Postpartum Care: Lochia, Self-Care, Mood Changes, and POST-BIRTH Warning Signs

Who needs this teaching

Every client before discharge after vaginal or cesarean birth, and the partner or support person. Many pregnancy-related deaths occur after discharge, up to 1 year after birth.

The priority teaching points

1. Lochia. Lochia rubra (dark red) lasts about 3 to 4 days. Lochia serosa (pink to brown) follows until about day 10. Lochia alba (yellowish white) ends by about 4 to 6 weeks. Saturating a pad in 1 hour, clots the size of an egg or larger, a return of bright red bleeding, or a foul odor is abnormal.
2. Perineal care. Rinse the perineum with warm water from a peri bottle, front to back, after each voiding and bowel movement. Apply ice packs for the first 24 hours to reduce edema. After 24 hours, use warm sitz baths for about 20 minutes, 2 to 3 times daily.
3. Cesarean incision. Shower daily and pat the incision dry. Splint the incision with a pillow when coughing. Lift nothing heavier than the baby until cleared.
4. Pain and bowel care. Take ibuprofen and acetaminophen as prescribed; both are compatible with breastfeeding. Drink fluids, eat fiber, walk, and take the prescribed stool softener. Clients with third- or fourth-degree lacerations avoid enemas and rectal suppositories.
5. Breast care and nutrition. Breastfeed 8 to 12 times in 24 hours. Clients not breastfeeding wear a supportive bra, apply cold packs, and avoid breast stimulation. Report a red, painful, warm area of the breast with fever (mastitis). Continue the prenatal vitamin and take iron as prescribed.
6. Mood. Baby blues (tearfulness, mood swings, anxiety) begin in the first days and resolve within 2 weeks. Symptoms lasting longer than 2 weeks, or that interfere with self-care or infant care, indicate postpartum depression. Screen with the Edinburgh Postnatal Depression Scale. Hallucinations or confusion indicate postpartum psychosis, an emergency.
7. Contraception and sexual activity. Ovulation returns before the first menstrual period, as early as 3 weeks after birth in clients who do not breastfeed. Breastfeeding prevents pregnancy only with exclusive breastfeeding, no menstrual period, and less than 6 months since birth. Avoid estrogen-containing methods in the first 21 days because of venous thromboembolism risk. Resume intercourse when the provider permits, usually after 6 weeks.
8. Follow-up and POST-BIRTH. Contact the provider within the first 3 weeks; complete a comprehensive visit no later than 12 weeks after birth. Teach the POST-BIRTH signs in the table: the right column requires a 911 call; the left column requires a call to the provider, or 911 if the provider is unreachable. Tell emergency staff about the recent birth.

Red flags the client reports

Teach-back questions

• "How will your bleeding change over the next weeks?"
• "How much bleeding means you call your provider?"
• "How long do the baby blues last?"
• "What does each letter of POST-BIRTH mean?"
• "What will you tell the emergency staff?"

Teaching tips

• Review the POST-BIRTH handout with the client and the support person.
• Screen mood at discharge and at every postpartum contact.

Read more on NCLEXPace

• Cord Prolapse, Abruption, Previa and Postpartum Hemorrhage: First Actions
• Immobility and VTE: Prevent the Clot Before It Travels
• Suicide Risk: What the NCLEX Expects You to Do

Sources

• Suplee PD, et al. Improving Postpartum Education About Warning Signs of Maternal Morbidity and Mortality. Nurs Womens Health. 2016;20(6):552-567.
• American College of Obstetricians and Gynecologists. Optimizing Postpartum Care: ACOG Committee Opinion No. 736. Obstet Gynecol. 2018;131(5):e140-e150.
• American College of Obstetricians and Gynecologists. Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4. Obstet Gynecol. 2023;141(6):1232-1261.
• Nguyen AT, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep. 2024;73(4):1-126.