Postnatal care of the woman and newborn, including breastfeeding and transition to parenting
This domain tests systematic postnatal assessment, recognition of postnatal deterioration, and support for feeding and parenting. The postnatal period is where serious pathology is most often missed.
Maternal assessment
- Observations, PV loss, fundus, perineum, bladder, bowels, BP, VTE risk and mental health.
- Postnatal pre-eclampsia can present up to 6 weeks postpartum; check BP with headache, visual change or epigastric pain.
- Sepsis: fever, tachycardia, uterine tenderness, offensive lochia.
- VTE: consider in any breathlessness or leg pain.
- Perineal care: analgesia, hygiene, pelvic floor exercises and review of repair.
- Schedule visits in the first week, then as needed, with a 6-week check.
Newborn
- Newborn examination, feeding, weight, jaundice, hypoglycaemia, cord and skin.
- Heel prick 48–72 hours; hearing screen; B4 School Check later.
- Safe sleep: wahakura or pepi-pod; discuss bed-sharing risk.
Breastfeeding and parenting
- 8–12 feeds per 24 hours, effective attachment, nappy output, weight loss ≤10%.
- Mastitis: continue feeding, analgesia, antibiotics if systemic.
- Contraception and preconception advice.
- Emotional support, sleep, partner and whānau involvement.
Worked example
On day 4 a baby has lost 8.5% of birth weight, is jaundiced and feeding poorly. Assess attachment and intake, check bilirubin and escalate; do not simply reassure.
Traps
Attributing fever to mastitis without screening for sepsis; missing postnatal mental illness; not weighing the baby.