POSTPARTUM COUNSELLING

Provide the following counselling at all postpartum visits.

General counselling

  • Breastfeeding/breast care
  • Nutrition, ferrous and folic acid supplements, avoid alcohol and tobacco
  • Self care and other good health practices, personal hygiene, handwashing, genital hygiene (care of the
    episiotomy or repaired tears)
  • Pelvic floor exercises
  • Sleeping under mosquito nets
  • Postpartum checks (6 days and 6 weeks)
  • Provide information on bonding by encouraging the mother to hold, touch, explore her baby as well as
    rooming-in (mother and baby sleeping in the same bed
  • HIV testing
  • Discuss with the couple the need for shared care of the newborn
  • Help build confidence by providing reassurance that the woman is capable of caring for the newborn

Counselling on baby care

  • Hygiene and care of the baby, (see previous sections)
  • Danger signs for the baby
  • Immunization schedule
  • Let baby sleep on the back or side
  • Ensure the baby is kept warm without overcovering
  • Apply chlorhexidine digluconate gel to the cord stump daily after every bath until the cord falls off. Provide the
    gel to the mother, and teach her how to use it while at home
  • Keep baby away from smoke and smokers
  • Keep baby (especially if small) away from anyone who is ill
  • Do not share supplies (for example, clothing, feeding utensils) with other babies

Complications and danger signs for the mother

  • Danger signs (see next table)
  • Readiness plan in case of an emergency
    • Advise her to have someone near for at least 24 hours after delivery to respond to any change in condition
    • Discuss emergency issues with her and partner/family: Where to go if danger signs appear, how to get there,costs involved, family/community support
    • Advise her to seek help from the community if needed
    • Advise her to bring any home-based maternal record to the health facility, even for an emergency visit

Reproductive health

  • Discuss family planning and provide appropriate method if required (PPFP), benefits of LAM, dual protection, safe delivery-pregnancy interval of 2 years
  • Advise mother to abstain from sexual activity for at least 6 weeks after birth
  • Discuss return to fertility (ovulation can occur before the first Menstrual Period
  • Perform cervical cancer screening at 6 weeks

Advise mother on danger signs as follows:

TYPE OF DANGER SIGN ACTION TO TAKE
  • Vaginal bleeding (>2 pads soaked in
    30 minutes after delivery or bleeding
    increases instead of decreases after
    delivery)
  • Fever or convulsions
  • Fast or difficult breathing
  • Too weak to get out of bed
  • Severe abdominal pain
  • Severe headache/blurred vision
  • Pain in the calf (ankle) muscles
 Go to health
facility
immediately
  • Fever; abdominal pain; feels ill;
    breasts red, tender, swollen; sore
    nipple; urine dribbling or pain on
    urination; perineal pain or draining
    pus; foul-smelling lochia
 Go to health
facility as soon
as possible