Care of mother — first 24 hours after birth
- Always call for help — get midwife/doctor/obstetrician on speaker phone, if none locally
- Find support people — if possible female ATSIHP or older women familiar with birthing
- Reassure woman and explain what is happening. Have someone stay with her for support
Check
- Calculate REWS — AVPU, RR, O2 sats, pulse, BP, Temp
- Weight, BGL
- Signs of shock
- Increased RR
- Pulse weak and fast (more than 100bpm) or difficult to feel
- Central capillary refill longer than 2 seconds
- Pale, cool, moist skin
- Restless, confused, drowsy, occasionally unconscious
- Low BP for age or relative to person's previously recorded values
Do — in first hour
After birth of placenta
- Check STI status
- Syphilis serology
- If STI status not known — do Pregnancy STI check
- Check that blood and swabs for all other routine tests have been collected
- Record in file notes
- Date and time of birth
- Time of delivery of placenta
- How much blood woman lost — 1 soaked pad is equal to about 100mL
- What you did, any problems you had, etc
- Any medicines, immunisations given to mother and/or baby
- Whether placenta and membranes are complete or incomplete
- Complete birth registration forms
- If mother comfortable — put baby on her chest, encourage skin-to-skin contact and breastfeeding. Offer help if needed
- Encourage woman to pass urine — full bladder can stop uterus contracting and cause heavy bleeding
- Offer woman something to eat and drink, shower and change of clothes
- Make sure placenta checked and is complete
- Don’t forget to celebrate and debrief
- If challenged or distressed by anything you saw or did talk with friends, colleagues and/or qualified counsellor, eg Bush Support Services on 1800 805 391
- Medical consult
- Refer to mother’s medical and obstetric history
Talk about
- Labour, birth, condition of mother and baby AND
- Problems with woman, baby or placenta
- If needing to send to hospital — send placenta, birth documents, bloods, birth registration and family assistance forms with woman
Do
Blood tests
- If no antenatal care — medical consult
- Bloods as for first antenatal visit including FBC (best done 24 hours after birth), syphilis serology — see Antenatal checklist
- If woman RhD negative or blood group unknown — medical consult
- May need to transfer to hospital for cord blood processing and RhD-Ig within 72 hours
- Take blood for Kleihauer test (to determine amount of foetal blood in maternal circulation) — within 2 hours of birth and before giving RhD-Ig
Talk with woman about
- Emptying bladder regularly to lessen risk of heavy bleeding
- How to feel top of her uterus and how to massage it to make it hard if she has heavy bleeding
- If heavy bleeding (needing to change pad more than every few hours) — tell clinic staff as soon as possible — this is an emergency
- Perineal hygiene and healing — changing pads often and shower at least once, preferably several times a day
- If perineal tear — call maternity service
- 'After birth' pains — crampy uterine pains, often worse when breastfeeding — give pain relief if needed
- Symptoms of thromboembolism (clots) — DVT or PE
- Breastfeeding
- Arrangements for follow-up/ongoing care including contraception — see Postnatal care of mother
Before leaving clinic
- Encourage woman to move about to help prevent blood clots in her legs
- If woman staying in community
- Mother and baby should rest in clinic for at least 4 hours or as long as needed after birth
- Make sure woman has passed urine before leaving clinic
- Make sure woman has someone staying with her to help look after baby
- Fill in forms for birth registration, perinatal statistics and family assistance
- Remind woman to attend Centrelink and have 100 points of identification ready