Care of mother — first 24 hours after birth

• Always call for help — get midwife/doctor/obstetrician on speaker phone, if none locally
• Find support people — if possible female ATSIHP or older women familiar with birthing
• Reassure woman and explain what is happening. Have someone stay with her for support

Check

Do — in first hour 

After birth of placenta

• Check STI status
• Syphilis serology
• If STI status not known — do Pregnancy STI check
• Check that blood and swabs for all other routine tests have been collected
• Record in file notes
• Date and time of birth
• Time of delivery of placenta
• How much blood woman lost — 1 soaked pad is equal to about 100mL
• What you did, any problems you had, etc
• Any medicines, immunisations given to mother and/or baby
• Whether placenta and membranes are complete or incomplete
• Complete birth registration forms
• If mother comfortable — put baby on her chest, encourage skin-to-skin contact and breastfeeding. Offer help if needed
• Encourage woman to pass urine — full bladder can stop uterus contracting and cause heavy bleeding
• Offer woman something to eat and drink, shower and change of clothes
• Make sure placenta checked and is complete
• Don’t forget to celebrate and debrief
• If challenged or distressed by anything you saw or did talk with friends, colleagues and/or qualified counsellor, eg Bush Support Services on 1800 805 391
• Medical consult
• Refer to mother’s medical and obstetric history

Talk ​about

• Labour, birth, condition of mother and baby AND
• Problems with woman, baby or placenta
• If needing to send to hospital — send placenta, birth documents, bloods, birth registration and family assistance forms with woman

Do

Blood tests

• If no antenatal care — medical consult
• Bloods as for first antenatal visit including FBC (best done 24 hours after birth), syphilis serology — see Antenatal checklist
• If woman RhD negative or blood group unknown — medical consult
• May need to transfer to hospital for cord blood processing and RhD-Ig within 72 hours
• Take blood for Kleihauer test (to determine amount of foetal blood in maternal circulation) — within 2 hours of birth and before giving RhD-Ig

Talk with woman about

• Emptying bladder regularly to lessen risk of heavy bleeding ​
• How to feel top of her uterus and how to massage it to make it hard if she has heavy bleeding
• If heavy bleeding (needing to change pad more than every few hours) — tell clinic staff as soon as possible — this is an emergency
• Perineal hygiene and healing — changing pads often and shower at least once, preferably several times a day
• If perineal tear ​— call maternity service
• 'After birth' pains — crampy uterine pains, often worse when breastfeeding — give pain relief if needed
• Symptoms of thromboembolism (clots) — DVT or PE
• Breastfeeding
• Arrangements for follow-up/ongoing care including contraception — see Postnatal care of mother

Before leaving clinic

• Encourage woman to move about to help prevent blood clots ​in her legs
• If woman staying in community
• Mother and baby should rest in clinic for at least 4 hours or as long as needed after birth
• Make sure woman has passed urine ​before leaving clinic
• Make sure woman has someone staying with her to help look after baby
• Fill in forms for birth registration, perinatal statistics and family assistance
• Remind woman to attend Centrelink and have 100 points of identification ready