Postnatal Care — Mother & Newborn
Postnatal care (PNC) covers the 6 weeks after delivery. This is the most dangerous period in a woman's reproductive life — 60% of maternal deaths occur in the postpartum period, mostly from haemorrhage, sepsis, and eclampsia. India's PNC model uses ASHA-led home visits complemented by facility-based check-ups, integrated with JSSK free services.
WHO recommends at least 4 postnatal contacts: Day 3, Day 7, Day 14, and 6 weeks postpartum. India's PNC schedule (more intensive):
- Day 0 (immediately after delivery): Facility-based — monitor for PPH, observe bleeding, BP, pulse, urine output for 24 hours after vaginal delivery, 48 hours after C-section
- Day 3 (home visit by ASHA): Check involution, lochia, perineum/episiotomy, BP, bleeding, breastfeeding, mood
- Day 7 (home visit): Same as Day 3 plus jaundice in newborn
- Day 14 (home visit): Same plus cord fall, weight check
- 6 weeks (facility visit): Full maternal and newborn check, family planning, immunisation
ASHA conducts 6-7 home visits in the first 42 days. Higher-risk mothers (anaemia, preeclampsia, LSCS, multiple gestation) receive additional visits.
Uterine involution: Fundus at umbilicus immediately postpartum, descends 1 cm/day, not palpable abdominally after 2 weeks. Involution delay suggests endometritis or retained products.
Lochia: Lochia rubra (red, day 1-4), serosa (pinkish-brown, day 5-10), alba (yellow-white, day 11-6 weeks). Foul-smelling lochia suggests puerperal sepsis. Excessive bleeding suggests retained products or subinvolution.
Breastfeeding: Exclusive breastfeeding for first 6 months. Colostrum in first 3 days (rich in IgA — must not be discarded). Mature milk by Day 3-5. Latch technique, feeding on demand (8-10 times in 24 hours). Manage engorgement, cracked nipples, mastitis.
Family planning: Discuss during pregnancy, decide postpartum. Lactational Amenorrhoea Method (LAM) — 98% effective if exclusive breastfeeding, amenorrhoea, baby < 6 months. Progestin-only pills from 6 weeks postpartum (safe in breastfeeding). IUCD (Cu-T 380A) inserted within 48 hours postpartum or after 6 weeks. Sterilisation (mini-lap) at 6 weeks.
Mental health: Baby blues (50-80%, day 3-10, self-limiting), postpartum depression (10-15%, persistent low mood, anhedonia, requires treatment), postpartum psychosis (rare, emergency). Screen with EPDS (Edinburgh Postnatal Depression Scale) at 6 weeks.
- Essential newborn care (ENC) immediately after birth: Dry, warm (skin-to-skin with mother), initiate breastfeeding within 1 hour (golden hour), delayed cord clamping (1-3 minutes), APGAR at 1 and 5 minutes, vitamin K 1 mg IM
- Exclusive breastfeeding for first 6 months — no water, no top feed, no gripe water
- Immunisation: BCG + OPV-0 + Hep B birth dose before discharge; pentavalent + OPV + IPV + RV + PCV at 6, 10, 14 weeks; MR at 9 months
- Weight monitoring: Loss up to 10% in first week is normal; regain birth weight by Day 10-14. Slow weight gain suggests inadequate feeding.
- Umbilical cord: Falls off by Day 5-15. Keep clean and dry. No antiseptic needed (clean dry cord care). Foul-smelling discharge = omphalitis.
- Jaundice: Physiological jaundice appears Day 2-3, peaks Day 5-7, resolves by 14 days. Phototherapy if total bilirubin exceeds age-specific cutoffs (Bhutani's nomogram). Pathological jaundice — within 24 hours, > 15 mg/dL, prolonged > 14 days.
- Danger signs in newborn: Not feeding well, fever (> 37.5°C) or hypothermia (< 36.5°C), severe chest indrawing, cyanosis, convulsions, lethargy, vomiting everything, bleeding from umbilicus — refer urgently to higher centre
- Postpartum haemorrhage (PPH): Blood loss > 500 mL (vaginal) or > 1000 mL (C-section) within 24 hours (primary) or 24 hours-12 weeks (secondary). Causes (4 Ts): Tone (atonic — most common), Trauma, Tissue (retained), Thrombin (coagulopathy). Manage: uterine massage, oxytocin 10 IU IM/IV, misoprostol 600 mcg sublingual, bimanual compression, referral to FRU.
- Puerperal sepsis: Fever > 38°C after 24 hours, foul lochia, uterine tenderness. Causes: endometritis, wound infection, mastitis, UTI, pneumonia. Treat with IV antibiotics (Ceftriaxone + Metronidazole ± Gentamicin).
- Postpartum eclampsia: Seizures within 6 weeks postpartum. Treat with IV Magnesium sulphate (Pritchard or Zuspan regimen) + antihypertensives.
- Postpartum depression: Persistent low mood, anhedonia, anxiety, thoughts of harming baby. Screen with EPDS. Treat with SSRIs (Sertraline safe in breastfeeding), psychotherapy.
- Mastitis/breast abscess: Painful red lump on breast, fever. Continue breastfeeding, antibiotics (Cloxacillin/Cephalexin). Abscess needs incision and drainage.
Postnatal care is where India's maternal mortality battle is won or lost. For UPSC CMS aspirants, PNC schedule, breastfeeding, PPH management, puerperal sepsis, and postpartum family planning are highly testable OBG topics.