A nurse is reviewing the medical record of a client who experienced a vaginal birth 2 hr ago. The nurse should identify which of the following findings places the client at risk for a postpartum hemorrhage.

Encourage the newborn to breastfeed every 2 hr. This is because breastfeeding helps the newborn to excrete bilirubin through stool and urine. Breastfeeding also prevents dehydration, which can worsen jaundice. The nurse should also monitor the newborn’s weight, hydration status, and bilirubin levels during phototherapy.

Choice A is wrong because monitoring the newborn’s blood glucose level hourly is not necessary for phototherapy.

Choice B is wrong because applying lotion to the newborn’s skin twice per day can interfere with the effectiveness of phototherapy and increase the risk of skin irritation.

Choice D is wrong because maintaining the newborn in a prone position can increase the risk of sudden infant death syndrome (SIDS) and limit the exposure of skin to light.

To check for postpartum hemorrhage.

This is because postpartum hemorrhage is a serious and potentially life-threatening complication that can occur within 24 hours of birth or later. It is defined as a blood loss of more than 500 mL in a vaginal delivery or more than 1000 mL in a cesarean delivery. The most common cause of postpartum hemorrhage is uterine atony, which is the failure of the uterus to contract after delivery. Other causes include lacerations, retained placental fragments, coagulation disorders, and uterine rupture. Monitoring the vital signs, especially blood pressure, and pulse, can help detect signs of hypovolemia due to blood loss. Other signs include pale skin, cold and clammy extremities, delayed capillary refill, decreased urine output, and altered mental status.

Choice B is not correct because determining if the mother's milk is coming in is not the primary rationale for monitoring a new mother every 15 minutes for the first hour after delivery. Milk production usually begins around 48 to 72 hours after delivery and is influenced by hormonal changes, breastfeeding frequency, and maternal health. Although breastfeeding support is important for postpartum care, it is not a priority over checking for postpartum hemorrhage.

Choice C is not correct because monitoring the mother's blood pressure to note any elevations is not the primary rationale for monitoring a new mother every 15 minutes for the first hour after delivery. Elevated blood pressure can indicate gestational hypertension or preeclampsia, which are serious conditions that can affect postpartum women. However, these conditions are more likely to cause symptoms such as headache, blurred vision, epigastric pain, and proteinuria⁴.

Moreover, blood pressure may not be a sensitive indicator of blood loss and may remain normal until a significant amount of blood is lost¹.

Choice D is not correct because answering questions the new parents may have is not the primary rationale for monitoring a new mother every 15 minutes for the first hour after delivery. Although providing education and support to the new parents is an essential part of postpartum care, it is not a priority over checking for postpartum hemorrhage. The new parents may have questions about infant care, feeding, contraception, recovery, and other topics that can be addressed during the postpartum period.