167303 IPERI-18 Post Natal Mother-2 HI

NHS
No.
Maternity Unit
These notes should be kept safe by the mother during the postnatal
period. If found, please return immediately to the owner, or her
midwife or maternity unit.
CONFIDENTIAL
First name
Postnatal
Notes
Surname
Address
for
Date
D
D D M
M M
of birth
Contact number
YY
Y Unit
No.
NHS number barcode
PL
E
Mother
Postcode
Mother’s contact numbers
NHS number barcode
Mother’s preferred language
Lead professionals
Midwife
Consultant
Maternity contacts
Named midwife
SA
M
Associate midwife
Place of birth
Team mobiles
9am - 5pm contact
24 hr contact
Community office
Postnatal ward
Primary care contacts
Centre
Other (s)
GP(+ initial)
Postcode(GP)
Health Visitor
Next of kin
Emergency contact
Name
Name
Address
Address
Relation
page
1
Previous history
Personal & Family History
Past Medical History
i.e Social care involvement
Past Obstetric History
Social assessment
No Yes
No Yes
Entitled to claim benefits
Has support from partner, family, friends
Has appropriate housing
Any household member had/has social services support
Employment status
PL
E
Needs help understanding postnatal notes
Name of social worker
If referral required to:
The Postnatal Notes
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These are your Postnatal Notes. They are a guide to your options in the postnatal period and are intended to help you make informed choices.
This is to promote care which is safe and personalised to you. However the explanations in these notes are a general guide only and not everything
will be relevant to you. Please feel free to ask if you have any questions. Additional information may be available in leaflets which you may be given as
and when needed.
Some of the information in these notes, about you and your baby will be recorded electronically, this is to help your health professionals provide the
best possible care.
The National Health Service (NHS) also wishes to collect some of this information about you and your baby, to help it to:
· monitor health trends
· increase our understanding of adverse outcomes
· strive towards the highest standards
· make recommendations for improving maternity care.
The NHS has very strict confidentiality and data security procedures in place to ensure that personal information is not given to unauthorised persons.
The data is recorded and identified by NHS number, and your name and address is removed to safeguard confidentiality. Other information such as
date of birth and postcode are included to help understand the influences of age and geography. In some cases, details of the care are looked at by
independent experts working for the NHS, as part of special investigations (confidential enquiries), but only after the records have been completely
anonymised. While it is important to collect data to improve the standard and quality of the care of all mothers and babies, you can ‘opt out’ and have
information about you or your baby excluded. This will not in any way affect the standard of care you receive. For further details, please ask your lead
professional (see page 1).
However your information may be shared with other agencies such as safeguarding teams or children centres, where there are concerns for you or
your child’s safety. In these cases information will be shared without your consent.
.
Signed*
Date D D M M Y Y
Data
collection and record keeping discussed
Smoking
Care Provider
Record further details on the Management plan (page 5)
No Yes
Have you smoked in the last 12 months
No. per day
No Yes
Have you tried to stop smoking in the last 12 months
Did you smoke at the beginning of pregnancy
Were you referred to a smoking cessation advisor
Did you smoke at the end of pregnancy
CO screening (if carried out)
Does anyone else in your home smoke
Result
Do you want to be referred to a smoking cessation advisor
Investigations/immunisations
Antenatal Serology Screening Yes
Test
page
2
No
Including antibodies, rubella, hepatitis B, syphilis, HIV, sickle cell, thalassaemia, if NOT done antenatally.
Postnatal follow-up required Yes
Explained Accepted by mother Date taken/
Date given
Yes No
Name
Unit No/
NHS No
No
Signed*
Results/Actions/Comments
Signed *
*Signatures must be listed on page 18 for identification
Postnatal venous thromboembolism (VTE) assessment
- to be completed immediately after birth. Update Management Plan as required.
Yes
High risk
At least 6 weeks postnatal prophylactic LMWH
Intermediate risk
At least 10 days’ postnatal prophylactic LMWH
Note: if persisting or > 3 risk factors, consider extending
thromboprophylaxis with LMWH
↑
2 or more risk factors
Fewer than 2 risk factors
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Any previous VTE
Anyone requiring antenatal LMWH
High-risk thrombophilia
Low-risk thrombophilia + family history
Caesarean section in labour
BMI > 40
Readmission or prolonged admission (> 3 days) in the puerperium
Any surgical procedure in the puerperium except
immediate repair of the perineum
Medical comorbidites e.g. cancer, heart failure, active SLE, IBD or
inflammatory polyarthropathy; nephrotic syndrome, type I DM with
nephropathy, sickle cell disease, current IVDU
Age>35 years
BMI >30
Parity >3
Smoker
Elective caesarean section
Family hisory of VTE
Low-risk thrombophilia
Gross varicose veins
Current systemic infection
Immobility, e.g. paraplegia, PGP, long distance travel
Current pre-eclampsia
Multiple pregnancy
Preterm delivery in this pregnancy (<37 weeks)
Stillbirth in this pregnancy
Mid cavity rotational or operative delivery
Prolonged labour (>24 hours)
PPH > 1 litre or blood transfusion
↑
Lower risk
Early mobilisation and avoidance of dehydration
No risks identified
Date
Signature*
Mother alerts
D D M M Y Y
Part of the assessment at each postnatal contact is to identify any additional needs you may have. The alerts below can be used by your
care team to help identify your risk of developing problems. The aim is to monitor your health and to check that you are well and
progressing normally after the birth. The management of any problems or special features can be documented on page 5.
Age > 35
Para > 3
BMI > 30
Pregnancy induced hypertension / Pre-eclampsia
Prolonged rupture of membranes
Pushing > 1.5 hours
Ventouse or forceps
Caesarean section
Incomplete placenta or membranes
Baby weight > 90th centile
High temperature / unwell
Episiotomy / 2nd degree tear
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
3rd / 4th degree tear
No spontaneous urinary void > 3 hours
Single catheter drainage > 500 ml
Indwelling catheter > 24 hours
Lack of support
Previous psychiatric illness
Previous postnatal depression
Family history of psychological illness
Excessive blood loss
Smoker
Antenatal anti-coagulation therapy
Thrombophilia
None identified at delivery
Key to risk
If you have one or more risk factors for any of the conditions below, it does not necessarily mean that you will develop a problem.
These are merely prompts for your carers to initiate further investigations, treatment or referral.
Infection
5
8
9 11 12 13 14 15 16 21 22
Abnormal bleeding
2
4
9 11 23 24
Hypertensive disorders
1
3
4
Urinary urgency or incontinence
Faecal urgency or incontinence
2
6
7 10 12 13 14 15 16
Psychological well being
17 18 19 20
For more information on what to do if you start to feel unwell, see pages 6, 13, 15 and 17.
Key to abbreviations: BMI = Body Mass Index;
DM - Diabetes Mellitus IBD = Inflammatory Bowel Disease
IVDU = Intravenous Drug User LMWH = Low Molecular Weight Heparin
SLE = Systemic Lupus Erythematosus
PGP = Pelvic Girdle Pain
Name
Unit No/
NHS No
page
3
First postnatal assessment
Date D
To be completed prior to: leaving a home birth, early transfer home, or on admission to postnatal ward.
D M M Y Y Time H H M M
Where seen
No Yes
Are there any concerns about the following:
Comments/Actions
A. Temperature, pulse, respirations and
blood pressure
MEOWS chart commenced
No
Infection, fever, chills, headache, visual disturbances
Yes
B. Breasts and nipples
Redness, pain, cracked, sore, bruised nipples
C. Uterus
D. Vaginal loss
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Abdominal tenderness, subinvolution
Clots, offensive smell, return to heavy loss
E. Legs
DVT, redness, swelling, pain, varicose veins, cramps
F. Bladder
Pain on passing urine, leakage, urgency
G. Bowels
Constipation, haemorrhoids, leakage, urgency
H. Wound
Suture removal, healing, infection
I. Perineum
Soreness, bruising, swelling, sutures, infection
J. Pain
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Headache, backache, abdominal
K. Fatigue
Unable to sleep, restless sleep, extreme tiredness
L. Emotions
Baby blues, excessive anxiety, postnatal depression
M. Postnatal exercises
Pelvic floor, abdominal, legs, deep breathing, relaxation
N. Tissue viability assessment completed
Risk of developing a pressure ulcer
Infant feeding method
Key to risk reviewed (page 3)
Yes
Management plan initiated
Yes
Signature*
DVT = Deep Vein Thrombosis
Orientation to ward
Introductions
Date
page
4
D
Name
Unit No/
NHS No
Call
system
D M M Y Y
Explanation of ward routine and layout (if applicable)
Security
system
Time
H
Ward
layout
H
M
M
Visiting
details
Signature*
Meals/
drinks
Information
leaflets
Expected date
of discharge
Booking B/P
Booking BMI
Special features
Blood group
+-
Key points (i.e. specific antenatal/intrapartum/postnatal events)
Medications
Para
Last Hb and Date
D D M M
+
1st urinary void Date
Time
Y Y
Amount (ml)
Allergies
Management plan
Risk factor /
Special features
Date/Time
D D M M
H
M
Y
Y
M
Management plan
Referred to
Signed *
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Insert continuation sheets here, and number them 5.1, 5.2 etc
H
PL
E
A management plan will outline a plan of care agreed between you and your care providers, including specialists. The aim is to keep
you well, and to ensure that everyone involved in your care is aware of your individual circumstances. If any special issues have been
identified from the alerts on page 3, which require further consideration they will be recorded below. This plan will be updated and
amended to reflect your changing needs.
Name
*Signatures must be listed on page 18 for identification
Unit No/
NHS No
page
5
Postnatal care for further information see pages 13,15 and 17.
At each postnatal assessment your midwife will check to see if you have any problems or symptoms which may affect you
after the birth. Please discuss any worries or questions that you may have with your midwife.
Infection. The midwife will check your temperature, pulse and breathing rates as required, depending on the type of birth
you have had. A high temperature, rapid pulse and increased breathing rate may be a sign of infection. This is more likely if
you are experiencing other symptoms such as pain on passing urine, a painful perineum (see below) or abdominal wound,
and/or abdominal tenderness. It is really important that you try to reduce the risk of infection by : good personal hygiene,
washing your hands properly before and after preparing food, using the toilet, sneezing/blowing your nose. If you feel unwell,
have a sore throat or respiratory infection contact your GP or midwife for advice.
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Blood pressure (hypertension). Pregnancy induced hypertension or pre-eclampsia may occur up to 3 days after the delivery.
High blood pressure may cause severe headaches or flashing lights. This is very rare, but if any of these symptoms occur you
need to inform your midwife or doctor immediately. Your blood pressure will be checked after the birth and subsequently as
required.
Breasts. All new mothers produce milk in their breasts whether they choose to breast or bottle feed. After two to three
days the breasts may become full and tender but this generally resolves spontaneously. However, if it worsens or you develop
flu-like symptoms and the breasts are hard and have a red mottled appearance, this is breast engorgement and you should
contact your midwife for additional help. If you are breastfeeding, you will need to feed your baby more often to relieve the
symptoms. Your midwife will check that your baby is attached effectively. Whether you are breast or bottle feeding your
midwife will advise you on how to relieve the discomfort.
Uterus (womb). After the birth your uterus should gradually return to its non-pregnant size. This can take about 10 days. By
gently feeling your abdomen your midwife can check this recovery process. Sometimes it may take longer, which in most cases
is normal. Occasionally this may be a sign of retained blood or fragments of the placenta or membranes. Often this problem
resolves spontaneously, however if you have any heavy bleeding, abdominal pain or a high temperature then referral to your
doctor for antibiotics or further treatment may be required.
Blood loss (lochia). Some vaginal bleeding straight after delivery is normal. Your midwife will measure this and record it as
estimated blood loss in your notes. Vaginal discharge after childbirth is called lochia - a mix of blood and other products from
inside the uterus. At first it is bright red, and then becomes a pinkish brown, turning to cream. It can be quite heavy at first,
requiring several changes of sanitary pads a day. After the first week it slows down, but you may find it lasts three or four
weeks before finally disappearing. If you start to lose fresh red blood or clots, have abdominal pain or notice an offensive
smell, inform your midwife or doctor. However, some fresh red blood loss is normal after a breastfeed.
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Legs (thrombosis). All pregnant women are at a slightly increased risk of developing blood clots (thrombosis) during pregnancy
and in the first weeks after the birth. This risk increases if you are over 35, overweight, a smoker or have a family history of
thrombosis. You are advised to see your midwife or doctor if you have any pain, redness or swelling in your legs. This may be
a sign of DVT (deep vein thrombosis). If you have pain in your chest, with shortness of breath or coughing up blood, this may
be a sign of pulmonary embolism (blood clot in the lung) and you should inform your doctor or midwife immediately.
Bladder (passing urine). Soreness after the birth can make passing urine painful initially, but it should resolve quickly. Drinking
plenty of fluids to keep the urine diluted helps. If you have problems passing urine after the birth then a warm bath or shower
might also help, but if it persists your midwife will refer you for medical advice. Sometimes leakage of urine may occur on
coughing or sneezing, this is known as stress incontinence. Some women may need to wear protective pads. If so, let your
midwife or GP know. They can refer you to a continence adviser, once other underlying causes such as infection have been
excluded.
Bowels (passing faeces/motions). Constipation is very common after childbirth. This can be made worse by haemorrhoids
(piles). Piles can be treated using good hygiene, Anusol cream, lactulose and pain relief. A high fibre diet including fresh fruit
and vegetables and drinking plenty of fluids can help to prevent constipation. It may feel more comfortable if a clean sanitary
pad is held against the perineum when having your bowels open. Occasionally women may have urgency, both of wind and
motions or have difficulty getting to the toilet in time. This is not normal and you can get help. Your midwife or GP (family
doctor) can refer you to a specialist if any of these problems occur.
Perineum (area between vagina and anus). Your midwife may check your perineum to see it is healing especially if you
have had a tear or stitches.The stitches usually take about two weeks to dissolve and throughout that time your perineum
should continue to heal. Regular pain relief will help with any discomfort, try to avoid constipation. It may be easier to lie on
your side rather than on your back, especially when you are breast feeding. The perineum is a common area for infection and
should be kept as clean and dry as possible.
Pain. It is not unusual to have some pain following the birth.This can be as a result of the type of birth you have had. It can
vary from minor discomfort which is eased by bathing and paracetamol, to post operative pain requiring prescribed pain relief
by your doctor. If you develop any type of pain, always tell your midwife and she will advise you on what to do to ease the
pain.
Sleep. As your nights will be disturbed caring for your baby, it is important to catch up on sleep when you can as your body
is still recovering from the birth. Try to have a sleep or a proper rest at least once a day when your baby is sleeping. Resist the
temptation to catch up on chores or housework.
page
6
Key to abbreviation:
GP = General Practioner
Feel free to ask your midwife or doctor – or look on the web: www.preg.info
Date/
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Name
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* Signatures must be listed on page 18 for identification
Insert continuation sheets here, and number them 12.1, 12.2 etc
D D M M
Signed*
Postnatal care
(continued - see page 6)
Caesarean section (wound/drain). After your caesarean section your blood pressure, pulse and breathing rates will be monitored
frequently. This is to check you are recovering from your anaesthetic and the birth. If you are well and have no problems, you
should be able to eat and drink if you are hungry or thirsty, your midwife will advise you when it is safe to do so.
You may have a drain in the wound to allow fluids to drain away to aid healing. It usually remains in place for a day or two and is
gently removed by your midwife. Some women experience numbness around the wound and even in the abdomen for some time
after the operation. This is normal as the nerves and muscles need time to heal. Your midwife will regularly check your wound for
signs of infection. Symptoms may be redness spreading from the wound, increased pain and a smelly discharge, often accompanied
by feeling unwell and having a high temperature. If you develop any of these contact your midwife or GP. It is important to complete
any prescribed antibiotics and to take pain relief as recommended by your carers. A tube which keeps your bladder empty (catheter),
will be removed once you are able to walk.
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Have a bath or shower daily, ensuring the wound is carefully washed and dried. If you notice any bleeding from your wound, contact
your midwife or GP for advice. There is no need to apply a dressing unless supplied by your midwife or GP. Wear loose clothing
and cotton underwear.
You will have stitches in your wound, they will either be dissolvable or will need to be removed. If they need to be removed your
midwife will gently do this after about 5 days.
Going home after a caesarean section. Women usually stay in hospital for 2 - 3 days after the birth. If you and the baby are
well, you may be able to go home earlier. When you go home, you should continue to take regular pain killers for as long as you
need them. There may be some things that you are not able to do straight after the birth, such as driving a car, lifting heavy things
and some exercises. If you are unsure, discuss any concerns or problems with your midwife or GP. Check with your car insurance
cover about driving after a caesarean. Some insurance companies require your GP to certify you are fit to drive.
Just because you have had a caesarean birth this time, it does not mean you will have to have another one next time. It will depend
on the reason for the caesarean. You can talk to your carers about the reason you had a caesarean this time and your options for
future pregnancies. Many women go on to have a vaginal birth after having a caesarean.
Care of the pelvic floor and perineum
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What is the pelvic floor? Layers of muscle stretch like a hammock from the pubic bone in the front of the pelvis to the bottom
of the backbone. These firm supportive muscles are called the pelvic floor. They help to hold the bladder, womb and bowel in
place, and to close the bladder outlet and back passage. The muscles of the pelvic floor are kept firm and slightly tense to stop
leakage of urine from the bladder or faeces from the bowel. When you pass urine or have a bowel motion, the pelvic floor
muscles relax. Afterwards they tighten again to restore control. Pelvic floor muscles can become weak and sag because of
childbirth.
Pelvic floor exercises. Pelvic floor exercises can strengthen these muscles so that they once again give support. This will
improve your bladder control and improve or stop leakage of urine. Like any other muscles in the body, the more you use and
exercise them, the stronger the pelvic floor will be.
Performing pelvic floor exercises
(Taken from FIT for the future, a leaflet produced by the Association of Chartered Physiotherapists in Women’s Health).
To do your pelvic floor exercises first get into a comfortable position (any position will do). Imagine that you are trying to stop
yourself from passing wind and at the same time trying to stop the flow of urine. The feeling is one of ‘squeeze and lift’, closing
and drawing up the back and front passages. This is called a pelvic floor contraction. Remember – you should start gently and
stop if it hurts. Do not pull in your stomach excessively, squeeze your legs together, tighten your buttocks or hold your breath.
This programme is designed to build up the endurance of the pelvic floor muscles, so that they will be able to work harder and
longer.
Firstly though, you will need to determine your ‘starting block’. Tighten your pelvic floor muscles as previously described and
hold for as many seconds as you can (maximum of 10 seconds). Release the contraction and rest for 4 seconds. Then repeat
the ‘tighten, hold and release’ movement as many times as you can (up to a maximum of 10). For example, if you can hold the
contraction for 2 seconds and repeat four times, this is your ‘starting block’. Now perform the basic pelvic floor exercise – but
squeeze and lift more firmly, then let go. This is called a quick contraction and will help your muscles react quickly when you
laugh, cough, sneeze, exercise or lift. Aim to increase the number of quick contractions, up to a maximum of 10. Remember it
can take several months for the pelvic floor muscles to return to their previous strength. Pelvic floor muscle exercises are
important for life - for all women.
Feel free to ask your midwife or doctor – or look on the web: www.preg.info
page
13
This page is for you to write any questions or concerns that you wish to discuss with your midwife.
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Mother’s page
Reflections on your birth experience
(Completed during the postnatal period, at appropriate times)
You may find it helpful to discuss aspects of your pregnancy, birth and postnatal experience with your care givers. This can take place
at any time and your midwife may wish to record the details below.
Details
Signature*/Date/Time
Pregnancy
Birth
Postnatal
page
14
Name
Unit No/
NHS No
* Signatures must be listed on page 18 for identification
Keeping fit and healthy
Important symptoms
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If you think you need to lose weight, talk to your GP or practice nurse. If you are breastfeeding and you’re overweight, the best way
to lose weight healthily is by eating a well-balanced diet and taking regular moderate exercise e.g. a brisk walk for 30 minutes every
other day. If you had a straightforward birth you can start exercising as soon as you feel ok to do so. If you had a complicated birth
e.g. caesarean section, discuss with your midwife before starting any strenuous exercise. Activity can relax you, it can help your body
recover after childbirth and increase your energy levels. Local postnatal classes may be run in your area. Ask your midwife or health
visitor if they know of any. Being overweight (i.e. BMI over 30) has a risk for long term health. You will more at risk of developing
diabetes and heart disease if you are overweight.
Quitting smoking for you and your family. The best thing you can do for you and your family’s health is to stop smoking. It is
never too late to stop smoking and now is a very good time. Tobacco smoke contains over 4000 chemicals. Babies and children
breathe faster than adults, and all of these chemicals can easily pass into their lungs. Their immune systems are less developed than
adults and this makes them more likely to develop a serious illness. e.g. asthma, glue ear, chest infections. Babies are at an increased
risk of cot death if they are exposed to cigarette smoke. Your midwife or health visitor will be able to tell you about local “Stop
Smoking” groups. Or you can access information on line www.nhs.uk/smokefree. Even if you do not smoke but other adults do in
your household, ask them to smoke outside. Never smoke in the car with your baby or children. Smokers increase the risk of house
fire by 40%. Smoke detectors and fire safety checks are provided for free from your local fire station.
Alcohol/street or illegal drugs. Drinking too much alcohol can cause a variety of health problems e.g. high blood pressure and
liver problems. Do not drink alcohol if breastfeeding. You should avoid drinking more than 2-3 units a day. Avoid binge drinking. The
safe level for women is no more than 14 units per week. 1 unit of alcohol = Half a pint of beer/lager. A single measure of spirits =
25 mls e.g. vodka, gin or a small glass of wine 125mls. 1.5 units = alcopops e.g. Smirnoff Ice. If you use street or illegal drugs, there
is support and help available. Speak to your midwife or GP who will be able to refer you to specialist services.
See page 18 for contact numbers for support groups.
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Abnormal vaginal bleeding. Varying amounts of blood loss during and after the delivery affect women in different ways. If you
begin to develop symptoms including palpitations, dizziness, a rapid pulse, weakness, sweating and restlessness following or during a
heavy blood loss, you should contact your midwife or GP immediately.
Infection. Signs of infection to look out for following childbirth are: fever and chills; a rash; lower abdominal pain and tenderness;
offensive, foul-smelling vaginal discharge; and a tender uterus. If you develop any of these tell your midwife or GP.
Headache with neck stiffness, fever and visual disturbances. Many women may suffer from tension headaches and/or migraines after
the birth. These usually resolve with mild pain relief (eg paracetamol) and rest. Relaxation exercises may also help to get rid of tension.
If however you have a sudden onset severe headache with neck stiffness and a high temperature you should contact your midwife
or GP straight away. If the severe headache occurs within 3 days of the birth and is accompanied with heartburn-type pain, blurred
vision and ‘flashing lights’, nausea or vomiting, you should also contact your carers as this may indicate a sudden rise in blood pressure,
which may require treatment. If you had an epidural and then develop a headache which worsens when you are upright but is relieved
when you lie down and is accompanied by nausea and vomiting and ringing in the ears, this could be symptomatic of epidural
complications and should be reported to your midwife or GP.
Red, painful area on the breast. This is most common in women who are breast feeding and maybe due to infective or non-infective
mastitis. Symptoms are a high temperature and flu-like symptoms. Non-infective mastitis is usually caused by blocked milk ducts. It
is relieved by frequent feeding and effective attachment. If the symptoms persist after a couple of feeds, there maybe an infection
Key to abbreviations: DVT = deep vein thrombosis
present, especially if you have cracked nipples.
You may need antibiotic treatment. Neither is a reason to stop breastfeeding, as this
helps to keep the milk flowing and relieve symptoms. Your midwife will check that your baby is attached effectively, and will show
you how to relieve the symptoms by massaging the breast as well as how to hand express between feeds. Pain killers will help to
relieve the symptoms and it is important to rest and drink plenty of fluids.
Breast feeding and thrush. Some women develop thrush in their breasts. This may happen if you have been given antibiotics or as a
result of cracked nipples. You and your baby may have no signs of infection, but if you develop marked nipple pain or, shooting pains deep
in your breasts during feeding, which continues after the feed, contact your midwife or GP as you may need treatment for thrush.
Persistent fatigue, faintness, dizziness, tingling fingers and toes. These are all symptoms of anaemia, which is caused by too
little haemoglobin (Hb) in the red blood cells. This can be treated with iron supplements and dietary advice. If you are concerned,
discuss this with your carers.
Backache. This is common after childbirth and is likely to improve with mild pain relief and normal activity. Your midwife will advise you on
the correct posture when handling, lifting and feeding your baby. If you experience pain radiating down one or both legs, this could be nerve
root pain (sciatica) and you should consult your GP.
Painful intercourse (dyspareunia). After childbirth it is not unusual for intercourse to be uncomfortable initially and may be one of
the reasons why many couples find enthusiasm for sex reduced for a time. Lubricant gel may ease the soreness and effective contraception
may relieve the added concern of another pregnancy. However, if the pain persists see your GP, who can assess whether you may need to
be referred to a specialist.
Planning for next time
It is recommended that you do not have intercourse until after the bleeding has stopped for a few days and you feel ready. This allows
time for healing to take place and to prevent infection. It may take longer depending on your own recovery and if you have had
stitches or a caesarean. It is very common during the early months to experience a reduction in sexual desire, due to many factors
such as tiredness and adjusting to your new role in life. Returning to normal sexual relations is very dependant on the individual.
Family Planning. There are many forms of contraception, ranging from natural family planning - such as methods based on urine
testing, barrier methods - male and female condoms, diaphragms, caps and spermicidal foams, creams and jellies. Hormonal
contraception - pill and implants. Intra-uterine devices (coil) are also available. Permanent methods are tubal ligation for women
and vasectomy for men. All these choices may seem confusing. Your midwife can provide you with leaflets to help you and
your partner choose the method that is most suited to you both. You can also ask your GP, practice nurse or family planning
clinic for more information on any method that you are interested in. You should return to your chosen method of contraception
within four weeks of the birth to ensure protection. It is also important to be aware that most methods of contraception do not
protect you from sexually transmitted infections.
Folic acid. When you are trying to get pregnant again, you should take a 400 microgram (mcg) folic acid supplement each day, from the
time you stop using contraception until the 12th week of pregnancy, to protect your baby from spinal defects. If you have diabetes; epilepsy
treated with medication; BMI over 30 or you or your family have a history of spinal defects, you will require a higher dose 5mg.
See your GP who can advise you.
BMI = Body Mass Index
page
15
Checklist for transfer of care to community midwife
To be completed by midwife prior to mother leaving hospital after the birth or following a home birth
Community midwife
Professionals informed
Health visitor
GP
Other
Yes No
Yes No
Discharge address checked
Prescription given if necessary
Contact numbers given
Pattern of postnatal visits explained
Support at home discussed
Out-patient appointment (if necessary)
Urinary/faecal incontinence referral
Breast self-awareness explained
Cervical smear explained
Serology results checked
Anti D given
MMR vaccine given
6-8 weeks postnatal exam appointment
Handover of care tool (as per Trust guideline)
Relevant details
Date
D
D M M Y Y
Appointments
Date
Time
D D M M
Y
Y
Time H H M M
Where
Signature*
With
Reason
Anyone writing in these notes should record their name and signature here
SA
M
Signatures
PL
E
Family and Friends test discussed
Abbreviations:
CMW = Community Midwife; MW = Midwife; StM = Student Midwife; HV = Health Visitor; MSW = Maternity Support Worker; Ph = Phlebotomist
GP = General Practitioner; Con = Consultant; ST = Specialist Trainee; FY Foundation year doctor; US = Ultrasonographer
Name (print clearly)
Post
Signature*
Name (print clearly)
Post
Signature*
Support Groups
Alcohol Concern
Bladder and Bowel Foundation Helpline
BLISS Family Support Line
Childline
Citizens Advice Bureau (CAB)
Contact a Family (Disability)
Frank About Drugs
Gingerbread
La Leche League (breastfeeding)
Maternity Action Advice Line
page
18
0300 123 1110
0845 345 0165
0500 618 140
0800 1111
0344 4111 444
0808 808 3555
0300 123 6600
0808 802 0925
0845 120 2918
0845 600 8533
MIND-for better mental health
National Breastfeeding Helpline
National Childbirth Trust - Postnatal
National Domestic Violence Helpline
NHS Direct
NHS Pregnancy Smoking Helpline
Parentline Plus
Tax Credit Information
Working Families (rights and benefits)
Postnatal Notes © - Version 15.1M (April 2015)
Web: www.perinatal.org.uk E-mail: [email protected] Tel: 0121 607 0101
0300 123 3393
0300 100 0212
0300 330 0700
0808 2000 247
111
0800 169 9169
0808 800 2222
0345 300 3900
03000 120 312
SUMMARY of BIRTH
Para
To be completed by midwife present at birth
+
Unit /Place
of birth
Health
Visitor
Name
Address
GP
Date
of birth
Postcode
D
D D M
M M
Y
Health visitor
NHS
No.
Unit No.
Baby 1
Baby 2
Name
NHS no.
Perineum
EBL
PL
E
Third stage management
Unit no.
Comments e.g.labour onset, prolonged rupture of membranes
DOB
Time
Sex
Gestation
Birth weight
Birth weight centile
Mode of delivery
Outcome
Apgars
Duration of labour
Date
YY
h
D
D D M
M M
YY
Y
m
Signature*
Title
MATERNAL DISCHARGE SUMMARY from Midwifery Care
SA
M
To be completed by midwife at discharge to Health Visitor/ GP.
Blood test results
Mental health
During the last month have you often been bothered by:
Feeling down, depressed or hopeless
Last Hb
Blood group
Investigations / immunisations
BN
Site
No Yes
Having little interest or pleasure in doing things
Date / Signed*
Feeling worried, nervous or on edge
Anti D
Not able to stop or control worrying
MMR
Is this something you feel you need or want help with
Mental health comments
Perineum
Contraception
Not discussed
Leaflet given
Chosen method:
Baby 1
Method of feeding
at discharge
Discharge
weight (g)
Smoke free
household
Referral to smoking
cessation
Family and Friends
test discussed
Baby 2
Blood spot
Yes
No test
Yes
No
Yes
No
D D M
M M
Date D
YY
Y
BCG vaccine
given
Signature*
Top copy to HEALTH VISITOR; second copy to GP
Details of any postnatal problems
6-8 week postnatal check arranged
Venue
Appointment
date/time
D
D D M
M M
YY
Comments
Initial safe sleeping assessment carried out?
Yes
No
Yes
No
Yes
Y
No
H H M M
No Yes
Title
* Signatures must be listed on page 18 for identification
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16
Emotional wellbeing
Help and support at home. You will probably need a lot of help at first, not just with cooking and housework, but also to give you
emotional support. The more you can share your baby’s care, the more you will enjoy your baby. You are bound to feel up and down
and get tired easily in the early days. Your partner can help with bathing, changing and dressing as well as cuddling and playing. If you are
on your own, or your partner is unable to be with you, perhaps your mother or a friend can be there. You may find it helpful to discuss
any problems or worries you may have with your midwife or GP.
Adjusting to a new baby can leave parents drained, especially in the first few months. Loss of sleep and all the new challenges in
understanding how to meet your baby’s needs can add to the pressure. There is often little or no time for you and your partner to
spend time together and attempting to be super parents may leave you both exhausted. Keep meals simple, try to space visitors out
and if you need extra help – ask. You may also want to talk to mothers in a similar situation. Your health visitor has information about
child health clinics or mother and baby groups in your area. Other contact numbers and support groups are available (see page 18).
Baby blues. Up to 80% of new mothers go through the ‘baby blues’. This is the tearfulness which can occur in the first three or four
days. It is rather like coming down to earth with a bump after giving birth. It may be caused by hormone changes, tiredness, and
discomfort from sore stitches or sore breasts. It usually passes after a few days, but rest as often as you can during the day.
PL
E
Other types of emotional changes that can occur after childbirth.
10-15% of new mothers have some experience of postnatal depression. Many more – perhaps half – go through spells of feeling
very low, lacking in confidence, loneliness, isolation and exhaustion – these are normal feelings if you have just given birth, but usually
they are mild.
If you are experiencing any of the following symptoms, contact your carers for advice.
feelings of anxiety
• varying degrees of tearfulness and irritability
loss of confidence
• feelings of hopelessness or despondency
sleeping and eating difficulties
• loss of interest in yourself or your baby
difficulty coping with day to day tasks
• feeling better in company and worse alone
dissatisfaction with the quality of relationships
• feelings of loneliness and isolation
What can be done if you develop postnatal depression? It is a real illness and the most important part of treatment involves
telling someone how you feel. Simple things like looking at your social support maybe all that is required. Your midwife, health
visitor or GP can help you and can arrange for further support. Your GP may prescribe anti-depressants, which are not considered
to be addictive, and have been found to be extremely helpful in treating the symptoms.
•
•
•
•
•
General information
SA
M
Screening. If you did not have screening for your Hb, blood group, antibodies, rubella, hepatitis B, syphilis, HIV, sickle cell and
Thalassaemia in the antenatal period, it is recommended to be done postnatally. Ask your midwife for more details.
Healthy eating and drinking. With a new baby it is important to eat a healthy balanced diet containing bread, breakfast cereals,
potatoes, pasta, and rice to give you energy, as well as fruit and vegetables. Lean meat, chicken, fish, eggs and pulses are good
sources of protein. Dairy foods, such as milk, cheese and yoghurt contain calcium as well as protein. It is also important that you
are a healthy weight for your height before you become pregnant again. If you have concerns about your weight, contact your GP.
General postnatal exercise. Postnatal exercises are very important and should be tailored to your individual needs dependent
on the type of birth you have had. They include abdominal, leg and breathing exercises as well as relaxation techniques. Please
ask your carers for more information. For pelvic floor exercises see page 13.
Domestic abuse. 1 in 4 women experience domestic abuse at some point in their lives and many cases start or worsen during
pregnancy or after the birth. It may take the form of physical, sexual, financial control, mental or emotional abuse. Domestic
abuse risks both your health and that of your baby. You can speak in confidence to your healthcare team who can offer help
and support, or you may prefer to contact a support agency such as the National Domestic Violence Helpline (see page 18).
Prescriptions and NHS dental treatment. These are free for 12 months after you have given birth. Your child is also entitled
to free prescriptions until the age of 16. To claim after your baby is born (if you did not claim whilst you were pregnant), ask
your midwife or GP for the appropriate form and you will be sent an exemption certificate (FW8). If you have private dental
care, you will need to discuss this with your dentist.
Work and benefits. The ‘Parents Guide to Money leaflet, has been developed to give you information on all financial aspects
of the arrival of a new baby including budgeting, benefits and work options. You may be given this leaflet during your stay, or
you can access information online: www.moneyadvicesevice.org.uk. Your midwife will be able to advise you on where to get
this leaflet. Your employer should provide information about your options regarding returning to work and maternity leave
entitlements. Child benefit is also available for each child from birth until at least age 16 and can be claimed by the mother or
the person responsible for the care of the child. You should receive a claim pack for this after the birth.
Family and friends test. This is an important opportunity for you to provide feedback on the services that provide your care
and treatment. Your feedback will help NHS England to improve services for everyone. You can ask a member of staff for more
information about how this information is used. Completion is voluntary, but if you do answer, your feedback will provide
valuable information for your hospital to celebrate good practice, and identify opportunities to make improvements. You will
be asked to complete this survey after the birth of your baby either before you leave the hospital/birthing unit or at home if you
had a home birth. The survey will be repeated when the community midwives discharge you from their care. For more
information about the programme visit www.england.nhs.uk
page
17
Feel free to ask your midwife or doctor – or look on the web: www.preg.info