Focus | Clinical
Reprinted from AJGP Vol. 51, No. 3, March 2022 105 © The Royal Australian College of General Practitioners 2022
Talila Milroy, Jacqueline Frayne
Background
The postnatal period is a rapidly
changing and challenging time for new
parents. General practitioners are well
placed to provide support, advice, clinical
care and intervention for common
psychosocial and physical concerns in
this critical period.
Objective
The aim of this article is to outline a
consistent approach to the content and
structure of the postnatal visit in the
general practice setting, along with key
management strategies for common
postnatal conditions and comorbidities.
Discussion
Common physical and mental health
postpartum concerns, follow-up
management of antenatal comorbidities
and contraceptive choices are outlined,
along with management of early
parenting issues.
THE POSTNATAL PERIOD is characterised
as beginning after delivery of the
placenta and lasting for six weeks,
1
with some groups advocating to include
up to 12 weeks, comprising what has
been termed the fourth trimester.
2
The
postnatal visit is crucial for effective
healthcare education, preventive medicine
and treatment, and it occurs at a time of
major life transition and increased need.
3
In addition to a review after birth, the
World Health Organization recommends
at least three postnatal contacts in this
period, including the six-week visit.
3
Early postnatal contact is increasingly
considered important and, depending on
individual circumstances, may transition
into chronic condition management.
2
Current guidelines for shared maternity
care recommend the timing of the postnatal
visit be individualised and flexible to reflect
the woman’s needs.
4
The importance of
primary care providers delivering postnatal
care is emphasised,
5,6
with women reporting
they value the identification of health issues,
facilitating disclosure regarding concerns
and providing support and reassurance
where necessary.
7
The postnatal visit
includes the physical, emotional and social
assessment of both mother and baby;
however, this article considers only issues
pertaining to the mother.
A mother and newborn commonly
present together, and a systematic approach
to the consultation allows adequate
time to provide support and education
and answer the many questions likely
to occur during this rapid and evolving
period. Most often, presentation occurs
between six and eight weeks postpartum,
coinciding with immunisations, with earlier
attendance encouraged if needed.
5
Ideally,
it is recommended that both mother
and baby have individual 20–30-minute
appointments for assessment, physical
examination and vaccinations. If a support
person is unavailable, a pram or carrier is
helpful to facilitate assessment. The infant
health record, relevant documentation
including discharge summary, and a list of
discussion questions should accompany
the woman.
Maternal assessment
History, physical examination, education
and counselling regarding ongoing
general and reproductive healthcare are
all considered important. Box 1 outlines
aspects of the history. Asking about
labour and birth, including delivery
complications, provides an opportunity
for the mother to debrief about the birth
experience or unexpected outcomes and
allows assessment for ongoing or future
concerns. Women may require counselling
regarding the birth outcome if there were
unrealised hopes and expectations and will
appreciate considered empathic responses
to their concerns.
Postnatal care
The general practitioner visit