Postpartum Care

Prof Shashi Prateek

Consultant & Head
VMMC & safdarjung hospital
New Delhi
 Main Concerns!
 Routine care of the postpartum woman
 Common Problems in the postpartum
period
 Vaginal bleeding
 Infection
 Related to Breast feeding
 Postpartum Family Planning
 Objectives

 To assess a woman in the postpartum

period properly
 To be able to recognize & respond to
abnormalities recognized in the
postpartum period
 To give proper counseling to postpartum
mothers
 When?

 Care during first 48 hrs/1wk

 At 6 wks
 Any time if required
 Steps to follow

Assess for emergency signs

• Looks very ill
• Marked Pallor
• Vaginal bleeding
• Fever

Do not make a very sick woman

wait, attend to her immediately
 Greet the mother !
Make her feel comfortable !!
Quick Assessment - History
 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?
 Informed Examination
• General Exam
• Abd Exam
• No Routine P/V – examine if symptoms
or signs
• Tell the woman you will examine her
• Wash your hands before & after
examining woman
• Maintain privacy – Presence of female if
male doctor
• Inform & explain findings to woman
Postpartum Assessment
Assess breastfeeding : Observe
for at least 4 mts
Is baby positioned well?
Is baby able to attach to the nipples
well?
Is baby sucking effectively?
 Is there any difficulty breastfeeding?
If yes, examine breast & nipple
 Routine Postpartum Care

Mother feels well

BP, pulse & temp. normal Give any treatment
No breast problems, or prophylaxis due
Iron
Breastfeeding well Tetanus
Uterus well contracted Advise & Counsel
No problem with urination Health education
No pain or other concern Schedule return visit
Baby vaccinated
Abnormalities in Postpartum Period
Pus or perineal pain
Elevated BP
Feeling unhappy
Pallor
Vaginal discharge
Vaginal Bleeding
Breast Problem
Foul smelling
Infection/ abscess
lochia
Sore or cracked nipple
Dribbling Urine Engorgement
Insufficient milk
Cough or breathing
REFER difficulty
 Postpartum Bleeding
Vaginal bleeding >24 hours postpartum
 May be due to retained placental
fragments
 If excessive bleeding: insert I/VFluids,
give 10 u oxytocin IM
 Uterus is soft & larger than expected
REFER!
 Elevated 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
Advise & Counsel
1. Postpartum care and hygiene
• Wash hands 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 couselling with
adolescents, ultra thin & obese women
Encourage Breastfeeding

Importance, benefits & management of

breastfeeding
Teach correct positioning &
attachment for breastfeeding
Support exclusive breastfeeding for the
first 6 months of life
Encourage breastfeeding on demand
Need to avoid supplementary feeds
Birth spacing & Family Planning

Explain Importance of family planning

A woman who is not exclusively
breastfeeding can become pregnant
as soon as 4 weeks after delivery if
she has sex
 Birth Spacing & Family Planning

 Inform about all contraceptive choices in

postpartum period –Cafeteria Aproach
 Facilitate free informed choice for all women
 Reinforce that non-hormonal methods (LAM,
barrier methods, IUCD and sterilization) are
best options for lactating mothers
 Discuss other method options for the
breastfeeding & non-breastfeeding woman
Danger signs: Baby
 Convulsions
 Not able to feed
 Fast breathing
 Severe chest-indrawing
 Nasal flaring
 Grunting
 Lethargy & unconscious
 Feels Hot or Cold
 Blood in stool

Refer
 Schedule Return Visits

6 weeks postpartum

Women who do not return for postpartum

visits should be visited at home.
 How to Keep Baby Warm?

 Kangaroo care: skin to skin contact

 Keep room warm
 1-2 or more layers of clothes as needed
 Cultural Influences
 Postpartum care my be affected by
cultural beliefs: No bath, no breastfeeding
for the first three days, “hot” and “cold”
foods
 No Prelacteal feeds, Give demand feed
 Do not make generalizations
 Gender Bias - Counselling
Extended family may play an important role in care
 “ Because the more a
mother is cared for,
the more easily she
can care for her
baby.” -Shivam Rachana

"Imagine Infinite Potential"

by Mara Friedman