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the postnatal periodare a critical

phase in the lives of mothers and newborn babies. Most maternal and infant deaths
occur in the first month after birth: almost half of postnatal maternal deaths occur
within the first 24 hours,1 and 66% occur during the first week.2 In 2013, 2.8
million newborns died in their first month of life1 million of these newborns died
on the first day.3,4. (WHO) Postnatal care includes counselling
on family planning, maternal mental health, nutrition and hygiene, and gender-based violence.

Masa nifas merupakan fase yang sangat kritis di kehidupan ibu dan bayi baru lahir. Banyak ibu
dan bayi yang meninggal terjadi dalam bulan pertama setelah melahirkan, hamper setengah
dari kematian ibu nifas terjadi dalam 24 jam pertama, dan 66% terjadi selama 1 minggu
pertama. Asuhan pada masa nifas meliputi konseling dalam perencaan keluarga, kesehatan
mental ibu, nutrisi dan kebersihan, dan kekerasan berdasarkan jenis kelamin. (WHO, 2013)

Postnatal care is the individualised care provided to meet the needs of a mother and her
baby
following childbirth. Although the postnatal period is uncomplicated for most women and
babies,
care during this period needs to address any variation from expected recovery after
birth. For the
majority of women, babies and families, the postnatal period ends 68 weeks after the
birth.
However for some women and babies, the postnatal period should be extended in order
to meet their needs. This is particularly important where a woman or baby has
developed complications and remains vulnerable to adverse outcomes. For example,
this could include women who have poor support networks, have developed a postnatal
infection or other health problem that is continuing to impact on their daily lives, or
women who are at risk of mental health problems or infant attachment problems.

Masa nifas adalah perawatan individual yang disediakan untuk memenuhi kebutuhan ibu dan bayinya
setelah melahirkan. Meskipun masa nifas bukan merupakan hal yang rumit untuk kebanyakan ibu dan
bayi, perawatan selama masa ini perlu dilakukan beberapa variasi dari pemulihan yang diharapkan
setelah melahirkan. Untuk kebanyakan ibu, bayi, dan keluarga, masa nifas berakhir 6-8 minggu setelah
melahirkan. Bagaimanapun juga, untuk beberapa ibu dan bayi, masa nifas harus diperuas untuk
memenuhi kebutuhan mereka. Hal ini sangat penting dimana seorang ibu dan bayi telah menimbulkan
komplikasi dan masih rentan terhadap hasil yang merugikan. Contohnya, ibu yang memiiki dukungan
lingkungan yang rendah, dapat mengembangkan infeksi setelah melahirkan atau masalah kesehatan
lainnya yang terus berdampak pada kehidupan sehari-hari, atau ibu yang berisiko dalam masalah
kesehatan mental atau masalah kasih sayang bayi.

A systematic review of evidence was commissioned to address this question. The review
was undertaken using standard Cochrane techniques (80) for evidence on preventive
interventions in the postnatal period, specifically in relation to puerperal sepsis, secondary
PPH, hypertension, anaemia, postnatal depression and obstetric fistula. No studies were
identified that addressed assessment of low-risk women after vaginal delivery to reduce
maternal mortality and morbidity.

Menurut studi yang dilakukan dengan menggunakan teknik Cochrane standar (80), asuhan nifas

dilakukan untuk pencegahan terjadinya masalah dalam masa nifas, khususnya dalam kaitannya dengan
sepsis nifas, pendarahan postpartum sekunder, hipertensi, anemia, depresi postnatal, dan fistula
obstetri.

Asuhan Nifas merupakan asuhan

Terdapat beberapa asuhan utama dalam masa nifas, diantaranya:

First 24 hours after birth


All postpartum women should have
regular assessment of vaginal bleeding, uterine contraction,
fundal height, temperature and heart rate (pulse) routinely
during the first 24 hours starting from the first hour after birth.
Blood pressure should be measured shortly after birth. If
normal, the second blood pressure measurement should be
taken within 6 hours. Urine void should be documented within 6

1. 24 jam pertama setelah melahirkan


Semua ibu nifas seharusnya mendapatkan penilaian teratur dari perdarahan pervaginam,
kontraksi uterus, tinggi fundus, suhu, dan nadi dengan rutin selama 24 jam pertama yang
dimulai dari 1 jam setelah melahirkan. Tekanan darah seharusnya diukur tak lama setelah
melahirkan. Jika normal, pengukuran tekanan darah yang ke dua seharusnya dilakukan
dalam 6 jam. Pengeluaran urin seharusnya di catat dalam 6 jam.
At the first postnatal contact, women should be advised of the signs and symptoms of potentially
life-threatening conditions (given in table 2) and to contact their healthcare professional
immediately or call for emergency help if any signs and symptoms occur. [2006]

Table 2 Signs and symptoms of potentially life-threatening conditions

Signs and symptoms Condition

Sudden and profuse blood loss or persistent increased blood loss Postpartum
haemorrhage
Faintness, dizziness or palpitations/tachycardia

Tiba-tiba dan kehilangan banyak darah atau kehilangan darah meningkat


drastic.

Pingsan, pusing, atau jantung berdebar/takhikardi

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

Demam, menggigil, sakit perut dan atau kerugian vagina ofensif

Headaches accompanied by one or more of the following symptoms Pre-eclampsia/


within the first 72 hours after birth: eclampsia

visual disturbances

nausea, vomiting

sakit kepala disertai oleh satu atau lebih dari gejala yang mengikuti dalam
72 jam pertama setelah melahirkan:

- Gangguan visual

- Mual, muntah

Unilateral calf pain, redness or swelling Thromboembolism


Shortness of breath or chest pain

Nyeri betis sebelah, kemerahan atau bengkak


Sesak napas atau nyeri dada

Ibu harus diberi nasihat mengenai tanda dan bahaya potensial dari kondisi yang
mengancam jiwa dan menghubungi ahli kesehatan mereka dengan segera atau
menelepon bantuan darurat jika ada tanda dan bahaya yang terjadi.
https://www.nice.org.uk/guidance/cg37/chapter/1-recommendations

Mothers/fathers should participate in all aspects of


their care, including planning for transition to
community care following birth. A care plan or care
pathway helps to assist the health care professional
and family in following this progress and in addressing
needs. (NSF DOH 2004)
.If urine has not been passed within 6 hours after the
birth then measures to assist urination (i.e. warm bath
or shower) should be taken. (NICE 2006)
Postnatal care is about empowering the mother to
care for herself and her newborn in order to promote
their longer term physical and emotional wellbeing
( NSF DOH 2004)
Ibu/ayah harus berpartisipasi dalam segala aspek mengenai asuhan mereka, termasuk
perencanaan untuk transisi ke asuhan di lingkungan sekitar setelah melahirkan. Sebuah
rencana asuhan membantu tenaga kesehatan dan keluarga dalam mengikuti kemajuan yang
terjadi dan memenuhi kebutuhannya. (NHS, 2009)

Beyond 24 hours after birth:


At each subsequent postnatal contact, enquiries should continue
to be made about general well-being and assessments made
regarding the following: urination and urinary incontinence,
bowel function, healing of any perineal wound, headache, fatigue,
back pain, perineal pain and perineal hygiene, breast pain, uterine
tenderness and lochia.
Breastfeeding should be assessed at each postnatal contact.
Women are advised, within 24 hours of the birth, of the symptoms and signs of
conditions that
may threaten their lives and require them to access emergency treatment.
Rationale
Women are at increased risk of experiencing serious health events in the immediate
hours, days and weeks following the birth, some of which could lead to maternal death
or severe morbidity.
Providing women with information about the symptoms and signs that may indicate a
serious physical illness or mental health condition may prompt them to access
immediate emergency treatment if needed. Emergency treatment could potentially avoid
unnecessary deaths and severe morbidity.
Ibu sedang berada pada peningkatan risiko dalam mengalami kejadian kesehatan yang serius di
jam awal, hari, dan minggu setelah kelahiran, beberapa ada yang dapat menyebabkan kematian
ibu atau morbiditas berat. Memberikan ibu informasi tentang tanda dan gejala yang mungkin
menunjukkan penyakit fisik yang serius atau kondisi kesehatan mental dapat mendorong mereka
untuk mengakses perawatan darurat segera jika diperlukan. Perawatan darurat berpotensi
menghindari kematian yang tidak perlu dan morbiditas berat.
http://www.nice.org.uk/guidance/qs37/resources/guidance-postnatal-care-pdf

2. 24 jam setelah melahirkan


Pada setiap asuhan nifas, pertanyaan harus dilanjutkan untuk dibuat kesejahteraan umum
dan penilaian-penilaian dibuat sehubungan dengan buang air kecil (BAK), inkontenensia
urin, fungsi usus, penyembuhan pada setiap luka perineum, sakit kepala, kelelahan, nyeri
punggung, nyeri perineum serta kebersihan perineum, nyeri payudara, rahim lembek dan lokia.
Pada setiap asuhan nifas, ibu harus ditanyai mengenai kesejahteraan emosi, apakah keluarga dan
lingkungan yang mereka miliki mendukung, dan strategi mengatasi mereka untuk berurusan
dengan berbagai masalah dari hari ke hari. Semua ibu dan keluarga/kerabat mereka seharusnya di
dorong untuk menceritakan ahli kesehatan mereka tentang perubahan perasaan, tingkat
emosional, dan kebiasaan yang di luar dari pola wanita normal.

At each postnatal contact, women should be asked about their


emotional wellbeing, what family and social support they have
and their usual coping strategies for dealing with day-to-day
matters. All women and their families/partners should be
encouraged to tell their health care professional about any
changes in mood, emotional state and behaviour that are outside
of the womans normal pattern.
3. 10-14 hari setelah melahirkan
Pada 10-14 hari setelah melahirkan, semua wanita harus ditanyakan mengenai resolusi
ringan, depresi postpartum sementara (maternal blues). Jika gejala-gejalanya tidak
diselesaikan, kesejahteraan psikologi ibu seharusnya selanjutnya dilakukan penilaian
depresi postpartum, dan jika gejala berlangsung lama, lakukan evaluasi.

At 1014 days after birth, all women should be asked about


resolution of mild, transitory postpartum depression (maternal
blues). If symptoms have not resolved, the womans
psychological well-being should continue to be assessed for
postpartum depression, and if symptoms persist, evaluated.

Women should be observed for any risks, signs and symptoms


of domestic abuse.
Ibu harus diamati untuk setiap resiko, tanda, dan gejala dari kekerasan dalam rumah
tangga.
Ibu harus diberitahu siapa yang dapat dihubungi untuk memberikan nasihat dan
pengendalian.

Women should be told whom to contact for advice and


management.

Postpartum depression is a serious condition of significant public health importance. A clear


beneficial effect in the prevention of postpartum depression was found from a range of
psychosocial and psychological interventions. Promising
interventions included professionally-based postpartumhome visits, lay- or peer-based
postpartum telephone support, and interpersonal
psychotherapy. Interventions provided by various health professionals and lay individuals were
similarly beneficial. Interventions that.
Overall, psychosocial and psychological interventions significantly reduce the number of women who
develop postpartum depression.

Depresi postpartum adalah sebuah kondisi serius dari pentingnya kesehatan masyarakat
yang signifikan. Sebuah efek yang jelas bermanfaat dalam pencegahan depresi postpartum
ditemukan dari berbagai intervensi psikososial dan psikologis. Intervensi yang menjanjikan
termasuk melakukan kunjungan rumah postpartum, memberikan dukungan melalui telepon, dan
psikoterapi interpersonal, Intervensi yang diberikan oleh berbagai tenaga kesehatan dan orang
biasa sama-sama menguntungkan. Secara keseluruhan, intervensi psikososial dan psikologis
dengan signifikan menurunkan angka terjadinya depresi postpartum. (The Cochrane
Colaboration, 2013)

postnatal home visiting program improves population-level infant health care outcomes for the
first 12 months of life. Nurse home visiting can be implemented universally at high fidelity with
positive impacts on infant emergency health care that are similar to those of longer, more
intensive home visiting programs. This approach offers a novel solution to the paradox of
targeting by offering individually tailored intervention while achieving population-level impact.

4. 2-6 minggu postpartum


Semua ibu harus ditanyakan tentang dimulainya kembali hubungan seksual dan
kemungkinan rasa nyeri saat berhubungan sebagai bagian dari penilaian kesejahteraan
secara keseluruhan setelah 2-6 minggu melahirkan.
All women should be asked about resumption of sexual
intercourse and possible dyspareunia as part of an assessment of
overall well-being 26 weeks after birth.

Counseling about family planning is standard for most women who just gave birth. Few providers
and researchers have looked at how well the counseling works. We do not know if postpartum
women want to use family planning or whether they will return to a health provider for birth
control advice. Women may wish to discuss family planning before they have the baby and after
they leave the hospital. Women may also prefer to talk about birth control along with other
health issues. In this review, we looked at the effects of educational programs about family
planning for women who just had a baby.

Penyuluhan tentang keluarga berencana merupakan hal biasa untuk kebanyakan wanita
yang baru melahirkan. Beberapa penyedia dan peneliti telah melihat seberapa baik
konseling bekerja. Wanita mungkin ingin mendiskusikan keluarga berencana sebelum
mereka memiliki bayi dan setelah mereka meninggalkan rumah sakit. Perempuan juga
dapat memilih untuk berbicara tentang pengendalian kelahiran bersama dengan
masalah kesehatan lainnya.
Postpartum contraception improves the health of mothers and children by lengthening
birth intervals. For lactating women, contraception choices are limited by concerns about
hormonal effects on milk quality and quantity and passage of hormones to the infant.
Ideally, the contraceptive chosen should not interfere with lactation or infant growth.
Timing of contraception initiation is also important. Immediately postpartum, most
women have contact with a health professional, but many do not return for follow-up
contraceptive counseling. However, immediate initiation of hormonal methods may
disrupt the onset of milk production.

Kontrasepsi postpartum dapat meningkatkan kesehatan ibu dan anak-anak dengan


memperpanjang interval kelahiran. Bagi wanita menyusui, pilihan kontrasepsi dibatasi
oleh kekhawatiran tentang efek hormonal pada kualitas susu dan kuantitas dan bagian
dari hormon untuk bayi. Idealnya, kontrasepsi yang dipilih tidak harus mengganggu
laktasi atau pertumbuhan bayi. Waktu inisiasi kontrasepsi juga penting. Segera setelah
melahirkan, kebanyakan wanita memiliki kontak dengan tenaga kesehatan, tetapi
banyak yang tidak kembali untuk konseling kontrasepsi tindak lanjut. Namun, inisiasi
langsung dari metode hormonal dapat mengganggu timbulnya produksi susu. (Lopez
dkk, 2015)

In one study, the implant group infants gained more weight than those in the no-method
group but less weight than infants in the Depo group. Two trials noted that a combined
pill had a negative effect on breast milk volume or content. One report did not have
much data. The other showed lower volume for combined pill users than for women
taking pills with only progestin.
We found little information on any specific birth control method, with usually two studies
per method. Results were not consistent across all trials. The data were of moderate
quality overall. The results of better quality showed little effect on breastfeeding or infant
growth.

Dalam sebuah penelitian, bayi dengan kelompok ibu yang menggunakan implan
memperoleh berat badan lebih dibandingkan pada kelompok ibu yang tidak memiliki
metode KB, tetapi kurang berat daripada bayi pada kelompok 'Depo' (Progestin). Dua uji
coba mencatat bahwa pil kombinasi memiliki efek negatif pada volume ASI atau
kandungannya. Penelitian lain menunjukkan volume yang lebih rendah bagi pengguna
pil kombinasi (estrogen dan progestin) daripada wanita yang menggunakan pil dengan
hanya progestin. (Lopez dkk, 2015)
Reversible, long-term contraception is relied on by millions of women to prevent
unwanted pregnancy. Two very common methods of pregnancy prevention are the use
of a copper-containing intrauterine device (IUD) or an injection of a progestogen
hormone.
We reviewed studies that compared these two highly effective methods and found the
IUD to be better at preventing pregnancy than depot medroxyprogesterone acetate
(DMPA). Relevant to HIV positive women are the results of one small trial that found that
women using the IUD for contraception where less likely to experience a worsening of
their HIV disease than those using hormonal contraception. A large, high quality study is
urgently needed to shed light on these findings.

IUD merupakan Kontrasepsi jangka panjang reversibel yang diandalkan oleh jutaan perempuan
untuk mencegah kehamilan yang tidak diinginkan. Dua metode yang sangat umum pencegahan
kehamilan adalah penggunaan perangkat yang mengandung tembaga intrauterine (IUD) atau
suntikan hormon progestogen. Peneliti meninjau studi yang membandingkan dua metode yang
sangat efektif ini dan menemukan IUD lebih baik dalam mencegah kehamilan dibandingkan
depot medroksiprogesteron asetat (DMPA) (Hofmeyr dkk, 2010)

Selain itu, motode kontrasepsi lainnya yang aman digunakan dan tidak mempengaruhi ASI
adalah kondom. Selain aman, mencegah kehamilan dan HIV / IMS. Dalam studi terakhir, lebih
banyak perempuan dalam kelompok intervensi melaporkan penggunaan rutin metode ganda,
yaitu pil KB ditambah kondom. (Lopez dkk, 2014)
Selain itu, ada pula metode kontrasepsi alamiah yang dapat digunakan, di antaranya metode
metode alamiah laktasi (MAL), kalender, pengecekan lender serviks, dan metode suhu basal.
(Faculty of Sexual & Reproductive Health Care Clinical Guidance, 2015)

Terdapat beberapa alat kontrasepsi yang dianjurkan selama menyusui:


a. IUD

b. Suntik dan Pil


Pilihan gabungan pil kontrasepsi hormonal atau progestin-satunya diberikan 2 minggu
postpartum tidak mempengaruhi menyusui kelanjutan
http://www.ncbi.nlm.nih.gov/pubmed/22143258 2012

c. Implant

First 24 hours after birth:


All postpartum women should have regular assessment of vaginal bleeding, uterine
contraction, fundal height, temperature and heart rate (pulse) routinely during the first
24 hours starting from the first hour after birth.
Blood pressure should be measured shortly after birth. If normal, the second blood
pressure
measurement should be taken within six hours.
Urine void should be documented within six hours.
Beyond 24 hours after birth:
At each subsequent postnatal contact, enquiries should continue to be made about
general well-being and assessments made regarding the following: micturition and
urinary
incontinence, bowel function, healing of any perineal wound, headache, fatigue, back
pain, perineal pain and perineal hygiene, breast pain and uterine tenderness and lochia.
Breastfeeding progress should be assessed at each postnatal contact.
At each postnatal contact, women should be asked about their emotional well-being,
what
family and social support they have, and their usual coping strategies for dealing with
day-to-day matters. All women and their families/partners should be encouraged to tell
their health care professional about any changes in mood, emotional state or behaviour
that are outside of the womans normal pattern.
At 1014 days after birth, all women should be asked about resolution of mild, transitory
postpartum depression (maternal blues). If symptoms have not resolved, the womans
psychological well-being should continue to be assessed for postnatal depression, and if
symptoms persist, evaluated.

Women should be observed for any risks, signs and symptoms of domestic abuse.
Women
should be told who to contact for advice and management.
All women should be asked about resumption of sexual intercourse and possible
dyspareunia as part of an assessment of overall well-being two to six weeks after
birth.

Counselling
RECOMMENDATION 9
All women should be given information about the physiological process of recovery after
birth, and told that some health problems are common, with advice to report any health
concerns to a health care professional, in particular:
Signs and symptoms of PPH: sudden and profuse blood loss or persistent increased
blood loss; faintness; dizziness; palpitations/tachycardia
Signs and symptoms of pre-eclampsia/eclampsia: headaches accompanied by one
or more of the symptoms of visual disturbances, nausea, vomiting, epigastric or
hypochondrial pain, feeling faint, convulsions (in the first few days after birth)
Signs and symptoms of infection: fever; shivering; abdominal pain and/or offensive
vaginal loss
Signs and symptoms of thromboembolism: unilateral calf pain; redness or swelling of
calves; shortness of breath or chest pain.
Women should be counselled on nutrition.
Women should be counselled on hygiene, especially handwashing.
Women should be counselled on birth spacing and family planning. Contraceptive
options
should be discussed, and contraceptive methods should be provided if requested.
Women should be counselled on safer sex including use of condoms.
In malaria-endemic areas, mothers and babies should sleep under insecticide-
impregnated
bed nets.
All women should be encouraged to mobilize as soon as appropriate following the birth.
They should be encouraged to take gentle exercise and time to rest during the postnatal
period.
GDG consensus, based on existing WHO guidelines
The above recommendations are based on existing WHO guidelines (http://www.who.
int/maternal_child_adolescent/documents/924159084x/en/index.html), for which the
GDG did not feel the necessity of new evidence reviews

Iron and folic acid supplementation


RECOMMENDATION 10
Iron and folic acid supplementation should be provided for at least three months after
delivery.

Prophylactic antibiotics
RECOMMENDATION 11
The use of antibiotics among women with a vaginal delivery and a third or fourth degree
perineal tear is recommended for prevention of wound complications.
The GDG considers that there is insufficient evidence to recommend the routine use of
antibiotics in all low-risk women with a vaginal delivery for prevention of
endometritis.

Psychosocial support
RECOMMENDATION 12
Psychosocial support by a trained person is recommended for the prevention of
postpartum depression among women at high risk of developing this condition.
Dukungan psikososial dari orang yang terlatih direkomendasikan untuk mencegah terjadinya
depresi postpartum di antara ibu yang berisiko tinggi terjadinya kondisi ini.
Weak recommendation based on very low quality evidence
The GDG considers that there is insufficient evidence to recommend routine formal
debriefing to all women to reduce the occurrence/risk of postpartum depression.
Weak recommendation based on low quality evidence
The GDG also considers that there is insufficient evidence to recommend the routine
distribution of, and discussion about, printed educational material for prevention of
postpartum depression.
Weak recommendation based on very low quality evidence
Health professionals should provide an opportunity for women to discuss their birth
experience during their hospital stay.
GDG consensus based on existing WHO guidelines
A woman who has lost her baby should receive additional supportive care.
Weak recommendation based on very low quality evidence
Remarks
For further guidance, see the mhGAP intervention guide for mental, neurological and
substance use disorders in non-specialized health settings available at: http://whqlibdoc.
who.int/publications/2010/9789241548069_eng.pdf.1
Based on the studies supporting this recommendation the GDG considered the following
conditions as risk factors for postpartum depression: previous postpartum depression,
previous mental illness, vulnerable population, traumatic childbirth, infant born preterm,
stillbirth or neonatal death, infant admitted to intensive care and history of being a
neglected child.
GDG consensus, based on existing guidelines
(http://whqlibdoc.who.int/publications/2010/9789241548069_eng.pdf )2

Planning the Content and Delivery of Care


4.1 Recommendations
Principles of care
1 Each postnatal contact should be provided in accordance with the
principles of individualised care. In order to deliver the core care
recommended in this guideline postnatal services should be
planned locally to achieve the most efficient and effective service
for women and babies. [D(GPP)]
2 A coordinating healthcare professional should be identified for
each woman. Based on the changing needs of the woman and
baby, this professional is likely to change over time. [D(GPP)]
3 A documented, individualised postnatal care plan should be
developed with the woman, as soon as possible (ideally in the
antenatal period) to include:

relevant factors from the antenatal, intrapartum and


immediate postnatal period
details of the healthcare professionals involved in her care
and that of her baby including roles and contact details
plans for the postnatal period.
This should be reviewed at each postnatal contact. [D(GPP)]
4 Women should be offered an opportunity to talk about their birth
experiences and to ask questions about the care they received
during labour. [GPP]

Women should be offered relevant and timely information to


enable them to promote their own and their babies health and
well-being and to recognise and respond to problems. [D(GPP)]
6 At each postnatal contact the healthcare professional should:
ask the woman about her health and well-being and that of
her baby. This should include asking women about their
experience of common physical health problems. Any
symptoms reported by the woman or identified through
clinical observations should be assessed.
offer consistent information and clear explanations to
empower the woman to take care of her own health and
that of her baby, and to recognise symptoms that may
require discussion
encourage the woman and her family to report any
concerns in relation to their physical, social, mental or
emotional health, discuss issues and ask questions
document in the care plan any specific problems and followup.
[D(GPP)]
7 Length of stay in a maternity unit should be discussed between the
individual woman and her healthcare professional, taking into
account the health and well-being of the woman and her baby and
the level of support available following discharge. [D(GPP)]
Professional communication
8 There should be local protocols about written communication, in
particular about the transfer of care between clinical sectors and
healthcare professionals. These protocols should be audited.
[D(GPP)]

Healthcare professionals should use hand-held maternity records,


the postnatal care plans and personal child health records, to
promote communication with women. [C]
Competencies
10 All healthcare professionals who care for mothers and babies
should work within the relevant competencies developed by Skills
for Health (www.skillsforhealth.org.uk). Relevant healthcare
professionals should also have demonstrated competency and
sufficient ongoing clinical experience in:
undertaking maternal and newborn physical examinations
and recognising abnormalities
supporting breastfeeding women including a sound
understanding of the physiology of lactation and neonatal
metabolic adaptation and the ability to communicate this to
parents

recognising the risks, signs and symptoms of domestic


abuse and whom to contact for advice and management, as
recommended by Department of Health guidance
(Department of Health. 2005)
in recognizing the risks, signs and symptoms of child abuse
and whom to contact for advice and management, as
recommended by Department of Health
guidance(Department of Health. 2005).[D(GPP)]

Evidence Statements for Planning Care


Note: The title of each section is linked to the relevant narrative for ease of
Reference

Professional communication
1 Hand held records appear to be well retained by women and parents
and are more thoroughly completed by health professionals than clinic
held records. Level 3
2 Hand held records improve womens communication with their own and
their childs health care provider .Level 3
3 Health care providers who have experience with hand held records
favour this method of documentation. Level 3
Is there an optimal length of stay?
4 In a systematic review of discharge, the quality of the studies on length
of stay has been inadequate to show any difference in outcomes
between early and standard discharge for healthy mothers and term
infants Level 1++
5 In one Swiss study of a mixed birth cohort (including CS), discharge of
women who had had uncomplicated pregnancies and non-caesarean
births between 24-48 hours was a cost-effective approach compared to
discharge between 4-5 days. Level 1 ++
6 There is no evidence relating to cost-effectiveness concerning discharge
prior to 24 hours.
7 It is not possible to compare the cost savings of first day discharge with
any possible harm since there is no clear measure of this harm due to
healthy baby bias.
Sumber nccpc

Senam nifas merupakan salah satu bentuk mobilisasi dini setelah melahirkan. Senam ini bermanfaat
untuk memperbaiki sirkulasi darah, memperbaiki sikap tubuh, memperbaiki kekuatan otot panggul, otot
perut, dan otot tungkai bawah. Senam nifas sebaiknya dilakukan dalam waktu 24 jam setelah
melahirkan, lalu secara teratur setiap harinya. Setiap gerakan di ulang selama 5 kali. (Sinsin, 2008)

Dalam senam nifas dikenal pula latihan otot dasar panggul. Latihan otot dasar panggul adalah lini
pertama pengobatan konservatif untuk inkontinensia urin pada wanita. Perawatan aktif lainnya meliputi:
terapi fisik (misalnya kerucut vagina/senam kegel); terapi perilaku (misalnya pelatihan kandung kemih);
listrik atau stimulasi magnetik; perangkat mekanik (misalnya pessaries kontinensia); terapi obat
(misalnya antikolinergik (solifenacin, oxybutynin, dll) dan duloxetine); dan intervensi bedah termasuk
prosedur sling dan colposuspension. (Ayeleke dkk, 2013)

Pelvic floor muscle training (PFMT) is a first-line conservative treatment for urinary incontinence in
women. Other active treatments include: physical therapies (e.g. vaginal cones); behavioural therapies
(e.g. bladder training); electrical or magnetic stimulation; mechanical devices (e.g. continence pessaries);
drug therapies (e.g. anticholinergics (solifenacin, oxybutynin, etc.) and duloxetine); and surgical
interventions including sling procedures and colposuspension. This systematic review evaluated the
effects of adding PFMT to any other active treatment for urinary incontinence in women

Latihan otot dasar panggul (PFMT) adalah lini pertama pengobatan konservatif untuk inkontinensia urin
pada wanita. Perawatan aktif lainnya meliputi: terapi fisik (misalnya kerucut vagina); terapi perilaku
(misalnya pelatihan kandung kemih); listrik atau stimulasi magnetik; perangkat mekanik (misalnya
pessaries kontinensia); terapi obat (misalnya antikolinergik (solifenacin, oxybutynin, dll) dan duloxetine);
dan intervensi bedah termasuk prosedur sling dan colposuspension. Tinjauan sistematis ini mengevaluasi
efek penambahan PFMT untuk pengobatan aktif lainnya untuk inkontinensia urin pada wanita. (Ayeleke
dkk, 2013)

There is some evidence that for women having their first baby, PFMT can prevent urinary incontinence
up to six months after delivery. There is support for the widespread recommendation that PFMT is an
appropriate treatment for women with persistent postpartum urinary incontinence. It is possible that
the effects of PFMT might be greater with targeted rather than mixed prevention and treatment
approaches and in certain groups of women (for example primiparous women; women who had bladder
neck hypermobility in early pregnancy, a large baby, or a forceps delivery). These and other
uncertainties, particularly long-termeffectiveness, require further testing.

About a third of women leak urine and up to a 10th of women leak stool (faeces) after giving birth. Pelvic
floor muscle training is commonly recommended both during pregnancy and after the birth to prevent
and treat incontinence. The training involves exercises that women can do several times a day to
strengthen their pelvic floor muscles. They are usually taught by a health professional such as a
physiotherapist. There is little evidence that doing antenatal pelvic floor exercises makes labour more
difficult. Instead, there is mounting evidence to suggest that they may help. This review shows that even
women who did not leak urine while pregnant could reduce the possibility of leaking for the first six
months after childbirth by doing the exercises during and after their pregnancy. The exercises may also
be helpful for women who are at higher risk of suffering urine leakage, like those having a large baby or
those who are anticipating a forceps delivery. The exercises can also help women who start to leak after
giving birth, and may help them leak less stool. However, there is not enough evidence to say if these
effects last after the first year, although there is some evidence to suggest that exercising rates diminish
over time.

Latihan otot dasar panggul


Ada beberapa bukti bahwa perempuan memiliki bayi pertama mereka, PFMT dapat mencegah
inkontinensia hingga enam bulan setelah melahirkan. Ada dukungan untuk rekomendasi luas bahwa
PFMT adalah pengobatan yang tepat untuk wanita dengan inkontinensia urin persisten postpartum. Ada
kemungkinan bahwa efek dari PFMT mungkin lebih besar dengan yang ditargetkan daripada pencegahan
dan pengobatan pendekatan campuran dan di kelompok perempuan tertentu (misalnya wanita
primipara; wanita yang memiliki leher kandung kemih hipermobilitas pada awal kehamilan, bayi besar,
atau pengiriman forsep ). Dan ketidakpastian lainnya, terutama panjang-termeffectiveness, memerlukan
pengujian lebih lanjut.

Sekitar sepertiga dari wanita bocor urin dan sampai 10 wanita bocor tinja (feses) setelah melahirkan.
Latihan otot dasar panggul umumnya direkomendasikan baik selama kehamilan dan setelah kelahiran
untuk mencegah dan mengobati inkontinensia. Pelatihan melibatkan latihan bahwa perempuan dapat
melakukan beberapa kali sehari untuk memperkuat otot-otot dasar panggul mereka. Mereka biasanya
diajarkan oleh seorang profesional kesehatan seperti fisioterapis. Ada sedikit bukti bahwa melakukan
antenatal panggul latihan dasar membuat kerja lebih sulit. Sebaliknya, ada bukti yang meningkat untuk
menunjukkan bahwa mereka dapat membantu. Ulasan ini menunjukkan bahwa bahkan wanita yang
tidak bocor urin saat hamil dapat mengurangi kemungkinan bocor untuk enam bulan pertama setelah
melahirkan dengan melakukan latihan selama dan setelah kehamilan mereka. Latihan juga dapat
membantu untuk wanita yang beresiko tinggi menderita kebocoran urine, seperti mereka yang memiliki
bayi besar atau mereka yang mengantisipasi pengiriman forsep. Latihan juga dapat membantu wanita
yang mulai bocor setelah melahirkan, dan mungkin membantu mereka bocor kurang tinja. Namun, tidak
ada cukup bukti untuk mengatakan jika efek ini lalu setelah tahun pertama, meskipun ada beberapa
bukti yang menunjukkan bahwa tingkat berolahraga berkurang dari waktu ke waktu. (Boyle dkk, 2012)