6W postnatal check

Question 1

Structure of check

Answer 1

History (biological, psychological, social)

Examination

Sex & contraception

Pelvic floor exercises

SCALF

Question 2

physical Qs

Answer 2

How was the baby delivered?

Any particular worries about her own health?
fever
leg swelling//SOB

Is perineum/c-sec scar healing well

Periods resumed? Offer contraception

Bowel & bladder functioning normally

Question 3

breastfeeding

Answer 3

Is she breastfeeding? If so, encourage to continue & ask if any problems

nippl pain? engorgement? mastitis?

Question 4

Sex & contraception

Answer 4

If sexual intercourse has not resumed reassure now safe to try

Contraception? ? - full time breast feeding if amenorrhoeic.

Condoms, IUCD, IUS, progestogen-only pills and implants

Question 5

Smear hx

Answer 5

when was last smear

offer smear test

Question 6

Psychological Qs

Answer 6

How was the birth? Are there any issues that need to be talked through?

Mood? Consider postnatal anxiety, depression, psychosis, baby blues

Any worries about the baby? - content? healthy? growing? responsive? Vision? hearing?

Question 7

Social Qs

Answer 7

Support at home? Sleeping?

Household smokers increase risk of SIDS and childhood asthma

Question 8

Examination

Answer 8

Palpate abdomen - retained products of conception or endometritis, if tender +/- LSCS wound

BP / HR / temperature / urinalysis

Vaginal examination if tears, episiotomy, bleeding, dyspareunia

Cervical smear if indicated

Haemoglobin if previously anaemic

Rubella status

Question 9

Pelvic floor exercises

Answer 9

Incontinence problems in antenatal period (30% 6 weeks after birth)

Tried anything yet? How is it affecting your ADLs?

Pull up pelvic floor muscles to stop self-urinating and hold for 10 seconds

Contract & relax pelvic muscles rapidly in succession 4 times

Question 10

general advice

Answer 10

keep mobility
baby on back for sleep
++ risk SIDS co-sleeping
immunisations