Maternity pathway and schedule of care: clinical guidance and schedule
This pathway illustrates the core care that women and their babies should receive. All core contacts antenatally and postnatally (other than 32 weeks antenatal visit for primigravid and parous as required) should be face to face as they include physical examination.
5. Postnatal Care
The postnatal period, defined here as the period beginning immediately after the birth of the baby and extending up to six weeks (42 days), is a critical time for women, newborns, partners, parents, caregivers and families.[1]
Postnatal care: The number of postnatal visits should be discussed with and tailored to the woman and baby’s needs, based on clinical, emotional, infant feeding and social requirements. A wellbeing assessment will have been carried out in the antenatal period, and continually reviewed throughout antenatal care, and this should be reviewed as part of postnatal care. Any additional social and medical support services will be brought in to the postnatal care plan, coordinated by the primary midwife and wider team. Consider Near Me and other technology enabled services where appropriate for keeping in touch and providing support.
Postnatal care should be planned to ensure continuity of carer, with an individualised care plan encompassing the woman, baby and family. The emphasis should be on practical advice and information on pain management, signs and symptoms to look out for, infant feeding, social networks and coping strategies with a seamless handover from midwife to health visitor/FNP keeping the woman informed and involved at all stages. The pathway advises on what should be carried out during the postnatal period, but the actual number of postnatal visits should be individualised to the woman and baby’s needs. Prior to discharge women should be given the opportunity to discuss their maternity journey with their midwife and any appropriate referrals to other services should be made at this time.
Mothers of babies who are receiving neonatal care, those whose baby is taken into care at or near birth, and those who have experienced the loss of their baby will still be offered postnatal care appropriate to their individual circumstances.
Early Postnatal Care
Refer to WHO recommendations on maternal and newborn care for a positive postnatal experience and Postnatal care (nice.org.uk) for details on physiological assessment of the mother and baby.
Minimum schedule of appointments
Face to Face – day */1 to day 2 inclusive for All women.
Face to Face – 96 to 120 HRS (around day 5) post birth for All women.
Telephone - around day 7 for all women (include full physical and emotional assessment).
Face to Face - around day 10 for all women.
| Postnatal | ||
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Postnatal |
Post Natal | Content of Care |
First Hour |
In the first hour, if mother and baby are together, recognise importance of moment and encourage bonding by minimising separation of baby, mother and birth companion. Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Explain and offer perineum inspection to assess trauma. With informed consent, repair if required. Offer inspection of wound if caesarean birth. Skin to skin contact for ideally at least an hour. Offer women help with first and subsequent feeds, as required. Offer to show all breastfeeding mothers how to hand express their breastmilk. Set of maternal observations: MEWS, fundal palpation and blood loss Ensure nutrition and hydration needs are met. Bladder care. When appropriate, check baby’s temperature, undertake initial examination of the newborn, and weigh baby. At a minimum, weigh baby at birth, 5 days and 2 weeks while following local guidelines. For low birth weight babies, follow local guidelines. Discuss findings with parents and make appropriate referral after findings if required. Vitamin K consent and administration Full discussion about crying baby and touchpoint key messages from ICON: Babies Cry, You Can Cope! Where possible this should be in the presence of both parents. |
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Up to 3 days |
Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Notify GP and HV/FNP of birth. Ongoing care of mother and baby on ward/in unit. Recording of vital signs. Temperature, pulse, BP and respiratory rate. VTE Risk Assessment. Examination of newborn <72 hours. Newborn hearing consent and test. Vitamin K consent and administration. Sepsis awareness. Offer women help with first and subsequent feeds, as required. Offer to show all breastfeeding mothers how to hand express their breastmilk. Keep mothers and babies together. Parenthood education and support, including feed preparation information for mothers choosing to formula feed, contraception advice, and lifestyle information. Undertake full feeding assessment and develop feeding plan if appropriate Safer sleep discussion - Safer Sleep for Babies resource. Full discussion about crying baby and key messages. Discuss ICON: Babies Cry, You Can Cope! Arrange GP/consultation/PN follow up where required. Consider Long-acting reversible contraception before discharge if appropriate. Discuss pelvic floor health. Where appropriate all processes should be aligned and streamlined to support transfer to community care. Reminder: Consider financial inclusion and referral to welfare rights. Update mother and baby care plan regularly. Update GIRFEC Wellbeing Plan as required. Supply Vitamin D supplement to mothers breastfeeding or giving breastmilk Update postnatal conversations sheet. Review and update risk assessment. Full assessment of continence for all Postnatal Women. |
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Post Natal (Home Visits) Day 4 – 9 |
Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Postnatal assessment, emotional assessment, at least 2 breastfeeding assessments in first 10 days. Sepsis awareness. At a minimum, weigh baby at birth, 5 days and 2 weeks while following local guidelines. For low birth weight babies, follow local guidelines. Provide information about access to local support for infant feeding. Newborn blood spot as close to 96 hrs post birth as possible. Reminder: Update GIRFEC Wellbeing Assessment as required financial inclusion and referral to welfare rights. Discuss and document safety and security of accommodation and planning where mother and baby will sleep as per RCM guidance. Remind/encourage women to apply for Best Start Foods. Remind/encourage women to take vitamin D supplements if appropriate. Discuss the use of Vitamin D children’s vitamin drops at day 5 with all women, this information will be recorded and communicated at the HV and FN handover from midwives (Vitamin D will be provided by the HV/FN on their first visit if mother breastfeeding). Complete postnatal conversation sheet. Full discussion about crying baby and key messages. Discuss ICON: Babies Cry, You Can Cope! Where possible this should be in the presence of both parents. |
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Postnatal (Home Visits) Day 10 – 42 as needs required. Midwife/ Health Visitor |
Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Ongoing care of mother and baby in home. Postnatal assessment, infant feeding assessment at first visit by Health Visitor / FNP Health promotion tailored to individual needs. Transition to Health Visitor / FNP after day 10 (Primary Visit) and ensure full information is shared. At a minimum, weigh baby at birth, 5 days and 2 weeks while following local guidelines. For low birth weight babies, follow local guidelines. Those with additional care needs: Ongoing care of mother and baby, if baby home with mother. With agreement from management, midwifery services can extend care for women with the most complex additional care needs up to 42 days post birth. Ensure screening tests are recorded including hearing screening and blood spot. Reminder: Update GIRFEC Wellbeing Plan as required. Remind/encourage women to take vitamin D supplements if appropriate. Ensure all women are supported to discuss their experience, reflect with their primary (or team) midwife prior to discharge or an appointment is offered. Ensure any postnatal appointment is arranged as required with appropriate professional – obstetrician, neonatologist etc. Full discussion about crying baby and key messages. Discuss ICON: Babies Cry, You Can Cope! Where possible this should be in the presence of both parents. |
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