UNIT

12:POSTPARTUM
CARE
Postpartum care
◦It is the provision of
care to woman
following the childbirth
to observe and monitor
the health of mother
and newborn baby as
well as provide support
and guidance in
breastfeeding and
parenting skills.
Postpartum care
◦A woman centered
approach to care the
postpartum period should
assist physical and
psychological recovery by
focusing on the need of
woman.
Goal
• The main goals of postpartum care to assist
and support women’s recovery to the non
pregnant state, assess and identify
deviations from normal and educate mother
about her own-self and infant care.
Goal
• To note the progress of the baby including the
immunization schedule for the infant.

• To impart family planning guidance.

• To support the mother for an easy transition.

• To detect and treat at the earliest any gynecological

condition arising out of obstetric legacy.

• To guide mother for breastfeeding.

Component
Component
• Examination of mother and newborn for
prevention, early detection and treatment of
complications.

• Counseling regarding breastfeeding birth

spacing, prevention of infection (mother and
newborn) and availability and provision of
appropriate services.
Component
• Education on danger sign in
mother and newborn.

• Supplement of vitamin A and

iron.

• Immunization of Newborn.

• Referral and transport for

emergencies to appropriate
management.
 Assessment of baby
◦Assess
◦vital signs
◦adequacy of breastfeeding and elimination
pattern
◦condition of umbilical cord
◦hygiene
◦color of skin
◦activity of newborn
Assessment of mother
◦First 24 hours after birth
◦All postpartum women should have regular
assessment routinely during the first 24 hours
starting from the first hour after birth-
◦ vaginal bleeding,
◦ uterine tonus,
◦ fundal height,
◦ temperature and
◦ heart rate (pulse)
Assessment of mother
◦First 24 hours after birth
◦Blood pressure should be measured shortly
after birth. If normal, the second blood
pressure measurement should be taken within
six hours.

◦Urine void should be documented within six

hours.
◦Beyond 24 hours after birth
◦At each subsequent postnatal contact,
enquiries should continue to be made about
general well-being and assessments
made regarding the following:
◦ micturition and urinary incontinence,
◦ bowel function,
◦ healing of any perineal wound,
◦ headache, fatigue,
◦ back pain,
◦ perineal pain and perineal hygiene,
◦ breast pain,
◦ uterine tenderness and lochia.
◦Breastfeeding
progress should
be assessed at
each postnatal
contact.
◦At each postnatal contact, women should
be asked about
◦their emotional wellbeing,
◦what family and social support they have
and
◦their usual coping strategies for dealing
with day-to-day matters.
◦All women and their families/partners
should be encouraged to tell their health
care professional about any changes in
mood, emotional state and behaviour that
are outside of the woman’s normal
pattern.
◦At 10–14 days after birth, all women should
be asked about resolution of mild, transitory
postpartum depression (“maternal blues”).

◦If symptoms have not resolved, the woman’s

psychological well-being should continue to
be assessed for postnatal depression, and if
symptoms persist, evaluated.
◦Women should be observed for any risks, signs
and symptoms of domestic abuse.

◦Women should be told whom to contact for

advice and management (e.g OCMC)

◦All women should be asked about resumption

of sexual intercourse and possible dyspareunia
as part of an assessment of overall well-being
two to six weeks after birth.
 Counselling
◦Women should be counselled on nutrition.

◦Women should be counselled about

exclusive breast feeding, position and
attachment during breastfeeding,
duration of breastfeeding etc.
◦Women should be counselled on hygiene,
especially handwashing, perineal hygiene.

◦Women should be counselled on birth

spacing and family planning.
Contraceptive options should be discussed,
and contraceptive methods should be
provided as requested.
◦Women should be counselled on safer sex
including use of condoms.

◦In malaria endemic areas, mothers and babies

should sleep under insecticide impregnated bed
nets.

◦All women should be encouraged to mobilize as

soon as appropriate following the birth. They
should be encouraged to take gentle exercise
and make time to rest during the postnatal
Educate on danger signs
◦All women should be given information about
the physiological process of recovery after
birth, and that some health problems are
common, with advice to report any health
concerns to a health care professional, in
particular:
◦Signs and symptoms of PPH:
◦sudden and profuse blood loss or persistent
increased blood loss,
◦faintness,
◦dizziness,
◦palpitations/tachycardia.
◦Signs and symptoms of
pre-eclampsia/eclampsia:
◦headaches accompanied by one or more of
the symptoms of visual disturbances,
◦nausea,
◦vomiting,
◦epigastric or hypochondrial pain,
◦feeling faint,
◦convulsions
◦Signs and symptoms of infection:
◦ fever,
◦ shivering,
◦ abdominal pain and/or
◦ offensive vaginal loss.
◦Signs and symptoms of thromboembolism:
◦ unilateral calf pain,
◦ redness or swelling of calves,
◦ shortness of breath or chest pain.
◦ The following signs should be assessed during each
postnatal care contact and the newborn should be
referred for further evaluation if any of the signs is
present:
◦ stopped feeding well,
◦ history of convulsions,
◦ fast breathing (breathing rate ≥60 per minute),
◦ severe chest in-drawing,
◦ no spontaneous movement,
◦ fever (temperature ≥37.5 °C),
◦ low body temperature (temperature <35.5 °C),
◦ any jaundice in first 24 hours of life, or yellow
palms and soles at any age.
Nutrition and supplement
◦Exclusive breast feeding
◦All babies should be exclusively breastfed
from birth until 6 months of age. Mothers
should be counselled and provided support
for exclusive breastfeeding at each postnatal
contact.
◦Iron and folic acid supplementation
◦Iron and folic acid supplementation should be
provided for 6-12 weeks.

◦Vitamin A
◦Vitamin A supplementation in postpartum
women (2,00,000 IU)
◦ (WHO- not recommended for the prevention of
maternal and infant morbidity and mortality )
Immunization of newborn
◦Newborn immunization
should be promoted as
per the latest existing
recommendations for
routine immunization.
Postnatal visits (WHO)
◦Provide every mother and baby a total of four
postnatal visits on:
─ First day (within 24 hours)

─ Day 3 (48–72 hours)

─ Between days 7–14

─ During week six after birth.

Postnatal visits (National)
◦Four postnatal check-ups,
◦The first within 24 hours of delivery,
◦The second on the third day,
◦Third on the seventh to fourteenth, and
◦Fourth on the 42 days after delivery.
Principles of Postpartum
Care
◦Provide care in women friendly environment.

◦Rooming-in (the mother and baby are in same

room)

◦Respect the woman’s dignity and right to

privacy

◦Be sensitive and responsive to the woman’s

needs
◦Be nonjudgemental about the decision that the
woman and her family have made for the care of
her and baby

◦Provider/nurse should be aware of the right of the

woman when receiving postnatal care services

◦Provider/nurse should speak in calm, quiet

manner and assure that the conversation of
woman is confidential
◦Be sensitive to any cultural or religious
considerations and respect her views

◦Follow infection prevention measures to

prevent major infections when providing care
and minimize risk of transmitting serious
diseases such as hepatitis and HIV/AIDS to
women and service providers
◦Hand washing must to be done before and
after examination of the mother and baby,
after exposure of blood or body fluids, and
after removing gloves

◦Wear gloves and gowns when performing

procedures, handling soiled instrument, and
disposing contaminated waste items
◦Handling of sharp instrument and needles in
“safe zone” where to place sharps

◦Waste disposal must be done properly to

prevent spread of infection
Role of nurse in postnatal
care
◦Promoting physical and psychological well being
of the mother and her family

◦Identification of deviation from normal

physiological or psychological progress and
prompt referral as required

◦Encourage sound method of infant care and

feeding and prompt development of effective
parent infant relationship
◦Monitor progress of mother and child according
to the needs, expectations and attitudes of a
particular mother and baby

◦Promotion of a relaxed environment conducive to

establish effective communication between
mother and her family

◦Provide non-judgemental approach offer

guidance and advice whenever necessary
◦Promote breast feeding

◦Encourage and teach self care during every

contact