Routine postnatal care of women and their babies

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Routine postnatal care of women and their babies
July, 2006
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Changing clinical practice

• NICE guidelines are based on the best available
  evidence
• The Department of Health asks NHS organisations
  to work towards implementing guidelines
• Compliance will be monitored by the Healthcare
  Commission
• Changes should be linked with other NICE guidance
  and relevant national policies

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The postnatal period

• The guideline covers maternal and infant care in
  the period after transfer from intrapartum care
  until the end of the postnatal period. This is
  usually 68 weeks after the birth

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Need for the guideline

• Common health problems in the postnatal period
• Dissatisfaction of those receiving care
• Creating services which are woman and family
  centred

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Aim of the guideline

• Appropriate objectives, purpose, content and
  timing
• Best practices and competencies for assessment
• Information, education and support
• Planning
• Good practice in communication

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Essential principles of care

• Kindness, respect and dignity
• Views, beliefs and values
• Womens full involvement
• All actions and interventions fully
  explained
• Supporting informed decisions

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This guideline covers

• Planning the content and delivery of care for
  woman and baby
• Maintaining maternal health
• Infant feeding
• Maintaining infant health

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Planning content and delivery of care

• Documented, individualised care plan
• Written communication
• Relevant and timely information

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Suggested actions

• Local care planning documentation and use
• Local protocols about written communication
• Quality of local information provision for
  effectiveness and relevance to local community
• Identifying the named postnatal coordinator
  within the care plan

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Maintaining maternal health

• Signs and symptoms of potentially
  life-threatening conditions
• postpartum haemorrhage
• infection
• pre-eclampsia/eclampsia
• Thromboembolism
• Emotional wellbeing

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Suggested actions

• Local protocols within primary and secondary
  care
• Continuous professional development programmes
• Maternity and Care of the Newborn Competence
  Frameworks
• Clinical Negligence Scheme for Trusts (CNST)
  standards

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Infant feeding

• Programme to encourage breastfeeding, using an
  externally evaluated structured programme using
  the Baby Friendly Initiative as a minimum
  standard
• Support of breastfeeding initiation and
  continuation

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Suggested actions

• Look at the UNICEF UK Baby Friendly Initiative
  which provides one possible framework for
  implementing an externally evaluated, structured
  programme which supports breastfeeding.
• This can be used by NHS trusts, other healthcare
  facilities and higher education institutions
• www.babyfriendly.org.uk

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Maintaining infant health

• Information and guidance offered to enable
  parents to
• assess their babys general condition
• identify signs and symptoms of common health
  problems seen in babies
• contact a healthcare professional or emergency
  service if required

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Suggested actions

• Distribution of Birth to five
• Quality of local information
• Named postnatal coordinator within the care
  plan
• Maternity and Care of the Newborn Competence
  Frameworks

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Costs and savings

• Use NICE costing tools to identify
  recommendations with the greatest impact on
  resources
• savings
• savings are linked to the reduction in the
  incidence of certain childhood disease because of
  the protective effects of breastfeeding
• costs
• structured programme that encourages
  breastfeeding including training

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NICE into practice guides
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Access tools online

• Costing tools
• costing report
• costing template
• Audit criteria
• Available from www.nice.org.uk/cg037

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Access the guideline online

• quick reference guide a summary
• NICE guideline all of the recommendations
• full guideline all of the evidence and
  rationale
• Information for the public a version for
  people using the NHS in England and Whales
• All found at http//guidance.nice.org.uk/CG37

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Care pathway

• Key components maintaining maternal health,
  infant feeding, and maintaining infant health
• Time bands first 24 hours, first week and first
  28 weeks after birth
• Action levels emergency, urgent and non-urgent
• Includes core information, core care and areas
  for concern

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Example signs of thromboembolism
Area for concern unilateral calf pain and
redness or swelling
Time band 24 hours
Maintaining maternal health
Emergency action
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Example routine immunisations
Core care
Time band 26 weeks
Offer routine baby immunisations