Importance of post natal check-ups Conventionally, the first 42 days (six weeks) after delivery are considered the post-partum period. The first 48 hours of the post-partum period, followed by the first one week, are the most crucial period for the health and survival both of the mother and her newborn. Most of the fatal and near-fatal maternal and neonatal complications occur during this period. Evidence has shown that more than 60% of maternal deaths take place during the post-partum period. Ensuring post natal care during this period is hence important for identification and management of emergencies occurring during post natal period. Post natal check-up Schedule First visit - If the delivery has not happened in the health centre, the first visit is to be within 24 hours of delivery. Second visit - 3rd day after delivery Third visit - 7th day after delivery Fourth visit - 6 weeks after delivery There should be three additional visits in the case of babies with low birth weight, on days 14, 21 and 28 (as per the Integrated Management of Neonatal and Childhood Illness [IMNCI] guidelines). Components of Post natal check-up First visit For mother History-taking Place of delivery Person who conducted the delivery History of any complications during the delivery / bleeding per vaginum / convulsions or loss of consciousness Pain in the legs / abdominal pain / fever / dribbling or retention of urine / any breast tenderness, etc. Initiation of breastfeeding the baby Has she started her regular diet? Are there any other complaints? Examination Pulse, blood pressure, temperature and respiratory rate. Presence of pallor. Abdominal examination. Examine vulva and perineum for the presence of any tear, swelling or discharge of pus. Examine the pad for bleeding to assess if the bleeding is heavy, and also see if the lochia is healthy and does not smell foul Examine the breasts for any lumps or tenderness, check the condition of the nipples and observe breastfeeding. Management / Counseling Post-partum care and hygiene Nutrition Contraception Registration of birth IFA supplementation Breastfeeding First visit for baby History-taking When did the child pass urine and meconium? Has the mother started breastfeeding the baby and are there any difficulties in breastfeeding? Fever Not suckling well Difficulty in breathing Umbilical cord is red or swollen, or is discharging pus Movements of the newborn are less than normal Skin infection (pustules) - red spots which contain pus or a big boil Convulsions. Examination Count the respiratory rate for one minute. Look for severe chest indrawing Check the baby’s color for pallor / jaundice / central cyanosis (blue tongue and lips) Check the baby’s body temperature. Examine the umbilicus for any bleeding, redness or pus. Examine for skin infection Examine the newborn for cry and activity Examine the eyes for discharge Examine for congenital malformations and any birth injury Management / Counseling Maintain hygiene while handling the baby Delay the baby’s first bath to beyond 24 hours after birth. Maintain body temperature. Should not apply anything on the cord, and must keep the umbilicus and cord dry. Should observe the baby while breastfeeding and try to ensure proper/good attachment. Second and third visits For mother History-taking Apart from the questions asked during the first visit, also ask about the following:1. Continued bleeding P/V - occurring 24 hours or more after delivery2. Foul-smelling vaginal discharge3. Fever4. Swelling (engorgement) and/or tenderness of the breast5. Any pain or problem while passing urine (dribbling or leaking)6. Fatigue / ‘not feeling well’7. Unhappiness / Cry easily - post-partum depression Examination Pulse, blood pressure and temperature. Check for Pallor. Conduct an abdominal examination to see if the uterus is well contracted Examine the vulva and perineum for the presence of any swelling or pus. Examine the pad for bleeding and lochia. Examine the breasts for the presence of lumps or tenderness. Check the condition of the nipples. Management / Counseling Diet and rest Contraception Second and third visits for baby History-taking - same questions as during the first post- partum visit Examination - observe the baby for the following: Whether he/she is sucking well If there is difficulty in breathing (fast or slow breathing and chest indrawing) If there is fever or the baby is cold to the touch. If there is jaundice (yellow palms and soles) Whether the cord is swollen or there is discharge from it If the baby has diarrhea with blood in the stool If there are convulsions or arching of the baby’s body. Management / Counseling - In addition to what was provided during the first visit counsel Exclusively breastfeed the baby for six months. Should feed the baby on demand or every 2 hours Supplementary foods should be introduced at 6 months of age, while breastfeeding can continue simultaneously. Baby’s weight loss Hygiene of the baby When and where to seek help in case of signs of illness Immunization Fourth visit For mother History-taking - Ask the mother the following: Has the vaginal bleeding stopped Has her menstrual cycle resumed Is there any foul-smelling vaginal discharge Does she have any pain or problem while passing urine (dribbling or leaking) Does she get easily fatigued and/or ‘does not feel well’ Is she having any problems with breastfeeding Examination - includes the following: Check the woman’s blood pressure. Check for pallor. Examine the vulva and perineum for the presence of any swelling or pus. Examine the breasts for the presence of lumps or tenderness. Management / Counseling Diet and rest As in the second and third visits, emphasize the importance of Nutrition / Contraception Fourth visit for baby History-taking - Ask the mother the following: Has the baby received all the vaccines recommended so far Is the baby taking breastfeeds well How much weight has the baby gained Does the baby have any kind of problem? Examination Check the weight of the baby Check if the baby is active/lethargic. Management / Counseling Emphasize the importance of exclusive breastfeeding. Tell the mother that if the baby is having any of the following problems, he/she should be taken immediately to the MO at the FRU - The baby is not accepting breastfeeds / The baby looks sick (lethargic or irritable) / The baby has fever or feels cold to the touch / The baby has convulsions / Breathing is fast or difficult / There is blood in the stools / The baby has diarrhea. Counsel the mother on where and when to take the baby for further immunization Source : Guidebook for Enhancing Performance of Multi-Purpose Worker (Female) Related Resources Guidelines for Antenatal Care and Skilled Attendance at Birth by ANMs/LHVs/SNs .