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Postpartum Care


Hot to touch in spite of undressing. Difficulty breathing. Lethargy. Convulsions. 14 ... Separate counseling of woman on breastfeeding and on contraception ... – PowerPoint PPT presentation

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Title: Postpartum Care

Postpartum Care
  • Managing Complications in Pregnancy and Childbirth

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

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

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

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
  • Integration of postpartum and newborn care

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

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

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

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

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

Promoting Health and Preventing Disease
  • 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)

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

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

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.)

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

Woman-Centered Education and Counseling Family
  • Inform about all contraceptive choices in
    postpartum period (ideally done antenatal as
  • Facilitate free informed choice for all women
  • Reinforce that non-hormonal methods (lactational
    amenorrhea, barrier methods, IUD and
    sterilization) are best options for lactating
  • 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

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

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
  • Prescribing hormonal contraceptives during first
    6 weeks postpartum

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

  • 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