Post natal care

1. COLLEGE OF HEALTH SCIENCE
SCHOOL OF NURSING AND MIDWIFERY
DEPARTMENT OF MATERNITY AND REPRODUCTIVE
HEALTH NURSING
ADVANCED MATERNITYAND RHN - II
GROUP ASSIGNMENT ON
POSTPARTUM CARE FOR WOMEN
S.NO NAME OF THE STUDENTS ID TRACK
1) ABRHAM TESFAYE GSR/8639/15 MATERNITY & RH NURSING
2) MIHRET DEBEBE GSR/0122/15 MATERNITY & RH NURSING
3) GEDEFAYE TESFAHUN GSR/2544/15 MATERNITY & RH NURSING
4) YONAS MINGESTU GSR/6132/15 MATERNITY & RH NURSING
SUBMITTED TO: MRS. ROZA T., (MSC, ASSISTANT PROFF)
SUBMISSION DATE: JUNE, 2023
ADDIS ABABA, ETHIOPIA

2. ii
Acknowledgment
First of all, we would like to say thanks AAU forgiving a chance for this MSc program. For
being of heart and our heartfelt thanks goes to all our respected instructors department of
maternity and reproductive health for their unreserved effort of lecturing and their excellent
teaching skill & guidance on the course maternity and reproductive health nursing II and for
giving this chance to write paper.

3. 1
Contents
Acknowledgment......................................................................................................................ii
Contents ....................................................................................................................................1
Introduction..............................................................................................................................2
Immediate postpartum care for the mother (first one hours after birth) ..........................3
Postpartum care for the mother (the first 24 hrs. after birth).............................................4
Postpartum care for the mother (after 48 hrs. of birth)......................................................5
References.................................................................................................................................6

4. 2
Introduction
The days and weeks following childbirth (the postnatal period) are a critical phase in the lives of
mothers and newborn babies. Most maternal and infant deaths occur in the first month after birth:
almost half of postnatal maternal deaths occur within the first 24 hours, 1 and 66% occur during
the first week. In 2013, 2.8 million newborns died in their first month of life, 1 million of these
newborns died on the first da. The world health organization (WHO) describes the postnatal
period as the most critical and yet the most neglected phase in the lives of mothers and babies;
most maternal and newborn deaths occur during the postnatal period.
Post-natal care is care that is provided to a mother and newborn baby after delivery and within
the first 42 days after child birth. Timing of care: i) Immediate PNC: Care provided to the mother
and/or newborn within the first 24 hours after delivery, ii) Early PNC: Care provided to the
mother and/or newborn between 3rd
to 7th
Day after delivery or birth, iii) Late PNC: At least
three additional postnatal contacts are recommended for all mothers and newborns, on day 3
(48–72 hours), between days 7–14 after Birth, and six weeks after birth.
The time immediately following the delivery of the baby and placenta is considered the fourth
stage of labour. After delivery, the fourth stage of labour normally lasts one to two hours,
however it can occasionally last longer. The fourth stage of labour is a crucial time for the
mother to relax and recover because her body has recently undergone a large amount of physical
exertion. The medical professional might recommend taking painkillers, and breastfeeding may
help to stimulate the uterus to contract and lessen the chance of severe bleeding.
The mother will be sent to a recovery area after the fourth stage of labour, where she will be
watched for several hours to make sure she is stable and not having any issues. The healthcare
practitioner will give advice on postpartum care, such as when to seek medical attention if
necessary, how to manage pain, and how to care for the perineum.

5. 3
Immediate postpartum care for the mother (first one hours after birth)
The first hours postpartum are extremely important. During this time caregivers should:
 Monitor the mother every 15 min for the first hour:
 Assess maternal well-being: measure and document BP, temperature and pulse every 15
min for the first 1 hour.
 Assess for vaginal bleeding, uterine contraction and fundal height regularly and massage
the uterus every 15 min.
 Check for any perineal problem, suture the perineum where necessary and inspect
episiotomy site if done.
 Encourage early initiation of breast feeding
NB: The primary goal is to prevent post-partum hemorrhage and decrease maternal mortality and
morbidity

6. 4
Postpartum care for the mother (the first 24 hrs. after birth)/Before discharge/
Monitor the mother at a regular interval of time and do the following:
 Measure and document the vital sign every 6 hour
 Assess the uterine tone and check lochia
 Assess active vaginal bleeding and check for pallor.
 Inspect episiotomy site if done for sign of infection and hematoma
 Monitor urine output for 6 hours and encourage voiding of urine.
 Encourage for mobility / ambulation.
 Encourage exclusive breast feeding
 Repeat examination of the mother before discharge
 Always have someone near her for the first 24 hours to respond to any change in her condition
Give preventive measures:
 If screening for syphilis is positive, treat the woman, her partner and newborn.
 Change perineal pads every 4 to 6 hours, or more frequently if heavy lochia
 Provide tetanus toxoid (TT) according to her immunization status / schedule.
 Provide mebendazole (depending on the previous dose - once in 6 months).
 Provision of iron/folate and give 3 month’s supplies.
 Provide postpartum family planning based on counseling during ANC. Options include
implants, postplacental insertion of IUCD; and for those who have completed their family
numbers, BTL by mini-laparotomy or vasectomy can be done.
 Give appropriate supportive care for mothers with stillborn or dead baby.
Counseling measure:
 Counsel on breast feeding
 Counsel on danger signs of the mother and newborn.
 Counsel on nutrition.
 Counsel on safe sex (including use of condoms).
 Counsel on continued abstinence from tobacco, alcohol and drugs.
 Advise on postpartum care and hygiene.
 Advice on use of insecticide treated bed net.
 Finally, Counsel for return visit.

7. 5
Postpartum care for the mother (after 48 hrs. of birth)/After discharge/
The mother had three follow-up visits after discharge (at 3rd
, 7th day and 6 week).
 The following care are given for the women:
Maternal care measures:
 Check blood pressure; passage of urine and urinary incontinence, bowel function, healing of
any perineal wound, headache, fatigue, back pain, perineal pain and perineal hygiene, breast
pain, engorgement, fever and uterine tenderness and status of lochia.
 Advise on mobility / ambulation, exercise and adequate rest.
 Check for leg swelling (DVT).
 Breastfeeding progress should be assessed at each postnatal contact.
 Assess and support emotional and psychological wellbeing.
 Search for any risks, signs and symptoms of domestic abuse and inform whom to contact for
advice and management.
 Ask for resumption of sexual intercourse and possible dyspareunia
 Assess for signs of postpartum complications.
 Encourage on continued use of ITN for women living in malaria endemic areas.
 Routine offering of HIV testing (if not tested earlier).
Counseling measure:
 Counsel on danger signs
 Counseling on appropriate nutrition, and micronutrient supplementation
 Counseling on personal hygiene and disposal of soiled pads
 Counsel on safer sex (including use of condoms).
 Advice on insecticide treated bed net use (if required).
 Counseling on breastfeeding and support as needed
 Counsel on PPFP if not done earlier and initiate based on the availability of methods,
commodities, instruments and trained personnel. Options include mini-pills, implants and for
those who have completed their family numbers BTL by mini-laparotomy or vasectomy can
be done.

8. 6
References
1. WHO. Postpartum Care of the Mother and Newborn: Practical guide. Safe Motherhood.
Matern newborn Heal unit World Heal Organ b Geneva. 1998; 10-17.
2. World Health Organization (WHO). Postnatal care of the mother and newborn 2013.
World Heal Organ. 2013;1–72.
3. Turner LADJEDMB. A pocket guide to clinical midwifery : the efficient midwife. Second
edition. 2020. 54–71.
4. Woman’s. Postpartum Care Guide. 2017. 23–37
5. MOH. BASIC EMERGENCY OBSTETRIC & NEWBORN CARE (BEmONC). Fed
Democr Repub Ethiop Minist Heal. 2018;19(4):269–273.
6. EFMOH. Obstetrics Management Protocol, for hospitals. Fed Democr Repub Ethiop
Minist Heal. 2021;34-67.