NURSING CARE OF A WOMAN AND FAMILY IN

PREPARATION FOR DISCHARGE

The greatest need of a postpartal woman before discharge from a health care agency is education
to prepare her to care for herself and her newborn at home.
SHE MUST:
Be aware danger signs to look for and know whom to call if she notices any of them
understand safe baby care.
be aware that learning does not take place if the learner is overwhelmed and hurried
use common sense to determine when it is time to teach and when it is time to observe or listen.
Observation of mother–child or parent–child interactions and evaluation of a woman’s support
system at home are the basis for much of the teaching.

Many mothers say that child care did not seem real during pregnancy.
The postpartal period is a time for teaching, reteaching, and offering anticipatory guidance to
help in the new situations a family can expect when they go home.
During the taking-in phase of the puerperium, a woman may not show much interest in learning;
she is more in need of the comfort of being taken care of. Some nurses assume that multiparas
will react negatively to child care suggestions.
All mothers, whether primiparas or multiparas, need to be evaluated individually and helped
whenever they ask or you find that they need guidance.

Group Classes
Providing group classes on bathing infants, breastfeeding techniques, minimizing jealousy in
older children, and maintaining health in the newborn can be helpful to mothers and fathers,
because in these settings they can learn not only from the instructor but also from other parents.
Brain-storming this way is helpful to women who envision jealousy problems with older
children or who plan to return to a full-time job and also breastfeed (Abdulwadud & Snow,
2009).
Be certain that a time for questions and answers is planned at these sessions, so parents can
apply what is being taught to their individual circumstances.
Urging fathers to attend classes is helpful, because many fathers give direct child care for at least
part of every day. Problems that arise with newborn care are, by their nature, family problems,
and every effort should be made by nursing personnel to help both parents prepare to deal with
them.

Individual Instruction
Every family needs some individual instruction in how to care for their infant and how the
woman can care for herself after discharge.
How to bathe and feed the baby, how to care for the infant’s cord and circumcision if the infant
has this, a review of how much infants sleep during 24 hours, and how to fit a newborn into the
family’s pattern of living are topics parents like to discuss.
You can teach without lecturing by making a comment such as, “Notice how large all newborns’
heads seem” while you are showing the parents how to bathe the baby, or “Babies like to be
bundled firmly” while you are helping dress the child, or “Notice how uneven newborn
respirations are.”
Discharge Planning
Before a postpartal family is discharged from the health care agency, a woman will be given
instructions by her physician or nurse-midwife concerning her care at home.
Before discharge, make sure a woman is aware that she must return for an examination 4 to 6
weeks after birth, and that she should make an appointment to take her baby to a primary care
provider for an examination at 2 to 4 weeks of age.
If a woman does not have an adequate rubella antibody titer and anticipates further pregnancies,
she may receive a rubella immunization before discharge. Women who are Rh negative and who
have had an Rh-positive infant will receive RhiG or Rh antibodies to prevent problems in a
future pregnancy (Crowther & Middleton, 2009).
Be certain that discharge instructions are given both verbally and in writing. Getting ready to go
home, dressing the baby, seeing him or her in new clothes for the first time, and experiencing the
thrill of realizing the baby is really theirs to take home is so exciting that oral instructions may go
unheard.
Review the instructions with the parents to be sure they understand them.
Many health care agencies have a community liaison person, ideally a nurse, who calls or makes
a home visit to mothers after discharge.
This person helps the new mother assess her own health and that of her baby and answers
questions from families who lose their instructions or are unable to interpret them after they have
returned home.
Making a telephone call to or visiting a family 24 hours after discharge is the most helpful way
to evaluate whether the family is able to continue self-evaluation and infant care and is able to
integrate the new infant into the family.

POSTPARTAL DISCHARGE INSTRUCTIONS

Area Instructions

Work
All women should avoid heavy work (lifting or straining) for at least the first 3 weeks
after birth. Women differ in their concept of heavy work, so it is a good idea to explore what a
woman considers heavy work. If she plans to do too much, you can perhaps help her to modify
her plans. It is usually advised that a woman not return to an outside job for at least 3 weeks (or
better, 6 weeks), not only for her own health but also for enjoyment of the early weeks with her
newborn.

Rest
A woman should plan at least one rest period each day and try to get a good night’s sleep.
She can rest during the day when her newborn is sleeping, unless she has other children or an
aged parent to care for. If she has others dependent on her, explore the possibility of having a
neighbor, another family member, or a person from a community health agency relieve her.

Exercise
A woman should limit the number of stairs she climbs to one flight/day for the first week
at home. Beginning the second week, if her lochial discharge is normal, she may start to increase
this activity. This limitation will involve some planning on her part, especially if her washing
machine is in the basement and she must wash diapers every day, or if she must go up and down
stairs to check on her baby. It is probably better to arrange for a place for the baby to sleep
downstairs as well as upstairs, so the baby must be taken upstairs only at bedtime. She should
continue with musclestrengthening exercises, such as abdominal crunches.

Hygiene
A woman may take either tub baths or showers. She should continue to apply any cream
or ointment as ordered for the perineal area and cleanse her perineum from front to back. Any
perineal stitches will be absorbed within 10 days. She should not use vaginal douches until she
returns for her postpartal checkup.

Coitus
Coitus is safe as soon as a woman’s lochia has turned to alba and, if present, the
episiotomy is healed (usually about the first week after birth). Vaginal cells may not be as thick
as formerly because prepregnancy hormone balance has not yet completely returned. Use of a
contraceptive foam or lubricating jelly will aid comfort. Be certain she knows safer sex
precautions.

Contraception
If desired, a woman should begin a contraception measure with the initiation of coitus. If
she wishes an IUD, this may be fitted immediately after birth or at her first postpartal checkup.
Oral contraceptives are begun about 2–3 weeks after birth. A diaphragm must be refitted at a 6-
week checkup. Until she returns for this checkup, an over-the-counter spermicidal jelly and
condoms can provide protection.

Follow-up
A woman should notify her physician or nurse-midwife if she notices an increase, not a
decrease, in lochial discharge, or if lochia serosa or lochia alba becomes lochia rubra. Delayed
postpartal haemorrhage can occur in women who become extremely fatigued. Getting adequate
rest during her first weeks at home will do much to prevent the possibility of this complication.
Four to 6 weeks after birth, a woman should return to her physician or nurse-midwife for an
examination. This visit is important to ensure that involution is complete, immunization against
the virus associated with cervical cancer (HPV), and reproductive life planning (if desired) can
be discussed.

REFERENCE: Pilliteri (2010). Maternal and Child Nursing Care of the Childbearing and
Childrearing Family 6th edition. Pp. 438-441