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As concerning the bringing up, nourishment and giving of suckle to the child, it shal be beste that the mother give her child sucke her selfe, for the mothers milk is more convenient and agreeable to the infant than any other woman’s or other milke.

Thomas Raynalde, The Byrthe of Mankynde (1540)

Education for the puerperium and caring for the baby should begin during pregnancy so that a new mother is familiar with the basic principles of motherhood, especially infant feeding.1 The puerperium is defined as the period of approximately 42 days from the completion of the third stage to the return of the normal physiological state.

The newborn screening test or ‘heel prick’ test should have been performed on the baby routinely. The testing from a single blood sample should include cystic fibrosis, phenylketonuria, congenital hypothyroidism, galactosaemia and several other uncommon metabolic conditions.

Be mindful of the possibility of neonatal abstinence syndrome in a child exposed to excessive drug and alcohol intake during pregnancy.

Postnatal care really begins with the birth of the baby. Once the airways are cleared the baby should be given to the mother as soon as possible and not taken from her except for essential management.

The mother should remain in the labour ward (if delivered in hospital) for at least an hour after giving birth and until she has passed urine. She should be inspected frequently to exclude the possibility of a silent postpartum haemorrhage and vital signs checked before transferring to a lying-in ward. It is worth remembering that one-third of eclamptic convulsions occur postpartum.

It is important to educate postpartum women on care of the baby and breastfeeding, self-care, hygiene, healing of the genital tract, sexual life and contraception, nutrition and what happens to their bodies and preventive issues. The uterus involutes to non-pregnant size by 6 weeks and the cervical os should be closed by 2–3 weeks post delivery.2

Guidelines for the post-natal ward1

  • Every mother needs rest but should have full toilet and shower facilities.

  • The baby should be in a bassinet beside the mother and may be taken into bed any time the mother likes.

  • Room in: the baby should not go to the nursery unless it is sick or the mother requests it.

  • In the first 24 hours check pain, perineum, blood loss and BP.

  • Subsequently check the same parameters plus temperature, signs of infection, lochia, breast care and psyche.

  • Demand feed to appetite.

  • A golden rule is that breastfeeding and the supply of mother’s milk is a classic case of ‘supply and demand’.

  • The doctor should listen carefully to what the mother is saying (and not saying) during visits.

  • Check that anti-D vaccine was given (if necessary).

Postnatal consultations

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