Definition

Postnatal Period: the period that extends from delivery up to 6 weeks postpartum. More than half of maternal deaths occur in the postnatal period, 40% of them in the first 24 hours after delivery.

Immediate postnatal period: period between delivery of the placenta and the first 2 hours after delivery. Also referred to as the fourth stage of delivery

---

Normal features

Uterus:

• Just after delivery: uterus is contracted just below umbilicus level
• During the first 5 days: uterus contracts each day around 1 cm which is approximately 1 finger diameter below the umbilicus each day. At day 5 postpartum it should be between umbilicus and symphysis pubis
•  Day 10 postpartum: uterus is at symphysis pubis and cervix is closed.
•  Week 6: uterus has recovered its normal size.

Bleeding/Lochia:

• Bleeding is moderate to heavy during the first 3 days and starts decreasing progressively. Lochia become blood stained and are odourless.
• Bleeding usually stops between 2-3 weeks postpartum – First menstrual period in clients that are not breastfeeding happens 6-8 weeks postpartum.

Breastfeeding:

•  Day 0-2 postpartum: secretion of colostrum, a yellowish secretion in small quantity which is highly caloric.
•  – Day 3-5: first days of breastmilk production accompanied by breast tenderness and possible febricula

Recommended Postnatal Care Routine

The postnatal period requires specific monitoring for mother and newborn:

• Close monitoring in the immediate postnatal period (first 2 hours after delivery)
• Admission in the health facility for 24 hours for all mothers and newborns after a normal u delivery
• At least 4 postnatal check-ups in the first 6 weeks:
  • D1: during admission and upon discharge
  • D3: for C-S the check-up will be done while admitted. For normal deliveries that were already discharged it is advisable that the client attends a follow up visit. Home visits performed by a skilled attendant are a valid alternative.
  • D7-14: Outpatient follow up.
  • Week 6: outpatient follow up.

Immediate postnatal period

• Requires special attention as the majority of PPH occur during the first 2 hours after delivery
•  Monitoring of mother: vital signs (BP, pulse, RR and temperature), uterine contraction, and bleeding every 15 min the first hour and every 30 min the second hour.
•  Monitoring of baby: HR, temperature and RR every 30 min the first 2 hours of life.
• Encourage and support mother-to-baby skin-to-skin contact and early breastfeeding.
• Encourage passing urine.
• For the baby within the first hour of life provide essential and routine neonatal care.
• During the first 24 hours following the birth, all clients will be monitored for:
• Bleeding
  • Uterine contraction and fundal heighEpisiotomy/perineal tear healingVital signs every 6-8 hoursSigns of anemia.Urine void should be documented within 6 hours of birth.BreastfeedingEmotional wellbeing
  • Early mobilization

---