Postnatal Care
Topic outline
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Postnatal Care at the Health Post and in the Community
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Why is effective postnatal care so important?
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When do most mothers and newborns die in the postnatal period?
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What do mothers and newborns in the postnatal period die from?
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Physiological changes in the postnatal mother
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Complications in the newborn
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Your actions in the postnatal period
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Evaluating the postnatal mother
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Evaluating the newborn baby
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Follow-up after immediate postnatal care
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Methods for mobilising community action
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Establishing partnerships with community gatekeepers
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Conducting a community profile
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The Normal Puerperium
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Vagina and vulva
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Ovaries
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Breasts and initiation of lactation
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Excretion of excess body fluids
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Looking after the baby
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Birth control options
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In conclusion
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The Abnormal Puerperium
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Postpartum haemorrhage
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Causes of late postpartum haemorrhage
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Pre-referral management of PPH
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Puerperal sepsis and fever
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Endometritis
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Puerperal mastitis
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Wound infection
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Screening for postpartum hypertension
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Deep vein thrombosis (DVT)
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Postpartum ‘blues’ and postpartum depression
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Preparation for Postnatal Care
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Home visits: the best opportunity to provide postnatal care
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Barriers to facility-based postnatal care
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Evidence that home visits improve the effectiveness of PNC
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Schedule for postnatal home visits
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Personal hygiene
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Equipment
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Key steps to follow while conducting a home visit
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Counselling mothers during the postnatal period
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Routine Postnatal Care for the Mother
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Check the mother's vital signs
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Check if her uterus is contracting normally
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Clean the mother's belly, genitals and legs
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Check the mother’s genitals for tears and other problems
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Help the mother to urinate
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Eating and drinking in the first few hours
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Counselling on postnatal nutrition
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Preventing iodine deficiency
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Preventing vitamin A deficiency
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Preventing iron and folate deficiency
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Fathers and other family members can help
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When the mother isn’t interested in her baby
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Encouraging care-seeking behaviour
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Routine Screening of Newborns for Life-Threatening Conditions
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Your first actions before assessing a newborn
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Screening the newborn for general danger signs
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How can you recognise a convulsion in a newborn?
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Is the newborn lethargic or unconscious?
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Is the baby breathing too fast?
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Is the baby’s temperature normal?
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Infection in the newborn
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What are the signs of eye infection in newborns?
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What are the signs of an infected umbilical cord stump?
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What are the signs of skin infection?
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What is neonatal tetanus?
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How can you prevent infection in newborns?
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Neonatal assessment check list for critical conditions
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Breastfeeding, the Warm Chain Principle and Counselling HIV-Positive Mothers
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Counselling the mother on newborn feeding
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Four signs of good positioning
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Four signs of good attachment
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Benefits to the newborn of breastfeeding
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Benefits to the mother of breastfeeding
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Breastfeeding and birth control
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Counselling the HIV-positive mother about feeding her baby
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Replacement feeding and the AFASS criteria
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Keeping the baby warm
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How to take the newborn's temperature
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How do newborns lose heat?
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The warm chain principle in postnatal care
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Special Care for Preterm and Low Birth Weight Babies
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Why do preterm or low birth weight babies need special care?
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Classification on gestational age
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Tips to help a mother breastfeed a preterm or low birth weight baby
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Expressing breast milk
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Show mothers how to cup feed the baby
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Special care to keep preterm and low birth weight babies warm
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KMC procedures
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Making a Referral for Postnatal Care
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Effective referral
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The referral link: a two-way street
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Knowing about local health facilities
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What prevents referrals from happening effectively?
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Good documentation
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Transport and the emergency evacuation plan
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Making sure the health facility knows how to communicate with you