[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Maternal and child nursing](https://durgical.com/en/nursing/areas/maternal-child/) › Labour and postpartum nursing: monitoring and warning signs

# 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 Nov 5, 2026

## Key points

- Active phase: more than 6 cm of dilation, with regular contractions.
- Maternal vital signs at least every hour in labour; fetal heart rate for one full minute every 30 minutes in the active phase and every 5 minutes in the second stage.
- Immediate postpartum: vital signs and bleeding every 15 minutes for the first 2 hours, and check every 15 minutes that the uterus is contracted.
- Postpartum fever: above 38 °C, except in the first 24 hours.
- WHO recommends at least 24 hours of care in the facility after birth and postnatal contacts at 48–72 hours, 7–14 days and 6 weeks.

## 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

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

## Related 3

- [Immediate care of the newborn](https://durgical.com/en/nursing/immediate-care-of-the-newborn/)
- [Prenatal care: the nursing visit and warning signs](https://durgical.com/en/nursing/prenatal-care-the-nursing-visit-and-warning-signs/)
- [Breastfeeding support: latch, positions and common problems](https://durgical.com/en/nursing/breastfeeding-support-latch-positions-and-common-problems/)

[← All of nursing](https://durgical.com/en/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](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-3280-de-2018.pdf) (Ministerio de Salud y Protección Social de Colombia, 2018); [WHO urges quality care for women and newborns in critical first weeks after childbirth](https://www.who.int/news/item/30-03-2022-who-urges-quality-care-for-women-and-newborns-in-critical-first-weeks-after-childbirth) (World Health Organization, 2022); [Maternal mortality (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/maternal-mortality) (World Health Organization, 2025).

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Source: https://durgical.com/en/nursing/labour-and-postpartum-nursing-monitoring-and-warning-signs/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/labour-and-postpartum-nursing-monitoring-and-warning-signs/