A nurse is providing discharge teaching to a postpartum client who had a vaginal delivery with an episiotomy.

The client asks, “How can I take care of myself at home?” Which of the following responses should the nurse give?

The correct answer is choice D. Postpartum adaptation.

This is the process of adjusting to the physical, emotional, and social changes that occur after childbirth.The woman in the question shows signs of positive mood, confidence, and adequate support, which are indicators of successful postpartum adaptation.

Choice A is wrong because postpartum blues are characterized by mild depressive symptoms, such as mood swings, crying spells, irritability, and anxiety, that usually occur within the first few days after delivery and resolve within two weeks.

Choice B is wrong because postpartum depression is a more severe and persistent form of depression that affects 10-15% of women after childbirth.

It can cause symptoms such as sadness, hopelessness, guilt, loss of interest, insomnia, appetite changes, and suicidal thoughts.It usually requires treatment with psychotherapy and/or medication.

Choice C is wrong because postpartum psychosis is a rare but serious psychiatric emergency that affects 1-2 in every 1000 women after childbirth.

It can cause symptoms such as delusions, hallucinations, paranoia, confusion, agitation, and attempts to harm oneself or the baby.It usually requires hospitalization and treatment with mood stabilizers and antipsychotics.

Advanced maternal age is a risk factor for preterm labor, which occurs when regular contractions begin to open the cervix before 37 weeks of pregnancy.

Preterm labor can lead to premature birth, which can have serious health consequences for the baby.

Choice B is wrong because full-term gestation is not a risk factor for preterm labor.Full-term gestation means that the pregnancy lasts between 39 and 40 weeks, which is the ideal duration for the baby’s development.

Choice C is wrong because absence of medical or obstetric complications is not a risk factor for preterm labor.Some medical or obstetric complications that can increase the risk of preterm labor include urinary tract infections, high blood pressure, bleeding from the vagina, placenta previa, diabetes and blood clotting problems.

Choice D is wrong because lack of uterine contractions before 37 weeks of gestation is not a risk factor for preterm labor.Uterine contractions are a sign of preterm labor, not a cause of it.

Some other risk factors for preterm labor that the nurse should include in the discussion are:

• Previous preterm delivery or preterm labor

• Multiple gestation (twins, triplets or more)

• Abnormalities of the reproductive organs, such as a short cervix

• Ethnicity (African American and American Indian/Alaska Native mothers have higher rates of preterm birth than white mothers)

• Age of the mother (women younger than 18 are more likely to have a preterm delivery)

• Tobacco use and substance abuse

• Short time period between pregnancies (less than 18 months)