11.2 Postpartum care for the mother

More than 60% of maternal deaths occur in the post-partum period and 45% of postpartum deaths occur within the first 24 hours. Women should therefore remain in the health care facility for at least 24 hours1 after delivery.

11.2.1 In the maternity hospital

Following the immediate postpartum (Chapter 5, Section 5.2.2), monitor during the first day (and daily if the patient stays for more than 24 hours):
– Vital signs (heart rate, blood pressure, temperature, respiratory rate) 2 times daily.
– Uterine involution.
– Vaginal bleeding.
– Perineal tear/episiotomy scar.
– Urination and bowel movement.
– Signs of anaemia (if present, measure haemoglobin).
Record all information in the patient’s chart.
In case of caesarean section, see Chapter 6, Section 6.4.

Inform and advise the mother:
– Personal hygiene (clean the perineum daily with soap and water, change sanitary napkins every 4 to 6 hours).
– Mobilisation and ambulation to prevent thrombosis.
– Care of the neonate (Chapter 10, Section 10.6).
– Breastfeeding (Appendix 3).
– Maternal signs requiring immediate consultation:
  • significant vaginal bleeding (e.g., sanitary napkin needs to be changed every 20 to 30 minutes during 1 to 2 hours and/or expulsion of clots in several occasions),
  • headache with visual disturbance or nausea and vomiting; seizures,
  • difficult or rapid breathing,
  • fever,
  • significant abdominal pain,
  • foul-smelling vaginal discharge,
  • urinary leakage,
  • hot, red, painful breast,
  • emotional instability, depression, etc.
– Contraception (Section 11.5).

Special situations: intrauterine foetal death or neonatal death or child abandonment.

In the absence of contra-indication (cardiac valvulopathy, hypertension, preeclampsia, history of postpartum psychosis), lactation may be suppressed by using:
cabergoline PO: 1 mg single dose on the first day postpartum to inhibit lactation or 0.25 mg every 12 hours for 2 days to suppress established lactation.

Note: the use of cabergoline is limited to the above particular situations.

If cabergoline is not available or contra-indicated:
– Do not use any other dopamine agonists such as bromocriptine.
– Do not compress the breasts by a bandage (uncomfortable and ineffective).
– Wearing a bra at all times (day and night) and paracetamol can reduce the discomfort of lactation. In the absence of stimulation, milk production stops within one to two weeks.

In addition, psychological support should be offered to all women concerned at the maternity hospital and in postpartum period. See Chapter 4, Section 4.11.2.

11.2.2 Upon discharge

– If there is no clinical anaemia, continue iron + folic acid supplementation for 3 months1 (Chapter 1, Section 1.2.5). In case of anaemia, see Chapter 4, Section 4.1.
– Give vitamin A (retinol PO: 200 000 IU single dose) in countries where night blindness is a public health problem (follow national recommendations). 
– Schedule an appointment for the postnatal consultation (Section 11.3).
– Verify that information and advice were given.