concept about postnatal care – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Concept about Postnatal Care
Definition of Post Natal Care
Postnatal care includes systemic examination of the mother & baby and appropriate advice given to the mother during postpartum period.
Definition of Post Natal Period:
The postnatal period is usually considered the interval extending from the birth of the baby until 6 weeks after. It is the 6 weeks interval between the birth of the newborn and the rectum of the reproductive organs to their normal non-pregnant state.
Aims/Objectives/Importance of Post Natal Care:
➤ To detect & treat at the earliest any gynaecological condition arising out of obstetric legacy.
➤ To note the progress of the baby including the immunization schedule for the infant.
➤ To promote and monitor the mother’s psychological, emotional and social well-being and provide appropriate support.
➤ To promote and monitor the mother’s and baby’s physical well-being.
➤ To help the mother establish a successful infant feeding regime.
➤ To faster the development of good maternal infant relationships and the acceptance of the new baby within the family.
➤ To enhance the mother’s confidence in her ability to fulfill her mothering role.
➤ To impart family planning guidance.
➤ To promote health education, including education for Planned Parenthood.
Care to a mother during postnatal period
1. Assessment of Breasts:
Redness, heat, pain, cracked, and fissured nipples, inverted nipples, palpable mass, painful, bleeding, bruised, blistered, cracked nipples.
2. Assessment of Uterine Fundus: Fundus is deviated from the midline, boggy consistency, remains above the umbilicus for after 24 hours.
3. Assessment of Bowel Function:
Assess abdomen for distention, LBM, bowel sounds, hemorrhoids.
Abnormal Findings (Bowel):
Constipation, diarrhea, epigastric pain, hemorrhoids.
4. Assessment of Bladder Function:
Asses last void, rule out urinary retention.
Abnormal Findings (Bladder)
Inability to void, frequency, urgency, dysuria.
5. Assessment of Lochia:
Note amount, colour, consistency, odour, presence of clots.
Abnormal Findings (Lochia)
Heavy, foul, odour, bright red bleeding.
6. Assessment of Legs:
Assess for edema (peripheral, sacral, dependent), varicose veins, risk factors of
thrombophlebitis, Homan’s sign.
Abnormal Findings (Legs)
Positive Homan’s sign, painful, reddened area, warmth on posterior aspect of calf.
7. Assessment of Emotions:
Assess for sleep deprivation, ability to rest, energy level, comfort level, anxiety level, appetite, bonding behaviours, support system.
8. Postpartum Hemorrhage:
Loss of more than 500 mL of blood after vaginal birth, loss of more than 100 mL of blood after cesarean birth, a 10% change in HCT between admission for labor and postpartum or the need for RBC transfusion.
9. Assessment of Attachment Behaviour:
Comforting techniques by parents, speaking about the infant in terms of identification, holding the infant, body contact, talking to the infant, affection to the newborn.
10. Postpartum Depression:
An intense and pervasive sadness with severe and labile mood swings; it is more serious and persistent than the baby blues.
11. Postpartum Psychosis:
Syndrome characterized by depression, delusions, and thoughts by the mother of harming either the infant or herself.
Postnatal care:
A. Definition-Above discussed
B. Aims/objectives- Above discussed
C. Care of mother and newborn:
Care of mother:
➤ The importance of having someone nearby for the first 24 hours
➤ The importance and recommended timing of postnatal visits!
➤ The importance of the new mother eating more and healthier foods discuss in the context of local practices and taboos to ensure women have access to good nutrition. The new mother should also drink plenty of clean, safe water.
➤The importance of rest and sleep and the need to avoid hard physical labour
➤ Discussion of normal postpartum bleeding and lochia – discuss with women how much blood loss they can expect, for how long. When bleeding is more than normal, they should seek care urgently
➤ Discuss the danger signs for the woman and baby and the importance of seeking help quickly.
➤ Personal hygiene in the context of local practices and the environment. Discuss with women the type of pads they will use and their disposal, and care of episiotomy in the context of home conditions. Hand washing is particularly important to prevent infections. It is also important not to insert anything into the vagina,
➤ Talk to them about when they can resume sexual relations and the importance of condom use to prevent STI and HIV transmissionild
➤Discuss infant feeding and breast care and the importance of only taking prescribed medicines when breastfeeding.
➤ Discuss the importance of the home environment fof promoting the health of the baby and recovery of the mother. For example, discuss the need for warinth, good ventilation and hygiene for both mother and baby
➤ In an area with malaria, discuss the importance of mother and baby sleeping under an insecticide-treated bed net.
Counseling on nutrition:
➤ Advise the woman to eat a greater amount and variety of healthy foods, such as meat, fish, oils, nuts, seeds, cereals, beans, vegetables, cheese and milk to help her feel strong and well (give examples of how much to eat).
➤ Reassure the mother that she can eat any normal foods these will not harm the breastfeeding baby
➤ Discuss any taboos that exist about foods which are nutritionally healthy
➤ Talk to her partner or other family members to encourage them to ensure that the woman eats enough and avoids hard physical work.
Monitor danger signs of the women:
Following danger signs:
➤ vaginal bleeding has increased
➤ fits
➤ fast or difficult breathing
➤ fever and too weak to get out of bed
➤ severe headaches with blurred vision
➤ calf pain, redness or swelling; shortness of breath or chest pain
➤ swollen, red or tender breasts or nipples
➤ problems urinating, or leaking
➤ increased pain or infection in the perineum
➤ infection in the area of the wound (redness, swelling, pain, or pus in wound site)
➤ smelly vaginal discharge
➤ severe depression or suicidal behaviour (ideas, plan or attempt)
Postnatal depression of women:
They may also experience any of the following:
➤ persistent sad or anxious mood, irritability
➤ low interest in or pleasure from activities that used to be enjoyable
➤ difficulties carrying out usual usual work, v school, domestic of social activities
➤ negative or hopeless feelings about herself or her newborn
➤ multiple symptoms (aches, pains, palpitations, numbness) with no clear physical cause
Encourage women to do things for themselves that they enjoy such as
➤ meeting a friend
➤ getting out of the home or walking, or things which help them to let their feelings out
➤ singing, drawing or writing
➤ spiritual relief through prayer
➤ meditation
Care of newborn
It is important to provide mothers, fathers and families with practical advice on how to care for the baby during the first few days,
➤ Keep the baby warm – a baby should wear 1-2 layers more than an adult. If cold, put a hat n the baby’s head.
➤ Care for the umbilical cord. Do not put anything on the stump
➤ Keep the baby clean. It is not necessary to wash the baby every day, but wash baby’s face nd bottom when needed. Make sure the room is warm when undressing baby
➤ Provide nothing but breast milk day and night.
➤ They should see a health worker on day 3 and between 7 and 14 days and 4-6 weeks after birth. At the 6 week visit the baby will be immunized.
➤ Let the baby sleep on his/her back or side,
➤ Keep the baby away from smoke.
➤ It is not recommended to expose the baby to direct sun
Monitor and treat following danger signs of newborn:
Advise the mother and family to seek care immediately, day or night. They should not wait if the baby has any of these signs:
➤ difficulty in breathing or indrawing
➤ fits
➤ fever
➤ feels cold
➤ bleeding
➤ not feeding
➤ yellow palms and soles of feet
➤ diarrhea
The mother and family should go to the health centre as soon as possible if a baby has any of the following signs:
➤ difficulty feeding (poor attachment, not suckling well)
➤ is taking less than 8 feeds in 24 hours
➤ pus coming from the eyes or skin pustules
➤ irritated cord with pus or blood
➤ Yellow eyes or skin.
➤ Ulcers or thrush (white patches) in the mouth explain that this is different from normal breast milk in the mouth.
Postnatal complications:
Women may experience a wide range of postnatal problems, some more serious than others and each with its own symptoms. Some of the more common problems include:
1. Postpartum infections, (including uterine, bladder, or kidney infections)
2. Excessive bleeding after delivery
3. Pain in the perineal area (between the vagina and the rectum)
4. Vaginal discharge
5. Breast problems, such as swollen breasts, infection and clogged ducts
6. Stretch marks
7. Hemorrhoids and constipation
8. Urinary or fecal (stool) incontinence
9. Hair loss
10. Postpartum depression
11. Discomfort during sex
12. Difficulty regaining pre-pregnancy shape.
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