Postpartum Narrative

Postpartum Narrative

Valerie delivered a baby girl at 0035 SVD with a repaired 20 tear. Baby Apgars 81 + 95. Skin to skin and breastfeeding were initiated shortly after birth. Placenta was delivered intact and preserved as per birth plan. Dad was present throughout. Heavy vaginal bleeding was noted 2 hours postpartum with a boggy fundus, but after voiding X 2 fundus is firm, one finger below umbilicus and midline. Lochia is now moderate flow. IV N/S with Oxytocin 20u is infusing. Ice was applied X 2 to her perineum with some relief. Valerie complained of cramping after baby’s last feed, reporting 5/10 pain, and has self-medicated with ibuprofen. Her vitals are stable.

Baby has been on breast X 2 with a good latch both feeds. She has had one wet diaper, no meconium stool at this time. RR stable, acrocyanosis improving.

Valerie’s birth plan included discharge home within 4 hours post birth but has been required to stay longer due to heavy vaginal bleeding. She is eager to get home to her two sons who are being cared for by Valerie’s parents.

1. What observations/assessments would you make and what hypotheses might you develop given what you are noticing?

2. What clues/cues do you need to really notice during this time?

3. Is there anything not documented that you believe is important to the care of this couple at this time?