11.3 Postnatal consultations

11.3.1 Timing of postnatal consultations

Two postnatal consultations, for the mother and infant, should be offered within the first six weeks after delivery:
– The first within 8 days of delivery, especially for women who delivered at home. For patients who delivered in a health care facility and stayed there for more than 24 hours, the discharge visit for the mother and infant is considered the first postnatal consultation.
AND
– The second visit within four to six weeks of delivery for all patients.

If the infant weighs less than 2000 g, a weekly consultation is recommended for the first month, and then at 6 weeks.

The postnatal consultations are usually done in the maternity services.

11.3.2 For the mother

– Assess vital signs: heart rate, blood pressure, temperature, respiratory rate.

– Assess uterine involution.

– Assess the healing of the incision in cases of caesarean section.

– Examine the vulva and perineum: look for tears, assess the healing of episiotomy or sutured wound, and appearance of vaginal discharge.

– Inquire about urination and intestinal transit. In case of urine leakage, look for potential fistula (Chapter 7, Section 7.2.5).

– Check for breast lesions.

– Look for anaemia. If there is no clinical anaemia, continue iron + folic acid supplementation for 3 months (Chapter 1, Section 1.2.5). In case of anaemia, see Chapter 4, Section 4.1.

– Perform a dipstick urinalysis if there are any symptoms of urinary tract infection and/or fever and/or hypertension.

– Offer HIV counselling and testing if not done during pregnancy or delivery.

– Note the mother-infant interaction, and the mother’s psychological state.

– Provide information on contraception (time until fertility returns, available contraceptive methods, efficacy, benefits, constraints, and adverse effects of each method) and prescribe contraceptive if desired (Section 11.5).

– Administer vitamin A (retinol PO: 200 000 IU as a single dose) if not done at delivery.

– Complete tetanus immunisation if necessary.

– Give information and advice (danger signs, hygiene, breastfeeding, use of insecticide-treated mosquito nets for mother and infant).

11.3.3 For the infant

– Clinical examination:
• height, weight. A term infant should have regained birth weight by Day 10; infants less than 2500 g normally regain their birth weight by Day 14 (unless they have been sick);
• condition of umbilical cord;
• presence/absence of danger signs (Chapter 10, Section 10.3.1);
• if there are signs of anaemia (pallor of conjunctivae, the palms of the hands and soles of the feet), measure haemoglobin.
Normally, the haemoglobin level of infants younger than 2 months and weighing less than 2500 g at birth should not be < 7 g/dl. Refer to neonatal unit if the haemoglobin is < 7 g/dl in a non-sick infant and < 10 g/dl in a sick infant.

– Apply tetracycline eye ointment (up to 8 days after birth) if not done at birth (Chapter 10, Section 10.1.7).

– Administer vitamin K1 if not done at birth (Chapter 10, Section 10.1.7). Catch-up can be done up to age 3 months.

– Feeding: assess breastfeeding (Appendix 3).

– Vaccination:
Normally, vaccinations (Hepatitis B Dose 0, BCG, Polio Dose 0) are given at birth. They are then continued at 6, 10 and 14 weeks (Doses 1, 2 and 3 Polio and the pentavalent vaccine containing Hepatitis B). Follow the recommendations of the Expanded Programme on Immunization.
If the infant did not receive vaccines at birth:
• Hepatitis B: Dose 0 may still be administered, but the later it is given, the less effective it is in preventing mother-to-child transmission.
• Polio and BCG: administer Dose 0 of the Polio vaccine and the BCG vaccine.

11.3.4 Postnatal care card

Register all relevant information on an individual post partum follow-up card (Appendix 6).