Postpartum Care

1
Postpartum Care

• Managing Complications in Pregnancy and Childbirth

2
Session Objectives

• To define essential elements of postpartum care
• To discuss best practices and technologies for
  postpartum care

3
Objectives of Postpartum Care

• Prevent or detect and manage complications
  arising during postpartum period, whether
  medical, surgical or obstetric
• Support mother and her family in transition to a
  new family constellation
• Promote and maintain physical, mental and social
  well-being of both mother and newborn by
  providing education on danger signals, nutrition,
  rest, sleep and personal hygiene, and by
  providing micronutrients, if necessary

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Objectives of Postpartum Care (continued)

• Counsel on newborn care
• Support breastfeeding
• Counsel and provide services for contraception
  and resumption of sexual activity
• Immunize mother against tetanus
• Work with mother, her family and her community to
  prepare a plan in case of complication

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What is Good Postpartum Care?

• Visits at 6 hours, 6 days and 6 weeks postpartum
• Care provided by skilled provider who attended
  childbirth (midwife, general practitioner or
  obstetrician/gynecologist)
• Integration of postpartum and newborn care

6
Components of Postpartum Care Visit

• Early detection and management of complications
• Complication readiness
• Promoting health and preventing disease
• Woman-centered education and counseling

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Early Detection and Management of Complications

• Malnutrition General health, night blindness,
  goiter
• Depression/psychosis Mood
• Infection Temperature
• Pre-eclampsia Blood pressure, proteinuria
• Anemia Hemoglobin, conjunctiva/tongue/palms
• Breast problems Breast examination, assessment
  of breastfeeding, newborns weight

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Early Detection and Management of Complications
(continued)

• Subinvolution Fundal height
• Incontinence/fistula Bowel and bladder function
• Thrombophlebitis Homans sign, inspection of
  legs
• Genital infection Perineum, lochia/bleeding/disch
  arge, rapid plasma reagin (RPR)

9
Complication Readiness

• Establish savings plan/scheme
• Make plan for decision-making
• Arrange system of transport
• Establish plan for blood donation

10
Promoting Health and Preventing Disease

• Iron/Folate 1 tablet to be taken by mouth once a
  day for at least 40 days postpartum
• Six monthly presumptive treatments with
  broad-spectrum anti-helminthics in areas of
  significant prevalence
• Sleeping under a bednet
• Vitamin A One dose of 200,000 IU within 30 days
  after childbirth in vitamin A deficient regions

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Promoting Health and Preventing Disease
(continued)

• Iodine supplementation 400600 mg by mouth or IM
  as soon as possible after childbirth if never
  given, or if given before the third trimester
  (only in areas where deficiencies exist)
• Tetanus toxoid
• RPR, HIV (voluntary testing)

12
Woman-Centered Education and Counseling Danger
Signals for Woman

• Heavy or sudden increase in vaginal bleeding
• Fever
• Vaginal discharge with unpleasant odor
• Painful or hot breast(s)
• Abdominal pain
• Excessive tiredness
• Edema in hands and face
• Severe headache

13
Woman-Centered Education and Counseling Danger
Signals for Newborn

• Cord red or draining pus
• Suckling poorly
• Eyes swollen, sticky or draining pus
• Cold to touch in spite of rewarming
• Hot to touch in spite of undressing
• Difficulty breathing
• Lethargy
• Convulsions

14
Woman-Centered Education and Counseling Nutrition

• Intake should be increased by 10 (not physically
  active) to 20 (moderately or very active) to
  cover energy cost of lactation
• Eating more of staple food (cereal or tuber)
• Greater consumption of non-saturated fats
• Avoid all dietary restrictions
• Encourage foods rich in iron (e.g., liver, dark
  green leafy vegetables, etc.)

15
Woman-Centered Education and Counseling Factors
that Affect Womens Sexual Desire After Childbirth

• Fatigue and disturbed sleep patterns
• Genital lacerations/episiotomy
• Hypo-estrogenization of the vagina
• Libido
• Power issues in marriage
• Resumption of sexual activity

16
Woman-Centered Education and Counseling Family
Planning

• Inform about all contraceptive choices in
  postpartum period (ideally done antenatal as
  well)
• Facilitate free informed choice for all women
• Reinforce that non-hormonal methods (lactational
  amenorrhea, barrier methods, IUD and
  sterilization) are best options for lactating
  mothers
• Initiate progestogen-only methods after 6 weeks
  postpartum to breastfeeding women, if woman
  chooses a hormonal method
• Advise against use of combined oral
  contraceptives in breastfeeding women in the
  first 6 months after childbirth or until weaning,
  whichever comes first

17
Woman-Centered Education and Counseling
Breastfeeding

• Importance, benefits and management of
  breastfeeding
• Positioning and attaching newborn to breast
• Need to avoid supplementary feeds
• Encourage breastfeeding on demand

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Forms of Postpartum Care Likely to Be Ineffective
or Even Harmful

• Breastfeeding
• Limiting suckling time to 10 min. on each breast
  or any other arbitrary period
• Restricting frequency of breastfeeds to once in 3
  hours or to any other arbitrary period
• Giving artificial teats and pacifiers to
  breastfed infants
• Providing bottle supplements with water, glucose
  or formula while breastfeeding is becoming
  established
• Prescribing hormonal contraceptives during first
  6 weeks postpartum

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Forms of Postpartum Care Likely to Be Ineffective
or Even Harmful (continued)

• Hormonal treatment of postpartum depression
• Separate counseling of woman on breastfeeding and
  on contraception
• Lactation inhibition by estrogens or bromocriptine

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Summary

• Good postpartum care includes
• Care by skilled provider
• Focus on mother and newborn
• Multiple visits
• Detection and management of complications in a
  timely fashion
• Interventions and education to promote continued
  good health of the mother and newborn