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 mother’s 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 babyshould 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.
The two-week consultation
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
The six-week consultation
This is basically a repeat of the previous consultation—a checklist is presented in TABLE 101.1.
Table 101.1Checklist for postnatal check at 4–6 weeks ||Download (.pdf) Table 101.1 Checklist for postnatal check at 4–6 weeks
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 strength
Cervical screening test (if due)
Review antenatal screening tests for follow-up action (e.g. rubella booster)
Further follow-up if necessary
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
Lactational amenorrhoea method (LAM) ...