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Chapter 109: Postnatal care

INTRODUCTION

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.

It is important to educate postpartum women on care of the baby and breastfeeding, self-care, 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

POSTNATAL CONSULTATIONS

The two-week consultation

Mother:

  • take history of birth and any perinatal complications

  • check blood pressure, weight (BMI)

  • assess how she is adjusting to motherhood

  • look for signs/symptoms of postpartum depression

  • provide encouragement and advice

  • check breastfeeding

Baby:

  • measure weight, height and head circumference

  • routine baby examination by checking the following:

  • – fontanelles

  • – eyes (observation, corneal reflexes, white pupil)

  • – cardiovascular examination

  • – femoral pulses

  • – hip tests for dislocation

  • – testes fully descended

  • – genitalia

  • – anal region

  • – skin

  • – reflexes

The six-week consultation

This is basically a repeat of the previous consultation—a checklist is presented in TABLE 109.1.

Table 109.1Checklist for postnatal check at 4–6 weeks
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Table 109.1 Checklist for postnatal check at 4–6 weeks

Mother

Enquire about vaginal discharge (lochia) and whether ceased

Ask about healing of the perineum if vaginal delivery

Check for any bowel or urinary problems

Check if breastfeeding and whether there are concerns

Check abdomen (uterus should be impalpable) and Caesarean wound if present

Check if intercourse has resumed and whether there are problems or concerns

Discuss contraception options

Advise on postnatal exercises

Discuss adequate diet, rest and personal care

Check psychological health, consider Edinburgh Postnatal Depression Scale

Consider pelvic examination, checking the perineum and pelvic floor strengths

Cervical screening test (if due)

Review antenatal screening tests for follow-up action (e.g. rubella booster)

Further follow-up if necessary

Baby

Measure weight, height and head circumference

Routine examination, e.g. check for red reflex, hips, heart sounds, testes in boys

Check growth and feeding

Complete childhood health record

Discuss immunisation schedule with parent/s

CONTRACEPTION

Lactational ...

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