Editing Maternal and Newborn Nursing (section)

=== Psychosocial and discharge issues ===

* '''Postpartum blues''': tearfulness, mood lability, and fatigue affecting a majority of patients, beginning within days and resolving by about 2 weeks. Care is reassurance, rest, and support.
* '''Postpartum depression''': persists beyond 2 weeks or begins later within the first year, with impaired function, anhedonia, guilt, and possible thoughts of harming self or the infant. Screening with a validated tool such as the Edinburgh Postnatal Depression Scale is standard. Treatment is effective; the nurse screens, refers, and follows up rather than reassuring the patient that it will pass.
* '''Postpartum psychosis''': a '''psychiatric emergency''' with hallucinations, delusions (often about the infant), disorganized thinking, and elevated risk of infanticide and suicide. It requires immediate evaluation and usually hospitalization, and the infant must not be left alone with the parent.
* '''Rubella-nonimmune patients''' receive MMR before discharge, with teaching to avoid pregnancy for 28 days. '''Rh-negative patients with an Rh-positive newborn''' receive Rho(D) immune globulin within 72 hours.
* Teach the patient to report fever, foul-smelling lochia, bleeding that soaks a pad in an hour, severe headache or visual changes (preeclampsia can present or worsen ''after'' birth, including up to 6 weeks postpartum), chest pain or dyspnea, unilateral leg pain and swelling, and thoughts of harming self or baby.
* Ovulation can return before the first menses, so contraception counseling happens before discharge. Estrogen-containing contraception is generally avoided in the early postpartum period because of VTE risk and is timed with lactation and risk factors in mind.