Postnatal Care

Postnatal Care - PNC Foundations

• Definition: Care provided to mother & newborn immediately after birth up to 6 weeks (42 days) postpartum.
• Objectives:
  • Prevent & detect complications (mother & baby).
  • Promote health: breastfeeding, nutrition, hygiene, contraception.
  • Support psychosocial adjustment.
  • Ensure infant well-being: growth, immunization.
• PNC Visit Schedule:
  • Crucial for monitoring maternal & neonatal health.
  • Home visits by ASHA/ANM are key in India.

  ⭐ Minimum 4 PNC visits recommended by WHO (Day 1, Day 3, Day 7-14, 6 weeks). National guidelines (e.g., HBNC) specify additional visits like on days 3, 7, 14, 21, 28, 42 for home births/early discharge cases in India.

  • Institutional PNC: At discharge, then follow-up as needed or per protocol (e.g., 6 weeks visit).

Postnatal Care - Mom's MOT

• Definition: Care from placental delivery to 6 weeks (42 days) postpartum.
• Objectives: Restore maternal health, prevent complications, family planning, infant care education.
• Maternal Assessment (📌 BUBBLE-HE):
  • Breasts: Engorgement, nipples (cracks, inversion), lactation.
  • Uterus: Involution (firm, central, ↓1 fingerbreadth/day), tenderness. Afterpains common.
  • Bladder: Function, retention, infection signs.
  • Bowel: Function, hemorrhoids.
  • Lochia: Character, amount, odor. Normal progression:
    • Rubra: Days 1-4 (red, fleshy).
    • Serosa: Days 4-10 (pinkish-brown).
    • Alba: Up to 2-6 weeks (yellowish-white).
  • Episiotomy/Laceration (REEDA scale): Redness, Edema, Ecchymosis, Discharge, Approximation.
  • Homan's Sign/Hemorrhoids: DVT check (calf pain on dorsiflexion - controversial), hemorrhoid care.
  • Emotional Status: Postpartum blues, depression screening.

⭐ Lochia rubra (first 3-4 days), serosa (up to 10 days), and alba (2-6 weeks) indicate normal uterine healing and endometrial regeneration.

• Key Danger Signs: Fever >38°C, excessive bleeding, foul-smelling lochia, severe pain, dysuria, calf pain/swelling, persistent sadness/anxiety.

Postnatal Care - Baby's Best Start

• Immediate Care (at birth): Clear airway, dry & wrap, warmth (skin-to-skin, Kangaroo Mother Care - KMC). APGAR score at 1 & 5 min. Eye care (e.g., tetracycline ointment). Vitamin K (1 mg IM). Umbilical cord care (clean, dry, no application).
• Breastfeeding: Initiate within 1 hour (colostrum). Exclusive breastfeeding for 6 months. Ensure correct attachment & positioning.
  • Signs of good attachment: Mouth wide open, lower lip everted, chin touching breast, more areola visible above than below.
• Essential Newborn Care: Maintain warmth, hygiene. Immunization (BCG, OPV-0, Hep B-birth dose).
• Neonatal Examination: Daily check for danger signs. Head-to-toe exam. Screening for congenital anomalies, hypothyroidism, G6PD deficiency, hearing loss.
• Danger Signs in Newborn: ⚠️ Poor feeding/sucking, lethargy/unconsciousness, convulsions, respiratory rate >60/min or <30/min, severe chest in-drawing, grunting, temperature <35.5°C (hypothermia) or >37.5°C (fever), jaundice in first 24 hrs or deep jaundice, umbilical redness/pus.

⭐ The 'Warm Chain' is crucial for preventing neonatal hypothermia, involving 10 interlinked steps from delivery room to home.

Postnatal Care - Red Flag Roundup

• Maternal DANGER Signs:
  • PPH: Bleeding >500ml (NVD), >1000ml (CS). Primary <24h, Secondary 24h-12wks.
  • Puerperal Sepsis: Fever >38°C, foul lochia, uterine tenderness.
  • Thromboembolism: Leg pain/swelling, dyspnea, chest pain.
  • Severe Headache/Vision changes: Pre-eclampsia/eclampsia.
  • Mood: Persistent sadness, psychosis.
• Newborn DANGER Signs:
  • Jaundice: <24h onset, ↑bilirubin, yellow palms/soles.
  • Sepsis: Lethargy, poor feed, temp instability, convulsions.
  • Respiratory Distress: Rate >60/min, grunting, retractions.
  • Poor Feeding/Vomiting/Distension.
  • No urine >24h / meconium >48h.

⭐ Uterine atony is the most common cause (70-80%) of primary postpartum hemorrhage.

PPH Management (4Ts)

High‑Yield Points - ⚡ Biggest Takeaways

• Key PNC visits: within 24 hours, day 3, day 7, and 6 weeks.
• Exclusive Breastfeeding (EBF): Initiate within 1 hour; continue exclusively for 6 months.
• Postpartum Hemorrhage (PPH): Major maternal killer; AMTSL is key for prevention.
• Postpartum contraception: Counsel on options; PPIUCD (Post-Partum IUCD) is highly effective.
• Maternal danger signs: Heavy bleeding, fever, foul lochia, convulsions, severe headache.
• Newborn danger signs: Poor feeding, lethargy/convulsions, fast breathing, jaundice <24h, hypothermia/fever.
• IFA supplementation: Continue Iron-Folic Acid for 100 days postpartum.