Postpartum and Newborn Care
Postpartum and Newborn Care
This domain tests immediate and ongoing assessment of the mother–baby pair: uterine tone, bleeding, lochia, perineum, breastfeeding, thermoregulation, newborn examination, and timely referral. The exam often uses a deteriorating mother or a small baby to test prioritisation.
Core rules
- After birth, check maternal vital signs, uterine contraction, blood loss, bladder, and perineum; massage a boggy uterus and give uterotonics according to protocol.
- Promote skin-to-skin contact and breastfeeding within the first hour; support exclusive breastfeeding on demand.
- Newborn: dry, warm, stimulate, assess breathing and heart rate; APGAR at 1 and 5 minutes; give vitamin K 1 mg IM to term babies (0.5 mg if preterm) and eye prophylaxis per national policy.
- Keep the cord clean and dry; in high neonatal mortality settings, chlorhexidine cord care may be used.
- Schedule postpartum contacts within 24 hours, on day 3, day 7, and at 6 weeks; teach danger signs for mother and baby.
Worked example
Two hours after a normal birth, a woman has a boggy uterus and heavy bleeding. Reasoning: this is uterine atony until proven otherwise. Call for help, massage the fundus, empty the bladder, give oxytocin, start IV access, monitor vital signs, and refer if bleeding continues. Do not wait for a doctor before basic resuscitation.
Traps
Judging blood loss by lochia alone; forgetting bladder distension; bathing the newborn early; applying harmful substances to the cord; and discharging before feeding and temperature are stable.