Care of Postnatal Mother

Objectives:
 List out
Definition
Principle
 Purpose
Articles
Procedure
Puerperium (postnatal period)
Puerperium:
• Puerperium is the period following childbirth during which
the organs, specially the pelvic organ revert back
approximately to pre pregnant state both anatomically and
physiologically.
• Puerperium is begins as soon as placenta is expelled and last
for approximately 6 weeks ,when the uterus become
regressed almost to the non-pregnant size.
 Immediate :Within 24 hours
 Early :Up to 7 day
 Remote :Up to 6 weeks
Care of postnatal care:
Postnatal care includes systematic examination of the mother and
appropriate advice given to the mother during postpartum period.
Over 5,36000 women die annually from complications during
pregnancy, child birth or the postpartum period.
Care of mother and newborn from 1hour after delivery up to 6week
post delivery.
Objective/Goal:
• To prevent from infection and complication.
• To help for proper involution.
• To promote for lactation
• To provide emotional support
• To teach for mother about :
Self care
Care of the baby
According to needs
Component of postnatal Care:
1. Examination of mother and newborn for preventive, early detection
and treatment of complications.
2. Counseling regarding breastfeeding ,birth spacing ,prevention of
infection (mother to newborn)and availability of appropriate service.
3. Education on danger sign of mother and newborn.
4. Education on maternal nutrition
5.Supplement vitamin A and iron.
6.Immunization of newborn baby
7.Referral and transport for emergencies for appropriate management.
Postnatal Care:
1. Postnatal examination of mother
2. Daily assessment of mother
3. General care of mother.
Postnatal examination
Postnatal examination is a medical examination to detect any
abnormalities as well as to find out the condition of mother and baby.
The National Essential Maternal and Neonatal Health care service
package for Nepal recommended three postnatal visit for all women
whether delivered at home or in health institution.
1. First Visit: Within 72hours of delivery.
2. Second Visit: Within 4-7days
3. Third visit :Within 45 days
Objective:
1. To detect and correct any abnormal condition of mother and baby.
2. To detect and treat life threatening complication of mother and
newborn.
3. To establish breastfeeding to the baby and prevent breast
complication.
4. For early detection of minor and major disorder of puerperium.
5. To improve mental and physical health of mother
6. Provide advice to the mother on immunization to the baby and
family planning to the mother.
Equipment :
• TPR tray
• Screen
• Bed pan
• Tape measure
• Equipment for urine test of protein and sugar
• Weight Machine
• Sterile gloves
• Dettol Swabs
• Kidney tray
• Cotton balls/pin
Time of postnatal visit:
1. With 72 hours or as soon as possible after delivery.
2. With 4-7 days following delivery
3. Third Postpartum Visit: within 6weeks of delivery.
Procedure
1. Prepare the necessary equipment and brings on beside or right side
of examiner.
2. Screen the patient to maintain privacy.
3. Explain the mother with polite language about procedure.
4. Ask mother to empty the bladder and bring specimen of urine for
sugar and protein test.
5. Wash the hands with soap and water thoroughly
6. Take weight, TPR,BP and Test urine for sugar and protein.
7. Inspect the mother’s general appearance e.g. Facial expression
,tiredness, happy, sad, stress as well as any sign of pale e.g. anemic
,yellowish color(jaundice),cyanosis.
8. Asses the physical status of mother in systematic way from head to
toe .During this process, if any abnormalities is found .We should tell
her and suggest for improving them.
BUBBLHE
B:Breast H:Homan’s sign
U:uterus E:Episiotomy and perineum
B:Bladder
B:Bowels
L:lochia
9.Systematic examination from head to toe include:
a) Head: Lice ,dandruff ,dirty ,hair distribution, injury, provide needful
advice.
b) Eyes: Conjunctiva for sign of anemia and jaundice, swelling of
eyelids ,eye movement ,symmetrical in size, infection; observe both
eyes in same time to compare each other.
c) Ear: Pain ,discharge, hearing problem etc.
d) Nose: Nasal discharge ,patency ,congestion, sinusitis, epistaxis ,polyps
etc.
e) Mouth: Color of lip, crack lip, angular stomatitis teeth for dental caries
,tongue for color and sore ,tonsillitis etc.
F) Neck: Goiter ,sore throat, pain on swallowing must be asked
,enlargement of lymph node
g) Hands: Color of nails, long or short ,rashes in between finger
(scabies),dirty, give advice as needed.
h) Chest: Respiratory problem, axillary lymph node.
i) Breast examination : Size, symmetry ,lump, condition of nipple ,clean
or dirty ,type of nipple (normal ,flat, inverted ),hygiene of nipple
(crack),breast engorgement.
• J)Abdomen: Liver, spleen for any palpable condition, abdominal scar,
Fundal height, condition of uterus.
• Inspection
• Techniques of taking Fundal height
 The bladder should be empty
The mother should keep in dorsal recumbent or supine position.
Palpate abdomen from symphysis pubis and feel the uterus.
Press the abdomen just above the uterine fundus by ulnar side of
hand.
Measure the length from symphysis pubis to the fundus of uterus
and record the fundal height in centimeters.
k) Lower extremities :Edema of leg ,pain during sitting and sleeping,
any sign of deep vein thrombosis ,varicose vein, thrombo-embolic sign
etc. Ask for any tiredness and tenderness.
Homan’s sign:
Varicose vein:
L) Genital Organs: Observe for condition, swelling, varicose vein of
vulva ,observe and record lochia for amount ,color ,odor ,consistency
and any abnormalities.
 Observe stitches for condition, swelling ,any gap between stitches
,infection etc.
 Perineum for tear ,laceration ,bruising.
m) Back: pain at loin side ,backache.
n) Ask about appetite :Well or not ,problem in diet.
o) Rest and sleep: Can sleep or not at night if not we must find out
cause and manage it accordingly.
p) After procedure, the equipment must be clean and replace it in their
respective place.
q) Wash your hands.
r) Explain the finding to mother and recording reporting of finding on
chart and seniors.
Reference
• Dutta,DC.1998,textbook of obstetetric,4th edition, New central book
agency PVT LTD,India.