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