2.2.c Postpartum and Newborn Care
Postpartum Course
Twenty-five minutes after the birth of her son, Mee pushes out a complete placenta. Serena and Karen instantly notice that while the placenta appears normal, it is emitting a foul odour. Mee has swaddled the baby tightly in blankets and is holding it close to her. Serena takes a set of vital signs from the baby and finds the temperature to be slightly elevated at 37.6 Celsius. (Normal newborn axilla temperature can range from 34.7°C to 37.3°C, according to the Canadian Pediatric Society). Karen sees the temperature and immediately takes Mee’s temperature; her fever has disappeared. Serena helps to unswaddle the baby and explains that skin-to-skin is the best way to thermoregulate a baby. Mee nods in agreement but looks uninterested. Serena makes a mental note to re-check the baby’s temperature in 15 minutes.
Conversations After Birth
Serena and Karen move briefly to the hall outside of Mee's room and they agree that the timing is right for a birth debrief with Mee and Alang. After Serena, Karen, and the parents have the birth debrief, Serena decides to head over to the nursing station to provide some feedback to staff on shift about the family's overall satisfaction with their care. She has a lot of paperwork to catch up on so she sits down to do her charting. Serena is nearly finished her documentation when Karen approaches her. “I wanted to let you know, Mee has swaddled her baby tightly again and when I stepped out briefly, I think Alang must have turned up the thermostat- the room is stifling hot.” “Mee is also expressing a strong desire to go home now,” Karen adds. Serena nods. “Thanks for the update Karen. I’ll come back to check in on them now.”
Postpartum and Newborn Care
Serena re-enters the room and finds it to be very warm. Alang says Mee wanted the thermostat raised. Serena notices that as Karen described, Mee has swaddled the baby tightly in many layers of blankets. Mee herself is covered in many blankets, even though it is mid summer. Serena sits down to begin a conversation with the parents. She reviews with Mee and Alang the basics of newborn regulation, the risks of over- or under-heating a newborn, and the benefits of skin-to-skin contact. She encourages Mee to unswaddle the baby and place him on her chest. Alang turns down the thermostat.
Mee speaks. “Thank you for the information Serena, I appreciate it. You must also know that in Hmong culture, women and babies must always be kept warm after the birth. If our heads become cold, we will suffer migraines; a cold body will cause bodily aches. After birth we use heaters, and blankets. In the olden days, we slept next to our fires. These are my beliefs; Hmong beliefs…”
"I am also concerned about the placenta." Serena says. "It has a strange odour to it that may be of concern. It may be related to your fever. It would be helpful to send your placenta to the pathology lab in the hospital; this may offer us more answers. Do you have any questions or concerns about this?"
"I will keep my afterbirth with me." Mee states simply. "In Hmong culture" Alang begins, "a family must bury its child's afterbirth in the soil on their property to ensure that the child can be reunited with its ancestors in the afterlife." Mee nods. "This is a very important tradition in our culture. I must take my placenta home with me."
Mee and Alang have established their values and beliefs. Serena believes that her concerns for baby have been understood. She rechecks the baby’s temperature. Since being skin-to-skin, his temperature has come down to 37.3 Celsius. Alang nods when he sees the lowered temperature. “It is time for us to return home. We are forever grateful for your assistance. Our child is a gift. We wish to bring him home to begin our journey as a family. Mee feels fine and has latched the baby to the breast successfully. Look!” Alang points. “He is feeding so well.” Mee nods and smiles. “I am feeling ready to go home. I want to go home.”
Serena acknowledges Alang and Mee’s request but does not yet give them a response. She knows she needs to consider this request carefully in light of the clinical history, and availability of specialized care should the clinical picture change.