From the Guidelines
A comprehensive 6-week postnatal check should include both maternal and infant assessments, prioritizing the mother's physical recovery, mental health, and the infant's growth and development, as recommended by the most recent guidelines 1.
Maternal Assessment
The assessment should begin by reviewing the mother's physical recovery, checking for proper healing of any delivery-related wounds (episiotomy, cesarean incision), assessing for pelvic floor issues, and evaluating for postpartum complications like infection or persistent bleeding.
- Perform a pelvic examination to ensure the uterus has returned to normal size and position.
- Check vital signs including blood pressure, especially for those who experienced hypertensive disorders during pregnancy.
- Screen for postpartum depression using a validated tool like the Edinburgh Postnatal Depression Scale, asking about mood, sleep patterns, and adjustment to parenthood.
- Discuss contraception options, as fertility may return even before the first postpartum period.
- Address breastfeeding concerns, examining breasts for mastitis if needed.
Infant Assessment
For the infant, assess:
- Growth parameters (weight, length, head circumference)
- Developmental milestones
- Feeding patterns
- Any health concerns
Additional Considerations
Consider the risk of venous thromboembolism (VTE) and the need for prophylaxis, especially in women with additional risk factors, as suggested by guidelines from the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynaecologists 1. Encourage a gradual transition back to physical activity, starting slowly and gradually resuming exercise, as recommended by public health guidelines from around the world 1.
This comprehensive approach is crucial because the postpartum period represents a significant transition with both physical and psychological components that require medical attention to prevent long-term complications and ensure both mother and baby are thriving.
From the Research
Conducting a 6 Weeks Post Natal Check
To conduct a 6 weeks post natal check, the following steps can be taken:
- Review the patient's medical history, including any complications during pregnancy or delivery, such as postpartum hemorrhage (PPH) 2, 3, 4, 5, 6
- Assess the patient's physical and emotional well-being, including any symptoms of postpartum depression or anxiety 3, 4, 5, 6
- Perform a physical examination, including a check of the patient's vital signs, abdominal and pelvic examination, and breast examination
- Discuss any concerns or questions the patient may have, including birth control options, breastfeeding, and parenting
Postpartum Hemorrhage (PPH) Considerations
Women who have experienced PPH may be at increased risk of postpartum depression and anxiety 3, 4, 5, 6
- Active management of the third stage of labor can help reduce the risk of PPH 2
- Women who have experienced PPH should be closely monitored for signs of postpartum depression and anxiety 3, 4, 5, 6
Mental Health Assessment
A mental health assessment should be performed as part of the 6 weeks post natal check, including:
- Screening for postpartum depression and anxiety using a validated tool, such as the Edinburgh Postnatal Depression Scale 3
- Assessing the patient's emotional well-being and any symptoms of postpartum depression or anxiety 3, 4, 5, 6
- Providing support and referrals to mental health services as needed 3, 4, 5, 6