What are the key assessments and interventions for a mother and baby on day 7 postpartum, including feeding evaluation and management of potential complications?

Day 7 Postpartum Assessment for Mother and Baby

At day 7 postpartum, a comprehensive assessment of both mother and baby should focus on feeding evaluation, physical recovery, and screening for complications, with particular attention to breastfeeding support and maternal mental health.

Maternal Assessment

Physical Health Evaluation

• Vital signs: Check blood pressure, heart rate, and temperature 1, 2
  • For women with hypertensive disorders, blood pressure should be checked within 7 days of delivery 1
  • Monitor for signs of postpartum preeclampsia which can develop up to 7 days after delivery 1

Bleeding and Uterine Involution

• Assess lochia (amount, color, odor)
• Check uterine involution and fundal height 2
• Evaluate perineal wounds or cesarean incision for:
  • Signs of infection (redness, warmth, discharge)
  • Proper healing
  • Pain level 2

Breastfeeding Assessment

• Observe a complete feeding session to evaluate:
  • Latch and positioning
  • Infant swallowing
  • Maternal comfort during feeding 1
• Address common day 7 breastfeeding concerns:
  • Milk supply concerns (reported by 40% of mothers at day 3) 3
  • Nipple pain (reported by 44% of mothers at day 3) 3
  • Infant feeding difficulties (reported by 52% of mothers at day 3) 3
• Note: Breastfeeding concerns at day 7, particularly "infant feeding difficulty," account for 32% of the attributable risk for stopping breastfeeding 3

Mental Health Screening

• Screen for postpartum depression using a validated tool 1, 4
  • Postpartum depression prevalence ranges from 9.5-20.1% 4
• Assess for anxiety (affects approximately 16% of women) 4
• Evaluate mother-infant bonding 1, 4
• Screen for social support and coping strategies 1

Additional Assessments

• For women with gestational diabetes: Schedule 75g oral glucose tolerance test between 4-12 weeks postpartum 5
• Check for urinary or fecal incontinence (affects 8-12% of postpartum women) 4
• Assess for venous thromboembolism risk factors 1, 2
• Review contraception plan and provide counseling 4

Newborn Assessment

Physical Examination

• Weight check and assessment of hydration status 1
• Vital signs including temperature, heart rate, and respiratory rate 1
• Jaundice evaluation 1
  • Visual assessment
  • Transcutaneous or serum bilirubin if indicated

Feeding Evaluation

• Document successful feeding performance 1
• Assess for adequate stool and urine output patterns:
  • At least 6 wet diapers daily
  • Stool pattern appropriate for feeding method 1, 4
• Review feeding frequency and duration 1

Development and Behavior

• Assess infant alertness and responsiveness
• Evaluate sleep patterns
• Check primitive reflexes 1

Interventions and Education

Breastfeeding Support

• Provide targeted support for identified breastfeeding challenges 3, 6
• Education on normal breastfeeding patterns at this stage
• Hands-on assistance with positioning and latch if needed 1, 4
• Information on breast engorgement management: breast massage, continued breastfeeding, and pain relief 6

Maternal Education

• Review warning signs requiring immediate medical attention:
  • Heavy bleeding
  • Severe headache
  • Visual changes
  • Shortness of breath
  • Chest pain
  • Fever 1, 4
• Provide guidance on:
  • Pain management options (NSAIDs and acetaminophen are effective for perineal pain) 6, 2
  • Activity resumption (can resume most activities when comfortable) 6
  • Sleep strategies with a newborn 4

Infant Care Education

• Safe sleep practices (Box 2 from AAP guidelines) 1:
  • Infant's face should be visible
  • Head in "sniffing" position
  • Nose and mouth uncovered
  • Back sleeping position
• Umbilical cord care
• Recognition of infant illness signs 1
• Prevention of sudden unexpected postnatal collapse (SUPC) 1

Follow-up Planning

• Schedule next follow-up appointment
• Ensure connection to a medical home for both mother and infant 1
• Coordinate mother and baby visits when possible 4
• Provide contact information for lactation support 1, 4

Special Considerations

• For women with asthma who are breastfeeding: Continue medications as most are compatible with breastfeeding 1
• For women after bariatric surgery: Monitor micronutrient levels during lactation 1
• For women with risk factors for cardiovascular disease: Ensure appropriate follow-up 1

Remember that day 7 is a critical time when many breastfeeding problems emerge and intervention at this point can significantly impact long-term breastfeeding success 3.