6.0 INTRODUCTION

The postpartum/ post natal period is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time. Yet it is the most neglected period for the provision of quality care.

6.1 DEFINITION OF POSTPARTUM

Postpartum is the period starting after the delivery of the baby and placenta to six weeks after delivery. It is also called post natal or Puerperial period. Post natal care:  is the care given to mother and child during the puerperium.

6.2 Objectives of post-partum care

• Early detection of complications and abnormalities

• Ensure the initiation of exclusive breastfeeding

• To motivate Mothers for family planning

• To initiates routine immunization for baby

• Appropriate referral when the need arises.

6.3 POSTPARTUM CARE

1. Establish mother to baby contact which encourage bonding, by placing the baby on the mother’s chest

2. Clean the mother by:

• Swab the vulva.

• Check for abnormalities like prolapsed, growth

• Check for lacerations, tears and bruises

• Check for bleeding, note the color, quantity and odor

• Apply sanitary pad

• Educate on vulval hygiene

3. Examine the uterus for firmness to ensure good contraction

4. Estimate blood loss (Average 150-300mls) Control haemorrhage through:

• Rubbing the uterus for contractions every 15 minutes for 2 hrs

• Check placenta and membranes for completion.

• Repair any tear, laceration or episiotomy immediately

5. Check the vital signs

6. Encourage emptying the bladder

7. Encourage Mother to take warm food

8. Give the mother and baby time to rest

9. Observe mother’s attitude toward her baby

10. Initiate breastfeeding at least 30 minutes  - 1 hour after delivery

11. Educate on proper nutrition with plenty of fruits and vegetables for mother

12. Place on oral medication of Antibiotics, Analgesics and haematinics/ vitamin C

6.3.1 Post Natal Visit

The first 48 hours following delivery is very crucial to the survival of both mother and child during the postpartum period.

• The first visits is therefore scheduled within the 1st 48hrs

• The second visit is carried out after the 1st week of delivery.

• The third visit is carried out by the 6th week of delivery.

6.3.2 Post Natal Check Ups

1. Observe the general wellbeing/ physical appearance.

• Excess tiredness and unwell looking may indicative of anaemia, hypoglycaemia or developing infection.

• Encourage adequate rest as excess fatigue can lead to depression.

2. Examine the abdomen for contraction of the uterus

• Check if uterus is hard,well contracted

• If it is soft- think of uterine atony

• If tender and soft-infection is likely present

• Check for involution- the uterus weigh 1kg after labour and can be felt just below the umbilicus, by the end of puerperium it goes back to its pre- gravid stage 

3. Examine the breast for cracks and soreness of nipples.

• Advice on proper positioning during breastfeeding,

• Advice on breast hygiene (no soap should be used in cleaning the breast before breast feeding)

4. Examine the perineum for any tear, nature of healing, amount of bleeding, nature of lochia- normal or foul smelling?

5. Check the vital signs – BP, temp, pulse, respiration. High temp and pulse rate is a cardinal sign of sepsis.

6. Advice on diet and give Vitamin A supplement (200,000 iu) to mothers.

7. Give third dose of T.T immunization.

8. Provide child spacing options

9. Counsel on:

• Exclusive breastfeeding,

• Complimentary feeding,

• Routine immunization.