In the first week postpartum assessment of the condition of mother and baby is important, together with appropriate advice and counselling, particularly where this is the woman's first child. The postpartum visit during the first week should include:
The Mother
General well-being, micturition (especially the first 8-12 hours, see 3.5), possible complaints.
Abdomen: fundal height, distended bladder?
Perineum, vaginal haemorrhage, lochia, haemorrhoids.
Legs: thrombophlebitis, signs of thrombosis?
Temperature, if there is reason to suspect infection. Body temperature of 38.0°C is abnormal, especially during the first days after delivery (section 3.3).
Assessment and help with breastfeeding, to prevent problems.
The caregiver should be prepared to support the woman in the initiation and practice of breastfeeding (sections 6.3, 6.4), but also in many other problems that arise in the first week after birth, especially if the mother is primipara. The special problems of HIV positive women are discussed in section 8; they include the decisions on HIV testing and on infant feeding. Counselling on contraception should be offered in combination with the advice on breastfeeding (sections 7.2, 7.3, 7.5). Too often these two issues are dealt with separately by different persons, who don't know about the other's advice. In case of anaemia, an iron preparation is prescribed to the mother. Rhesus negative women with a Rh positive infant should receive anti Rh-D (section 9.4). If the mother is known to be non-immune to rubella, immunization may be offered (section 9.5).
Nutritional advice and supplementation of pregnant and lactating women is a subject of special importance for those countries and regions with a high prevalence of malnutrition. Under these conditions nutritional advice and supplementation of women with proteins and energy is useful for the woman and probably for her infant (section 4.3). The provision of these supplements will primarily be a matter of concern for government authorities, but health care providers may support the government by advice, and by selection of the women who are eligible for supplementation. Micronutrient supplementation (section 4.4) is usually regulated by governments, dependent on the local situation.
More specifically, caregivers should offer:
advice/counselling on maternal and newborn physical, psychosocial and culturo-environmental needs, including nutrition and breastfeeding
information regarding warning signs of problems and where to seek help
counselling to women and men on sexual issues related to the postpartum period, including fertility regulation and provision of contraceptives
voluntary counselling and testing of HIV/AIDS
immunization of the newborn/infant and the women, including Rh immunization where/when applicable.
Assessing the baby
A routine neonatal examination does not take more than 5-10 minutes and should be done in a quiet, warm and clean environment, preferably in daylight and with parents present. Assessment should include:
asking the mother how she feels about the baby, how the baby is feeding and about any concerns
general condition: is the baby active, feeding well and frequently? (be alert for the "too good baby", who never cries)
if necessary, observing breastfeeding and helping the mother to improve the technique
skin: is it clean (no pustules), not jaundiced?
are eyes clean (not draining pus)?
if the baby is not active, not feeding well or other abnormalities are observed more thorough examination should be done:
- respiration: frequency; is there difficult and fast breathing, grunting, intercostal indrawing?- temperature measured (section 5.3)
- tone and motor function: hypotonia, paresis?
In countries and populations at high risk of tuberculosis infection, infants receive BCG as soon as possible after birth (sections 9.2, 9.3). A first injection of hepatitis B vaccine is given in the first week, and also the first dose of oral poliomyelitis vaccine (OPV). In countries with a screening programme on hypothyroidism and phenylketonuria at the end of the first week a blood sample is taken and tested in a laboratory.
Observation of the baby during the first week is much more important than a once-only examination by a health worker.
