Practical skills for postpartum midwifery care after an operative birth

1. Practical skills for postpartum midwifery care after an operative birth

2. In the immediate period after an operative birth the attendant will be closely monitoring recovery from the anaesthetic used for CS • Regular observation of: • vaginal loss • leakage on to wound dressings • fluid loss in any ‘redivac’ drain system should also be undertaken. • Once the woman has fully recovered from the operation she should be transferred to a ward.

3. documented postnatal care plan so that she and caregivers have a clear framework by which to promote recovery • Women who have undergone an operative birth need time to recover from a major physical shock to the systems of the body • to allow tissue repair to take place as well as psychological adjustment to the events of the birth

4. During their hospital stay, they will need help to maintain their personal hygiene, to get out of bed and mobilize and to start to care for their baby. • It is strongly suggested that caregivers should not expect all women to have reached a certain level of recovery in line with their ‘postnatal day’.

5. It is now common for women to have a much shorter period in hospital after birth; some women might return home 48–72 hours after a major operation with very minimal support • For example; the midwife might suggest that the woman identifies the ways in which she could reduce the need to go upstairs

6. women can be encouraged to go out with their baby when someone is available to help with all the baby transportation equipment • this will encourage venous return and cardiac output at a level that is beneficial rather than exhausting. • getting ‘out and about’ can provide a sense of feeling good and improved wellbeing

7. The benefits of mobility after surgery are well known and although women may be supplied with thromboembolitic stockings prior to the operation and be prescribed an anticoagulant regimen such as heparin • women need to be encouraged to mobilize as soon as she can after the operation to reduce the risk of circulatory problems. • Women need an explanation that mobility is of benefit soon after the birth

8. Regular use of appropriate analgesia as required • Good information about self-care and recovery is important to every woman and the midwife has a key role to play in this process. • Each woman is an individual and unique

9. Emotional wellbeing: psychological deviation from normal • both, midwife and women have commented positively where such continuity has been achieved • the midwife might detect or be concerned about a change in the woman's behaviour that has not been noticed by her family.

10. it is the balance between the woman's physical condition and her psychological state that might influence an eventual decision to refer for expert advice.

11. the woman and her partner are likely to have an expectation of reduced sleep once the baby is born • The cause of the lack of sleep or tiredness is what is important – is the being unable to get to sleep a result of anxiety about the future and what is, as yet, unknown? • This might include fears about the possibility of a cot death, or a lack of confidence in coping as a mother, financial or relationship worries. • The opportunity to sleep might be reduced because the feeding is not yet established or the baby is not in a settled environment and so the mother is constantly disturbed when she tries to sleep. • other people may not be allowing the mother to sleep when the baby does not need her attention.

12. Tiredness and fatigue can adversely affect women's health and interfere with their adaptation to motherhood • the terms fatigue and tiredness are subjective and difficult to define postnatally. • Seeking what is the underlying cause and whether simple interventions could improve the situation. • chronic fatigue or anxiety prevents them from sleeping when the opportunity arises she needs referral and support.

13. where there is a physiological reason for the tiredness, as a result of anaemia for example, the situation can be managed clinically • Enabling women to plan and set realistic goals as part of their own recovery from childbirth is ongoing and extends beyond 28 days and 6 weeks

14. Self-care and recovery • notions of a set time period (6 weeks) • Women need guidance and sound information to enable them to recover so that they are clear about what they can expect and what to do when they are concerned. • Good rapport and positive feedback from midwives are known to help women in their recovery as well as support from partners, family and friends

15. Talking and listening after childbirth • The essence of the contact between the woman and the midwife after the birth event is to strive to maintain a therapeutic relationship • builds on the relationship formed ideally antenatally. Within the current provision of care, it is not always possible to achieve the objective of continuity of carer postnatally • some women will have postnatal home visits from several different midwives, possibly previously unknown to them. • maternity support workers (MSWs) may form part of the postnatal care-giving process under the supervision of midwives.

16. Where appropriate, a midwife undertaking postnatal care in the woman's home might be able to help the woman review and reflect on the birth by talking about it and listening to her concerns. • Where necessary, the midwife can facilitate referral to the key people

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