Postnatal Care

Question 1

Immediate post-birth care

Answer 1

• Skin-to-skin contact if no neonatal resus required (supports physiological transition of newborn and mother)
• Neonatal thermoregulation and respiratory regulation increases successful breastfeeding
• Maternal stimulation of oxytocin increases uterine contractions and milk production
• Rhesus bloods and Anti-D if required
• Assessment of postpartum psychosis/depression, child protection or social concerns
• 6-hour discharge if mother and baby well

Question 2

Breastfeeding

Answer 2

Question 3

First 10 days post-birth care

Answer 3

• Usually 3 visits from midwife
• Discuss physicaland emotional problems
• Discuss birth and PTSD
• Risk of postnatal depression
• Physical examination (signs of haemorrhage etc)
• Discuss contraception
• Physical examination of baby (feeding, winding, changing/washing, sleeping)

Question 4

Late postnatal examination

Answer 4

• 6 weeks postnatal
• Review the birth
• Discuss physical symptoms (pain, incontinence, bleeding)
• FBC
• Cervical smear
• Discuss contraception

Question 5

Postnatal complications

Answer 5

• Anaemia (oral iron if asymptomatic, consider transfusion of Hb <70g/L)
• Bowel problems (constipation, fear of defacation)
• Breast problems (pain, infection)
• Perineal breakdown (common but long term problems uncommon)
• Incontinence (commonly resolves spontaneously)
• Peurperal pyrexia (temperature >38oC in first 14 days after birth - Sepsis important so treat if suspected)
• Secondary PPH (usually due to infection)
• VTE (peurperium is highest risk, manage with LMWH)
• Maternal health problems (postnatal depression, postpartum psychosis - important to spot early signs and admit to mother and baby unit + antipsychotic drugs)

Question 6

Stillbirth

Answer 6

• Baby delivered with no signs of life that is known to have died after 24 completed weeks of pregnancy
• Advanced maternal age, obesity, social deprivation, smoking, non-white ethnicity and domestic violence are risk factors
• Is suspected US should be carried out by experienced sonographer
• Diagnosis must be communicated in sensitive but clear fashion
• Most undergo vaginal birth
• Aftercare important (psychological care, memory box, funeral arrangements, suppression of lactation, post-mortem, support groups, community team)
• No evidence on when can conceive again