Midwife Licensure Exam The Midwife's Public Health Service Delivery — Prenatal Home-Based and Postnatal Home CareCheat Sheet
A printable cheat sheet for Prenatal Home-Based and Postnatal Home Care, built for Midwife Licensure Exam reviewers who want one go-to reference in the final stretch. Covers formulas, key definitions, common question types, and the Professional Regulation Commission (PRC) — Board of Midwifery-specific twists you will see on Midwife Licensure Exam day.
Exam context
For the Midwife Licensure Examination, Professional Regulation Commission (PRC) — Board of Midwifery tests The Midwife's Public Health Service Delivery under a "Core" label, with Prenatal Home-Based and Postnatal Home Care in the 4th slot across 4 chapters. Midwife Licensure Exam candidates must clear the 75% weighted average cut on the 2026 paper, which draws about a meaningful share of The Midwife's Public Health Service Delivery questions. Date to watch: April and November 2026 (expected).
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.
Sections
Section Title
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
Term
Bag Technique
Example
Opening the bag, washing hands, removing only needed articles, keeping the inside of the bag clean throughout the visit.
Definition
Standardized method of using the public health bag to deliver clean, organized care in the home while minimizing infection risk.
Term
Home Visit
Example
Observing water supply, sanitation, household composition, and transport to assess maternal risk factors.
Definition
Planned, purposeful, family-centered contact in the client's own environment to assess real living conditions and build health system trust.
Term
Public Health Bag
Example
Contains soap dish, hand towels, vital signs equipment, examination articles, teaching materials, and delivery supplies.
Definition
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
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
Section Title
Prenatal Home-Based Care: Standards & Schedule
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
Term
Antenatal Care (ANC) Contact
Example
First trimester contact to establish baseline health status and calculate estimated date of delivery (EDD).
Definition
Planned maternal assessment during pregnancy to monitor health, detect risk, and prepare for safe delivery.
Term
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.
Definition
Five-dose vaccine schedule during pregnancy to protect mother and baby against tetanus; confers long-term immunity.
Term
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.
Definition
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)
Common Values
Value
10 cardinal signs
Symbol
Danger signs
Quantity
Number of pregnancy danger signs to know
Section Title
Pregnancy Danger Signs — Referral Triggers
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
Term
Pregnancy Danger Sign
Example
Severe headache with blurred vision is a danger sign of pre-eclampsia; mother is referred immediately, not managed at home.
Definition
Symptom or sign in pregnancy that indicates serious complication and requires IMMEDIATE referral to BEmONC or CEmONC facility.
Term
Referral
Example
Upon recognition of vaginal bleeding in second trimester, midwife arranges immediate transport to BEmONC facility.
Definition
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
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
Section Title
Postpartum Home Care: Mother Assessment
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
Term
Postpartum Period
Example
Most maternal deaths from hemorrhage, infection, or pre-eclampsia occur in first week; frequent follow-up is critical.
Definition
First 6 weeks after delivery; the highest-risk period for maternal death, especially first 24–48 hours.
Term
Uterine Involution
Example
Postpartum day 1 fundus at umbilicus; day 7 fundus at 2 cm below umbilicus; day 14 not palpable above pubis.
Definition
Progressive shrinkage of uterus after delivery; fundus descends one fingerbreadth per day; normally complete by 6 weeks.
Term
Lochia
Example
Day 2 lochia is heavy, red; by day 10 it becomes pinkish-brown; if foul-smelling at any stage, infection suspected.
Definition
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)
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
Section Title
Newborn Home Care & Assessment
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
Term
Exclusive Breastfeeding
Example
Newborn fed on demand; mother checks for good latch, audible swallowing, and adequate wet and stool output.
Definition
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.
Term
Cord Care
Example
Cord washed with clean water and soap if contaminated; dried immediately; no powder, oil, or ash applied.
Definition
Practice of keeping umbilical cord stump clean and dry until separation to prevent infection; no dressing, no herbal remedies.
Term
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.
Definition
Placement of naked newborn on bare skin of parent's chest; maintains warmth, promotes bonding, and stabilizes vital signs.
Term
Expanded Newborn Screening (ENS)
Example
Blood spot on filter card screened for congenital hypothyroidism, phenylketonuria (PKU), sickle cell disease, G6PD deficiency, and other conditions.
Definition
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.
Term
Newborn Hearing Screening
Example
Newborn placed in quiet room; OAE probe placed in ear canal; normal response indicates normal hearing.
Definition
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)
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
Section Title
Newborn Danger Signs — Referral Triggers
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
Term
Newborn Danger Sign
Example
Fast breathing (≥60 breaths/minute) or severe chest indrawing is a danger sign of pneumonia or respiratory distress; refer immediately.
Definition
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
Section Title
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
Term
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.
Definition
Barangay register of all pregnant women and mothers with children under 5; used to track contacts, defaulters, and coverage.
Term
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.
Definition
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
Rows
Values
- 4 visits minimum
- ANC1 (1st trimester), ANC2 (2nd trimester), ANC3 & ANC4 (3rd trimester)
- Based on risk; early detection and management of complications
Property
DOH (Current)
Values
- 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
Property
WHO (Emerging Model)
Columns
- Standard
- Number of Contacts
- Timing
- Rationale
Table Title
DOH vs WHO Prenatal Visit Standards
Rows
Values
- 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
Property
Vaginal bleeding
Values
- Lochia has a normal odor (similar to menstrual discharge)
- Foul, putrid smell at any postpartum day
- Indicates intrauterine infection (endometritis); fever usually present
Property
Lochia odor
Values
- 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
Property
Temperature
Values
- 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
Property
Uterine fundus
Values
- 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
Property
Perineal pain
Values
- 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
Property
Headache
Values
- 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
Property
Calf pain/swelling
Values
- Normal, no shortness of breath
- Difficulty breathing, chest pain, tachypnea
- Sign of pulmonary embolism, anemia, or cardiac issue; refer urgently
Property
Breathing
Columns
- Sign/Symptom
- Normal Postpartum
- Danger Sign (Refer)
- Why It Matters
Table Title
Postpartum Danger Signs vs Normal Postpartum Changes
Rows
Values
- 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
Property
Feeding
Values
- 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
Property
Breathing
Values
- 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
Property
Muscle tone
Values
- 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
Property
Temperature
Values
- 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
Property
Skin color
Values
- 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
Property
Cord
Values
- Clear, no drainage or swelling
- Redness, swelling, or purulent discharge from eyes
- Ophthalmia neonatorum (gonococcal or chlamydial infection); risk of blindness if untreated
Property
Eyes
Values
- 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
Property
Seizures/convulsions
Columns
- Sign/Behavior
- Normal Newborn
- Danger Sign (Refer)
- Underlying Condition
Table Title
Newborn Danger Signs vs Normal Newborn Behavior
Rows
Values
- 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
Property
Lochia Rubra (Red)
Values
- 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
Property
Lochia Serosa (Pink-Brown)
Values
- 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
Property
Lochia Alba (White-Yellow)
Values
- 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
Property
DANGER: Abnormal lochia
Columns
- Phase
- Days Postpartum
- Color & Appearance
- Volume & Odor
- What It Tells You
Table Title
Lochia Phases: Color, Character, and Timeline
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