A nurse is giving discharge instructions to a new mother. What is the most important instruction to address the prevention of postpartum infection?

A) Skin to Skin contact:
Skin-to-skin contact, also known as "kangaroo care," is a highly beneficial practice for both the mother and the infant in the immediate postpartum period. It promotes bonding by enhancing emotional connections, helps the infant maintain their body temperature through the transfer of warmth from the mother’s chest, and supports the initiation of breastfeeding, which is essential for the infant's nourishment. Additionally, skin-to-skin contact stimulates the release of oxytocin, which can aid in uterine contractions and promote involution of the uterus.

B) Swaddling the infant:
While swaddling the infant can provide comfort and a sense of security, it does not directly promote bonding or help with temperature regulation as effectively as skin-to-skin contact does. Swaddling can help the infant feel secure and prevent the startle reflex but does not have the same physiological benefits in terms of promoting involution or maintaining body temperature.

C) Allowing family members to hold the infant:
While allowing family members to hold the infant can help with bonding, it does not offer the same immediate physical benefits as skin-to-skin contact between the mother and infant. Skin-to-skin contact is particularly beneficial in terms of temperature regulation and promoting the early stages of breastfeeding, which can help with the involution of the uterus.

D) None of the above:
This option is incorrect because skin-to-skin contact has been shown to promote bonding, help regulate the infant's temperature, and support postpartum recovery processes, including uterine involution.

A) Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract:
Newborns are born with a sterile gastrointestinal tract, meaning they do not yet have the intestinal bacteria necessary to synthesize vitamin K. Vitamin K is essential for the activation of clotting factors, and without sufficient vitamin K, newborns are at risk for bleeding disorders, particularly a condition known as vitamin K deficiency bleeding (VKDB). Administering vitamin K by injection shortly after birth ensures the baby has adequate levels to prevent bleeding.
B) Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection:
This statement is incorrect. Vitamin K does not prevent the synthesis of prothrombin; rather, it is essential for the liver to synthesize clotting factors, including prothrombin. The injection of vitamin K in newborns is necessary to provide adequate levels of vitamin K to support proper blood clotting, as newborns cannot produce enough on their own at birth due to the absence of gut bacteria that normally produce it.

C) The supply of vitamin K is inadequate for at least 12 months, and the newborn must be supplemented throughout infancy:
While it is true that newborns have a limited supply of vitamin K at birth, this deficiency is typically addressed with a single injection given shortly after birth. Supplementing vitamin K throughout infancy is generally not required, as the infant's gastrointestinal tract will start to develop the necessary bacteria to synthesize vitamin K within the first few weeks to months of life. The first dose of vitamin K prevents bleeding disorders, and in most cases, additional supplementation is not necessary.

D) Most mothers have a diet deficient in vitamin K, which results in the infant being deficient:
While maternal diet does play a role in the newborn's initial vitamin K levels, it is not the primary reason for the deficiency. Vitamin K deficiency in newborns is primarily due to the lack of gut bacteria necessary to produce it, rather than maternal diet. The practice of administering vitamin K to all newborns ensures that they receive adequate levels to prevent bleeding, regardless of maternal dietary intake.