The first 2 hours after birth are exciting and joyous as mother and baby get to know each other. Transitions from pregnancy to postpartum and from in utero to extrauterine life are also times of risk, even for seemingly healthy mothers and babies. Careful ongoing assessment and timely invention as needed enhances safety; therefore, the nurse caring for the mother during the immediate postpartum recovery should have no other responsibilities (American Academy of Pediatrics [AAP] & American College of Obstetricians and Gynecologists [ACOG], 2012; Association of Women's Health, Obstetric, and Neonatal Nurses [AWHONN], 2010). A separate nurse is needed for the baby at birth and during transition until the critical elements of care have been met. These critical elements during postpartum recovery before the mother's nurse accepts the baby as part of the care assignment have been defined by AWHONN. When mother and baby are stable and critical elements of care are met, one nurse can care for both the mother and the baby (AWHONN). Critical elements are usually accomplished within 30 to 45 minutes. Nurses who care for mothers and babies during recovery and those in leadership positions that determine nurse staffing should be aware of these definitions and use them to guide their care and assignment.

Mothers are at risk for postpartum hemorrhage, hence frequent assessment via blood pressure and heart rate every 15 minutes along with determination of fundal height and amount of lochia are recommended by AAP and ACOG (2012) and AWHONN (2010). The baby requires careful attention as well. Temperature, heart and respiratory rates, skin color, peripheral circulation, type of respiration, level of consciousness, tone, and activity should be monitored at least once every 30 minutes until baby has been stable for 2 hours (AAP & ACOG). Healthy mothers and babies should stay together. If the baby is stable, immediate and sustained skin-to-skin contact (SSC) between the mother and the baby should be encouraged (AAP & ACOG). A blanket covering the baby up to the neck during SSC helps maintain warmth while allowing ongoing nursing assessment, including the baby's color and respiratory efforts. The baby's head should be turned to the side when not breastfeeding so the baby can breathe without obstruction and the nurse can make sure the baby's nose and mouth are easily assessed. Some mothers may not be fully awake or may fall asleep during recovery, so maternal status is a major factor in SSC. Breastfeeding should be initiated within 1 hour after birth for breastfeeding mothers. Some babies may be lacking the ability to move their head to maintain normal breathing during SSC and/or attempts at breastfeeding processes, so all babies being held by their mothers during the 2-hour transition and recovery process require frequent assessment to assure safety. The mother and her support person/s should be instructed about maintaining the baby's airway. Continued nursing bedside attendance during this 2-hour period is recommended and should be the norm because the nurse caring for the mother and baby (after the critical elements are met) should have no other responsibilities.

In some hospitals, nurses caring for women during the 2-hour recovery period are being expected to take on another assignment during the second hour. It is impossible to conduct a thorough admission history of a newly presenting woman in labor while maintaining careful surveillance of the woman and her baby during the 2-hour recovery. In some hospitals, nurse-to-patient ratios during recovery care are as per recommended by AWHONN (2010); however, the nurse does not stay in the room with the new mother and baby, and/or assessments are not as per standards and guidelines (AAP & ACOG, 2012). These situations increase risk. Significant postpartum hemorrhage and baby suffocation during SSC and/or breastfeeding have been reported when mothers and babies are left unattended during this transition period. To promote safe care, new mothers and their babies require frequent assessment and careful monitoring during the first 2 hours after birth as per national standards and guidelines.

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