Traditionally, the puerperium period is the period from the delivery of the placenta until the end of the sixth week after delivery. However, adaptation to new motherhood/fatherhood may last longer depending on the maternal physical and emotional state and the new born wellbeing.
The midwife's role in postpartum care is essentially to care for the mother, thereby allowing the mother to take care of her child. The midwife should promote the new mother's independence and ability to make responsible decisions (Jay, 2008). Every woman should be involved in planning her own care and that of her baby during the postnatal period so that it focuses on their specific needs (Baston, 2005) but ideally it should be planned before the birth, so the mother will not be so overwhelmed afterwards, counting from the very beginning with the needed logistical and emotional support. Therefore, as a midwife, I adapt the care I offer to each family according to their cultural and economic situation (NICE, 2015), the way they want to feed the baby, the home environment, the number of children in the family, the baby’s wellbeing and thriving, and the maternal physical improvement her psychological state.
After the immediate postpartum care, especially after a hospital birth, the mother may often feel lonely, uncertain and fragile, as well as overwhelmed by a completely new burden of responsibility.
Whether I myself attended the home birth, or if the woman asks for support only in the postpartum period, I am on call until clinically necessary. This means that both the woman and any family member who feels concerned about the state of the mother or the baby can call me anytime.
On a postpartum visit, I ensure that the mother is recovering physically by checking her vital signs, breasts, uterus and perineum, the blood loss and the ability to urinate and defecate properly. I always give the woman and her family information to be able to recognise typical postpartum complications, as well as giving guidance on contraception. I also provide guidelines on infant care in all its aspects and how to make breastfeeding successful, explaining step by step the positioning of the baby and how to recognize effective latching, as well as doing a follow up on its weight gain.
Perhaps the least obvious and most important work of a midwife, however, is to give emotional support and company (Baston, 2005). Often, many mothers find it difficult to adjust to their new life and the presence of a person outside the family, whom they can trust, can help them release anxieties and gain confidence and self esteem (Jay, 2008).
Postpartum care is where more than ever the work of the midwife has a great impact on the health of families and therefore a major impact on public health (Midwifery 2020, 2010) prioritizing the care individualisation and personalisation to ensure the best results and most satisfaction (Malouf et al, 2019).
What do I offer as a childbirth professional?
- Postpartum visits on days 1, 3, 5, 10 and/or until discharge. However, I adapt my visits if there are complications or specific needs.
- Individualized breastfeeding advice or support if there are severe complications or physical and/or emotional difficulties in attending a support group.
- Pelvic floor evaluation before discharge with ergonomy, habits and carrying baby supervision. Personalized exercises recomendation according to each situation.
- A Closing Ritual once the first 6 weeks postpartum are over.