6a post partum care

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

CARE AFTER DELIVERY POST PARTUM CARE
Government of India
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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

Government of India
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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.

Government of India
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Starting the care at 4th
stage of Labour &
immediate PNC
Definition
The first one hour after delivery of the placenta is sometimes
referred to as the 4th
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 3rd
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

Government of India
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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

Government of India
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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.

Government of India
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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.

Government of India
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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.

Government of India
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Advise at discharge from the facility
Home care of New Born
 Breast feeding
 Keeping the baby warm
 Infection Prevention
 Cord care

Government of India
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Subsequent visits
 Scheduled visits
• At 3rd
day
• At 7th
day
• At 6 weeks
 SOS emergency visits in presence of danger
signs

Government of India
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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

Government of India
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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

Government of India
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Counselling on Care & Hygiene
 Wash hands before handling baby
 Wash perineum daily
 Avoid sexual intercourse until perineal wound
heals

Government of India
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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

Government of India
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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.

Government of India
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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

Government of India
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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

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

Government of India
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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

Government of India
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Key Messages
 Danger signs for mother & Neonate
 Immediate Post Partum Care
 Counselling on diet, rest & contraception
 Cultural influences

Government of India
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Case study
 Case Study number 22 on page number 85 on
Trainee’s Hand Book

6a post partum care

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