Question

Case scenario 3: You are seeing a woman in the postnatal ward, she delivered yesterday.

Discuss how you would elicit points in the history which would be important for the following:

What you will ask her about breast feeding?

What would you ask her to ascertain or determine whether she has any perineal complications?

If her temperature is raised: What history would suggest a likely cause of infection?

What history may suggest postnatal depression?

What history would suggest puerperal psychosis?

What will you ask her about her contraceptive needs?

Should you ask her about screening for cervical cancer?

What advice would you give her about resumption of coitus?

Answer 1

Questions regarding breast feeding

1. What was her opinions about breast feeding?
2. How long does she wish to breast feed her baby?
3. Does she know the benefits of breast feeding for the baby? ( low infection, lower allergies)
4. Does she know the maternal benefits of breast feeding?
   1. reduced incidence of breast cancer
   2. It is natural contraception. Breastfeeding increases prolactin levels. Prolactin suppresses follicle stimulating hormone and gonadotropin releasing hormone. This prevents ovulation.
5. Does she know breast feeding is also economically beneficial? - no need of buying formula feeds, no time in preparation
6. Does she know the correct technique of breast feeding?

Clues to perineal complication.

1. Excessive bleeding during delivery
2. Discharge of foul smelling discharge from the birth canal - suggestive pepeural sespsis
3. Fecal incontinence due perineal tears
4. Low mood, hopelessness - suggestive of postpartum depression

If the patient develops fever, it suggests the patient has peripheral sepsis. following questions should be asked:

1. Was the delivery prolonged
2. Was there premature rupture of membrane
3. Whether aspetic precautions like hand washing wearing gloves followed of the attendant.
4. Was an episiotomy given ( episiotomy is an incision made on the perineum to prevent child birth related injuries)
5. History of genito- urinary tract infection.
6. History of malnutrition, HIV and diabetes
7. Any other system involvement like cough sputum(lungs)

History suggestive of postpartum psychosis:

1. Hallucinations - someone is commanding to kill the baby
2. Delusions
3. Illogical thoughts
4. Unable to sleep
5. Confusion
6. Impaired memory
7. Disorientation.

Contraceptive needs - the mother and if the father is available then the father should also be counselled regarding contraception.

The mother will not be able to conceive when she is breastfeeding. However when the mother starts weaning the child, h