Postnatal Care

The subject of discussion for this assignment will be the midwives role and responsibilities in delivering postnatal care and support to Rosie and her family, following the birth of her third child.

The Midwives rules and standards (Nursing and Midwifery Council (NMC) 2004) state that "the Ð''postnatal period' mean's the period after the end of labour during which the attendance of a midwife upon a woman and baby is required, being not less than ten days and for such longer period as the midwife considers necessary". In a previous publication of the Midwives Rules and Code of Practice by the United Kingdom Central Council (UKCC) (1998) this period of time was for up to twenty-eight days. Rule 6 of the Rules and Standards (NMC 2004), states that the primary focus of the midwives practice should be the needs of the mother and baby and that the midwife should work in partnership with the woman and her family to enable the woman to make informed decisions in her care. In providing the care to a woman the midwife will work within the boundaries of the NMC's Code of professional conduct (2004b), by gaining consent before giving care and in maintaining the woman's confidentiality and privacy in her home.

The puerperium, also known as the postnatal period, is the time immediately following the birth of a baby and represents the period of time when a woman's reproductive organs and structures are returning to their near pre-gravid state. This period is estimated to be between six to eight weeks depending on the individual woman (Coad and Dunstall 2005). For the purpose of the essay the definition of the post natal period will be the first ten days.

The role of the midwife during the postnatal period should include care of all aspects of the woman's health. During this time women are adjusting physically, emotionally and socially to a major life changing event. The care that a woman receives should be tailored to meet her individual needs (Royal College of Midwives 1997) and to ensure there are not any deviations from the normal in respect to health. The aim of good midwifery postnatal care is to build up the woman's, and her partner's confidence in their own abilities to care for their child competently, so that when the time comes for the midwife to cease calling; the parents and the midwife will feel confident that they are able to care for the child safely (Cronk and Flint 1989). Routine discharge from midwifery care is usually around the tenth to the fourteenth day depending on the individual needs of the woman, followed up with a postnatal check by the woman's General Practitioner (GP) at six to eight weeks.

While working in the community the author was able to visit many women postnatally and has gained an understanding of the importance in the provision of sound evidence based postnatal care and support. By providing continuity of care in visiting women more than once the author found that she was able to build up a rapport with some of the women. This can make it easier for a woman to confide in and talk about any problems they might have. Continuity of care is referred to as care provided by the same person or small group of people for a period of time, for example the postnatal period (Hodnett 2000). In a review of trials by Hodnett (2000), it was found that women who had continuity of care by a team of midwives were more likely to discuss postnatal concerns, feel better prepared and supported. In the author's experience she found that women like Rosie, who are having their second and subsequent children still require the same, if not more support, but in a different way, for example how to cope strategies and child care.

A postnatal visit by the midwife should include the following routine maternal observations:-

Blood pressure, if indicated Temperature, if indicated

Abdominal palpation Lochia

Perineum Examination of legs

Micturition Bowels

Breasts Abdominal wound (if present)

Information on sudden infant death syndrome (SIDS), exercise, family planning and registration of the baby, would also be given before Rosie is discharged from the midwife's care. The clinical observations would be performed and recorded as appropriate to the woman's condition (Bick 2004). In an evaluation by Takahashi (1998) on routine maternal temperature checking, it was suggested that routine observation of the maternal temperature in the puerperium has limited value as a screen test for detecting infection. This was due to variability of when it was taken, the reliability of how it was taken and pyrexia in itself is not always an indication of infection. In the author's Trust routine observation of temperature is not undertaken unless there is a clinical indication.

Rosie had indicated that this pregnancy was unplanned and she was concerned about how they were going to manage. With this in mind the midwife would be aware that Rosie may still be worried after the birth and that this could affect the way she recovers. From practice experience the author found that a routine postnatal check would begin with introductions if the midwife had not met the woman before, followed by a period of relaxed discussion (chatting) during which the midwife would observe how the woman responded. During this time questions would be asked about how the woman felt in herself, if she was getting enough sleep at night to cope during the day and if she had any concerns about herself or the baby. The midwife would be looking for any signs that Rosie maybe feeling down, such as being tearful and withdrawn and appearing to not be coping very well generally. Lack of sleep can affect mental and physical wellbeing and after only two Ð'- three days of reduced sleep the ability to perform even simple tasks is impaired (Ockenden2003).

Depression is also related to fatigue and The National Institute for Health and Clinical Guidelines on postnatal care (NICE 2006) competencies include recognising the signs and symptoms of maternal mental health problems, which could include tiredness. The author feels that trying to understand Rosie's physical and mental concerns would be more likely through careful observation from a midwife who is able to visit on more than one occasion.

Rosie is breastfeeding this baby, her other children were bottle fed, so Rosie may need extra support with breastfeeding. This will include making sure that the baby is attaching to the breast