Postpartum Care

TOPICS
Routine

care of the postpartum

woman
Common Problems in the postpartum
period

Vaginal bleeding
Infection

Postpartum

Family Planning

Objectives
To

assess a woman in the postpartum

period properly
To be able to recognize and respond
to abnormalities recognized in the
postpartum period
To give proper counseling to
postpartum mothers

Components of
Postpartum Care Visit
Early

detection and management of

complications
Complication readiness
Promoting health and preventing
disease
Woman-centered education and
counseling

Steps to follow in
Post partum care
1) Assess for emergency signs.

Vaginal bleeding
Fever
Pallor
Looks very ill
* Do not make a very sick woman
wait, attend to her immediately.

2) Greet the mother. Make her

feel comfortable.

Postpartum Care
Assess:
When,

where delivered
How are you feeling? Appetite
Is there any difficulty?
Painful breast/abdomen? Fever?
Hard to void urine?/ Hard to pass stools?
Bleeding since delivery

Family

Planning?
Other concerns?
Check records: complications, treatment
during delivery?

Postpartum Care

Providing GOOD CARE during

postpartum visit:
Make the woman comfortable
Tell the woman you will examine her
Wash your hands before and after
examining woman.
Maintain privacy
Inform and explain findings to woman

3. Assess breastfeeding
Is there any difficulty
breastfeeding?
Observe how mother
breastfeeds for at least 4
minutes.
Is baby positioned well?
Is baby able to attach to the
nipples well?
Is baby sucking effectively?

Routine Postpartum Care

Mother feels well
BP, pulse & temperature
normal
No breast problems,
breastfeeding well
Uterus well contracted
No problem with urination
No pain or other concern

Give any treatment

or prophylaxis due
Iron
Vitamin A
Tetanus
Advise and Counsel
Health education
Schedule return visit

Abnormalities in Postpartum
Period
Elevated BP
Pallor
Vaginal Bleeding
Foul smelling lochia
Dribbling Urine

REFER

Pus or perineal pain

Feeling unhappy
Vaginal discharge
Breast Problem
Infection/ Breast abscess
Sore or cracked nipple
Engorgement
Insufficient milk

Cough or breathing
difficulty

Postpartum Bleeding
Women who develop vaginal bleeding
>24 hours postpartum have LATE
postpartum bleeding.
May be due to retained placental
fragments
Uterus is soft and larger than expected
REFER!
If excessive bleeding: insert IVF, give 10
u oxytocin IM

Elevated BP
Blood

pressure > 140/90

Look for signs that could indicate
severe pre-eclampsia

Severe headache
Blurring of vision
Epigastric pain
Severe breathing difficulty

Treatment and Prophylaxis

1. Prevent anemia with iron/folate
supplementation.
2 tablets of iron/folate daily for 2
months
(or more if mother is pale)

2. Give one capsule Vitamin A

(200,000 IU) if none was given
antepartum --- to protect the baby
from nutritional blindness and
infections.

ADVISE AND COUNSEL

1. Postpartum care and hygiene

Wash hands before handling baby

Wash perineum daily
Have enough rest and sleep
Avoid sexual intercourse until perineal
wound heals.

2. Nutrition

Eat a greater amount and variety of

healthy foods
Spend more time on nutrition
couselling with thin women and
adolescents.

Encourage Breastfeeding
Importance, benefits and management
of
breastfeeding
Teach correct positioning and
attachment for breastfeeding
Support exclusive breastfeeding for
the first 6 months of life
Encourage breastfeeding on demand
Need to avoid supplementary feeds

Birth Spacing & Family

Planning

Counsel on importance of family planning

Inform about all contraceptive choices in
postpartum period (ideally done antenatal)
Facilitate free informed choice for all women
Reinforce that non-hormonal methods (LAM,
barrier methods, IUD and sterilization) are
best options for lactating mothers
Discuss other method options for the
breastfeeding & non-breastfeeding woman

Birthspacing and Family

Planning

Importance of family planning

A woman who is not exclusively breastfeeding
can become pregnant as soon as 4 weeks after
delivery if she has sex.
Method options for
Method options for
breastfeeding woman
non-breastfeeding woman
Immediately postpartum:
Immediately postpartum:
LAM, Condom, BTL, IUD
Condoms, IUD, BTL
Delay 6 weeks: Progestin
Progestogen only OCP and
only pills and injectables
injectables
(DMPA)
Delay 6 months:
Delay 3 weeks:
combined OCP, Natural
Combined OCP/injectables
family planning
Natural family planning

Lactation Amenorrhea
Method (LAM)
1st

line contraceptive for postpartum

women
3 conditions
Exclusive breastfeeding
Menstruation has not returned
(amenorrhea)
Within 1st 6 months of delivery

Schedule Return Visits

All postpartum women should have at least
2 routine postpartum visits.

1st visit:

1st week postpartum,

preferably within 48 -72
hours.

2nd visit

6 weeks postpartum

Women who do not return for postpartum

visits should be visited at home.

 Because the more a

mother is cared for,
the more easily she
can care for her
baby.
"Imagine Infinite Potential"
by Mara Friedman

-Shivam Rachana