POSTPARTUM CARE

Postpartum care enables health professionals to check if the mother and baby are doing well and detect and manage any problems early. This is also the best time to offer the opportunity to support breastfeeding and provide family planning and services.The first 24-48 hours is most critical and period where most postpartum deaths occur. The following are steps to follow in postpartum care. STEPS TO FOLLOW: 1. Do a quick check for emergency signs.

Emergency signs.
Unconscious/Convulsing Vaginal bleeding Severe headache with visual disturbance Severe abdominal pain Look very ill Severe breathing difficulty Fever Severe vomiting

Do NOT make a very sick woman wait, attend to her quickly.

2. Make the woman comfortable.

Greet her, make sure she is comfortable and ask how she is feeling. If first visit, register the woman and issue a Mother and child Book.

3. Assess the postpartum woman and her baby

For the mother up to 6 weeks postpartum: 1. Ask and review record: -When and where did you deliver? -How are you feeling?

-Have you had any pain or fever or bleeding since delivery? - Do you have any problem urinating? - Have you decided on any contraception? - How do your breast feel? - Any complications during delivery? - Receiving any treatments? - Do you have any other concerns? Ask about the use of any modern FP services -If not, counsel client and provide if FP services -If using FP,ask about any problems related to method, if with problem provide necessary advice/management Examine the woman -Measure BP,temperature and pulse -Check abdomen for uterine contraction and bladder distention -Check the vulva for tear, swelling and pus. -Check pad for bleeding and lochia, note smell and amount -Assess mothers breast if there are any cracks or swelling . For the baby during the first week of life: Ask and review record: -How old is the baby? -Preterm (less than 37 weeks or 1 month or more early) -Breech delivery? -Difficult delivery? -Has baby had convulsions? -How is the baby feeding? -Do you have other concerns regarding baby?

Assess the newborn -Assess breathing (baby must be calm).

Listen for grunting. Count breaths: are they 30-60 per minute? Repeat if the count is not. Look at the chest for in-drawing. -Look at the movements, are they normal and symmetrical? -Look at the presenting part, is there swelling and bruises? -Look at the abdomen for pallor. -Feel for warmth. If cold, or very warm, measure temperature -Weigh the baby. Assess breastfeeding

Is there any difficulty breathing Is baby satisfied with feeds How many times baby breastfeed in 24 hours? Has she given the baby anything other than breast milk Has baby breastfeed in the previous hour? -Observe a breastfeed for at least 4 minutes (If baby has not fed in the previous hour, asks the mother to put the baby on her breast. If baby has already fed, ask the mother to tell you when her baby is willing to fed again) Is the baby able to attach to the nipples well? Is baby suckling effectively? Is baby positioned well? Is husband/are parents supportive of breastfeeding? Is she willing to join or organize breastfeeding support group here in the community? Has she been given samples of milk formula? If yes, discourage her from using formula.

Ask about newborn screening. If not yet done ,refer the newborn to the nearest facility offering newborn screening.

-Ask the mother to bring the newborn to the facility within 48 hours up to 2 weeks after birth. Ask about birth registration of the baby. If no registration yet, register the baby at the municipal civil registry office as soon as possible. -Insure that the mother gets a copy of the registered birth certificate.

4.

Check for pallor or anemia.

Ask about getting tired easily or shortness of breath during routine work. -Look for conjunctival pallor. -Look for palmar pallor. If pallor: Is it severe pallor? Some pallor? -Count number of breaths in one minute.

5.

Treat for intestinal parasites.

Give mebendazole 500 mg tablet, 1 tablet, single dose if none has been given during pregnancy.

6 Prevent anemia with iron/ folate supplementation.

Give iron/folate,60mg/400ug tablet daily to last until scheduled return visit.

-Tell her to continue taking the tablets until she complete 3 months postpartum supplementation. 7. Give Vitamin A if none was given postpartum. Check if mother has already received Vitamin A postpartum. If none was taken, give Vitamin A 200,000IU, once within 6 weeks after delivery.

8. Counsel on family planning and provide the appropriate family planning method if available. Ask what are her plans regarding having more children or desired number of children Give relevant information and advice. Help her to choose the most appropriate method for her and her partner.

If method of choice is not appropriate place.

available in the clinic, refer her to the

BHS (NFP) -Basal Body Temperature( BBT) -cervical Mucus( Billings) -Symto Thermal (ST) Condom Progestin oral pills Natural planning family

RHU Natural planning -BBT -Billings -ST Condom Progestin oral pills Combined oral pills family

HOSPITAL Natural family planning -BBT -Billings ST Condom Progestin oral pills Combined oral pills Progestin injection

Combined oral pills Progestin injection Lactational Amenorrhea Method( LAM) Intra uterine Device (IUD) Non-Scalpel Vasectomy(NSV)for men Lam SDM

IUD Surgical sterilization for women and men LAM SDM

Standard Method ( SDM)

days

9.Provide health information ,advice and counseling.

Discuss first the topics that are most important to the woman during the visit. Cover other suggested topics once main concern of the woman has already been addressed. Spend more time on nutrition education and counseling on very thin women adolescents.

Important information and advice postpartum Hygiene for the mother Hygiene for the baby Keeping the baby warm Care of the babys cord Self-care during postpartum care Nutrition Preventing anemia When and where to seek for care Breast milk and breastfeeding Family planning Newborn screening Role of father in postpartum and newborn

10. Encourage the woman to come back with her baby for return visits. Schedule the next visit and note it down on the Mother and Baby Book Remind her to return for the well-baby clinic and immunization.

Recommended Schedule of Postpartum Care Visits Ist visit 2nd visit Ist week postpartum preferably within 24-48 hours 6 weeks postpartum

First visit should be within 24-48 hours since it is the most critical period. All postpartum women should have at least 2 routine postpartum visits. Women who do not return for postpartum visits should be visited at home.

3.6 Information and Advice for MCH

Health education is very critical in preventing maternal and child mortality and morbidity. However, this is not only done inside the health station. Even other non-health converging areas in the community like the sari-sari store, market or town plaza may used as avenues in promoting maternal and child health.Information and education materials such as brochures,flipcharts,posters,etc.written in the vernacular language also help women in understanding information and advice on maternal and child health.

The following are some of the information and advice which midwives can give to the mothers, family members and the community in general.

Nutrition for pregnant, postpartum and breastfeeding women Eat a variety of food everyday. -Eating different kinds of food will help you fell and strong. It will also prevent you from becoming weak and getting prone to infection and bleeding. -During pregnancy, it will also ensure that your baby gets the different kinds of nutrients needed for growth and development.

Eat more food during meals and have an extra meal everyday.

-Eating more food will help satisfy the required nutrients that you need to stay well and strong. -Take care to increase your intake of vegetables,fruits,beans fish,poultry and meat. -Eating more during pregnancy will help prevent low birth weight and will help prevent your baby from becoming sickly. -Eating more during pregnancy is NOT the cause of difficult labor. Food restriction particularly during postpartum is harmful.

-It may cause weakness. -It will prevent you from recovering fast from the strain of pregnancy and childbirth. Always used iodized salt as table salt and seasoning.

-Iodine deficiency may cause abortion and mental retardation of the baby. -Iodine is important in the physical and mental development of the baby. Cook vegetables with oil,fat,nuts add energy to food and enhances the absorption of vitamins A and E from vegetables.

Preventing anemia Iron deficiency is common among pregnant,postpartum and breastfeeding women. -Iron is important for normal blood formation. -Iron and folate requirement is increased during pregnancy and postpartum if woman is breastfeeding. -The iron stores in the mothers body are used up in the formation of the blood of the baby and the placenta and in the production of milk. Iron and folate deficiency leads to anemia.Folate defiency during pregnancy also causes neural tubes defects in the baby. -Anemia is dangerous. -Anemia makes the pregnant and pastpartum woman weak and prone to infections. -a woman with anemia is more likely to suffer from bleeding during delivery and postpartum and give birth to a small and weak baby. -folate defiency causes malformation in the brain and/or spinal colmn(neural tube defects).These defects may cause death or disability. -Neural tube defects can be prevented by daily supplementation of 400ug folate a month before the pregnancy up to the third trimester.

Take iron /folate tablet regularly to prevent anemia. -Iron /folate tablet 60mg/400ug taken regularly for six months during pregnancy and at least three months postpartum is effective in preventing anemia.However,prevention is achieved better if iron and folate supplementation is taken before pregnancy. -It can be taken anytime of the day but best in the evening with meals to avoid nausea. -Iron tablets may make you supplementation of this occurs. fell less tired.DO NOT stop

-Side effects such as nausea,constipation and epigastric pain may be experienced but this usually disappears after some time of taking the tablets. Iron tablets discolor the stools but this should not be a cause for worry. Also increase your intake of green leafy vegetables,fruits,fish and meat to prevent anemia. -Meat particularly liver and blood,fish and green leafy vegetables are very good sources of iron and folate. -Always cook meat,meat products and fish thoroughly before eating.You may get parasites from uncooked meat and fish. -Do not make iron tablets a substitute for eating iron-folate rich food.

Preventing tetanus Tetanus is a serious infection. -It causes deaths in newborn. -It also endangers the lives of mothers. Be immunized against tetanus. -Tetanus immunization is provided for free in fixed health facilities and by mobile immunization teams in places where immunization cannot be given regularly.

-Five injections according to schedule will give lifelong protection against tetanus. Tetanus immunization is safe. -It does not cause miscarriage or malformatios. -It can be given anytime during pregnancy. Apart from immunization, you can also protect yourself and your baby from tetanus and other infections by: -Having a clean delivery. -NOT putting dust,powder or anything on the babys cord and keeping it from getting soiled.

Preventing malaria
Malaria is a serious disease. Malaria can cause miscarriage, stillbirth or premature birth. Pregnant women particularly those in their first or second pregnancy are prone to getting malaria. -Malaria is transmitted by mosquito bites at night. Malaria can also cause severe anemia. -Anemia is dangerous. -Anemia makes pregnant women weak and prone to infections. -A woman with anemia is more likely to suffer from bleeding during delivery and postpartum and give birth to small and weak baby. If you are residing in a malaria endemic area and in your first or second pregnancy, take preventive intermittent treatment for malaria.

-Two doses of sulfadoxine-pyrimethamine 500mg -25mg tablet, 3tablets taken at the beginning of the 2nd and 3rd trimesters (not less than one month interval) will prevent malaria. Protect yourself and your baby from mosquito bites at night. -Encourage sleeping under a bed net, preferably insecticide treated. -If possible scree homes and bedrooms. -Wear long sleeve shirts and long pants or skirts in the evening especially when going outdoors.

Discomforts of pregnancy
Some women may experience discomforts during pregnancy. -This may manifest as morning sickness/nausea, constipation,hemorrhoids,heartburn or leg cramps. -These are usually caused by changes in the womans body. -These are usually temporary and should not be a cause for worry. vomiting,

Practical ways to ease the discomforts of pregnancy

Morning sickness/nausea and vomiting -Eat small, frequent meals. -Eat a small serving of bread, biscuit or rice immediately after walking up. -Take small sips of water. Constipation -increase usual fluid intake from 6 to 8 glasses to 10 to 12 glasses per day. -Eat lots of vegetables, fruits and nuts. -Do regular exercise such as walking.

Hemmorrhoids -Avoid long periods of sitting. -Avoid constipation. -Avoid staining during bowel movements. -Bath the perineum with warm water twice a day. -Replace the hemorrhoid with a finger after passing stool (woman should wash hands thoroughly with bubbling soap and water after replacing hemorrhoid).

For heartburn or indigestion - Eat small, frequent meals. -Avoid spicy or greasy foods. -Avoid lying down right after eating.

For leg cramps -Keep legs propped up when sitting. -If leg cramps occur, straighten knee and bend foot back towards the leg or stand up on the cramping leg. -Massage legs lightly.