Routine Postnatal Care of Women and Babies
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Routine postnatal care 2013–15 ROUTINE POSTNATAL CARE OF WOMEN AND BABIES PRINCIPLES To encourage women to participate in planning postnatal care and to provide information to enable them to make informed choices To provide woman relevant and timely information to enable her to recognise and respond to problems Community midwife is responsible for postnatal period until woman and baby are discharged from midwifery care Document all discussions in maternal healthcare record POSTNATAL PERIOD At every postnatal contact Named midwife will: Maternal health Infant health Ascertain physical and emotional health and wellbeing Enquire about baby’s health Offer woman opportunity to talk about her birth Provide information about: experience and to ask questions about the care promoting baby’s health and general condition received recognising signs and symptoms of common health inform her about the debriefing service and how/who to problems in newborns and how to contact healthcare contact if this is required professionals as soon as a problem suspected or in Discuss vaginal loss and perineal healing an emergency Look for signs and symptoms of mental health Advise women to contact healthcare professionals if problems baby: Discuss coping strategies and support becomes jaundiced (or is jaundiced and it worsens) Encourage partner involvement passes pale stools Provide health promotion information and how to Provide advice and support on infant feeding recognise life-threatening and common health discuss breastfeeding and document any support problems – see Life-threatening conditions in required women, and Common health problems in women Give information regarding local support networks sections Check healthcare record for previous alerts Confirm contact numbers (if at home) and need to report any concerns Women with physical, emotional, social or educational needs – see Women with multiagency or multidisciplinary needs below Be alert to signs of domestic abuse, if concerned follow your Trust’s child protection and domestic abuse guidance Midwives have direct access for referral to a consultant obstetrician at all times during the postnatal period if required Women with multiagency or multidisciplinary needs During in-patient episodes on delivery suite or postnatal ward, allocate woman and baby a named midwife for each shift, who will: co-ordinate woman’s multiagency and multidisciplinary needs liaise with named community midwife, lead midwife for vulnerable women and appropriate agencies and healthcare professionals with woman’s knowledge and (where possible and safe to do so), ensure appropriate agencies and healthcare professionals are involved according to local practice See also the following guidelines: Local Safeguarding guideline or local Child protection guideline Local Mental health problems in pregnancy guidance (if available) Substance misuse guideline Local Management of domestic violence in pregnancy guideline (if available) Routine postnatal care 2013–15 Document outcomes of multiagency or multidisciplinary meetings in woman’s postnatal care plan Initial postnatal period See Immediate care of newborn at delivery guideline Commence Red child health record book Check woman’s wellbeing, ensuring a minimum of one set of general observations have been taken and recorded and are within normal limits. It is the accepting midwife’s responsibility to ensure it is safe to accept woman and/or baby Ensure all allergies and sensitivities are documented Check baby is wearing 2 name bands containing woman’s hospital number. Check this against mother’s name band Assess general condition of baby Check that a birth weight has been performed and recorded in all relevant documentation Establish Vitamin K has been administered and recorded Determine chosen method of feeding and obtain details of initial feed on delivery suite Allocated midwife on postnatal ward will: See woman at each handover, review care plan and document in maternal healthcare record, date, time and sign See POSTNATAL PERIOD, At every postnatal contact section at beginning of guideline See specific guidelines for appropriate care: Breastfeeding guideline in Staffordshire, Shropshire & Black Country Newborn Network guidelines (if used locally) Hypoglycaemia guideline in Staffordshire, Shropshire & Black Country Newborn Network guidelines (if used locally) Care of the newborn at delivery guideline Caesarean section guideline Bladder care guideline Group B streptococcal (GBS) disease guideline Prolonged rupture of membranes guideline Substance misuse guideline local Transitional care guideline (if available) Hypothermia guideline in Staffordshire, Shropshire & Black Country Newborn Network guidelines (if used locally) Jaundice guideline in Staffordshire, Shropshire & Black Country Newborn Network Neonatal guidelines (if used locally) Meconium stained liquor guideline local Administration of IV antibiotics guideline, Admission to SCBU guideline and Bedsharing policy (if available) Discharge home from delivery suite/birth unit Dependent on individual circumstances and preferences, woman may choose to go home from delivery suite/birth unit or to be admitted to postnatal ward If woman or baby are not considered appropriate for early discharge and woman insists on going home, complete a ‘Discharge against medical advice’ form Routine postnatal care 2013–15 Discharge directly following delivery Discharge from delivery suite/birth unit/postnatal ward Provided no risk factor identified and no See also POSTNATAL PERIOD – At every postnatal neonatal indication for admission, the contact section at beginning of guideline following women may transfer home: received midwifery-led care with normal Midwife will ensure: complication-free delivery Physical condition of mother and baby is satisfactory, and consultant booked multi-parous with normal confirm identification of baby complication-free delivery Referrals for mother and baby organised post-dates induction of labour with Woman’s Hb, Rubella and Rhesus status have been spontaneous labour following checked and treated appropriately propess/prostin resulting in normal Contraception has been discussed and recorded complication-free delivery Smoking, including passive smoking and access to normal delivery of any parity with post- cessation of smoking programme for woman and other delivery blood loss <500 mL family members discussed first and second degree perineal/labial tears Understanding of effective breastfeeding and, if planning to vaginal birth after caesarean section formula feed, correct preparation, sterilisation of equipment previous postpartum haemorrhage with and storage of feeds discussed <500 mL blood loss at 6 hr post-delivery Cot safety leaflet provided and discussed (if available return of full mobility and 200 mL urine locally) voided following epidural in labour Baby car seats discussed insignificant meconium stained liquor in Provide 24 hr contact number labour File copy of discharge documentation any significant problem in previous Concerns relayed directly by postnatal midwife to pregnancy not affecting this birth e.g. community midwife previous retained placenta, third degree Inform woman that community midwife will visit the day tear, instrumental delivery after discharge and a subsequent visit will be arranged at walked to bathroom and passed 200 mL of that time urine in a single void ensure address documented is where the woman will be Discuss with team leader/registrar any staying for first community visit, and confirm contact details mother who does not fit the above criteria are correct but requests early transfer home. Discuss Examination of newborn discussed (if not performed in neonatal concerns with ANNP/neonatal staff hospital) Inform parents how to register birth Woman has all relevant documentation, leaflets and prescribed medication Postnatal visiting Community midwife will: Visit woman at home on day following discharge and offer a minimum of two further postnatal contacts (day of delivery is day 0) second contact: day 5, to weigh baby and perform bloodspot test third contact: on or after day 10, to weigh baby and transfer care to GP and health visitor if appropriate date and venue to be agreed with woman. Can be the home or a drop-in clinic Discuss individual social, clinical and emotional needs, taking into account the views and beliefs of woman, her partner and family See also POSTNATAL PERIOD – At every postnatal contact section at beginning of guideline Community team leader is responsible for ensuring that all caseloads are picked up during periods of annual leave and/or sickness Newborn screening It is the midwife’s responsibility to: discuss newborn screening with parents at least one day before being performed provide national screening committee leaflet ‘Screening tests for your baby’ obtain consent and take sample on day 5 (count date of birth as day 0). See Bloodspot screening guideline in the Staffordshire, Shropshire & Black Country Newborn Network guidelines (if used locally) ensure sufficient neonatal barcode labels available (if used locally) for when test is taken Routine postnatal care 2013–15 complete request card after performing test apply separate neonatal barcode label to each sheet of the card after checking details with parent(s) place specimen in correctly addressed envelope (use appropriate addressograph label) send to regional screening unit on day sample taken document