually subsides.

Helpful Hints for Care of the Perineum:

• Always wash hands well before and after cleaning the vaginal area.
• In the first 24 hours after delivery, place ice on your perineum to reduce swelling and pain. Ice may be continued at home as needed.
• When sitting, position yourself squarely on the bed or in the chair, tightening the perineum, buttocks, and thigh muscles. (Sitting only on one hip may pull your stitches.) Start gentle perineal exercises (see Postpartum Exercise Program in this section).
• After urination or bowel movements, cleanse your stitches by squirting warm water from the top of the stitches back toward the rectum. At home, continue to use your peribottle. Pat dry with a clean tissue, again from front to back. If you have burning over your stitches when you urinate, pour warm water over this area to dilute the urine as you go.
• Apply a clean sanitary pad from the front to back. Some women find it soothing to place witch hazel compresses between the pad and the stitches.
• Twelve hours after your baby’s birth, you can start taking sitz baths. Your nurse will instruct you in how to use a sitz bath. When you go home, you may also use your bathtub, filled with several inches of warm water. Sitz baths may be done several times a day for 20 minutes and may be continued as needed for comfort.

Cesarean Birth

Helpful Hints

• If you need to cough or sneeze, hug a pillow snugly against your incision to splint it and reduce the pain and pressure over the incision.
• Constipation is common after any abdominal surgery. It is also a side effect of many pain medications. Therefore, it is important to continue to take a stool softener and to eat foods that are high in fiber.
• Pain medications prescribed by your physician or midwife are safe to take while breastfeeding, and should be taken as directed to remain comfortable.
• Rest as much as you can and avoid lifting anything heavier than your baby.
• Mothers who have had Cesareans are just as successful at breastfeeding as women who have given birth vaginally.
• To increase your comfort during breastfeeding, use a pillow to position your baby away from your incision.
• Your physician or midwife will discuss the events that led to the decision to deliver your baby by Cesarean. Most causes are non-repeating, and it is possible that if you choose to have another baby, you may deliver vaginally.
• You will leave the hospital with steri strips over your incision. These tape strips stay in place until your physician or midwife removes them at your postpartum check.
• Call your physician or midwife if your incision opens, or if it becomes sore and red, has a greenish-yellow drainage, or bleeds.

Hemorrhoids
Hemorrhoids are protruding veins in the rectum that often cause a constant dull pain or feeling of pressure around the anal area. They become prominent during late pregnancy or labor. Hemorrhoids can become aggravated by the constipation that commonly follows delivery. They may become swollen and tender, sometimes itch, and may bleed.

Treatment for Hemorrhoids

• Apply a cold ice pack for 20 to 30 minutes, several times a day as needed for swelling and comfort.
• Take sitz baths in warm or iced water. Lie down for 15 minutes after a sitz bath.
• You may use soothing over-the-counter medications such as Tucks, witch hazel, or hemorrhoid ointments.
• Avoid constipation by using stool softeners.
• Drink lots of water and eat fresh fruits, vegetables, and whole grains.
• Ask your physician or midwife for a prescription for hemorrhoid medication if these measures do not increase your comfort.

Which of the following would you emphasize in the teaching plan for a postpartum woman who is reluctant to begin taking warm sitz baths?

Which action would most make the nurse believe that a postpartum woman is accepting a child well?

For which reason is a postpartum client encouraged to walk?

Which of the following findings would lead you to suspect that a woman is developing a postpartum complication *?