Postnatal care overview

A NICE pathway brings together all NICE guidance, quality

standards and materials to support implementation on a specific
topic area. The pathways are interactive and designed to be used
online. This pdf version gives you a single pathway diagram and
uses numbering to link the boxes in the diagram to the associated
recommendations.
To view the online version of this pathway visit:
http://pathways.nice.org.uk/pathways/postnatal-care
Pathway last updated: 29 July 2015. To see details of any updates to this pathway since its launch,
visit: About this Pathway. For information on the NICE guidance used to create this path, see:
Sources.
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Postnatal care

No additional information

Care of women and their babies

See Postnatal care / Care of women and their babies

Health problems in women and babies

See Postnatal care / Health problems in women and babies in postnatal care

Infant feeding and maternal nutrition

See Postnatal care / Infant feeding and maternal nutrition in postnatal care

A supportive environment

All healthcare providers should:

have local protocols about communication and the transfer of care between clinical sectors
and healthcare professionals
ensure the Baby Friendly Initiative (or another similar externally evaluated breastfeeding
programme) is implemented
have a written breastfeeding policy that is communicated and implemented
ensure breastfeeding support is available in all care locations.
Hospitals should ensure:
round the clock rooming in
privacy
adequate rest
ready access to food and drink.
How long a woman stays in hospital after birth should be negotiated; consider the health and
well-being of the woman and her baby and the level of support available following discharge.

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Commercial packs that contain formula milk or advertisements for formula should not be
distributed.
Recommendations for public, community, voluntary and private sector organisations
Commissioners and managers should work with local partners to ensure mothers can feed their
babies in public areas without fear of interruption or criticism.
The Healthy Start scheme
Promote the Healthy Start scheme. Ensure an adequate supply of application forms is available
and that uptake of benefits is regularly audited.
Community pharmacists should ensure the Healthy Start maternal vitamin supplements are
available for purchase by women who are not eligible to receive them free of charge.

Quality standards
The following quality statements are relevant to this part of the pathway.
Nutrition: improving maternal and child nutrition quality standard
2.

Structured weight loss programme

5.

Advice on introducing solid food

6.

Advice on Healthy Start food vouchers

Resources
The following implementation tools are relevant to this part of the pathway.
Postnatal care: costing report
Postnatal care: costing template
Postnatal care: implementation advice
Routine postnatal care of women and their babies: presenter slides

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Competencies and training

Competencies
All healthcare professionals caring for women and their babies should meet the relevant
competencies developed by Skills for Health.
If relevant, you should also have demonstrated competency and ongoing experience in:
maternal and newborn physical examinations
supporting breastfeeding women
recognising the signs and symptoms of maternal mental health problems
recognising risks, signs and symptoms of domestic and child abuse and knowing who to
contact for advice.
Topics for training and continuing professional development
The nutritional needs of women and the importance of a balanced diet before, during and after
pregnancy (including the need for suitable folic acid supplements).
For training and professional development on vitamin D, see the NICE pathway on vitamin D.
Breastfeeding management, using the Baby Friendly Initiative training as a minimum standard.
For breastfeeding peer supporters: how to provide breastfeeding peer support (a recognised,
externally accredited training course).
For link workers who speak the mother's first language: how to provide information and support
on breastfeeding, use of infant formula, weaning and healthy eating.
Training on weighing and measuring infants. This should include: how to use equipment, how to
document and interpret the data, and how to help parents and carers understand the results
and implications.
Support staff need training to weigh infants and to record the data accurately in the child health
record held by the parents.

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Quality standards
The following quality statement is relevant to this part of the pathway.
Postnatal care quality standard
5.

Breastfeeding

Local breastfeeding policy

Encouraging breastfeeding
Adopt a multifaceted approach or a coordinated programme of interventions across different
settings to increase breastfeeding rates. It should include:
activities to raise awareness of the benefits of and how to overcome the barriers to
breastfeeding
training for health professionals
breastfeeding peer-support programmes
joint working between health professionals and peer supporters
education and information for pregnant women on how to breastfeed, followed by proactive
support during the postnatal period (the support may be provided by a volunteer).
Implement a structured programme that encourages breastfeeding, using the Baby Friendly
Initiative as a minimum standard. The programme should be subject to external evaluation.
Ensure there is a written, audited and well-publicised breastfeeding policy that includes training
for staff and support for those staff who may be breastfeeding. Identify a health professional
responsible for implementing this policy.
Ensure health professionals who provide information and advice to breastfeeding mothers have
the required knowledge and skills.
Ensure support workers receive training in breastfeeding management from someone with the
relevant skills and experience before they start working with breastfeeding mothers.
Ensure all those who work in maternity and children's services, including receptionists,
volunteers and ancillary staff, are made fully aware of the importance of breastfeeding and help
to promote a supportive environment.

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Avoid promoting or advertising infant or follow-on formula.

Do not display, distribute or use product samples, leaflets, posters, charts, educational or other
materials and equipment produced or donated by infant formula, bottle and teat manufacturers.
Peer support and link workers
Provide local, easily accessible breastfeeding peer support programmes and ensure peer
supporters are part of a multidisciplinary team.
Ensure peer supporters:
attend a recognised, externally accredited training course in breastfeeding peer support
contact new mothers directly within 48 hours of their transfer home (or within 48 hours of a
home birth)
offer mothers ongoing support according to their individual needs. This could be delivered
face-to-face, via telephone or through local groups
can consult a health professional and are provided with ongoing support
gain appropriate child protection clearance.
NHS trusts should train link workers who speak the mother's first language to provide
information and support on breastfeeding, use of infant formula, weaning and healthy eating.
Where link workers are not available, ensure women whose first language is not English have
access to interpreting services and information in a format and language they can understand.
NHS trusts should encourage women from minority ethnic communities whose first language is
not English to train as breastfeeding peer supporters.
Prescribing medication
Ensure health professionals and pharmacists who prescribe or dispense drugs to a
breastfeeding mother consult supplementary sources (for example, the Drugs and Lactation
Database [LactMed] ) or seek guidance from the UK Drugs in Lactation Advisory Service.

Quality standards
The following quality statement is relevant to this part of the pathway.

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Postnatal care quality standard

5.

Breastfeeding

Resources
The following implementation tool is relevant to this part of the pathway.
A peer support programme for women who breastfeed: commissioning guide

NICE pathway on safe midwifery staffing for maternity settings

See Safe midwifery staffing for maternity settings

NICE pathway on patient experience in adult NHS services

See Patient experience in adult NHS services

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Glossary
Diet
in this pathway, the term 'diet' refers to the habitual eating patterns of individuals and groups of
people who are not slimming or eating to manage or treat a medical condition
Emergency
life-threatening or potential life-threatening situation
Follow-on formula
under UK law, follow-on formula may provide the liquid component of a progressively varied diet
for healthy infants aged over 6 months
Healthy eating
there is no standard definition. However it is widely accepted that 'healthy eating' means
following a diet which is low in fat (particularly saturated fat), sugar and salt, and high in fruit,
vegetables and fibre-rich starchy foods. More details are available from NHS Choices
Infant formula
under UK law, infant formula is the term used to describe a food intended to satisfy, by itself, the
nutritional needs of infants during the first months of life. The Department of Health advises that
infant formula may be used on its own for the first 6 months
Non-urgent
continue to monitor and assess
Reference nutrient intake
The amount of a nutrient needed to meet the needs of around 97% of individuals in a group
Significant hyperbilirubinaemia
an elevation of the serum bilirubin to a level requiring treatment

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Urgent
potentially serious situation, which needs appropriate action
Visible jaundice
jaundice detected by visual inspection
Weaning
weaning or 'complementary feeding' is the transition from an exclusively milk-based diet to a
diet based on solid foods
Co-sleeping
parents or carers sleeping on a bed or sofa or chair with an infant
SIDS
sudden infant death syndrome

Sources
Postnatal care (2006 updated 2014) NICE guideline CG37
Maternal and child nutrition (2008) NICE public health guidance 11

Your responsibility
The guidance in this pathway represents the view of NICE, which was arrived at after careful
consideration of the evidence available. Those working in the NHS, local authorities, the wider
public, voluntary and community sectors and the private sector should take it into account when
carrying out their professional, managerial or voluntary duties. Implementation of this guidance
is the responsibility of local commissioners and/or providers. Commissioners and providers are
reminded that it is their responsibility to implement the guidance, in their local context, in light of
their duties to avoid unlawful discrimination and to have regard to promoting equality of
opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent
with compliance with those duties.

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Copyright
Copyright National Institute for Health and Care Excellence 2015. All rights reserved. NICE
copyright material can be downloaded for private research and study, and may be reproduced
for educational and not-for-profit purposes. No reproduction by or for commercial organisations,
or for commercial purposes, is allowed without the written permission of NICE.

Contact NICE
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