Course Syllabus ©National College of Midwifery 2012
01/2012
Course Title: Postpartum Provision of Care
Credits: 1.0
Course Description:
This course covers management of the postpartum period from its initiation to 6-weeks
including: delivery of the placenta, care of the placenta and umbilical cord, estimation and
management of blood loss, continual assessment of maternal well-being, assisting mother to
initiate and persist in breast feeding, facilitation of the attachment and bonding between infant
and parents, and management of pain, constipation, and hemorrhoids. The student learns the
provision of education, guidance and support to mother and family.
NARM Skills
I. Midwifery Counseling, Education and Communication
(6)-I F. Educates the mother concerning the natural physical and emotional processes of
pregnancy, labor, birth and postpartum
(7)-I G. Applies the principles of informed consent
(8)-I H. Provides individualized care
(20)-I J 11. Postpartum care concerning complications and self-care
V. Postpartum
(131)-V A. Performs postpartum reevaluation of mother and baby at appropriate intervals
(132)-V B. Completes the birth certificate
(133)-V C. Provides contraceptive education and counseling
(136)-V *F. Performs thorough and appropriate maternal four- to six-week postpartum checkup
(139)-V I. Knows breastfeeding referral resources
MANA Core Competencies:
I. Guiding Principles of Practice.
The midwife provides care according to the following principles:
1 A. Midwives work in partnership with women and their chosen support community throughout
the care giving relationship.
1 B. Midwives respect the dignity, rights and the ability of the women they serve to act
responsibly throughout the care giving relationship.
1 C. Midwives work as autonomous practitioners, collaborating with other health and social
service providers when necessary.
1 D. Midwives understand that physical, emotional, psychosocial and spiritual factors
synergistically comprise the health of individuals and affect the childbearing process.
1 F. Midwives understand that the childbearing experience is primarily a personal, social and
community event.
1 H. Midwives recognize the empowerment inherent in the childbearing experience and strive
to support women to make informed decisions and take responsibility for their own well-being.
1 J. Midwives synthesize clinical observations, theoretical knowledge, intuitive assessment and
spiritual awareness as components of a competent decision making process.
1 K. Midwives value continuity of care throughout the childbearing cycle and strive to maintain
continuous care within realistic limits.
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Course Syllabus ©National College of Midwifery 2012
01/2012
1 L. Midwives understand that the parameters of “normal” vary widely and recognize that each
pregnancy and birth is unique.
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Course Syllabus ©National College of Midwifery 2012
01/2012
II. General Knowledge and Skills
The midwife provides care incorporating certain concepts, skills and knowledge from a
variety of health and social sciences including, but not limited to:
2 C. Community standards of care for women and their developing infants during the
childbearing cycle, including midwifery and bio-technical medical standards and the rationale
for and limitations of such standards
2 M. The ability to develop, implement and evaluate an individualized plan for midwifery care.
2 N. Woman-centered care, including the relationship between the mother, infant and their
larger support community.
2 O. Knowledge and application of various health care modalities as they apply to the
childbearing cycle
IV. Care During Labor, Birth and Immediately Thereafter
The midwife provides health care, support, and information to women throughout labor,
birth and the hours immediately thereafter. She determines the need for consultation or
referral as appropriate. The midwife uses a foundation of knowledge and/or skill which
includes the following:
4 D. Emotional responses and their impact during labor, birth and immediately thereafter.
4 E. Comfort and support measures during labor, birth and immediately thereafter.
4 H. Fluid and nutritional requirements during labor, birth and immediately thereafter.
4 I. Assessment of and support for maternal rest and sleep as appropriate during the process
of labor, birth and immediately thereafter.
4 J. Causes of, evaluation of and appropriate treatment for variations which occur during the
course of labor, birth and immediately thereafter.
V. Postpartum Care
The entry-level midwife provides health care, support and information to women
throughout the postpartum period. She determines the need for consultation or referral
as appropriate. The midwife uses a foundation of knowledge and/or skill, which
includes, but is not limited, the following:
5 B. Lactation support and appropriate breast care including evaluation of, identification of and
treatments for problems with nursing.
5 C. Parameters and methods for evaluating and promoting maternal well-being during the
postpartum period.
5 D. Causes of, evaluation of, and treatment for maternal discomforts during the postpartum
period.
5 E. Emotional, psychosocial and sexual variations during the postpartum period. Maternal
nutritional requirements during the postpartum period including methods of nutritional
evaluation and Counseling.
5 F. Maternal nutritional requirements during the postpartum period including methods of
nutritional evaluation and Counseling.
5 G. Support, information and referral for family planning methods, as the individual woman
desires
Learning Activities:
A. Student reads appropriate sections from the Learning Materials/Resources.
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Course Syllabus ©National College of Midwifery 2012
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B. Student answers the questions listed in the Learning Objectives by researching the
Learning Materials/Resources for the course and correctly cites the sources and page
numbers for each of their answers.
C. Student presents answers the questions listed in the Learning Objectives for review by
preceptor.
D. Student participates in preceptor elaboration/discussion of Learning Objectives.
E. In the case that the required texts are more than 5 years old, the student must research,
prepare & present a summary of current best midwifery care/practices appropriate to
the topic of the course from a current journal article/study, less than 5 years old.
F. Recommended Role-playing and/or Clinical Interactions
Note: The clinical requirement of NARM /Clinical Skills is completed at any time
throughout the ASM apprenticeship during actual clinical practice and is NOT a
requirement to complete this academic course.
Activities specific to NARM skills learned in this section:
1. Create a handout for clients giving anticipatory guidance for the first 24 hours
postpartum. Highlight a section called “When to call your midwife.”
2. Create a handout for clients giving anticipatory guidance for the second day through six
weeks postpartum. Highlight a section called: “When to call your midwife.”
3. Practice estimating blood loss by pouring tomato juice or other liquid on disposable
underpads. Weigh the pads. Test yourself until you can estimate pretty accurately.
4. Attend a breastfeeding class provided by a local lactation consultant or if not available,
a La Leche League class. Make a list of breastfeeding resources in your community.
5. Research tools (such as surveys or questionnaires) for identifying women with
postpartum depression. Pick out your favorite and practice giving the questionnaire to
other students or to clients.
6. Create a list of professionals in your community who can care for and treat women with
postpartum depression.
7. Role play with your instructor or another student a routine postpartum visit at 24 hours
postpartum, 3 days postpartum, two weeks and six weeks postpartum.
8. Create a list of appropriate birth control methods for women who are breastfeeding.
9. Make a list of simple recipes or food choices that meet the nutritional needs of
breastfeeding women.
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Course Syllabus ©National College of Midwifery 2012
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10. Role-play counseling new mothers on common discomforts of the postpartum period,
including constipation, hemorrhoids, perineal pain, breast engorgement, sore nipples,
and increased sweating.
Learning Materials / Resources:
Please use textbooks less than 5 years old or most recent edition.
1. Fraser, DM, et al. Myles Textbook for Midwives. 15th ed. Churchill Livingstone Press.
2009
2. Chapman, Vicky and Charles, Cathy. The midwife’s labour and birth handbook. 2nd
edition. Blackwell Publishing. 2009
3. Tharpe, Nell and Farley, Cindy. Clinical practice guidelines for midwifery and women’s
health. 3rd ed. Jones and Bartlett publishers. 2009
4. Varney, Helen, et al. Varney’s Midwifery. Fourth Edition. Jones and Bartlett Publishers.
2004
5. Mohrbacher, Nancy and Stock, Julie. The Breastfeeding Answer Book. Third Revised
Edition. 2003. La Leche League International.
6. Davis, Elizabeth. Heart and Hands: A midwife’s guide to pregnancy and birth. 4th
Edition. Celestial Arts Press. 2004
7. MEAC Abbreviated NARM Skills Form.
8. MANA Core Competencies for Midwives
9. Midwives Model of Care®.
10. Students must find 1 article/study less than 5 years old. Recommended internet links
as needed for latest developments in midwifery care:
The Cochrane Collaboration
EBSCO
National Library of Medicine
PubMed
Medline
SCIRUS
Medscape
World Health Organization
Evaluation Tools / Methods:
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Course Syllabus ©National College of Midwifery 2012
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Minimum passing grade for all courses is a cumulative 80% / B-. Students and preceptors are
encouraged to work together until the student masters the information.
Final grade for the course is based on preceptor evaluation of the following:
A. Learning Objectives count for 80-90% of the final grade.
The preceptor evaluates each answer based on three elements:
1. Answers should reflect a thorough review of current literature regarding best
current practices in midwifery care.
2. Each answer should be formed in the student’s own words or paraphrased
from the text. The answer should be minimal, not a re-write of the entire text,
but enough to show appropriate comprehension of the learning objective.
3. Student identification of sources and page numbers for each of the Learning
Objectives. (Preceptor should do a random check to determine that sources
cited are correctly identified.)
B. Summary of current journal article / study counts for 10% of the final grade in the case that
other scholarly resources used are more then five years old.
C. Exam counts for 10% of the final grade.
Course credit:
One Academic credit equals approximately 15 hours of formal time plus 30 hours of additional
study or homework. Formal time is defined as the amount of time taken to answer the Learning
Objectives to the level of 80% and to complete any learning activities to the preceptor's
satisfaction, including any time spent face to face with the preceptor. Informal time includes
any time spent actively reading relevant sources and textbook/s, researching Learning
Objectives, and studying for examinations.
Learning Objectives:
A. The student must research, prepare & present a summary of an aspect of current best
midwifery care/practices appropriate to the topic of the course from a current journal
article/study.
B. Student answers the questions below and cites the sources and page numbers.
1. Discuss the management of third stage. What events occur during this time and what is
the midwife’s role in facilitating these events?
2. Why is it important to discuss the postpartum period before the birth? Explain the
midwife’s role in making a postpartum plan with the family.
3. What is the minimum amount of time a midwife should be present after the birth of the
baby and placenta? Why?
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Course Syllabus ©National College of Midwifery 2012
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4. Discuss what is done with the placenta after it is delivered. Why is it important to include
the parents in the decision making about the disposal of the placenta?
5. Discuss how the midwives model of care is different from the medical model in regards
to the first three hours after birth.
6. Discuss how attachment and bonding between infant and parents can be facilitated
7. During birth and immediately following birth.
a. During the postpartum and early caretaking period.
b. During rooming in.
8. Discuss ways that attachment and bonding can be facilitated between infant and other
family members (siblings, grandparents, close friends, etc…)
9. Discuss 2 ways in which a midwife can provide individualized care during the
postpartum period.
10. Discuss the role of informed consent in the postpartum period. Give an example of a
postpartum scenario in which the principles of informed consent should be applied.
11. Why is postpartum follow-up just as important as prenatal care?
12. What topics should be covered with a client at the 24-hour postpartum visit?
13. What topics should be covered with a client at the 3-day postpartum visit?
14. What topics should be covered with a client at the 1 or 2-week postpartum visit?
15. What topics should be covered with a client at the 6-week postpartum visit?
16. Why is it important to assist the postpartum woman with breast-feeding and how this is
carried out?
17. Explain the nutritional needs of a woman during the postpartum period and how these
needs are affected by breastfeeding.
18. Discuss hydration during the postpartum period. How is it different from pregnancy?
19. What complications can arise from inadequate hydration postpartum?
20. Discuss how to refer a client for assistance with breast-feeding.
21. Discuss 3 methods for facilitating the postpartum woman's parenting.
22. Describe how a midwife might convey the importance of self-care to a mother during the
post-partum period. Discuss its importance in preventing postpartum complications.
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Course Syllabus ©National College of Midwifery 2012
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23. Discuss what anticipatory guidance and instructions should be given postpartum
regarding breastfeeding.
24. Discuss what anticipatory guidance should be given postpartum regarding the emotional
adjustment of the mother.
25. Discuss what anticipatory guidance and instructions should be given postpartum
regarding the physiological adjustment of the mother.
26. Discuss what anticipatory guidance should be given postpartum regarding the
adjustment of siblings to a new baby.
27. Discuss what anticipatory guidance should be given postpartum regarding the
relationship between intimate partners.
28. Describe the state regulations regarding filing a birth certificate in the state where you
intend to practice. Are there any regulations specifically regarding births that happen out
of hospital?
29. Describe the procedure for filing for a social security card in the state where you intend
to practice.
30. Give an example of an informed consent that might be giving to parents who do not
wish to file for a social security card or birth certificate.
31. Discuss the occurrence of postpartum cramps (after-pains) and what advice should be
given to the postpartum mother regarding the management of this discomfort.
32. Discuss the management of excessive perspiration postpartum.
33. Discuss the management of breast engorgement. Give the rationale for each step.
34. Discuss the management of sore/cracked nipples.
35. Explain how good breast support is affected and what the rationale is.
36. Name 5 steps that can lead to a successful breast-feeding relationship.
37. Discuss 3 common complaints that may occur with breast-feeding during the first week
postpartum. Describe what advice you would give the mother in resolving these issues.
38. Discuss the management of constipation postpartum.
39. Discuss the management of hemorrhoids postpartum.
40. Discuss when it is appropriate to counsel about sex and contraception postpartum.
41. Describe normal changes in a sexual relationship that might occur during the
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Course Syllabus ©National College of Midwifery 2012
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postpartum period and why these changes often occur.
42. Describe a scenario postpartum that would require a consult with a social services
provider.
43. Explain LAM (lactation amenorrhea method). Discuss how it can be used to prevent
pregnancy postpartum.
44. How do sleep patterns change during the postpartum period? Give an example of how
you might counsel new parents on the importance of adequate rest in the first 6 weeks
postpartum.
45. Why is it important to discuss sleeping arrangements during the postpartum period?
What important information can be gathered by inquiring about these arrangements?
46. What are 3 ways to reduce pain and swelling of the vagina and perineal tissues
postpartum.
47. What activity restrictions, if any, should be recommended to a woman in the first 6
weeks following the birth of her baby?
48. Discuss the feelings of grief or sadness that are normal during the postpartum period.
49. Discuss advice that can be given to mothers who feel exhausted and overwhelmed
during the postpartum period.
50. Discuss the importance of social interaction with peers postpartum.
51. Give an example of exercises that can be done postpartum to restore abdominal muscle
tone.
52. Give an example of exercises that can be done postpartum to restore the tone of the
pelvic floor
53. Why is it important to restore pelvic floor tone after the birth of the baby?
54. Discuss the practice of “confinement” or resting for 40 days after the birth of the baby.
What is the rationale for this practice and what relevance does it have for modern
women during the postpartum period?
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