CMT05207: REPRODUCTIVE AND CHILD HEALTH

4. Provide postpartum care to mother and

infant

Facilitator: Ms Lucy Mathias

Learning Objectives
By the end of this session students are expected to be able to:
Define post-partum care
Outline routine post-partum services for mother and infant according
to guideline
Perform clinical assessment to mother and infants
Assess infant for correct breast feeding positioning and attachment
Counsel on importance of postpartum care, family planning, hygiene
and nutrition
Counsel on newborn care
Learning Objectives cont....

Provide routine health promotion services to mother and infant

(supplements, HIV preventive services, immunization, infant growth
and development monitoring & promotion)
Educate on danger signs to mother and infant
Provide follow-up care for mother and infant
Document findings on appropriate tool(s)
Introduction
• Post-partum care: The care given to a mother who has just delivered a
baby and time between expulsion of the placenta and membranes to
42 days (six weeks) after delivery. This period is critical for the mother
and the newborn.
• Postpartum care for mothers and infants begins in the delivery room
and extends throughout the postnatal period.
Routine post-partum services

• monitoring and assessent of maternal and neonatal well-being

• support for good caregiving practices
-warmth, hygiene,early initiationand exclusive breastfeeding, responsive care
and stimulation
• prevention, detection and treatment of complications
- maternal: postpartum haemorrhage
-neonatal: asphyxia,prematurity, sepsis
• providing information and counselling
-nutrition, family planning, pyschological support
Routine post-partum services cont......
• Postnatal Care (PNC) follow-up visits should be scheduled at the
following intervals to monitor the mother and baby’s condition:
• 24-48 hours before discharge
• 7 days after delivery
• 28 days after delivery
• 42 days after delivery
WHO twelve recommendations on post-natal care

• assessment of the baby • assessment of the mother

• exclusive breastfeeding • counselling
• cord care • iron anf folic acid
• other postnatal care for the supplementation
newborn (ie. immunization etc) • prophylactic antibiotics
• pyschological support
Perform clinical assessment to mother and
infant according to guideline
• Immediately after delivery, the woman is still in great danger of
getting serious complications like haemorrhage and eclampsia;
therefore close monitoring during this period is important.
• The health care provider should conduct postpartum examinations as
follows:
Examination of the mother
• Check vital signs: Blood pressure, pulse rate, and respiration rate
hourly in the first six hours, then every four hours. Check temperature
every 12 hours.
• Check for pallor (palms, tongue and conjunctiva) to rule out anaemia.
• Abdominal palpation hourly in the first six hours, then every four
hours to make sure the uterus is well contracted and feels firm.
Instruct the mother to observe and report excessive vaginal bleeding.
• Inspect the genitalia for perineum for edema, lacerations, or/and
episiotomy immediately after delivery
• In case of delivery by Caesarean section, check wound for bleeding.
Examination of the baby
• Check for color (palms, tongue and conjunctiva) to rule out cyanosis
• Check the umbilical cord for any abnormality (such as bleeding)
• Look for the movement activity
• Asses for primary reflexes
• Ensure that the mother is able to breastfeed the baby correctly
• Check, document and take action for any congenital malformations
Assess infant for correct breast feeding
positioning and attachment
• Good positioning and attachment
4 signs of good positioning: baby’s body should be straight, and
facing the breast, baby should be close to mother, and mother
should support the baby’s whole body, not just the neck and
shoulders with her hand and forearm.
Signs of good attachment: mouth wide open, chin touching breast,
more areola showing above than below the nipple, and lower lip
turned out.
• Observation of breastfeeding, or alternative feeding
During this time and up to six month after birth of the baby, the
mother is advised and encouraged to breast feed the infant more
than 8 times as the baby needs and with no additional food.
Exclusive breast feeding must be started at once after delivery
(within one hour) if there is no problem and mother and baby are
all doing fine.
Early feeding is very important to prevent a fall in blood sugar
(hypoglycaemia) and it will make physiological jaundice less
severe.
The more the breasts are emptied, the more milk increases, the
less they are emptied the less they produce
Counsel on importance of postpartum care,
family planning, hygiene and nutrition
Importance of Postpartum Care
• Is a set of activities such as observation, treatment, counseling, and
advice provided during the postpartum period that can prevent,
identify, and treat complications that may arise for the mother or
baby.
• Postpartum Care is crucial for both mother and newborn
• Ensure that any complications arising from the delivery are detected
and treated
• Mothers are provided with important information on how to care for
themselves and their newborn
Family planning
• Birth spacing 3 to 5 years apart is recommended for better health of both
mother and child.
• Advise women to use family planning methods which include modern and
natural.
• Safe methods for postpartum/lactating mothers are those methods which
will not interfere with breastfeeding such as LAM and barrier methods.
• HIV positive mothers should be advised to use effective family planning
methods that provide dual protection that is prevention of pregnancy and
STIs including HIV/AIDS (use of condoms)
Hygiene
• Infection can be prevented by careful attention to the mother’s
hygiene, encouragement of drainage by early ambulation and by the
prevention of cross infection.
• The mother’s hygiene is maintained by; daily shower or bath,
vulva toilet, vulva pads should be changed frequently, the
woman should be advised not to contaminate the vulva and
perineum with organisms from the anus when changing pad.
• Midwives should wear gloves when handling pads and should
maintain aseptic technique when applying any treatment
• Puerperal infection can be prevented by careful attention to the
mother’s hygiene, encouragement of early ambulation, increases
muscle tone and venous return from the legs and lower abdomen, it
also increases drainage of lochia and voiding of urine.
Nutrition
• The diet of a puerperal woman should be nourishing, balanced and
varied
• It should include adequate protein to aid tissue renewal and milk
production, iron and vitamins to counteract anemia, fiber to aid
excretion and plenty of fluids
Counsel on newborn care

Routine Care
• Wash hands before touching a new born baby
• Keeping the baby warm
• The baby must be kept warm at all time by wrapping him well keep
him in close with his mother all the time.
• The room temperature should be 24oC, to prevent neonatal
hypothermia which may be the cause of many deaths to newborn
babies
• Feeding
• Exclusive breast feeding must be started at once after delivery
(within one hour) if there is no problem and mother and baby are
all doing fine.
• Early feeding is very important to prevent a fall in blood sugar
(hypoglycaemia) and it will make physiological jaundice less
severe.
• The more the breasts are emptied, the more milk increases, the
less they are emptied the less they produce
• Care of the umbilical cord
• Cord is left uncovered
• The umbilicus is examined every day for redness, discharge, and
bad smell, and moist it, moist will be cleaned
• Care of the skin
• If there is skin infection like septic spots the baby is treated by
gentile violet or bathed with antiseptic solution.
• Newborn have delicate skin, therefore do not mix the soap or
clothes of baby with others in order to prevent skin infections.
• In serious infection, give antibiotic – Amoxicillin syrup.
• Care of the eyes
• Discharge or puss form the eyes is due to conjunctivitis ophthalmic
neonatorum, if it is a milk infection eyes are cleaned with normal
saline and antibiotic eye drops is given.
• If conjunctivitis is very severe and is caused by gonococcal
infection through birth canal many times it may lead to blindness,
treat it with chloromphenical eye drop every 10 minutes for the
first hour, every hour for the next 6 hours, then every after 2-3
hours and amoxicillin syrup systemically until you complete the
dose.
• Immunization
• At birth BCG and Polio O is given.
• Health education in child care.
• Health education is given as routine to the mother about.
• Hygiene
• Cord care
• Warmth for the baby Feeding (breast feed her baby up to 2 years)
• Attending reproductive and child health clinic (RCHC) regularly
• Family planning
• Follow up after birth
• Weight
• A newborn baby may loose up to 10% of birth weight the first few days,
after that he/she should gain 150 – 200gm per week
• The causes of not gaining well are:-
Not getting enough milk
Cold (hypothermia neonatorum)
Infection of any kind e.g. pneumonia
• Congenital disease e.g. heart or kidney disease
• All babies should be followed up in reproductive and child health
clinics.
• Mother should receive health education in child care attendance of
clinic regularly up to 5 years
Provide routine health promotion services to mother and infant

• Asses for psychological state (depression, psychosis)

• Counsel the mother for HIV testing if her HIV sero-status is unknown
• Advise on adequate rest, proper nutrition, personal hygiene and exercises
• Counsel for family planning and offer chosen method if not
contraindicated (e.g., tubal ligation)
• Continue nutritional supplementation (iron and folic acid tablets)
• Give Vitamin A if not given at delivery
• Continue tetanus toxoid vaccination as scheduled
• Remind about the danger signs for mother and baby
• Advice on the use of insecticide treated nets (ITNs)
Educate on danger signs to mother and
infant
Danger signs to the mother:
• Excessive vaginal bleeding
• Severe pain in the genitalia
• Fever
• Headache
• Convulsions/fits
• Abdominal pain
• Foul smelling lochia/vaginal discharge
Educate on danger signs to mother and infant cont...

• Pain in the calf muscles

• Emotional/psychological changes and/or abnormal behaviour
(depression, psychosis)
• Pallor (palms, tongue and conjunctiva)
• Painful, engorged breasts
Educate on danger signs to mother and infant cont...

Danger signs to the baby

• Convulsion/fits
• Difficulty breathing
• Fever or hypothermia
• Not able to feed
• Bleeding from the cord/umbilicus
• Yellow coloration of skin and eyes
• Not passing stools
• Eye discharge
• Vomiting
Provide follow-up care for mother and
infant
• During the puerperium, the woman’s body continues to undergo
physiological adjustment and healing. Certain pathological conditions,
such as infections, haemorrhage, psychological morbidity, and poor
nutrition, can interfere with the healing and adjustment process.
Some of these conditions can lead to maternal death.
• Therefore, continued care should be provided to women during the
postpartum period. Postnatal Care (PNC) follow-up visits should be
scheduled at the following intervals to monitor the mother and baby’s
condition.
Postnatal Visits for the Mother
At every visit, do the following:
• Check vital signs:
• BP, Temperature, respiratory rate, and pulse rate
• Take thorough history:
• Ask about breastfeeding
• Check for bladder and bowel action
• Ask for any abnormal conditions/problems
Physical Examination
• Check for pallor (palms, tongue and conjunctiva) to rule out anaemia
• Examine the breasts for engorgement, abscesses, mastitis and cracked or
sore nipples
• Palpate the abdomen to feel for uterus involution and tenderness
• Examine the perineum for the lochia/discharge, and to monitor
condition of episiotomy/tear
• Asses for psychological state (depression, psychosis)
• Counsel the mother for HIV testing if her HIV sero-status is unknown
• Advise on adequate rest, proper nutrition, personal hygiene and
exercises
• Counsel for family planning and offer chosen method if not
contraindicated (e.g., tubal ligation)
• Continue nutritional supplementation (iron and folic acid tablets)
• Give Vitamin A if not given at delivery
• Continue tetanus toxoid vaccination as scheduled
• Remind about the danger signs for mother and baby
• Advice on the use of insecticide treated nets (ITNs)
• Record all the findings on the RCH card No. 4
• Remind mother when to schedule the next PNC follow-up
Follow-up Visits for the Baby
During follow-up visits, it is important to do the following:
• Assessment of the baby to identify problems
• Check baby’s weight and assess growth
• Observation of breastfeeding, or alternative feeding
• Counsel and advise the mother and family on baby care and danger
signs
• Vaccinate the baby according to national immunization schedules
• Manage any problems appropriately
Document findings on appropriate tool(s)
Importance of Record Keeping
• Planning clients’ care, enabling continuity of care over time
• Facilitating communication among health care workers at different
levels and with community/clients
• Managing health services and making decisions at health facilities,
district, regional and at national levels
• Measuring service uptake, provision of evidence-based practices by
providers, and the health status of women and babies.
Tools for source and data recording
• Antenatal card (RCH card number 4)
• MTUHA Books:
• Book 2: Health Facility Monthly Report
• Book 3: Community Based Data
• Book 4: Ledger (Control and Supplies)
• Book 6: ANC Register
• Book 10: Quarterly Health facility register
• Book 12: Delivery Register
• Tally sheet form for TT and Vitamin A
• Other registers such as ITN vouchers and PMTCT registers
Summary
• Post-partum care: The care given to a mother who has just delivered a
baby and time between expulsion of the placenta and membranes to
42 days (six weeks) after delivery. This period is critical for the mother
and the newborn.
• Postnatal Care (PNC) follow-up visits should be scheduled at the
following intervals to monitor the mother and baby’s condition: 24-48
hours before discharge, 7 days after delivery, 28 days after delivery
and 42 days after delivery.
• Signs of good positioning: baby’s body should be straight, and facing
the breast, baby should be close to mother, and mother should
support the baby’s whole body, not just the neck and shoulders with
her hand and forearm.
• Danger signs to the mother includes: excessive vaginal bleeding,
severe pain in the genitalia, fever, headache, convulsions/fits,
abdominal pain and foul smelling lochia/vaginal discharge.
• Danger signs to the baby includes: convulsion/fits, difficulty breathing,
fever or hypothermia, not able to feed, bleeding from the
cord/umbilicus, yellow coloration of skin and eyes, not passing stools,
eye discharge and vomiting.
Evaluation questions
• What is post-partum?
• What are routine post-partum services for mother and infant
according to guideline?
• What are the danger signs to the mother and child during post-
partum period?