Postnatal care of mother

Red Flags — Urgent Medical Consult	High risk needing more frequent review and further assessment
Heavy bleeding and/or clots at any time Persistent bleeding up to 6 weeks Offensive vaginal discharge Abdominal pain Calf swelling and/or pain Significant mood changes	Breast or nipple pain Difficult birth Domestic family violence Mental health concerns

Planned schedule of visits should consider individual woman’s needs. See also — Postnatal care of baby
If difficult to see woman and baby as often as recommended, use any opportunity to assess wellbeing and provide care
If worried woman or baby medically or socially 'at risk' — keep regular contact with mother and review baby more than once a week

Schedule

First postnatal visit

First visit should be completed as soon as possible after mother and baby return to community
First visit will be long. Spend time getting to know woman explaining what needs to be done
Review discharge paperwork and take detailed history and examination

Normally bright blood loss for 2-3 days then dark to pink. Gets less over 2 weeks. May have light bleeding for 4-6 weeks — should stop by 6 weeks

Wounds — healing and pain
Severe pain — abdominal, perineal, headache, neck or back, calves
Social and emotional wellbeing — family supports, mood changes, symptoms of depression or anxiety

If BGL abnormal — see Diabetes in pregnancy
U/A — if positive or symptoms of UTI — MC&S
Immunisation status — give any due
RhD-Ig given in hospital if woman RhD negative with no Anti-D antibodies and baby RhD positive — RhD-Ig usually given in hospital within 72 hours of birth (IM 625 international units)
Head-to-toe exam — with attention to

Breasts, nipples — cracked or sore nipples, redness, inflammation, breast lumps or pain, issues with breastfeeding
Abdominal exam — if caesarean section check wound for healing
Abdominal palpation — do not feel for uterus if caesarean section. Uterus should feel like a firm lump below umbilicus. If not there or tenderness — midwife/medical consult
Perineum — clean, not infected, healing if tear or episiotomy
Haemorrhoids (piles)
Legs — signs of blood clots. Check for heat, pain, swelling in calf muscles

Check abdominal wound daily until healed, sutures removed or absorbed
Give adequate pain relief — see Pain management (acute)
Encourage to move about as much as possible
Advise to avoid lifting, strenuous activity
Talk with woman about the birth, her feelings about having a caesarean section, impact on future pregnancies

POC test — Hb. If less than 110g/L — see Anaemia (weak blood) in adults
Medical consult to follow-up medical problems in pregnancy (eg high BP, diabetes, RHD, kidney disease)
Give iodine oral — 150microgram, once a day. Can be in multivitamin designed for pregnancy and breastfeeding

Mild lower abdominal pains — can last a few days, often happen when breast feeding. Give paracetamol oral — adult 1g, up to 4 times a day (qid)
Constipation — advise exercise, high fibre diet and lots of fluids. Consider ‘bulking agent’ (eg Metamucil) or softener (eg docusate) laxative if not passed faeces for 3 days
Haemorrhoids — make sure not constipated. Give anorectal cream or suppository but only for a few days

Urine — may sting vulva, perineum, labia. Encourage drinking lots of water, lean forward to pass urine or pass urine in shower. Treat UTI and give urinary alkalinizer
Mood — reassure feeling bit sad, teary for a few days after the birth is common

Medical consult if depressed, acting in strange way or still sad feelings more than 2 weeks after the birth

Important to come to clinic for checks for herself and baby over next few weeks, especially if concerns

Strongly encourage breastfeeding
If not able to breastfeed — talk with midwife, lactation consultant
If choosing not to breastfeed — talk about formula feeding — see Postnatal nutrition for mother and baby (up to 6 months old)

Sleep baby on their back
Do not cover head and/or face
Do not smoke near baby
Use a firm, flat mattress and clean bedding
If co-sleeping, adults should not drink, smoke or take drugs and baby should be between the edge of mattress and carer

Self-care
Emotional changes after birth — birth experiences, adjustment to mothering, feelings toward baby, fatigue — see Perinatal depression and anxiety
Social circumstances and support, domestic or family violence
Diet — regular healthy meals and snacks, plenty of fluids — see Postnatal nutrition for mother and baby (up to 6 months old)
Exercise — leg exercises and walking to prevent blood clots
Pelvic floor exercises — help prevent urinary incontinence
Contraception and baby-spacing, sexual health, sexual activity after birth

Check any problems previously identified have resolved
Check has and is taking prescribed medicines
Discuss nutrition/feeding, exercise, sleeping, smoking, social and emotional wellbeing

Edinburgh Postnatal Depression Score (EPDS)
Full STI check including syphilis serology
Any pathology needed and medical consult for Postpartum follow-up of medical conditions
Cervical screening test if due
Contraception
Discuss nutrition/feeding, safe sleeping, self-care, wellbeing, exercise as per first visit

Advise to avoid lifting, strenuous activity
Talk with woman about the birth, her feelings about having a caesarean section, impact on future pregnancies
Advise to come to clinic with baby for medical follow up