- Temperature
- Pulse
- Blood pressure
- Respiration rate
- Oxygen saturation
The MOEWS chart serves as an early warning system; specific triggers in these vital signs require immediate escalation or clinical review. For example, a body temperature exceeding 37.5∘C is classified as pyrexial. If a patient is pyrexial, clinicians must follow the Maternal Sepsis guideline (M1089) to manage potential infection.
Digital Documentation
All observations, care plans, and standard postnatal information are documented using BadgerNet, a digital health record system. This ensures that care is continuous and accessible to authorized healthcare professionals via computers, tablets, or smartphone apps.
Holistic Health and Wellbeing
The guidelines emphasize a holistic approach, moving away from a "tick-box" mentality to focus on the person's overall wellbeing.
Perinatal Mental Health
Mental health is a primary concern during the postnatal period. Midwives are required to assess emotional wellbeing at every contact.
- The 'Whooley' Questions: During the very first home visit, midwives must use these specific screening questions to identify potential mental health concerns.
- Monitoring Trends: Clinicians should monitor for the "baby blues," which typically resolve within 10–14 days. If symptoms like tearfulness, anxiety, or low mood persist beyond this window, the patient must be assessed for postnatal depression and potentially referred for urgent action under the Perinatal Mental Health guideline (M1078).
Domestic Abuse Screening
Safety is paramount. All birthing people must be screened for domestic abuse during the postnatal period, and this screening must be documented prior to their discharge from maternity care.
Identifying Health Concerns
Clinicians must be vigilant in distinguishing between common postpartum discomforts and serious, potentially life-threatening conditions.
Common Health Problems
During routine contacts, midwives should ask about common physical issues, including:
- Headaches
- Fever or signs of infection
- Shortness of breath
- Pain or swelling in the calf (to screen for DVT)
- Abdominal or perineal pain
- Breast discomfort or redness
Serious Conditions (Red Flags)
Patients must be empowered with information regarding "red flag" symptoms that require immediate medical attention. These include:
- Haemorrhage: Sudden or persistent profuse blood loss.
- Cardiovascular/Respiratory: Faintness, dizziness, palpitations, chest pain, or shortness of breath.
- Neurological: Headaches accompanied by visual disturbances, nausea, or vomiting.
- Infection: Fever, shivering, or offensive vaginal discharge.
- Thromboembolism: Unilateral calf pain, redness, or swelling.
Infant Care and Support Services
The guidelines extend care to the infant, focusing on nutrition, safety, and developmental milestones.
Infant Feeding and Breastfeeding
Support for infant feeding is a recurring theme in every postnatal contact.
- Breastfeeding Support: Midwives provide advice and support according to the Breastfeeding Policy (M1080).
- Feeding Monitoring: For babies in the community, midwives or Maternity Support Workers (MSW) monitor weight. If a baby's weight loss is between $10%$ and $12.4%$, a specific feeding plan and daily visits are required. If weight loss exceeds $12.5%$, a referral to a paediatrician is mandatory.
Safer Infant Sleeping
To reduce the risk of Sudden Infant Death Syndrome (SIDS), discussions regarding safer infant sleeping must occur at every postnatal contact with the parent or main carer. This includes providing both verbal and written guidance on sleep environments.
Postnatal Contraception Pathway
Family planning is integrated into the postnatal period via the Postnatal Contraception Pathway (AC2). If a patient requests a contraceptive implant, the midwife coordinates this by contacting sexual health services via a designated email during the labour or early postnatal period.
Exam Note: When reviewing the postnatal pathway, remember that the first contact after discharge must be a face-to-face visit for primiparous (first-time) birthing people, whereas multiparous individuals may receive a telephone contact.