Routine postpartum care for the woman Name of presenter: Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project BASICS

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Routine postpartum care for the woman Name of
presenter Prevention of Postpartum Hemorrhage
Initiative (POPPHI) ProjectBASICS
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Objectives

• By the end of this session, participants will be
  able to
• Describe essential care to provide to the
  postpartum woman.
• Provide counseling to the woman during the
  postpartum period.

Note Examination and care of the postpartum
woman are beyond the scope of this course. A
brief review of components of the examination and
care will be provided, but the emphasis in this
course will be on counseling the woman on
self-care.
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Integration of maternal and newborn care
The mother and her newborn are inseparable both
should be evaluated and treated at the same time.
This presentation concentrates on care of the
postpartum woman and complements the sessions on
care of the newborn in the postnatal period.
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Working in pairs

• Work in pairs with a participant sitting next to
  you.
• Tasks
• Read the sections on male involvement, postpartum
  care, and the importance of routine couple
  visits in Chapter 7 in the Reference Manual.
• After 15 minutes, be ready to actively
  participate in a question/answer session.

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When should the woman receive routine postpartum
exams?

• At 1 hour and 6 hours after childbirth
• At least once a day when in the facility
• At discharge
• 2-3 days after childbirth
• 6 weeks after childbirth

More visits / exams may be needed depending on
the womans health status or needs.
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Basic Postpartum Care

• Throughout assessment, apply key tools
• Rapid assessment and management of the woman
• Clinical decision-making
• Interpersonal skills
• Infection prevention practices
• Record-keeping
• Consider each finding in context of other findings

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What diseases and conditions will the postpartum
woman be screened for?

• Malaria
• Tuberculosis
• Urinary tract infection
• Anemia
• Diabetes
• HIV/AIDS
• Sexually transmitted infections (syphilis,
  chlamydia, gonorrhea, trichomoniasis)

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What pregnancy-related complications will the
postpartum woman be screened for?

• Postpartum infection
• Metritis
• Wound infection
• Breast infection
• Hypertension
• Preeclampsia/Eclampsia
• Hemorrhage (immediate or delayed)
• Thrombophlebitis

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What information will you gather during the
history?

• Assess for all emergency and danger signs
  immediately and, if present, initiate the
  designated emergency response procedures and
  begin appropriate treatment and/or referral.
• Ask the woman if she now has or has had danger
  signs and respond appropriately.
• Check the womans medical record.
• Check records and take a detailed history to
  identify any problems/potential problems social
  problems, medical problems, problems during the
  most recent pregnancy and birth, and reported
  symptoms/ problems.
• Review plans for family planning.

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Postpartum visit Physical exam (1)

• Assess general health.
• Check skin, noting lesions and bruises.
• Take the womans blood pressure, pulse, and
  temperature.

Examine the womans conjunctivae and the palms of
her hands for pallor.
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Postpartum visit Physical exam (2)
Examine the womans legs to assess for localized
pain, tenderness, and hot spots.
Examine the womans breasts for engorgement,
soreness, and cracked nipples.
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Postpartum visit Physical exam (3)
Examine the abdomen to assess involution of the
uterus, the firmness and roundness of uterus, if
there is tenderness (lower abdomen).
Examine the perineum and genitalia for tears,
swelling, tenderness, and pus. Observe lochia
to assess color, odor, amount.
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Evaluate findings from history and physical
examination

• Based on analysis of findings
• Identify problems and complications.
• Decide where and by whom the woman should receive
  care. Refer all women who need specialized care
  for any reason.
• Decide if there is need for further laboratory
  tests or investigations.
• Make a plan of care with the woman for all
  identified problems / complications / needs.
• Identify plans for family planning.
• Make a plan for counseling the woman on self-care
  and follow-up of any identified problems.

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What laboratory examinations may need to be
ordered in the postpartum?

• Hemoglobin levels
• RPR (or VDRL)
• Gram-stain and cultures for gonorrhea / chlamydia
  
• Wet mount of vaginal secretions
• HIV
• Check urine with dipstick or perform urinalysis
• Rapid test for malarial parasites
• Stool exam for ova and parasites

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Make a plan of care

• Provide treatment for any medical conditions,
  illnesses, and infections detected.
• Manage any pregnancy-related complications.
• Provide prophylaxis for health promotion and
  disease prevention TT, long lasting insecticidal
  nets (LLINs), iron/folate tablets, Vitamin A,
  broad-spectrum anti-helminthics, and other
  nutritional supplements as needed.
• Provide client-centered counseling for women and
  partners/supporters.

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Routine care for the postpartum woman Health
promotion and disease prevention (1)

• Give Vitamin A 200,000 IU.
• Provide preventive treatment for hookworm to
  prevent anemia in endemic areas.
• Provide iron/folic acid supplementation for at
  least 30 days postpartum to prevent and treat
  anemia.

Give TT as needed.
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Care for women whose HIV status is positive (1)

• Breast care
• Where breastfeeding, counsel how to prevent sore
  nipples, engorgement, and mastitis.
• Where formula feeding, counsel on care of breasts
  and management of engorgement.
• Check CD4 count according to national protocols.
• Perform or refer the woman for clinical
  assessment and evaluation of the need for ARV
  treatment if eligible.
• Provide cotrimoxazole prophylaxis therapy (CPT),
  according to national guidelines.

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Care for women whose HIV status is positive (2)

• Provide psychosocial support and link the mother
  to community support for HIV care and services.
• Provide an appointment for the next visit for HIV
  care according to national guidelines.
• Place the family in contact with an available
  community health worker/volunteer where available
  and feasible.
• Counsel on family planning.

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Role play

• Work in groups of 2-3 participants.
• Tasks
• Read the section on health promotion and disease
  prevention in Chapter 7 of the Reference Manual.
• You have 10 minutes to prepare a role play to
  demonstrate counseling a postpartum woman and her
  partner on the following subjects
• Group 1 Family planning for the breastfeeding
  woman.
• Group 2 Family planning for the
  non-breastfeeding woman.
• Group 3 Prevention of malaria / exclusive
  breastfeeding
• Group 4 Hygiene / Rest
• Group 5 Nutrition / Fluids

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Routine care for the postpartum woman Counseling
for self-care (1)
Counsel on birth spacing and family planning.
Provide family planning method for
non-breastfeeding women.
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Routine care for the postpartum woman Counseling
for self-care (2)

• Prevention of malaria.

Exclusive breastfeeding on demand
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Routine care for the postpartum woman Counseling
for self-care (3)
Hygiene
Rest
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Routine care for the postpartum woman Counseling
for self-care (4)

• Nutrition

Fluids
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Safer sex

• Safer sex
• Resumption of sexual activity

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Routine care for the postpartum woman Develop a
complication-readiness plan

• Recognize danger signs.
• Establish a financing plan/scheme.
• Develop a plan for decision-making.
• Arrange a system of transport.
• Establish a plan for blood donation where
  feasible.

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Routine care for the postpartum woman Educate
about danger signs (1)

• Vaginal bleeding
• More than 2 or 3 pads soaked in 20-30 minutes
  after delivery, OR
• Bleeding increases rather than decreases after
  delivery

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Routine care for the postpartum woman Educate
about danger signs (2)

• Severe abdominal pain

Fever and too weak to get out of bed
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Routine care for the postpartum woman Educate
about danger signs (3)

• Fast or difficult breathing
• Severe headache, blurred vision
• Convulsions

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Routine care for the postpartum woman Educate
about danger signs (4)

• Pain in the perineum or draining pus
• Foul-smelling lochia

Dribbling of urine or pain on micturition
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Routine care for the postpartum woman Educate
about danger signs (5)
The woman doesnt feel well.
Breasts swollen, red or tender breasts, or sore
nipples
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Team work

• Divide into groups of 3-4 participants.
• TASKS
• You have 5 minutes to develop a catchy way to
  help women and their families remember danger
  signs in the postpartum period.
• Present your team work to all of the participants.

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Postpartum visit Closing (1)

• Ask the woman if she has any further questions or
  concerns.
• Tell the woman when to return for routine
  postpartum care.
• Reassure the woman that she can return at any
  time she has questions or concerns.

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Postpartum visit Closing (2)

• Advise the woman to go to the hospital/health
  center immediately, day or night, WITHOUT waiting
  if she has any danger signs.
• Thank the woman for coming.
• Record the relevant details of care for the woman.

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Review session objectives

• By the end of this session, participants will be
  able to
• Describe essential care to provide to the
  postpartum woman.
• Provide counseling to the woman during the
  postpartum period.

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