Postnatal Care Health Problems in Women and Babies in Postnatal Care

Health problems in womenand babies in postnatal care

A NICE pathway brings together all NICE guidance, qualitystandards and materials to support implementation on a specifictopic area. The pathways are interactive and designed to be usedonline. This pdf version gives you a single pathway diagram anduses numbering to link the boxes in the diagram to the associatedrecommendations.

To view the online version of this pathway visit:

http://pathways.nice.org.uk/pathways/postnatal-care

Pathway last updated: 29 July 2015. To see details of any updates to this pathway since its launch,visit: About this Pathway. For information on the NICE guidance used to create this path, see:Sources.Copyright © NICE 2015. All rights reserved

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Health problems in women and babies in postnatal care NICE Pathways

Postnatal care pathwayCopyright © NICE 2015.

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1 Women and babies with health problems

No additional information

2 Common health problems in women

Health problem Action

Baby bluesIf symptoms not resolved after 10–14 days, assess for postnatal

depression, and if symptoms persist, evaluate further (urgent action).

Perineal pain,

discomfort,

stinging, offensive

odour or

dyspareunia

Offer to assess the perineum. Evaluate for signs of infection, inadequate

repair, wound breakdown or non-healing (urgent action).

Advise use of topical cold therapy and paracetamol (if not contra-

indicated), but if neither is effective consider oral or rectal non-steroidal

anti-inflammatory drug (non-urgent action).

Dyspareunia

In cases of perineal trauma offer to assess the perineum (see above).

Advise use of water-based lubricant.

If problem persists, evaluate further (non-urgent action).

Headache

Advise women who have had epidural/spinal anaesthesia to report

severe headache.

For tension/migraine headaches offer advice on relaxation and avoiding

factors associated with headache.

For mild headache follow local protocols.



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Persistent fatigue

Ask about general well-being and offer advice on diet, exercise and

planning activities. If it affects a woman's care of herself or baby,

evaluate underlying cause. Measure haemoglobin level and if low, treat

according to local policy.

Backache Manage as general population.

ConstipationAssess diet and fluid intake. If changes in diet are ineffective advise use

of a gentle laxative.

Haemorrhoids

If haemorrhoids are severe, swollen or prolapsed, evaluate (urgent

action). Otherwise advise dietary measures to avoid constipation and

manage according to local protocol.

Faecal

incontinence

Assess severity, duration and frequency. If symptoms don't resolve,

evaluate further (urgent action).

Urinary

incontinence

Teach the woman to do pelvic floor exercises, and if symptoms don't

improve or get worse, evaluate.

NICE has produced a pathway on urinary incontinence in women.

Urinary retention

(within 6 hours of

birth)

Advise methods of assisting urination such as taking a warm bath or

shower.

If this doesn't work, assess bladder volume and consider catheterisation

(urgent action).

Quality standards

The following quality statement is relevant to this part of the pathway.

Postnatal care quality standard

10. Maternal health – mental wellbeing



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http://pathways.nice.org.uk/pathways/urinary-incontinence-in-women

Resources

The following implementation tools are relevant to this part of the pathway.

Postnatal care: costing report

Postnatal care: costing template

Postnatal care: implementation advice

Routine postnatal care of women and their babies: presenter slides

3 Life-threatening conditions in women

Possible sign/symptom Evaluate for Action

Sudden or profuse blood loss, or blood loss and signs/

symptoms of shock, including tachycardia, hypotension,

hypoperfusion, change in consciousness.

Postpartum

haemorrhage

Emergency

action

Offensive/excessive vaginal loss, tender abdomen or fever. If

no obstetric cause consider other causes.

Postpartum

haemorrhage/

sepsis/ other

pathology

Urgent

action

Fever, shivering, abdominal pain and/or offensive vaginal loss.

If temperature exceeds 38°C repeat in 4–6 hours. If

temperature still high or other symptoms and measurable signs,

evaluate further.

Infection/

genital tract

sepsis

Emergency

action

Severe or persistent headache.Pre-eclampsia/

eclampsia

Emergency

action

Diastolic BP is greater than 90 mmHg and accompanied by

another sign/symptom of pre-eclampsia.

Pre-eclampsia/

eclampsia

Emergency

action



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http://www.nice.org.uk/guidance/CG37/costing


http://www.nice.org.uk/guidance/cg37/resources


Diastolic BP is greater than 90 mmHg and no other sign/

symptom, repeat BP within 4 hours. If it remains above 90

mmHg after 4 hours, evaluate.

Pre-eclampsia/

eclampsia

Emergency

action

Shortness of breath or chest pain.Pulmonary

embolism

Emergency

action

Unilateral calf pain, redness or swelling.Deep vein

thrombosis

Emergency

action

Quality standards



2. Maternal health – life-threatening conditions

Resources






4 Health problems in babies

Health problem Action



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Jaundice in first 24

hoursEmergency action

Jaundice in babies

aged 24 hours or

more

Monitor, record jaundice and overall well-being, hydration and alertness.

Jaundice in babies

starting aged 7

days or lasting

longer than 14

days

Urgent action

Significantly

jaundiced or unwell

babies

Evaluate serum bilirubin.

Jaundice in

breastfeeding

babies

Advise frequent breastfeeding, waking the baby to feed if necessary;

routine supplementation is not recommended.

ThrushOffer information and guidance on hygiene. If symptoms are causing

pain to the woman or baby treat with antifungal medication.

Nappy rashConsider hygiene and skin care, sensitivity, infection (for example,

thrush).

Persistent painful

nappy rash

Consider antifungal treatment. If it doesn't resolve evaluate further (non-

urgent action).

No meconium in

first 24 hoursEmergency action



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Constipation in

formula fed baby

Evaluate feed preparation, quantity, frequency and composition (urgent

action).

Diarrhoea Evaluate (urgent action).

Excessive

inconsolable crying

Reassure parents and assess general health, antenatal and perinatal

history, onset and length of crying, nature of stools, feeding, woman's

diet if breastfeeding, family allergy, parent's response, factors making

crying better/worse (urgent action).

Colic

Advise parents that holding their baby during the crying episode and

peer support may be helpful.

Dicycloverine should not be used.

Colic in formula fed

babiesConsider use of hypoallergenic formula.

Unwell baby

A full assessment, including physical examination, should be

undertaken. Take temperature and if it is above 38°C, evaluate cause

(emergency action).

For more information about risk factors for neonatal jaundice, inspection for neonatal jaundice

and information and support for parents and carers, see information on neonatal jaundice in this

pathway.

For more information about managing suspected or obvious jaundice, see the neonatal jaundice

pathway.

For information on managing gastro-oesophageal reflux and reflux disease, see infants in the

NICE pathway on dyspepsia and gastro-oesophageal reflux disease.



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http://pathways.nice.org.uk/pathways/postnatal-care/care-of-women-and-their-babies#content=view-node%3Anodes-information-on-neonatal-jaundice

http://pathways.nice.org.uk/pathways/neonatal-jaundice/neonatal-jaundice-overview

http://pathways.nice.org.uk/pathways/dyspepsia-and-gastro-oesophageal-reflux-disease/managing-gastro-oesophageal-reflux-and-reflux-disease-in-infants

Interventional procedures

NICE has published interventional procedures guidance on drainage, irrigation and fibrinolytic

therapy (DRIFT) for post-haemorrhagic hydrocephalus in preterm infants, which should be used

only in the context of research.

Quality standards



3. Infant health – life-threatening conditions

Resources








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http://www.nice.org.uk/guidance/ipg412

http://www.nice.org.uk/guidance/ipg412





Glossary

Diet

in this pathway, the term 'diet' refers to the habitual eating patterns of individuals and groups of

people who are not slimming or eating to manage or treat a medical condition

Emergency

life-threatening or potential life-threatening situation

Follow-on formula

under UK law, follow-on formula may provide the liquid component of a progressively varied diet

for healthy infants aged over 6 months

Healthy eating

there is no standard definition. However it is widely accepted that 'healthy eating' means

following a diet which is low in fat (particularly saturated fat), sugar and salt, and high in fruit,

vegetables and fibre-rich starchy foods. More details are available from NHS Choices

Infant formula

under UK law, infant formula is the term used to describe a food intended to satisfy, by itself, the

nutritional needs of infants during the first months of life. The Department of Health advises that

infant formula may be used on its own for the first 6 months

Non-urgent

continue to monitor and assess

Reference nutrient intake

The amount of a nutrient needed to meet the needs of around 97% of individuals in a group

Significant hyperbilirubinaemia

an elevation of the serum bilirubin to a level requiring treatment



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http://www.nhs.uk/Livewell/healthy-eating

Urgent

potentially serious situation, which needs appropriate action

Visible jaundice

jaundice detected by visual inspection

Weaning

weaning or 'complementary feeding' is the transition from an exclusively milk-based diet to a

diet based on solid foods

Co-sleeping

parents or carers sleeping on a bed or sofa or chair with an infant

SIDS

sudden infant death syndrome

Sources

Postnatal care (2006 updated 2014) NICE guideline CG37

Neonatal jaundice (2010) NICE guideline CG98

Drainage, irrigation and fibrinolytic therapy (DRIFT) for post-haemorrhagic hydrocephalus in

preterm infants (2011) NICE interventional procedure guidance 412

Your responsibility

The guidance in this pathway represents the view of NICE, which was arrived at after careful

consideration of the evidence available. Those working in the NHS, local authorities, the wider

public, voluntary and community sectors and the private sector should take it into account when

carrying out their professional, managerial or voluntary duties. Implementation of this guidance

is the responsibility of local commissioners and/or providers. Commissioners and providers are

reminded that it is their responsibility to implement the guidance, in their local context, in light of

their duties to avoid unlawful discrimination and to have regard to promoting equality of



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http://www.nice.org.uk/guidance/CG37

http://www.nice.org.uk/guidance/CG98

http://www.nice.org.uk/guidance/IPG412

http://www.nice.org.uk/guidance/IPG412

opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent

with compliance with those duties.

Copyright

Copyright © National Institute for Health and Care Excellence 2015. All rights reserved. NICE

copyright material can be downloaded for private research and study, and may be reproduced

for educational and not-for-profit purposes. No reproduction by or for commercial organisations,

or for commercial purposes, is allowed without the written permission of NICE.

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Postnatal Care Health Problems in Women and Babies in Postnatal Care

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