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Postnatal Care

Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

Immediate care

It is advisable for mother and infant to remain in the midwife's care for at least an hour after birth, regardless of the birth setting.

  • The woman should be encouraged to pass urine because a full bladder may impede uterine contraction
  • Uterine contraction and blood loss should be checked on several occasions in the first hour
  • Throughout this same period the midwife should pay regard to the baby's general wellbeing. She should check the security of the cord clamp and observe general skin colour, respirations and temperature
  • The warmest place for a baby is to be placed in a direct skin-to-skin contact position with the mother, or wrapped and cuddled, whichever she prefers
  • Most women intending to breastfeed will wish to put their baby to the breast during the first moments of contact

Once the placenta is expelled, a number of physiological processes take place and the uterus returns to its non-pregnant state (involution). The midwife should undertake immediate and then regular observations of fundal height and the degree of uterine contraction in the first few hours after birth. On abdominal palpation, the fundus of the uterus should be located centrally, at the same level or slightly below the umbilicus, and should feel firm. A well-contracted uterus will gradually reduce in size until it is no longer palpable above the symphasis pubis. It should not feel tender, although the woman may experience afterpains.

 

Postpartum vaginal fluid loss (lochia)

Blood products constitute the major part of the vaginal loss immediately after the birth of the baby and expulsion of the placenta. As involution progresses, the vaginal loss changes from a predominantly fresh blood loss to one that contains stale blood products, lanugo, vernix and other debris from the unwanted products of conception. This loss varies from woman to woman, being lighter or darker in colour, but for any individual the shade and density tend to be consistent.

Assessment of vaginal blood loss

The mother should be asked about the current vaginal loss:

  • Whether this is more or less than previously
  • Whether this is lighter or darker than previously
  • Whether she herself has any concerns about it.

It is particularly important to record any clots passed and when these occurred.

The Practising Midwife featured article

A woman-led approach to improving postnatal care 2014; 17(7): 21 - 23 Authors: Claire Fryer-Croxall, Elizabeth Bailey

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