(1) If the single mother is keeping the infant, the nurse should teach basic
infant care skills, encourage positive maternal-infant adaptation responses, and provide
resources for assistance in the community.
(2) If placing the infant for adoption, the nurse should provide emotional
support, use individual assessment of each mother in determining if mother and infant
should be separated, and allow the mother and family to do caretaking activities. An
emotionally healthy mother with the support of family and staff may work through this
crisis better if allowed to do caretaking activities for her baby.
c. The social worker or community health nurse can help solve problems with
income, employment, childcare, transportation, emotional support, and assistance in the
d. Considerations for discharge planning. Make discharge plans based on the
patient's age, maturity level, knowledge level, and maternal-infant adaptation process
during hospital stay. A significant concern should be availability and support of family,
relatives, friends, knowledge level, and maternal-infant adaptations process during the
Section III. COMPLICATIONS OF POSTPARTUM
6-12. POSTPARTAL HEMORRHAGE
Postpartal hemorrhage is the postpartum loss of blood totaling 500 ml or more
within a twenty-four hour period. After bladder distention is ruled out, the three main
causes of postpartal hemorrhage are uterine atony, lacerations, and retained placental
fragments in the uterus.
a. Uterine Atony. This is the inability of the myometrium to contract and
constrict the blood vessels within the muscle fibers, resulting in open sinuses at the site
of placental separation. Decreased muscle tone causes slow, insidious loss of blood.
Factors usually leading to uterine atony.
(a) Conditions which result on overextension of uterine musculature
(multiple pregnancy - two or more fetuses and hydramnios - excessive amniotic fluid).
(b) Conditions resulting in exhaustion of the uterine musculature are
large fetuses, prolonged or difficult labor, Pitocin induced or augmented labor (this may
result in decreased response to postpartal administration of pitocin) and precipitous or
(2) Situations resulting in drug related relaxation of uterine musculature are
the use of MgSO4 for preeclampsia and the use of general anesthesia for cesarean
delivery. Conditions resulting in abnormal bleeding or uterine tissue damage are
cesarean section, placenta previa, abruptio placenta, uterine rupture, and retained