Author: Ms Christa Maria Joel Moderator- Dr. Shannon Department of Obstetrics and Gynecology Father Muller Medical College 4th Year MBBS

1. Postnatal care &
counselling
Christa Maria Joel

2. • Postnatal care includes systematic
examination of the mother and baby
and appropriate advice given to the
mother during postpartum period.
• First postnatal examination done
and advice is given on discharge of
the patient from the hospital.
• Second routine postnatal care is
conducted at the end of 6th week
postpartum

3. Aims and objectives
• To assess the health status of the mother. Medical disorders-
diabetes, hypertension, thyroid disorders.
• To detect and treat any gynaecological condition arising out of
obstetric legacy.
• To note the progress of the baby including immunisation schedule
for the infant.
• To impart family planning guidance.

4. Procedure
Examination
of mother
Advice given
to mother
Examination
of the baby
and advice

5. Examination of mother
• Routine examination: weight, pallor,
blood pressure and tone of abdominal
muscles, progress of normal involution of
uterus and examination of breasts.
• Pelvic examination: cervical smear for
exfoliative cytology and insertion of IUD
when desired.
• Laboratory investigation depending on
clinical need (Hb).

6. Advice given to mothers- first visit
• Measures to improve her general health. Continue iron
supplementation.
• Procedures for gradual return to day to day activities.
• Breastfeeding and care of the newborn.
• Avoidance of intercourse for a period of 4-6 weeks until
lacerations or episiotomy wound are healed.
• Postnatal checkup after 6 weeks.

7. Postnatal exercises
• Objectives:
- to improve the muscle tone
- to educate about correct posture to
be attained when the patient is
getting up from her bed.
• Advantages:
- minimize risk of puerperal venous
thrombosis
- to prevent backache, to prevent
genital prolapse and stress
incontinence of urine.
• Procedure:
- breathing exercise and leg
movements lying in bed.
- instructed to tone up the
abdominal and perineal muscles
and to correct postural defects.
- Continued for 3 months.

8. • To tone up the pelvic floor muscles:
patient asked to contract the pelvic
muscles in a manner to withhold the act
of defecation or urination, then to relax.
• To tone up abdominal muscles: patient
lies in dorsal position with the knees bent
and the feet flat on the bed. Abdominal
muscles contracted and relaxed
alternately, the process is to be repeated
several times a day.
• To tone up back muscles: patient lies on
her face with the arms by her side.
Shoulders slowly moved up and down.
Repeated 3-4 times a day, gradually
increased each day.

9. To impart family planning guidance
• Family planning counselling and guidance:
Method of contraception depends upon:
- Breastfeeding status
- State of health
- Number of children

10. • Natural methods: Exclusive breastfeeding
provides 98% contraceptive protection. Cannot
be used until menstrual cycles are regular.
Barrier methods may be used.
• In non lactating mothers: steroidal
contraception can be used. Should be started 3
weeks after delivery.
• In lactating women: progestin only pill can be
used. Other progestins- DMPA, Levonorgestrel
implants.
• IUDs can be used irrespective of breastfeeding
status. Inserted immediately after delivery.
• Sterilisation: for those who have completed
their families.

11. Advice given to mother- second visit
• If the patient is in sound health she is allowed to do her usual
duties.
• Postpartum exercises may be continued for another 4-6 weeks.
• Evaluate the progress of the baby periodically and to continue
breastfeeding for 6 months.
• Family planning counselling and guidance.

12. To detect and treat any gynaecological condition
arising out of obstetric legacy.
• Complications of postpartal period:
- Puerperal sepsis: infection of genital tract within 3 weeks after
delivery. Treated with gentamicin. Adequate fluid and calorie intake.
- Thrombophlebitis: inflammation of veins of the legs. Analgesics,
antibiotics, anticoagulants like heparin.
- Secondary haemorrhage: bleeding from vagina between 6 hours after
delivery to the end of puerperium. May be due to retained placenta or
membranes.
- Others: UTI and mastitis (dicloxacillin 500mg every 6hrs orally)

13. • Gynaecological problems:
- Irregular vaginal bleeding: usually
the first period especially in non
lactating women. Persistence of
bleeding dating back from childbirth
likely due to retained bits of
conceptus. Requires ultrasound
followed by D&C.
- Leukorrhea: profuse white discharge
may be due to ill health, vaginitis,
cervicitis or subinvolution. Improve
general health and specific therapy.
- Cervical ectopy: without any
symptom should not be
treated surgically. Thus
examined again after 6 weeks
and if still persists,
cauterization.

14. • Backache: due to sacroiliac or
lumbosacral strain. Backache over
the sacrum - pelvic pathology.
• Slight degree of uterine descent
with cystocele, stress incontinence
and relaxed perineum- effective
pelvic floor exercise. If prolapse
marked- effective surgery should be
done after 3 months.
• Urinary and anal incontinence- any
sphincter injury. Perineal exercises.
• Retroversion: produces
backache. If associated with
subinvolution with symptoms, a
pessary is inserted after
correcting position, to be kept
about 2 months.

15. To note progress of the baby
• Examination of the baby-
- Done by a paediatrician.
- Progress of the baby evaluated
- Immunization of baby started.