6a post partum care

1. 1
Care after delivery
Post Partum Care
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
BEMoC - Presentation 6 (a)
Session 6a

2. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
2
Session Objectives
Number and timing of postpartum visits for
mother and baby
History-taking, examination, management
and counseling on diet, rest & contraception
during postpartum visits
Identification of danger signs
Indications for referral for mother & baby

3. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
3
Importance of Postpartum Care
More than 60% of maternal deaths take
place during postpartum period
First 48 hours are most crucial; hence length of
stay in health facility is 48 hours
Most maternal and neonatal complications
occur during this period.

4. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
4
Starting the care at 4
th
stage of Labour &
immediate PNC
Definition
The first one hour after delivery of the placenta is sometimes
referred to as the 4
th
stage of labour
Observations
BP pulse temperature
Vaginal bleeding
Uterus to make sure it is well contracted
Monitor the following
Every 10 minutes for the first 30 minutes
Every 15 minutes for the next 30 minutes
Every 30 minutes for the next 3 hours
Estimate & Record the amount of the blood loss in 3
rd
stage & after
If loss is around 250ml & bleeding has stopped – observe for the
next 24 hours
Then every 30 minutes for next 3 hours
If >250 ml then look for the cause & treat it fast to save her life

5. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
5
Immediate PNC – Mother (Contd...)
Put a sanitary pad or a folded cotton under her
buttocks to collect blood –to estimate blood loss
Keep mother & baby together, encourage early
breast feeding
Encourage the mother to eat, drink and rest
Consider IUD insertion
Encourage her to pass urine & if she is not able
to pass urine, gently pour water over her vulva
Weigh the baby
Do not leave the mother & the new born alone

6. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
6
Call for help if any of the following occurs
The bleeding increases.
The woman feels dizzy.
The woman has severe headache.
The woman has visual disturbance.
The woman has epigastric distress.
The woman complains of breathlessness.
The woman complains of increased abdominal
or perineal pain.

7. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
7
Enter the following in the labour register
Name of the woman
Age of the woman
Parity
ANC received (or not): mention the number of
ANC visits received
Mode of delivery (normal or assisted)
Birth weight of the baby
Apgar score of the baby at 1 minute and 5
minutes after delivery.

8. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
8
Post Partum care & Hygiene
Not to be left unattended; any change in condition should be
reported
Not to insert anything into the vagina.
To wash the perineum daily and after passing stools. Wash in
an anteroposterior direction from the vulva to the anus.
To change the perineal pads every 4-6 hours, or more
frequently, if there is heavy lochia.
To wash cloth pads, if used, with plenty of soap and water and
dry them in the sun.
To bathe daily.
To have enough rest and sleep.
To avoid sexual intercourse for the first six weeks or until the
perineal wound heals, whichever is later.
To wash her hands before handling the baby.

9. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
9
Advise at discharge from the facility
Home care of New Born
Breast feeding
Keeping the baby warm
Infection Prevention
Cord care

10. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
10
Subsequent visits
Scheduled visits
•At 3
rd
day
•At 7
th
day
•At 6 weeks
SOS emergency visits in presence of danger
signs

11. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
11
Neonatal Danger Signs to be taken to FRU
Neonatal danger signs
•Convulsions
•Not able to feed
•Fast breathing
•Severe chest-indrawing (not during crying)
•Nasal flaring
•Grunting
•Lethargy & unconscious
•Feels Hot or Cold
•Blood in stool

12. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
12
Counselling – Diet & Rest
Reassure the mother that she can eat normal food ; these will not
harm the breast fed baby
Diet to be rich in iron & fibre
Discuss about food taboos especially against food that are
nutritionally healthy
Talk to family members like mother in law , husband to encourage
them to ensure that the woman easts enough & avoids heavy
physical work
Take care of the mother so that she can take care of the baby
Counselling on diet especially for adolescent mother
IFA Supplementation
Women with normal Hb are advised to take 1 IFA tablet daily for 3
months
If Hb below 11 gm%, advise her to take 2 IFA tabs daily and repeat
Hb after 1 month
Family support specially for girl child
Rest to the Mother

13. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
13
Counselling on Care & Hygiene
Wash hands before handling baby
Wash perineum daily
Avoid sexual intercourse until perineal wound
heals

14. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
14
Danger Sings
For the following symptoms and signs in the mother,
advise the woman and her family to go to an FRU
immediately, day or night, WITHOUT WAITING.
Excessive vaginal bleeding, i.e. soaking more than
2 or 3 pads in 20-30 minutes after delivery, OR
bleeding increases rather than decreases after the
delivery
Convulsions
Fast or difficult breathing
Fever and weakness; inability to get out of bed
Severe abdominal pain

15. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
15
Advice to go to nearby facility in case of
following symptoms
Fever
Abdominal pain
The woman feels ill
Swollen, red or tender breasts, or sore nipples
Dribbling of urine or painful micturition
Pain in the perineum, or pus draining from the
perineal area
Foul-smelling lochia.

16. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
16
Counselling on Breast feeding
Rooming –in is important for breast feeding. It helps:
•Makes demand feeding easier to practice as the
mother can hear the child cry
•Prevents hypothermia
•Builds a bond between mother & the baby
Importance, benefits & management of breastfeeding
Teach correct positioning & attachment for
breastfeeding
Support exclusive breastfeeding for the first 6 months of
life
Need to avoid supplementary feeds

17. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
17
Counselling on Family Planning
A woman who is not exclusively breastfeeding
can become pregnant as soon as 4 weeks
after delivery if she has sex

18. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
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Counselling on 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

19. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
19
Cultural Influences
Postpartum care may be affected by cultural
beliefs:
•No breastfeeding for the first three days
•Hot and Cold foods
•No Prelacteal feeds, give demand feed
•Do not make generalizations
•No bath to the mother and for the baby is
practiced – Wrong Practice
•Gender Bias - Counselling

20. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
20
Key Messages
Danger signs for mother & Neonate
Immediate Post Partum Care
Counselling on diet, rest & contraception
Cultural influences

21. CARE AFTER DELIVERY POST PARTUM CARE
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
21
Case study
Case Study number 22 on page number 85 on
Trainee’s Hand Book

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Thank you