Routine postnatal care of women and their babies

July, 2006

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

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 6–8 weeks after the birth

Need for the guideline

Common health problems in the postnatal period

Dissatisfaction of those receiving care

Creating services which are woman and family centred

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

Essential principles of care

Kindness, respect and dignity

Views, beliefs and values

Women’s full involvement

All actions and interventions fully explained

Supporting informed decisions

This guideline covers

Planning the content and delivery of care for woman and baby

Maintaining maternal health

Infant feeding

Maintaining infant health

Planning content and delivery of care

Documented, individualised care plan

Written communication

Relevant and timely information

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

Maintaining maternal health

Signs and symptoms of potentially life-threatening conditions:

• postpartum haemorrhage• infection• pre-eclampsia/eclampsia• Thromboembolism

Emotional wellbeing

Suggested actionsLocal 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

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

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

Maintaining infant health

Information and guidance offered to enable parents to:

•assess their baby’s general condition•identify signs and symptoms of common health

problems seen in babies•contact a healthcare professional or emergency

service if required

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

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

NICE into practice guides

Access tools online

Costing tools

•costing report•costing template

Audit criteria

Available from: www.nice.org.uk/cg037

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

Care pathway

Key components – maintaining maternal health, infant feeding, and maintaining infant health

Time bands – first 24 hours, first week and first 2–8 weeks after birth

Action levels – emergency, urgent and non-urgent

Includes – core information, core care and areas for concern

Example: signs of thromboembolismArea for concern:

unilateral calf pain and redness or swelling

Emergency action

Time band 24 hours

Maintaining maternal health

Example: routine immunisations

Core care

Time band2–6 weeks

Offer routine baby immunisations