Guia Nice Postnatal Care PDF 66142082148037

Postnatal care
NICE guideline
Published: 20 April 2021
www.nice.org.uk/guidance/ng194
© NICE 2023. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-

conditions#notice-of-rights).
Postnatal care (NG194)
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful
consideration of the evidence available. When exercising their judgement, professionals
and practitioners are expected to take this guideline fully into account, alongside the
individual needs, preferences and values of their patients or the people using their service.
It is not mandatory to apply the recommendations, and the guideline does not override the
responsibility to make decisions appropriate to the circumstances of the individual, in
consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment
or in a procedure should be reported to the Medicines and Healthcare products Regulatory
Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the

guideline to be applied when individual professionals and people using services wish to
use it. They should do so in the context of local and national priorities for funding and
developing services, and in light of their duties to have due regard to the need to eliminate
unlawful discrimination, to advance equality of opportunity and to reduce health
inequalities. Nothing in this guideline should be interpreted in a way that would be
inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally

sustainable health and care system and should assess and reduce the environmental
impact of implementing NICE recommendations wherever possible.
© NICE 2023. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 2 of
conditions#notice-of-rights). 65
Contents
Overview ..................................................................................................................................... 5
Who is it for? .......................................................................................................................................... 5
Recommendations ...................................................................................................................... 6
1.1 Organisation and delivery of postnatal care .................................................................................. 6
1.2 Postnatal care of the woman ......................................................................................................... 12
1.3 Postnatal care of the baby ............................................................................................................. 18
1.4 Symptoms and signs of illness in babies ...................................................................................... 23
1.5 Planning and supporting babies' feeding ...................................................................................... 26
Terms used in this guideline................................................................................................................. 34
Recommendations for research ................................................................................................ 38
1 Length of postpartum stay and first midwife visit after transfer of care ...................................... 38
2 Timing of first health visitor visit ...................................................................................................... 38
3 Clinical tools to assess women's health .......................................................................................... 39
4 Perineal pain ....................................................................................................................................... 39
5 Breastfeeding support for parents with twins or triplets ............................................................... 39
Rationale and impact.................................................................................................................. 40
Principles of care ................................................................................................................................... 40
Communication between healthcare professionals at transfer of care ........................................... 41
Transfer to community care ................................................................................................................. 42
First midwife visit after transfer of care from the place of birth or after a home birth .................. 43
First health visitor visit.......................................................................................................................... 44
Assessment and care of the woman ................................................................................................... 45
Postpartum bleeding ............................................................................................................................ 47
Perineal health ....................................................................................................................................... 48
Assessment and care of the baby ....................................................................................................... 49
Bed sharing ............................................................................................................................................ 51
Promoting emotional attachment ........................................................................................................ 51
Symptoms and signs of illness in babies ............................................................................................ 52
General principles about babies' feeding ........................................................................................... 54
Giving information about breastfeeding ............................................................................................. 54
Role of the healthcare professional supporting breastfeeding ........................................................ 56
Supporting women to breastfeed ........................................................................................................ 57
Assessing breastfeeding ...................................................................................................................... 58
Formula feeding ..................................................................................................................................... 59
Lactation suppression........................................................................................................................... 60
Context ........................................................................................................................................ 62
Finding more information and committee details .................................................................... 64
Update information .................................................................................................................... 65
This guideline replaces CG37.
This guideline is the basis of QS37, QS129 and QS169.
Overview
This guideline covers the routine postnatal care that women and their babies should
receive in the first 8 weeks after the birth. It includes the organisation and delivery of
postnatal care, identifying and managing common and serious health problems in women
and their babies, how to help parents form strong relationships with their babies, and baby
feeding. The recommendations on emotional attachment and baby feeding also cover the
antenatal period.
The guideline uses the terms 'woman' or 'mother' throughout. These should be taken to
include people who do not identify as women but are pregnant or have given birth.
Similarly, where the term 'parents' is used, this should be taken to include anyone who has
main responsibility for caring for a baby.
The Royal College of Obstetricians and Gynaecologists has produced guidance on

COVID-19 and postnatal care for all midwifery and obstetric services.
Who is it for?
• Healthcare professionals
• Commissioners and providers
• Women having routine postnatal care, and their families
Recommendations
People have the right to be involved in discussions and make informed decisions
about their care, as described in NICE's information on making decisions about your
care. Parents and carers have the right to be involved in planning and making
decisions about their baby's health and care, and to be given information and support
to enable them to do this, as set out in the NHS Constitution and summarised in
NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the
strength (or certainty) of our recommendations, and has information about
prescribing medicines (including off-label use), professional guidelines, standards
and laws (including on consent and mental capacity), and safeguarding.
Please note that the Royal College of Obstetricians and Gynaecologists has produced
guidance on COVID-19 infection and pregnancy for all midwifery and obstetric
services.
This guideline uses the term 'woman' or 'mother' and includes all people who have
given birth, even if they may not identify as women or mothers. 'Woman' is generally
used but in some instances, 'mother' is used when referring to her in relation to her
baby.
This guideline uses the term 'partner' to refer to the woman's chosen supporter. This
could be the baby's father, the woman's partner, a family member or friend, or anyone
who the woman feels supported by or wishes to involve. The term 'parents' refers to
those with the main responsibility for the care of a baby. This will often be the mother
and the father, but many other family arrangements exist, including single parents.
1.1 Organisation and delivery of postnatal care
Principles of care
1.1.1 When caring for a woman who has recently given birth, listen to her and
be responsive to her needs and preferences. Also see the NICE guideline
on patient experience in adult NHS services.
1.1.2 Be aware that the 2020 MBRRACE-UK reports on maternal and perinatal
mortality showed that women and babies from some minority ethnic
backgrounds and those who live in deprived areas have an increased risk
of death and may need closer monitoring. The reports showed that:
• compared with white women (8 per 100,000), the risk of maternal death during
pregnancy and up to 6 weeks after birth is:
－ 4 times higher in black women (34 per 100,000)
－ 3 times higher in mixed ethnicity women (25 per 100,000)
－ 2 times higher in Asian women (15 per 100,000; does not include Chinese
women)
• the neonatal mortality rate is around 50% higher in black and Asian babies
compared with white babies (17 compared with 25 per 10,000)
• women living in the most deprived areas are more than 2.5 times more likely to
die compared with women living in the least deprived areas (6 compared with
15 per 100,000)
• the neonatal mortality rate increases according to the level of deprivation in

the area the mother lives in, with almost twice as many babies dying in the
most deprived areas compared with the least deprived areas (12 compared
with 22 per 10,000).
1.1.3 A woman may be supported by her partner in the postnatal period.

Involve them according to the woman's wishes.
1.1.4 When caring for a baby, remember that those with parental responsibility
have the right be involved in the baby's care, if they choose.
1.1.5 When giving information about postnatal care, use clear language and
tailor the timing, content and delivery of information to the woman's
needs and preferences. Information should support shared decision
making and be:
• provided face-to-face and supplemented by virtual discussions and written

formats, for example, digital, printed, braille or Easy Read
• offered throughout the woman's care
• individualised and sensitive
• supportive and respectful
• evidence based and consistent
• translated by an appropriate interpreter to overcome language barriers.
For more guidance on communication, providing information (including different

formats and languages) and shared decision making, see the NICE guidelines
on patient experience in adult NHS services and shared decision making, and
the NHS Accessible Information Standard.
1.1.6 Check that the woman understands the information she has been given,
and how it relates to her. Provide regular opportunities for her to ask
questions, and set aside enough time to discuss any concerns.
1.1.7 Follow the principles in the NICE guideline on pregnancy and complex
social factors for women who may need additional support, for example:
• women who misuse substances
• recent migrants, asylum seekers or refugees, or women who have difficulty

reading or speaking English
• young women aged under 20
• women who experience domestic abuse.
For a short explanation of why the committee made the recommendations and how
they might affect practice, see the rationale and impact section on principles of care.
Full details of the evidence and the committee's discussion are in evidence review G:
provision of information about the postnatal health of women.
Communication between healthcare professionals at transfer of

care
1.1.8 Ensure that there is effective and prompt communication between
healthcare professionals when women transfer between services, for
example, from secondary to primary care, and from midwifery to health
visitor care. This should include sharing relevant information about:
• the pregnancy, birth, postnatal period and any complications
• the plan of ongoing care, including any condition that needs long-term
management
• problems related to previous pregnancies that may be relevant to current care
• previous or current mental health concerns
• female genital mutilation (mother or previous child)
• who has parental responsibility for the baby, if known
• the woman's next of kin
• safeguarding issues (also see the NICE guideline on domestic violence and
abuse and the NICE guideline on child abuse and neglect)
• concerns about the woman's health and care, raised by her, her partner or a
healthcare professional
• concerns about the baby's health and care, raised by the parents or a
healthcare professional
• the baby's feeding.
1.1.9 Midwifery services should ensure that:
• the transfer of care from midwife to health visitor is clearly communicated

between healthcare professionals and
• the woman or the parents are informed about the transfer of care from midwife
to health visitor.
they might affect practice, see the rationale and impact section on communication
between healthcare professionals at transfer of care.
Full details of the evidence and the committee's discussion are in evidence review B:
information transfer.
Transfer to community care

1.1.10 Before transfer from the maternity unit to community care, or before the
midwife leaves after a home birth:
• assess the woman's health (see recommendations 1.2.2 and 1.2.3)
• assess the woman's bladder function by measuring the volume of the first void
after giving birth
• assess the baby's health (including physical inspection and observation)
• if the baby has not passed meconium, advise the parents that if the baby does
not do so within 24 hours of birth, they should seek advice from a healthcare
professional (also see recommendation 1.3.12)
• make sure there is a plan for feeding the baby, which should include observing
at least 1 effective feed.
1.1.11 Before transfer from the maternity unit to community care, discuss the
timing of transfer to community care with the woman, and ask her about
her needs, preferences and support available.
1.1.12 When deciding on the timing of the transfer to community care, take into
account the woman's preferences, the factors in recommendations 1.1.10
and 1.1.11 and any concerns, including any safeguarding issues (also see
the NICE guideline on domestic violence and abuse).
1.1.13 Before transfer from the maternity unit to community care, or before the
midwife leaves after a home birth, give women information about:
• the postnatal period and what to expect
• the importance of pelvic floor exercises (see the NICE guideline on pelvic floor
dysfunction)
• what support is available (statutory and voluntary services)
• who to contact if any concerns arise at different stages.
they might affect practice, see the rationale and impact section on transfer to
community care.
Full details of the evidence and the committee's discussion are in evidence review A:
length of postpartum stay.
First midwife visit after transfer of care from the place of birth or
after a home birth
1.1.14 Ensure that the first postnatal visit by a midwife takes place within
36 hours after transfer of care from the place of birth or after a home
birth. The visit should be face-to-face and usually at the woman's home,
depending on her circumstances and preferences.
For a short explanation of why the committee made the recommendation and how it
might affect practice, see the rationale and impact section on first midwife visit after
transfer of care from the place of birth or after a home birth.
Full details of the evidence and the committee's discussion are in evidence review C:
timing of first postnatal contact by midwife.
First health visitor visit

1.1.15 Be aware of the Department of Health and Social Care's Healthy Child
Programme. Consider arranging the first postnatal health visitor home
visit to take place between 7 and 14 days after transfer of care from
midwifery care so that the timing of postnatal contacts is evenly spread

out.
1.1.16 If a woman did not receive an antenatal health visitor visit, consider
arranging an additional early postnatal health visitor visit.
they might affect practice, see the rationale and impact section on first health visitor
visit.
Full details of the evidence and the committee's discussion are in evidence review D:
timing of first postnatal contact by health visitor.
1.2 Postnatal care of the woman
Assessment and care of the woman

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 problems and how to
seek help
• symptoms and signs of potential postnatal physical problems and how to seek
help
• the importance of pelvic floor exercises, how to do them and when to seek
help (see the NICE guideline on pelvic floor dysfunction)
• fatigue
• factors such as nutrition and diet, physical activity, smoking, alcohol

consumption and recreational drug use (also see the NICE guidelines on
maternal and child nutrition, weight management before, during and after
pregnancy, tobacco and the UK Chief Medical Officer's physical activity
guidelines for women after birth)
• contraception (see the Faculty of Sexual & Reproductive Healthcare (FSRH)

guideline on contraception after pregnancy)
• sexual intercourse
• safeguarding concerns, including domestic abuse (see the NICE guideline on

domestic violence and abuse and the NICE guideline on child abuse and
neglect).
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
－ nipple and breast discomfort 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 birth:
－ perineal healing (see the section on perineal health)
• for women who have had a caesarean section (also see the NICE guideline on
caesarean birth):
－ 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
• worsening reddening and swelling of breasts persisting for more than 24 hours
despite self-management, which could indicate mastitis
• symptoms or signs of potentially serious conditions that do not respond to

treatment.
1.2.5 At each postnatal contact, give the woman the opportunity to talk about
her birth experience, and provide information about relevant support and
birth reflection services, if appropriate. See the section on traumatic
birth, stillbirth and miscarriage in the NICE guideline on antenatal and
postnatal mental health and the NICE guideline on post-traumatic stress
disorder.
1.2.6 All healthcare professionals should ensure appropriate referral if there

are concerns about the woman's health.
1.2.7 At 6 to 8 weeks after the birth, a GP should:
• carry out an assessment including the points in recommendations 1.2.1 to 1.2.5

and taking into account the time since the birth
• respond to any concerns, which may include referral to specialist services in

either secondary care or other healthcare services such as physiotherapy.
1.2.8 For guidance on care for women with symptoms or signs of sepsis, see
the NICE guideline on sepsis. If the woman has confirmed or suspected
puerperal sepsis, assess the baby for symptoms or signs of infection.
1.2.9 For postnatal care of women who have had hypertension or

pre-eclampsia in pregnancy, see the NICE guideline on hypertension in
pregnancy, in particular:
• postnatal investigation, monitoring and treatment:
－ for women with chronic hypertension
－ for women with gestational hypertension
－ for women with pre-eclampsia
• antihypertensive treatment during the postnatal period, including when

breastfeeding
• advice and follow-up at transfer to community care.
1.2.10 For postnatal care of women with pre-existing diabetes or who had
gestational diabetes, see the recommendations on postnatal care in the
NICE guideline on diabetes in pregnancy.
1.2.11 For guidance on assessing the risk and preventing venous

thromboembolism in women who have given birth, see the NICE
guideline on venous thromboembolism and the Royal College of
Obstetricians and Gynaecologists' guideline on reducing the risk of
venous thromboembolism during pregnancy and the puerperium.
1.2.12 For guidance on assessing and managing urinary incontinence and pelvic
organ prolapse in women who have given birth, see:
• the NICE guideline on urinary incontinence and pelvic organ prolapse in women
• the NICE guideline on pelvic floor dysfunction.
they might affect practice, see the rationale and impact section on assessment and
care of the woman.
Full details of the evidence and the committee's discussion are in:
• evidence review F: content of postnatal care contacts
• evidence review H: tools for the clinical review of women
• evidence review I: assessment of secondary postpartum haemorrhage
• evidence review E: timing of comprehensive assessment.
Postpartum bleeding
1.2.13 Discuss with women what vaginal bleeding to expect after the birth
(lochia), and advise women to seek medical advice if:
• the vaginal bleeding is sudden or very heavy
• the bleeding increases
• they pass clots, placental tissue or membranes
• they have symptoms of possible infection, such as abdominal, pelvic or

perineal pain, fever, shivering, or vaginal bleeding or discharge has an
unpleasant smell
• they have concerns about vaginal bleeding after the birth.
1.2.14 If a women seeks medical advice about vaginal bleeding after the birth,
assess the severity, and be aware of the risk factors for postpartum
haemorrhage in the NICE guideline on intrapartum care. Also be aware of
the following factors, which may worsen the consequences of secondary
postpartum haemorrhage:
• anaemia
• weight of less than 50 kg at the first appointment with the midwife during
pregnancy (booking appointment).
they might affect practice, see the rationale and impact section on postpartum
bleeding.
Full details of the evidence and the committee's discussion are in evidence review I:
assessment of secondary postpartum haemorrhage.
Perineal health
1.2.15 At each postnatal contact, as part of assessing perineal wound healing,
ask the woman if she has any concerns and ask about:
• pain not resolving or worsening
• increasing need for pain relief
• discharge that has a strong or unpleasant smell
• swelling
• wound breakdown.
1.2.16 Advise the woman about the importance of good perineal hygiene,
including daily showering of the perineum, frequent changing of sanitary
pads, and hand washing before and after doing this.
1.2.17 Consider using a validated pain scale to monitor perineal pain.
1.2.18 If the woman or the healthcare professional has concerns about perineal
healing or if the woman asks for reassurance, offer or arrange an

examination of the perineum by a midwife or a doctor.
1.2.19 If needed, discuss available pain relief options, taking into account if the
woman is breastfeeding.
1.2.20 If the perineal wound breaks down or there are ongoing healing
concerns, refer the woman urgently to specialist maternity services (to
be seen the same day in the case of a perineal wound breakdown).
1.2.21 Be aware that perineal pain that persists or gets worse within the first
few weeks after the birth may be associated with symptoms of
depression, long-term perineal pain, problems with daily functioning and
psychosexual difficulties.
1.2.22 Be aware of the following risk factors for persistent postnatal perineal
pain:
• episiotomy, or labial or perineal tear
• assisted vaginal birth
• wound infection or breakdown
• birth experienced as traumatic.
they might affect practice, see the rationale and impact section on perineal health.
Full details of the evidence and the committee's discussion are in evidence review J:
perineal pain and evidence review H: tools for the clinical review of women.
1.3 Postnatal care of the baby
Assessment and care of the baby

1.3.1 At each postnatal contact, ask parents if they have any concerns about
their baby's general wellbeing, feeding or development. Review the

history and assess the baby's health, including physical inspection and
observation. If there are any concerns, take appropriate further action.
1.3.2 Be aware that if the baby has not passed meconium within 24 hours of
birth, this may indicate a serious disorder and requires medical advice.
1.3.3 Carry out a complete examination of the baby within 72 hours of the
birth and at 6 to 8 weeks after the birth (see the Public Health England
newborn and infant physical examination [NIPE] screening programme).
This should include checking the baby's:
• appearance, including colour, breathing, behaviour, activity and posture
• head (including fontanelles), face, nose, mouth (including palate), ears, neck
and general symmetry of head and facial features
• eyes: opacities, red reflex and colour of sclera
• neck and clavicles, limbs, hands, feet and digits; assess proportions and
symmetry
• heart: position, heart rate, rhythm and sounds, murmurs and femoral pulse
volume
• lungs: respiratory effort, rate and lung sounds
• abdomen: assess shape and palpate to identify any organomegaly; check

condition of umbilical cord
• genitalia and anus: completeness and patency and undescended testes in boys
• spine: inspect and palpate bony structures and check integrity of the skin
• skin: colour and texture as well as any birthmarks or rashes
• central nervous system: tone, behaviour, movements and posture; check

newborn reflexes only if concerned
• hips: symmetry of the limbs, Barlow and Ortolani's manoeuvres
• cry: assess sound.
1.3.4 At 6 to 8 weeks, assess the baby's social smiling and visual fixing and
following.
1.3.5 Measure weight and head circumference of babies in the first week and
around 8 weeks, and at other times only if there are concerns. Plot the
results on the growth chart.
1.3.6 For advice on identifying and managing jaundice, see the NICE guideline
on jaundice in newborn babies under 28 days.
1.3.7 If there are concerns about the baby's growth, see the NICE guideline on
faltering growth.
1.3.8 Carry out newborn blood spot screening in line with the NHS newborn
blood spot screening programme.
1.3.9 Carry out newborn hearing screening in line with the NHS newborn
hearing screening programme.
1.3.10 Give parents information about:
• how to bathe their baby and care for their skin
• care of the umbilical stump
• feeding (see recommendations on planning and supporting babies' feeding)
• bonding and emotional attachment (see recommendations on promoting

emotional attachment)
• how to recognise if the baby is unwell, and how to seek help (see
recommendations on symptoms and signs of illness in babies)
• established guidance on safer sleeping (including recommendations on bed

sharing)
• maintaining a smoke-free environment for the baby (see also the NICE
guideline on tobacco)
• vitamin D supplements for babies in line with the NICE guideline on vitamin D
supplement use
• immunising the baby in line with Public Health England's routine childhood
immunisations schedule.
1.3.11 Consider giving parents information about the Baby Check scoring
system and how it may help them to decide whether to seek advice from
a healthcare professional if they think their baby might be unwell.
1.3.12 Advise parents to seek advice from a healthcare professional if they think
their baby is unwell, and to contact emergency services (call 999) if they
think their baby is seriously ill.
they might affect practice, see the rationale and impact section on assessment and
care of the baby.
Full details of the evidence and the committee's discussion are in evidence review F:
content of postnatal care contacts and evidence review L2: scoring systems for illness
in babies.
Bed sharing
1.3.13 Discuss with parents safer practices for bed sharing, including:
• making sure the baby sleeps on a firm, flat mattress, lying face up (rather than
face down or on their side)
• not sleeping on a sofa or chair with the baby
• not having pillows or duvets near the baby
• not having other children or pets in the bed when sharing a bed with a baby.
1.3.14 Strongly advise parents not to share a bed with their baby if their baby
was low birth weight or if either parent:
• has had 2 or more units of alcohol
• smokes
• has taken medicine that causes drowsiness
• has used recreational drugs.
they might affect practice, see the rationale and impact section on bed sharing.
Full details of the evidence and the committee's discussion are in evidence review M:
benefits and harms of bed sharing and evidence review N: co-sleeping risk factors.
Promoting emotional attachment

1.3.15 Before and after the birth, discuss the importance of bonding and
emotional attachment with parents, and the approaches that can help
them to bond with their baby.
1.3.16 Encourage parents to value the time they spend with their baby as a way
of promoting emotional attachment, including:
• face-to-face interaction
• skin-to-skin contact
• responding appropriately to the baby's cues.
1.3.17 Discuss with parents the potentially challenging aspects of the postnatal
period that may affect bonding and emotional attachment, including:
• the woman's physical and emotional recovery from birth
• experience of a traumatic birth or birth complications
• fatigue and sleep deprivation
• feeding concerns
• demands of parenthood.
1.3.18 Recognise that additional support in bonding and emotional attachment

may be needed by some parents who, for example:
• have been through the care system
• have experienced adverse childhood events
• have experienced a traumatic birth
• have complex psychosocial needs.
they might affect practice, see the rationale and impact section on promoting
emotional attachment.
Full details of the evidence and the committee's discussion are in evidence review O:
emotional attachment.
1.4 Symptoms and signs of illness in babies

1.4.1 Listen carefully to parents' concerns about their baby's health and treat
their concerns as an important indicator of possible serious illness in
their baby.
1.4.2 Healthcare professionals should consider using the Baby Check scoring
system:
• to supplement the clinical assessment of babies for possible illness, particularly

as part of a remote assessment and
• as a communication aid in conversations with parents to help them describe

the baby's condition.
1.4.3 Follow the recommendations in the NICE guideline on neonatal infection

on:
• assessing and managing the risk of early-onset neonatal infection after birth
(within 72 hours of the birth)
• risk factors for and clinical indicators of possible late-onset neonatal infection
(more than 72 hours after the birth).
1.4.4 Be aware that fever may not be present in young babies with a serious
infection.
1.4.5 If the baby has a fever, follow the recommendations in the NICE guideline
on fever in under 5s.
1.4.6 If there are concerns about the baby's growth, follow the
recommendations in the NICE guideline on faltering growth.
1.4.7 Be aware of the possible significance of a change in the baby's

behaviour or signs, such as refusing feeds or a change in the level of
responsiveness.
1.4.8 Be aware that the presence or absence of individual symptoms or signs

may be of limited value in identifying or ruling out serious illness in a
young baby.
1.4.9 Recognise the following as 'red flags' for serious illness in young babies:
• appearing ill to a healthcare professional
• appearing pale, ashen, mottled or blue (cyanosis)
• unresponsive or unrousable
• having a weak, abnormally high-pitched or continuous cry
• abnormal breathing pattern, such as:
－ grunting respirations
－ increased respiratory rate (over 60 breaths/minute)
－ chest indrawing
• temperature of 38°C or over or under 36°C
• non-blanching rash
• bulging fontanelle
• neck stiffness
• seizures
• focal neurological signs
• diarrhoea associated with dehydration
• frequent forceful (projectile) vomiting
• bilious vomiting (green or yellow-green vomit).
See the following sections in other NICE guidelines for more information:
• fever in under 5s: clinical assessment of children with fever
• neonatal infection: assessing and managing the risk of early-onset neonatal

infection after birth and risk factors for and clinical indicators of possible late-
onset neonatal infection
• sepsis: identifying people with suspected sepsis
• meningitis (bacterial) and meningococcal septicaemia in under 16s: symptoms,

signs and initial assessment
• gastroesophageal reflux disease (GORD) in children and young people:

diagnosing and investigating GORD
• diarrhoea and vomiting caused by gastroenteritis in under 5s: assessing

dehydration and shock
• urinary tract infection in under 16s: diagnosis.
1.4.10 If a baby is thought to be seriously unwell based on a 'red flag' (see

recommendation 1.4.9) or on an overall assessment of their condition,
arrange an immediate assessment with an appropriate emergency
service. If the baby's condition is immediately life-threatening, dial 999.
they might affect practice, see the rationale and impact section on symptoms and
signs of illness in babies.
Full details of the evidence and the committee's discussion are in evidence review L1:
signs and symptoms of serious illness in babies and evidence review L2: scoring
systems for illness in babies.
1.5 Planning and supporting babies' feeding
General principles about babies' feeding

1.5.1 When discussing babies' feeding, follow the recommendations in the
section on principles of care, and:
• acknowledge the parents' emotional, social, financial and environmental

concerns about feeding options
• be respectful of parents' choices.
might affect practice, see the rationale and impact section on general principles about
babies' feeding.
Full details of the evidence and the committee's discussion are in evidence review T:
formula feeding information and support.
Giving information about breastfeeding

1.5.2 Before and after the birth, discuss breastfeeding and provide information
and breastfeeding support (see the section on supporting women to
breastfeed). Topics to discuss may include (see also recommendation
1.5.12):
• nutritional benefits for the baby
• health benefits for both the baby and the woman
• how it can have benefits even if only done for a short time
• how it can soothe and comfort the baby.
1.5.3 Give information about how the partner can support the woman to
breastfeed, including:
• the value of their involvement and support
• how they can comfort and bond with the baby.
1.5.4 Inform women that vitamin D supplements are recommended for all
breastfeeding women (see the NICE guideline on vitamin D).
1.5.5 Inform women and their partners that under the Equality Act 2010,
women have the right to breastfeed in 'any public space'.
they might affect practice, see the rationale and impact section on giving information
about breastfeeding.
• evidence review P: breastfeeding interventions
• evidence review Q: breastfeeding facilitators and barriers
• evidence review S: breastfeeding information and support.
Role of the healthcare professional supporting breastfeeding

1.5.6 Healthcare professionals caring for women and babies in the postnatal
period should know about:
• breast milk production
• signs of good attachment at the breast
• effective milk transfer
• how to encourage and support women with common breastfeeding problems
• appropriate resources for safe medicine use and prescribing for breastfeeding
women.
1.5.7 Encourage the woman to have early skin-to-skin contact with her baby
so that breastfeeding can start when the baby and mother are ready.
1.5.8 Those providing breastfeeding support should:
• be respectful of women's personal space, cultural influences, preferences and

previous experience of infant feeding
• balance the woman's preference for privacy to breastfeed and express milk in
hospital with the need to carry out routine observations
• obtain consent before offering physical assistance with breastfeeding
• recognise the emotional impact of breastfeeding
• give women the time, reassurance and encouragement they need to gain
confidence in breastfeeding.
they might affect practice, see the rationale and impact section on the role of the
healthcare professional supporting breastfeeding.
Full details of the evidence and the committee's discussion are in evidence review Q:
breastfeeding facilitators and barriers and evidence review S: breastfeeding
information and support.
Supporting women to breastfeed

1.5.9 Give breastfeeding care that is tailored to the woman's individual needs
and provides:
• face-to-face support
• written, digital or telephone information to supplement (but not replace) face-

to-face support
• continuity of carer
• information about what to do and who to contact if she needs additional

support
• information for partners about breastfeeding and how best to support

breastfeeding women, taking into account the woman's preferences about the
partner's involvement
• information about opportunities for peer support.
1.5.10 Make face-to-face breastfeeding support integral to the standard

postnatal contacts for women who breastfeed. Continue this until
breastfeeding is established and any problems have been addressed.
1.5.11 Be aware that younger women and women from a low income or
disadvantaged background may need more support and encouragement
to start and continue breastfeeding, and that continuity of carer is
particularly important for these women.
1.5.12 Provide information, advice and reassurance about breastfeeding, so

women (and their partners) know what to expect, and when and how to
seek help. Topics to discuss include:
• how milk is produced, how much is produced in the early stages, and the
supply-and-demand nature of breastfeeding
• responsive breastfeeding
• how often babies typically need to feed and for how long, taking into account
individual variation
• feeding positions and how to help the baby attach to the breast
• signs of effective feeding so the woman knows her baby is getting enough milk
(it is not possible to overfeed a breastfed baby; see also recommendation
1.5.14)
• expressing breast milk (by hand or with a breast pump) as part of

breastfeeding and how it can be useful; safe storage and preparation of
expressed breast milk; and the dangers of 'prop' feeding
• normal breast changes during pregnancy and after the birth
• pain when breastfeeding and when to seek help
• breastfeeding complications (for example, mastitis or breast abscess) and

when to seek help
• strategies to manage fatigue when breastfeeding
• supplementary feeding with formula milk that is sometimes, but not commonly,
clinically indicated (also see the NICE guideline on faltering growth)
• how breastfeeding can affect the woman's body image and identity
• that the information given may change as the baby grows
• the possibility of relactation after a gap in breastfeeding
• safe medicine use when breastfeeding.
they might affect practice, see the rationale and impact section on supporting women
to breastfeed.
• evidence review P: breastfeeding interventions
• evidence review Q: breastfeeding facilitators and barriers
• evidence review S: breastfeeding information and support.
Assessing breastfeeding
1.5.13 A practitioner with skills and competencies in breastfeeding support
should assess breastfeeding to identify and address any concerns.
1.5.14 As part of the breastfeeding assessment:
• ask about:
－ any concerns the parents have about their baby's feeding
－ how often and how long the feeds are
－ rhythmic sucking and audible swallowing
－ if the baby is content after the feed
－ if the baby is waking up for feeds
－ the baby's weight gain or weight loss
－ the number of wet and dirty nappies
－ the condition of the woman's breasts and nipples
• observe a feed within the first 24 hours after the birth, and at least 1 other feed
within the first week.
1.5.15 If there are ongoing concerns, consider:
• observing additional feeds
• other actions, such as:
－ adjusting positioning and attachment to the breast
－ giving expressed milk
－ referring to additional support such as a lactation consultation or peer

support
－ assessing for tongue-tie.
they might affect practice, see the rationale and impact section on assessing
breastfeeding.
Full details of the evidence and the committee's discussion are in evidence review R:
tools for predicting breastfeeding difficulties.
Formula feeding
1.5.16 Before and after the birth, discuss formula feeding with parents who are
considering or who need to formula feed, taking into account that babies
may be partially formula fed alongside breastfeeding or expressed breast
milk.
1.5.17 Information about formula feeding should include:
• the differences between breast milk and formula milk
• that first infant formula is the only formula milk that babies need in the first
year of life, unless there are specific medical needs
• how to sterilise feeding equipment and prepare formula feeds safely, including
a practical demonstration if needed
• for women who are trying to establish breastfeeding and considering

supplementing with formula feeding, the possible effects on breastfeeding
success, and how to maintain adequate milk supply while supplementing.
1.5.18 For parents who formula feed:
• have a one-to-one discussion about safe formula feeding
• provide face-to-face support
• provide written, digital or telephone information to supplement (but not

replace) face-to-face support.
1.5.19 Face-to-face formula feeding support should include:
• advice about responsive bottle feeding and help to recognise feeding cues
• offering to observe a feed
• positions for holding a baby for bottle feeding and the dangers of 'prop' feeding
• advice about how to pace bottle feeding and how to recognise signs that a
baby has had enough milk (because it is possible to overfeed a formula-fed
baby), and advice about ways other than feeding that can comfort and soothe
the baby
• how to bond with the baby when bottle feeding, through skin-to-skin contact,
eye contact and the potential benefit of minimising the number of people
regularly feeding the baby.
1.5.20 For parents who are thinking about supplementing breastfeeding with
formula or changing from breastfeeding to formula feeding, support them
to make an informed decision.
they might affect practice, see the rationale and impact section on formula feeding.
Full details of the evidence and the committee's discussion are in evidence review T:
formula feeding information and support.
Lactation suppression
1.5.21 Discuss lactation suppression with women if breastfeeding is not started
or is stopped, breastfeeding is contraindicated for the baby or the
woman, or in the event of the death of a baby. Follow the
recommendations in the section on principles of care. Topics to discuss
include:
• how the body produces milk, what happens when milk production stops, and
how long it takes for milk production to stop
• self-help advice, such as:
－ avoiding stimulating the breast
－ wearing a supportive bra
－ using ice packs
－ over-the-counter pain relief
－ sparingly expressing milk to ease engorgement
• when to seek help
• medicines that can be prescribed to suppress lactation
• the advantages and disadvantages of the different methods of lactation

suppression
• the possibility of becoming a breast milk donor (also see the section on
screening and selecting donors in the NICE guideline on donor milk banks).
might affect practice, see the rationale and impact section on lactation suppression.
Full details of the evidence and the committee's discussion are in evidence review K:
information for lactation suppression.
Terms used in this guideline

This section defines terms that have been used in a particular way for this guideline.
Bonding and emotional attachment

Bonding is the positive emotional and psychological connection that the parent develops
with the baby.
Emotional attachment refers to the relationship between the baby and parent, driven by
innate behaviour and which ensures the baby's proximity to the parent and safety. Its
development is a complex and dynamic process dependent on sensitive and emotionally
attuned parent interactions supporting healthy infant psychological and social

development and a secure attachment. Babies form attachments with a variety of
caregivers but the first, and usually most significant of these, will be with the mother and/
or father.
Continuity of carer
Better Births, a report by the National Maternity Review, defines continuity of carer as
consistency in the midwifery team (between 4 and 8 individuals) that provides care for the
woman and her baby throughout pregnancy, labour and the postnatal period. A named
midwife coordinates the care and takes responsibility for ensuring the needs of the woman
and her baby are met throughout the antenatal, intrapartum and postnatal periods.
For the purpose of this guideline, the definition of continuity of carer in the Better Births
report has been adapted to include not just the midwifery team but any healthcare team
involved in the care of the woman and her baby, including the health visitor team. It
emphasises the importance of effective information transfer between the individuals
within the team. Having continuity of carer means that a trusting relationship can be
developed between the woman and the healthcare professional(s) who cares for her. For
more information, see the NHS Implementing Better Births: continuity of carer.
Effective feed
In general, effective feeding includes the baby showing readiness to feed, rhythmic
sucking, calmness during the feed and satisfactory weight gain. For a first feed at the
breast or with a bottle, effective feeding is shown by the baby latching to the breast or
drawing the teat into mouth when offered and showing some rhythmic sucking.
First infant formula

First infant formula or 'first milk' is the type of formula milk that is suitable for a baby from
birth to 12 months.
Low birth weight

A birth weight of less than 2,500 grams regardless of gestational age.
Nominal group technique

This is a structured method that uses the opinions of individuals within a group to reach a
consensus. It involves anonymous voting with an opportunity to provide comments.
Options with low agreement are eliminated and options with high agreement are retained.
Using the comments that individuals provide, options with medium agreement are revised
and then considered in a second round. For more information, see supplement 1 on
methods.
Parental responsibility
See the government definition of parental responsibility.
Parents
Parents are those with the main responsibility for the care of a baby. This will often be the
mother and the father, but many other family arrangements exist, including single parents.
Partner
Partner refers to the woman's chosen supporter. This could be the baby's father, the
woman's partner, a family member or friend, or anyone who the woman feels supported by
or wishes to involve.
Prop feeding
When a baby's feeding bottle is propped against a pillow or other support, rather than the
baby and the bottle being held when feeding.
Responsive feeding
Responsive feeding means feeding in response to the baby's cues. It recognises that feeds
are not just for nutrition, but also for love, comfort and reassurance between the baby and
mother (or parent in case of bottle feeding). Responsive breastfeeding also involves a
mother responding to her own desire to feed for her comfort or convenience. Responsive
bottle feeding involves holding the baby close, pacing the feeds and avoiding forcing the
baby to finish the feed by recognising signs that the baby has had enough milk, and to
reduce the risk of overfeeding. For more information, see the UNICEF Baby Friendly
Initiative (BFI) information sheet on responsive feeding.
Recommendations for research

The guideline committee has made the following key recommendations for research.
1 Length of postpartum stay and first midwife visit

after transfer of care
How does the length of postpartum stay and the timing of the first midwife visit after
transfer of care affect unplanned or emergency health contacts for women and babies?
For a short explanation of why the committee made this recommendation for
research, see the rationale section on timing of transfer to community care.
Full details of the recommendation for research are in evidence review A: length of
postpartum stay.
See also the rationale section on first midwife visit after transfer of care from the
place of birth or after a home birth.
Full details of the recommendation for research are in evidence review C: timing of
first postnatal contact by midwife.
2 Timing of first health visitor visit

What is the most effective timing of the first postnatal contact by a health visitor?
research, see the rationale section on first health visitor visit.
Full details of the recommendation for research are in evidence review D: timing of
first postnatal contact by health visitor.
3 Clinical tools to assess women's health

What tools for the clinical review of women (including pain scores) are effective during the
first 8 weeks after birth?
research, see the rationale section on assessment and care of the woman.
Full details of the recommendation for research are in evidence review H: tools for the
clinical review of women.
4 Perineal pain
What characteristics of perineal pain suggest the need for further evaluation?
research, see the rationale section on perineal health.
Full details of the recommendation for research are in evidence review J: perineal
pain.
5 Breastfeeding support for parents with twins or

triplets
What support with breastfeeding do parents of twins or triplets find helpful?
research, see the rationale section on supporting women to breastfeed.
Full details of the recommendation for research are in evidence review S:

breastfeeding information and support.
Rationale and impact

These sections briefly explain why the committee made the recommendations and how
they might affect practice.
Principles of care
Recommendations 1.1.1 to 1.1.7
Why the committee made the recommendations

The committee agreed that one of the key principles of care in the postnatal period is to
listen to women and be responsive to their needs, in line with the findings of the Ockenden
report on maternity services at the Shrewsbury and Telford hospital NHS trust. The NICE
guideline on patient experience in adult NHS services gives comprehensive guidance on
individualised and person-centred care.
The committee also agreed that healthcare professionals should be aware of the
disproportionate maternal and neonatal mortality rates among women and babies from
black, Asian and minority ethnic backgrounds and those living in deprived areas, as
highlighted by the 2020 MBRRACE-UK reports on maternal and perinatal mortality. This
increased risk of death indicates that closer monitoring and lower thresholds for further
care or admission might be needed. Future research could help understand these
disparities and what interventions could improve the outcomes.
The committee recognised that the home and family circumstances for women vary, and it
is up to the woman who she may want to involve in her postnatal care. The committee also
recognised the role of the baby's father or other parents (or whoever has parental
responsibility) in the care of the baby.
There was evidence that information given in the postnatal period is often inconsistent,
and this was supported by the committee's experience. There was some evidence that
information may need to be repeated at different times by different healthcare
professionals. The committee agreed that this is good practice given the number of
healthcare professionals that new parents are likely to come into contact with. They
discussed concerns about the wide range and varied quality of information available from
healthcare professionals, the internet and social media.
The evidence showed that healthcare professionals are a trusted source of information, so
the committee agreed that it is important for healthcare professionals to provide evidence-
based and consistent information throughout the woman's care. It should also take into
consideration the individual needs and preferences of the woman. The evidence
suggested that it is helpful to deliver information in different formats, for example, face-to-
face discussions and printed or digital materials. The NICE guideline on patient experience
in adult NHS services gives more information. The committee discussed the importance of
allowing sufficient time for discussions.
The NICE guideline on pregnancy and complex social factors provides guidance for the
antenatal period for specific groups. The committee agreed that the principles of care that
are not specific to the antenatal period can also be applied to the postnatal period for
potentially vulnerable groups of women.
How the recommendations might affect practice

There is some variation in what information is provided, and the recommendations may
result in a change in practice for some centres, involving more training for healthcare
professionals, and more time in postnatal appointments. The recommendations are
expected to have a positive effect on women's experience of the healthcare service by
increasing their confidence in the information provided. This may result in parents being
more likely to follow the advice given, which may enable them to react more appropriately
to difficulties and thereby reduce morbidity and mortality.
Return to recommendations
Communication between healthcare professionals

at transfer of care
Recommendations 1.1.8 and 1.1.9

The evidence highlighted issues that should be communicated between healthcare
professionals at transfer of care, including the woman's history in relation to her pregnancy
and birth experience, and any mental health problems or safeguarding issues. Based on
this evidence and their knowledge and experience, the committee agreed the information
that should be passed on when women transfer between services, so that healthcare
professionals do not miss relevant information and the woman does not always have to
repeat the same information to different healthcare professionals. What is relevant and the
level of detail needed may vary depending on whether the healthcare professional is a GP,
midwife or a health visitor.
The committee also emphasised the importance of seamless transfer of care from
midwifery to health visitor care so that there is continuous care provision.

There is variation in practice regarding what information, if any, is transferred between the
different teams. The recommendation should lead to clearer guidance, improve relevant
transfer of information and improve care for women and babies.
Transfer to community care


Studies looking at varying transfer timings showed that there was no consistent evidence
about the best time to transfer the care of women and their babies to community care.
Based on their knowledge and experience, the committee agreed that the timing should
depend on the health and wellbeing of the woman and the baby. This also applies to the
departure of the midwife in the case of a home birth. This will help to safely manage
potential complications, prevent readmissions in the immediate postnatal period, and take
into account any safeguarding concerns so that the woman and the baby are not
discharged to an unsafe environment.
Assessing the woman's bladder function to rule out urinary retention is important because
undetected or unmanaged urinary retention can lead to serious long-term consequences
such as urinary incontinence.
Not passing meconium (the baby's first bowel movement) within the first 24 hours can be
a sign of bowel obstruction, so it is important that parents know to seek advice from a
healthcare professional. This might be for example a midwife, a doctor or, if the baby is
thought to be seriously unwell, the emergency services.
Observing at least 1 effective feed (regardless of the method of feeding) is important to

establish feeding and lower the chance of feeding problems at home and the need for
readmission.
The committee also agreed that in order to reassure women that they and their babies are
being taken care of, they should be given information about what happens next, what
support is available and who to contact in case of concerns. It is also important to
highlight the importance of pelvic floor exercises soon after birth to prevent potentially
long-term and serious conditions such as incontinence and pelvic organ prolapse.
No evidence on timing of transfer to home care was identified for twins or triplets, but the
committee agreed that the same principles apply for multiple births as for singleton births.
Because of the lack of clear evidence, the committee made a recommendation for
research on length of postpartum stay to assess how the length of the hospital stay after
giving birth affects unplanned or emergency contacts with primary or secondary care.

There is wide variation in practice in how long women stay in hospital after giving birth.
The committee noted that observing a feed before transfer is already current practice in
settings that are UNICEF Baby Friendly Initiative (BFI)-accredited, but many providers in
England do not have this accreditation. The recommendations should lead to more
consistency. If potential problems are prevented or managed early, this could potentially
lead to cost savings because of lower reattendance or readmission.
First midwife visit after transfer of care from the

place of birth or after a home birth
Recommendation 1.1.14
Why the committee made the recommendation

There was little evidence and the committee had low confidence in it, so the committee
used their knowledge and experience to agree the timing of the first midwife visit. Having
the first visit within 36 hours after transfer of care would usually mean that the visit is not
left too long, so that any health or support needs can be identified early.
The committee agreed that the first postnatal visit by the midwifery team should be by a
midwife (and not, for example, by a maternity support worker), face-to-face and,
depending on the woman's circumstances and preferences, in the home. This should
enable a comprehensive assessment of the health and support needs of the woman and
her baby.
Because of the lack of evidence, the committee made a recommendation for research on
the first midwife visit after discharge to assess how the timing of the first midwife visit
after the transfer of care affects unplanned or emergency contacts with primary or
secondary care.
How the recommendation might affect practice

The recommendation should reduce variation in practice and improve care for women. The
recommendation might affect practice because a midwife should attend the first postnatal
visit, and in current practice this might be a maternity support worker or a student midwife
instead. However, no significant resource implications are expected.
First health visitor visit


No evidence was found about when the first postnatal health visitor visit should take
place, so the committee used their knowledge and experience to agree the timing. The aim
is to involve health visitors when they are most needed, and spread the visits evenly
throughout the postnatal period.
According to the Department of Health and Social Care's Healthy Child Programme, there
should be 2 health visitor visits in the postnatal period. The first visit is often very soon
after transfer of care from midwifery care (which usually takes places 10 to 14 days after
birth). This creates a gap of several weeks before the second health visitor visit at around
6 to 8 weeks. The first 2 weeks after birth may be overwhelming for some families, with
several visits from both the midwifery team and health visitors. Having the first postnatal
health visitor visit 1 to 2 weeks after transfer of care from midwifery care will mean that
the visits are more evenly spread out.
Although the Healthy Child Programme includes an antenatal visit by the health visitor, the
committee agreed that this does not always happen. If this is the case, an additional early
postnatal visit by the health visitor to replace the missed antenatal visit could be
considered to enable the health visitor to get to know the family and their circumstances
early on.
Because of the lack of evidence, the committee made a recommendation for research on
the most effective timing of the first postnatal visit by a health visitor.

There is variation in when the first postnatal health visitor visit takes place. However, 1 of
the key performance indicators of the Healthy Child Programme is that the first postnatal
health visitor visit takes place between 10 and 14 days after birth, so the recommendation
would mean a change in practice. The recommendation aims to reduce variation in
practice and improve care for women and their babies. Some additional resources may be
needed to organise an additional early postnatal visit by a health visitor in the exceptional
circumstance when a mandated antenatal health visitor visit has not taken place; however,
the resource impact of this is not considered to be large, and is likely outweighed by the
potential benefits.
Assessment and care of the woman


The recommendations were not developed by the usual NICE guideline systematic review
process because of the scale and complexity of the topic. Using the nominal group
technique to vote on statements about the content of postnatal care contacts, the
committee made recommendations through formal consensus because reaching
consensus by committee discussion alone would be challenging. The statements were
based on a review, including critical appraisal, of existing guidelines and systematic
reviews. The committee based the recommendations on these and their knowledge and
experience.
The committee agreed that at each postnatal contact, women's general health and
wellbeing, including psychological and emotional health, should be assessed and women
should be asked if they have any concerns. The committee also agreed the physical health
areas that midwives should assess. In order to prevent serious outcomes, women should
also be made aware of the signs and symptoms of potentially serious conditions so they
can seek help. Women's physical health assessment is not in the remit of the health visitor
but when there are concerns, either observed by the healthcare professional or expressed
by the woman, all healthcare professionals, including health visitors, should refer or advise
self-referral so that the woman can get appropriate assessment and care.
The committee acknowledged that some women may want to talk about their birth
experience. In some cases, women might need additional support in coping with their
experience.
No evidence was identified on the timing of the comprehensive routine postnatal check.
Based on their knowledge and experience, the committee agreed this should ideally
happen between 6 and 8 weeks after birth, as is current practice, to coincide with the
Public Health England newborn and infant physical examination.
No evidence was identified about which tools are effective in the clinical postnatal review
of women. A tool that has been tested and validated in an independent sample assessing
postnatal physical and mental health problems could help identify those women who need
additional care and support, so the committee made a recommendation for research on
clinical tools to assess women's health.
References were made to NICE guidelines on different conditions that may affect women
postnatally. A bacterial infection could be transmitted to the baby, so it is important to
assess the baby if the mother has suspected or confirmed puerperal sepsis.

By ensuring that women's physical and psychological health and wellbeing is
comprehensively assessed, and any problems are managed appropriately, there may be an
increase in referrals if problems are identified. The committee agreed that any referrals
would prevent delays in diagnosing and treating problems, and improve care.
Postpartum bleeding

No relevant evidence was identified about how to assess early symptoms and signs of
postpartum haemorrhage, so the committee used their knowledge and experience to make
the recommendations. Discussing with women what to expect after birth helps women to
distinguish between a normal amount of lochia (vaginal discharge containing blood, mucus
and uterine tissue) and signs and symptoms of postpartum haemorrhage. Women should
be advised to seek medical advice if they observe these signs or symptoms because
postpartum haemorrhage can have severe consequences.
The committee agreed that although all women are at risk of secondary postpartum
haemorrhage, some factors increase this risk and these should be taken into account
when assessing the severity of blood loss. The risk factors for postpartum haemorrhage
are listed in the NICE guideline on intrapartum care. The committee used their knowledge
and experience to list other factors that might worsen the consequences of postpartum
bleeding so that appropriate action can be taken.

It is not routine practice to discuss what blood loss to expect postnatally, so the
recommendations will involve a minor change to current practice but will potentially
improve outcomes by early identification of secondary postpartum haemorrhage.
Perineal health

Perineal pain and its complications are often overlooked and falsely considered to be part
of normal postnatal healing. However, early identification and management of perineal pain
may prevent long-term consequences and improve the woman's overall experience of
postnatal care. To help healthcare professionals identify women with perineal pain and to
prompt appropriate care, healthcare professionals should ask women if they have any
perineal concerns.
Practical advice about how to maintain good perineal hygiene can prevent infection or
complications. In order to assess changes in the severity of perineal pain over time, a
validated pain score might help to give a clearer view. Physical examination of the
perineum could help determine the severity or cause of the pain, or whether further action
is needed. In some cases, medication might be needed to alleviate the pain.
The committee emphasised that women with perineal wound breakdown should be
urgently referred to appropriate maternity services for further management to prevent
further complications and potential long-term adverse outcomes.
There was evidence that prolonged perineal pain and severity of pain is associated with
depressive symptoms. There was no other relevant evidence about perineal pain, but the
committee agreed, based on their knowledge and experience, that it can have negative
long-term implications. To help healthcare professionals identify women with persistent or
worsening perineal pain and to prompt appropriate care, they should be aware of the
factors that can increase the risk of persistent postnatal perineal pain.
Because of the lack of evidence about what characteristics of perineal pain suggest the
need for further evaluation, a recommendation for research on perineal pain was made.

In current practice, some women only receive treatment for perineal complications when
the situation has become serious. By ensuring that perineal pain is identified early and
treated without delay, then further complications and long-term consequences can be
avoided. There may be an increase in referrals to secondary care for women who are
usually seen by their GP, but the recommendations should improve care and outcomes.
Assessment and care of the baby


Most of the recommendations in this section were not developed by the usual NICE
guideline systematic review process because of the scale and complexity of the topic.
Using the nominal group technique to vote on statements about the content of postnatal
care contacts, the committee made recommendations through formal consensus because
reaching consensus by committee discussion alone would be challenging. The statements
were based on a review, including critical appraisal, of existing guidelines and systematic
reviews. The committee based the recommendations on these, and their knowledge and
experience.
The general wellbeing, feeding and development of the baby should be assessed at every
postnatal contact so that any concerns can be identified early. Not passing meconium (the
baby's first bowel movement) within the first 24 hours can be a sign of bowel obstruction,
so it is important that healthcare professionals engaging with the family in the immediate
postnatal period are aware of the need for advice from a doctor.
There was no reason for the committee to change the current recommended assessment
criteria that healthcare professionals should use within 72 hours after the birth. The
committee agreed that the same criteria could be used in the 6- to 8-week assessment.
The recommendation about weight and head circumference measurement is based on
guidance from the UK-WHO (World Health Organization) growth charts.
The recommendations refer to other NICE guidelines for guidance on specific clinical
situations, and relevant NHS screening programmes.
To help parents, healthcare professionals should also discuss and provide information
about how to care for their baby. Established guidance exists on safer sleeping practices,
and resources for these are available from, for example, UNICEF, Baby Sleep Information
Source (Basis), and the Lullaby Trust.
Baby Check is a scoring system intended to help in the assessment of babies up to

6 months of age, taking into account the presence or absence of various symptoms and
signs of illness. It gives an overall score to help in deciding whether the baby may need
clinical assessment or care. Although the evidence base for the Baby Check was
predominantly in relation to babies attending secondary care, there was evidence that in
the community setting, it can identify babies who are likely to be well. Also, the studies
included babies ranging from birth to 6 months and were not therefore specifically
focused on those in the early weeks of life.
The Lullaby Trust has produced parent-friendly modified versions of the Baby Check
scoring system, in the form of a mobile app and a downloadable booklet. Although the
modifications are mostly related to the language used, the committee had some concerns
because the modified versions have not been validated, and neither has the use of Baby
Check by parents, as opposed to healthcare professionals. Finally, the committee noted
that the Lullaby Trust's modified versions have adopted current practices regarding
temperature measurement (armpit or ear), and this differs from the original Baby Check
evaluations, which use rectal temperature.
Although Baby Check cannot therefore provide complete reassurance, the committee
agreed that the Baby Check scoring system could be helpful to parents as a 'checklist' of
symptoms and signs of possible illness when they are uncertain whether their baby might
be unwell and deciding whether to seek advice from a healthcare professional. The
committee agreed it would be best for parents to be given information about Baby Check
in advance rather than when they are concerned about their baby's wellbeing.

The recommendations largely reflect current practice. There may be an increase in the use
of Baby Check scoring system by parents. It is not known if this would have an impact on
parents seeking advice from healthcare professionals, but the impact would not be
expected to be large.
Bed sharing

There was evidence of varying quality from multiple studies about the different risk factors
associated with sudden unexpected death in infancy when bed sharing (up to 1 year of
age). Based on the evidence and their knowledge and experience, the committee agreed
the safe bed sharing practices that should be discussed with all parents and the
circumstances in which bed sharing with a baby should be strongly advised against. The
evidence also showed an association between bed sharing and breastfeeding although
there is uncertainty about the causality. Preterm babies are outside the remit of this
guideline and are therefore not mentioned in the recommendations; however, the
committee were aware of evidence showing an increased risk of sudden unexpected
death in infancy when bed sharing with a baby born preterm.

In current practice, there is confusion and mixed messages from both healthcare
professionals and within the community on the best practice for safe sleeping, including
advice about never sharing a bed with a baby. These recommendations should lead to
clear guidance, reduce variation in practice, and improve care for women and babies.
Promoting emotional attachment


There was limited evidence on how to promote attachment between the mother and baby,
and it did not show any specific interventions to be effective, so the recommendations are
based on the committee's knowledge and experience. The committee agreed to make the
recommendations for parents, not just the mother, because discussing and recognising
the issues related to developing emotional attachment are relevant for other parental
caregivers as well.
The committee agreed that discussions about emotional attachment should begin
antenatally and continue into the postnatal period. The committee highlighted that
emotional attachment will usually happen naturally if the primary carer is able to spend
quality time with their baby. The value of such quality time is not always recognised as
important by the parent(s) when there are so many other demands on parents' time in the
postnatal period.
The committee recognised that attachment can also be affected by the woman's
wellbeing, recovery from birth and other demands that parenthood brings. Therefore, it is
important to discuss these issues with the parents to support them in building a
relationship with their baby. It was considered important for the woman's partner (if there
is one) to understand the various challenging aspects that the mother might be
experiencing in the postnatal period, which might affect bonding and emotional
attachment.
Based on their knowledge and experience, the committee highlighted particular groups of
parents who may be more vulnerable to difficulties in attachment and may need more
support.

There is variation in practice regarding what women are offered in support relating to
emotional attachment. The recommendations should lead to clear guidance, reduce
variation in practice and improve care for women.
Symptoms and signs of illness in babies


It is important to identify babies who are seriously ill early so that the condition can be
managed and adverse outcomes can be avoided. In the committee's experience, parents'
concern about 'something being not quite right' can sometimes be overlooked, but it can
be an important sign of serious illness and should be taken seriously.
Baby Check is a scoring system intended to help in the assessment of babies up to

6 months of age, taking into account the presence or absence of various symptoms and
signs of illness. It gives an overall score to help in deciding whether the baby may need
clinical assessment or care. Based on the evidence in the secondary care setting, its
sensitivity to identify those babies who are seriously ill varied. In the community setting, it
was found to identify babies who are well suggesting that further assessment is not
needed but the evidence regarding its accuracy in identifying seriously ill babies is lacking.
Also, the studies in which it was being tested included babies ranging from birth to
6 months and were not therefore specifically focused on those in the early weeks of life as
this guideline.
The Lullaby Trust has produced parent-friendly modified versions of the Baby Check
scoring system, in the form of a mobile app and a downloadable booklet. Although the
modifications are mostly related to the language used, the committee had some concerns
because the modified versions have not been validated, and neither has the use of Baby
Check by parents, as opposed to healthcare professionals. Finally, the committee noted
that the Lullaby Trust's modified versions have adopted current practices regarding
temperature measurement (armpit or ear), and this differs from the original Baby Check
evaluations, which use rectal temperature.
For these reasons, the committee agreed that Baby Check should not be used in isolation
to determine the need for further assessment or care but that it could be a helpful tool
when used in addition to clinical judgement. Also, by focusing attention on important
symptoms and signs, it could help during a remote assessment as a communication aid
between healthcare professionals and parents.
The committee also noted that sometimes the presence of fever in young babies is not
recognised as a serious concern. It is particularly important to note changes in the baby's
wellbeing and behaviour.
There was evidence that single signs and symptoms are not necessarily useful predictors
of serious illness on their own. However, based on various other NICE guidelines, there are
some 'red flag' symptoms and signs that indicate a serious illness that needs immediate
action.

The recommendations should reinforce current good practice and improve care for babies.
There may be an increase in the use of the Baby Check scoring system as a supplemental
tool for healthcare professionals, particularly during remote appointments.
General principles about babies' feeding


Based on their knowledge and experience, the committee agreed that the choices parents
make around feeding are not easy and sometimes their preferred choice might not be an
option for them. Evidence among parents who bottle fed their babies showed that they
sometimes felt judged by the healthcare professionals about their choices. Therefore, the
committee agreed that as a general principle, discussions around feeding should be
respectful and acknowledge the various consequences different feeding options may
have.

There is some variation in practice, so the recommendation aims to improve the
consistency of support given to parents about feeding their baby.
Giving information about breastfeeding


Based on their knowledge and experience, the committee agreed that discussion and
support around breastfeeding should start in the antenatal period so that women are
equipped to make decisions about feeding and are prepared to start breastfeeding when
the baby is born. The discussions and support should continue in the postnatal period so
that any questions and concerns can be addressed and women feel they are being
supported.
There was good evidence about women being motivated by the many benefits of
breastfeeding, so it is important to share these with the women. It is established
knowledge that breastfeeding has nutritional and health benefits for the baby (such as
lower rates of infection) and some health benefits for the woman (such as lower risk of
breast cancer). There was evidence that women felt they were able to soothe and comfort
the baby by breastfeeding.
The committee agreed that it is important to explain that breastfeeding can have benefits
even if done for a short period of time. For example, colostrum (the breast milk that is
produced in the first few days) is known to have various nutritional and health benefits for
the baby.
The committee also agreed that parents should receive information about partners'
involvement in supporting breastfeeding. The evidence showed that some women and
their families believed that bottle feeding was a way for the baby to bond with their
partner or other family members. The committee agreed that partners and family members
should be given information about alternative ways to comfort and bond with the baby.
Because breastfeeding women may be at risk of vitamin D deficiency, they should be

informed about the NICE recommendation about taking vitamin D supplementation.
There was evidence that some women thought that other people felt that breastfeeding in
public is inappropriate or insensitive to other people's feelings, which can be a barrier for
breastfeeding in public places. The committee agreed the importance of reassuring
women and their partners that under the 2010 Equality Act, women have the right to
breastfeed in 'any public space'.

The recommendations largely reflect current practice and should reinforce good practice
across the country.
Role of the healthcare professional supporting

breastfeeding

Feeding is an integral part of the postnatal period, so healthcare professionals should have
the relevant knowledge to encourage breastfeeding and to support women to establish
and continue breastfeeding. The BNF provides useful information on safe medicine use
and prescribing for women who are breastfeeding. If needed, further advice is available
from an NHS medicines information centre or other specialist sources.
The World Health Organization (WHO) recommends that breastfeeding is started early in
order to facilitate establishment of breastfeeding, and the committee agreed that
healthcare professionals caring for women and babies in the immediate postnatal period
should encourage early skin-to-skin contact to help start breastfeeding when the baby
and the mother feel ready.
The committee agreed that healthcare professionals should be sensitive to the individual
preferences, experiences and values of the woman when supporting her with
breastfeeding. There was evidence that after birth, women value having privacy in
hospital, and a lack of privacy can be a barrier to breastfeeding and expressing breast
milk. However, the committee noted that healthcare professionals also need to be able to
carry out clinical observations of women easily, so recommended that these needs be
balanced against each other.
The evidence also showed that varying experiences with breastfeeding can have an
impact on the woman's emotional wellbeing, and women often need reassurance and
encouragement to gain confidence.

In the committee's experience, some healthcare professionals caring for women and
babies during the postnatal period may not have adequate knowledge to support women
with breastfeeding and might need more training. The recommendations should reinforce
best clinical practice and lead to better consistency of care.
Supporting women to breastfeed


There was evidence that women value breastfeeding care that provides individualised
support and continuity of carer, and feel that 'remote' support (such as online or telephone
support) can be a helpful addition but should not replace face-to-face support.
The evidence also showed that partners often feel that they lack knowledge and
understanding of breastfeeding, and want to know how they can best support
breastfeeding mothers.
There was evidence that women find peer support valuable. Through peer support,
women can share their experiences and gain information and social contacts, which can
provide ongoing support.
There was no evidence that extra interventions increase breastfeeding rates so the
committee agreed that breastfeeding support should be an integral part of standard
postnatal care contacts.
There was some evidence that younger women may have additional barriers to
breastfeeding, such as feeling alone in the maternity unit, the feeling of needing to 'carry
on with life' and therefore choosing to formula feed, and lack of peer support. Evidence
also suggested that additional support may be beneficial for improving the rate of
breastfeeding among women from low income or socially disadvantaged backgrounds.
The evidence showed that women value support and practical information about
breastfeeding, as well as information about the underlying physiology of breastfeeding.

This will help them to recognise what is or is not normal, and when to seek help. The
evidence also showed that some common features of breastfeeding, such as sore nipples,
can discourage women if they do not know in advance what to expect.
There was no evidence about breastfeeding support for parents of twins or triplets, so the
committee made a recommendation for research.

There is significant variation in the provision of practical and professional breastfeeding
support, so the recommendations will support best practice in some settings and improve
practice in other settings. They will reduce variation in practice and improve care for
women and babies. Providing continuity of carer may have an impact on how services are
organised, but no significant resource impact is expected.
Assessing breastfeeding

Assessing breastfeeding is an important part of postnatal contacts. None of the clinical
tools identified in the evidence review were useful in identifying women who would not be
breastfeeding (or exclusively breastfeeding) at follow up, which was considered an
indication of breastfeeding difficulties, so the committee did not recommend any tools.
The committee used their knowledge and experience to make the recommendations, in
line with the principles in the UNICEF Baby Friendly Initiative (BFI) breastfeeding
assessment tool, including asking the parents about any concerns and about indications of
successful breastfeeding.
In addition, observing a feed twice in the first week can help establish good breastfeeding
practice. Additional observations or interventions may be needed if there are ongoing
concerns.

In current practice, observing a full feed in the first week might not always happen, so this
may mean a change in practice and may have some impact on time needed at the
postnatal contacts. The recommendations are based on the UNICEF BFI breastfeeding
assessment tool, which is already widely used in practice. In places where it is not already
used, the committee were aware that work is underway to reach that standard. The
recommendations will improve and standardise practice.
Formula feeding

The committee recognised that babies can be formula fed in combination with breastmilk
or they can be fed with formula milk only. There was good evidence about what
information and support parents who formula feed find helpful, so the committee used the
evidence together with their knowledge and experience to make the recommendations.
Common themes in the evidence were the lack of impartial information about formula
feeding, women feeling that they were not supported in their feeding choices, and the
emotional impact that feeding choices can have on parents. The committee agreed that,
as for women who breastfeed, women who formula feed should be supported regardless
of their feeding choices. The recommendations reflect the key features of formula feeding
support and the information that should be given to women and their families if they are
formula feeding or are considering to formula feed and who need to formula feed because
of a medical or other reason.
The evidence showed that women value face-to-face feeding support but also feel that
additional information to support feeding can be helpful. The evidence showed that
women who are formula feeding feel that they are not given the information or support
they need, for example, about how to interpret and respond to the baby's behaviours and
cues, and how to formula feed safely. Based on the committee's experience, it is important
to give information about how to hold the baby and how feeding can be used as an
opportunity to bond with the baby, and also advise parents against using a 'propped up'
bottle during a feed because it can be harmful for the baby.
The evidence also showed that women were unaware of the impact introducing formula
feeding could have on breastfeeding and felt unsupported by healthcare professionals
when considering this. Therefore, the committee agreed it was important that women
were supported to make an informed, guilt-free decision by providing balanced and
evidence-based information.

The committee noted that there is significant variation in practice in providing formula
feeding support, so the recommendations will support best practice in some settings and
improve practice in other settings. Overall, they will improve consistency.
Lactation suppression

No evidence was identified on the information and support that should be given to women
about lactation suppression. The committee discussed when discussions about lactation
suppression should happen and what should be discussed, and used their knowledge and
experience to agree the recommendation. The committee agreed that discussions should
be sensitive and individualised according to the woman's situation. Practical advice about
how to ease the process of milk drying up can be helpful for women, and in some cases,
medicine to suppress lactation might also be appropriate to make the process quicker,
although for most this is not needed.
Donating breast milk to a local breast milk bank, depending on the local services, could be
valuable to some women who cannot breastfeed their own baby.

The recommendation largely reflects current practice and should reinforce best practice.
To ensure that women understand the information they are given, and that information is
being provided at the most appropriate time, some extra time from healthcare
professionals may be needed.
Context
Approximately 700,000 women give birth in England and Wales each year. For women,
their partners and their babies, this is a major life event that means considerable emotional
and physical adjustment. It applies to all births but is perhaps most marked for those
having their first child. Healthcare professionals have the responsibility to help families
adjust to their new life, but at the same time they have to be able to spot and care for the
families where complications arise.
Postnatal care has for long been regarded as a 'Cinderella service' where in comparison
with some other European countries, provision is scanty and inadequate. This approach
risks missing an opportunity to have a profoundly beneficial effect on the lives of the
babies and their families, now and in the future. In a National Childbirth Trust (NCT)
survey: left to your own devices – the postnatal care experiences of 1,260 first-time
mothers, 1 in 8 women were highly critical of their postnatal care. Their feedback reflects
fragmentation of care, poor planning and communication between healthcare
professionals, and insufficient advice about emotional recovery. Furthermore, women
continue to report receiving insufficient or inconsistent information on baby's feeding,
particularly after giving birth to their first baby.
This guideline addresses the organisation and delivery of postnatal care, including the
relationship between the different agencies that share the responsibility for postnatal care;
assessment and health of women; assessment and health of babies; how to help parents
form strong relationships with their babies; and babies' feeding. It specifically does not
cover issues covered by other NICE guidelines, in particular problems of mental health,
preterm birth or specialist care (care beyond routine postnatal care), but refers to other
NICE guidelines, where appropriate.
This guideline covers the postnatal period up to 8 weeks after birth. However, the sections
on babies' feeding and emotional attachment also address the antenatal period because
discussion around these is essential already during pregnancy. The postnatal period of
course does not end at 8 weeks. A time point of 8 weeks was agreed in order to focus the
guideline on the most critical early weeks after birth. The remit for some of the topics in
this guideline was to address the needs of families giving birth to twins and triplets in
addition to single babies. The evidence specific to twins and triplets was lacking and the
consensus was that healthcare professionals and families dealing with twins or triplet
births should use the recommendations of the guideline within the constraints of the
changed circumstances of having to care for more than 1 child.
The committee were aware of the higher postnatal mortality rates among women of black,
Asian and minority ethnic origin and women living in deprived areas reported in the
MBRRACE-UK report: saving lives, improving mothers' care (2020). Black women in
particular had an over four-fold increase in maternal mortality rates compared with white
women. The MBRRACE-UK report: perinatal mortality surveillance report (2020) also
highlights the higher neonatal mortality rates for babies of black and Asian ethnicity and
babies born to mothers living in deprived areas. It is important that clinicians are aware of
these inequalities in clinical practice.
This guideline was written with the hope that healthcare professionals can use it to
provide consistent and high-quality care, while taking into consideration each family's
individual situation and needs, in order to reduce morbidity and mortality and to support
families in this new phase.
Finding more information and committee

details
To find NICE guidance on related topics, including guidance in development, see the NICE
topic page on postnatal care.
For full details of the evidence and the guideline committee's discussions, see the
evidence reviews. You can also find information about how the guideline was developed,
including details of the committee.
NICE has produced tools and resources to help you put this guideline into practice. For
general help and advice on putting our guidelines into practice, see resources to help you
put NICE guidance into practice.
Update information
April 2021: This guideline updates and replaces NICE guideline CG37 (published July
2006).
Minor changes since publication
October 2023: We updated links to the NICE guideline on intrapartum care, which has
been updated.
August 2023: We added a link to the Department of Health and Social Care's Healthy
Child Programme to recommendation 1.1.15.
November 2022: We changed 'symptoms' to 'signs' in recommendation 1.4.7.
December 2021: We added a link to NICE's guideline on pelvic floor dysfunction in

recommendations 1.1.13, 1.2.1 and 1.2.12.
October 2021: We added a link to NICE's shared decision making guideline in

recommendation 1.1.5.
ISBN: 978-1-4731-4078-3
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Postnatal care

© NICE 2023. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-

Local commissioners and providers of healthcare have a responsibility to enable the

Commissioners and providers have a responsibility to promote an environmentally

Who is it for? .......................................................................................................................................... 5

1.1 Organisation and delivery of postnatal care .................................................................................. 6

1.2 Postnatal care of the woman ......................................................................................................... 12

1.3 Postnatal care of the baby ............................................................................................................. 18

1.4 Symptoms and signs of illness in babies ...................................................................................... 23

1.5 Planning and supporting babies' feeding ...................................................................................... 26

Terms used in this guideline................................................................................................................. 34

Recommendations for research ................................................................................................ 38

2 Timing of first health visitor visit ...................................................................................................... 38

3 Clinical tools to assess women's health .......................................................................................... 39

4 Perineal pain ....................................................................................................................................... 39

5 Breastfeeding support for parents with twins or triplets ............................................................... 39

Rationale and impact.................................................................................................................. 40

Principles of care ................................................................................................................................... 40

Communication between healthcare professionals at transfer of care ........................................... 41

Transfer to community care ................................................................................................................. 42

First health visitor visit.......................................................................................................................... 44

Assessment and care of the woman ................................................................................................... 45

Postpartum bleeding ............................................................................................................................ 47

Perineal health ....................................................................................................................................... 48

Assessment and care of the baby ....................................................................................................... 49

Bed sharing ............................................................................................................................................ 51

Promoting emotional attachment ........................................................................................................ 51

Symptoms and signs of illness in babies ............................................................................................ 52

General principles about babies' feeding ........................................................................................... 54

Giving information about breastfeeding ............................................................................................. 54

Role of the healthcare professional supporting breastfeeding ........................................................ 56

Supporting women to breastfeed ........................................................................................................ 57

Assessing breastfeeding ...................................................................................................................... 58

Formula feeding ..................................................................................................................................... 59

Finding more information and committee details .................................................................... 64

Update information .................................................................................................................... 65

This guideline replaces CG37.

This guideline is the basis of QS37, QS129 and QS169.

The Royal College of Obstetricians and Gynaecologists has produced guidance on

• Commissioners and providers

• Women having routine postnatal care, and their families

1.1 Organisation and delivery of postnatal care

－ 4 times higher in black women (34 per 100,000)

－ 3 times higher in mixed ethnicity women (25 per 100,000)

• the neonatal mortality rate increases according to the level of deprivation in

1.1.3 A woman may be supported by her partner in the postnatal period.

• provided face-to-face and supplemented by virtual discussions and written

• offered throughout the woman's care

• individualised and sensitive

• supportive and respectful

• evidence based and consistent

• translated by an appropriate interpreter to overcome language barriers.

For more guidance on communication, providing information (including different

• women who misuse substances

• recent migrants, asylum seekers or refugees, or women who have difficulty

• young women aged under 20

• women who experience domestic abuse.

Communication between healthcare professionals at transfer of

• the pregnancy, birth, postnatal period and any complications