Postpartum care of Mother ( After Delivery )

National Essential MNH package recommends 3 postnatal visits :

·         First visit – within 24 hours.

·         Second visit – within 3 days.

·         Third visit – within 7 days.

·         Monitor mother after delivery of placenta within 1 hour then 2,3 and 4 hours, then every 4 hours  till discharge.

·         Do not discharge before 12 hours.

History :

·         Detail of delivery.

·         Time of delivery : how many hours ago the baby wasdelivered.

·         Whether urine passed.

·         Abdominal pain : if more than normal menstrual cramps.

·         Perennial area : pain.

Examination :

·         Emergency sign.

·         General condition.

·         Skin and mucous memembrane : anaemia.

·         BP, Pulse, Temperature if BP greater than 140/90, see pre-eclampsia protocol 2-7.

·         Breast examination engorgement, redness, nipple (cracked, retracted).

·         Per abdominal exam.

-          Height of uterus (involution of uterus).

-          Tenderness.

-          Abdominal mass.

·         Per vaginal exam

-          Vaginal discharge/bleeding

-          Episiotomy stitch

-          Perineum  (perineal tenderness and perineal wound ) and swelling.

-          Continued leakage of urine or stool from vagina.

·         Extremities : calf tenderness

Consideration for Rh immune globulin : ·         If mother is Rh positive – no action ·         If mother is Rh negative – check the Rh status of baby ·         If baby is Rh negative – no action ·         If baby is Rh positive – consider Rh immune globulin.

Discharge instruction : ·         Counselling for FP ·         Instruction for breastfeeding ·         Follow-up instruction