Postnatal care - of the woman

Postnatal care of the woman

Assessment and care of the woman

At each postnatal contact, ask the woman about her general health and whether she has any concerns, and assess her general wellbeing. Discuss topics that may be affecting her daily life, and provide information, reassurance and further care as appropriate. Topics to discuss may include:

• the postnatal period and what to expect
• symptoms and signs of potential postnatal mental health problems and how to seek help
• symptoms and signs of potential postnatal physical problems and how to seek help
• the importance of pelvic floor exercises, how to do them and when to seek help
• fatigue
• factors such as nutrition and diet, physical activity, smoking, alcohol consumption and recreational drug use
• contraception
• sexual intercourse
• safeguarding concerns, including domestic abuse

At each postnatal contact, assess the woman's psychological and emotional wellbeing

At each postnatal contact by a midwife, assess the woman's physical health,including the following:

• symptoms and signs of infection
• pain
• vaginal discharge and bleeding
• bladder function
• bowel function
• nipple and breast discomfort and symptoms of inflammation
• symptoms and signs of thromboembolism
• symptoms and signs of anaemia
• symptoms and signs of pre-eclampsia

for women who have had a vaginal birth:

• perineal healing

for women who have had a caesarean section:

• wound healing
• symptoms of wound infection

At the first postnatal midwife contact, inform the woman that the following are symptoms or signs of potentially serious conditions, and she should seek medical advice without delay if any of these occur:

• sudden or very heavy vaginal bleeding, or persistent or increased vaginal bleeding, which could indicate retained placental tissue or endometritis
• abdominal, pelvic or perineal pain, fever, shivering, or vaginal discharge with an unpleasant smell, which could indicate infection
• leg swelling and tenderness, or shortness of breath, which could indicate venous thromboembolism
• chest pain, which could indicate venous thromboembolism or cardiac problems
• persistent or severe headache, which could indicate hypertension, pre-eclampsia, postdural-puncture headache, migraine, intracranial pathology or infection
• worsening reddening and swelling of breasts persisting for more than 24 hours despite self-management, which could indicate mastitis
• symptoms or signs of potentially serious conditions that do not respond to treatment

At each postnatal contact, give the woman the opportunity to talk about her birth experience, and provide information about relevant support and birth reflection services, if appropriate

All healthcare professionals should ensure appropriate referral if there are concerns about the woman's health.

At 6 to 8 weeks after the birth, a GP should:

• carry out an assessment including the points mentioned above and taking into account the time since the birth
• respond to any concerns, which may include referral to specialist services in either secondary care or other healthcare services such as physiotherapy.

Perineal health

At each postnatal contact, as part of assessing perineal wound healing, ask the woman if she has any concerns and ask about:

• pain not resolving or worsening
• increasing need for pain relief
• discharge that has a strong or unpleasant smell
• swelling
• wound breakdown

Be aware of the following risk factors for persistent postnatal perineal pain:

• episiotomy, or labial or perineal tear
• assisted vaginal birth
• wound infection or breakdown
• birth experienced as traumatic.

Reference:

1. NICE (April 2021). Postnatal care