BSC SEM 6 UNIT 5 MIDWIFERY / OBSTETRIC AND GYNECOLOGY NURSING- I
UNIT 5 Postpartum care/Ongoing care of women
🌸 Postpartum (Puerperium) Care / Ongoing Care of Women
🔶 Definition of Postpartum Period:
The postpartum or puerperium period is the time after childbirth, lasting 6 weeks, during which the mother’s body returns to its pre-pregnant state, both physically and emotionally.
🔷 Objectives of Postpartum Care:
Monitor and promote physical recovery from childbirth.
Prevent postpartum complications.
Support emotional and psychological adaptation to motherhood.
Encourage and assist with breastfeeding.
Provide health education and family planning advice.
Support the family and involve them in care.
🔶 Key Components of Postpartum Care:
1. Physical Assessment and Monitoring
Performed regularly in the immediate, early, and late postpartum periods:
Parameter
What to Monitor
Vital Signs
BP, pulse, temperature, respiratory rate – for signs of infection, hemorrhage, preeclampsia.
Uterine Involution
Palpate fundus for firmness and descent. A boggy uterus may indicate uterine atony.
Lochia
Type (Rubra, Serosa, Alba), amount, odor. Foul-smelling lochia may indicate infection.
Perineum & Episiotomy Site
Check for pain, swelling, redness, hematoma, signs of infection.
Breasts
Engorgement, nipple condition, lactation status.
Bladder Function
Encourage voiding, check for retention or infection.
Bowel Function
Monitor bowel movement, dietary intake, signs of constipation.
Legs
Check for signs of DVT – swelling, redness, tenderness.
2. Psychological and Emotional Support
Baby blues are common in the first week (tearfulness, irritability, anxiety).
Monitor for signs of Postpartum Depression or Psychosis – refer if needed.
Encourage emotional expression and reassure the mother.
Involve family in support and care.
3. Breastfeeding Support
Educate on:
Proper latch and positioning
Burping the baby
Signs of adequate milk intake
Manage problems:
Cracked nipples
Engorgement
Mastitis (refer if fever, pain, redness)
Encourage exclusive breastfeeding for 6 months.
4. Perineal Care
Educate mother on:
Perineal hygiene
Use of sitz baths
Pain relief measures (ice packs, analgesics)
Signs of infection
Monitor for hematoma or wound dehiscence.
5. Bladder and Bowel Care
Encourage early ambulation.
Adequate hydration and fiber-rich diet to prevent constipation.
Use stool softeners if required.
Monitor for urinary incontinence or infection.
6. Nutrition and Hydration
Nutritional counseling for:
Increased caloric needs during breastfeeding
Iron, calcium, and protein-rich diet
Adequate fluid intake
Supplements: Iron, calcium, folic acid as advised.
7. Rest and Sleep
Encourage rest between infant feeding schedules.
Educate family to support household responsibilities.
8. Postpartum Exercises
Teach pelvic floor (Kegel) exercises.
Gradual return to light physical activity.
Avoid strenuous activity until cleared by healthcare provider.
9. Family Planning and Sexual Health
Discuss return of fertility and contraception options.
Safe resumption of sexual activity (usually after 6 weeks).
Importance of spacing pregnancies.
10. Education and Counseling
Self-care practices
Newborn care and danger signs
Follow-up visits (usually at 6 weeks)
Immunization schedule for infant
🔷 Nursing Interventions and Role of Midwife
Area
Nursing Role / Midwifery Action
Assessment
Regular monitoring, documentation, early identification of complications.
Health Education
Breastfeeding, hygiene, nutrition, danger signs.
Emotional Support
Build rapport, active listening, provide reassurance.
Referral
Identify and refer cases of infection, depression, hemorrhage.
Family Involvement
Educate family members to support the mother.
Advocacy
Ensure mother’s rights and preferences are respected.
🔷 Complications to Watch For (and Nursing Response):
Complication
Nursing Response
Postpartum Hemorrhage
Fundal massage, administer uterotonics, alert medical team.
Infection (UTI, endometritis, mastitis)
Monitor temp, antibiotics, promote hygiene.
DVT
Early ambulation, monitor leg swelling/pain, refer.
Puerperal Sepsis
Recognize early signs, maintain asepsis, urgent referral.
Postpartum Depression
Emotional support, screen using tools like EPDS, refer to mental health services.
🔷 Follow-Up and Discharge Planning
Ensure mother knows:
When to seek help (fever, excessive bleeding, depression)
Date of postpartum check-up (usually at 6 weeks)
Neonatal care and immunization schedule
🔷 Summary Table:
Area of Care
Focus
Physical
Uterus, lochia, perineum, breasts, vitals
Emotional
Psychological adaptation, depression signs
Education
Breastfeeding, hygiene, contraception
Nutrition
Iron-rich, protein diet; hydration
Family
Involvement, support, education
🌸 Normal Puerperium (Normal Postpartum Period)
🔷 Definition:
The puerperium (also called the postpartum period) is the time following childbirth during which the woman’s body returns to its pre-pregnant physiological state, except for the lactating breasts.
🔷 Duration of Puerperium:
Stage
Duration
Description
Immediate
First 24 hours after delivery
Focus on vital signs, hemorrhage risk, and uterine contraction
Early
Up to 7 days postpartum
Involution begins, lochia, breastfeeding starts
Late
6 weeks (42 days) postpartum
Complete involution of reproductive organs and return to normal function
🔶 PHYSIOLOGICAL CHANGES DURING PUERPERIUM
These are system-wise changes that occur in a normal postpartum woman:
1. 🧠 General/Systemic Changes
Hormonal levels decline (estrogen and progesterone drop sharply).
Prolactin rises (if breastfeeding).
Body gradually returns to non-pregnant metabolic state.
Postpartum chills or sweating is common (due to hormone shift and fluid loss).
2. 👩⚕️ Reproductive System
A. Uterus – Involution
Aspect
Details
Size
Shrinks from 1000g to ~50-100g in 6 weeks
Fundal height
Immediately after delivery: midway between umbilicus and symphysis pubis; rises to umbilicus in 12 hours, then descends 1 cm/day
Position
Midline, firm on palpation
Failure of involution
Called subinvolution – may be due to infection, retained products, etc.
B. Lochia – Vaginal Discharge
Type
Duration
Description
Lochia Rubra
Day 1–3
Red, blood + decidua
Lochia Serosa
Day 4–10
Pinkish-brown, serous fluid + leukocytes
Lochia Alba
Day 11–14 (up to 6 weeks)
Whitish/yellow, mucus + leukocytes
Abnormal signs: Foul odor, excessive bleeding, clots – may indicate infection or retained placenta.
C. Cervix and Vagina
Cervix remains soft, flabby; regains tone in 1 week.
Cervical os changes from circular (nullipara) to slit-like (multipara).
Vagina regains tone gradually; pelvic floor exercises (Kegels) help.
Nursing care: Support breastfeeding, manage sore nipples, teach proper latch.
4. 🚽 Urinary System
Increased diuresis (fluid loss) first 2–3 days.
Risk of urinary retention (due to trauma, edema, anesthesia).
Full bladder can displace uterus → risk of hemorrhage.
5. 💩 Gastrointestinal System
Appetite increases.
Constipation common due to fear of pain, reduced motility, iron intake.
Encourage fluids, high-fiber diet, and ambulation.
6. 🩸 Circulatory System
Blood volume returns to normal within 1–2 weeks.
Hematocrit may fluctuate.
Clotting factors remain elevated → risk of thromboembolism.
Leg assessment important (for signs of DVT).
7. 🦵 Musculoskeletal System
Joints regain tone.
Diastasis recti (separation of abdominal muscles) may occur.
Encourage gentle exercises to regain strength.
8. 😌 Psychological Changes
Postpartum blues: Mild mood swings, tearfulness, resolves in ~1 week.
Monitor for Postpartum depression or psychosis.
Support, rest, family involvement essential.
🔷 Nursing Role in Normal Puerperium:
Focus Area
Nursing Interventions
Uterus
Fundal massage, monitor involution
Lochia
Observe amount, type, odor
Perineum
Hygiene education, pain relief
Breasts
Support breastfeeding, prevent engorgement
Bladder/Bowel
Promote elimination, prevent UTI/constipation
Nutrition
Encourage balanced diet, hydration
Rest
Encourage naps, limit visitors if needed
Education
Self-care, newborn care, contraception
Emotional Support
Watch for mood changes, encourage bonding
🔷 Health Education for Mother:
Personal hygiene (especially perineal)
Signs of infection or danger: Fever, foul lochia, pain, bleeding
Breast care and breastfeeding techniques
Contraception advice
Exercise and rest balance
Follow-up visit at 6 weeks postpartum
🌺 PHYSIOLOGY OF PUERPERIUM
(Normal Postpartum Recovery Changes)
🔷 Definition:
Puerperium is the period following childbirth during which the mother’s reproductive organs and body systems return to the pre-pregnant physiological state, excluding the breasts (which adapt for lactation).
⏳ Duration: Approximately 6 weeks (42 days) after delivery 📍 Divided into:
Immediate Puerperium (First 24 hours)
Early Puerperium (Up to 7 days)
Late Puerperium (Up to 6 weeks)
🔶 SYSTEM-WISE PHYSIOLOGICAL CHANGES
1. 🧠 Endocrine System
Estrogen & Progesterone: Sharp decline after delivery of placenta.
Prolactin: Increases in breastfeeding women; stimulates milk production.
Oxytocin: Stimulated by suckling; promotes milk let-down and uterine contractions.
hCG, hPL, relaxin: Rapidly disappear from circulation.
2. 👩⚕️ Reproductive System
A. Uterus – Involution
Uterus shrinks from ~1000g to ~50–100g over 6 weeks.
Fundal height decreases ~1 cm/day postpartum.
Physiological contraction & autolysis of uterine muscle cells leads to shrinking.
Subinvolution = failure to involute normally (abnormal).
B. Lochia (Postpartum Vaginal Discharge)
Type
Days
Contents
Lochia Rubra
1–3
Blood, fragments of decidua
Lochia Serosa
4–10
Serous fluid, leukocytes
Lochia Alba
11–14 (can last up to 6 weeks)
Mucus, leukocytes, epithelial cells
Lochia has a fleshy odor — foul smell may indicate infection.
C. Cervix & Vagina
Cervix becomes soft and gradually regains tone.
Os changes from round (nullipara) to slit-like (multipara).
Vaginal tissues regain elasticity, especially in non-lactating women.
D. Ovaries & Menstruation
Non-lactating: Ovulation returns in 6–8 weeks.
Lactating: Suppressed ovulation due to high prolactin levels.
Menstruation may be delayed in breastfeeding mothers (lactational amenorrhea).
3. 🤱 Breasts and Lactation
Colostrum secreted in first 2–3 days — rich in antibodies.
Mature milk follows (~day 3–5).
Breast changes: enlargement, tenderness, warmth during engorgement.
Milk let-down reflex due to oxytocin.
4. 🚽 Urinary System
Diuresis (increased urine output) for 2–3 days due to hormonal changes and fluid shift.
Risk of urinary retention and UTI due to edema, trauma, or anesthesia.
Dilated ureters and renal pelvis gradually return to normal.
5. 💩 Gastrointestinal System
Appetite returns.
Constipation is common due to decreased bowel motility, fear of pain, dehydration.
Hemorrhoids may persist or worsen temporarily.
6. 🩸 Cardiovascular System
Blood volume reduces (diuresis + bleeding).
Cardiac output remains high for 48 hours, then normalizes.
WBC count may remain elevated for 1 week.
Clotting factors stay elevated — ↑ risk of thromboembolism.
7. 🦵 Musculoskeletal System
Joints return to pre-pregnancy state gradually.
Abdominal wall is soft; diastasis recti may be present.
Exercises help strengthen abdominal and pelvic muscles.
8. 😌 Psychological/Emotional Changes
“Baby blues” (mild sadness, tearfulness): seen in first week due to hormonal shift, sleep deprivation.
Monitor for Postpartum Depression or Psychosis — especially in high-risk women.
Emotional support and family involvement are essential.
🔷 Summary Table
System
Physiological Change
Uterus
Involution, uterine shrinkage
Lochia
Rubra → Serosa → Alba
Breasts
Lactation begins (Colostrum → Milk)
Hormones
Drop in estrogen/progesterone; rise in prolactin & oxytocin
Ovaries
Delayed ovulation (if lactating)
Bladder
Diuresis; possible retention
Bowel
Constipation common
Heart
High cardiac output; risk of clotting
Emotions
Mood swings, baby blues
🌸 Postnatal Assessment
(Maternal Assessment After Childbirth) 📅 Time Frame: Begins immediately after delivery and continues through the first 6 weeks of the puerperium.
🔷 Objectives of Postnatal Assessment:
Monitor the mother’s physical and emotional recovery.
Detect and manage early postpartum complications.
Assess breastfeeding success and newborn care.
Provide health education and promote maternal well-being.
🔶 TIMING OF POSTNATAL ASSESSMENTS
Timing
Key Actions
Immediate (within 1–2 hrs)
Monitor vitals, uterine firmness, bleeding
Early (first 24 hrs)
Frequent assessments of vitals, uterus, lochia, bladder
First week
Monitor involution, breastfeeding, nutrition, perineal care
6-week follow-up
Comprehensive review of physical and emotional health, menstruation, contraception, etc.
🔷 COMPONENTS OF POSTNATAL ASSESSMENT (HEAD-TO-TOE)
1. 🧠 General Appearance and Vital Signs
Temperature: Monitor for infection (>38°C is abnormal).
Pulse: Should be normal; tachycardia may indicate blood loss or infection.
BP: Watch for hypertension (e.g., postpartum preeclampsia) or hypotension (shock).
Respiration: Observe for dyspnea or abnormal patterns.
2. 👀 Psychological & Emotional Status
Mood, bonding with baby
Signs of postpartum blues, depression, or psychosis
Sleep pattern and fatigue level
3. 👶 Breast Assessment
Parameter
Observations
Size & Shape
Symmetry, fullness
Nipples
Inverted, flat, cracked, bleeding
Areola
Soft or engorged
Milk
Colostrum or mature milk present
Complaints
Pain, engorgement, mastitis signs
4. 👕 Abdominal Assessment
Uterine involution (fundus should descend 1 cm/day)
Fundal height and position (midline and firm)
Any signs of subinvolution or uterine atony
Check for diastasis recti (separation of abdominal muscles)
5. 👗 Perineal and Genital Area Assessment
Use REEDA Scale for Episiotomy or Laceration:
R – Redness
E – Edema
E – Ecchymosis (bruising)
D – Discharge (lochia)
A – Approximation of wound edges
Also observe:
Hemorrhoids
Perineal pain or discomfort
Hygiene practices
6. 💉 Lochia Assessment
Feature
Normal Findings
Type
Rubra (1–3 days), Serosa (4–10 days), Alba (11–14+ days)
Amount
Moderate to scant
Odor
Fleshy, not foul
Excessive bleeding, clots, or foul smell = abnormal
7. 🚽 Bladder Function
Frequency and ease of urination
Signs of urinary retention or infection (burning, urgency, foul smell)
Palpate for bladder distention if uterus is displaced
8. 💩 Bowel Function
Return of bowel sounds
Passing flatus or stool
Constipation or hemorrhoids present
Appetite and fluid intake
9. 🦵 Lower Limb Examination
Observe for swelling, redness, warmth (signs of DVT)
Encourage early ambulation
Assess for pain or cramping in calves
10. 💊 Nutritional Status and Hydration
Adequacy of diet (especially for breastfeeding)
Fluid intake
Iron, calcium, and vitamin supplementation
11. ❤️ Bonding and Mother-Baby Interaction
Eye contact, touch, response to baby’s cues
Confidence in infant care tasks
Teach and observe bathing, feeding, and hygiene practices
🔷 SPECIAL TOOLS USED
BUBBLE-HE framework for memory:
B – Breasts
U – Uterus
B – Bowel
B – Bladder
L – Lochia
E – Episiotomy/Perineum
H – Homan’s Sign (for DVT)
E – Emotional Status
🔷 Nursing Responsibilities in Postnatal Assessment:
Task
Action
Monitoring
Regular charting of vitals, lochia, uterus
Education
Breastfeeding, perineal care, contraception
Emotional Support
Recognize mood changes, support bonding
Referral
Promptly refer for infection, depression, hemorrhage
Documentation
Accurate and timely recording of findings
🔷 Summary Checklist:
✅ Vitals ✅ Uterine involution ✅ Lochia type and amount ✅ Perineum and episiotomy site ✅ Breast condition ✅ Bladder and bowel habits ✅ Nutrition and rest ✅ Emotional and psychological status ✅ Bonding and newborn care ✅ Contraceptive counseling
🏥 Postnatal Care – Facility for Postnatal Women
Postnatal care facilities are designed to provide physical, emotional, and educational support to mothers during the puerperium period (first 6 weeks after childbirth).
🔷 Types of Postnatal Care Facilities
Type
Description
Hospital Maternity Ward
Immediate care for mothers (usually 24–72 hrs) after delivery
Postnatal Ward
Extended observation after complicated births (e.g., C-section, preterm)
Primary Health Centres (PHC)
Basic postnatal services in rural/semi-urban areas
Community Health Centres (CHC)
24×7 maternal health services, trained staff for deliveries and postnatal care
Maternity Homes/Nursing Homes
Private setups for routine postnatal care
Home-based Postnatal Care
Outreach services by ASHA, ANM, or midwives in the community
Mother & Baby Friendly Clinics
Specialized outpatient clinics offering breastfeeding support, immunization, health education
🔶 Core Services Provided at Postnatal Care Facilities
1. 🩺 Medical & Nursing Assessments
Regular monitoring of vital signs, uterine involution, lochia, wound healing, etc.
Early identification of infection, hemorrhage, or hypertension.
2. 🤱 Lactation Support
Breastfeeding education
Management of sore nipples, engorgement, mastitis
Breast care teaching
3. 🧼 Perineal & Surgical Site Care
Episiotomy/stitch care
C-section wound care
Pain management
4. 🧠 Psychological and Emotional Support
Counseling for postpartum depression, anxiety, baby blues
Support for bonding and maternal confidence
5. 💊 Medication and Supplementation
Iron, calcium, vitamin supplements
Analgesics, antibiotics (if needed)
Immunizations for mother (e.g., Tetanus, Rubella if needed)
6. 🍲 Nutrition and Hygiene Guidance
Diet counseling for breastfeeding mothers
Personal hygiene education (especially perineal care)
7. 👶 Newborn Care Support
Guidance on feeding, bathing, immunization
Danger signs and when to seek help
8. ♀️ Family Planning Services
Counseling and provision of contraceptives
Lactational amenorrhea method (LAM)
Referral for IUDs, sterilization if desired
🔷 Staffing at Postnatal Care Facilities
Personnel
Role
Midwife
Provides primary care, assessments, education
Nurse (Maternal & Child Health)
Ongoing monitoring, emotional support, newborn care
Obstetrician/Gynaecologist
Management of complications, surgeries
Pediatrician
Newborn checks, immunizations
Counselor
Mental health support, family planning advice
ASHA/ANM (in rural settings)
Community-level follow-up, health education, referral services
🔶 Infrastructure Requirements for Postnatal Facilities
Clean, private recovery beds with good ventilation
Breastfeeding/lactation counseling area
Sanitation and handwashing facilities
Basic diagnostic and emergency equipment
Neonatal resuscitation area
Storage for essential drugs and immunizations
🔷 Government Guidelines in India (Example)
Under National Health Mission (NHM) and Janani Suraksha Yojana (JSY):
Mothers are entitled to 48 hours of facility-based postnatal care.
Free transport, medication, food, and counseling are provided.
Home-based Newborn and Postnatal Care (HBNC) visits by ASHA workers.
🔶 Nursing Responsibilities in Postnatal Facilities
Area
Nursing Role
Physical Care
Monitor vitals, uterus, lochia, stitches
Emotional Support
Active listening, psychological care
Education
Self-care, baby care, warning signs
Breastfeeding
Positioning, troubleshooting
Documentation
Record assessments, report abnormalities
Coordination
Liaise with doctors, counselors, health workers
Discharge Planning
Educate mother before discharge, give follow-up date
✅ Stable vital signs ✅ Uterus well contracted ✅ Normal lochia ✅ Pain managed ✅ Breastfeeding established ✅ Education provided (nutrition, hygiene, danger signs) ✅ Baby feeding well and passed urine/stool ✅ Family planning advice ✅ Follow-up appointment given
🏡 Home-Based Care for Postnatal Women
(Home-Based Postnatal Care – HBPNC)
🔷 Definition:
Home-based postnatal care refers to supportive healthcare services provided to a mother at her home after childbirth, especially during the first 6 weeks postpartum, to promote recovery, prevent complications, and educate the family.
🔶 Importance of Home-Based Postnatal Care:
Ensures continuity of care after hospital discharge
Facilitates early detection of postpartum and newborn complications
Strengthens mother-infant bonding
Educates family and mother on hygiene, nutrition, infant care
Reduces maternal and neonatal mortality, especially in rural/low-resource settings
✅ Heavy vaginal bleeding ✅ Foul-smelling lochia ✅ Fever > 100.4°F (38°C) ✅ Severe abdominal or perineal pain ✅ Swelling, pain in legs (possible DVT) ✅ Signs of depression or withdrawal
🔶 Baby Danger Signs to Report Immediately:
✅ Difficulty feeding or not feeding ✅ Fast or difficult breathing ✅ Fever or cold to touch ✅ Convulsions ✅ Yellowing of eyes/palms (jaundice) ✅ Umbilical redness or pus discharge
🔷 Advantages of Home-Based Postnatal Care
Builds trust between health worker and family
Addresses cultural beliefs in real settings
Reduces need for travel, especially in rural areas
Promotes comprehensive, personalized care
📋 Summary Table:
Component
Details
Duration
First 6 weeks after delivery
Visits
At least 6 visits (Day 1, 3, 7, 14, 21, 28, and 42)
Early detection of complications, mother-infant wellness
🌺 Postpartum Perineal Hygiene and Care
🔷 Definition:
Postpartum perineal care refers to cleaning, monitoring, and managing the perineal area (area between vagina and anus) after vaginal delivery, especially in women with episiotomy, lacerations, or swelling.
🔶 Importance of Perineal Care:
Promotes healing of tears or episiotomy stitches
Prevents infection and odor
Reduces pain, swelling, and discomfort
Maintains maternal hygiene and confidence
Enhances early mobility and comfort
🔷 Nursing/Midwifery Assessment of the Perineum
Use the REEDA Scale to assess episiotomy or perineal healing:
R
Redness
E
Edema (Swelling)
E
Ecchymosis (Bruising)
D
Discharge (Lochia, pus, odor)
A
Approximation of wound edges (healing of stitches)
📝 Document findings daily and report abnormalities.
🔶 General Guidelines for Perineal Hygiene:
Wash hands before and after perineal care
Use clean, warm water for washing
Gently pat dry the area from front to back (vagina to anus)
Change sanitary pads every 4–6 hours or when soaked
Avoid using perfumed soaps or antiseptics directly on the perineum
Wear loose, cotton undergarments and change frequently
🔷 Nursing Interventions for Perineal Care:
Intervention
Purpose
Perineal wash (peri-wash) with warm water 2–3 times/day
Keeps area clean, prevents infection
Sitz bath (warm shallow bath) 2–3 times/day
Reduces pain, promotes blood flow and healing
Ice packs in first 24 hours
Reduces swelling and numb pain
Topical antiseptic sprays/creams (if prescribed)
Provides pain relief, prevents infection
Analgesics or anti-inflammatory drugs
Reduces pain and discomfort
Tight stitch monitoring
For signs of pain, gaping, infection, hematoma
🔷 Patient Education for Mothers:
✅ How to clean perineal area ✅ Importance of changing pads frequently ✅ Signs of infection: foul-smelling discharge, fever, increasing pain ✅ How to do a sitz bath at home ✅ Encourage Kegel exercises to restore pelvic tone ✅ Advise sexual abstinence until 6 weeks postpartum or until healing is complete
🔶 Signs That Require Immediate Medical Attention:
🚩 Foul-smelling or purulent discharge 🚩 Persistent or worsening perineal pain 🚩 Fever > 100.4°F (38°C) 🚩 Swelling or hematoma formation 🚩 Gaping or dehiscence of stitches
🔷 Role of Midwife/Nurse:
Assess perineum regularly using REEDA
Assist with first perineal care post-delivery
Educate mother on hygiene and care practices
Encourage compliance with sitz baths and pain relief
Report and refer if infection, hematoma, or delayed healing is noted
Promote emotional support and respect mother’s privacy
📋 Summary Chart
Aspect
Details
Method
Perineal wash, sitz bath, pad change, front-to-back cleaning
Assessment, education, documentation, emotional support
Education Focus
Self-hygiene, warning signs, home care
🚽 Postpartum Bladder Function and Care
🔷 Overview:
After childbirth, many women experience changes in bladder function due to trauma, swelling, anesthesia, or hormonal effects. Proper care is essential to restore normal voiding, prevent complications, and support recovery.
🔶 1. Normal Postpartum Changes in Bladder Function
Physiological Changes
Explanation
Increased diuresis
Body eliminates excess fluids (especially in first 48–72 hours)
Decreased bladder tone
Due to hormonal effects and pressure during labor
Reduced sensation to void
From perineal trauma, edema, or epidural anesthesia
Displacement of uterus
Full bladder can push uterus upward, affect involution
Risk of retention
Common especially after prolonged labor or C-section
🔷 2. Nursing Assessment of Bladder Function
✅ Time of first void after delivery ✅ Frequency and amount of urination ✅ Difficulty, pain, or burning while voiding ✅ Signs of urinary retention (full bladder, no urge, small voids) ✅ Distended bladder on palpation ✅ Urine color, odor, and clarity
Stimulates reflex urination (especially for first void)
Monitor intake and output (I/O charting)
Detect retention or inadequate output
Palpate for bladder distention
If uterus is not midline or firm
Catheterization (if needed)
Temporary, for retention >6 hours after delivery
Educate about pelvic floor exercises
Improves tone, reduces incontinence risk
🔶 5. Postpartum Bladder Care After C-section or Anesthesia
Assess return of bladder sensation post-anesthesia
Remove indwelling catheter (usually within 12–24 hrs post-C-section)
Monitor first void after removal
Educate about avoiding bladder overdistention
🔷 6. Patient Education
✅ Void every 2–3 hours, even without urge ✅ Report burning, urgency, or difficulty in urinating ✅ Drink at least 2–3 liters of water daily unless contraindicated ✅ Maintain perineal hygiene to prevent infection ✅ Do Kegel exercises to restore pelvic floor tone ✅ Avoid caffeine or carbonated drinks if experiencing irritation
🔶 7. Nursing Responsibilities
Task
Action
Monitoring
Timely assessment of voiding pattern and urine output
Documentation
Record frequency, volume, and characteristics of urine
Support
Reassure and provide comfort to anxious mothers
Early Detection
Identify signs of retention, UTI, or atony
Coordination
Inform physician if catheterization or antibiotics needed
🌸 Minor Disorders of Puerperium and Their Management
These are non-life-threatening, commonly experienced physical or psychological issues occurring in the postnatal period (first 6 weeks after childbirth), due to physiological and anatomical adjustments.
🔶 1. Afterpains (Uterine cramps)
Cause
Intermittent uterine contractions during involution, especially in multiparas or breastfeeding women
Symptoms
Cramp-like pain in lower abdomen, worse during breastfeeding
Management
Reassure mother: normal sign of uterine involution
Mild analgesics (Paracetamol or Ibuprofen)
Warm compress to lower abdomen
Encourage urination (full bladder worsens pain)
🔶 2. Perineal Discomfort or Pain
Cause
Due to episiotomy, lacerations, swelling, or hemorrhoids
Symptoms
Pain, difficulty sitting or walking
Management
Sitz bath 2–3 times/day
Local antiseptic ointments (if prescribed)
Ice packs in first 24 hours
Analgesics as ordered
Maintain perineal hygiene
🔶 3. Breast Engorgement
Cause
Milk stasis due to delayed or poor breastfeeding technique
Symptoms
Swollen, hard, painful breasts; may lead to mastitis
Management
Encourage frequent breastfeeding
Manual expression or warm compress before feeding
Cold compress after feeding
Supportive bra
Pain relief if needed
🔶 4. Constipation
Cause
Reduced bowel motility, fear of pain, dehydration, iron supplements
Assessment, education, early intervention, support
🍼 PHYSIOLOGY OF LACTATION.
🌼 Definition:
Lactation is the process by which the female breast produces and secretes milk to nourish the newborn. It involves hormonal, neurological, and mechanical components.
🧠 STAGES OF LACTATION:
Stage
Description
1️⃣ Mammogenesis
Development of mammary glands during puberty and pregnancy
2️⃣ Lactogenesis
Initiation of milk secretion (begins in late pregnancy and after delivery)
3️⃣ Galactopoiesis
Maintenance of milk production
4️⃣ Involution
Cessation of milk production when feeding stops
💡 KEY HORMONES INVOLVED:
Hormone
Role
Estrogen
Develops ducts and breast tissue (during pregnancy)
Progesterone
Develops alveoli and lobules (during pregnancy)
Prolactin (from anterior pituitary)
Stimulates milk synthesis
Oxytocin (from posterior pituitary)
Causes milk ejection or “let-down reflex”
Human Placental Lactogen (hPL)
Helps in breast maturation
🧬 MECHANISM OF LACTATION:
🔹 1. During Pregnancy:
Estrogen and progesterone prepare the breasts but inhibit milk secretion
Prolactin levels rise, but high estrogen and progesterone prevent its full action
🔹 2. After Delivery (Postpartum):
Estrogen and progesterone drop rapidly (due to expulsion of placenta)
Prolactin becomes active and initiates milk secretion
Baby’s suckling stimulates nerve endings in nipple → Hypothalamus signals:
Anterior pituitary to release Prolactin → milk production
Posterior pituitary to release Oxytocin → milk ejection
Promote early initiation of breastfeeding (within 1 hour)
Teach correct latching techniques
Encourage exclusive breastfeeding for 6 months
Assess for breast engorgement, cracked nipples, or insufficient milk
Provide emotional support and reassurance
📚 QUICK REVISION TABLE:
Process
Key Hormone
Action
Milk production
Prolactin
Synthesizes milk in alveoli
Milk ejection
Oxytocin
Contracts ducts to eject milk
Inhibits milk during pregnancy
Estrogen, Progesterone
Blocks prolactin effect
Breast development
Estrogen, Progesterone, hPL
Prepares ducts and lobules
🍼 LACTATION MANAGEMENT.
🌸 Definition:
Lactation Management refers to the promotion, support, assessment, and treatment of breastfeeding to ensure optimal feeding, health, and well-being of both mother and baby.
🔄 PHASES OF LACTATION MANAGEMENT:
Phase
Focus
1️⃣ Initiation
Early initiation after birth, correct latching
2️⃣ Establishment
Frequent feeding to stimulate supply
3️⃣ Maintenance
Sustaining lactation over months
4️⃣ Weaning
Gradual replacement of breast milk with other foods
🧠 PRINCIPLES OF EFFECTIVE LACTATION MANAGEMENT:
Early Initiation: Within the first hour after birth
Exclusive Breastfeeding: For first 6 months – no water or formula
Feeding on Demand: Day and night
Correct Position and Latch: To ensure effective milk transfer and prevent nipple trauma
Emptying of Breasts: Prevents engorgement and maintains supply
Avoid Artificial Teats: They cause nipple confusion
👶 SIGNS OF EFFECTIVE BREASTFEEDING:
Baby’s Signs
Mother’s Signs
Regular swallowing sounds
No pain in nipples
Baby appears satisfied after feeding
Breasts feel softer post-feed
Passing urine 6–8 times/day
Let-down reflex (tingling sensation)
Adequate weight gain
🩺 NURSING RESPONSIBILITIES IN LACTATION MANAGEMENT:
🧷 1. Assessment:
Breast condition (engorgement, cracks, inverted nipples)
Positioning and latch
Baby’s sucking ability
Signs of dehydration or poor weight gain
👩🏫 2. Education & Support:
Demonstrate proper breastfeeding techniques
Counsel on feeding frequency (every 2–3 hrs)
Explain importance of exclusive breastfeeding
Address myths (e.g., colostrum is bad – educate it’s vital)
💊 3. Managing Common Problems:
Problem
Management
Breast engorgement
Cold compress, frequent feeding, gentle massage
Cracked nipples
Correct latch, apply breast milk on nipples, avoid soap
Inverted nipples
Use of breast pump, syringe method, nipple shields
Warm compress, massage, continue feeding, antibiotics if needed
🧃 DIETARY ADVICE FOR LACTATING MOTHERS:
High-calorie, high-protein diet
Plenty of fluids (3–3.5 L/day)
Calcium, iron, and vitamin supplements
Avoid smoking, alcohol, and strong medications
💡 TIPS FOR PROPER LATCHING:
🔹 Good latch includes:
Baby’s mouth wide open
Chin touching breast
More areola visible above than below
No clicking or smacking sounds
🔹 Positioning styles:
Cradle hold
Cross-cradle
Football hold
Side-lying position
🛡️ BABY-FRIENDLY HOSPITAL INITIATIVE (BFHI):
Promotes 10 steps to successful breastfeeding including:
Policy support
Staff training
Rooming-in
No formula or pacifier
Community support post-discharge
📚 SUMMARY TABLE:
Key Aspect
Ideal Practice
Initiation
Within 1 hour of birth
Frequency
8–12 times/day
Exclusive feeding
First 6 months
Weaning starts
At 6 months (with complementary feeding)
Full breastfeeding duration
Up to 2 years or more
👩⚕️ POSTNATAL COUNSELING AND PSYCHOLOGICAL SUPPORT.
🌸 DEFINITION:
Postnatal counseling is the process of providing emotional, informational, and psychological support to mothers during the postpartum period (first 6–8 weeks) to promote mental health, maternal well-being, and positive adjustment to motherhood.
🧠 WHY IS IT IMPORTANT?
Hormonal fluctuations, physical exhaustion, and role transition make postpartum women vulnerable to mental health issues
Early support helps prevent:
Postpartum depression
Anxiety
Postpartum psychosis
Bonding difficulties with baby
Breastfeeding problems due to stress
🩺 OBJECTIVES OF POSTNATAL COUNSELING:
Promote maternal confidence and emotional well-being
Facilitate mother-infant bonding
Identify early signs of mental health problems
Support in breastfeeding, sleep, rest, and role adaptation
Empower family involvement and support systems
💬 KEY TOPICS TO ADDRESS IN POSTNATAL COUNSELING:
Area
Details
🌼 Emotional Adjustment
Mood swings, baby blues, anxiety, feelings of inadequacy
👶 Infant Care Guidance
Feeding, sleeping patterns, hygiene, soothing
🧘 Self-care
Rest, nutrition, hygiene, time management
👫 Family Dynamics
Relationship with partner, family support, expectations
💔 Warning Signs
Depression, suicidal thoughts, detachment from baby, excessive worry
📞 Support Services
Mental health referral, support groups, helplines
👂 NURSE/MIDWIFE’S ROLE IN POSTNATAL PSYCHOLOGICAL SUPPORT:
🔍 1. Assessment:
Screen for postnatal depression using tools like EPDS (Edinburgh Postnatal Depression Scale)
Postnatal Baby Blues refers to a mild, temporary emotional disturbance that many women experience after childbirth. It is not a psychiatric disorder and usually resolves on its own without medical treatment.
📅 ONSET AND DURATION:
Begins: Usually 2–5 days after delivery
Peaks: Around day 4 or 5
Duration: Lasts for a few hours to up to 10–14 days
If symptoms persist beyond 2 weeks → assess for postpartum depression
🤱 CAUSES:
Postnatal baby blues are caused by a combination of:
Factor
Explanation
Hormonal Changes
Sudden drop in estrogen and progesterone after delivery
Fatigue
Physical exhaustion from labor and delivery
Sleep Deprivation
Frequent waking to feed or care for the baby
Emotional Stress
New responsibilities, fear of inadequacy
Physical Discomfort
Pain from stitches, breast engorgement
⚠️ COMMON SIGNS AND SYMPTOMS:
Emotional Signs
Physical Signs
Tearfulness for no clear reason
Trouble sleeping even when baby sleeps
Irritability or mood swings
Fatigue or low energy
Anxiety or worry
Poor concentration
Feeling overwhelmed
Headache or appetite changes
Emotional sensitivity
Feeling unsure about motherhood
🔔 Note: Despite these symptoms, the mother usually still cares for and bonds with her baby.
🩺 NURSING CARE AND COUNSELING:
👂 1. Listen and Reassure:
Normalize the experience: “Many new mothers feel this way.”
Offer emotional support and nonjudgmental listening
🧠 2. Educate:
Explain that baby blues are common and temporary
Differentiate from postpartum depression
👪 3. Promote Support System:
Encourage rest and help from family members
Involve the partner in caregiving and emotional support
🌿 4. Encourage Self-Care:
Sleep when the baby sleeps
Eat nourishing food and stay hydrated
Take short breaks for personal time
📞 5. Monitor:
If symptoms worsen or continue beyond 2 weeks, refer to mental health services
🔄 DIFFERENCE BETWEEN BABY BLUES & POSTPARTUM DEPRESSION:
Feature
Baby Blues
Postpartum Depression
Onset
2–5 days after birth
Within 2–6 weeks
Duration
≤ 2 weeks
> 2 weeks
Severity
Mild
Moderate to severe
Functioning
Normal bonding with baby
May avoid baby or feel disconnected
Treatment
Support and rest
May require counseling or medication
📚 SUMMARY FOR NURSING STUDENTS:
Key Point
Description
% of women affected
50–80% of new mothers
Onset
2–5 days after birth
Duration
Resolves in 1–2 weeks
Treatment
Reassurance, rest, support
Nurse’s role
Educate, support, monitor for PPD
🌧️ RECOGNITION OF POSTNATAL DEPRESSION.
🧠 WHAT IS POSTNATAL DEPRESSION?
Postnatal Depression (PND) is a moderate to severe depressive disorder that occurs in women after childbirth, typically within 2–6 weeks postpartum, but it can develop anytime in the first year.
It is different from baby blues — longer-lasting, more intense, and interferes with daily functioning and mother–infant bonding.
📊 PREVALENCE:
Affects 10–15% of postpartum women
Often underdiagnosed due to stigma, denial, or lack of awareness
Withdrawal from family/friends, disinterest in baby or self-care, excessive worry or detachment
Physical
Sleep disturbances (insomnia or oversleeping), fatigue, appetite changes, headaches
🛑 Red Flag: Thoughts of harming the baby or self = emergency referral required.
🕵️ NURSING RECOGNITION STRATEGIES:
1️⃣ Observation:
Note persistent sadness, detachment, or anxiety
Check for lack of interest in baby, hygiene, or feeding
2️⃣ Verbal Cues:
Statements like “I feel like a failure,” “I’m not a good mother,” or “I can’t cope anymore”
3️⃣ Use Screening Tools:
Tool
Use
EPDS (Edinburgh Postnatal Depression Scale)
Most widely used; 10-item questionnaire
PHQ-9
General depression screening tool
Clinical Interview
Ask open-ended and empathetic questions
Example EPDS questions:
“Have you been able to laugh and see the funny side of things?”
“Have you felt scared or panicky for no good reason?”
A score of ≥13 on EPDS suggests possible depression → needs further assessment.
💡 DIFFERENTIATE FROM BABY BLUES:
Feature
Baby Blues
Postnatal Depression
Onset
2–5 days postpartum
2–6 weeks (up to 1 year)
Duration
< 2 weeks
> 2 weeks
Symptoms
Tearful, emotional
Persistent sadness, withdrawal
Functioning
Able to care for baby
May neglect baby or self
Treatment
Support and rest
Psychological therapy ± medication
👩⚕️ NURSE’S ROLE IN EARLY RECOGNITION:
Build rapport so the mother feels safe sharing emotions
Create non-judgmental and empathetic space
Involve family/support systems in observation
Monitor mother–infant bonding
Document and report any concerns to mental health professionals
Refer to psychologist or psychiatrist as per institutional protocol
📞 WHEN TO REFER IMMEDIATELY:
Suicidal thoughts or attempts
Refusal to feed or care for baby
Psychotic symptoms (hallucinations, delusions)
Severe functional impairment
📚 QUICK REFERENCE TABLE:
Sign
Action
Crying for no reason
Ask about sleep, stress, mood
“I can’t do this anymore”
Screen using EPDS
Avoiding the baby
Refer to mental health team
Lack of sleep & appetite
Counsel and monitor closely
Family reports unusual behavior
Involve in care planning
👪 TRANSITION TO PARENTHOOD.
🌸 DEFINITION:
Transition to parenthood refers to the physical, emotional, psychological, and social adjustments that individuals and couples undergo as they become parents and adapt to their new roles after childbirth.
🧠 WHY IS THIS TRANSITION IMPORTANT?
It is a major life change involving new responsibilities
Affects the mother, father/partner, baby, and extended family
Requires adaptation to changes in identity, lifestyle, roles, and relationships
🔄 PHASES OF TRANSITION:
Phase
Description
1️⃣ Anticipatory Stage
During pregnancy – mental preparation for parenthood
2️⃣ Formal Stage
Begins after birth – learning baby care through external guidance
3️⃣ Informal Stage
Parents develop their own methods of care through experience
4️⃣ Personal Stage
Parents gain confidence and internal satisfaction in their role
👩👧👦 COMPONENTS OF TRANSITION:
1. Physical Changes
Recovery from childbirth (mother)
Sleep deprivation
Breastfeeding demands
Fatigue for both parents
2. Emotional Changes
Joy and bonding
Anxiety or fear of incompetence
Mood swings or baby blues
Stress over new responsibilities
3. Psychological Adjustments
Formation of parental identity
Change in self-image
Shift in priorities and roles
4. Relationship Dynamics
Changes in couple intimacy and communication
Division of responsibilities
Partner support becomes critical
5. Social Adjustments
Shift in social life and independence
Balancing work, home, and caregiving
Cultural expectations of parenting
⚖️ CHALLENGES DURING TRANSITION:
Challenges
Examples
Emotional stress
Fear of harming baby, self-doubt
Physical exhaustion
Interrupted sleep, breastfeeding issues
Relationship strain
Less time for partner, tension
Financial concerns
Increased expenses, job leave
Lack of support
Isolation, lack of guidance or help
🩺 NURSE’S ROLE IN SUPPORTING PARENTHOOD TRANSITION:
👂 1. Emotional Support
Reassure that mixed emotions are normal
Listen actively and validate concerns
Encourage open discussion between partners
👩🏫 2. Education and Preparation
Teach newborn care, feeding, hygiene
Explain normal physical and emotional changes
Prepare both parents during antenatal classes
🤝 3. Involve Partner
Promote shared responsibilities
Encourage skin-to-skin, involvement in care
Teach partner how to support the mother
📞 4. Identify Red Flags
Watch for postpartum depression signs
Refer to counselors or social workers if needed
Monitor parent–infant bonding
👪 5. Promote Bonding and Confidence
Encourage early contact, rooming-in
Celebrate small successes (“You’re doing great!”)
Help build a support network (family, groups)
📚 QUICK TIPS FOR PARENTING TRANSITION:
Tip
Benefit
Take rest when baby sleeps
Reduces exhaustion
Communicate openly with partner
Strengthens relationship
Ask for help when needed
Prevents burnout
Join parenting groups
Emotional and social support
Avoid comparing with others
Builds confidence
📌 SUMMARY FOR MIDWIFERY NOTES:
Key Area
Nurse’s Role
Physical recovery
Support, educate, monitor
Emotional changes
Counsel, reassure, screen
Parenting skills
Teach and guide
Partner role
Involve and empower
Bonding
Promote skin-to-skin, closeness
🌸 CARE FOR THE MOTHER FROM 72 HOURS TO 6 WEEKS AFTER DELIVERY.
🧠 INTRODUCTION:
The postnatal period (puerperium) begins after the delivery of the placenta and lasts for about 6 weeks. The care provided during this period is crucial for the physical recovery, emotional well-being, and adjustment to motherhood.
Special focus: From 72 hours (3rd day) to 6 weeks postpartum, as the mother returns home and continues recovery.
🗓️ POSTNATAL PERIOD OVERVIEW:
Phase
Timeframe
Immediate
First 24 hours
Early
Day 2 to 7
Late
1 week to 6 weeks
We are focusing on Early & Late Postnatal Phase.
🩺 ROUTINE POSTNATAL CHECKUPS:
✔️ Usually scheduled at:
1 week
6 weeks (mandatory) Also done during home visits by midwives/community health nurses.
Watch for: Foul smell, heavy bleeding, clots → may indicate infection or retained placenta
3. Perineal & Vaginal Care
Care after episiotomy/laceration
Sitz baths, antiseptic cleaning, proper hygiene
Teach wiping front to back
Observe for swelling, pain, or pus
4. Breast Care
Assess for engorgement, sore nipples, mastitis
Teach proper breastfeeding techniques and hygiene
Express milk if needed
5. Bowel & Bladder Function
Encourage hydration, high-fiber diet
Check for constipation, urinary incontinence or retention
Treat hemorrhoids if present
6. Cesarean Wound Care (if applicable)
Daily inspection, dry dressing
Monitor for redness, discharge, fever
💉 IMMUNIZATIONS & MEDICATION
TT booster (if missed in pregnancy)
Iron and calcium supplements for at least 3 months
Vitamin A dose may be given postnatally (as per local policy)
🧘♀️ REST, NUTRITION, AND EXERCISE
🍱 Nutrition:
High-protein, iron-rich diet
Fluids: 3–3.5 liters/day (especially for breastfeeding)
Small frequent meals
😴 Rest:
Encourage rest when baby sleeps
Avoid overexertion
🧘♀️ Exercise:
Pelvic floor (Kegel) exercises
Postnatal stretches and abdominal tightening
No heavy lifting for 6 weeks
🧠 PSYCHOLOGICAL SUPPORT
Watch for signs of postnatal depression or anxiety
Support with baby care, emotional expression
Counsel and refer if symptoms persist beyond 2 weeks
Reassure and normalize emotional ups and downs
👪 SOCIAL & FAMILY SUPPORT
Involve partner and family in care and bonding
Educate family on mother’s needs and rest
Community health workers can support home visits
🧑⚕️ SEXUAL & REPRODUCTIVE HEALTH COUNSELING
Resumption of sexual activity: advised after 6 weeks or once healed
Discuss contraceptive options:
Lactational amenorrhea method (LAM)
Condoms, IUCD, POPs, etc.
Spacing pregnancies: ideally 2–3 years
📞 WHEN TO SEEK MEDICAL ATTENTION:
Excessive bleeding (soaking >1 pad/hour)
Foul-smelling lochia
High fever >100.4°F (38°C)
Severe abdominal pain
Breast redness, pain, or pus
Signs of postpartum depression (persistent sadness, suicidal thoughts)
📋 NURSE’S CHECKLIST FOR POSTNATAL VISITS (3 DAYS TO 6 WEEKS):
Area
Action
General health
Vitals, pallor, hydration
Uterus
Fundal height, involution
Lochia
Amount, color, odor
Perineum
Healing, pain, infection
Breasts
Engorgement, nipple care, latch
Bowel/bladder
Regularity, issues
Psychological
Mood, bonding, depression signs
Baby care
Feeding, hygiene, immunization
Education
Self-care, family planning, warning signs
📚 SUMMARY FOR STUDENTS:
Timeframe
Key Focus
72 hrs – 7 days
Recovery monitoring, lochia, bonding
2–6 weeks
Involution, return to normal life, contraception, emotional health
Nurse’s Role
Physical care, education, emotional support, early detection of danger signs
🌍 CULTURAL COMPETENCE
(With Focus on Taboos Related to Postnatal Diet and Practices)
🌸 WHAT IS CULTURAL COMPETENCE?
Cultural Competence in nursing means the ability to understand, respect, and appropriately respond to the unique cultural needs, beliefs, and values of clients — especially in sensitive periods like postnatal care.
It involves nonjudgmental care, respecting traditions, and balancing scientific knowledge with cultural beliefs.
🧠 WHY IS IT IMPORTANT IN POSTNATAL CARE?
Postnatal period is influenced by deep-rooted cultural beliefs and taboos
Helps build trust, ensure compliance, and improve health outcomes
Prevents miscommunication and cultural conflicts
🥣 COMMON CULTURAL POSTNATAL Taboos & PRACTICES
These vary across regions, religions, and communities. Below are examples observed in India and South Asia, but similar concepts may exist globally.
1️⃣ Dietary Taboos
Belief/Taboo
Cultural Explanation
Scientific View
❌ Avoid cold foods (curd, citrus, cold water)
Believed to cause colds or affect milk
No scientific basis; focus should be on balanced nutrition
Purpose: Boost immunity, improve healing, support baby’s development
4️⃣ Calcium-Rich Foods
Sources: Milk, curd, sesame seeds, ragi, almonds, green leafy vegetables
Purpose: Prevents maternal bone loss and supports baby’s bone growth
5️⃣ Iron-Rich Foods
Sources: Jaggery, dates, green leafy vegetables, meat, eggs, fortified cereals
Tip: Take Vitamin C (e.g., lemon juice) to improve iron absorption
💧 FLUID INTAKE
Drink 3 to 3.5 liters of fluids/day: water, milk, soups, coconut water, herbal teas
Fluids help prevent dehydration and maintain milk supply
🧄 TRADITIONAL FOODS THAT MAY HELP (SAFE WHEN USED IN MODERATION)
Item
Benefit
Ajwain water
Aids digestion, relieves gas
Fenugreek (methi)
Believed to enhance milk production
Dill seeds (suwa)
Improves lactation
Gondh laddoos, panjiri
Energy-rich; promote strength & recovery
Jeera, ginger
Anti-inflammatory, aid digestion
🚫 FOODS TO AVOID OR LIMIT
Food
Reason
Excess caffeine (tea/coffee)
May cause irritability or sleep issues in baby
Excess sugar and fried foods
Can cause weight gain, low energy
Spicy or gas-forming foods (in excess)
May cause discomfort in some babies
Alcohol & smoking
Strictly avoided during lactation
Fish high in mercury (e.g., shark, swordfish)
Can affect baby’s brain development
🧠 TIPS FOR PRACTICAL COUNSELING TO MOTHERS:
Eat every 2–3 hours: 3 main meals + 2–3 healthy snacks
Take supplements (Iron, Calcium, Vitamin D) if prescribed
Avoid skipping meals — especially breakfast
Use local, seasonal, and affordable foods
Ensure rest and reduce physical stress to aid digestion and milk flow
👶 SIGNS THAT MOTHER’S DIET IS SUPPORTING BREASTFEEDING:
Baby is gaining weight normally
Baby passes urine 6–8 times/day
Mother feels healthy, energetic, and alert
Breast milk flows well during feeds
🧑⚕️ NURSE’S ROLE IN LACTATION NUTRITION COUNSELING:
Task
Action
Assess
Diet history, food taboos, supplement use
Educate
Explain food groups, local options, hydration
Correct Myths
E.g., “fruits are cold” → Explain their benefits
Support
Encourage traditional foods if safe
Refer
To dietitian if mother is undernourished, diabetic, etc.
📋 SAMPLE DAILY MENU PLAN (Indian Context)
Meal Time
Foods
Morning
Warm ajwain water, dry fruits
Breakfast
Whole grain roti/paratha + curd + fruit
Mid-morning
Coconut water / milkshake / fruit
Lunch
Rice + dal + sabzi + salad + curd
Evening
Roasted chana / milk / herbal tea
Dinner
Chapati + vegetable curry + dal / paneer
Bedtime
Warm milk with a pinch of turmeric
📚 QUICK SUMMARY FOR STUDENTS
Focus Area
Key Point
Calories
+500/day for lactation
Fluids
3–3.5 liters/day
Proteins
75–90 g/day
Calcium, Iron, Vitamins
Increase intake or supplement
Avoid
Alcohol, excess caffeine, processed foods
Nurse’s role
Educate, assess, support, refer
👪 POSTPARTUM FAMILY PLANNING (PPFP).
🌸 DEFINITION:
Postpartum Family Planning refers to the prevention of unintended and closely spaced pregnancies during the first 12 months after childbirth. It includes a range of contraceptive methods that can be safely used by breastfeeding and non-breastfeeding women during this time.
🧠 WHY IS POSTPARTUM FAMILY PLANNING IMPORTANT?
Prevents unplanned pregnancies
Reduces maternal and infant mortality
Helps in birth spacing (ideal gap: 2–3 years)
Supports maternal recovery
Enhances emotional and physical readiness for the next child
📅 IDEAL TIME TO START FAMILY PLANNING:
Method
When to Start
Lactational Amenorrhea Method (LAM)
Immediately postpartum
Postpartum IUCD (PPIUCD)
Within 10 minutes of placenta delivery or within 48 hours
Condoms
Any time after delivery
Injectables (DMPA)
6 weeks postpartum (if breastfeeding)
Progestin-only pills (POP)
6 weeks postpartum (if breastfeeding)
Combined oral contraceptives (COC)
6 months postpartum (if not breastfeeding)
Sterilization (Tubectomy)
After delivery or at 6 weeks postpartum
Implants
After 6 weeks (if breastfeeding); anytime (if not breastfeeding)
🍼 SAFE METHODS FOR BREASTFEEDING MOTHERS
Method
Safe for Lactation?
Notes
LAM
✅ Yes
Natural method; effective if exclusive BF, amenorrhea, <6 months postpartum
Condoms
✅ Yes
Barrier method; also prevents STIs
POP
✅ Yes
Start after 6 weeks if breastfeeding
IUCD (Copper T)
✅ Yes
Long-term method; non-hormonal
Implants
✅ Yes
Start after 6 weeks; long-acting
❌ Combined hormonal pills (COCs) are not recommended before 6 months in breastfeeding mothers due to risk of affecting milk supply.
🧘♀️ NON-BREASTFEEDING MOTHERS
Can use most contraceptive methods after 3–6 weeks postpartum
COCs may be started after 3 weeks if no risk of thrombosis
⚠️ CONTRAINDICATIONS TO SOME METHODS
IUCD: Active pelvic infection, uterine abnormalities
Sterilization: Requires informed consent and counseling
LAM: Not reliable after 6 months or if baby is formula-fed
📊 EFFECTIVENESS OF METHODS
Method
Effectiveness
LAM
98% (only if all criteria met)
IUCD
>99%
POP/Implants
>99%
Condoms
85–95%
Sterilization
>99%
Injectables (DMPA)
94–99%
📋 NURSE’S ROLE IN POSTPARTUM FAMILY PLANNING
🧠 1. Education & Counseling
Explain importance of spacing and rest
Discuss options during antenatal period, postpartum visits, and immunization visits
Use visual aids and simple language
🩺 2. Assess
Mother’s health, breastfeeding status, desire for more children, and cultural preferences
🤝 3. Support Informed Choice
Respect the woman’s decision
Involve partner or family (with woman’s consent)
📞 4. Refer & Follow-Up
Refer to family planning clinics if needed
Schedule follow-ups to manage side effects or change methods
🧠 COUNSELING TIPS:
Use GATHER approach:
Greet the woman
Ask about her reproductive goals
Tell about available options
Help her choose
Explain method use and side effects
Refer or return for follow-up
Emphasize that fertility can return before menstruation resumes, especially if not breastfeeding
🧾 DOCUMENTATION:
Nurses should record:
Counseling done and method chosen
Client’s understanding and consent
Any complications or follow-ups
📚 SUMMARY TABLE FOR NURSING NOTES:
Timeframe
Method Options
Immediate (<48 hrs)
IUCD, LAM, condoms, sterilization
6 weeks postpartum
POP, injectables, implants
After 6 months
COCs (if not breastfeeding), all methods
👩⚕️ FOLLOW-UP OF POSTNATAL MOTHERS.
🌸 INTRODUCTION:
Postnatal follow-up refers to the ongoing care and assessment provided to a mother after delivery, from the time of hospital discharge up to 6 weeks postpartum (puerperium). This care may occur through home visits, clinic visits, or community health outreach.
Goal: Ensure physical recovery, emotional adjustment, safe infant care, and family planning support.
📅 TIMELINE OF POSTNATAL FOLLOW-UP:
Time
Mode of Visit
Key Focus
Within 48–72 hours after discharge
Home or phone
Early complications
7–10 days postpartum
Clinic/home
Uterus, lochia, perineum, infant care
4–6 weeks postpartum
Clinic visit (final checkup)
Complete recovery, contraception, mental health
More frequent visits may be needed for high-risk mothers (e.g., C-section, PPH, infection, hypertension, depression).
Provide emotional support and contraceptive advice
Advocate
Involve family and refer to higher center if needed
📚 SUMMARY FOR MIDWIFERY STUDENTS:
Component
Focus
Timeline
48 hrs, 7–10 days, 6 weeks
Assessments
Uterus, lochia, perineum, breast, mood
Counseling
Nutrition, hygiene, FP, danger signs
Documentation
All findings and education provided
Nurse’s Goal
Promote safe recovery and well-being
💊 DRUGS USED IN THE POSTNATAL PERIOD.
🌸 INTRODUCTION:
The postnatal period (first 6 weeks after childbirth) is a time of physiological recovery and adaptation for the mother. Medications may be prescribed for:
Pain relief
Prevention and treatment of infections
Uterine involution
Lactation support
Nutritional supplementation
Family planning
Mental health (if required)
📋 CATEGORIES OF DRUGS COMMONLY USED POSTNATALLY
1️⃣ Analgesics (Pain Relievers)
Used for perineal pain, episiotomy, cesarean pain, uterine cramping.
Drug
Type
Use
Paracetamol
Non-opioid
Mild to moderate pain, safe in breastfeeding
Ibuprofen
NSAID
Uterine cramps, afterpains, inflammation
Diclofenac
NSAID
Pain after C-section or episiotomy
Tramadol
Opioid (used cautiously)
Moderate pain, limited use if breastfeeding
2️⃣ Uterotonics
Promote uterine contraction and involution, prevent postpartum hemorrhage (PPH).
Drug
Use
Oxytocin
To stimulate uterine contractions (IM/IV)
Methylergometrine (Methergine)
For uterine atony; contraindicated in hypertension
Misoprostol
Tablet or rectal use to control PPH
3️⃣ Antibiotics
Given for infection prevention or treatment (e.g., C-section, perineal wound, mastitis).
Drug
Indication
Amoxicillin-Clavulanic Acid
Wound infection, UTI
Cefixime / Ceftriaxone
Broad-spectrum use post-cesarean
Metronidazole
Anaerobic infection, perineal wound
Clindamycin
Alternate in penicillin allergy
🔔 All antibiotics should be prescribed only as needed, and compatibility with breastfeeding must be checked.
4️⃣ Iron and Folic Acid Supplements
Given to correct or prevent postpartum anemia.
Drug
Use
Ferrous sulfate/gluconate
Iron deficiency anemia
Folic acid
Cell repair, RBC formation
5️⃣ Calcium & Vitamin D Supplements
Promote bone health and replenish maternal calcium loss due to breastfeeding.
Drug
Use
Calcium carbonate/citrate
Bone health, muscle function
Vitamin D3 (Cholecalciferol)
Enhances calcium absorption
6️⃣ Lactation Support Drugs (Galactagogues)
Used if milk production is low (only after assessing proper feeding techniques first).
Drug
Action
Domperidone
Increases prolactin secretion
Metoclopramide
Also promotes milk let-down (used short term)
🔔 Natural galactagogues: Fenugreek, fennel, garlic, Shatavari (used with guidance)
7️⃣ Antidepressants / Anti-anxiety Drugs
Used cautiously for postpartum depression or anxiety (after assessment).
Drug
Class
Notes
Sertraline
SSRI
Preferred in breastfeeding
Fluoxetine
SSRI
May be used but monitor baby for fussiness
Diazepam
Benzodiazepine
Short-term use, monitor sedation
💡 Always consult a psychiatrist for mental health meds during lactation.
8️⃣ Drugs for Family Planning
Given during postnatal follow-up based on the woman’s lactation status and choice.
Drug
Method
Notes
POP (Progestin-only pills)
Oral
Safe in breastfeeding (start after 6 weeks)
DMPA injection
Injectable
3-month protection, safe in lactating women
IUCD (Copper T)
Device
Inserted within 48 hrs or after 6 weeks
Levonorgestrel (Plan B)
Emergency
If unprotected intercourse occurs postpartum
Combined pills (COCs)
Oral
Start after 6 months in non-lactating women
🚫 DRUGS TO AVOID OR USE WITH CAUTION DURING LACTATION
Drug
Risk
Tetracyclines
Affects baby’s teeth development
Chloramphenicol
Bone marrow suppression in infant
Aspirin
Risk of Reye’s syndrome
Sulfa drugs
Avoid in jaundiced or premature infants
High-dose diuretics
Suppresses milk production
👩⚕️ NURSE’S ROLE IN DRUG MANAGEMENT POSTNATALLY:
Role
Responsibility
Assessment
Monitor for pain, infection, anemia, lactation issues
Education
Teach mothers about dosage, side effects, drug safety in breastfeeding
Administration
Ensure timely and correct dose
Observation
Watch for adverse drug reactions
Referral
To physician for dosage adjustment or psychiatric support if needed
📚 SUMMARY TABLE FOR STUDENTS:
Drug Type
Common Drugs
Use
Pain relief
Paracetamol, Ibuprofen
Episiotomy, C-section pain
Uterotonics
Oxytocin, Misoprostol
PPH, uterine involution
Antibiotics
Amoxicillin, Cefixime
Infection control
Supplements
Iron, Calcium, Folic acid
Anemia, bone health
Galactagogues
Domperidone
Improve milk supply
Family planning
POP, IUCD, DMPA
Contraception
Mental health
Sertraline
Postpartum depression
📑 RECORDS AND REPORTS RELATED TO THE POSTPARTUM PERIOD.
🌸 INTRODUCTION:
Records and reports in the postpartum period are essential for:
Monitoring maternal and newborn health
Ensuring continuity of care
Legal documentation
Health statistics and planning
Education and audit purposes
Accurate and timely documentation helps detect complications early and supports evidence-based care.
📋 TYPES OF RECORDS IN POSTNATAL CARE
1️⃣ Postnatal Case Record (Mother)
Includes comprehensive documentation of mother’s recovery from delivery up to 6 weeks postpartum.