Prenatal Home-Based and Postnatal Home Care - Cheat Sheet
Your last-minute revision companion for home-based maternal and newborn care in the PH context. Master bag technique, prenatal danger signs, postpartum assessments, and newborn red flags — all critical for the MLE.
Bag Technique & Home Visit Principles
Important facts
- Bag is placed on a CLEAN, FLAT SURFACE; if none available, use the bag's own lining or clean paper as barrier.
- WASH HANDS THOROUGHLY before removing any articles from the bag.
- The INSIDE OF THE BAG is always treated as CLEAN — never allow contamination by dirty hands or used items.
- Take out ONLY articles needed for the specific procedure; close the bag between removals.
- Bag technique saves TIME, EFFORT, and DEMONSTRATES PROFESSIONALISM.
- Four guiding principles: clean and well-arranged bag, minimize infection spread, save time and effort, show value of good technique.
- Paper lining creates a clean working field when bag is opened.
- Used articles are cleaned and replaced; hands washed again after procedure.
- Every visit is recorded on mother-and-child records and Target Client List (TCL) for tracking and FHSIS reporting.
Key definitions
Bag Technique
Example
Opening the bag, washing hands, removing only needed articles, keeping the inside of the bag clean throughout the visit.
Standardized method of using the public health bag to deliver clean, organized care in the home while minimizing infection risk.
Home Visit
Example
Observing water supply, sanitation, household composition, and transport to assess maternal risk factors.
Planned, purposeful, family-centered contact in the client's own environment to assess real living conditions and build health system trust.
Public Health Bag
Example
Contains soap dish, hand towels, vital signs equipment, examination articles, teaching materials, and delivery supplies.
Mobile clinic containing clean, organized equipment and supplies needed for safe home-based maternal and newborn care.
Diagrams to know
- Sequence of bag technique on arrival (7-step sequence)
- Clean vs. contaminated zones in home-based care
Prenatal Home-Based Care: Standards & Schedule
Common values
Value
4 visits
Symbol
ANC contacts
Quantity
Minimum DOH prenatal visits
Value
8 contacts
Symbol
WHO model
Quantity
WHO recommended prenatal contacts
Value
First trimester, as early as possible
Symbol
ANC1
Quantity
Timing of first ANC visit
Value
5-dose schedule
Symbol
TT5
Quantity
Tetanus toxoid lifetime protection
Important facts
- DOH STANDARD: minimum of 4 PRENATAL VISITS — 1st trimester, 2nd trimester, and 2 visits in 3rd trimester.
- WHO now recommends 8 contacts during pregnancy (emerging standard in PH); services moving toward this model.
- FIRST VISIT as EARLY AS POSSIBLE in first trimester; calculation of LMP and EDD is central.
- At EVERY PRENATAL VISIT: blood pressure MUST be checked (key sign of pre-eclampsia risk).
- Prenatal package includes: history/risk assessment, physical exam, vital signs, fundal height, fetal heart tones, Leopold's maneuvers (3rd trimester).
- TT/Td: 5-dose lifetime protection schedule — essential for both maternal and neonatal tetanus prevention.
- Iron + folic acid supplementation given at every visit; calcium supplementation; deworming in 2nd or 3rd trimester.
- Blood typing, hemoglobin, urinalysis, syphilis/infection screening where available.
- Health teaching at every contact: nutrition, rest, breastfeeding preparation, DANGER SIGNS.
- Birth plan defeats the THREE DELAYS: delay in recognizing danger, delay in deciding to go, delay in reaching facility.
- Facility delivery with skilled birth attendant ONLY — NO traditional birth attendant home births.
- Blood donor identified in advance (not just named on day of delivery).
Key definitions
Antenatal Care (ANC) Contact
Example
First trimester contact to establish baseline health status and calculate estimated date of delivery (EDD).
Planned maternal assessment during pregnancy to monitor health, detect risk, and prepare for safe delivery.
Tetanus Toxoid (TT/Td) Immunization
Example
TT1 at first contact, TT2 at least 4 weeks apart, TT3+ at least 6 months apart; 5 doses = lifetime protection.
Five-dose vaccine schedule during pregnancy to protect mother and baby against tetanus; confers long-term immunity.
Birth Plan
Example
Mother and family decide delivery will be at RHU with midwife; brother will provide transport; cousin is blood donor; mother's mother is companion.
Written, family-endorsed agreement naming facility, skilled attendant, transport, companion, funds, blood donor, and labor danger signs.
Diagrams to know
- Prenatal visit schedule timeline (4-visit DOH standard vs 8-contact WHO model)
- Components of the prenatal package at each trimester
- Birth plan checklist (6 key elements)
Pregnancy Danger Signs — Referral Triggers
Common values
Value
10 cardinal signs
Symbol
Danger signs
Quantity
Number of pregnancy danger signs to know
Important facts
- VAGINAL BLEEDING — at any stage of pregnancy, always a danger sign.
- SEVERE HEADACHE or BLURRED VISION — classic signs of pre-eclampsia; also with visual disturbances is eclampsia risk.
- SWELLING OF FACE AND HANDS (edema) — sign of pre-eclampsia; especially sudden onset.
- CONVULSIONS or FITS — eclampsia; life-threatening emergency, refer IMMEDIATELY.
- HIGH FEVER — suggest infection (UTI, pneumonia, malaria in endemic areas); screen and refer.
- SEVERE ABDOMINAL or EPIGASTRIC PAIN — may indicate abruption, appendicitis, HELLP syndrome; refer urgently.
- PERSISTENT, SEVERE VOMITING — risk of dehydration and electrolyte loss; assess and refer if not resolving.
- DECREASED or ABSENT FETAL MOVEMENT — loss of fetal viability or compromise; refer for fetal assessment.
- WATERY VAGINAL DISCHARGE — rupture of membranes (ROM); refer to facility to assess and plan for delivery.
- FOUL-SMELLING VAGINAL DISCHARGE — intrauterine infection; refer for assessment and antibiotics.
- FAST or DIFFICULT BREATHING — may indicate pulmonary edema, anemia, cardiac disease, or infection; refer for assessment.
- ALL DANGER SIGNS = IMMEDIATE REFERRAL; midwife does NOT attempt to manage these at home.
- Family teaching: 'Go now to facility if you see these signs; do not wait.'
Key definitions
Pregnancy Danger Sign
Example
Severe headache with blurred vision is a danger sign of pre-eclampsia; mother is referred immediately, not managed at home.
Symptom or sign in pregnancy that indicates serious complication and requires IMMEDIATE referral to BEmONC or CEmONC facility.
Referral
Example
Upon recognition of vaginal bleeding in second trimester, midwife arranges immediate transport to BEmONC facility.
Act of arranging immediate transfer of mother to appropriate level of care for emergency assessment and management of complications.
Diagrams to know
- Decision tree: 'Is this a pregnancy danger sign?' (Yes → Refer immediately; No → Continue home care)
- List of 10 pregnancy danger signs with referral urgency levels
Postpartum Home Care: Mother Assessment
Common values
Value
Within 24 hours
Symbol
PP1
Quantity
First postpartum check-up timing
Value
Around day 7 (one week)
Symbol
PP2
Quantity
Second postpartum check-up timing
Value
1 fingerbreadth/day
Symbol
Involution rate
Quantity
Fundal descent per day
Value
Pad soaked in 1–2 hours = light
Symbol
Lochia volume
Quantity
Normal lochia saturation
Value
Rubra 1–3 days, Serosa 4–10 days, Alba 2–6 weeks
Symbol
Lochia phases
Quantity
Lochia phases duration
Important facts
- DOH STANDARD: minimum 2 postpartum check-ups — 1st within 24 HOURS of delivery, 2nd on about DAY 7 (one week), plus 6-week visit.
- WHO model adds contacts at day 3 and days 7–14 for higher-frequency early monitoring.
- At EVERY postpartum visit: vital signs, temperature (fever = infection risk).
- UTERINE INVOLUTION: fundus firm and descending; fundus at umbilicus on day 1; descends 1 fingerbreadth/day thereafter.
- LOCHIA ASSESSMENT: amount (normal = soaking pad in 1–2 hours is light; >1 pad/hour is heavy), color (rubra → serosa → alba), odor (foul = infection).
- PERINEUM/WOUND: assess healing of tear or episiotomy; redness, warmth, fluctuance = infection (refer).
- BREASTS: check for engorgement, cracked nipples, mastitis (redness, warmth, tender nodule), abscess; support exclusive breastfeeding.
- BLADDER & BOWEL: assess urination and bowel habits; retention or constipation common; teach fluid and fiber intake.
- POSTPARTUM DEPRESSION: screen for low mood, loss of interest, sleep disturbance, guilt, inability to cope; refer if severe.
- Family planning counseling: discuss options, timing of return to sexuality, Lactational Amenorrhea Method (LAM) if exclusively breastfeeding.
- Iron supplementation continues postpartum to restore hemoglobin, especially if anemic during pregnancy.
- HEAVY VAGINAL BLEEDING (soaking >1 pad/hour), FOUL-SMELLING LOCHIA, FEVER, SEVERE HEADACHE, CONVULSIONS, BREAST INFECTION, CALF PAIN/SWELLING, DIFFICULTY BREATHING, SEVERE DEPRESSION = all DANGER SIGNS, refer immediately.
Key definitions
Postpartum Period
Example
Most maternal deaths from hemorrhage, infection, or pre-eclampsia occur in first week; frequent follow-up is critical.
First 6 weeks after delivery; the highest-risk period for maternal death, especially first 24–48 hours.
Uterine Involution
Example
Postpartum day 1 fundus at umbilicus; day 7 fundus at 2 cm below umbilicus; day 14 not palpable above pubis.
Progressive shrinkage of uterus after delivery; fundus descends one fingerbreadth per day; normally complete by 6 weeks.
Lochia
Example
Day 2 lochia is heavy, red; by day 10 it becomes pinkish-brown; if foul-smelling at any stage, infection suspected.
Vaginal discharge after delivery; normally rubra (red) days 1–3, serosa (pinkish-brown) days 4–10, alba (white-yellow) weeks 2–6.
Diagrams to know
- Postpartum visit schedule: day 1, day 7, week 6
- Lochia color/character progression (rubra → serosa → alba)
- Uterine fundal descent timeline (height by day postpartum)
Newborn Home Care & Assessment
Common values
Value
24–72 hours after birth
Symbol
ENS window
Quantity
ENS timing
Value
24 hours (NOT earlier)
Symbol
ENS minimum
Quantity
Earliest ENS can be done
Value
10% of birth weight acceptable
Symbol
Weight loss threshold
Quantity
Normal weight loss by day 3
Value
>15% of birth weight
Symbol
Weight loss alert
Quantity
Concerning weight loss
Value
6 or more per day (exclusively breastfed)
Symbol
Output minimum
Quantity
Wet diapers by day 5
Value
3 or more per day (exclusively breastfed)
Symbol
Stool minimum
Quantity
Stools by day 5
Important facts
- EXCLUSIVE BREASTFEEDING: on demand (not scheduled), no water or formula, no other foods until 6 months old.
- Breastfeeding assessment: good latch, audible swallowing, mother comfortable, infant alert and suckling effectively.
- Teach mother to recognize adequate output: 6+ wet diapers by day 5, 3+ stools by day 5 in exclusively breastfed infant.
- CORD CARE: keep clean and dry; wash with clean water and soap if soiled; no dressing, powder, oil, herbal remedies, or ash.
- Cord stump normally separates by day 7–14; assess for redness, discharge, foul smell (signs of infection; refer).
- WARMTH & SKIN-TO-SKIN CARE: prevent hypothermia; kangaroo care for small or cold babies; dress infant, keep in warm environment.
- WEIGHT & GROWTH: weigh newborn at day 1, day 7, and continue monitoring; 10% weight loss by day 3 is acceptable; >15% loss is concern.
- EXPANDED NEWBORN SCREENING (ENS): heel-prick blood sample taken BETWEEN 24–72 HOURS (NOT before 24 hours).
- ENS screens for: congenital hypothyroidism, phenylketonuria (PKU), sickle cell disease, G6PD deficiency, and other treatable disorders.
- NEWBORN HEARING SCREENING (OAE or ABR): done before discharge or in first weeks; early detection is key.
- BCG vaccine and HEPATITIS B birth dose: confirm these were given at delivery; if not, arrange at home visit.
- EPI SCHEDULE: set the schedule for further immunizations (pentavalent, pneumococcal, rotavirus, inactivated polio vaccine, etc.); start at 6 weeks.
- Newborn assessment at each visit: feeding, cord, warmth, weight, growth, color (jaundice), cry, movement, breathing.
Key definitions
Exclusive Breastfeeding
Example
Newborn fed on demand; mother checks for good latch, audible swallowing, and adequate wet and stool output.
Infant receives only breast milk (no water, formula, or other foods) for at least the first 6 months of life; recommended for optimal nutrition and immunity.
Cord Care
Example
Cord washed with clean water and soap if contaminated; dried immediately; no powder, oil, or ash applied.
Practice of keeping umbilical cord stump clean and dry until separation to prevent infection; no dressing, no herbal remedies.
Kangaroo/Skin-to-Skin Care
Example
Small or preterm baby placed prone on mother's chest with cover over both; done especially when infant is cold or unable to maintain temperature.
Placement of naked newborn on bare skin of parent's chest; maintains warmth, promotes bonding, and stabilizes vital signs.
Expanded Newborn Screening (ENS)
Example
Blood spot on filter card screened for congenital hypothyroidism, phenylketonuria (PKU), sickle cell disease, G6PD deficiency, and other conditions.
Heel-prick blood sample taken 24–72 hours after birth (no earlier than 24 hours) to screen for metabolic, hemoglobin, and other treatable newborn disorders.
Newborn Hearing Screening
Example
Newborn placed in quiet room; OAE probe placed in ear canal; normal response indicates normal hearing.
Assessment of newborn's auditory function using otoacoustic emission (OAE) or auditory brainstem response (ABR); done before hospital discharge or in first weeks of life.
Diagrams to know
- Newborn screening timeline: when and what to screen (ENS 24–72 hours, hearing screening before discharge)
- EPI immunization schedule starting from birth doses (BCG, Hep B, DPT1 at 6 weeks)
- Breastfeeding assessment checklist (latch, swallowing, output, mother comfort)
Newborn Danger Signs — Referral Triggers
Common values
Value
≥60 breaths per minute
Symbol
Danger RR
Quantity
Fast breathing threshold
Value
>38°C axillary
Symbol
Danger temp
Quantity
Fever in newborn
Value
<36.5°C core
Symbol
Cold danger
Quantity
Hypothermia threshold
Value
9 cardinal signs
Symbol
Danger signs
Quantity
Number of newborn danger signs to recognize
Important facts
- POOR FEEDING or NOT FEEDING — inability to suckle, weak suck, or refusal to feed (sign of infection, neurological issue, or severe jaundice); refer.
- CONVULSIONS or FITS — seizure activity in newborn (sign of infection, hypoglycemia, hypocalcemia, or birth trauma); REFER IMMEDIATELY.
- FAST BREATHING (≥60 breaths/minute) or SEVERE CHEST INDRAWING — signs of pneumonia, respiratory distress syndrome, or sepsis; REFER IMMEDIATELY.
- FEVER (>38°C axillary) or HYPOTHERMIA (core temperature <36.5°C) — sign of infection or inability to maintain warmth; refer for assessment.
- NO MOVEMENT even when stimulated — severe lethargy or coma (sign of infection, hypoglycemia, or CNS injury); REFER IMMEDIATELY.
- YELLOW PALMS AND SOLES (pathological jaundice) — kernicterus risk; different from physiological jaundice of face; assess bilirubin level and refer if indicated.
- REDNESS, SWELLING, or PUS AROUND CORD — omphalitis (umbilical infection); treat with antibiotics and refer if signs of sepsis.
- REDNESS, SWELLING, or DISCHARGE FROM EYES — ophthalmia neonatorum (gonococcal or chlamydial infection); treat and refer.
- Other danger signs: bleeding from any site, abdominal distension with vomiting, excessive crying or inconsolable, severe jaundice at any age.
- ALL NEWBORN DANGER SIGNS = REFER IMMEDIATELY; midwife does NOT manage these at home.
- Family teaching: 'Take baby to facility immediately if not feeding, convulsing, breathing fast, too hot or cold, or has swollen eyes/cord.'
Key definitions
Newborn Danger Sign
Example
Fast breathing (≥60 breaths/minute) or severe chest indrawing is a danger sign of pneumonia or respiratory distress; refer immediately.
Symptom or sign in newborn that indicates serious illness or complication requiring IMMEDIATE referral to BEmONC or CEmONC facility.
Diagrams to know
- Decision tree: 'Is this a newborn danger sign?' (Yes → Refer immediately; No → Continue home care)
- List of 9 newborn danger signs with clinical meaning
Recording & Data Systems
Important facts
- EVERY HOME VISIT is recorded on the mother-and-child record AND the Target Client List (TCL).
- TCL serves as the tracking tool for the midwife to identify: due for visit, defaulters, outcomes.
- Records include date of visit, findings, immunizations given, danger signs identified, referrals made, and next appointment.
- TCL data feeds into FHSIS, enabling aggregation of coverage indicators at barangay and municipal levels.
- Coverage targets: 95% pregnant women with 4 ANC visits, 90% with postpartum check-up within 24 hours, 85% with day 7 postpartum visit.
- Recording is both accountability (for supervision) and service delivery (for continuity and follow-up).
- Data is used to identify high-risk mothers and newborns needing intensified support.
- Defaulter tracking: mother overdue for visit is contacted and re-engaged before she is lost to follow-up.
Key definitions
Target Client List (TCL)
Example
Midwife maintains TCL showing names, addresses, LMP, EDD, and dates of each ANC visit; identifies who is overdue for follow-up.
Barangay register of all pregnant women and mothers with children under 5; used to track contacts, defaulters, and coverage.
Field Health Services Information System (FHSIS)
Example
Midwife's home visit records feed into TCL, which rolls up into FHSIS reports showing barangay ANC coverage and maternal/neonatal outcomes.
Philippine DOH data system that aggregates mother-and-child health indicators (ANC coverage, postpartum visits, immunization rates) from RHUs and health facilities.
Diagrams to know
- Flow of home visit data: home visit record → TCL → FHSIS → coverage indicators
Must remember
- BAG TECHNIQUE FIRST STEP: Place bag on clean surface, then WASH HANDS before removing any articles. Inside of bag is always CLEAN; never contaminate it.
- PRENATAL VISITS: DOH minimum 4 visits (1st trimester early, 2nd trimester, 2× 3rd trimester); WHO standard now 8 contacts. EVERY visit = blood pressure check.
- PREGNANCY DANGER SIGNS: Vaginal bleeding, severe headache/blurred vision, facial/hand swelling, convulsions, fever, severe abdominal pain, severe vomiting, decreased fetal movement, watery/foul discharge, difficulty breathing — ALL ARE IMMEDIATE REFERRALS.
- BIRTH PLAN ELEMENTS: Facility with skilled attendant (NO home birth), transport + backup, companion, funds, blood donor identified, and knowledge of labor/danger signs — defeats Three Delays.
- TETANUS TOXOID: 5-dose schedule = lifetime protection; TT1 at first contact, TT2–5 at proper intervals (4 weeks minimum between doses); protects mother AND baby.
- POSTPARTUM VISITS: DOH standard ≥2 visits: within 24 hours (PP1) and day 7 (PP2), plus 6-week check. First 24–48 hours = highest mortality risk.
- POSTPARTUM DANGER SIGNS: Heavy bleeding (>1 pad/hour), foul lochia, fever ≥38°C, severe headache, convulsions, breast infection, calf swelling/pain, difficulty breathing, severe depression — ALL ARE REFERRALS.
- NEWBORN ENS SCREENING: Heel prick blood sample taken 24–72 hours (NOT before 24 hours); screens for congenital hypothyroidism, PKU, sickle cell, G6PD deficiency.
- EXCLUSIVE BREASTFEEDING: On demand, no water/formula/other foods; assess latch, swallowing, output (6+ wet diapers, 3+ stools by day 5); support mother comfort.
- NEWBORN DANGER SIGNS: Not feeding, convulsions, fast breathing ≥60/min with chest indrawing, fever ≥38°C or hypothermia <36.5°C, no movement when stimulated, yellow palms/soles (pathological jaundice), cord/eye redness with discharge — ALL ARE IMMEDIATE REFERRALS.
Last minute tips
- REFERRAL VS. MANAGEMENT: This is a HOME-BASED care chapter — midwife MANAGES normal pregnancy, labor, and postpartum; but REFERS all complications. If an exam question shows a danger sign, the answer is always 'refer immediately' — NOT 'manage with antibiotics' or 'continue monitoring at home.'
- BAG TECHNIQUE IS PRACTICAL: The MLE often has a scenario-based question about what the midwife does on arrival at a home. Always: (1) place bag cleanly, (2) get water and soap, (3) WASH HANDS FIRST, (4) open bag with paper lining, (5) take out only needed items. This sequence prevents contamination and shows professionalism.
- DANGER SIGNS = IMMEDIATE REFERRAL: Memorize the 10 pregnancy danger signs and 9 newborn danger signs. On the exam, if you see any of these in a scenario, STOP and refer — do not continue home care, do not give partial treatment, do not 'monitor at home.' This is the midwife's legal and ethical boundary.
- TIMING IS CRITICAL: First ANC visit should be as early as possible in the first trimester (not late second/third); postpartum visits are within 24 hours and day 7 (not day 3 or day 10); ENS is 24–72 hours (not 48 hours or day 5). Exact timing often appears in MLE questions.
- RECORD AND REFER: Every visit is recorded on TCL and mother-and-child record — this is HOW the midwife and RHU track defaulters and coverage. If the question asks 'what should the midwife do after the visit,' always include 'record on TCL' and 'schedule next appointment' along with care provided.
Comparison tables
DOH vs WHO Prenatal Visit Standards
| Standard | Number of Contacts | Timing | Rationale |
|---|---|---|---|
| DOH (Current) | 4 visits minimum | ANC1 (1st trimester), ANC2 (2nd trimester), ANC3 & ANC4 (3rd trimester) | Based on risk; early detection and management of complications |
| WHO (Emerging Model) | 8 contacts | ANC1 (8–12 wks), then 2-weekly until 36 wks, then weekly to delivery | More frequent contact reduces maternal and perinatal mortality; closer monitoring of blood pressure, fetal well-being |
Postpartum Danger Signs vs Normal Postpartum Changes
| Sign/Symptom | Normal Postpartum | Danger Sign (Refer) | Why It Matters |
|---|---|---|---|
| Vaginal bleeding | Heavy for 1–3 days, then decreasing; soaking 1 pad/2 hours is light | Soaking >1 pad/hour continuously; bright red after 3 days; passage of clots >golf ball size | Sign of hemorrhage, retained placenta, or infection; can lead to shock |
| Lochia odor | Lochia has a normal odor (similar to menstrual discharge) | Foul, putrid smell at any postpartum day | Indicates intrauterine infection (endometritis); fever usually present |
| Temperature | Normal 36.5–37.5°C; may have mild temperature elevation day 1 | Fever ≥38°C on 2+ consecutive days or ≥38.5°C on any day | Sign of infection (UTI, endometritis, mastitis, or other); requires antibiotic assessment |
| Uterine fundus | Firm, descending at rate of 1 fingerbreadth/day; no tenderness | Boggy or failing to descend; tender to touch; foul-smelling lochia | Sign of retained products, infection, or subinvolution; risk of hemorrhage |
| Perineal pain | Mild to moderate pain, decreasing over days; no purulent drainage | Severe pain, swelling, redness, warmth, fluctuance, or purulent discharge | Sign of infection or hematoma; requires assessment and possible drainage |
| Headache | No headache or mild tension headache | Severe headache, especially with visual changes, upper abdominal pain, or low platelets | Sign of pre-eclampsia/eclampsia postpartum; life-threatening; needs urgent assessment |
| Calf pain/swelling | No calf pain or swelling; legs normal | Unilateral calf swelling, pain, warmth, positive Homan's sign | Sign of deep vein thrombosis (DVT); risk of pulmonary embolism; refer urgently |
| Breathing | Normal, no shortness of breath | Difficulty breathing, chest pain, tachypnea | Sign of pulmonary embolism, anemia, or cardiac issue; refer urgently |
Newborn Danger Signs vs Normal Newborn Behavior
| Sign/Behavior | Normal Newborn | Danger Sign (Refer) | Underlying Condition |
|---|---|---|---|
| Feeding | Breastfeeds on demand, audible swallowing, alert when feeding | Does not feed, weak or no suck, difficult to rouse, or vomiting all feeds | Infection, hypoglycemia, severe jaundice, neurological injury, or gastrointestinal obstruction |
| Breathing | Quiet breathing 30–60 breaths/minute, no work | ≥60 breaths/minute OR severe chest indrawing (ribs, sternum pulling in) | Pneumonia, respiratory distress syndrome, sepsis, or pulmonary edema |
| Muscle tone | Flexed arms and legs, alert, cries vigorously, moves spontaneously | Floppy or stiff; no movement even when stimulated; weak cry | Sepsis, hypoglycemia, hypocalcemia, birth asphyxia, or CNS infection |
| Temperature | Axillary 36.5–37.5°C (skin warm to touch) | ≥38°C or <36.5°C (too hot or too cold to touch) | Infection, environmental exposure, or inability to thermoregulate |
| Skin color | Pink (may have mild jaundice of face on day 2–3, disappears by day 7) | Yellow PALMS and SOLES (pathological jaundice); yellow at birth; worsening jaundice | Severe hyperbilirubinemia; risk of kernicterus; also consider hemolytic disease or infection |
| Cord | Umbilical stump clean and dry; minor oozing stops within 24 hours; separates day 7–14 | Redness, swelling, purulent drainage, or foul smell around cord; persistent bleeding | Umbilical infection (omphalitis); risk of sepsis if signs progress |
| Eyes | Clear, no drainage or swelling | Redness, swelling, or purulent discharge from eyes | Ophthalmia neonatorum (gonococcal or chlamydial infection); risk of blindness if untreated |
| Seizures/convulsions | None; normal startle reflex and jitteriness present | Rhythmic jerking movements, stiffening, eye rolling, or loss of consciousness | Hypoglycemia, hypocalcemia, intracranial hemorrhage, infection, or birth trauma |
Lochia Phases: Color, Character, and Timeline
| Phase | Days Postpartum | Color & Appearance | Volume & Odor | What It Tells You |
|---|---|---|---|---|
| Lochia Rubra (Red) | Days 1–3 | Bright red, similar to heavy menstrual bleeding | Heavy (1–2 pads/hour normal), odorless or mild odor | Normal shedding of uterine lining; expect soaking pads, no alarm needed if volume normal |
| Lochia Serosa (Pink-Brown) | Days 4–10 | Pinkish-brown or brownish color; smaller clots normal | Moderate (soaking 1 pad/2 hours), mild odor | Decreasing lining and RBC shedding; normal progression; volume should be decreasing |
| Lochia Alba (White-Yellow) | Weeks 2–6 | White, yellowish, or cream-colored discharge | Light (small amount on underwear), no odor or mild odor | Epithelial tissue and white cells; can persist 4–8 weeks; normal and expected |
| DANGER: Abnormal lochia | Any time postpartum | Foul-smelling at ANY stage; bright red after day 3; large clots | Soaking >1 pad/hour or heavy bleeding weeks 2–6; foul odor | Sign of retained products, infection, or disrupted involution; REFER for assessment |
Diagrams
Home Visit Bag Technique: Step-by-Step Sequence
The 12-step sequence ensures the bag stays clean, contamination is prevented, and the visit is organized and professional. Key emphasis: wash hands before removing items, keep the inside of the bag clean at all times.
Pregnancy Danger Signs: Recognition and Referral Pathway
Any danger sign in pregnancy requires immediate referral; there is no 'wait and see' at home. The midwife's role is to recognize the sign, inform the family, arrange transport, and refer urgently.
Prenatal & Postpartum Contact Schedule (DOH Standard)
Timeline shows the DOH-recommended minimum contacts from pregnancy through 6 weeks postpartum. Early, frequent contact is key to the continuum of care.
Lochia Phases: Color Transition & Assessment
The normal progression of lochia from red to brown to white over 2–6 weeks. Any deviation (bright red after day 3, foul smell, excessive clots) is abnormal and signals infection or retained products.
Newborn Assessment at Home Visit: Five Key Domains
The five pillars of newborn home assessment: feeding, cord care, warmth, screening/immunization, and danger sign recognition. Each domain has specific checkpoints and referral triggers.
Postpartum Danger Signs: Mother Assessment Decision Tree
Decision pathway for identifying postpartum danger signs that require immediate referral. The midwife assesses vital signs first, recognizes warning signs, and refers urgently while documenting all actions.