5c_Postpartum-Care.ppt

Care after delivery:
Postpartum Care
SBA - Presentation 5 (c)
Maternal Health Division
Ministry of Health & Family Welfare
Government of India

Care after delivery: Postpartum Care 2
Objectives
To learn
• Number and timing of postpartum visits for
mother and baby
• History-taking, examination, management and
counseling during postpartum visits
• Steps for referral and transfer of baby

Importance of Postpartum Care
• More than 60% of maternal deaths take
place during postpartum period
• First 48 hours are most crucial
• Most maternal and neonatal complications
occur during this period.

Postpartum visits by ANM/ASHA
* There should be three additional visits in case of babies with low birth weight,on days 14,21 and 28
as per Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines.
6 weeks after delivery
6 weeks after delivery
Fourth visit
7th day after delivery
7th day after delivery
Third visit *
3rd day after delivery
3rd day after delivery
Second visit
Not applicable
1st day(within 24 hrs)
First visit
After delivery at PHC/FRU
(woman discharged after 48 hrs)
After delivery at home / sub centre
Visits

First postpartum visit
Mother
• History
• Examination
• Management and Counseling
– Postpartum care and hygiene
– Nutritional advice
– Rest
– IFA supplementation
– Contraception
– Breast feeding
– Birth registration
New born
• History
• Examination
• Newborn care
– Keeping baby warm
– Hygiene
– Cord care
– Breast feeding
– Immunization

First postpartum visit:Mother
History
• Place of delivery
• Initiation of breast feeding
• Any complaints :
Excessive bleeding
Abdominal pain
Convulsions
Loss of consciousness
Pain in legs ,fever
Urinary retention
Difficulty in breathing
Foul smelling lochia
Examination
• Pulse,BP,RR.Temp
• Pallor
• Abdomen : tender uterus,refer to FRU
• Vulva and perineum:
tear,swelling or pus,
refer to FRU after initial management
• Excessive bleeding P/V
refer to FRU after initial management
• Breast : lump,tender
refer to FRU

Management / Counseling
1.Postpartum care and hygiene
Advise the mother to
• Wash perineum daily and after passing urine and stools
• Change perineal pads every 4 - 6 hours
• Wash hands frequently and take bath daily

Management / Counseling contd..
2.Nutritional Advice
• To increase intake of fluid and food especially iron and
protein rich foods like green leafy vegetables, jaggery,
lentils, eggs and meat
• Increase intake of milk and milk products like curd,
cheese etc
3.Advise adequate rest

4.IFA Supplementation
• Women with normal Hb are advised to take 1 IFA tablet
daily for 3 months
• If Hb below 11 gm%,advise her to take 2 IFA tabs daily and
repeat Hb after 1 month
5.Contraception
• Counsel couple regarding contraception

6.Breastfeeding
Advise the mother-
• For exclusive breast feeding on demand,at least 6 to 8
times during day & 2-3 times during night
AVOID PRE- LACTEAL FEEDS

Breast feeding problems:
Cracked /sore nipples
Advise the mother:
• to apply hind milk for soothing effect
• ensure correct positioning and attachment of baby
Engorged breasts
Advise the mother:
• to continue breast feeding
• to put warm compresses

Registration of birth
Emphasize the importance of registration of birth
with local panchayat
• It is a legal document
• Required for many purposes

Postpartum period: danger signs
Woman should be counseled
to report to FRU if she has
• Fever
• Convulsions
• Excessive bleeding
• Severe abdominal pain
• Difficulty in breathing
• Foul smelling lochia

First postpartum visit for baby
History taking:
• Ask if breast feeding has been initiated
• Inquire whether the baby has passed urine and meconium
• Elicit h/o any problems in newborn
Refer to FRU if
• Not feeding well
• Cold to touch or fever
• Baby is lethargic or has had convulsions

Examination of newborn Refer to FRU
Cry and activity Poor cry
Lethargic / unconscious
Chest in drawing Severe chest in drawing is a sign of pneumonia
Respiration If <30 or ≥ 60 breaths /min
Central Cyanosis Bluish discoloration of tongue and lips
Body temperature If temperature is <35.5oC or > 37.4o C

Examination of newborn Refer to FRU
Umbilical stump Any bleeding, redness or pus
Skin infection If ≥ 10 pustules or a big boil
Jaundice If appears in < 24 hrs of birth
Eyes Redness,discharge or swelling
Congenital malformation
and Birth injury
If present

Breast Feeding : Signs of good attachment
• Chin touching breast
• Mouth wide open
• Lower lip turned outward
• More areola visible above than below the mouth
A baby poorly attached to the breast
A baby well attached to the breast

Breast Feeding: Effects of poor attachment
• Pain and damage to nipples,leading to sore nipples
• Breast is not emptied completely,resulting in
breast engorgement
• Poor milk supply: baby not satisfied
• Poor weight gain of baby.

Immunization of Newborn
Counsel mother on where and when
to take baby for immunization

2nd and 3rd visit for mother
On 3rd and 7th day following delivery
History taking:
As on first visit
In addition ask for history of
• Continued bleeding P/V,foul discharge P/V
• Swelling or tenderness of breast.
• Feeling unhappy or crying easily
Examination: Same as on 1st visit
Management and Counseling: Same as on 1st visit

History taking and Examination:
Same as in first visit
Management and Counseling:
In addition to counseling in first visit, advise the mother :
To exclusively breast feed for six months.
To wean at six months.
2nd and 3rd visit for baby

Fourth visit for mother
At 6 weeks following delivery
History taking:
Ask the mother for following:
• Has vaginal bleeding stopped?
• Has menstrual cycle returned?
• Is there any foul smelling vaginal discharge?
• Any problems regarding breast feeding?
• Any other complaints?
• Give relevant advice & refer to M.O.if needed

Fourth visit for mother
Examination:
Similar to examination during previous visit
Diet and Rest:
Emphasize importance of nutrition as in second and third visit.
Contraception:
Emphasize importance of using contraceptive methods for
spacing and limiting family size

Fourth visit for baby
History taking:
Ask the mother about
• Vaccines received by baby so far
• Is baby taking breast feed well?
• Weight gain of baby
• Any other problem
Examination:
• Check weight of baby.
• General examination of baby

Fourth visit for baby
Emphasize on exclusive breast feeding
Refer baby to F.R.U. if
• Not sucking well at breast
• Is lethargic / unconscious
• Has fever or is cold to touch
• Cord - swollen or discharge present
• Diarrhea,blood in stool
• Convulsions

Key messages
Post partum care: Mother
• Make at least 4 postpartum visits for timely recognition
of complications like PPH, puerperal sepsis
• Advise mother on nutrition
• Advise mother on rest, hygiene,breast feeding and
contraception

Key messages
Post partum care: New born
Screen for danger signs in newborn
Advise the mother to
• Keep baby warm
• Take care of umbilicus, skin & eyes
• Give exclusive breast feeds
• Ensure correct positioning & attachment to breast
• Immunize the baby

Steps for transfer and referral of baby
Preparation:
• Explain reason for transferring baby to higher facility
• If possible transfer the mother with baby so that she can
feed the baby
• A health care worker should accompany baby
• Ask relative to accompany baby and mother

Steps for referral of baby
Communication:
• Fill up a referral form with baby’s essential information and
send it with baby
• If possible contact health care facility in advance

Steps for transfer of baby
Care during transfer:
• Keep baby in skin to skin contact with mother, if not
possible keep baby dressed and covered
• Ensure that baby receives feeds
• If baby gasping or respiratory rate <30 breaths /minute,
resuscitate baby using bag and mask

Thank you

5c_Postpartum-Care.ppt

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