Postnatal care of mother

If woman has biethed in community — see Care of mother — first 24 hours after birth

Related topic — see also Postnatal care of baby

Schedule of visits

• 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 visit within first 24 hours of birth THEN
• 2nd day following birth
• 3rd day following birth
• 4-7 days following birth
• 7-10 days following birth
• Weekly until 6 weeks following birth
• 8 weeks following birth

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

Ask

• Does she have concerns
• How baby is going, how she is managing care of baby
• Is she eating, sleeping, walking around community
• Substance use (smoking, chewing tobacco, alcohol, other drugs)
• Breastfeeding, breast and/or nipple pain, other problems
• Urinary or bowel problems or incontinence
• Vaginal bleeding or discharge — colour, amount, smell, changing pads often
• 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

Check

• 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

If caesarean section

• 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

Do

• 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
• If woman has thyroid condition — medical consult
• Help mother to complete forms — birth registration, family allowance, Medicare
• Remind woman to attend Centrelink and have 100 points of identification ready

Treat common problems

• 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
• Medical consult about surgical referral if severe or does not get better
• 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

Discuss

• Planned schedule of care for mother and baby
• Feeding baby
• 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)
• Safe sleeping
• 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

Follow-up visits

• Ask about red flag items

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

6-8 week postnatal check

• Can be long. Spend time getting to know woman, explaining what needs to be done
• Take detailed history and examination as per first postnatal visit AND
• 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

If caesarean section

• Check abdominal wound daily until healed
• Give adequate pain relief
• Encourage to move about as much as possible
• Check for complications of operation
• Transient ileus (bowels not working)
• UTI or chest infection
• DVT (Blood clot) in leg
• Wound infection
• 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