Postpartum hemorrhage is defined as a loss of blood in the postpartum period of more than

500 mL. The average, spontaneous vaginal birth will typically have a 500 mL blood loss. In
cesarean births the average blood loss rises to 800-1000 mL. There is a greater risk of
hemorrhage in the first 24 hours after the birth, called primary postpartum hemorrhage. A
secondary hemorrhage occurs after the first 24 hours of birth. In the majority of cases the cause
of hemorrhage is uterine atony, meaning that the uterus is not contracting enough to control the
bleeding at the placental site. Other reasons for a hemorrhage would include retained placental
fragments (possibly including a placenta accreta), trauma of some form, like a cervical
laceration, uterine inversion or even uterine rupture, and clotting disorders.

Common Signs and Symptoms:

• uncontrolled bleeding
• decreased blood pressure
• increased heart rate
• decrease in the red blood cell count (hematocrit)
• swelling and pain in tissues in the vaginal and perineal area

Conditions that may increase the risk for postpartum hemorrhage include the following:

• placental abruption – the early detachment of the placenta from the uterus.
• placenta previa – the placenta covers or is near the cervical opening.
• overdistended uterus – excessive enlargement of the uterus due to too much amniotic
fluid or a large baby, especially with birthweight over 4,000 grams (8.8 pounds).
• multiple pregnancy – more than one placenta and overdistention of the uterus.
• pregnancy-induced hypertension (PIH) – high blood pressure of pregnancy.
• having many previous births
• prolonged labor
• infection
• obesity
• medications to induce labor
• medications to stop contractions (for preterm labor)
• use of forceps or vacuum-assisted delivery
• general anesthesia

Nursing Diagnosis: Risk for altered parenting

Defining characteristics:

Risk for inability of the primary caretaker to create, maintain, or regain an

environment that promotes the optimum growth and development of the child.

Related factors:

Physical illness
NOCParent-Infant Attachment

Indicators:

Parents verbalize positive feelings toward infant Parents touch/stroke/pat infant

Parents use eye contact Parents respond to infant cues
Parents console/sooth infant

NOCCopingIndicators:

Identifies effective coping patterns Uses effective coping strategies

Adapts to developmental changes Uses available social support

Discuss parents’ reaction topregnancy

Determine the image mother has ofher unborn child

Place infant on mother’s bodyimmediately after birth

Discuss parent’s reaction to fetalmovement

Identify body parts of infant onultrasound image

Discuss parent’s reaction to viewingultrasound image of fetus.

Encourage parent(s) to note fetalmovement

Provide parent(s) the opportunity tohear fetal heart tones as soon aspossible.

Encourage father/significant other toparticipate in labor and delivery.

Assist father/significant otherduring participation in labor anddelivery

Ascertain before birth whether theparent(s) has names picked out forboth sexes.

Encourage mothers to hold, touch,and examine the infant while cord isbeing cut.

Provide father opportunity to holdnewborn.

Provide opportunities for parent(s) tosee, hold, and examine newbornimmediately

after birth.

Encourage parents to identify familycharacteristics observed in newborn

Place pictures of family in isolette soinfant can “see” family

Encourage parent(s) to hold infantclose to body.

Assist parent(s) to participate ininfant care.

Provide pain relief for motherEncourage parents to massage infant.Reinforce eye

contact with infant.

Reinforce caregiver role behaviors.Provide assistance in selfcare tomaximize focus

on infant.

Provide roomingin in hospitals

Encourage parent(s) to bring toys orclothing for newborn.

Assist parent(s) in planning for earlydischarge.

Refer for further follow-up care,when appropriate.

Explain equipment used to monitorinfant in nursery.

Encourage parent(s) to visit infant inthe nursery

Demonstrate ways to touch infantconfined to isolette.

Take Polaroid picture of infant toleave with mother beforetransporting infant to

anotherhospital

Encourage parent(s) to bring personalitems, such as toy or picture, to beput in

isolette or at bedside of infant

Inform parent(s) of behavioralcharacteristics infant exhibits whilebeing cared for in

another hospital

Point out infant state changes toparent(s)

Assist parent(s) in planning infantcare during alert state.

Encourage parent(s) to see and touchnewborn before transport.

Encourage parent(s) to accompanyinfant transferred to anotherhospital.

Inform parent(s) of care being givento infant in another hospital.

Point out infant cues that showresponsiveness to parent(s).

. Give parent(s) lock of infant’s hairwhen shaved for IV.

Give parent(s) footprint of infant toorientate to reality of size ofnewborn.

Discuss infant behavioralcharacteristics with parent(s)

Instruct parent(s) on signs ofoverstimulation.

Reinforce normal aspects of infantwith a defect