Care of mother — first 24 hours after birth

  • Always call for help — get midwife/doctor/obstetrician on speaker phone, if none locally
  • Find support people — if possible female ATSIHP or older women familiar with birthing
  • Reassure woman and explain what is happening. Have someone stay with her for support

Check

  • Calculate REWS — AVPU, RR, O2 sats, pulse, BP, Temp
  • Weight, BGL 
  • Signs of shock
    • Increased RR
    • Pulse weak and fast (more than 100bpm) or difficult to feel
    • Central capillary refill longer than 2 seconds
    • Pale, cool, moist skin
    • Restless, confused, drowsy, occasionally unconscious
    • Low BP for age or relative to person's previously recorded values

Do — in first hour 

After birth of placenta

  • Check STI status
  • Check that blood and swabs for all other routine tests have been collected
  • Record in file notes
    • Date and time of birth
    • Time of delivery of placenta
    • How much blood woman lost — 1 soaked pad is equal to about 100mL
    • What you did, any problems you had, etc
    • Any medicines, immunisations given to mother and/or baby
    • Whether placenta and membranes are complete or incomplete
  • Complete birth registration forms
  • If mother comfortable — put baby on her chest, encourage skin-to-skin contact and breastfeeding. Offer help if needed
  • Encourage woman to pass urine — full bladder can stop uterus contracting and cause heavy bleeding
  • Offer woman something to eat and drink, shower and change of clothes
  • Make sure placenta checked and is complete
  • Don’t forget to celebrate and debrief
    • If challenged or distressed by anything you saw or did talk with friends, colleagues and/or qualified counsellor, eg Bush Support Services on 1800 805 391
  • Medical consult
    • Refer to mother’s medical and obstetric history

Talk ​about

  • Labour, birth, condition of mother and baby AND
  • Problems with woman, baby or placenta
  • If needing to send to hospital — send placenta, birth documents, bloods, birth registration and family assistance forms with woman

Do

Blood tests

  • If no antenatal care — medical consult
    • Bloods as for first antenatal visit including FBC (best done 24 hours after birth), syphilis serology — see Antenatal checklist
  • If woman RhD negative or blood group unknown — medical consult
    • May need to transfer to hospital for cord blood processing and RhD-Ig within 72 hours
    • Take blood for Kleihauer test (to determine amount of foetal blood in maternal circulation) — within 2 hours of birth and before giving RhD-Ig

Talk with woman about

  • Emptying bladder regularly to lessen risk of heavy bleeding ​
  • How to feel top of her uterus and how to massage it to make it hard if she has heavy bleeding
  • If heavy bleeding (needing to change pad more than every few hours) — tell clinic staff as soon as possible — this is an emergency
  • Perineal hygiene and healing — changing pads often and shower at least once, preferably several times a day
    • If perineal tear ​— call maternity service
  • 'After birth' pains — crampy uterine pains, often worse when breastfeeding — give pain relief if needed
  • Symptoms of thromboembolism (clots) — DVT or PE
  • Breastfeeding
  • Arrangements for follow-up/ongoing care including contraception — see Postnatal care of mother

Before leaving clinic

  • Encourage woman to move about to help prevent blood clots ​in her legs
  • If woman staying in community
    • Mother and baby should rest in clinic for at least 4 hours or as long as needed after birth
    • Make sure woman has passed urine ​before leaving clinic
    • Make sure woman has someone staying with her to help look after baby
  • Fill in forms for birth registration, perinatal statistics and family assistance
    • Remind woman to attend Centrelink and have 100 points of identification ready