Checklist for Post natal check-up

Importance of post natal check-ups

Conventionally, the first 42 days (six weeks) after delivery are considered the post-partum period. The first 48 hours of the post-partum period, followed by the first one week, are the most crucial period for the health and survival both of the mother and her newborn. Most of the fatal and near-fatal maternal and neonatal complications occur during this period. Evidence has shown that more than 60% of maternal deaths take place during the post-partum period. Ensuring post natal care during this period is hence important for identification and management of emergencies occurring during post natal period.

Post natal check-up Schedule

• First visit -  If the delivery has not happened in the health centre, the first visit is to be within 24 hours of delivery.
• Second visit - 3rd day after delivery
• Third visit - 7th day after delivery
• Fourth visit - 6 weeks after delivery

There should be three additional visits in the case of babies with low birth weight, on days 14, 21 and 28 (as per the Integrated Management of Neonatal and Childhood Illness [IMNCI] guidelines).

Components of Post natal check-up

First visit

For mother

• History-taking
• Place of delivery
• Person who conducted the delivery
• History of any complications during the delivery / bleeding per vaginum / convulsions or loss of consciousness
• Pain in the legs / abdominal pain / fever / dribbling or retention of urine / any breast tenderness, etc.
• Initiation of breastfeeding the baby
• Has she started her regular diet?
• Are there any other complaints?
• Examination
• Pulse, blood pressure, temperature and respiratory rate.
• Presence of pallor.
• Abdominal examination.
• Examine vulva and perineum for the presence of any tear, swelling or discharge of pus.
• Examine the pad for bleeding to assess if the bleeding is heavy, and also see if the lochia is healthy and does not smell foul
• Examine the breasts for any lumps or tenderness, check the condition of the nipples and observe breastfeeding.
• Management / Counseling
  • Post-partum care and hygiene
  • Nutrition
  • Contraception
  • Registration of birth
  • IFA supplementation
  • Breastfeeding

First visit for baby

• History-taking
• When did the child pass urine and meconium?
• Has the mother started breastfeeding the baby and are there any difficulties in breastfeeding?
• Fever
• Not suckling well
• Difficulty in breathing
• Umbilical cord is red or swollen, or is discharging pus
• Movements of the newborn are less than normal
• Skin infection (pustules) - red spots which contain pus or a big boil
• Convulsions.
• Examination
• Count the respiratory rate for one minute.
• Look for severe chest indrawing
• Check the baby’s color for pallor / jaundice / central cyanosis (blue tongue and lips)
• Check the baby’s body temperature.
• Examine the umbilicus for any bleeding, redness or pus.
• Examine for skin infection
• Examine the newborn for cry and activity
• Examine the eyes for discharge
• Examine for congenital malformations and any birth injury
• Management / Counseling
• Maintain hygiene while handling the baby
• Delay the baby’s first bath to beyond 24 hours after birth.
• Maintain body temperature.
• Should not apply anything on the cord, and must keep the umbilicus and cord dry.
• Should observe the baby while breastfeeding and try to ensure proper/good attachment.

Second and third visits

For mother

• History-taking
• Apart from the questions asked during the first visit, also ask about the following:
  1. Continued bleeding P/V - occurring 24 hours or more after delivery
  2. Foul-smelling vaginal discharge
  3. Fever
  4. Swelling (engorgement) and/or tenderness of the breast
  5. Any pain or problem while passing urine (dribbling or leaking)
  6. Fatigue / ‘not feeling well’
  7. Unhappiness / Cry easily - post-partum depression
• Examination
• Pulse, blood pressure and temperature.
• Check for Pallor.
• Conduct an abdominal examination to see if the uterus is well contracted
• Examine the vulva and perineum for the presence of any swelling or pus.
• Examine the pad for bleeding and lochia.
• Examine the breasts for the presence of lumps or tenderness.
• Check the condition of the nipples.
• Management / Counseling
• Diet and rest
• Contraception

Second and third visits for baby

• History-taking - same questions as during the first post- partum visit
• Examination - observe the baby for the following:
• Whether he/she is sucking well
• If there is difficulty in breathing (fast or slow breathing and chest indrawing)
• If there is fever or the baby is cold to the touch.
• If there is jaundice (yellow palms and soles)
• Whether the cord is swollen or there is discharge from it
• If the baby has diarrhea with blood in the stool
• If there are convulsions or arching of the baby’s body.
• Management / Counseling - In addition to what was provided during the first visit counsel
• Exclusively breastfeed the baby for six months.
• Should feed the baby on demand or every 2 hours
• Supplementary foods should be introduced at 6 months of age, while breastfeeding can continue simultaneously.
• Baby’s weight loss
• Hygiene of the baby
• When and where to seek help in case of signs of illness
• Immunization

Fourth visit

For mother

• History-taking - Ask the mother the following:
• Has the vaginal bleeding stopped
• Has her menstrual cycle resumed
• Is there any foul-smelling vaginal discharge
• Does she have any pain or problem while passing urine (dribbling or leaking)
• Does she get easily fatigued and/or ‘does not feel well’
• Is she having any problems with breastfeeding
• Examination - includes the following:
• Check the woman’s blood pressure.
• Check for pallor.
• Examine the vulva and perineum for the presence of any swelling or pus.
• Examine the breasts for the presence of lumps or tenderness.
• Management / Counseling
• Diet and rest
• As in the second and third visits, emphasize the importance of Nutrition / Contraception

Fourth visit for baby

• History-taking - Ask the mother the following:
• Has the baby received all the vaccines recommended so far
• Is the baby taking breastfeeds well
• How much weight has the baby gained
• Does the baby have any kind of problem?
• Examination
  • Check the weight of the baby
  • Check if the baby is active/lethargic.
• Management / Counseling
• Emphasize the importance of exclusive breastfeeding.
• Tell the mother that if the baby is having any of the following problems, he/she should be taken immediately to the MO at the FRU - The baby is not accepting breastfeeds / The baby looks sick (lethargic or irritable) / The baby has fever or feels cold to the touch / The baby has convulsions / Breathing is fast or difficult / There is blood in the stools / The baby has diarrhea.
• Counsel the mother on where and when to take the baby for further immunization

Source : Guidebook for Enhancing Performance of Multi-Purpose Worker (Female)

Related Resources

1. Guidelines for Antenatal Care and Skilled Attendance at Birth by ANMs/LHVs/SNs
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