Mild, Moderate, Heavy Recovery bleeding??

[labor&deliverynurse]

I am a new L and D nurse, and find myself always thinking that my moms are bleeding too much in the recovery period within 2 hours after delivery. Generally, my preceptor says that the bleeding amount is within normal range, but it's hard for me to gauge on my own.

Also, I've read that in the immediate postpartum period ( within 2 hours after birth) , saturating a pad in 15 minutes is considered heavy bleeding, as opposed to saturating a pad in an hour, which is the criteria for heavy bleeding in the later phases of recovery.

Should I keep the same pad under mom the whole time until it is saturated? I've been changing the pads every 15 minutes when I did fundal checks so I could assess the amount of bleeding within that period, but that makes it hard for me to assess the overall amount of bleeding.

Any advice?

[Jolie, BSN]

Are you referring to a "Chux" waterproof bed pad, or a "Kotex" menstrual pad?

I agree that soaking a pad in 15 minutes or 4 pads in an hour is considered heavy for the immediate post-partum period. But I would be referring to a Kotex pad, not a bed pad. I think it would take considerably more flow to saturate a bed pad than a Kotex, and I would be concerned that a patient soaking a Chux in 15 minutes IS bleeding excessively.

[labor&deliverynurse]

I was referring to soaking a Kotex pad in 15 minutes.

When referencing a heavily soaked pad, does that mean that the whole thing is saturated in blood from top to bottom? Do you think I should keep the same pad under mom until it is saturated in order to see how long it takes for it to be saturated?

What do you do if mom is bleeding heavily on your first check, other than massage the fundus, try to expell any clots and run the Pitocin in faster?

Would you alert the MDs right away? If the bleeding stops, do you wait until the next check and if it's heavy again let the MD's know then?

so many questions!...

[heartbeat2]

This is one of the hardest things to deal with, how much is too much and how do you know it. First, you want to make sure the fundus is firm. There are times when you massage, yes the fundus is firm, but does it get firmer when you massage. This will usually decrease the "trickle" you may easily see. We would do pad counts and we kept the same one under the patient until it is about soaked if the patient has heavy bleeding or if we are concerned about the amount of blood loss. You will be able to tell the difference just by how heavy the pad is. When in doubt and a more experience nurse isn't available right away, keep the pads laid out on a chuck in the recovery room area, or in the tub if you are in the patients room. Let the nurse in charge know what's going on. Keep a watch on the patients bladder. A full bladder will not let a uterus contract as needed. If the fundus is firm, and the bladder empty, then you are usually looking for lacerations or possible retained placenta. The doctors I've worked with would have standing orders about catherizations and pitocin. If this doesn't correct the situation, call the Dr. It's normal that when the patient first gets up, the pooled blood in the lady parts will pass and be a large amount, but it doesn't continue. Keep a check on the vital signs, but moms can lose a good bit of blood before vitals will change. We had a doctor that collected cord blood after deliveries, heparinized it, and then used it in an inservice. Measured out in ML.s what 50ml, 100ml, 200ml, and 250 ml would look like on a pad. If you have baby scales available, you can weigh the pads also when you are concerned. You can also describe the amount in sizes of softball, cantaloupe, basketball....especially when it's "congealed" and you don't have individual clots. I hope this helps.

[matchstickxx]

The OP's have all offered very good advice. Also, I want to know if this is a regular pad or a cold peri-pad/ice pad. The cold pads do not absorb well and will "look" like excessive bleeding. Typically the "pad per hour" rule applies to a regular peri-pad, not a cold pad.

[labor&deliverynurse]

Thanks for the detailed information, it is very helpful!