As a health extension worker, you should evaluate the mother as well as the newborn baby even after a successful delivery. This is because due to the physiological and anatomical changes that will occur on the mother after birth and due to struggle for adaptation of the extrauterine life (external environment) on the baby, something may get wrong and threaten the lives of both the mother and the baby, especially up to the first 24 hours.

In this case, close supervision and evaluation of both the mother and the newborn baby for any danger signs and symptoms with immediate decision making is necessary for your postnatal care provision is to be said effective. The following subsection will help you what to evaluate and what to do if any.

Evaluating the Postnatal Mother

The following signs are danger signs which will threaten the life of the postnatal mother unless immediate measures were taken. The evaluation must be performed with in the first six hours.

Uterine atonicity(if the uterus fails to contract adequately within six hours after delivery of the baby due to loss of its normal tone). Here, you should have to consider referral if the size of the uterus (within six hours) is bigger than the abdominal size of 20 weeks gestation or above the umbilicus; or, if the uterus is so soft and cannot be palpated on abdominal examination because of its softness. (Do the pre-referral management which you will learn in session three of this module).

Active vaginal bleeding: This means that if you see a profuse bleeding which is bright red in color, other than that of normally oozing bloody discharge called lochia, this is a danger sign for the maternal life which could be due to a tear inside the vagina, or due to failure of the uterus to contract adequately due to loss of its normal tone as commonly seen on mothers who gave birth to many children. This is also a condition which needs urgent referral after the pre-referral treatment trial of which you will learn in session three of this module.

Unstable vital signs: This means that, if there high blood pressure (the pressure of blood applied on the arterial wall) which is above 140/90_mmHg indicating the presence of hypertension related to pregnancy or the presence of chronic hypertension, or low blood pressure below 90/60_mmHg accompanied by signs of shock, fast heart beat above 100 beats/minute, fast respiration rate more than 24/min and if the size of the uterus remains large after childbirth, may be due to internal bleeding (also called concealed bleeding).

So as soon as you record such instabilities of the vital sign, you should consider referral because she is losing too much blood and may die.