Nursing care
Postpartum Infection nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Postpartum infection is suspected when temperature exceeds 38°C on two occasions after the first 24 hours, within the first ten days postpartum, accompanied by foul-smelling lochia and uterine tenderness. Caesarean birth is the single biggest risk factor. Nursing care centres on early recognition, cultures before antibiotics, and fundal assessment.
What it is and why it happens
Postpartum infection covers endometritis, wound infection, and less commonly septic pelvic thrombophlebitis, all arising when bacteria ascend into tissue exposed by birth. The uterine cavity, raw after placental separation, is an ideal medium. Caesarean section carries the highest risk because it combines surgical incision, longer labour before delivery in many cases, and instrumentation of the uterine cavity.
Risk climbs further with prolonged rupture of membranes, multiple vaginal exams in labour, manual placental removal, and pre-existing bacterial vaginosis. Endometritis is the most common form and usually starts with organisms already present in the vagina and cervix moving upward once the natural barrier is breached. Recognising who walked in at higher risk shapes how closely you watch them afterward.
How it presents — what you will actually see
The defining pattern is fever over 38°C on two separate occasions during the first ten postpartum days, excluding the first 24 hours when a low-grade temperature is common and not diagnostic. Alongside the fever, look for foul-smelling or purulent lochia, a uterus that is tender and boggy rather than firm, and subinvolution — the fundus not descending at the expected rate.
Tachycardia often precedes the fever spike and is a useful early clue. The patient may report lower abdominal or pelvic pain distinct from normal afterpains, and general malaise out of proportion to a typical postpartum recovery. A Caesarean incision with infection adds localised redness, warmth, induration, or drainage at the wound site. Chills frequently accompany the temperature rise.
Nursing assessment priorities
Take a full set of vital signs on a defined schedule rather than only when something looks wrong, and trend the temperature rather than reacting to a single reading. Palpate the fundus for height, position, and firmness at every assessment, and note any deviation from midline or lateral displacement suggesting a full bladder or hematoma.
Assess lochia for colour, odour, and amount, comparing against the expected progression from rubra to serosa. A return to rubra, or an odour described as foul rather than the normal musty smell, is significant. Inspect any Caesarean or perineal incision for the classic signs of infection: redness, edema, ecchymosis, discharge, and approximation. Ask directly about pain location and quality, since the patient may attribute uterine tenderness to normal cramping unless prompted.
Interventions and what to do first
Obtain blood and, where ordered, endometrial or wound cultures before starting antibiotics, since treatment will alter culture results. Notify the provider promptly once the diagnostic fever pattern is met rather than waiting for a full ten-day picture. Broad-spectrum intravenous antibiotics, commonly a combination covering both aerobic and anaerobic organisms, are started empirically and narrowed once sensitivities return.
Position the patient in semi-Fowler's to promote lochia drainage by gravity. Encourage fluids and monitor intake and output closely, since fever increases insensible losses and the patient may be reluctant to drink while feeling unwell. Administer antipyretics as ordered and reassess temperature response. Continue fundal massage as needed to support involution, and keep the family informed since separation anxiety around a sick new mother is common.
Complications to watch for
Untreated or delayed-treatment endometritis can progress to pelvic abscess, peritonitis, or septic shock, so a rising heart rate with falling blood pressure after an initial fever response is a red flag, not reassurance. Watch for septic pelvic thrombophlebitis if fever persists despite appropriate antibiotics and no other source is found.
Wound dehiscence can follow an infected Caesarean incision, particularly in patients with obesity, diabetes, or corticosteroid use. Monitor for a sudden increase in serosanguineous drainage or the patient reporting something has given way. Report any signs of systemic deterioration immediately rather than waiting for the next scheduled assessment.
Patient teaching before discharge
Teach the patient to take her own temperature if she feels unwell at home and to seek care for fever over 38°C, foul-smelling discharge, or pain that worsens rather than improves. Explain that lochia should progress from red to pink to white or yellow over roughly the following weeks, and that a return to bright red bleeding or clots warrants a call to the provider.
Reinforce hand hygiene before and after perineal care, and front-to-back wiping to limit contamination. If she is discharged on oral antibiotics, stress completing the full course even once she feels better. For a Caesarean incision, review keeping the site clean and dry and watching daily for increasing redness, warmth, or drainage, and give a clear number to call if symptoms appear.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our maternity and newborn practice questions are the closest set to what this page covers.
Common questions
What temperature defines a postpartum infection?
The standard criterion is a temperature of 38°C or higher on two separate occasions, at least four hours apart, after the first 24 postpartum hours and within the first ten days. A single elevated reading in the first 24 hours is common and not diagnostic on its own.
Why is Caesarean birth the biggest risk factor for postpartum infection?
Caesarean birth combines a surgical incision with instrumentation of the uterine cavity, giving bacteria more routes and more exposed tissue than a vaginal birth. Rates of endometritis after Caesarean are consistently higher in the literature than after vaginal delivery, especially when the section follows a long labour or ruptured membranes.
What is the first nursing action when postpartum infection is suspected?
Obtain cultures before antibiotics are started, and notify the provider with a clear summary of temperature trend, lochia findings, and fundal assessment. Starting antibiotics before cultures are drawn can compromise identification of the causative organism.
How does postpartum endometritis show up on the NCLEX?
Expect a scenario giving temperature, lochia description, and fundal findings together, asking you to identify the priority assessment or first intervention. The correct answer usually prioritises obtaining cultures, notifying the provider, or recognising the fever pattern over generic comfort measures.