1. Postpartum Care

2. TOPICS Routine care of the postpartum woman Routine care of the postpartum woman Common Problems in the postpartum period Common Problems in the postpartum period –Vaginal bleeding –Infection Postpartum Family Planning Postpartum Family Planning

3. Objectives To assess a woman in the postpartum period properly To assess a woman in the postpartum period properly To be able to recognize and respond to abnormalities recognized in the postpartum period To be able to recognize and respond to abnormalities recognized in the postpartum period To give proper counseling to postpartum mothers To give proper counseling to postpartum mothers

4. Components of Postpartum Care Visit Early detection and management of complications Early detection and management of complications Complication readiness Complication readiness Promoting health and preventing disease Promoting health and preventing disease Woman-centered education and counseling Woman-centered education and counseling

5. Steps to follow in Post partum care 1) Assess for emergency signs. –Vaginal bleeding –Fever –Pallor –Looks very ill * Do not make a very sick woman wait, attend to her immediately. 2) Greet the mother. Make her feel comfortable.

6. Assess: 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 Family Planning? Other concerns? Check records: complications, treatment during delivery? Postpartum Care

7. Providing GOOD CARE during postpartum visit: Providing GOOD CARE during postpartum visit: Make the woman comfortable Make the woman comfortable Tell the woman you will examine her Tell the woman you will examine her Wash your hands before and after examining woman. Wash your hands before and after examining woman. Maintain privacy Maintain privacy Inform and explain findings to woman Inform and explain findings to woman

8. 3. Assess breastfeeding  Is there any difficulty breastfeeding?  Observe how mother breastfeeds for at least 4 minutes. –Is baby positioned well? –Is baby able to attach to the nipples well? –Is baby sucking effectively?

9. Routine Postpartum Care Mother feels well BP, pulse & temperature normal No breast problems, breastfeeding well Uterus well contracted No problem with urination No pain or other concern Give any treatment or prophylaxis due Iron Vitamin A Tetanus Advise and Counsel Health education Schedule return visit

10. Abnormalities in Postpartum Period Elevated BP Pallor Vaginal Bleeding Foul smelling lochia Dribbling Urine Pus or perineal pain Feeling unhappy Vaginal discharge Breast Problem Infection/ Breast abscess Sore or cracked nipple Engorgement Insufficient milk Cough or breathing difficulty REFER

11. Postpartum Bleeding Women who develop vaginal bleeding >24 hours postpartum have LATE postpartum bleeding. Women who develop vaginal bleeding >24 hours postpartum have LATE postpartum bleeding. May be due to retained placental fragments May be due to retained placental fragments Uterus is soft and larger than expected Uterus is soft and larger than expected REFER! REFER! If excessive bleeding: insert IVF, give 10 u oxytocin IM If excessive bleeding: insert IVF, give 10 u oxytocin IM

12. Elevated BP Blood pressure > 140/90 Blood pressure > 140/90 Look for signs that could indicate severe pre-eclampsia Look for signs that could indicate severe pre-eclampsia –Severe headache –Blurring of vision –Epigastric pain –Severe breathing difficulty

13. 1. 1.Prevent anemia with iron/folate supplementation. 2 tablets of iron/folate daily for 2 months (or more if mother is pale) 2. Give one capsule Vitamin A (200,000 IU) if none was given antepartum --- to protect the baby from nutritional blindness and infections. Treatment and Prophylaxis

14. ADVISE AND COUNSEL 1. 1. Postpartum care and hygiene – –Wash hands before handling baby – –Wash perineum daily – –Have enough rest and sleep – –Avoid sexual intercourse until perineal wound heals. 2. Nutrition – –Eat a greater amount and variety of healthy foods –. –Spend more time on nutrition couselling with thin women and adolescents.

15. Importance, benefits and management of breastfeeding breastfeeding Teach correct positioning and attachment for breastfeeding Support exclusive breastfeeding for the first 6 months of life Encourage breastfeeding on demand Need to avoid supplementary feeds Encourage Breastfeeding

16. Counsel on importance of family planning Counsel on importance of family planning Inform about all contraceptive choices in postpartum period (ideally done antenatal) Inform about all contraceptive choices in postpartum period (ideally done antenatal) Facilitate free informed choice for all women Facilitate free informed choice for all women Reinforce that non-hormonal methods (LAM, barrier methods, IUD and sterilization) are best options for lactating mothers Reinforce that non-hormonal methods (LAM, barrier methods, IUD and sterilization) are best options for lactating mothers Discuss other method options for the breastfeeding & non-breastfeeding woman Discuss other method options for the breastfeeding & non-breastfeeding woman Birth Spacing & Family Planning

17. Birthspacing and Family Planning Importance of family planning 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. Method options for non-breastfeeding woman Immediately postpartum: Condoms, IUD, BTL Progestogen only OCP and injectables Delay 3 weeks: Combined OCP/injectables Natural family planning Method options for breastfeeding woman Immediately postpartum: LAM, Condom, BTL, IUD Delay 6 weeks: Progestin only pills and injectables (DMPA) Delay 6 months: combined OCP, Natural family planning

18. Lactation Amenorrhea Method (LAM) 1 st line contraceptive for postpartum women 1 st line contraceptive for postpartum women 3 conditions 3 conditions –Exclusive breastfeeding –Menstruation has not returned (amenorrhea) –Within 1 st 6 months of delivery

19. Schedule Return Visits All postpartum women should have at least 2 routine postpartum visits. 1 st visit:1 st week postpartum, preferably within 48 -72 hours. 1 st visit:1 st week postpartum, preferably within 48 -72 hours. 2 nd visit6 weeks postpartum 2 nd visit6 weeks postpartum Women who do not return for postpartum visits should be visited at home.

20. "Imagine Infinite Potential" by Mara Friedman “ “ Because the more a mother is cared for, the more easily she can care for her baby.” -Shivam Rachana