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Postpartum CarePostpartum Care
ProfProf ShashiShashi PrateekPrateekConsultant & HeadConsultant & Head
VMMC &VMMC & safdarjungsafdarjung hospitalhospitalNew DelhiNew Delhi
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Main Concerns!Main Concerns!
Routine care of the postpartum womanRoutine care of the postpartum woman
Common Problems in the postpartumCommon Problems in the postpartum
periodperiod Vaginal bleedingVaginal bleeding
InfectionInfection
Related to Breast feedingRelated to Breast feeding
Postpartum Family PlanningPostpartum Family Planning
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ObjectivesObjectives
To assess a woman in the postpartumTo assess a woman in the postpartum
period properlyperiod properly
To be able to recognize & respond toTo be able to recognize & respond toabnormalities recognized in theabnormalities recognized in the
postpartum periodpostpartum period
To give proper counseling to postpartumTo give proper counseling to postpartummothersmothers
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When?When?
Care during first 48 hrs/1wkCare during first 48 hrs/1wk
At 6 wksAt 6 wks Any time if requiredAny time if required
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Steps to follow
Assess for emergency signsAssess for emergency signs
Looks very illLooks very ill
Marked PallorMarked Pallor
Vaginal bleedingVaginal bleeding
FeverFever
Do not make a very sick womanDo not make a very sick womanwait, attend to her immediatelywait, attend to her immediately
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Greet the mother !Make her feel comfortable !!
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Quick AssessmentQuick Assessment -- HistoryHistory
When, where delivered How are you feeling? Appetite
Is there any difficulty? Painful breast/abdomen? Fever?
Hard to void urine?/ Hard to pass stools?
Bleeding since delivery
H/O convulsions
Family Planning? Other concerns?
Check records: complications,treatment during delivery?
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General ExamGeneral Exam
AbdAbd ExamExam
No Routine P/VNo Routine P/V examine if symptomsexamine if symptoms
or signsor signs
Tell the woman you will examine herTell the woman you will examine her
Wash your hands before & afterWash your hands before & after
examining womanexamining woman
Maintain privacyMaintain privacy Presence of female ifPresence of female if
male doctormale doctor
Inform & explain findings to womanInform & explain findings to woman
Informed Examination
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PostpartumPostpartum AssessmentAssessment
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Assess breastfeeding : Observefor at least 4 mts
Is baby positioned well?Is baby positioned well?
Is baby able to attach to the nipplesIs baby able to attach to the nippleswell?well?
Is baby sucking effectively?Is baby sucking effectively?
Is there any difficulty breastfeeding?Is there any difficulty breastfeeding?If yes, examine breast & nippleIf yes, examine breast & nipple
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Routine Postpartum CareRoutine Postpartum Care
Mother feels well
BP, pulse & temp. normal
No breast problems,
Breastfeeding well
Uterus well contracted
No problem with urination
No pain or other concern
Baby vaccinated
Give any treatment
or prophylaxis dueIron
Tetanus
Advise & Counsel
Health educationSchedule return visit
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Abnormalities in Postpartum PeriodAbnormalities in Postpartum Period
Elevated BPElevated BP
PallorPallor
Vaginal BleedingVaginal Bleeding
Foul smellingFoul smellinglochialochia
Dribbling UrineDribbling Urine
Pus orPus or perinealperineal painpain
Feeling unhappyFeeling unhappy
Vaginal dischargeVaginal discharge
Breast ProblemBreast ProblemInfection/ abscessInfection/ abscess
Sore or cracked nippleSore or cracked nipple
EngorgementEngorgement
Insufficient milkInsufficient milk
Cough or breathingCough or breathingdifficultydifficultyREFER
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Postpartum BleedingPostpartum Bleeding
Vaginal bleeding >24 hours postpartumVaginal bleeding >24 hours postpartum
May be due to retained placentalMay be due to retained placental
fragmentsfragments If excessive bleeding: insert I/If excessive bleeding: insert I/VFluidsVFluids,,
give 10 ugive 10 u oxytocinoxytocin IMIM
Uterus is soft & larger than expectedUterus is soft & larger than expectedREFER!REFER!
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Elevated BPElevated BP
Blood pressure > 140/90
Look for signs that could indicate
severe pre-eclampsia Severe headache
Blurring of vision
Epigastric pain Severe breathing difficulty Refer
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Advise & Counsel
1. Postpartum care and hygiene
Washhands before handling baby
Wash perineum daily
Have enough
rest & sleep Avoid sexual intercourse until perineal
wound heals
2. Nutrition Eat a greater amount & variety of healthy
foods Rainbow diet
Spend more time on nutrition cousellingwith adolescents, ultra thin & obese women
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Importance, benefits & management of
breastfeeding
Teach correct positioning &
attachment for breastfeedingSupport exclusive breastfeeding for the
first 6 months of life
Encourage breastfeeding on demandNeed to avoid supplementary feeds
Encourage BreastfeedingEncourage Breastfeeding
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Birth spacing & Family Planning
Explain Importance of family planning
A woman who is not exclusivelybreastfeeding can become pregnantas soon as 4 weeks after delivery ifshe has sex
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Inform about all contraceptive choices inInform about all contraceptive choices in
postpartum periodpostpartum period CafeteriaCafeteria AproachAproach
Facilitate free informed choice for all womenFacilitate free informed choice for all women Reinforce that nonReinforce that non--hormonal methods (LAM,hormonal methods (LAM,
barrier methods, IUCD and sterilization) arebarrier methods, IUCD and sterilization) are
best options for lactating mothersbest options for lactating mothers
Discuss other method options for theDiscuss other method options for thebreastfeeding & nonbreastfeeding & non--breastfeeding womanbreastfeeding woman
Birth Spacing & Family Planning
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Danger signs: BabyDanger signs: Baby
ConvulsionsConvulsions Not able to feedNot able to feed
Fast breathingFast breathing
Severe chestSevere chest--indrawingindrawing Nasal flaringNasal flaring
GruntingGrunting
Lethargy & unconsciousLethargy & unconscious Feels Hot or ColdFeels Hot or Cold
Blood in stoolBlood in stool
ReferRefer
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Schedule Return VisitsSchedule Return Visits
6 weeks postpartum6 weeks postpartum
Women who do not return for postpartumWomen who do not return for postpartumvisits should be visited at homevisits should be visited at home..
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Cultural InfluencesCultural Influences
Postpartum care my be affected by
cultural beliefs: No bath, no breastfeeding
for the first three days, hot and coldfoods
No Prelacteal feeds, Give demand feed
Do not make generalizations Gender Bias - Counselling
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Extended family may play an important role in care
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"Imagine Infinite Potential"by Mara Friedman
Because the more a
mother is cared for,the more easily shecan care for herbaby. -Shivam Rachana