Recognising Maternal Sepsis on a Home Visit
On a day-four postnatal home visit, a woman who had a spontaneous vaginal birth at 39 weeks has a temperature of 38.4 C, pulse 118, respiratory rate 24, BP 104/62, and oxygen saturation 96 percent. Her uterus is tender, lochia is offensive, and the perineal repair is intact. She is alone with her newborn, has no car, and lives 25 minutes from hospital by ambulance. Her partner is at work. She says she feels a bit flu-ish and does not want to make a fuss. The newborn is feeding less than yesterday, temperature 36.9 C, respiratory rate 50, and is pink. The midwife must decide whether to manage at home, refer, and how to communicate the risk.
1. Does this woman meet sepsis criteria, and what should the midwife do in the next hour?
Read the worked answer
This is suspected maternal sepsis until proven otherwise. She has fever, tachycardia, tachypnoea, uterine tenderness, and offensive lochia, which suggest postpartum endometritis with possible sepsis. The midwife should use the local sepsis screening tool and act on it. She should not manage this at home with oral antibiotics or advice to monitor.
The midwife should call the hospital obstetric unit and arrange emergency ambulance transfer. She should stay with the woman, check observations again, and prepare for transfer. If trained and equipped, she may secure intravenous access and give fluids according to protocol, but antibiotics should be started at hospital within one hour of recognition. The woman should be told clearly that this is not a minor flu and that delay is dangerous. If she declines transfer, the midwife should assess capacity, explain the risks, involve the partner or emergency contact, and escalate. The newborn should not be left without a carer. Documentation should include all observations, times, advice, and referral.
2. How should the newborn be assessed and managed?
Read the worked answer
The newborn is at risk because the mother has a probable infection and because feeding has reduced. The midwife should assess tone, colour, respiratory rate, temperature, feeding, nappies, umbilical stump, and whether there are any signs of lethargy or poor perfusion. A respiratory rate of 50 and a temperature of 36.9 are within normal limits, but they do not exclude illness, especially with reduced feeding.
The baby should be kept with the mother if possible and transferred with her for review. The midwife should support breastfeeding or expressing, but should not assume that feeding alone will fix the problem. If the baby becomes floppy, dusky, grunting, or has a temperature outside normal range, urgent neonatal review is needed. The midwife should avoid unnecessary separation, but should not leave the baby at home with an unassessed carer. The reasoning is that neonatal sepsis is subtle, and the safest place for this baby is with the mother and under paediatric review.
3. How should the midwife communicate, document, and follow up?
Read the worked answer
The midwife should say: this is not making a fuss; these signs can become serious quickly, and you need hospital assessment today. She should explain what will happen, who will look after the baby, and how the partner will be contacted. She should arrange transport and not suggest that the woman drives herself. She should give an SBAR handover to the receiving unit, including birth history, observations, lochia, uterine tenderness, and newborn feeding.
Documentation should include the time of the visit, vital signs, the sepsis screen result, the advice given, the woman's response, the ambulance call, the handover, and the newborn assessment. The midwife should inform the community team and arrange follow-up after discharge. She should also reflect on whether earlier signs were missed and report the case through the incident system if appropriate. The reasoning is that clear communication and a complete record are part of the treatment: they ensure the woman receives timely care and the team can learn from the case.