Key Takeaways
- Prenatal care focuses on monitoring fetal development and identifying risk factors for complications
- Warning signs during pregnancy that require immediate attention include vaginal bleeding, severe headache, and decreased fetal movement
- The stages of labor are first (dilation), second (delivery), third (placenta), and fourth (recovery)
- Postpartum assessment focuses on uterine involution, lochia characteristics, bonding, and breastfeeding
- The LPN/LVN reinforces teaching about newborn care, self-care, and when to seek medical attention
Last updated: January 2026
Antepartum, Intrapartum, and Postpartum Care
The LPN/LVN cares for pregnant and postpartum patients in various settings. Understanding normal pregnancy progression and warning signs is essential for safe care.
Antepartum (Prenatal) Care
Normal Pregnancy Duration:
- Full term: 37-42 weeks
- Calculated from first day of last menstrual period (LMP)
- Divided into three trimesters
Expected Weight Gain:
| Pre-pregnancy BMI | Recommended Gain |
|---|---|
| Underweight (<18.5) | 28-40 lbs |
| Normal (18.5-24.9) | 25-35 lbs |
| Overweight (25-29.9) | 15-25 lbs |
| Obese (≥30) | 11-20 lbs |
Prenatal Visit Schedule:
- Weeks 4-28: Every 4 weeks
- Weeks 28-36: Every 2 weeks
- Weeks 36-40: Weekly
Common Discomforts and Interventions:
| Discomfort | Nursing Interventions |
|---|---|
| Nausea/vomiting | Small, frequent meals; avoid triggers; crackers before rising |
| Heartburn | Small meals, avoid lying down after eating, elevate head |
| Constipation | Increase fluids and fiber, regular exercise |
| Back pain | Good posture, supportive shoes, sleeping on side |
| Leg cramps | Stretch calf muscles, adequate calcium intake |
| Edema (mild) | Elevate legs, avoid prolonged standing, reduce sodium |
Warning Signs in Pregnancy
Report Immediately:
| Sign | Possible Problem |
|---|---|
| Vaginal bleeding | Placenta previa, abruption, miscarriage |
| Severe headache | Preeclampsia |
| Visual changes | Preeclampsia |
| Epigastric pain | Preeclampsia |
| Decreased fetal movement | Fetal distress |
| Leaking fluid | Ruptured membranes |
| Contractions before 37 weeks | Preterm labor |
| Severe nausea/vomiting | Hyperemesis gravidarum |
Fetal Assessment
Fetal Heart Rate:
- Normal range: 110-160 bpm
- Assessed at each prenatal visit
- Electronic monitoring during labor
Fetal Movement Counting:
- Count kicks daily in third trimester
- 10 movements in 2 hours is reassuring
- Decreased movement requires evaluation
Intrapartum (Labor and Delivery)
Stages of Labor:
| Stage | Description | Duration (Primipara) |
|---|---|---|
| First | Cervix dilates 0-10 cm | 12-18 hours |
| Second | From full dilation to delivery | 1-2 hours |
| Third | Delivery of placenta | 5-30 minutes |
| Fourth | Recovery (first 1-2 hours postpartum) | 1-2 hours |
First Stage Phases:
| Phase | Dilation | Contractions |
|---|---|---|
| Latent | 0-6 cm | Mild, irregular |
| Active | 6-10 cm | Strong, regular, 2-3 min apart |
Signs of Labor
True Labor:
- Regular contractions that increase in frequency, duration, intensity
- Contractions don't stop with walking or position change
- Cervical change (dilation and effacement)
- May have bloody show
False Labor (Braxton Hicks):
- Irregular contractions
- Stop with walking or position change
- No cervical change
Postpartum Care
BUBBLE-HE Assessment:
| Letter | Assessment |
|---|---|
| B | Breasts (engorgement, nipples) |
| U | Uterus (fundus height and firmness) |
| B | Bladder (voiding, distension) |
| B | Bowels (bowel movement, hemorrhoids) |
| L | Lochia (color, amount, odor) |
| E | Episiotomy/incision (healing, signs of infection) |
| H | Homan's sign (calf pain with dorsiflexion) |
| E | Emotional status (bonding, mood) |
Uterine Involution:
- Immediately after birth: at umbilicus
- Decreases about 1 fingerbreadth per day
- Non-palpable by day 10
Lochia Progression:
| Type | Color | Duration |
|---|---|---|
| Rubra | Dark red | Days 1-3 |
| Serosa | Pinkish-brown | Days 4-10 |
| Alba | Yellowish-white | Days 10-14+ |
Warning Signs Postpartum
Report Immediately:
- Heavy bleeding (soaking pad in 15 minutes)
- Foul-smelling lochia
- Fever >100.4°F (38°C)
- Severe headache
- Visual changes
- Leg pain, swelling, warmth
- Chest pain or difficulty breathing
- Signs of depression or thoughts of self-harm
Postpartum Teaching
| Topic | Key Points |
|---|---|
| Perineal care | Ice packs, sitz baths, proper wiping |
| Breastfeeding | Positioning, latch, frequency, hydration |
| Activity | Gradual increase, avoid heavy lifting |
| Sexual activity | Usually after 4-6 week checkup |
| Contraception | Discuss options, especially if breastfeeding |
| Newborn care | Cord care, feeding, sleep positioning |
| When to call | Warning signs, temperature taking |
On the NCLEX-PN
Expect questions about:
- Warning signs during pregnancy and postpartum
- Normal vs. abnormal findings
- Patient teaching for self-care
- Fetal heart rate norms
Test Your Knowledge
A postpartum patient reports that she is soaking a perineal pad every 15 minutes with bright red blood. What should the LPN do FIRST?
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B
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D
Test Your Knowledge
A pregnant patient at 32 weeks reports decreased fetal movement over the past day. What should the LPN advise?
A
B
C
D
Test Your Knowledge
On postpartum day 5, what type and color of lochia is expected?
A
B
C
D