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(WHO) stated that postnatal care is defined as a care given to the mother and her newborn baby immediately after the birth of the placenta and for the first six weeks of life. Majority of maternal and neonatal deaths occur during childbirth and the postpartum period. Scaling up of maternal and newborn health through proper postnatal care services is the best way of reducing maternal and neonatal mortality.
1- Postpartum Patient discharged from the hospital according to the policy (after 24 hrs post NVD, after 48-72 hrs post CS)
2- Postnatal assessment will be done by the physician and discharge with postnatal follow-up clear on discharge summary (home visit)
3- The home care team received postpartum patient information for home visit arrangements.
4- 1st visit will be on 1st week home visit or PHC (low-risk cases) in detail (check below)
5- After 1st visit, a clear plan will be given to the patient and documented for 2nd visit which will be 6 weeks postpartum (PHC VISIT, virtual clinic, OPD at hospital)
6- Communication with the patient through (phone number, and SMS).
History of any complications during the delivery / bleeding per vagina / convulsions or loss of consciousness
Pain in the legs / abdominal pain / fever / dribbling or retention of urine / any breast tenderness, etc.
Initiation of breastfeeding the baby
Has she started her regular diet?
Are there any other complaints?
Pulse, blood pressure, temperature and respiratory rate.
Presence of pallor.
Abdominal examination.
Examine vulva and perineum for the presence of any tear, swelling or discharge of pus.
Examine the pad for bleeding to assess if the bleeding is heavy, and also see if the lochia is healthy and does not smell foul
Examine the breasts for any lumps or tenderness, check the condition of the nipples and observe breastfeeding.
Post-partum care and hygiene
Nutrition
Registration of birth
IFA supplementation
Breastfeeding
Sexual advise and contraception counselling
Exercise:-exercise after childbirth can help body recover and may help to feel more energetic. And also pelvic floor exercises to strengthen the muscles around the bladder, vagina and anus.
Apart from the questions asked during the first visit, also ask about the following:
1. Continued bleeding P/V - occurring 24 hours or more after delivery
2. Foul-smelling vaginal discharge
3. Fever
4. Swelling (engorgement) and/or tenderness of the breast
5. Any pain or problem while passing urine (dribbling or leaking)
6. Fatigue / ‘not feeling well’
7. Unhappiness / Cry easily - post-partum depression
Pulse, blood pressure and temperature.
Check for Pallor.
Conduct an abdominal examination to see if the uterus is well contracted
Examine the vulva and perineum for the presence of any swelling or pus.
Examine the pad for bleeding and lochia.
Examine the breasts for the presence of lumps or tenderness.
Check the condition of the nipples.
Diet and rest
Contraception
A physician will agree to a plan with the woman for visits at home or PHC (in case of low risk) until her baby is at least 10 days old. This is to check that the woman and her baby are well and support the woman in these first few days.
The midwife will contact or refer the woman to the hospital if:
- A high temperature over 38C.
- The bleeding smells unusual for her.
- Pain that gets worse.
- The bleeding gets heavier.
- Pain in the perineum that gets worse it could be a sign of infection.
As often as the baby want. This may be every 2 hours. Let the baby decide when he had enough (this is called baby-led feeding).Check if the woman can express breast milk or if she has any problem with breastfeeding, it can include breast engorgement or mastitis.
Find out if she feel a bit down, tearful or anxious in the first week after giving birth. This is normal. If these feelings start later or last for more than 2 weeks after giving birth, it could be a sign of postnatal depression.
A woman can has sex as soon as she feel ready after having a baby.(6 weeks post-partum)
Full and complete counseling if patient is willing for family planning and this individualized according her medical condition and health circumstances.
Gentle exercise after childbirth can help body recover and may help to feel more energetic. And also pelvic floor exercises to strengthen the muscles around the bladder, vagina and anus.
1- Should have Blood glucose monitor and control,
2- Women with insulin-treated should reduce their insulin immediately after birth and monitor their blood glucose levels carefully to establish the appropriate dose.
3- Explain to women with insulin-treated pre-existing diabetes that they are at increased risk of hypoglycemia in the postnatal period, especially when breastfeeding, and advise them to have a meal or snack available before or during feeds
4- Women who have been diagnosed with gestational diabetes should discontinue blood glucose-lowering therapy immediately after birth.
5- Women with pre-existing type 2 diabetes who are breastfeeding can resume or continue to take metformin[2] and glibenclamide immediately after birth, but should avoid other oral blood glucose-lowering agents while breastfeeding.
6- Women with diabetes who are breastfeeding should continue to avoid any medicines for the treatment of diabetes complications that were discontinued
7- Refer women with pre-existing diabetes back to their routine diabetes care arrangements
8- Remind women with diabetes of the importance of contraception and the need for preconception care when planning future pregnancies.
1- Test blood glucose in women who were diagnosed with gestational diabetes to exclude persisting hyperglycemia before they are transferred to community care.
2- Remind women who were diagnosed with gestational diabetes of the symptoms of hyperglycemia.
3- For women who were diagnosed with gestational diabetes and whose blood glucose levels returned to normal after the birth:• Offer lifestyle advice (including weight control, diet and exercise).
A- Offer a fasting plasma glucose test 6–13 weeks after the birth to exclude diabetes (for practical reasons this might take place at the 6-week postnatal check).
B- If a fasting plasma glucose test has not been performed by 13 weeks, offer a fasting plasma glucose test, or an HbA1c test if a fasting plasma glucose test is not possible, after 13 weeks.Do not routinely offer a 75 g 2-hour OGTT
1.CBC
2. Blood biochemistry
POST NATAL CARE NICE GUIDELINE PUBLISHED 20 APRIL 2021
MOTHER HEALTH PASSPORT
Postnatal Care for Mothers and Newborns (World Health Organization 2013 Guidelines)
