After a normal birth the health worker’s role is to:

• l observe the mother to make sure that no problems are developing
• l to give her advice and support.

Straight after the birth Breastfeeding The sooner after birth the mother breastfeeds, the easier it is likely to be. This is most important if it is the mother’s first baby. Customs about the first feed will vary greatly from place to place. If there are any customs which prevent early breastfeeding, or which advocate giving any food to the baby other than breastmilk, then there is a job to be done in the community to teach good breast-feeding practice.
If there is a trained traditional birth attendant, then she is usually the best person to help the mother breastfeed.
If the mother is known to be HIV positive then the decision to breastfeed is more difficult. As a guide, unless she can bottle feed safely (with a sterile bottle and boiled water for every feed, read the instructions on the tin, afford to buy milk powder for at least 6 months and so on) then the baby is more at risk from bottle feeding than it is from HIV. A further discussion on breastfeeding and HIV will be included in the next issue of HD.
Blood loss Check that the blood loss is normal. If it is too heavy, see Danger signs
Empty the bladder Help the woman to get up and pass urine. Giving her a drink straight after delivery will help.
Afterpains For women who have had several babies, the afterpains can be very strong, especially when breastfeeding. Paracetamol can be given.

Postnatal care
If possible, visit the woman at home once or twice after she has had the baby. Remember that one of the biggest causes of maternal death is infection after delivery. How are these deaths to be prevented if she is not seen by a health worker?
Look for infection A raised pulse rate or a raised temperature is a danger sign. Ask the mother about her blood loss – is there anything abnor-mal about the colour, the amount or the smell? Put your hand on her abdo-men, low down where the uterus is. Is it tender? If you suspect an infection, treat it as an emergency. Get her anti-biotics as soon as possible and use expert advice to find the best regime.
The mother could also get an infection in the urine, in her breast or somewhere else. Ask her questions carefully about where she feels pain, what feels abnormal. Do not hesitate to refer if you do not have the training or medicines to treat her.
Check for anaemia Just like in pregnancy, look in the lower eyelid to see whether the mother is anaemic. Unless the lower eyelid is a healthy red colour, give the mother iron and folic acid for about 6 weeks, according to national guidelines.
Ask about breastfeeding Encourage the mother in good breastfeeding practice. Ask her if she is giving any-thing else to the baby; if so, explain the dangers. Let her know how important you think exclusive breastfeeding is. Praise her for all that she is doing well.
Diet While good diet is extra important while the mother is recovering from birth and breastfeeding, there may be little that a health worker can do. If there are strong beliefs about which foods a mother should and should not eat, it may be a waste of your time trying to change those beliefs with each individual woman. Also, if she is poor, or doesn’t decide what food the family eats, then she may not be able to follow any advice that you give her. Be understanding, listen to what she tells you. Rather than you simply telling her what to eat, you can discuss together how she could improve her diet within the limitations of her lifestyle.
Contraception If the woman is interested in contraception, discuss with her various types available and tell her where she should go to get contraceptives. it may be more important to speak with her husband-he might need accurate information more than his wife!

Octavio Peralta, Jose Ramon Gutierrez, 295 - Depto 3-Correo 22 - Casilla 96,Santiago,Chile

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