10 Maternal and Newborn Nursing

Purpose and approach

Maternal and newborn nursing promotes the health of the pregnant or birthing person, fetus, newborn, and family through assessment, prevention, education, and timely escalation of care. Nurses combine objective findings with the patient’s concerns, follow facility protocols and scope of practice, and respond promptly to changes in maternal or fetal status.

Pregnancy and prenatal care

Pregnancy is dated from the first day of the last menstrual period and typically lasts about 40 weeks. Prenatal care begins as early as possible and includes health history, physical assessment, screening tests, education, and monitoring of maternal and fetal well-being.

At visits, track blood pressure, weight, symptoms, and fetal growth. Assess fetal heart rate and movement when appropriate. Tailor screening and testing to gestational age, history, and risk factors. Prenatal screening includes tests for infections that may affect the pregnant person or infant.

Gestational diabetes is commonly screened for at 24–28 weeks if it was not identified earlier. Teach patients to discuss all prescription medicines, over-the-counter products, supplements, and substance use with their clinician before starting or stopping anything. Encourage a balanced diet and hydration, and avoidance of alcohol, tobacco, and nonprescribed drugs.

Vaccination decisions should follow current guidance and individual clinical advice. Tdap is recommended during each pregnancy, while certain live vaccines are generally avoided during pregnancy.

Warning signs and pregnancy complications

Urgent pregnancy warning signs include vaginal bleeding more than light spotting, leaking fluid, severe or persistent abdominal pain, severe headache or vision changes, fainting, trouble breathing, fever, or a noticeable decrease in fetal movement. These warning signs can also occur after birth. Promptly notify the obstetric clinician or activate emergency response as appropriate; do not reassure a patient solely because a prior assessment was normal.

Complications requiring assessment

• Hypertensive disorders: New hypertension after 20 weeks may progress to preeclampsia, which can affect multiple organs and can occur after delivery. Severe headache, visual changes, upper abdominal or shoulder pain, breathing difficulty, or severe-range blood pressure require urgent evaluation. Trend blood pressure and symptoms, communicate changes promptly, and implement prescribed monitoring and treatment.

• Gestational diabetes: Elevated glucose can affect fetal growth and increase the risk of newborn hypoglycemia and other complications. Support the prescribed meal plan, activity, glucose monitoring, and medication regimen. Ensure ordered newborn glucose monitoring after birth.

• Ectopic pregnancy: Early pregnancy with pelvic pain or abnormal bleeding requires assessment. Sudden severe pain, shoulder pain, weakness, dizziness, or fainting may indicate rupture and internal bleeding, which is an emergency.

• Pregnancy loss: Bleeding or cramping may occur with early pregnancy loss, but symptoms alone do not establish the diagnosis. Provide compassionate, nonjudgmental support, assess stability, and promptly report heavy bleeding, severe pain, fever, or faintness.

Labor and birth

Assess labor by contraction pattern, cervical change, fetal status, maternal status, and the patient’s experience. True labor generally produces regular contractions that become stronger and are accompanied by cervical change. The first stage extends from labor onset to full cervical dilation; the second stage is from full dilation to birth; and the third stage is delivery of the placenta. The period immediately after placental delivery requires close observation.

On admission, obtain the obstetric history and gestational age, assess vital signs and pain, ask about fetal movement, bleeding, and fluid leakage, and review relevant prenatal results. Monitor contractions and fetal heart rate as ordered and per protocol. Report persistent abnormal fetal heart patterns, heavy bleeding, severe constant pain, maternal instability, or suspected cord prolapse immediately.

If a concerning fetal heart-rate change occurs, stay with the patient, summon help, assess the situation, and initiate unit-approved interventions while preparing to escalate care. Support informed choices about comfort and pain relief, mobility and position changes when safe, hydration as permitted, breathing, and continuous emotional support. Explain procedures before providing care and protect privacy, dignity, and consent.

When oxytocin is administered, use the prescribed infusion safeguards and closely monitor uterine activity and fetal response. Promptly report excessive contraction frequency or a nonreassuring fetal response.

Postpartum assessment and recovery

The postpartum period involves physical recovery, adjustment to infant feeding and care, and changing emotional needs. Use a consistent assessment approach such as BUBBLE-HE to review breasts, uterus, bladder, bowel function, lochia, perineum or incision, lower extremities, and emotional status. Also assess vital signs, pain, mobility, and ability to void. Compare findings with the patient’s baseline and the expected course of recovery.

A soft or boggy uterus with heavy bleeding may indicate uterine atony and postpartum hemorrhage. Call for help, assess fundal tone and bleeding, and follow the emergency protocol. Uterine massage and prescribed uterotonic medication may be indicated. Do not delay escalation while completing routine tasks. Heavy bleeding, such as soaking a pad in an hour, or passing large clots requires urgent assessment.

Teach perineal or incision care, hand hygiene, hydration, rest, and when to seek help. Arrange postpartum follow-up and address blood pressure, chronic conditions, mood, infant feeding, contraception, and recovery. Postpartum visits should assess physical, social, and emotional well-being; urgent symptoms should not wait for a routine appointment.

“Baby blues” are short-lived mood changes that often improve within one to two weeks. Persistent or worsening sadness, anxiety, inability to function, or thoughts of self-harm or harming the baby require prompt professional evaluation. Thoughts of harm require immediate safety action.

Newborn transition and care

Immediately after birth, support warmth, breathing, and transition to life outside the uterus. Dry the newborn, maintain a warm environment, assess breathing and tone, and promote skin-to-skin contact when clinically appropriate. Apgar scoring documents the newborn’s condition at one and five minutes, but does not replace immediate assessment or delay resuscitation when needed.

Routine nursing care includes observing color, respiratory effort, temperature, activity, feeding, and elimination; supporting breastfeeding or the chosen feeding plan; and checking identification and security measures. Follow local protocols for newborn prophylaxis and screening. An abnormal newborn screening result requires follow-up; it does not mean a diagnosis is confirmed.

Teach caregivers to place the infant on the back for every sleep, on a firm, flat sleep surface with only a fitted sheet. Keep pillows, loose blankets, toys, and other soft items out of the sleep space. Room-share without bed-sharing. Demonstrate safe handling and car-seat use, and explain when to contact the newborn’s clinician for feeding difficulty, breathing problems, fever, unusual sleepiness, or other concerning changes.

Reproductive health and medication safety

Reproductive health care includes menstrual concerns, contraception, fertility, and prevention, screening, and treatment of sexually transmitted infections (STIs). Ask about symptoms and sexual-health concerns respectfully and privately. Use inclusive, nonjudgmental language and protect confidentiality within applicable rules. Many STIs cause no symptoms, so recommended screening matters. During pregnancy, screening and treatment help reduce risks to the pregnant person and infant; partners may also need evaluation and treatment.

Discuss contraception as a voluntary, patient-centered choice. Methods include barrier methods, hormonal methods, intrauterine devices, implants, and permanent contraception; effectiveness, suitability, and timing vary. Pregnancy can occur before menstrual periods return after birth, so discuss postpartum options before discharge or at follow-up. Condoms also reduce STI transmission risk.

For medication safety, verify the patient, medication, dose, route, time, allergies, indication, and required assessments. Use independent checks when required and evaluate the response. In obstetric care, monitor relevant maternal and fetal findings for medications such as oxytocin, insulin, or magnesium sulfate, and promptly report unexpected effects or signs of toxicity. Follow the order, current drug reference, and facility protocol rather than relying on memory alone.

Clinical judgment and escalation

A postpartum patient who reports a severe headache and blurred vision may have an urgent hypertensive complication. Stay with the patient, assess vital signs and symptoms, notify the responsible clinician immediately, and prepare to carry out ordered evaluation and treatment. The priority is rapid recognition and escalation—not attributing the symptoms to fatigue or routine postpartum recovery.

Across maternal and newborn care, ongoing assessment, prevention, clear teaching, and early recognition of deterioration are central. Monitor maternal and fetal status during pregnancy and labor; assess bleeding, uterine tone, recovery, and mood postpartum; and support newborn transition, feeding, screening, and safe sleep. When findings are abnormal or a patient reports a serious concern, act promptly, communicate clearly, and follow emergency and medication-safety protocols.