Daily Assessment of Mother

The midwife should conduct daily assessments for at least 10 days after delivery, examining her overall health and recording her physical and mental well-being. Daily assessments allow the midwife and mother to discuss the mother's and the baby's needs.

Aims of daily assessment

• Mother's health should be preserved.
• Contributes to the involution of a pelvic organ.
• Encourage breastfeeding.
• Infection and other puerperal complications can be avoided.
• Educate the mother on how to properly care for both her baby and herself.
• General well-being: The midwife should keep an eye on the mother's general health. The mother should be welcomed and asked how she is doing. If a mother has an infection or is anemic, she will not feel well.
• Vital signs: Critical indicators for the first few days, check and record them at least twice a day. Then record once a day until the 10th day of puerperium. The pulse rate is typically 70 to 80 beats per minute. If the pulse rate rises, it signals heavy bleeding, and the blood pressure will decline. To identify PPH and puerperal sepsis, nurses should examine the uterus and lochia. If there has been any h/o hemorrhage, HTN, or eclampsia, blood pressure should be examined 24 hours a day.
• Urine examination: If the mother has diabetes, renal illness, pre-eclampsia, or eclampsia, urine sugar and protein levels should be tested every 6-8 hours or as needed.
• Weight: Weight must be taken daily or on alternate days if the mother has edema or a known cause of Nephrotic Syndrome.
• The uterus: Palpation of the uterus should be done on a daily basis until the uterine fundus is no longer palpable above the symphysis pubis. The fundal height is 12.5cm to 15cm above the symphysis pubis at the start of the puerperium. The uterine size will shrink by 1.5cm per day. The bladder must be emptied before taking fundal height. The uterus should be tightly closed and not uncomfortable.
  Note: In women, uterine involution is usually faster.
  Sub - involution is recognized when the uterus retains the same size for several days due to the presence of blood clots or retained products of conception, the mother is not an early mother, she does not nurse, she has a full bladder and rectum, and she is in abnormal labor.
• The lochia: The nature and amount of lochia are noted, and the color and amount of lochia are gradually increased or decreased.
• The perineum: The perineum, vulva, and anus should all be examined to verify that any injuries are healing properly.
• Micturition: The mother should be urged to pass urine within 12 hours of giving birth. If a woman has trouble urinating, the cause must be determined. It could be caused by urethral edema, pain aversion, or other factors. Urine retention may result if the condition is not addressed promptly.
• Elimination: Identify the regular elimination pattern.  The fear of stitch pain may cause the control of regular elimination to gap the stitch. During labor, fetal head pressure on the rectum loosens their tone and may cause constipation.

Equipment

• TPR tray
• Screen
• Bedpan
• Tape measure
• Equipment for urine test of protein and sugar
• Weight machine
• Sterile gloves
• Dettol swabs
• Kidney tray’
• Cotton balls/pin

Procedure

1. Prepare the essential equipment and bring it alongside or to the right of the examiner.
2. To protect the patient's privacy, screen him or her.
3. Explain a method to the mother in respectful language.
4. Request that the mother empty her bladder and bring a urine specimen for a sugar and protein test.
5. Thoroughly wash your hands with soap and water.
6. Take a weight, TPR, BP, and sugar and protein urine test.
7. Examine the mother's overall look, including facial expressions, exhaustion, happiness, sadness, and stress, as well as any signs of paleness, such as anemia, yellowish hue (jaundice), and cyanosis.
8. Evaluate the mother's physical condition from head to toe in a systematic manner. If any anomalies are discovered during this process. We should inform her and make suggestions to improve them. Interaction during the assessment procedure gives her confidence or motivates her to express her difficulty.
9. A thorough inspection from head to toe includes the following steps:

• Head: lice, dandruff, dirty, hair distribution, injury; provide needful advice.
• Eyes: conjunctiva for a sign of anemia and jaundice, swelling of eyelids, eye movement, symmetrical in size, infection; observe both eyes at the same time to compare each other.
• Ear: pain, discharge, hearing problem,
• Nose: nasal discharge, patency, congestion, sinusitis, epistaxis, polyps, etc.
• Mouth: a color of lip, crack lip, angular stomatitis, teeth for dental caries, tongue for color and sore, tonsillitis, etc.
• Neck: goiter, sore throat, pain on swallowing must be asked, enlargement of a lymph node.
• Hands: a color of nails, long or short, rashes in between fingers, dirty; give advice as needed.
• Chest: respiratory problem, axillary lymph node.
• Breast: size, symmetry, lumps, condition of a nipple, clean or dirty, type of nipple, hygiene of nipple, breast engorgement.
• Abdomen: liver, spleen for any palpable condition, abdominal scar, fundal height, a condition of the uterus.

Techniques of Taking Fundal Height

• The bladder should be completely empty.
• The mother should remain dorsal recumbent or supine.
• Palpate the abdomen from the symphysis pubis to the uterus.
• Using the ulnar side of your palm, press the abdomen right above the uterine fundus.
• Measure the distance between the symphysis pubis and the fundus of a uterus in millimeters.

Note:

1. Ask about appetite: well or not, the problem in the diet.
2. Rest and sleep: can sleep or not at night if not we must find out a cause and manage it accordingly.
3. After a procedure, the equipment must be clean and replaced in their respective place.
4. Wash your hands.
5. Explain the finding to the mother and record reporting of finding on charts and seniors.