POSTNATAL CARE

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 Introductions
• Following the birth of the baby and expulsion of the placenta
and membranes, the mother enters a period of physical and
psychological recovery.
• Expectation is that by 6 weeks after the birth all the systems in
the woman’s body will have recovered from the effects of
pregnancy and returned to their non-pregnant state

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 Objectives
• General objectives; A the end of the discussion the students
should be able to manage and care for a woman during
puerperium (postnatal period.
• Specific objective: at the end of this presentation students should
be able to;
i. Define postnatal care
ii. Discuss nursing care of during puerperium

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• Postnatal care is care given to the mother and her baby during
the first six weeks following delivery (CBOH 2002)
• Postnatal care is the attention given to the general mental and
physical welfare of the mother and infant after delivery up to a
period of 6 weeks.

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This Care is directed toward prevention, and early detection
and treatment of complications and diseases.
In addition, postnatal care also includes; counselling, advice,
and services on breastfeeding, family planning.

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 Immediate nursing care (0 to 6 hours) postpartum

• Care to the mother. Generally the mother is kept for an

hour in the labour ward before being transferred to the
postnatal ward during this time the following should be done.
• Observations
• Ensure that the bladder is empty to enhance uterine contraction
to prevent postpartum haemorrhage.
• Massage the uterus and blood clots are expelled to ensure that
the uterus is contracted to prevent excessive bleeding.
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• Check blood pressure, respirations, pulse, vaginal bleeding and
palpate the fundus every 15 min for 1 hour.
• After an hour, when the general condition is good and the uterus
is well contracted she is then transferred to the postnatal ward
together with her baby where they are kept for a minimum of
6 hours.
• While in postnatal ward, the receiving midwife ensures that
the uterus is well contracted, the woman is not bleeding
excessively and that the bladder is empty
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• The nurse also checks vital signs of blood pressure, pulse,
respirations and temperature to ensure that they are normal.
• Check blood pressure, respirations, pulse, vaginal bleeding and
palpate the fundus every 15 min for 1 hour , Every 30min for 2
hrs. Every 1hr for 3 hrs.
• Check emotional response and general condition every 30
minutes to rule out puerperal psychosis.
• Check breasts and breastfeeding during the 1st 6 hours of
puerperium MR NKOLE J 8
• Check temperature every 4 hours if high can be the sign of
infection
• Check hydration every 4 hours
• Medication
• Give Vitamin A 200,000 i.u stat P.O.
• Folic acid 5mg once daily and ferrous Sulphate 200mg TDS to
for blood formation to replace lost blood in labour.
• Paracetamol 1g t.d.s x 3/7
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• If the HIV status is un known counsel and test for HIV. For HIV
positive appropriate care must be given.
• Mother on HAART should continue with treatment.
• The full post natal examination of the mother and the baby will
be conducted at six hours and before discharge to ensure that
the general condition is good.

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 Care of the baby
• Observations
• Baby is kept warm and observed for;
• General condition, skin colour to rule out cyanosis and jaundice,
and activity.
• Head to toe examination is done to Check for birth traumas
and congenital abnormalities. Baby should be active.
• All reflexes should be present e.g. startle reflex, rooting etc.
• Take and record baby’s vital signs- normal breathing (30-60
b/m), heart rate (100), as often as you do the vital signs for the
mother in the first 6 hours. MR NKOLE J 11
• Check the cord for any bleeding and ensure cord clump is well
secured.
• Ensure that the baby has passed meconium and urine within
24hours of birth.
• The postnatal care midwife enquires if the baby has passed
meconium and urine to rule out congenital abnormalities.
• Give the first immunizations (BCG and OPV 0) before discharge
if possible or within two weeks of birth.
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• Encourage exclusive breastfeeding if it is the chosen feeding
option.
• Breast feeding exposed infant is given the appropriate ART.

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 Danger signs of the baby
• Baby is cold (hypothermia) or hot (fever) despite the
appropriate clothing.
• Sucking is weak or unable
• Diarrhoea and vomiting
• Cord stump is red or draining pus
• Excessive crying
• Difficulties in breathing
• Jaundice of conjunctivae, hands and feet
• Convulsions or lethargy. MR NKOLE J 14
 Danger signs of the mother
• Fever
• Foul-smelling lochia
• Large blood clots, or bleeding that saturates a pad in 1 hour
• Discharge or severe pain from incisions
• Hot, red, painful areas on the breasts or legs.
• Severe pain in the nipples
• Severe headaches or blurred vision
• Chest pain or dyspnea without exertion
• Frequent, painful urination MR NKOLE J 15
 On discharge
• It is important that physical examination is done.
• The general condition of the mother and baby should be good
before they are released from the hospital.
• Information, Education and Communication is given .

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 IEC on discharge
• Sleep and Rest: the mother is advised to take enough rest at
home so that her body can recover from the stress of pregnancy
and indeed labour. Stress may affect lactation and breast
feeding patterns.
• If the woman feels able to participate in light activities of daily
life she can do so as long as she rests adequately.

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• Nutrition; the mother is advised on the need to take a mixed
diet to promote lactation and healing. Mothers should keep their
fluid and calorie intake fairly high to ensure optimum quality
and quantity of breast milk.
• Hygiene; the mother is advised to maintain high standard of
hygiene to prevent infections.

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• Children’s clinic; the mother is advised on the importance of
children’s clinic to take the baby for growth monitoring and
immunizations.
• Family planning; Mother is advised to start family planning
and when to resume sexual intercourse, preferably after 6
weeks.
• Exercise; the importance of exercises such as promoting blood
circulation, lactation, restoration of tone of muscles, maintenance
of posture and a general well being is discussed.
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• To resume most normal daily activities after 6-8 weeks.
• These include going back to work (if they wish to) gentle
exercise, shopping, swimming, sexual relations, etc.
• However, it depends on how she feels physically and
psychologically.
• Exercise; after adequate rest, the mother should be as mobile
as possible after the delivery and gently exercising the legs and
feet to help to prevent clots (thrombosis) from developing in the
calves. Pelvic floor exercises should be started in the ante-natal
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• The pelvic floor muscles become stretched during delivery
resulting in 'weakness' of the bladder (or bowels), a degree of
prolapse of the vagina or sometimes can cause painful
intercourse.
• Tightening these muscle regularly can help to strengthen the
muscle and return its tone to normal.

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• Dangers signs and preparedness; Danger signs for both the
mother and the baby are discussed and prompt seeking of care
is advised.

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 Post natal care at 6 days
• Follow up on the observations done at six hours.
• Appropriate history of labour is taken.
• Assess the general health and concerns for both mother and
baby.
• The vital signs are checked to detect deviation from normal
• The physical examination is conducted.

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• Check for pallor and haemoglobin level.
• Breasts are assessed for lactation and engorgement.
• Assess the uterus for involution.
• Lochia is assessed for type, colour, consistency and odour.
• Check for danger signs
• Umbilical stump is assessed for signs of infection
• Jaundice and pallor
• Check for vaccination status (OPV0, BCG)
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• For HIV positive mothers assess adherence to treatment for both
the mother and infant. Check drug dosing and administration.
• Check for adverse drug reaction.
• Assess for disclosure.
• Counsel on family planning and condom use.
• Information, education and communication is given.
• Advise on six weeks postnatal.

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 Postnatal examination at six weeks
• Assess general health of the baby and mother by doing
examination is done.
• Assess involution of the uterus which should be complete at six
weeks.
• Assess lactation and breastfeeding are successful.
• Emphasis on family planning; For breasting mothers progestin
only contraceptives such as Microlut, depo Provera and
Noristarat as they do not suppress lactation.

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• For non breastfeeding mothers combined contraceptives such as
microgynon because it contains oestrogen which suppresses
action of prolactin.
• Condom use is promoted for all mothers for prevention of
sexually transmitted infections including HIV.
• Ensure immunizations for the baby are started e.g. OPV,
Pentavalent, Rota, PCV and growth monitoring and promotion.

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THE END

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