HEALTHY MOTHER, HEALTHY BABY
POST-NATAL CARE
PRIMARY CARE “TOOLKIT”
August 2013
August 2013
Dear Colleagues,
We are delighted to present Auckland PHO’s newest programme, Healthy Mother, Healthy
Baby to our Network.
The postnatal period marks the exciting establishment of a new phase of family life and the
beginning of the lifelong health journey for newborn babies.
As a GP I know just how important this period is and the vital role of the primary health care
team. I also know that in our busy days of consulting we may not always remember what
best practice is or what resources we have in our community for the mother, family,
whanau and baby, and therefore hope this “toolkit” may assist in this.
In addition to providing clinical guidance about particular topics, we as clinicians must
remember to identify the specific needs and preferences of the individual mother, their
families and whanau, thus offering appropriate, responsive and timely information for
promoting and supporting health. The toolkit aims to identify the essential ‘core care’ which
every new mother should receive, appropriate to their needs, during the first 6-8 weeks
after birth, based upon the best evidence available, but please note, this is by no means an
exhaustive guide.
We wish to empower our new mothers to care for their babies and themselves, so as to
promote and maximise their longer-term physiological and emotional well-being. Thus
health care must be a partnership with patients and involve a team approach in which we
work in an integrated, co-ordinated manner.
I hope by using this Toolkit we can recognise the necessary flexibility of healthcare
professionals’ roles in evolving healthcare systems and the need for coordination of care
throughout the postnatal period.
Effective communication between health care professionals is identified as an important
element in the delivery of high quality and cost effective care. If you need any further
guidance or assistance in delivering postnatal care, please contact us at the Auckland PHO.
Best Wishes
Dr Charlotte Harris
Clinical Director Auckland PHO
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Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
Index
1.
General Physical Wellbeing ......................................................................................
4
2.
Form of Delivery .......................................................................................................
5
3.
Co-morbidities ..........................................................................................................
5
4.
Cervical Screening .....................................................................................................
5
5.
Contraception ...........................................................................................................
5
6.
Infant feeding and Breast Care .................................................................................
7
7.
Mental Health and Well Being ………………………………………………………………………………
9
8.
Smoking and Alcohol ................................................................................................
11
9.
Family Violence Screening ........................................................................................
11
10.
Safe Sleep..................................................................................................................
12
11.
Immunisations for Mother .......................................................................................
12
12.
Maternal Examination ..............................................................................................
13
13.
Miscellaneous Support Links ....................................................................................
14
Well Child Providers .................................................................................................
14
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Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
1. General Physical Wellbeing
New mothers should be offered information and reassurance on:
1.1
The physiological process of recovery after birth (within the first 24 hours)
1.2
Common health concerns as appropriate (weeks 2–8)
1.3
At the first postnatal contact, women should be advised of the signs and symptoms of potentially lifethreatening conditions and to contact their healthcare professional immediately or call for
emergency help if any signs and symptoms occur.
1.4
Signs and Symptoms
Condition
Sudden and profuse blood loss or
persistent increased blood loss
Faintness, dizziness or
palpitations/tachycardia
Postpartum haemorrhage
Fever, shivering, abdominal pain
and/or offensive vaginal loss
Infection
Infection
Headaches accompanied by one
or more of the following
symptoms within the first 72
hours after birth:
• visual disturbances
• nausea, vomiting
Unilateral calf pain, redness or
swelling
Shortness of breath or chest pain
Pre-eclampsia/eclampsia
Thromboembolism
Fatigue: New mothers who report persistent fatigue should be asked about their general well-being,
and offered advice on diet, exercise and planning activities, including spending time with their babies.
If persistent, postnatal fatigue impacts on the woman’s care of herself or baby, underlying physical,
psychological or social causes should be evaluated
1.5
Discuss: bowels/bladder/pelvic floor
1.6
Lochia: If Lochia/bleeding continuing > 6 weeks postpartum, examine uterus per abdomen with
vaginal examination to check involution, and speculum examination.
Send vaginal swabs for microscopy, culture and sensitivity.
Causes include infection, retained products of conception, resumption of normal menstrual cycle, side
effects of contraception (e.g. if Depo-Provera given), cervical bleeding due to trauma or other
pathology, unhealed tears.
If no cause found, you are concerned and the problem is not settling, refer to gynaecology as soon as
possible (discuss with team on call).
1.6
Sexual Intercourse Women should be asked about resumption of sexual intercourse and possible
dyspareunia 2-6 weeks after birth.
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Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
If a woman expresses anxiety about resuming intercourse, reasons for this should be explored.
1.7
Reference
http://www.nhs.uk/conditions/pregnancy-and-baby/pages/your-body-after-childbirth.aspx#close
2. Form of Delivery
2.1
Check
Complications i.e. check C-section scar
Healing of any perineal wound; ask about perineal pain, discomfort or stinging, offensive odour or
dyspareunia.
If a problem is identified , refer the woman to the episiotomy secondary care clinic or physiotherapist
3. Co-morbidities
3.1
Check for any follow up required to take place for co-morbidities present prior or established during
pregnancy, e.g gestational diabetes review, anaemia during pregnancy follow up - haemoglobin,
Hepatitis B, elevated Blood Pressure
4. Cervical Screening
4.1
Check that cervical screening is up to date – record in Dashboard.
http://www.nsu.govt.nz/files/NCSP/NCSP_Guidelines_ALL_small(1).pdf
5. Contraception
5.1
According to National Institute for Clinical Excellence (NICE) guidelines, contraceptive methods and
advice about when to start them should be addressed within the first postpartum week and is usually
discussed with hospital or community midwives. Further discussion and provision of contraception is
an integral part of the six-week postpartum GP check.
In order for a woman to make an informed choice about her future contraceptive method, discussion
(as well as the usual full contraceptive history) and follow up is recommended.
5.2
Contraceptive needs - has she resumed sexual activity yet? Are there any new or ongoing sexual
problems? What degree of efficacy is required? Does she want another child soon or has childbearing
been completed?
5.3
Whether ovulation may have restarted based on when was the baby delivered, method of feeding
and recurrence of menstruation. This can affect the starting regime of the contraceptive chosen and
also whether extra contraceptive measures are needed initially.
5.4
Feeding methods - the combined oral contraceptive is contra-indicated while breast-feeding.
Present or past medical problems, such as hypertension, venous thromboembolism or previous
trophoblastic disease - which may dictate choices.
Determine whether there are any contra-indications to a particular contraceptive.
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Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
METHOD
Combined Oral Contraceptive
(COC)
Progesterone Only Pill (POP)
Progesterone Only Injectables
IF NOT BREASTFEEDING*
IF BREASTFEEDING
Start > 3weeks after delivery
Contraindicated as it may inhibit
because of ↑risk of
lactation and enters the breast
thromboembolism.
milk in small quantities
NB: If pre-eclamptic toxaemia in
pregnancy, start only when
blood pressure and biochemical
abnormalities have returned to
normal.
Delay until > 3 weeks
↑quantity of breast milk.
postpartum to avoid ↑risk of
Can be started 3 weeks after
heavy bleeding
delivery or whenever needed (e.g.
If started > 3 weeks after
if baby weaned or started on
st
delivery, start on 1 day of
supplementary bottle feeds)
period for immediate protection If started > 3 weeks after delivery,
or, if cycle not established use
alternative protection for first
alternative protection for the
7days is required.
first 7days
These are licensed for use only after 6 weeks post-partum:



It is recommended that injections start at, or after, 6 weeks if
breast-feeding.
They can be started within 5 days of delivery, provided the
woman is not breast-feeding but this may risk heavy or
prolonged bleeding.
If cycle not re-established, check pregnancy test before
administration
Intrauterine devices
Intrauterine systems
NICE guidance suggests that both the IUD and IUS may be fitted from
4 weeks postpartum. The Mirena® IUS's product licence however
specifies fitting from 6 weeks postpartum.

This has no effect on breast milk production.

Take care with insertion as the uterus may be soft and
perforate easily
 There is a 1 in 20 expulsion risk
 Review 4-6 weeks after insertion or after the first period,
then annually.
 Teach woman to feel threads after each period
Etonogestrel Implant (IMPLANON
Starting regime for etonogestrel implant:
TM)


6
Start 21-28 days after delivery.
If later than this, extra barrier methods of contraception are
needed for 7 days.
Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
Condoms
Useful until other methods are established and to prevent transfer of
sexually transmitted diseases
*Ovulation can occur within 10days of termination/miscarriage and 28 days of delivery
1. Long-acting reversible contraception, NICE Clinical guideline (October 2005)
2. http://www.patient.co.uk/doctor/postpartum-contraception
3. Summary of Product Characteristics (SPC) - Mirena®; Summary of Product Characteristics
4.
5.
6.
7.
(SPC) - Mirena® (levonorgestrel intrauterine system), Schering Health Care Limited, electronic Medicines
Compendium. Updated April 2009
Diaz S, Zepeda A, Maturana X, et al; Fertility regulation in nursing women. IX. Contraceptive performance,
duration of lactation, infant growth, and bleeding patterns during use of progesterone vaginal rings, progestinonly pills, Norplant implants, and Copper T 380-A intrauterine devices. Contraception. 1997 Oct;56(4):223-32.
Penney G, Brechin S, de Souza A, et al; FFPRHC Guidance (January 2004). The copper intrauterine device as longterm contraception. J Fam Plann Reprod Health Care. 2004 Jan;30(1):29-41; quiz 42.
Postnatal care: Routine postnatal care of women and their babies, NICE Clinical Guideline (2006)
Postnatal Sexual and Reproductive Health, Faculty of Sexual and Reproductive Healthcare (2009)
6. Infant Feeding and Breast Care
6.1
A new mother’s experience with breastfeeding should be discussed at each contact to assess if she is
on course to breastfeed effectively and identify any need for additional support.
If breast feeding is not established or she is having problems (e.g.engorgement, cracked or inverted
nipples etc. Discuss with a lactation consultant and refer as appropriate. (see links below)
Check the baby for tongue-tie, examine woman’s breasts and nipples and continue supported
encouragement and review.
6.2
Nipple Pain
If nipples are painful or cracked, it is probably due to incorrect attachment.
If nipple pain persists after repositioning and re-attachment, assessment for thrush should be
considered
6.3
Mastitis
Women with signs and symptoms of mastitis should be offered assistance with positioning and
attachment and advised to: continue breastfeeding and/or hand expression to ensure effective milk
removal; if necessary, this should be with gentle massaging of the breast to overcome any blockage;
take analgesia compatible with breastfeeding, e.g. paracetamol, and increase fluid intake.
If signs and symptoms of mastitis continue for more than a few hours of self-management, a woman
should be advised to make contact with her practice again and be evaluated as she may need
antibiotic therapy (urgent action).
6.4 Breast Feeding Support Directory for the Auckland District 2013
Auckland City Hospital
9th Floor, Park Road, Grafton
Tel:307 4949
7
Auckland City Hospital has experienced lactation consultants
available on the wards for mothers who go in to National Women’s
Hospital to give birth. The consultants assist and support mothers
with breastfeeding including any breastfeeding challenges they may
be experiencing.
Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
Birthcare Auckland Ltd
Parnell, 20 Titoki Street, Level 2
Call 09 374 0800
Email parnell@birthcare.co.nz
www.birthcare.co.nz
Birthcare offers breastfeeding classes for pregnant women and their
whanau and a breastfeeding outpatient clinic with a lactation
consultant. A lactation consultant review is available for inpatients
as required. Referral forms can be downloaded from the website.
HOURS Preparation for Breastfeeding Course 10:30am-12:30pm
(Monthly) ($40)
Lactation Clinic Free appointments with a lactation consultant are
available for mothers and babies with breastfeeding difficulties in
the first 28 days, with a referral from the lead maternity carer (LMC).
Otherwise $65. Appointment required.
Community breastfeeding support
service (CBSS)
Auckland City Plunket
Call 09 846 3256
Fax 09 849 2672
Email cbss@xtra.co.nz
NZ Lactation Consultants
Association (NZLCA)
CBSS has Maori, Pacific, Asian and Middle Eastern breastfeeding
support workers, who visit mothers in their own homes. A lactation
consultant is available for phone advice and home visits as required.
The services provided are for pregnant women and breastfeeding
mothers, who are either referred by a LMC, health practitioner or
self-referred.
HOURS 8:30am-4:30pm (Monday-Friday) (Free). Telephone Support
available until 6pm
The NZLCA’s lactation consultants have specialist training in
breastfeeding and lactation. A list of private lactation consultants is
available on its website.
www.nzlca.org.nz
Ngati Whatua o Orakei Health
Services
Glen Innes, 272 Apirana Avenue
Otahuhu, 463 Gt South Road
Mission Bay, 25/215 Kepa Rd
Hours The Tamariki Ora Team is
available 8:30am-4pm, (MondayFriday) (Free)
Call 09 578 0941 or 09 528 1700 or
text 021 847 374
Email tuim@orakeihealth.org.nz
www.orakeihealth.org.nz
Plunket Family Centres
Meadowbank, 7 Meadowbank Road
St Lukes, 309 Sandringham Road
Call Meadowbank 09 521 5024;
St Lukes 09 849 5027
Area Office 09 820 6530 for general
information
Fax 09 820 6530
www.plunket.org.nz
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The Tamariki Ora Team provides a breastfeeding friendly
environment and offers a variety of antenatal and postnatal
services. Trained breastfeeding advocates offer support to
breastfeeding mothers and their family/Whanau.
Plunket Family Centres offer support and information on a range of
parenting issues, including breastfeeding. A lactation consultant also
offers breastfeeding support to mothers.
Hours: Meadowbank 8.30am-3pm (Monday-Friday by
appointment)
St Lukes 8.30am-3.30pm (Monday-Friday by appointment) Saturday
from 9am – 1pm (by appointment free).
Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
Tongan Health Society Vaevae
Manava‘a e Fa’e
The Tongan Health Society facilitates breastfeeding peer support
groups in Pacific churches. The services provided are for pregnant
women, breastfeeding mothers, and family members.
29 Hill Street Onehunga
Hours Flexible hours, call to make an
appointment (Free)
Call 09 636 4129 or 021 123 8730
Email vhaunga@tonganhealth.com
Other Breast Feeding Support
Breastfeeding in the Workplace
www.bfw.org.nz
or free
phone 0800 611 116
Women’s Health Action (WHA)
Call 09 520 5295,
Fax 09 529 5731
Email breastfeeding@womenshealth.org.nz
www.womens-health.org.nz and
www.bfw.org.nz
All New Zealand employers are required to provide facilities and
unpaid breaks for mothers who wish to breastfeed their babies or
express milk during working hours. Information about this legislation
and breastfeeding mothers’ rights within the workplace is available
WHA has a full time breastfeeding advocate and provides evidence
based information, support and advice on breastfeeding in the
community and at work. WHA coordinates the annual ‘Big Latch On’
and provides breastfeeding friendly spaces at shows and events.
La Leche League New Zealand LLLNZ is a community-based voluntary service providing
(LLLNZ)
breastfeeding support and information through regular group
Central Auckland & Waiheke Island
meetings, telephone and email counselling. Mother-to-mother help
is provided by experienced breastfeeding mothers, who are trained
Call General: 09 846 0752;
and LLLNZ and accredited by LLL International.
Central Auckland 09 846 9944;
LLLNZ Leaders are able to offer practical suggestions to help a
Waiheke 09 372 2210
mother avoid and overcome any breastfeeding difficulties.
or 09 372 2691
Fees (Free, but subscriptions and donations are welcomed)
Email help@lalecheleague.org.nz
Central Auckland
lll.centralauckland@woosh.co.nz;
Waiheke helga.lll@clear.net.nz
www.lalecheleague.org.nz
7. Mental Health and Wellbeing
http://www.mentalhealth.org.nz/resourcefinder/index.php?c=listings&m=results&topic=41
7.1
At each postnatal contact, new mothers should be asked about their emotional well-being, what
family and social support they have and their usual coping strategies for dealing with day-to-day
matters. Women and their families/partners should be encouraged to tell their healthcare
professional about any changes in mood, emotional state and behaviour that are outside of the
woman’s normal pattern.
7.2
At 10–14 days after birth, women should be asked about resolution of symptoms of baby blues (for
example, tearfulness, feelings of anxiety and low mood). If symptoms have not resolved, the woman
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Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
should be assessed for postnatal depression, and if symptoms persist, evaluated further (urgent
action)
7.3
Screen for post natural depression using Edinburgh Depression Score
Instructions for using the Edinburgh Postnatal Depression Scale:
1. The mother is asked to check the response that comes closest to how she has been feeling in
the previous 7 days.
2. All the items must be completed.
3. Care should be taken to avoid the possibility of the mother discussing her answers
with others. (Answers come from the mother or pregnant woman)
4. The mother should complete the scale herself, unless she has limited English or has difficulty
with reading.
EPDS Scoring and Provisional Diagnosis
QUESTIONS 1, 2, & 4 (without an *) are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom
box scored as 3
QUESTIONS 3, 5–10 (marked with an *) are scored 0, 1, 2 or 3 with top box scored as 3 and the
bottom box scored as 0.



Maximum score: 30
Possible depression: 10 or greater
Always look at item 10 (suicidal thoughts)
REFER AS APPROPRIATE:
If appropriate, refer to Auckland PHO M2M Connect Programme for counselling, or a local private
psychologist of choice
If high risk: exhibiting suicidal ideation/ post-partum psychosis/ concerns of harming herself or baby,
you must discuss and refer appropriately to the local CRISIS secondary care Mental Health Team.
CYFS and Social Services may also need to be considered.
See next page for Edinburgh Depression Scale Template
.
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8. Smoking and Alcohol Status (Record in dashboard)
Reference Websites




http://www.health.govt.nz/publication/new-zealand-smoking-cessation-guidelines
New Zealand primary Care Handbook 2012 (ABC Smoking Cessation)
http://www.lalecheleague.org/faq/alcohol.html
http://www.health.govt.nz/your-health/healthy-living/babies-and-toddlers/breastfeeding0/getting-ready-breastfeed/what-avoid-while-breastfeeding/avoiding-alcohol-whilebreastfeeding
9. Family Violence Screen
http://www.health.govt.nz/publication/family-violence-intervention-guidelines-child-andpartner-abuse
9.1
The risks, signs and symptoms of family violence need to be reviewed at each visit as per the
advanced form.
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Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
9.2
Maternal and family support
Assessment for emotional attachment should be carried out at each postnatal contact and that
there are support networks in place.
Offer fathers information and support in adjusting to their new role and responsibilities within the
family unit.
10. Safe Sleep
10.1 It is important to confirm safe sleep practice to parents of infants, particularly Maori parents. (60
Maori babies die each year from SUDI
10.2 Safe Sleep Spaces:
Free from other people who might overlay the infant
Free of gaps that could trap or wedge
Firm
Flat
Free from objects that may cover face
10.3 It is advised Infants should be:
BACK TO SLEEP (infants sleep on their backs, face up, face clear)
SMOKEFREE
TEMPERATURE COMFORTABLE FOR A LIGHTLY CLOTHED ADULT (18-22 ℃) , AVOID OVERHEATING
10.4 LINKS:



http://www.changeforourchildren.co.nz/pepi-pod
Whakawhetu National SIDS Prevention Māori www.whakawhetu.co.nz
Ministry of Health safe sleeping recommendations
http://www.health.govt.nz/publication/safe-sleep-essentials-preventing-suddenunexpected-death-infancy-sudi
11. Immunisations for the Mother
Refer to the Immunisation Handbook, MOH, 2011 for precise guidance or discuss with PHO
Immunisation Coordinator Marion Howie 09 379 4022
11.1 MMR: Women found to be sero-negative on antenatal screening for rubella should be offered an
MMR (measles, mumps, rubella) vaccination following birth
MMR vaccine may be given with anti-D (Rh0) immunoglobulin injection provided that separate
syringes are used and the products are administered into different limbs. If not given
simultaneously, MMR should be given 3 months after anti-D (Rh0) immunoglobulin.
MMR vaccine should NOT be given to pregnant women and pregnancy should be avoided for 4
weeks after immunisation, but breastfeeding may continue
Check immunity 3 months after vaccination
11.2 Childhood vaccinations – diphtheria, tetanus, polio, Hep B
11.3 Pertussis - Boostrix if not given during pregnancy - suggest for mother, father, grandparents or
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Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
anyone having contact with the baby (check practice policy funding or alternative means of funding
if required). Consider applying to Auckland PHO for one-off funding.
11.4 Hepatitis B – Discuss with the LMC/Obstetrics /paediatrics re the recommended follow-up and
immunisation schedule for babies of HBsAg positive mothers (refer to page 96 of the Immunisation
Handbook MOH 2011)
The mother should also be followed up if a carrier or HBsAg Positive, and discuss with her
LMC/gastroenterology or your local Hepatitis specialist.
11.4 HPV -if mother will have time to receive 3 doses before 20th birthday
11.5 NB: Anti-D immunoglobulin should be offered to every non-sensitised
Rh-D-negative woman within 72 hours following the delivery of an Rh-D-positive baby. (This should
hopefully have been discussed and performed by her LMC)
12.Maternal Examination
12.1 Examination includes:
General systems examination inclusive of blood pressure and temperature (puerperal pyrexia)
Breasts and nipples: to check their condition and assess milk supply
Uterus: to ensure it is returning to pre-pregnant size (usually by six weeks)
Lochia (blood loss): amount, colour and odour
Perineum/wound: to check healing, if appropriate, and observe for signs of infection
Bladder/bowels: to check that they are functioning normally
Legs: to observe for signs of blood clots/ superficial thrombophlebitis and to check that swelling is
reducing.
Pelvic floor exercises: instruction and encouragement, to reduce the risks of incontinence later in
life.
Thyroid: Up to 10% of women 1-3months after delivery can develop transient autoimmune
thyroiditis and may present with lethargy and fatigue (can check Full blood count, Ferritin, Thyroid
function as required)
13. Miscellaneous Support Links
Healthline: 0800 611 116
Multiple birth association
The Multiple Birth Association provides information, support and advice to the parents of multiples. There
are a number of club contacts across Auckland.
www.multiples.org.nz
Thrive Teen Parent Support Trust
Thrive offers support to teen parent families throughout Auckland through a variety of pregnancy and
parenting services and has a breastfeeding friendly environment.
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Central Hub
Mt Albert Community and Recreation Centre
773 New North Road, Mt Albert
551-4367
West Auckland Hub
34 Lincoln Rd, Henderson
213-9658
Hours From 8.30am – 5pm, (Monday-Friday) All services Free
admin@thrive.org.nz
Referrals Line 551-4368
See: www.thrive.org.nz
Parents Centre
Parents Centre is a community focused organisation offering a wide range of services in Auckland and
provides support to parents of pre-schoolers. Services include antenatal and postnatal support.
www.parentscentre.org.nz
Roskill South Oasis Early Years Service Hub
The aim of the hub is to improve coordination of services that assist families living in Mt Roskill with the
prime focus on children from pre-birth to six years of age.
Call 09 620 8079
Email thehub@roskillsouthoasis.org.nz
www.roskillsouthoasis.org.nz
AUCKLAND ‘WELL CHILD’ PROVIDERS
Well Child / Tamariki Ora focuses on babies, toddlers and pre-schoolers through ensuring they get the best
start in life by keeping them well, detecting problems early and supporting parents and families.
A number of health organisations provide ‘Well Child’ services across Auckland.
Community Child Health and Disability Services – Early Childhood Team, ADHB
09 639 0200 (ext 27415)
Ngati Whatua o Orakei Health Services
09 578 0941
Piritahi hau ora (Waiheke Island)
09 372 8824
Plunket – Auckland city
09 820 6532
Tongan Health Society Incorporated
09 636 4129
Waiheke Island Child Health Services
09 372 6837
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Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit
Disclaimer: The advice and information contained herein is provided in good faith. However the accuracy
of any statements made is not guaranteed and it is the responsibility of readers to make their own
enquiries as to the accuracy, currency and appropriateness of any information or advice provided. Links
provided and references may become out of date and will require re-review by the reader.
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Notes
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Auckland PHO Healthy Mother, Healthy Baby – Post Natal Care Took Kit