Postnatal Care

POSTNATAL CARE
Definition:
-Postnatal care means systemic examination of

puerperal woman and her infant and advices
given to them.
-Included under the Child Survival and Safe

Motherhood programme (1992) of RCH.
-Under essential obstetric care of RCH, there is

provision of three postnatal checkups to
monitor postnatal recovery and to detect
complications, if any
NEED OF THE HOUR
- Incidence of postnatal complications- 42%.

- MMR in India is 407 per 1,00,000 live births.
- A.P has an MMR of 154 per 1,00,000 live births.
- Of these:
- 29% are due to antenatal & postnatal
hemorrhage.
- 16% due to puerperal sepsis.
WHICH ARE THE PREVENTABLE CAUSES OF
MATERNAL DEATH
OBJECTIVES OF POSTNATAL CARE
- Prevent complications of postpartum period.

- Rapid restoration of optimum health of mother.
- Check adequacy of breast feeding.
- Provide family planning services.
- Inform about immunization schedule.
- Note the progress of the baby.
- Provide basic health education.
PUERPERIUM
Definition:
Puerperium is the postpartum 6 wks period during
which the maternal systems especially the pelvic
organs more or less return to the pre-gravid state.
Changes during puerperium:

 General physiological changes:
- Pulse rate
- Temperature
- Constipation & diuresis
- Weight loss
Contd…
 Uterine changes:
- Total involution by 6weeks
- Regression of the vessels
 Changes in cervix & lower uterine segment:
- Cervical os narrowed by end of 1st wk
- Does not assume pre-gravid state
- Lower uterine segment regresses
 After pains:
- In multiparous women
- Vigorous contractions of uterus
- Require an analgesic
- Become mild by third postpartum day
Contd…
 Lochia:
- Physiological postpartum uterine discharge
of mainly blood & necrotic decidua during the first
3-4wks of puerperium.
 Breast changes:
- Hypertrophy of breast tissue.
- Colostrum secretion for 2-3 days following
child birth.
- Actual milk secretion from 3-4th day.
- Milk secretion continues throughout
puerperium & thereafter.
EXAMINATION OF MOTHER AND INFANT
Routine checkups:
- Twice a day during first three days
- Once a day till umbilical cord drops off
- End of puerperial period
The HWF examines the mother for:

- Weight, temperature
- B.P, pulse and respiratory rate
- General health
- Signs of anaemia
- Breasts and lactation
- Tone of abdominal muscles & perineum
- Pelvic floor
- Records any complaints
- Uterine & adnexal structures
HWF examines the infant for:

- Records weight
- Feeding & progress of infant
- Gives immunization
- Refers to a pediatrician for further care
Further visits: - Once a month during 1st 6months

- Once in 2-3months till end of year
FUNCTIONS OF FEMALE HEALTH WORKER
A HWF, present at the sub-centre, limits her

activities among 300-500 families.
She: - She registers pregnant

mothers
- Gives advice on nutrition

to nursing mothers
- Provides at least 3 post

delivery visits
- Distributes IFA tablets.
- Spreads the message of family
planning.
- Advice regarding immunization of infant.
- Assesses the growth & development of infant.
- Refers high risk cases to FRU’s or District
hospitals.
- Educates mothers in better family health.
ADVICE GIVEN TO THE MOTHER
- Rest for about 8-12hrs.

- Return to normal activities should be restricted
for at least 2-3 wks.
- Fully balanced diet with adequate calories, proteins,
plenty of fluids, minerals and vitamins.
- Care of perineal stitches.
- Visitors to be restricted, especially those suffering
from common cold.
RDA FOR AN INDIAN WOMAN
Energy Protein Fat Calcium Iron Vit-A

Kcal/d g/d g/d mg/d mg/d u/d
Woman
doing
2225 50 20 400 30 600
moderate
work
Lactating
woman
+550 +25 45 1000 30 950
(0-6mon)
- Postpartum posture & exercises:
- Feed the baby in sitting posture.
- Deep breathing, simple movements of limbs
- Simple exercises to strengthen abdominal
muscles and pelvic floor.
- Postpartum psychosis:
- Psychological fear borne out of ignorance &
insecurity regarding the baby.
- Overcome by the support and companionship
of her husband and family.
- By proper prenatal instructions.
-Care of the breasts.
-Rooming-in is to be practiced.
-Training for contraceptive usage.

-Health education regarding asepsis & antiseptics.
BREAST FEEDING
- It is the “FIRST FOOD” to the infant.

- Every year, Aug 1-7th is considered
“ BREAST FEEDING WEEK”
Breast feeding can be started 30min after birth.
-Statistics:
- An average Indian mother feeds her infant for
nearly 2yrs.
- Secretes about 450-600ml milk per day
- Energy value of 70 Kcal/100ml
- Protein content of 1.1 gm/100ml
- % of children who are exclusively breast fed is 37%.
- Intervals between feeds may vary from 1-4hrs.
Advantages of breast feeding
- Safe, clean, hygienic, cheap, available at
right temperature.
- Complete food
- Antimicrobial factors
- Easily digestible
- Promotes bonding
- Sucking: development of jaws & teeth
- Protects from obesity
- Prevents malnutrition
- Biochemical advantages
- Helps in spacing between children
- After 4months, weaning foods rich
in protein & other nutrients like
animal milk, soft-cooked & mashed
vegetables, etc. started.
- Avoid bottle feeding: Nutritionally poor

Bacteriologically
dangerous
- Indications of artificial feeding:
Failure of breast milk
HIV positive mother
Death of mother
FAMILY PLANNING
- Postpartum sterilization recommended on 2nd day of

delivery.
- IUD’s & conventional contraceptives during first 6
months.
- Combined & sequential oral pills to be avoided.
- Following 6mon of breast feeding,
O.C pills, IUD’s given.
- Presently the contraceptive
prevalence is 47% in India.
-Small family norm:
- Objective of Family Welfare Programme in India.
- Symbolized by inverted
red triangle.
- Every postnatal woman is
educated about this by FHW.
MANAGEMENT OF COMPLICATIONS
1. Puerperal sepsis:
- Infection of the genital tract within 3weeks
after delivery.
Features: Increased pulse rate & temperature
Foul smelling lochia
Pain & tenderness in lower abdomen
Treatment: Strict asepsis during delivery
antibiotics
2. Secondary postpartum hemorrhage:

- Vaginal bleeding anytime from 6hrs after
delivery to 6weeks.
- Due to retained placenta or membranes.
3. Thrombophlebitis:
- Venous thrombosis in lower limb during
puerperium.
Causes: Venous stasis,
Increased coagulability of blood,
Trauma or low grade infection,
Treatment: Leg exercises,
Subcutaneous heparin
4. Prolapse of pelvic organs
5. Sub involution:
-When the process of involution becomes
impaired and deficient.
Causes: Multiparity
Twin pregnancy
Fibroid uterus
Features: Red discharge per vagina,
after pains,
Fever, anemia.
Treatment: Postural drainage,
Antibiotics,
Removal of any retained products.
6. Retroversion of uterus:
- Postural treatment is advised.
7. Backache: due to PID, prolapse, cervicitis, etc.
8. UTI
Thus postnatal care aims to bring
“ ALL MOTHERS UNDER SAFE MOTHERHOOD

& ALL INFANTS UNDER CHILD SURVIVAL
PROGRAMME”
Thank You

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POSTNATAL CARE

-Postnatal care means systemic examination of

-Included under the Child Survival and Safe

-Under essential obstetric care of RCH, there is

- Incidence of postnatal complications- 42%.

- Prevent complications of postpartum period.

Changes during puerperium:

The HWF examines the mother for:

HWF examines the infant for:

Further visits: - Once a month during 1st 6months

A HWF, present at the sub-centre, limits her

She: - She registers pregnant

- Gives advice on nutrition

- Provides at least 3 post

- Rest for about 8-12hrs.

Energy Protein Fat Calcium Iron Vit-A

-Training for contraceptive usage.

- It is the “FIRST FOOD” to the infant.

- Avoid bottle feeding: Nutritionally poor

- Postpartum sterilization recommended on 2nd day of

2. Secondary postpartum hemorrhage:

7. Backache: due to PID, prolapse, cervicitis, etc.

“ ALL MOTHERS UNDER SAFE MOTHERHOOD

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