Health problems in women

and babies in postnatal care

A NICE pathway brings together all NICE guidance, quality
standards and materials to support implementation on a specific
topic area. The pathways are interactive and designed to be used
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uses numbering to link the boxes in the diagram to the associated
recommendations.
To view the online version of this pathway visit:
http://pathways.nice.org.uk/pathways/postnatal-care
Pathway last updated: 29 July 2015. To see details of any updates to this pathway since its launch,
visit: About this Pathway. For information on the NICE guidance used to create this path, see:
Sources.
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Pathways

Health problems in women and babies in postnatal care

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Health problems in women and babies in postnatal care

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Women and babies with health problems

No additional information

Common health problems in women

Health problem

Baby blues

Perineal pain,
discomfort,
stinging, offensive
odour or
dyspareunia

Action
If symptoms not resolved after 1014 days, assess for postnatal
depression, and if symptoms persist, evaluate further (urgent action).
Offer to assess the perineum. Evaluate for signs of infection, inadequate
repair, wound breakdown or non-healing (urgent action).
Advise use of topical cold therapy and paracetamol (if not contraindicated), but if neither is effective consider oral or rectal non-steroidal
anti-inflammatory drug (non-urgent action).
In cases of perineal trauma offer to assess the perineum (see above).

Dyspareunia

Advise use of water-based lubricant.

If problem persists, evaluate further (non-urgent action).
Advise women who have had epidural/spinal anaesthesia to report
severe headache.

Headache

For tension/migraine headaches offer advice on relaxation and avoiding

factors associated with headache.
For mild headache follow local protocols.

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Persistent fatigue

Ask about general well-being and offer advice on diet, exercise and
planning activities. If it affects a woman's care of herself or baby,
evaluate underlying cause. Measure haemoglobin level and if low, treat
according to local policy.

Backache

Manage as general population.

Constipation

Assess diet and fluid intake. If changes in diet are ineffective advise use
of a gentle laxative.

Haemorrhoids

If haemorrhoids are severe, swollen or prolapsed, evaluate (urgent

action). Otherwise advise dietary measures to avoid constipation and
manage according to local protocol.

Faecal
incontinence

Assess severity, duration and frequency. If symptoms don't resolve,

evaluate further (urgent action).

Urinary
incontinence

Teach the woman to do pelvic floor exercises, and if symptoms don't

improve or get worse, evaluate.
NICE has produced a pathway on urinary incontinence in women.

Urinary retention
(within 6 hours of
birth)

Advise methods of assisting urination such as taking a warm bath or

shower.
If this doesn't work, assess bladder volume and consider catheterisation
(urgent action).

Quality standards
The following quality statement is relevant to this part of the pathway.
Postnatal care quality standard
10.

Maternal health mental wellbeing

Postnatal care pathway

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NICE Pathways

Health problems in women and babies in postnatal care

Resources
The following implementation tools are relevant to this part of the pathway.
Postnatal care: costing report
Postnatal care: costing template
Postnatal care: implementation advice
Routine postnatal care of women and their babies: presenter slides

Life-threatening conditions in women

Possible sign/symptom

Evaluate for

Action

Sudden or profuse blood loss, or blood loss and signs/

symptoms of shock, including tachycardia, hypotension,
hypoperfusion, change in consciousness.

Postpartum
haemorrhage

Emergency
action

Offensive/excessive vaginal loss, tender abdomen or fever. If

no obstetric cause consider other causes.

Postpartum
haemorrhage/
sepsis/ other
pathology

Urgent
action

Fever, shivering, abdominal pain and/or offensive vaginal loss.

Infection/
If temperature exceeds 38C repeat in 46 hours. If
genital tract
temperature still high or other symptoms and measurable signs,
sepsis
evaluate further.

Emergency
action

Severe or persistent headache.

Pre-eclampsia/ Emergency
eclampsia
action

Diastolic BP is greater than 90 mmHg and accompanied by

another sign/symptom of pre-eclampsia.

Pre-eclampsia/ Emergency
eclampsia
action

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NICE Pathways

Health problems in women and babies in postnatal care

Diastolic BP is greater than 90 mmHg and no other sign/

symptom, repeat BP within 4 hours. If it remains above 90
mmHg after 4 hours, evaluate.

Pre-eclampsia/ Emergency
eclampsia
action

Shortness of breath or chest pain.

Pulmonary
embolism

Emergency
action

Unilateral calf pain, redness or swelling.

Deep vein
thrombosis

Emergency
action

Quality standards
The following quality statement is relevant to this part of the pathway.
Postnatal care quality standard
2.

Maternal health life-threatening conditions

Resources
The following implementation tools are relevant to this part of the pathway.
Postnatal care: costing report
Postnatal care: costing template
Postnatal care: implementation advice
Routine postnatal care of women and their babies: presenter slides

Health problems in babies

Health problem

Postnatal care pathway

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Action

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Health problems in women and babies in postnatal care

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Jaundice in first 24
hours

Emergency action

Jaundice in babies
aged 24 hours or
more

Monitor, record jaundice and overall well-being, hydration and alertness.

Jaundice in babies
starting aged 7
days or lasting
longer than 14
days

Urgent action

Significantly
jaundiced or unwell
babies

Evaluate serum bilirubin.

Jaundice in
breastfeeding
babies

Advise frequent breastfeeding, waking the baby to feed if necessary;

routine supplementation is not recommended.

Thrush

Offer information and guidance on hygiene. If symptoms are causing

pain to the woman or baby treat with antifungal medication.

Nappy rash

Consider hygiene and skin care, sensitivity, infection (for example,

thrush).

Persistent painful
nappy rash

Consider antifungal treatment. If it doesn't resolve evaluate further (nonurgent action).

No meconium in
first 24 hours

Emergency action

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Constipation in
formula fed baby

Evaluate feed preparation, quantity, frequency and composition (urgent

action).

Diarrhoea

Evaluate (urgent action).

Excessive
inconsolable crying

Reassure parents and assess general health, antenatal and perinatal

history, onset and length of crying, nature of stools, feeding, woman's
diet if breastfeeding, family allergy, parent's response, factors making
crying better/worse (urgent action).

Colic

Advise parents that holding their baby during the crying episode and
peer support may be helpful.
Dicycloverine should not be used.

Colic in formula fed

babies

Consider use of hypoallergenic formula.

Unwell baby

A full assessment, including physical examination, should be

undertaken. Take temperature and if it is above 38C, evaluate cause
(emergency action).

For more information about risk factors for neonatal jaundice, inspection for neonatal jaundice
and information and support for parents and carers, see information on neonatal jaundice in this
pathway.
For more information about managing suspected or obvious jaundice, see the neonatal jaundice
pathway.
For information on managing gastro-oesophageal reflux and reflux disease, see infants in the
NICE pathway on dyspepsia and gastro-oesophageal reflux disease.

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Interventional procedures
NICE has published interventional procedures guidance on drainage, irrigation and fibrinolytic
therapy (DRIFT) for post-haemorrhagic hydrocephalus in preterm infants, which should be used
only in the context of research.

Quality standards
The following quality statement is relevant to this part of the pathway.
Postnatal care quality standard
3.

Infant health life-threatening conditions

Resources
The following implementation tools are relevant to this part of the pathway.
Postnatal care: costing report
Postnatal care: costing template
Postnatal care: implementation advice
Routine postnatal care of women and their babies: presenter slides

Postnatal care pathway

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Health problems in women and babies in postnatal care

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Glossary
Diet
in this pathway, the term 'diet' refers to the habitual eating patterns of individuals and groups of
people who are not slimming or eating to manage or treat a medical condition
Emergency
life-threatening or potential life-threatening situation
Follow-on formula
under UK law, follow-on formula may provide the liquid component of a progressively varied diet
for healthy infants aged over 6 months
Healthy eating
there is no standard definition. However it is widely accepted that 'healthy eating' means
following a diet which is low in fat (particularly saturated fat), sugar and salt, and high in fruit,
vegetables and fibre-rich starchy foods. More details are available from NHS Choices
Infant formula
under UK law, infant formula is the term used to describe a food intended to satisfy, by itself, the
nutritional needs of infants during the first months of life. The Department of Health advises that
infant formula may be used on its own for the first 6 months
Non-urgent
continue to monitor and assess
Reference nutrient intake
The amount of a nutrient needed to meet the needs of around 97% of individuals in a group
Significant hyperbilirubinaemia
an elevation of the serum bilirubin to a level requiring treatment

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Urgent
potentially serious situation, which needs appropriate action
Visible jaundice
jaundice detected by visual inspection
Weaning
weaning or 'complementary feeding' is the transition from an exclusively milk-based diet to a
diet based on solid foods
Co-sleeping
parents or carers sleeping on a bed or sofa or chair with an infant
SIDS
sudden infant death syndrome

Sources
Postnatal care (2006 updated 2014) NICE guideline CG37
Neonatal jaundice (2010) NICE guideline CG98
Drainage, irrigation and fibrinolytic therapy (DRIFT) for post-haemorrhagic hydrocephalus in
preterm infants (2011) NICE interventional procedure guidance 412

Your responsibility
The guidance in this pathway represents the view of NICE, which was arrived at after careful
consideration of the evidence available. Those working in the NHS, local authorities, the wider
public, voluntary and community sectors and the private sector should take it into account when
carrying out their professional, managerial or voluntary duties. Implementation of this guidance
is the responsibility of local commissioners and/or providers. Commissioners and providers are
reminded that it is their responsibility to implement the guidance, in their local context, in light of
their duties to avoid unlawful discrimination and to have regard to promoting equality of
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opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent
with compliance with those duties.

Copyright
Copyright National Institute for Health and Care Excellence 2015. All rights reserved. NICE
copyright material can be downloaded for private research and study, and may be reproduced
for educational and not-for-profit purposes. No reproduction by or for commercial organisations,
or for commercial purposes, is allowed without the written permission of NICE.

Contact NICE
National Institute for Health and Care Excellence
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Manchester
M1 4BT
www.nice.org.uk
nice@nice.org.uk
0845 003 7781

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