What Does a Postpartum Nurse Do?

Postpartum nurses get a bad rap for constantly interrupting new moms’ and babies’ sleep. It can be tough to get consecutive hours of rest when you are freshly postpartum, especially in the hospital. If your baby is not waking again to cluster feed, it is alarms going off in the hallway or another new mom getting ice from the machine outside your room. The last thing you need is another nurse’s knock on your door, but your and your baby’s health, safety, and comfort are their top priorities.

The nurses do not enjoy waking you, and while it may not seem like the case, there’s a reason for everything they do. So, what are all these interruptions, and why are postpartum nurses in your room so much? What is the purpose of all their interventions, and what does a postpartum nurse do? I’m here to explain it all.

What is a Postpartum Nurse?

While a labor and delivery nurse coaches you through the birth process and assists with your delivery, a postpartum nurse takes over after you give birth. At some hospitals, nurses can float between the labor and delivery and postpartum units, while at other hospitals, nurses work exclusively in one unit or the other. Some postpartum nurses may also float to the special care nursery or NICU.

Also called mother-baby nurses, postpartum nurses care for the new mother and her baby after delivery until discharge. This is a unique nursing role because you and your baby are their patients. The Association of Women’s Health, Obstetric, and Neonatal Nurses recommends that one postpartum nurse care for no more than three mother-baby couplets at a time, meaning they could have up to six patients to assess, assist, teach, and document.¹

What Do Postpartum Nurses Do for New Moms?

Many maternal deaths occur in the first 24 hours postpartum, so close monitoring and intervention of a new mother during that time is essential.²

Some of the things postpartum nurses look for and help you with while you are in the hospital include:

Checking Vital Signs

Maternal death soon after birth is often caused by conditions like high blood pressure, postpartum hemorrhage, blood clots, and sepsis or infection. All these conditions can be caught with close vital sign monitoring and treated more promptly and effectively. While it may be annoying to have your blood pressure and other vital signs checked so frequently postpartum, this allows your nurses to catch any red flags before they become severe.²

Assessment

Your postpartum nurse will inspect you from head to toe, probably at least once per 12-hour shift or more frequently. They may focus more frequent assessments on common areas of concern after birth, such as:^3,4

Breasts

Whether you plan to breastfeed or not, your body will likely gear up to do so relatively quickly postpartum. Your nurse will assess your breasts for signs of engorgement, pain, and infection.

Uterus

Your nurse will perform frequent fundal assessments to feel for the height and firmness of the top of your uterus. This indicates whether it is contracting and shrinking back to its standard size. If it feels soft or “boggy,” your nurse may massage your uterus to help it contract. If your uterus feels off-center, this can indicate a full bladder.

Bladder

A full bladder can put undue pressure on your uterus and increase your risk of postpartum hemorrhage. Again, your nurse can tell that your bladder is full if your uterus is deviated. Urine retention can indicate an issue with your epidural wearing off or your urinary catheter.

Bowels

Due to dehydration, lack of food and movement, hemorrhoids, and other damage and sensitivity to your perineal area, it may be difficult and take a while to move your bowels postpartum. Your nurse will want to know if you have been able to yet, and whether you are experiencing any gastrointestinal discomfort.

Wounds

If you experience tearing or an episiotomy during delivery, your nurse will examine your vaginal and perineal area to ensure your stitches heal appropriately. If you have a C-section, your nurse will look at your incision site and make sure the scar edges are closed and healing correctly. They will look for signs of bleeding, oozing, or infection.

Vaginal Bleeding

Regardless of whether you have a C-section or a vaginal birth, after delivery, you will experience vaginal bleeding called lochia as your uterus heals. Your nurse will assess this bleeding for amount, color, and any strong odor to look for signs of hemorrhage and infection.

Legs

Your postpartum nurse will look at your legs for signs of swelling, warmth, and redness, which could indicate blood clots or high blood pressure.

Emotional State

The birth experience, sleep deprivation, and hormone fluctuations can dramatically affect your mood. Your postpartum nurse should evaluate your emotions and assess you for signs of baby blues or postpartum depression. They will also notice whether you seem to be bonding appropriately with your new baby.

Medication Administration

Your doctor will write your medication orders that your nurse will fulfill, including any medications you usually take at home. From stool softeners to pain medications, it is essential to stay on top of your medication regimen and schedule so that your pain and other potential issues remain manageable.

Monitoring Your Intake and Output

Your postpartum nurse will show you how to order meals while in the hospital and even help you do so. If applicable, they will ensure you are eating and drinking enough, assisting in your recovery and breastfeeding journey. They will also encourage you to void urine frequently. An empty bladder leaves room for the uterus to heal. Finally, your nurse will want to know if you have had your first postpartum poop!

Breastfeeding Support

Postpartum nurses have witnessed many new mothers learn to breastfeed, and many are passionate about supporting you on this journey. Even if they cannot assist you with your baby’s latch, feeding positions, and milk supply, they will be able to connect you with a lactation consultant who can! Your nurse can also give tips on nipple and breast care, from balms to heat and ice. These may help if you are experiencing pain, engorgement, soreness, and other breastfeeding discomforts.

Hygiene

Your nurse will provide you with all the necessary postpartum supplies, from ice packs, pads, and adult diapers to shower essentials. They can also assist you with toileting and showering if needed.

Referrals

If you need any medical equipment, supplies, or resources (such as an at-home blood pressure cuff) upon discharge from the hospital, your nurse can help you coordinate that or get in touch with the person who can.

Paperwork

Your postpartum nurse will walk you through obtaining your baby’s birth certificate, give you the correct documents to fill out, and let you know where to submit them. If you need other paperwork or testing, such as paternity forms, your postpartum nurse will also know how to help you.

Education

Being a new parent can be overwhelming, but your nurse can help to educate you and your partner on many aspects of well-baby care, like feeding, diapering, soothing, safe sleep, and more. Postpartum nurses are excellent teachers for new parents because they have so much experience with newborns. After all, half of their patients are babies! Besides the care they provide new mothers, they also help monitor and care for your baby as they adjust to the world outside your womb.

What Do Postpartum Nurses Do for Babies?

Vital Signs

Your postpartum nurse will routinely check your baby’s heart rate, temperature, and respiratory rate to ensure they thrive outside the womb.

Assessment

Like the thorough assessment your postpartum nurse completes on you, they will also do a head-to-toe assessment of your baby. Some specific things the nurse might look for include:⁵

Skin

Your postpartum nurse will examine your baby for their coloring, texture, finger and toenails, hair, and rashes.

Head, Face, and Neck

A postpartum nurse will note your baby’s demeanor and level of consciousness. They will feel your baby’s soft spots on its skull and notice the shape of your baby’s head. They will observe all facial features and inspect the mouth’s inside for tongue mobility and an intact palate. The postpartum nurse will check for the range of motion of the head and neck and will assess the collarbone, which can sometimes experience damage during birth.

Heart and Lungs

Your postpartum nurse will listen to your baby’s heart and lung sounds for abnormalities. They will also observe their breathing pattern to look for signs of respiratory distress such as grunting, retractions, or nasal flaring.

Extremities

Your nurse will check for symmetrical movement of your newborn’s arms and legs and assess their reflexes. They will also notice your baby’s activity level and muscle tone.

Abdomen

The nurse will assess your infant’s umbilical cord and belly for masses, lesions, or hernias.

Genitals and Anus

Your nurse will check your baby’s diaper area to ensure their urine and stool exit passages are good. If you have a female baby, your nurse may warn you that some vaginal discharge is expected in response to maternal hormones. If you have a male baby, your nurse may check that his testicles are descended. If you choose for your son to be circumcized, your nurse will also monitor your son’s circumcision and help you with that care. They will check that your baby’s genitals generally appear normal.

Measurements

They will weigh your baby and take its length and head circumference. While the length and head circumference will probably only be checked once during your hospital stay, nurses may monitor their weight every 24 hours.

Intake and Output

Postpartum nurses document your baby’s feeds, whether formula or breastmilk, and their urine and stool output. If a nurse seems obsessed with diapers, it is because they are! They can assist with diaper changes, though they will encourage you to learn how to change a diaper on your own so you are prepared when you go home.

Coordinates Tests and Screenings

There are specific tests that someone may perform on your baby, such as a hearing screen and a small blood test that gets submitted to your state. Your postpartum nurse will coordinate these tests or even perform them. They will also complete any other blood tests at the bedside or send them to the hospital lab, like if your baby’s blood sugar or bilirubin are being monitored.

Administers Medications

Your baby may receive medications like erythromycin eye ointment, the vitamin K shot, and the hepatitis B vaccine soon after birth. Your postpartum nurse is often the one to administer these to your baby.

Assists with the First Bath

Postpartum nurses often help you give your baby their first bath. They will provide the supplies you need, from a wash basin to a washcloth and baby wash, and show you how to keep them warm and keep their cord dry while cleaning them for the first time. If you would rather delay the first bath, you can let them know—they will not do it without telling you.

Anything Else You or Your Baby Needs

In general, your postpartum nurse looks out for you and your baby. They likely chose this field because they are passionate about helping new moms and newborns. Some hospitals even have a newborn nursery staffed by postpartum nurses, where you can send your baby for supervision and feedings while you rest and recover. However, they will encourage you to learn much about baby care so you are ready when you get home.

Postpartum nurses are typically a great resource if you have questions or concerns. They have so much knowledge and experience with babies and moms and are happy to help. Nothing is awkward, off-limits, or too small. If time and their workloads permit, they will always go the extra mile for you. Try to forgive them for the constant interruptions because they genuinely look out for your health, safety, and well-being!

Resources

1. https://www.awhonn.org/education/staffing-exec-summary/

2. https://journals.lww.com/greenjournal/Fulltext/2021/02000/15.aspx

3. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/

4. https://www.ncbi.nlm.nih.gov/books/NBK326673/

5. https://www.urmc.rochester.edu/encyclopedia/content.aspx