6a post partum care

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6a post partum care

  1. 1. 1Care after deliveryPost Partum CareMaternal Health DivisionMinistry of Health & Family WelfareGovernment of IndiaBEMoC - Presentation 6 (a)Session 6a
  2. 2. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India2Session Objectives Number and timing of postpartum visits formother and baby History-taking, examination, managementand counseling on diet, rest & contraceptionduring postpartum visits Identification of danger signs Indications for referral for mother & baby
  3. 3. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India3Importance of Postpartum Care More than 60% of maternal deaths takeplace during postpartum period First 48 hours are most crucial; hence length ofstay in health facility is 48 hours Most maternal and neonatal complicationsoccur during this period.
  4. 4. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India4Starting the care at 4thstage of Labour &immediate PNCDefinitionThe first one hour after delivery of the placenta is sometimesreferred to as the 4thstage of labourObservations BP pulse temperature Vaginal bleeding Uterus to make sure it is well contractedMonitor the following Every 10 minutes for the first 30 minutes Every 15 minutes for the next 30 minutes Every 30 minutes for the next 3 hoursEstimate & Record the amount of the blood loss in 3rdstage & after If loss is around 250ml & bleeding has stopped – observe for thenext 24 hours Then every 30 minutes for next 3 hours If >250 ml then look for the cause & treat it fast to save her life
  5. 5. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India5Immediate PNC – Mother (Contd...) Put a sanitary pad or a folded cotton under herbuttocks to collect blood –to estimate blood loss Keep mother & baby together, encourage earlybreast feeding Encourage the mother to eat, drink and rest Consider IUD insertion Encourage her to pass urine & if she is not ableto pass urine, gently pour water over her vulva Weigh the baby Do not leave the mother & the new born alone
  6. 6. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India6Call for help if any of the following occurs The bleeding increases. The woman feels dizzy. The woman has severe headache. The woman has visual disturbance. The woman has epigastric distress. The woman complains of breathlessness. The woman complains of increased abdominalor perineal pain.
  7. 7. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India7Enter the following in the labour register Name of the woman Age of the woman Parity ANC received (or not): mention the number ofANC visits received Mode of delivery (normal or assisted) Birth weight of the baby Apgar score of the baby at 1 minute and 5minutes after delivery.
  8. 8. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India8Post Partum care & Hygiene Not to be left unattended; any change in condition should bereported Not to insert anything into the vagina. To wash the perineum daily and after passing stools. Wash inan anteroposterior direction from the vulva to the anus. To change the perineal pads every 4-6 hours, or morefrequently, if there is heavy lochia. To wash cloth pads, if used, with plenty of soap and water anddry them in the sun. To bathe daily. To have enough rest and sleep. To avoid sexual intercourse for the first six weeks or until theperineal wound heals, whichever is later. To wash her hands before handling the baby.
  9. 9. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India9Advise at discharge from the facilityHome care of New Born Breast feeding Keeping the baby warm Infection Prevention Cord care
  10. 10. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India10Subsequent visits Scheduled visits• At 3rdday• At 7thday• At 6 weeks SOS emergency visits in presence of dangersigns
  11. 11. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India11Neonatal Danger Signs to be taken to FRU Neonatal danger signs• Convulsions• Not able to feed• Fast breathing• Severe chest-indrawing (not during crying)• Nasal flaring• Grunting• Lethargy & unconscious• Feels Hot or Cold• Blood in stool
  12. 12. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India12Counselling – Diet & Rest Reassure the mother that she can eat normal food ; these will notharm the breast fed baby Diet to be rich in iron & fibre Discuss about food taboos especially against food that arenutritionally healthy Talk to family members like mother in law , husband to encouragethem to ensure that the woman easts enough & avoids heavyphysical work Take care of the mother so that she can take care of the baby Counselling on diet especially for adolescent mother IFA Supplementation Women with normal Hb are advised to take 1 IFA tablet daily for 3months If Hb below 11 gm%, advise her to take 2 IFA tabs daily and repeatHb after 1 month Family support specially for girl child Rest to the Mother
  13. 13. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India13Counselling on Care & Hygiene Wash hands before handling baby Wash perineum daily Avoid sexual intercourse until perineal woundheals
  14. 14. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India14Danger SingsFor the following symptoms and signs in the mother,advise the woman and her family to go to an FRUimmediately, day or night, WITHOUT WAITING. Excessive vaginal bleeding, i.e. soaking more than2 or 3 pads in 20-30 minutes after delivery, ORbleeding increases rather than decreases after thedelivery Convulsions Fast or difficult breathing Fever and weakness; inability to get out of bed Severe abdominal pain
  15. 15. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India15Advice to go to nearby facility in case offollowing symptoms Fever Abdominal pain The woman feels ill Swollen, red or tender breasts, or sore nipples Dribbling of urine or painful micturition Pain in the perineum, or pus draining from theperineal area Foul-smelling lochia.
  16. 16. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India16Counselling on Breast feeding Rooming –in is important for breast feeding. It helps:• Makes demand feeding easier to practice as themother can hear the child cry• Prevents hypothermia• Builds a bond between mother & the baby Importance, benefits & management of breastfeeding Teach correct positioning & attachment forbreastfeeding Support exclusive breastfeeding for the first 6 months oflife Need to avoid supplementary feeds
  17. 17. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India17Counselling on Family Planning A woman who is not exclusively breastfeedingcan become pregnant as soon as 4 weeksafter delivery if she has sex
  18. 18. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India18Counselling on Family Planning Inform about all contraceptive choices inpostpartum period –Cafeteria Aproach Facilitate free informed choice for all women Reinforce that non-hormonal methods (LAM,barrier methods, IUCD and sterilization) arebest options for lactating mothers Discuss other method options for thebreastfeeding & non-breastfeeding woman
  19. 19. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India19Cultural Influences Postpartum care may be affected by culturalbeliefs:• No breastfeeding for the first three days• Hot and Cold foods• No Prelacteal feeds, give demand feed• Do not make generalizations• No bath to the mother and for the baby ispracticed – Wrong Practice• Gender Bias - Counselling
  20. 20. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India20Key Messages Danger signs for mother & Neonate Immediate Post Partum Care Counselling on diet, rest & contraception Cultural influences
  21. 21. CARE AFTER DELIVERY POST PARTUM CAREMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India21Case study Case Study number 22 on page number 85 onTrainee’s Hand Book
  22. 22. 22Thank you

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