Chapter 12: Maternal Nursing — Pregnancy, Labor, and Postpartum Care

Maternal nursing encompasses the care of women from conception through the postpartum period. It requires understanding the profound physiological changes of pregnancy, the dynamic process of labor, and the physical and emotional recovery of the postpartum period.

Antepartum Care

Key Physiological Changes in Pregnancy

• Cardiovascular: blood volume increases 40–50%; heart rate increases 10–15 bpm; BP may drop in second trimester
• Respiratory: diaphragm elevated; TV increases; mild respiratory alkalosis (normal)
• Renal: GFR increases 40–60%; glucosuria may occur without pathology
• Hematological: physiological anemia (dilutional); WBC increases; hypercoagulable state

Warning signs (HELLP/Preeclampsia): hypertension ≥ 140/90, proteinuria, edema, headache, visual changes, epigastric pain, right upper quadrant pain → notify provider immediately.

Estimated Due Date (Naegele’s Rule)

LMP + 7 days − 3 months + 1 year = EDD

Stages of Labor

Stage	Description	Nursing Care
Stage 1 — Latent	Cervix 0–6 cm; contractions q5–30 min	Ambulation, positioning, comfort measures
Stage 1 — Active	Cervix 6–10 cm; contractions q2–3 min	Pain management, continuous monitoring, support
Stage 2	Full dilation to delivery; pushing	Coaching pushing; monitor FHR; prepare for delivery
Stage 3	Delivery of placenta (up to 30 min)	Oxytocin administration, fundal massage, monitor bleeding
Stage 4	First 1–2 hours postpartum	q15 min assessments; hemorrhage prevention

Fetal Heart Rate Monitoring: Normal FHR baseline 110–160 bpm. Reassuring: accelerations (good), early decelerations (head compression — benign). Non-reassuring: late decelerations (uteroplacental insufficiency), variable decelerations (cord compression), prolonged deceleration, absent variability.

Postpartum Assessment: BUBBLE-HE

Component	Assessment
Breasts	Engorgement, nipple soreness, milk production
Uterus	Fundal height, firmness (firm = contracted), midline vs. deviated
Bowel	First bowel movement (usually day 2–3), bowel sounds
Bladder	Urinary output, signs of retention, UTI
Lochia	Color (rubra → serosa → alba), amount, odor (foul = infection)
Episiotomy/Incision	REEDA: Redness, Edema, Ecchymosis, Discharge, Approximation
Homans Sign (limited utility)	Calf pain on dorsiflexion (DVT — but poor sensitivity; assess for warmth/redness/swelling)
Emotions	Postpartum blues vs. depression vs. psychosis

Postpartum Depression

Baby blues: transient tearfulness, mood swings, first 2 weeks — normal hormonal adjustment.

Postpartum depression (PPD): persistent sadness, inability to bond, insomnia, worthlessness, lasting > 2 weeks. Affects ~10–15% of new mothers. Screening: Edinburgh Postnatal Depression Scale (EPDS). Treatment: psychotherapy, antidepressants, support.

Postpartum psychosis: rare but dangerous; hallucinations, delusions, rapid onset — psychiatric emergency; risk of infanticide/suicide.

Breastfeeding Support

Latch assessment: LATCH score (Latch, Audible swallowing, Type of nipple, Comfort, Hold). Correct latch: baby’s mouth covers nipple and most of areola; no pain with feeding.

Key Checklist

• List the four stages of labor and describe the primary nursing interventions for each stage
• Perform a postpartum BUBBLE-HE assessment by describing what normal findings look like for each component
• Differentiate postpartum blues, postpartum depression, and postpartum psychosis in terms of timing, severity, and nursing/medical response