From the Guidelines
Postnatal history taking should prioritize a comprehensive assessment of both mother and newborn after delivery, focusing on physical recovery, mental health, and potential complications, as outlined in the most recent study published in The Lancet Global Health in 2024 1.
Key Components of Postnatal History
When taking a postnatal history, it is essential to consider the following key components:
- Delivery details (mode, duration, complications)
- Maternal health (physical recovery, bleeding, pain, urination, bowel movements)
- Infant feeding (breastfeeding establishment, difficulties)
- Newborn health (sleep patterns, feeding, urination, stooling)
- Maternal mental health (mood, anxiety, support systems)
Red Flags and Complications
It is crucial to ask about red flags such as:
- Excessive bleeding
- Severe headaches
- Breathing difficulties
- Fever
- Thoughts of self-harm According to a systematic review published in The Lancet Global Health in 2024 1, the pooled prevalence of postpartum depression was 14% (95% CI 12–15), and the pooled prevalence of PTSD was 1·1% (95% CI 0·5–2·0).
Timing and Individualization of Postnatal Assessments
The timing of postnatal assessments typically follows a schedule (24-48 hours, 5-7 days, 6 weeks postpartum) but should be individualized based on risk factors, as recommended by a study published in The Lancet Global Health in 2024 1.
Importance of Comprehensive Care
A comprehensive approach to postnatal care, extending beyond 6 weeks postpartum and embracing multidisciplinary models of care, is necessary to promptly identify and address potential complications, as highlighted in a study published in The Lancet Global Health in 2024 1.
From the Research
Postnatal History
The postnatal history, also known as the postpartum history, refers to the period after childbirth. This period is crucial for the mother's physical and emotional recovery, as well as for bonding with the newborn.
Key Aspects of Postnatal History
- Postpartum Depression: A common complication of childbirth, often unrecognized 2. Studies have shown that postpartum depression can be identified using screening instruments such as the Edinburgh Postnatal Depression Scale (EPDS) 2, 3.
- Social Support: Social support from family and friends plays a significant role in enhancing the wellbeing of postpartum women, including reducing stress and postnatal depression 4.
- Quality of Life: Factors such as marital intimacy, postpartum fatigue, postpartum depression, breastfeeding adaptation, and occupation can influence the quality of life of postpartum women 5.
- Interventions: Interventions such as cognitive behavioral therapy (CBT)-based workshops can be effective in reducing postpartum depression and anxiety, and improving the mother-infant relationship 6.
Screening and Assessment
- Edinburgh Postnatal Depression Scale (EPDS): A widely used screening instrument for postpartum depression, which can also assess anxiety 2, 3.
- Patient Health Questionnaire (PHQ-9): Another screening instrument used to identify postpartum depression, although less accurate than the EPDS 2.
- Postpartum Depression Screening Scale (PDSS): A screening instrument that can identify postpartum depression, but may have a higher false positive rate than the EPDS 2.