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Labour and postpartum nursing: monitoring and warning signs

  • Fundamental

In labour, mother and fetus are monitored on the partograph; in the first 2 postpartum hours, vital signs and bleeding are checked every 15 minutes.

Updated

What it is

During labour, nursing supports the woman, records vital signs and the fetal heart rate on the partograph and supports respectful care: a companion of her choice, freedom of position and pain relief. After the birth it watches the uterus and the bleeding, because postpartum haemorrhage is a leading cause of maternal death. In the puerperium, nursing detects complications, supports breastfeeding and teaches the warning signs before discharge.

Key points

  • The partograph records maternal vital signs, fetal heart rate, dilation, effacement, station, membranes and contractions.
  • A maximum of 3 vaginal examinations is suggested, avoiding them within 4 hours unless indicated.
  • Enemas, shaving, fundal pressure and episiotomy are not routine.
  • Colombia uses an obstetric early warning score adapted for the country.
  • Minimum stay: 24 hours after a vaginal birth and 48 hours after a caesarean; postpartum visit between day 3 and day 5.

Components

  • First stage: dilation, with a latent phase and an active phase.
  • Second stage: from full dilation to the birth.
  • Third stage: delivery of the placenta, with active management per protocol.
  • Immediate puerperium (first 2 hours) and early puerperium (from 2 to 48 hours).

What it is for

  • Detect fetal compromise or abnormal progress of labour early.
  • Prevent and recognise postpartum haemorrhage, infection and hypertension.
  • Support skin-to-skin contact, breastfeeding and bonding.

Step by step

  1. Give continuous support and allow a companion of the woman's choice — continuous support improves the birth experience.
  2. Record vital signs and fetal heart rate on the partograph as often as indicated — it shows a deviation in time.
  3. Encourage movement and whichever position the woman prefers — improves comfort and progress.
  4. After the birth, feel the uterus every 15 minutes to check it is contracted — a soft uterus bleeds.
  5. Monitor bleeding, blood pressure and pulse every 15 minutes for the first 2 hours — haemorrhage progresses quickly.
  6. Check the bladder and encourage voiding — a distended bladder keeps the uterus from contracting well.
  7. Assess lochia, temperature, pain, legs and mood in the puerperium — detects infection, thrombosis and depression.
  8. Before discharge, teach the warning signs for mother and newborn — most complications appear at home.

In nursing practice

  • Postpartum warning signs: foul-smelling lochia, heavy bleeding, fever, headache, blurred vision or seizures, abdominal pain, leg pain or swelling, red and painful breasts, and a mood that keeps her from caring for the baby.
  • Tachycardia, tachypnoea, fever and a soft or tender uterus suggest haemorrhage or infection.
  • Urinary retention is common: if there is no spontaneous voiding 6 hours after birth, report it.
  • Screen for postpartum depression with the protocol's questions at every contact.

Common mistakes

  • Measuring only blood pressure and not looking at the bleeding or the uterus.
  • Estimating blood loss «by eye» without checking pads and sheets.
  • Discharging without teaching the warning signs or booking the postpartum visit.
  • Separating mother and newborn without a clinical reason.

Test yourself

Think of the answer, then tap the question to see it.

How often is the fetal heart rate checked in the active phase and in the second stage?

For one full minute every 30 minutes in the active phase and every 5 minutes in the second stage.

What is checked every 15 minutes in the first 2 postpartum hours?

Vital signs, bleeding and whether the uterus is contracted.

From when is a temperature above 38 °C considered postpartum fever?

After the first 24 hours following the birth.

Which postnatal contacts does WHO recommend for a healthy mother and newborn?

At least 24 hours in the facility, then contacts at 48–72 hours, at 7–14 days and at 6 weeks.

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Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta Integral de Atención para la Promoción y Mantenimiento de la Salud y de la Ruta Integral de Atención en Salud para la Población Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); WHO urges quality care for women and newborns in critical first weeks after childbirth (World Health Organization, 2022); Maternal mortality (fact sheet) (World Health Organization, 2025).

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