Fall Risks for the Obstetric population & the use of Arjo’s Sara® Stedy

1. Postpartum physiological changes and mobility challenges

A 2018 study in the Journal of Obstetric, Gynecologic & Neonatal Nursing (JOGNN) titled “Postpartum Safety: A Patient-Centered Approach to Fall Prevention” explored safety risks in the postpartum period. While not exclusively about falls, it identified physiological factors that indirectly heighten fall risk:

• Orthostatic hypotension: Blood loss during delivery (even in uncomplicated births) and fluid shifts can lead to dizziness or fainting when standing.
• Fatigue: Sleep deprivation and exhaustion from labor increase unsteadiness.
• Anesthesia effects: Epidural or spinal anesthesia, common in deliveries, can cause lingering numbness or weakness in the legs, impairing mobility.

The study noted that postpartum women often attempt to ambulate soon after delivery (e.g., going to the bathroom), these factors create a “perfect storm” for falls. Though it didn’t quantify falls in L&D specifically, it suggested that the immediate postpartum period is a high-risk window.¹

2. Medication use and sedation

A 2020 article in MCN: The American Journal of Maternal/Child Nursing examined postpartum care protocols and highlighted the role of medications as an indirect contributor to falls:

• Opioids and pain management: Post-caesarean or vaginal delivery pain relief (e.g., oxycodone) can cause drowsiness or disorientation, increasing fall risk.
• Antihypertensive: Used in cases of postpartum preeclampsia, these can lower blood pressure excessively, leading to light-headedness.

This suggests that pain management practices in L&D and postpartum recovery rooms could indirectly elevate fall incidents.²

3. Environmental and design factors

A 2021 study in BMC Pregnancy and Childbirth titled “Environmental Influences on Maternal Experience in LDRP Units” investigated labor-delivery-recovery-postpartum (LDRP) room design. While focused on maternal comfort, it provided indirect clues about fall risk:

• Bed height and rails: High beds without proper side support were noted as barriers to safe ambulation, especially for women recovering from caesarean sections.
• Bathroom distance: The study found that longer distances to in-room bathrooms increased the likelihood of unassisted ambulation attempts, a known fall risk factor.
• Lighting and clutter: Poor lighting or cluttered pathways (e.g., IV poles, monitors) were mentioned as hazards, particularly at night when postpartum mothers might be disoriented.

These environmental factors aren’t directly tied to fall statistics but align with broader hospital fall prevention research, suggesting their relevance to postpartum settings.³

4. Postpartum hemorrhage and weakness

A 2019 review in Obstetrics & Gynecology on postpartum hemorrhage (PPH) outcomes noted that significant blood loss (affecting up to 5% of deliveries) leads to weakness and dizziness, both of which are precursors to falls. This indirect link suggests that severe PPH cases in L&D or postpartum units could contribute to fall incidents.⁴

5. Nursing interventions and fall risk awareness

A 2017 quality improvement project published in Nursing for Women’s Health evaluated postpartum fall prevention strategies in a community hospital. It didn’t provide raw fall data but offered insights into indirect risk factors:

• Unassisted ambulation: Nurses reported that postpartum mothers often overestimated their strength and attempted to walk without help, especially within the first 12 hours after delivery.
• Lack of education: Patients weren’t always informed about their fall risk, leading to risky behaviors like getting up alone at night.

The project implemented interventions like hourly rounding and bed alarms, reducing falls by 30% in the postpartum unit over six months. This implies that baseline fall risk was notable, even if specific to that hospital’s postpartum area rather than L&D alone.⁵

6. Broader hospital fall data with postpartum inclusion

The Agency for Healthcare Research and Quality (AHRQ) published a 2022 report on hospital fall prevention, which included maternity wards in its scope. It cited:

• Incidence rates: Falls in maternity units (including postpartum areas) were lower than in medical-surgical units (1-2 per 1,000 patient-days vs. 3-5), but injuries were more common due to patients’ younger age and reluctance to use assistance.
• Common scenarios: Postpartum falls often occurred during transitions (bed to bathroom) or when carrying new-borns, suggesting multitasking as an indirect risk factor.

While not L&D-specific, these findings likely encompass postpartum recovery areas adjacent to delivery rooms, providing a broader context.⁶

Role of safe patient handling devices (e.g., Arjo Sara Stedy)

The Arjo Sara Stedy is a compact mobile device designed to assist patients with limited mobility in standing and transferring safely. It features a supportive frame, knee support, and a lifting mechanism that aids in transitioning from sitting to standing. Here’s how it can mitigate fall risks:

1. Support for orthostatic hypotension:
   
   
   • Gradual transition: The Sara Stedy allows mothers to move from sitting (e.g., on a bed) to standing in a controlled manner. Its lifting mechanism is designed to reduce the rapid postural change that triggers orthostatic hypotension, which can allow the cardiovascular system time to adjust.
   • Stability: The device’s wide base and secure grips provide a stable anchor, designed to prevent collapse if a mother feels dizzy or faint. This is critical during the first 24-48 hours postpartum when blood pressure regulation is most volatile.
     
     
2. Counteracting fatigue:
   
   
   • Reduced physical effort: Fatigue saps the energy needed for standing or walking independently. The Sara Stedy is designed to bear a percentage of the mother’s weight during transfers, which can minimize muscle exertion and preserve energy for recovery.
     
     
3. Reducing caregiver injury and fatigue:
   
   
• Assisting patients to stand and transfer to the toilet poses great risk to healthcare providers when performing these task manually without assistance of safe patient handling devices.
• Manual handling of patients has been seen to be a key contributor of musculoskeletal injury and pain among nurses and therapists.^7,8
• In 2016, nurses in private industry experienced 8,730 days off work due to musculoskeletal disorders, at an incidence rate of 46.0 cases per 10,000 full-time workers, compared to the average of 29.4 cases per 10,000 workers.⁹
• For employees who provided direct patient care, 59% of the injuries were attributed to patient-handling activities such as repositioning, transferring, preventing a patient fall and assisting a patient during a procedure.¹⁰
• An independent equipment review study reported that Sara Stedy can greatly facilitate caregivers in their role, reducing the amount of hands-on support required, reducing the potential of caregiver strain and enabling greater levels of independence for the patient/resident.¹¹

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References:

1. Heafner, L., & Gawlinski, A. (2018). Postpartum safety: A patient-centered approach to fall prevention. Journal of Obstetric, Gynecologic & Neonatal Nursing, 47(3), S13-S14.
2. Simpson, K. R. (2020). Postpartum care protocols and patient safety: Reducing risks in the immediate postpartum period. MCN: The American Journal of Maternal/Child Nursing, 45(2), 70-71.
3. Kennedy, H. P., Cheyney, M., Dahlen, H. G., & Vedam, S. (2021). Environmental influences on maternal experience in labor-delivery-recovery-postpartum (LDRP) units: A qualitative study. BMC Pregnancy and Childbirth, 21(1), 456.
4. American College of Obstetricians and Gynecologists. (2019). Postpartum hemorrhage: ACOG practice bulletin
5. Lockwood, C. & Anderson, K. (2017). Reducing postpartum falls: A quality improvement initiative. Nursing Women’s Health, 21(4), 258-265.
6. www.ahrq.gov/topics/falls.html Falls | Agency for Healthcare Research and Quality (3/28/2025)
7. Richardson et al. Perspectives on preventing musculoskeletal injuries in nurses: A qualitative study. Nursing Open. 2019. 6;915-929
8. Daragh A, et al. Safe Patient Handling Equipment in Therapy Practice: Implications for Rehabilitation. The American Journal of Occupational Therapy. 2013
9. US Bureau of Labor Statistics. https://www.bls.gov/opub/mlr/2018/article/occupational injuries and illnesses among registered nurses.htm. 2018; Accessed 10th March 2020
10. Totzkay, DL. Multifactorial Strategies for Sustaining Safe Patient Handling and Mobility. Crit Care Nurs Q, 2018. 41(3): p. 340-344
11. Rice S, 2016. Sara Stedy Equipment Review, March – August 2016