Postnatal

Postnatal

1. 6 C's - Care, Compassion, Competence, Communication, Courage, Commitment

2. 1.Contiunity of care (as her CMW she knows me already)

3. 2.Congratulate her on the birth & ask her about her birth experience, listen to her recount events

4. 3.Try to answers any questions she may have

5. 4.Ask her how she adjusting to life as a mother, how is she feeling emotionally, bonding/emotional attachment

6. 5.Ask about family/partner support

7. 6.Assess the living environment for risks - smoking, pets etc

8. 7.Review purple notes

9. 8.Wash hands, Encourage empty bladder, gain consent and perform routine postnatal examination

10. B-breasts, U-uterus, B-bowels, B-bladder, L-lochia E-Episiotomy (Perineum) Pain, Temp,aches, pains, legs. All to rule out infections e.g. sepsis

11. 9. BREASTS - Looking for tenderness, pain, blisters, visible bleeding, lumps etc, all via word of mouth from mom

12. 10.UTERUS - Ensure the bladder is emptied, ensure private environment & comfortable position. Ask woman to lift/lower clothing. Inspection & Palpation. Locate fundus - Any pain or tenderness should be noted. After delivery uterus should be palpable at the umilicus. Should involute gradually daily, until day 10 when it has returned to its pre-pregnancy size and position in the pelvis (NICE)

13. 11.BLADDER - Ensure its regularly emptied and no urinary incontinence is recorded

14. 12.BOWELS - Ensure bowels are open regularly, no faecal incontinence is reported

15. 13.LOCHIA - 3-4 days lochia should be Rubra, moderate, lessening and changing colour over time. No offensive smell should be present

16. 14. PERINEUM - Assess perineal trauma for signs of infection or signs of healing. NICE recommends we ask all women about perineal discomfort regardless of trauma. Healing should occur in 7-10

17. 15.AFTER PAINS - Advise that afterpains are normal. Take appropriate analgesic (prior to BF) as it is production of oxytocin in relation to let down response that initiates contraction in the uterus and causes pain

18. 16.BABY CHECK - APPEARANCE - colour & breathing, behaviour, activity and posture. HEAD - fontanelles, face, nose, mouth, palate, ears, neck, general symmetry. EYES. NECK - limbs, feet & digits- proportions & symmetry, ABDOMEN,UMBILICAL CORD, GENITALIA & ANUS, SPINE, SKIN - colour texture, birth marks (jaundice), rashes

19. 17.Ask about sleeping - NEW safe sleeping initative (CMW checks sleeping arrangements & recommendations (unicef & NICE)

20. 18.Discuss BF, changing in stools (colour, consitency etc) Micturition - regularity

21. 19.Important for mother to know that breast do not store large amounts of milk. Breast milk is produced constantly in small amounts

22. 20.PHYSIOLOGY OF LACTATION - Prolactin is responsible for breasmilk production. Prolactin & suckling initiates lactation. Prolactin levels are highest at night,

23. 21.OXYTOCIN - Responsible for mil ejection - let down reflex. Earlydays let down reflext stimulated by infant suckling and mother seeing, touching, hearing and smelling her baby. Inhibited by stress and anxiety. Oxytocin is responsible for dilating blood vessels in maternal chest meaning mothers transfer warmth to their babies. Oxytocin contributes to increased maternal interaction and bonding and enhances sense of wellbeing

24. 22. Encourage skin to skin as it encourages prolactin and oxytocin release encouraging BF

25. 23.Reiterate importance of good P & A, show positions, observe a whole feed, importance of 8 feeds in 24hrs.

26. 24.Document contemporaneously as per NICE guidelines - Explain what you have written and why. Follow BFI & Unicef guidance

27. 25.Arrange next appointment & ensure that she has emergency contacts

28. 26.Artificially feeding - Support her choice, encourage her and ensure that milk is prepared correctly.