Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
CHAPTER 6: Monitoring the Woman and Newborn
during the First Six Hours Postpartum
The first six hours after childbirth is a critical period for maternal and newborn health and
survival, and providers need to carefully monitor the woman and her newborn to detect and
appropriately manage complications in a timely manner. Early recognition of danger signs by
providers, women, and families and timely, appropriate management of complications could
significantly reduce the incidence of maternal and newborn death and disability.
The woman and her newborn should remain in the delivery room for at least one hour after
delivery of the placenta, and for longer periods as necessary. After this, they should be
transferred to an area where they can continue to be closely monitored for at least an additional
five hours. If at all possible, women and newborns should not be discharged from the facility
before 12 hours after delivery of the placenta.
MONITORING THE WOMAN
PPH is the most important single cause of maternal death in the world, and the majority of these
deaths (88 percent) occur within four hours of delivery, indicating that they are a consequence
of events in the third stage of labor. It is therefore imperative that the provider carefully monitor
the woman to assess if the uterus is well contracted and how much the woman is bleeding
during the hours following childbirth.
During the first hour after delivery of the placenta, while the woman is still in the delivery room,
the provider should monitor the following parameters at least every 15 minutes (more often if
needed):
• Uterine contraction:
o Palpate the uterus to check for firmness.
o Massage the uterus until firm. (Ask the woman to
call for help if bleeding increases or her uterus gets
soft.)
o Ensure the uterus does not become soft after
massage is stopped.
o Instruct the woman how the uterus should feel and
how she can massage it herself.
• Before beginning, explain
what you will be doing to the
woman.
• If all vital and other signs
are normal, reassure the
woman. If they are not
normal, act immediately.
• Vaginal bleeding
• Blood pressure and pulse
Note: Action should be taken immediately to evaluate and treat
PPH if excessive bleeding is detected.
During this time the provider will also:
• ensure the woman has sanitary napkins or clean material to collect vaginal
blood.
• encourage the woman to eat, drink, and rest.
Integrated maternal and newborn care
Basic skills course
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