Postpartum Care

TOPICS
Routine care of the postpartum woman Common Problems in the postpartum period

Vaginal bleeding Infection

Postpartum Family Planning

Objectives
To assess a woman in the postpartum period properly To be able to recognize and respond to abnormalities recognized in the postpartum period To give proper counseling to postpartum mothers

Components of Postpartum Care Visit

Early detection and management of complications Complication readiness Promoting health and preventing disease Woman-centered education and counseling

Steps to follow in Post partum care

1) Assess for emergency signs.
* Vaginal bleeding Fever Pallor Looks very ill

Do not make a very sick woman wait, attend to her immediately.

2) Greet the mother. Make her feel comfortable.

Postpartum Care
Assess:

When, where delivered How are you feeling? Appetite Is there any difficulty?

Painful breast/abdomen? Fever? Hard to void urine?/ Hard to pass stools? Bleeding since delivery

Family Planning? Other concerns? Check records: complications, treatment during delivery?

Postpartum Care

Providing GOOD CARE during postpartum visit: Make the woman comfortable Tell the woman you will examine her Wash your hands before and after examining woman. Maintain privacy Inform and explain findings to woman

3. Assess breastfeeding Is there any difficulty breastfeeding? Observe how mother breastfeeds for at least 4 minutes.
Is baby positioned well? Is baby able to attach to the nipples well? Is baby sucking effectively?

Routine Postpartum Care

Mother feels well BP, pulse & temperature normal No breast problems, breastfeeding well Uterus well contracted No problem with urination No pain or other concern

Give any treatment or prophylaxis due Iron Vitamin A Tetanus Advise and Counsel Health education Schedule return visit

Abnormalities in Postpartum Period

Elevated BP Pallor Vaginal Bleeding Foul smelling lochia Dribbling Urine Pus or perineal pain Feeling unhappy Vaginal discharge Breast Problem
Infection/ Breast abscess Sore or cracked nipple Engorgement Insufficient milk

REFER

Cough or breathing difficulty

Postpartum Bleeding
Women who develop vaginal bleeding >24 hours postpartum have LATE postpartum bleeding. May be due to retained placental fragments Uterus is soft and larger than expected REFER! If excessive bleeding: insert IVF, give 10 u oxytocin IM

Elevated BP
Blood pressure > 140/90 Look for signs that could indicate severe pre-eclampsia

Severe headache Blurring of vision Epigastric pain Severe breathing difficulty

Treatment and Prophylaxis

1. Prevent anemia with iron/folate supplementation.
2 tablets of iron/folate daily for 2 months (or more if mother is pale)

2. Give one capsule Vitamin A (200,000 IU) if none was given antepartum --to protect the baby from nutritional blindness and infections.

ADVISE AND COUNSEL

1. Postpartum care and hygiene
Wash hands before handling baby Wash perineum daily Have enough rest and sleep Avoid sexual intercourse until perineal wound heals.

2. Nutrition
Eat a greater amount and variety of healthy foods Spend more time on nutrition couselling with thin women and adolescents.

Encourage Breastfeeding
Importance, benefits and management of breastfeeding Teach correct positioning and attachment for breastfeeding Support exclusive breastfeeding for the first 6 months of life Encourage breastfeeding on demand Need to avoid supplementary feeds

Birth Spacing & Family Planning

Counsel on importance of family planning Inform about all contraceptive choices in postpartum period (ideally done antenatal) Facilitate free informed choice for all women Reinforce that non-hormonal methods (LAM, barrier methods, IUD and sterilization) are best options for lactating mothers Discuss other method options for the breastfeeding & non-breastfeeding woman

Birthspacing and Family Planning

Importance of family planning A woman who is not exclusively breastfeeding can become pregnant as soon as 4 weeks after delivery if she has sex. Method options for Method options for breastfeeding woman non-breastfeeding woman Immediately postpartum: Immediately postpartum: LAM, Condom, BTL, IUD Condoms, IUD, BTL Delay 6 weeks: Progestin Progestogen only OCP and only pills and injectables injectables (DMPA) Delay 6 months: Delay 3 weeks: combined OCP, Natural Combined OCP/injectables family planning Natural family planning

Lactation Amenorrhea Method (LAM)

1st

line contraceptive for postpartum women 3 conditions

Exclusive breastfeeding Menstruation has not returned (amenorrhea) Within 1st 6 months of delivery

Schedule Return Visits

All postpartum women should have at least 2 routine postpartum visits.

1st visit:

1st week postpartum, preferably within 48 -72 hours. 6 weeks postpartum

2nd visit

Women who do not return for postpartum visits should be visited at home.

 Because the more a

mother is cared for, the more easily she can care for her baby.
-Shivam Rachana

"Imagine Infinite Potential" by Mara Friedman