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Post-natal care is the care given to a mother from the time of delivery of her baby to about 6 weeks after delivery. It should be distinguished from ante-natal care which is the care given to a pregnant woman up to the time she falls in labour and delivers her baby.
Post-natal care is increasingly on the decline in many hospitals as compared with ante-natal care. The reason is not clear. But it is probably due to the erroneous idea that once delivery is achieved, the problem is all over and the medical attendant becomes lukewarm towards the numerous post delivery complications such as thrombosis and embolism, post delivery (puerperal) infections of the pelvis, breast and urinary tract, secondary post partum haemorrhage, post delivery (puerperal) mental disorder, problems with lactation, and breast feeding and so on that may plague the woman.
Post-natal care is the responsibility of the midwife, the midwifery sister, the Matron and the Obstetrician. But the ideal post-natal care can only be achieved if there is a liaison between the patient, the obstetrician, the midwife, the physiotherapist and the social worker.
A woman who has just delivered should be under strict survelliance by a midwife. The first hour after delivery is important, as the womb should be stimulated to contract and to ensure that its cavity is not filling with blood. During this time a check on the vital signs such as blood pressure, temperature and pulse rate is mandatory.
It is customary at the end of the delivery, to clear the soiled drappings and towels and to ensure that the private part and buttocks of the patient are bathed with soap water or a mild antiseptic solution before a sterile vulval pad is applied and held in place by a T-bandage or otherwise as convenient.
Occasoinally we have found it advantageous to treat tender episiotomy tears with heat lamp several times a day. But over-heating a patient should be avoided as by so doing the dangers of Burns, suffocation, heat stroke, heat exhaustion, heat cramps, heat rashes, heat collapse and heart failure are avoided.
If anything there should be provision of congenial environment such as a tidy, moderately warm and ventilated housing and adequate clothing.
Some patients used to resort to the use of abdominal binder hoping to aid womb involution and restore their normal figure. This is less often used these days, but if a woman's abdomen is flabby and pendulous and she derives comfort from it, the abdominal binder may have a place.
To all accounts a woman who has just delivered will suffer from abdominal pain because the womb which formerly housed the baby is now contracting to become smaller following delivery. This pain is called "after pain" and mothers should be helped with pain relieving tablets.
Early movement or early ambulation within the first 12 to 24 hours is now the recommended measure in preference to the old time measure of long stay in bed. Early movement after delivery has numerous advantages. Patient feel better and stronger. Bladder complications and constipation are less frequent. Early movement reduces the risk of thrombosis and pulmonary embolism.
It is normal if patients are encouraged to pass urine within four hours after delivery.
Patients are not known to have poor appetite after delivery so the diet should be well-balanced and attractive. There is no need to restrict fluid intake.
Bowel care after delivery is important. If bowel movement has not occurred spontaneously a mild laxative may be called for in the evening of the second day or a warm enema on the third day.
The care of breast will continue to receive emphasis. The nipples should be kept clean. Any cracking of the nipples is watched for and appropriate measure taken to alleviate soreness and infection.
The new mother is more or less liable to exhaustion after delivery. Adequate sleep at night is most important for full recovery. Sleeplessness is a most disturbing feature and there may result puerperal mental disorder. The value of longer stay in hospital ensures that the nursing staff help with the care of mother and baby and thus allow the mother opportunity for rest. Early discharge from hospita implies that the new mother is going to face not only the disturbing baby care but also house hold duties as well, without enough time to rest from the load of pregnancy, the turmoil of labour and the crisis of delivery.
A good post-natal care must emphasize the importance of exercise which form an important part of the patient's return to normal health after delivery. The instructions given by a doctor or physiotherapist in exercises for the abdominal muscles, perineal muscles and limbs can be most valuable.
When all is well, it is customary to examine the patient fully and to discharge her home with more blood enhancing drugs and good advice about her well-being.
It is the practice of all good hospitals and maternities to see the patients again some six weeks after delivery to ensure a return of good health and to offer them opportunity to ask their questions. It is during such visits that matters arising such as patient's recovery, the progress of the baby, problems with intercourse, the advisability of further child-bearing and the need for family planning are discussed.
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