Postpartum Care

Assessment, breastfeeding, mastitis and mood

Maternity

Breasts	Soft, filling, engorged; nipple trauma
Uterus	Firm, midline; height vs. umbilicus
Bladder	Voiding; distension; displaced fundus
Bowel	Bowel sounds, flatus, constipation
Lochia	Color, amount, clots, odor
Episiotomy/incision	REEDA: redness, edema, ecchymosis, discharge, approximation
Legs	Calf pain, swelling (VTE)
Emotions	Bonding, mood, support

Rises to about the umbilicus within 12 h, then descends ~1 cm (1 fingerbreadth) per day; not palpable abdominally by ~2 weeks.
Boggy → massage. Up and to the right → full bladder: help her void.

Foul odor → infection. Temp up to 100.4°F (38°C) in the first 24 h is often dehydration; above that after 24 h → look for infection.

Feed on demand, 8–12 times in 24 h.
Good latch: wide open mouth, lips flanged out, much of the areola in the mouth, audible swallowing, no ongoing pain.
Enough milk: by day 5+, ≥6 wet diapers and 3–4 yellow stools a day; weight regained by 10–14 days.
Engorgement: feed often, cold packs after feeds, supportive bra.

Keep feeding normally on demand. It's safe for the baby to feed from the affected breast.
Don't over-pump to "empty" the breast: that increases milk production and swelling.
Ice or cold packs, ibuprofen and/or acetaminophen; supportive bra.
Avoid heat and deep massage; very gentle lymphatic drainage strokes only.
Antibiotics (e.g., cephalexin or dicloxacillin) if not improving in 12–24 h or systemically unwell; a lump that doesn't resolve → ultrasound for abscess.

Baby blues	Up to ~80%. Tearful, mood swings in the first days; gone by ~2 weeks. Reassure, rest, support.
Postpartum depression	Lasts >2 weeks and affects functioning. Screen (e.g., Edinburgh scale). Therapy; SSRIs (sertraline is compatible with breastfeeding); zuranolone (oral, 14 days). New
Postpartum psychosis	Emergency. Hallucinations, delusions, confusion, risk to self or baby. Don't leave her alone with the baby.

Rh immune globulin within 72 h if she is Rh-negative and the baby is Rh-positive.
MMR if not rubella-immune (avoid pregnancy for 1 month; breastfeeding is fine); Tdap if not given.
Contraception: progestin-only methods can start anytime; combined estrogen methods not before 3 weeks (later if breastfeeding or VTE risk).
Warning signs: chest pain or SOB, seizure, thoughts of harming self or baby, soaking a pad in an hour, red swollen leg, temp ≥100.4°F (38°C), severe headache or vision change.