From the Guidelines
Postnatal care for mothers and babies should prioritize comprehensive health assessments, breastfeeding support, emotional health monitoring, and education on newborn care, with a focus on preventing medium-to-long term consequences of labour and childbirth, as highlighted in a recent systematic analysis 1.
Key Components of Postnatal Care
- Regular health assessments for mothers and babies
- Breastfeeding support and education
- Emotional health monitoring, including screening for postpartum depression using tools like the Edinburgh Postnatal Depression Scale
- Education on newborn care, including safe sleep practices, feeding cues, diaper changing, bathing, and recognizing illness signs
- Physical recovery monitoring for mothers, including uterine involution checks, perineal care, and pain management with medications like ibuprofen (600mg every 6 hours as needed) or acetaminophen (650mg every 6 hours)
- Vital signs monitoring for complications such as postpartum hemorrhage, infection, or preeclampsia
- Weight monitoring, feeding assessment, jaundice screening, and umbilical cord care for babies
- Vitamin K (1mg intramuscular injection) at birth to prevent bleeding disorders, and hepatitis B vaccination for newborns
Preventing Medium-to-Long Term Consequences
- Dyspareunia, low back pain, urinary incontinence, anxiety, anal incontinence, depression, tokophobia, perineal pain, and secondary infertility are common medium-to-long term consequences of labour and childbirth 1
- Good-quality care at birth, systematic clinical assessments, screening of postpartum women to identify those at risk, and prompt management are essential in preventing these conditions 1
- Broader and more comprehensive health service opportunities are needed, extending beyond 6 weeks postpartum and embracing multidisciplinary models of care 1
Safe Sleep Practices
- Education on safe sleep practices, including the use of a separate sleep surface for newborns, is crucial in preventing suffocation and other sleep-related risks 1
- Staff should be immediately available to safely place newborns on a close but separate sleep surface when mothers fall asleep 1
- Side-car technology for hospital beds may provide a safe and convenient option for breastfeeding and sleep, but more research is needed to establish its safety and efficacy 1
From the Research
Key Components of Postnatal Care
The key components of postnatal care for mothers and babies include:
- Physical recovery from birth 2
- Infant care and feeding 2
- Mood and emotional well-being, including the management of postpartum depression 3, 2
- Sexuality, contraception, and birth spacing 2
- Sleep and fatigue management 2
- Chronic disease management, such as hypertensive disorders, obesity, diabetes, thyroid disorders, and renal disease 2
- Health maintenance 2
Postpartum Pain Management
Postpartum pain management is a crucial aspect of postnatal care, as pain can interfere with a woman's ability to care for herself and her infant 4, 5. The use of nonpharmacologic and pharmacologic therapies, including multimodal analgesia, can help manage postpartum pain 4, 5. It is essential to consider the effects of prescribed medications on the mother-infant dyad, particularly for breastfeeding women 4, 6.
Breastfeeding and Medication
For breastfeeding women, it is essential to consider the safety of medications, such as antidepressants, during postpartum care 6. Sertraline is considered one of the safest antidepressants during breastfeeding, but careful monitoring of the newborn for adverse effects is necessary 6. The benefits and potential harms of treatment, including during breastfeeding, should be carefully evaluated 3, 6.
Ongoing Postpartum Care
Postpartum care should be an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs 2. Women should have contact with their obstetrician-gynecologists or other obstetric care providers within the first 3 weeks postpartum, followed by ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth 2.