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NICE issues new draft guidance for 6-8 week GP postnatal check


pre-eclampsia check


NICE has published new draft guidance on the postnatal 6-8 week check of women who have given birth to a child, which became a contractual requirement for GPs this year.

The new guideline on postnatal mother and baby care is aimed at GPs and other health professionals, including midwives and health visitors, and covers the period from birth up to eight weeks after delivery.

It replaces NICE’s existing guidance on postnatal care, published in 2006, and ‘aims to improve consistency of care across the country’, NICE said. 

The guidance, which was developed based on evidence collected prior to the Covid-19 pandemic, says to ‘assess the woman at 6 to 8 weeks after the birth’, ‘taking into account the time since the birth, and respond to any concerns, which may include referral to specialist services’.

It says the assessment should include a large number of points made earlier in the guidance to midwives visiting women in the postnatal period.

These include discussing general health and wellbeing, as well as emotional and mental health; lifestyle; sexual intercourse; contraception; safeguarding concerns including domestic abuse; pain and healing; breast comfort and signs of inflammation.

Women should also be given the opportunity to talk about their birth experience, the guidance added.

As part of the 2020/21 GP contract agreement, a total of £12m of additional funding was added to the global sum to ensure all mothers receive the postnatal check – which is in addition to the GP appointment all babies receive at six to eight weeks.

NICE’s draft guidance is out for public consultation until 27 November 2020.

In full: Draft NICE guideline on caring for women after childbirth

1.2.7 Assess the woman at 6 to 8 weeks after the birth. Include the points in recommendations 1.2.1 to 1.2.5, taking into account the time since the birth, and respond to any concerns, which may include referral to specialist services. 

1.2.1 At each postnatal contact, ask the woman about her general health and whether she has any concerns, and assess her general wellbeing. Discuss topics that may be affecting her daily life, and provide information, reassurance and further care as appropriate. Topics to discuss may include:

• the postnatal period and what to expect 

• symptoms and signs of potential postnatal mental health and physical problems and how to seek help 

• fatigue

• healthy lifestyle (see the NICE guidelines on maternal and child nutrition, weight management before, during and after pregnancy and smoking: stopping in pregnancy and after childbirth) 

• physical activity 

• contraception 

• sexual intercourse 

• safeguarding concerns, including domestic abuse (see the NICE guideline on domestic violence and abuse).

1.2.2 At each postnatal contact, assess the woman’s psychological and emotional wellbeing. Follow the recommendations on recognising mental health problems in pregnancy and the postnatal period and referral in the NICE guideline on antenatal and postnatal mental health. If there are concerns, arrange for further assessment and follow-up. 

1.2.3 At each postnatal contact by a midwife, assess the woman’s physical health, including the following:

• for all women: − symptoms and signs of infection − pain − vaginal discharge and bleeding (see the section on postpartum bleeding) − bladder function − bowel function − breast comfort and symptoms of inflammation − symptoms and signs of thromboembolism − symptoms and signs of anaemia − symptoms and signs of pre-eclampsia 

• for women who have had a vaginal delivery: − perineal healing (see the section on perineal pain) 

• for women who have had a caesarean section (also see the NICE guideline on caesarean section):  − wound healing − symptoms of wound infection. 

1.2.4 At the first postnatal midwife contact, inform the woman that the following are symptoms or signs of potentially serious conditions, and she should seek medical advice without delay if any of these occur: 

• sudden or very heavy vaginal bleeding, or persistent or increased  vaginal bleeding, which could indicate retained placental tissue or endometritis

• abdominal, pelvic or perineal pain, fever, shivering, or vaginal discharge with an unpleasant smell, which could indicate infection 

• leg swelling and tenderness, or shortness of breath, which could indicate venous thromboembolism

• chest pain, which could indicate venous thromboembolism or cardiac problems

• persistent or severe headache, which could indicate hypertension, pre eclampsia, postdural-puncture headache, migraine, intracranial pathology or infection. 

1.2.5 At each postnatal contact, give the woman the opportunity to talk about her birth experience, and provide information about relevant support services, if appropriate.  

Source: NICE

READERS' COMMENTS [7]

John Graham Munro 21 October, 2020 6:25 pm

NEVER TAKEN ANY NOTICE OF NICE

Scottish GP 21 October, 2020 9:00 pm

Ooh, let’s get some ticky boxes!
Usual tripe written by ‘key stakeholders’ over repeated platters of prawn sarnies.
Just let us get on with the job.

Not Arvind Madan 22 October, 2020 12:18 pm

Im sure Vautrey and his goons will be very pleased with their ‘negotiating’ of £12m for this trash.

Patrufini Duffy 22 October, 2020 1:28 pm

Not real world worthy I’m afraid. Surprised there’s not a box for changing the nappy or singing a lullaby? I remember that breastfeeding room token CQC tick box years ago. Incredible.

Andi Williams 22 October, 2020 2:02 pm

never understood why we do a 6 week check, other countries the obstetrician checks the mother over post delivery and paeds do the 6 week check and get paid to do this, far more likely to pick up issues than we ever would, health visitors in a better position to pick up on post natal depression and domestic violence as they actually go into the home. as GPs now have very little to do with obstetrics time for a change one thinks and change the system altogether.

Dermot Ryan 22 October, 2020 2:38 pm

Hi Andi, in other countries women recieve superior antenatal and intrapartum care, not led by madwives. The appalling increase in neonatal mortality indicates we have a pretty useless system. As for the birth experience? talking about this is a waste of time unless something useful is done to improve it which would include proper diagnosis and management of labour by professionals who know what they are doing and care about it: Labours of more than 24 hour duration are simply not acceptable. NICE would do better in their brief of reducing health care costs, to improve ante and intra partum care so that the current damage being done due to lack of care and structure does not occur with resulting increase in mother and child well being and decreased costs.

Slobbering Spaniel 22 October, 2020 10:49 pm

GP postnatal check?!?!