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IMAP & Johnson & Johnson

MS. PATRICIA M. GOMEZ, RM, MCHS Executive Director

IMAP, Incorporated

POSTNATAL CARE

Discussion Outline

Importance of Postnatal Care

Recommendations for postnatal care for the mother

Recommendations for postnatal care for the baby

Who is responsible for postnatal care

Importance of newborn skin care in postnatal care

Caring for the newborn and infant skin

How important is postnatal care?

According to the World Health Organization (WHO),1

“The postnatal period—the days and weeks following childbirth—is a critical phase in the lives

of mothers and newborn babies.”

“Lack of appropriate care during this period could result in significant ill health and even death.”

Postnatal care

1. World Health Organization (WHO). WHO recommendations on postnatal care of mother and newborn. 2013.

Available at: http://apps.who.int/iris/bitstream/10665/97603/1/9789241506649_eng.pdf. Accessed 25 February 2016.

http://apps.who.int/iris/bitstream/10665/97603/1/9789241506649_eng.pdf

What are the recommendations

for postnatal care for

the mother & baby?

For number and timing of postnatal contact/visit, WHO recommends postnatal contact:

o At least 24 hours after birth (if birth is in a health facility)

o As soon as possible within 24 hours of birth (if birth is at home)

o At least three times

Day 3 (48-72 hours)

Between Days 7-14

6 weeks after birth

Postnatal care






the mother?

For 24 hours after birth, WHO recommends assessment of the

following1:

oVaginal bleeding

oUterine contraction

oFundal height

oVital signs (ie, temperature, heart rate, respiratory rate and

blood pressure)

oUrine output

Postnatal care






the mother? Beyond 24 hours, WHO recommends assessment of the

following1:

oGeneral well-being

oVital signs

oUrination and bowel function

oPerineal wound

Pain

oVaginal discharge, vaginal bleeding

oPresence of infection (with slight fever)

Postnatal care






the mother?

Beyond 24 hours, WHO recommends assessment of the

following1:

oPresence of postpartum depression

oNeed for counseling on:

Hygiene

Nutrition

Resumption if sexual intercourse

Contraception

Postnatal care






the baby?

WHO recommends the following1:

o Immediate assessment at birth

Weak pallor, sucking reflex

oFull clinical examination 1 hour after birth & before discharge

Vital signs, temperature

oCord care

oBreastfeeding (exclusively) from birth until 6 months of age

Positioning, attachment, per demand

Postnatal

care






the baby?


oNot separating mother and baby

oEncouraging communication and play between

mother and baby

oPromotion of immunization as per guidelines

Postnatal care






the baby?


oAppropriate clothing for the ambient temperature

oDelay of bathing until 24 hours after birth or at

least for at least 6 hours (if delaying for longer is

not possible for cultural reasons)

Postnatal care




Who is responsible for

postnatal care?

Checking for uterine involution

Checking for signs of infection and return of urinary and bowel functions

Inspecting perineum for any signs of local infection or wound dehiscence

Postnatal care

Midwife’s role in

postnatal care


postnatal care?

Educating mother on perineal care and hygiene

Coordinating care with other HCPs

Referring to doctor as needed

Promoting breastfeeding

Postnatal care

Midwife’s role in

postnatal care


postnatal care?

Eating a balanced diet

Taking dietary supplements when needed

Engaging in regular healthy physical activity

Seeking the help of others when needed

Postnatal care

The mother is in charge of her

own health after discharge from

the hospital. Her

responsibilities include:


postnatal care?

Following up as necessary with HCPs

Alerting HCP for any signs of infection (ie, fever, wound dehiscence, foul-smelling wound discharge

Postnatal care

The mother is in charge of her

own health after discharge from

the hospital. Her responsibilities

include:


postnatal care?

Ensuring that her newborn grows in a safe and loving environment

Feeding/nourishing/nurturing

Following up with HCPs regularly with HCP to monitor baby’s growth and development

Immunization/vaccination

Postnatal care

The mother is the primary

caregiver of the newborn.

Among her roles are the

following:

Is newborn skin care important in

postnatal care?

Apart of caring for the newborn’s nutrition, growth and

development, hygiene and skin care are also important components

of the newborn’s general health and well-being

Good skin care at birth ensures that the skin will be able to

perform its most important functions

oBarrier and protection1

oPrevention of dehydration1

oTemperature regulation2

Postnatal care

1. Lyon S. An evidence-based approach to newborn skin cleansing. Available at:https://www.rcm.org.uk/sites/default/files/Johnsons-baby.pdf. Accessed 25 February 2016.

2. Romanovsky AA. Acta Physiol 2014; 210:498-507.

How should we care for

newborn and infant skin?

As to hygiene:

oCleansing should be part of daily routine1

oKeeping the skin clean reduces the risk of infection2

oHowever, the skin of newborns and infants is3

Still developing until first year of life

Thinner and more sensitive than adult skin

Postnatal care

1. Morelli JG, et al. Pediatrics 1987;80:634-637.

2. World Alliance for Patient Safety. WHO guidelines on hand hygiene in health care (advanced draft).

http://www.who.int/patientsafety/information_centre/Last_April_versionHH_Guidelines%5B3%5D.pdf. Accessed 25 February 2016.

3. Telofski L, et al. Dermatology Research and Practice 2012; Volume 2012, Article ID 198789, doi:10.1155/2012/198789.



Because newborn and infant skin is sensitive1

oAvoid harsh or vigorous cleansing

oUse only gentle cleansing products that are clinically

proven safe for newborn and infant skin

IMPORTANT: Harsh cleansers and vigorous scrubbing

can damage their sensitive skin

Postnatal care

1. Telofski L, et al. Dermatology Research and Practice 2012; Volume 2012, Article ID 198789, doi:10.1155/2012/198789.



Experts suggest1,2

oDuring the neonatal period (ie, first month), sponge baths only until the

umbilical stump has fallen off

Cultures vary in practices with regard to cord care3

oTriple dye, alcohol, povidone-iodine, soap and water, or no treatment

at all

o In general, the umbilical cord stump is expected to be kept clean, dry

and uncovered to promote healing and cord separation

oNo single method of care has been proven to be superior

Postnatal care

1. Hollloway B, Moredich C, Adudell K. OB Peds Women’s Health. Nurse’s Clinical Pocket Guide. F.A. Davis Company, PA. 2006.

2. Umbilical cord care in newborns. Available at: https://www.nlm.nih.gov/medlineplus/ency/article/001926.htm. Accessed 20 March 2016.

3. McConnell T, Lee CW, Couillard M, et al. NAINR 2004;4:211-222.

https://www.nlm.nih.gov/medlineplus/ency/article/001926.htm



Experts suggest1,2

oLet the stump fall off naturally, which is within 2

weeks.

IMPORTANT: Watch out for signs of infection, ie,

fever, poor feeding, lethargy, poor muscle tone. Bring

baby to the doctor right away.

IMPORTANT: If stump does not fall off within 4

weeks, bring baby to the doctor right away.

Postnatal care


2. Umbilical cord care in newborns. Available at: https://www.nlm.nih.gov/medlineplus/ency/article/001926.htm. Accessed 20 March 2016.

https://www.nlm.nih.gov/medlineplus/ency/article/001926.htm



Experts suggest1

oUse cleansing agents approved only for very young

skin

oNo soap needed on the face; eyes to be cleansed only

with wet cotton balls

oWash hair last to prevent heat loss

oDry the baby quickly after sponge bath

Postnatal care




Experts suggest1

oDuring the first year, bathing thrice a week is sufficient

oUsing only cleansers that are mild and clinically proven safe

oUse soft cloth for washing

oBathing in a warm room, bathing with warm water

IMPORTANT: Bathing frequently may cause drying of skin

Postnatal care

1. Bathing the newborn. Available at: https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Bathing-Your-Newborn.aspx. Accessed 25 February

2016.

https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Bathing-Your-Newborn.aspx













Experts also suggest

oMoisturizing to prevent skin dehydration and itching and

enhance the skin’s integrity1,2

oTouch/massage therapy while bathing and moisturizing. Effects

of touch therapy include3:

Weight gain

Positive infant behavior

Improved sleep-wake pattern

Enhanced mother-baby interaction

Postnatal care

1. Fowler J. Understanding the role of natural moisturizing factor in skin hydration. Practical Dermatology 2012; pp 36-40.

2. Frieden I, et al. Emollient use on infant skin: recommendations for the primary care practice. Excellence in Pediatrics KOL Sessions 2011. 1-3

3. Kulkarni A, Kaushik JS, Gupta P, Sharma H, Agrawal RK. Massage and touch therapy in neonates: the current evidence. Indian Pediatr

2010;47:771-776.

How to care for newborn and infant skin

The 4-step newborn and

infant bathing ritual

Massage Cleanse Moisturize

Freshen

Postnatal care

Summary

The postnatal period—the days and weeks following childbirth—is a critical phase in the lives of the mother and her newborn baby

While the doctor, nurse and midwife are the HCPs to whom the mother can turn to for help and advice, the mother serves as her own and her baby’s caregiver after discharge from hospital

Ensuring a safe and loving home environment and adequate nourishment to achieve proper growth and development are the primary goals of care during infancy

Skin care should not be overlooked and should be a part of the infant’s overall care. Trust only products that are clinically proven safe for infant skin.

Memories

Thank you!

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