Routine Postnatal Care

Question 1

Routine Postnatal Care

Answer 1

Analgesia as required
Help establishing breast or bottle-feeding
VTE risk assessment
Monitoring for postpartum haemorrhage
Monitoring for sepsis
Monitoring blood pressure (after pre-eclampsia)
Monitoring recovery after a caesarean or perineal tear
FBC check (after bleeding, caesarean or antenatal anaemia)
Anti-D for rhesus D negative women (depending on the baby’s blood group)
Routine baby check

Question 2

Routine follow up with a midwife

Answer 2

General wellbeing
Mood and depression
Bleeding and menstruation
Urinary incontinence and pelvic floor exercises
Scar healing after episiotomy or caesarean
Contraception
Breastfeeding
Vaccines (e.g. MMR)

Question 3

A routine six-week postnatal appointment is

Answer 3

General wellbeing
Mood and depression
Bleeding and menstruation
Scar healing after episiotomy or caesarean
Contraception
Breastfeeding

Fasting blood glucose (after gestational diabetes)
Blood pressure (after hypertension or pre-eclampsia)
Urine dipstick for protein (after pre-eclampsia)

Question 4

Menstruation After Delivery

Answer 4

In the period shortly after birth, there will be vaginal bleeding as the endometrium initially breaks down, then returns to normal over time

Question 5

Lochia

Answer 5

Mix of blood, endometrial tissue and mucus

Initially, it will be a dark red colour and over time will turn brown, and become lighter in flow and colour

Question 6

Menstruation advice

Answer 6

Tampons should be avoided during the post natal period, as they carry a risk of infection

Bleeding should settle within six weeks

Question 7

When should normal menstrual bleeding return

Answer 7

Breast feeding - 6 months or longer

Bottle feeding - 3 weeks

Question 8

Lactational amenorrhoea

Answer 8

Absence of periods related to breastfeeding

Question 9

Contraception After Childbirth

Answer 9

Fertility is not considered to return until 21 days after giving birth - contraception after 21 days

Lactational amenorrhea is effective for up to 6 months after birth. Women must be fully breastfeeding and amenorrhoeic (no periods)

Progestogen-only pill and implant - safe in breastfeeding and can be started at any time after birth

COCP should be avoided in breastfeeding (UKMEC 4 before six weeks postpartum, UKMEC 2 after six weeks)

A copper coil or intrauterine system can be inserted either within 48 hours of birth or more than four weeks after birth but not inserted between 48 hours and four weeks of delivery