Postpartum Care of the Mother and Newborn: A Practical Guide

This paper defines the needs of women and their newborns, and classifies a number of practices common in postpartum care. It is a summary of the report, Postpartum Care of the Mother and Newborn: A Practical Guide, which was developed by a Technical Working Group of the World Health Organization and published in 1998. The report takes a comprehensive view of maternal and newborn needs during the postpartum period, examining major maternal and neonatal health challenges, nutrition and breastfeeding, birth spacing, immunization, HIV/AIDS, and the essential elements of care and service provision. The document lists recommendations, and classifies common practices in the postpartum period, dividing them into four categories: those which are useful, those which are harmful, those for which insufficient evidence exists, and those which are frequently used inappropriately.     

The Mother and Her Newborn: Mutual Caregivers

The concept of the mother and her newborn as mutual psychophysiological caregivers is discussed, with references to the supporting literature. Facilitating self-regulatory mother-newborn interaction from immediately after delivery onward is presented as the optimum approach to enhancing the benefits of mutual caregiving, and this approach is contrasted with current practice. The author also addresses reasons commonly given for denying self-regulatory mother-infant interaction and outlines relevant ongoing research activity at her institution.     

Home Care of the High-risk Newborn

When a newborn at high risk because of prematurity is discharged from the hospital, the family involved faces a time of crisis. Because parents experience increased stress during the transition to home care, both the parents and their infant are vulnerable to the effects of the added stress on the family's health and well-being. Community nursing intervention is a necessary component of care for the family of a high-risk newborn. Nursing strategies that address specific counseling and teaching needs of the family of a high-risk newborn are presented.     

Acute Respiratory Care of the Newborn

Respiratory problems account for most of the morbidity and mortality in the neonatal period. Etiology of respiratory difficulties and specific nursing assessments and interventions relevant to the neonate experiencing respiratory distress are discussed.     

Preparation for Discharge,Maternal Satisfaction,and Newborn Readmission for Jaundice: Comparing Postpartum Models of Care

ABSTRACT: Background: Physiological jaundice generally appears between the third and fifth days of life. The danger of hyperbilirubinemia is therefore a major challenge when postpartum hospital stays are short, and part of the responsibility for screening for signs of jaundice is assumed by the mother. The objective of this study was to identify the model of postnatal continuity of care most likely to prepare mothers for discharge, to reduce newborn readmission for jaundice, and to enhance maternal satisfaction. Methods: An epidemiological study was conducted in regions operating under 3 different models of postnatal continuity of care. Eligible mothers were those who had spent less than 60 hours in hospital after an uncomplicated vaginal delivery. Of this group, 70.8 percent participated in telephone interviews conducted 1 month after their deliveries (n = 1,096). Newborns who had presented with signs of jaundice were identified through statements from their mothers. Results: Of the participating newborns, 45.5 percent presented with signs of jaundice, and 3.2 percent were readmitted for jaundice during the first week of life. The follow‐up procedures used in regions operating under a community‐based model most closely followed the recommendations of health authorities and featured a high level of mothers’ satisfaction. In the region operating under a mixed hospital model, mothers reported signs of jaundice significantly more often, and postdischarge services received by mothers were less effective at allaying their fears compared with other models. Phototherapy was offered in the home only in the region operating under a mixed ambulatory model, and no readmissions for jaundice were recorded in this region. Conclusions: An effective coordination between community‐based perinatal services and hospital‐linked home phototherapy in the form of an integrated network appears to be an essential condition for improved monitoring of newborns’ health since it fosters a follow‐up that is focused not only on jaundice but also on mothers’ and newborns’ needs while reducing the costs generated by newborn readmissions. (BIRTH 34:2 June 2007)     

Group B Streptococcus: The Pregnant Woman and Her Neonate

Within the past 10 years, group B streptococcal disease has emerged as a major causative agent in neonatal morbidity and mortality. A brief history of this pathogen and its epidemiologic factors regarding maternal colonization and carriage is presented. Group B streptococcal disease in the neonate and concurrent treatment and prevention modalities also are presented. A case study is included. Suggestions for nursing assessment, intervention, and future considerations are offered.     

THE NATIONAL BIRTH CENTER STUDY Part II—Intrapartum and Immediate Postpartum and Neonatal Care

Part II of a three-part report of the National Birth Center Study describes care provided to 11,814 women and their newborns during and after labor and delivery until they were transferred or discharged from the birth centers. There were few low birth weight or preterm or postterm births, but more macrosomic babies than among all U.S. births during the same time period. Certified nurse-midwives provided most of the intrapartum care, which is described in the context of medically recommended standards and data that describe care provided to low-risk women giving birth in U.S. hospitals. Birth center care deviated from typical hospital care in several ways. Birth center clients were much less likely to receive central nervous system depressants, anesthesia, continuous electronic fetal monitoring, induction and/or augmentation of labor, intravenous infusions, amniotomies, or episiotomies, and they had relatively few vaginal examinations. They were more likely to eat solid food during labor and to take showers and/or baths Nulliparity was strongly associated with longer first stage labors and longer labor was associated with more frequent use of many kinds of interventions. Infant birth weight, mother's position during delivery, and forceps- or vacuum-assisted deliveries are examined in relation to episiotomies and lacerations and tears.     

Postpartum Home Care in the United States

Shorter postpartum hospital stays have increased the need for postpartum home care. Health-care reform in the United States must include postpartum follow-up care as a basic maternity benefit. This article explores the variety of options for postpartum home care, including telephone calls, home visits, information lines, lactation consultations, mother-infant outpatient clinics, support groups, and a model program for childbearing women in Washington state.     

Part 2. Antepartum and Intrapartum Care

The spread of human immunodeficiency virus (HIV) disease among childbearing women presents a unique nursing challenge in the delivery of specialized antepartum and intrapartum care. The nurse must be competent in the delivery of psychosocial and physical care to these women, as well as assume a pivotal role as a member of the multidisciplinary health-care team. Aspects of care, from the diagnosis of pregnancy through delivery of the neonate, that are unique to women with HIV disease are described.