postpartum care nihfw

8/7/2019 Postpartum Care NIHFW

1/24

Postpartum CarePostpartum Care

ProfProf ShashiShashi PrateekPrateekConsultant & HeadConsultant & Head

VMMC &VMMC & safdarjungsafdarjung hospitalhospitalNew DelhiNew Delhi


2/24

Main Concerns!Main Concerns!

Routine care of the postpartum womanRoutine care of the postpartum woman

Common Problems in the postpartumCommon Problems in the postpartum

periodperiod Vaginal bleedingVaginal bleeding

InfectionInfection

Related to Breast feedingRelated to Breast feeding

Postpartum Family PlanningPostpartum Family Planning


3/24

ObjectivesObjectives

To assess a woman in the postpartumTo assess a woman in the postpartum

period properlyperiod properly

To be able to recognize & respond toTo be able to recognize & respond toabnormalities recognized in theabnormalities recognized in the

postpartum periodpostpartum period

To give proper counseling to postpartumTo give proper counseling to postpartummothersmothers


4/24

When?When?

Care during first 48 hrs/1wkCare during first 48 hrs/1wk

At 6 wksAt 6 wks Any time if requiredAny time if required


5/24

Steps to follow

Assess for emergency signsAssess for emergency signs

Looks very illLooks very ill

Marked PallorMarked Pallor

Vaginal bleedingVaginal bleeding

FeverFever

Do not make a very sick womanDo not make a very sick womanwait, attend to her immediatelywait, attend to her immediately


6/24

Greet the mother !Make her feel comfortable !!


7/24

Quick AssessmentQuick Assessment -- HistoryHistory

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

H/O convulsions

Family Planning? Other concerns?

Check records: complications,treatment during delivery?


8/24

General ExamGeneral Exam

AbdAbd ExamExam

No Routine P/VNo Routine P/V examine if symptomsexamine if symptoms

or signsor signs

Tell the woman you will examine herTell the woman you will examine her

Wash your hands before & afterWash your hands before & after

examining womanexamining woman

Maintain privacyMaintain privacy Presence of female ifPresence of female if

male doctormale doctor

Inform & explain findings to womanInform & explain findings to woman

Informed Examination


9/24

PostpartumPostpartum AssessmentAssessment


10/24

Assess breastfeeding : Observefor at least 4 mts

Is baby positioned well?Is baby positioned well?

Is baby able to attach to the nipplesIs baby able to attach to the nippleswell?well?

Is baby sucking effectively?Is baby sucking effectively?

Is there any difficulty breastfeeding?Is there any difficulty breastfeeding?If yes, examine breast & nippleIf yes, examine breast & nipple


11/24

Routine Postpartum CareRoutine Postpartum Care

Mother feels well

BP, pulse & temp. normal

No breast problems,

Breastfeeding well

Uterus well contracted

No problem with urination

No pain or other concern

Baby vaccinated

Give any treatment

or prophylaxis dueIron

Tetanus

Advise & Counsel

Health educationSchedule return visit


12/24

Abnormalities in Postpartum PeriodAbnormalities in Postpartum Period

Elevated BPElevated BP

PallorPallor

Vaginal BleedingVaginal Bleeding

Foul smellingFoul smellinglochialochia

Dribbling UrineDribbling Urine

Pus orPus or perinealperineal painpain

Feeling unhappyFeeling unhappy

Vaginal dischargeVaginal discharge

Breast ProblemBreast ProblemInfection/ abscessInfection/ abscess

Sore or cracked nippleSore or cracked nipple

EngorgementEngorgement

Insufficient milkInsufficient milk

Cough or breathingCough or breathingdifficultydifficultyREFER


13/24

Postpartum BleedingPostpartum Bleeding

Vaginal bleeding >24 hours postpartumVaginal bleeding >24 hours postpartum

May be due to retained placentalMay be due to retained placental

fragmentsfragments If excessive bleeding: insert I/If excessive bleeding: insert I/VFluidsVFluids,,

give 10 ugive 10 u oxytocinoxytocin IMIM

Uterus is soft & larger than expectedUterus is soft & larger than expectedREFER!REFER!


14/24

Elevated BPElevated BP

Blood pressure > 140/90

Look for signs that could indicate

severe pre-eclampsia Severe headache

Blurring of vision

Epigastric pain Severe breathing difficulty Refer


15/24

Advise & Counsel

1. Postpartum care and hygiene

Washhands before handling baby

Wash perineum daily

Have enough

rest & sleep Avoid sexual intercourse until perineal

wound heals

2. Nutrition Eat a greater amount & variety of healthy

foods Rainbow diet

Spend more time on nutrition cousellingwith adolescents, ultra thin & obese women


16/24

Importance, benefits & management of

breastfeeding

Teach correct positioning &

attachment for breastfeedingSupport exclusive breastfeeding for the

first 6 months of life

Encourage breastfeeding on demandNeed to avoid supplementary feeds

Encourage BreastfeedingEncourage Breastfeeding


17/24

Birth spacing & Family Planning

Explain Importance of family planning

A woman who is not exclusivelybreastfeeding can become pregnantas soon as 4 weeks after delivery ifshe has sex


18/24

Inform about all contraceptive choices inInform about all contraceptive choices in

postpartum periodpostpartum period CafeteriaCafeteria AproachAproach

Facilitate free informed choice for all womenFacilitate free informed choice for all women Reinforce that nonReinforce that non--hormonal methods (LAM,hormonal methods (LAM,

barrier methods, IUCD and sterilization) arebarrier methods, IUCD and sterilization) are

best options for lactating mothersbest options for lactating mothers

Discuss other method options for theDiscuss other method options for thebreastfeeding & nonbreastfeeding & non--breastfeeding womanbreastfeeding woman

Birth Spacing & Family Planning


19/24

Danger signs: BabyDanger signs: Baby

ConvulsionsConvulsions Not able to feedNot able to feed

Fast breathingFast breathing

Severe chestSevere chest--indrawingindrawing Nasal flaringNasal flaring

GruntingGrunting

Lethargy & unconsciousLethargy & unconscious Feels Hot or ColdFeels Hot or Cold

Blood in stoolBlood in stool

ReferRefer


20/24

Schedule Return VisitsSchedule Return Visits

6 weeks postpartum6 weeks postpartum

Women who do not return for postpartumWomen who do not return for postpartumvisits should be visited at homevisits should be visited at home..


21/24


22/24

Cultural InfluencesCultural Influences

Postpartum care my be affected by

cultural beliefs: No bath, no breastfeeding

for the first three days, hot and coldfoods

No Prelacteal feeds, Give demand feed

Do not make generalizations Gender Bias - Counselling


23/24

Extended family may play an important role in care


24/24

"Imagine Infinite Potential"by Mara Friedman

Because the more a

mother is cared for,the more easily shecan care for herbaby. -Shivam Rachana

postpartum care nihfw

Documents