L7+Postnatal+care+of+the+mother+and+baby

1. Postnatal Care of the Mother

1.1 Aims of Postnatal Care

• Assist the woman in adapting to and fulfilling her roles and responsibilities as a mother.

• Monitor the mother’s psychological well-being.

• Establish and support infant feeding.

• Foster attachment between the infant and mother.

• Promote healthy family relationships.

• Educate the woman and her family regarding the needs and development of the infant.

• Enhance the mother’s confidence in her role as a parent.

• Promote health awareness and health-related information.

1.2 Puerperium

• Defined as the period from birth until the reproductive organs return to their non-pregnant state, typically lasting about six weeks.

• Midwives should monitor the mother’s progress and provide necessary advice on infant care for optimal newborn development (NMBI Guidelines for Midwives 2015).

1.3 Physiological Changes

1.3.1 Involution

• Involution: The process of the uterus returning to its original pelvic position.

  • Involves ischaemia and autolysis.

  • Results in lochia (postpartum bleeding) which progresses through different stages: Rubra, Serosa, Alba.

  • The decidual lining is shed containing blood and serum.

  • Duration is generally 3-4 weeks; longer durations may be noted.

  • Watch for heavy bleeding or clots.

1.3.2 Lactation

• Initiated by prolactin secretion from the anterior pituitary gland.

  • Prolactin levels increase during pregnancy; after birth, oestrogen and progesterone levels fall and prolactin levels rise, promoting milk production.

  • Oxytocin increases, aiding in milk ejection and stimulating uterine contractions post-delivery.

1.3.3 Other Physiological Changes

• Cardiovascular System:

  • Blood volume, muscle tone in vessels, cardiac output, and blood pressure return to pre-pregnancy metrics.

• Respiratory System:

  • Changes not explicitly outlined but generally stabilize post-delivery.

• Musculoskeletal System:

  • Abdominal and pelvic floor muscles regain tone.

• Gastrointestinal Tract:

  • Improvement in smooth muscle tone.

• Urinary System:

  • Increased diuresis following birth.

• Reproductive System:

  • Ovulation can occur before menstruation resumes due to falling hormone levels leading to luteinizing hormone release.

1.4 Midwifery Care

• Conduct daily health checks focusing on:

  • Comprehensive assessments (head-to-toe)

  • Psychological and emotional well-being.

  • Vital signs monitoring.

  • Breast care practices related to infant feeding.

  • Fundal height measurement to confirm involution.

  • Perineal care: Assess healing and pain management.

  • Monitor lochia in terms of amount and color.

  • Assess elimination through urine and bowel movements.

  • Encourage hygienic practices and ensure a nutritious diet and hydration.

1.5 Psychological Care Postnatally

• Baby Blues: A common temporary condition.

• Postnatal Depression:

  • Affects 10-15% of women.

  • Symptoms: Feelings of hopelessness, lethargy, tearfulness, anxiety, guilt, sleep disturbances.

• Puerperal psychosis: A rare but severe condition occurring in 1:500 women.

1.6 Care of the Mother

1.6.1 After Pains

• Common, as the uterus contracts back after birth.

• Breast Care:

  • For mothers not breastfeeding: Suppress lactation and prevent engorgement through minimal stimulation.

  • For breastfeeding mothers: Ensuring proper hygiene and care to prevent issues such as soreness and infection.

1.6.2 Perineal Care

• Daily suture checks for healing and cleanliness.

• Encourage self-care habits like vulval douching or bathing.

• Provide analgesia for discomfort.

1.7 Instrumental/Surgical Birth Care

• Caesarean Birth:

  • Daily tracking of temperature, pulse, and respiration rates, BP.

  • Wound care monitoring to prevent infection.

  • Minimize risk of DVT through mobility interventions (TED stockings/innohep).

• Vaginal Instrumental Birth:

  • Ensure physiotherapy interventions as needed and check perineal care.

  • Consider laxatives to prevent postpartum constipation.

1.8 Postpartum Education and Care

1.8.1 Exercises

• Promote pelvic floor exercises for recovery and strength.

1.8.2 Infant Care Education

• Detailed instructions on:

  • Bathing the infant.

  • Feeding techniques.

  • Infant safety practices.

  • Vaccination schedules.

  • Family planning and contraception.

  • Encouraging healthy eating and smoking cessation.

1.9 Postnatal Sexuality

• Vaginal laxity considerations and exercises as a potential remedy.

• Discuss contraception options and lubrication use.

1.10 Discharge Advice

• Assess need for iron supplements.

• Schedule follow-up visits with GP for both mother and infant (2 weeks for the mother, 6 weeks for the baby).

• Importance of cervical smear tests every 3 years.

• Advise on breast health checks.

• Rh-negative women should receive anti-D immunoglobulin if delivering an Rh-positive infant.

• Non-immune women advised to receive rubella vaccination.

1.11 Support Services

• Available community support services:

  • Public Health Nurses (PHN).

  • Doulas for additional care.

  • Community midwives providing home birth options and primary care initiatives.

  • GP access for medical and mental health support.

  • Postnatal distress support groups; reference to HSE publication "Chasing the Blues Away."