Obstetrics: Post Natal Care

• Labour: Stages of Labour | How the Baby Is Born | Care in Normal Labour | Delay in Labour | Fetal Monitoring and the CTG | Pain Relief in Labour | Malposition and Malpresentation in Labour
• Assisted birth: Instrumental Birth | Caesarean Birth | Perineal Tears and Episiotomy
• After the birth: The Third Stage and the Newborn | Postnatal Care | Contraception After Birth | Breastfeeding | Breastfeeding Problems and Mastitis | Postnatal Complications | Perinatal Mental Health
• Revision: Drug Reference Table | Spot the Diagnosis | Exam-style Scenarios | Key Points | Guidelines and Further Reading

👶 Labour, birth and the postnatal period — most labours are normal and need support rather than intervention. The skills are recognising normal progress, spotting delay, reading a CTG, knowing when an assisted birth is needed, and caring well for women and babies afterwards. The year after birth is a time of high risk for mental illness: suicide is a leading cause of maternal death in the UK in the year after birth.
Your four questions for every patient: Is labour progressing normally (dilatation, descent, contractions)? Is the baby well (heart rate pattern)? Is the mother well (observations, bleeding, pain, mood)? What does she want — and has her consent been sought for each step?

Stages of Labour

• Signs of labour — regular painful contractions, a "show" (mucus plug), rupture of membranes (waters breaking).
• The three Ps that determine progress:
  • Power — contractions (frequency, strength, duration; ideally 3–4 in 10 minutes).
  • Passenger — the baby's size, presentation, position and attitude (flexion).
  • Passage — the pelvis and soft tissues.

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How the Baby Is Born

• Terms:
  • Lie — the long axis of the baby relative to the mother (longitudinal, transverse, oblique).
  • Presentation — the part entering the pelvis first (cephalic, breech, shoulder).
  • Position — the position of the denominator (occiput in a cephalic baby) relative to the pelvis — e.g. occipito-anterior (OA) is ideal; occipito-posterior (OP) or transverse (OT).
  • Station — level of the head relative to the ischial spines (−3 to +3); or fifths palpable abdominally (engaged when 2/5 or less is palpable).
  • Attitude — flexion of the head (a well-flexed head presents the smallest diameter).
• Mechanism of labour (cardinal movements of a cephalic baby):
  • Engagement (head enters the pelvis, usually occipito-transverse).
  • Descent and flexion.
  • Internal rotation to occipito-anterior.
  • Extension — the head is born.
  • Restitution and external rotation — the head turns to line up with the shoulders.
  • Delivery of the shoulders (anterior first) and body.

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Care in Normal Labour

• Place of birth (NICE) — women with uncomplicated pregnancies can choose:
  • Home, a freestanding or alongside midwifery unit, or an obstetric unit.
  • For women who have had a baby before, midwife-led settings are as safe for the baby and have fewer interventions.
  • For a first baby, a home birth has a small increase in adverse outcomes for the baby.
• Supportive care:
  • One-to-one midwifery care in established labour.
  • Encourage movement and upright positions; eat and drink lightly; empty the bladder regularly.
  • Water immersion for pain relief.
• Monitoring the mother — pulse hourly, BP and temperature 4-hourly, contractions every 30 minutes, vaginal examination about 4-hourly (or if concerns), fluid balance. Recorded on a partogram.
• Monitoring the baby — intermittent auscultation for low-risk labours; continuous CTG for higher risk (see below).
• Signs that need obstetric review:
  • Maternal fever (38 °C or more), tachycardia, raised BP.
  • Meconium-stained fluid (significant).
  • Fresh bleeding.
  • Abnormal fetal heart rate.
  • Delay in progress.
  • Malpresentation, cord presentation.
• Prelabour rupture of membranes at term — see the Obstetric Complications chapter.

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Delay in Labour

• Delay in the first stage (NICE) — suspected if:
  • Cervical dilatation of under 2 cm in 4 hours (first or later labours).
  • Slowing progress in a later labour.
  • Changes in descent or rotation, or in the strength, duration and frequency of contractions.
• Actions:
  • Amniotomy (if membranes intact) — reassess in 2 hours.
  • Oxytocin infusion (augmentation) if progress remains slow — with continuous CTG; reassess after 4 hours.
  • Caesarean if progress doesn't improve (or fetal concerns).
  • Check for obstruction — high head, moulding, caput, cervix not applied to the head (oxytocin is dangerous in obstruction, especially in women who have given birth before — rupture risk).
• Delay in the second stage:
  • First labour — suspected after 1 hour of active pushing; diagnosed if birth isn't imminent after 2 hours (refer at that point).
  • Later labours — suspected after 30 minutes; diagnosed after 1 hour.
  • Actions — obstetric review; consider oxytocin (first labour with poor contractions), position change; instrumental birth or caesarean.
• Causes — inefficient contractions (the commonest in a first labour), malposition (OP), deflexion, large baby, small pelvis (cephalopelvic disproportion), full bladder, exhaustion.

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Fetal Monitoring and the CTG

• Intermittent auscultation (low-risk labour) — listen with a Pinard or handheld Doppler for 1 minute after a contraction: every 15 minutes in the established first stage, every 5 minutes in the second stage; feel the maternal pulse to distinguish.
• Continuous CTG (cardiotocography) is recommended for:
  • Maternal factors — pre-eclampsia, diabetes, previous caesarean, fever, sepsis, APH, oxytocin, epidural (for 30 minutes after placement or top-ups), prolonged labour.
  • Fetal factors — FGR, preterm, breech, twins, meconium, reduced movements, abnormal auscultation.
• Reading a CTG (one way to remember — "Dr C BRAVADO": Define Risk, Contractions, Baseline RAte, Variability, Accelerations, Decelerations, Overall):

• Overall assessment (NICE NG229) — consider the whole clinical picture (risk factors, progress, trends over time), not the CTG in isolation.
• Actions for concerning features:
  • Correct reversible causes — change position (left lateral), stop or reduce oxytocin, treat low BP (fluids after epidural), treat fever, tocolysis for hyperstimulation.
  • Senior review; consider expediting birth.
  • Fetal blood sampling (scalp lactate or pH) is now used less often.
  • Fetal scalp electrode if the external trace is poor.

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Pain Relief in Labour

• Non-drug — support, breathing, massage, movement, water (birth pool); TENS in early labour.
• Entonox (50% nitrous oxide and oxygen) — fast-acting; light-headedness, nausea.
• Opioids — IM pethidine or diamorphine: nausea and drowsiness; can cause breathing depression in the baby if given within a few hours of birth (naloxone for the baby); may reduce breastfeeding. Remifentanil patient-controlled analgesia (with one-to-one monitoring) if epidural isn't possible.
• Epidural — the most effective:
  • Low-dose local anaesthetic plus opioid into the epidural space.
  • Effects — longer second stage, more instrumental births (not more caesareans); low BP; itching; fever; urinary retention (catheter); leg weakness.
  • Complications — post-dural puncture headache (worse sitting up — epidural blood patch); rare high block, nerve damage, epidural haematoma or abscess.
  • Contraindications — patient refusal, coagulopathy or low platelets (e.g. under 75–80 × 10⁹/L), LMWH within 12 hours (prophylactic) or 24 hours (treatment dose), local infection, uncorrected hypovolaemia.
• Spinal anaesthetic — for caesarean and instrumental births in theatre (single injection, rapid, dense block).
• General anaesthesia — category 1 caesarean when regional isn't possible; risks of difficult airway and aspiration (antacid prophylaxis).

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Malposition and Malpresentation in Labour

• Occipito-posterior (OP) — the commonest malposition:
  • Back pain, slow labour, early urge to push.
  • Most rotate to OA spontaneously; otherwise rotational instrumental birth (Kielland's forceps or ventouse), manual rotation, or caesarean; or born "face to pubis".
• Deflexed head — larger diameter presents; slow labour.
• Face presentation (fully extended head) — vaginal birth possible if mento-anterior; mento-posterior needs caesarean. Never use ventouse on a face.
• Brow presentation (partly extended) — largest diameter; caesarean unless it flexes.
• Transverse lie in labour — caesarean (risk of cord prolapse and obstructed labour).
• Cord presentation (cord below the presenting part with intact membranes) — caesarean.
• Obstructed labour — no progress despite good contractions; caput and moulding, high head, haematuria; risk of uterine rupture and fistula — caesarean.

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Instrumental Birth

• Indications:
  • Delay in the second stage.
  • Suspected fetal compromise.
  • Maternal reasons to shorten pushing — exhaustion, heart disease, severe hypertension, some neurological conditions (e.g. intracranial aneurysm), proliferative retinopathy.
• Prerequisites (RCOG):
  • Cervix fully dilated; membranes ruptured.
  • Head 1/5 or less palpable abdominally (0/5 ideal) and at or below the ischial spines.
  • Position known exactly.
  • Adequate analgesia; empty bladder; contractions present.
  • Informed consent; experienced operator; backup plan (theatre if a higher-risk "trial").
• Ventouse (vacuum cup):
  • Less maternal trauma than forceps; more likely to fail.
  • Not before 34 weeks (bleeding risk), and not for face presentations.
  • Baby — chignon (normal swelling), cephalhaematoma, subgaleal haemorrhage (rare, dangerous — boggy scalp swelling crossing suture lines, shock), jaundice, retinal haemorrhages.
• Forceps:
  • More successful; more perineal and anal sphincter tears.
  • Baby — facial bruising, facial nerve palsy (usually recovers), skull fracture (rare).
  • Rotational forceps (Kielland's) for OP/OT — experienced operators only.
• After instrumental birth — check for OASI; offer prophylactic antibiotics (single dose of co-amoxiclav — ANODE trial); VTE assessment; bladder care (retention after epidural); debrief.

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Caesarean Birth

• About a third or more of UK births are now caesarean.
• Urgency categories (NICE):

• Common reasons — previous caesarean, failure to progress, suspected fetal compromise, breech, placenta praevia, maternal request (should be supported after discussion), some maternal conditions (HIV with high viral load, primary herpes near term).
• Before surgery:
  • Consent (including risks below); FBC, group and save.
  • Antacid prophylaxis (H2 blocker or PPI, plus antiemetic).
  • Antibiotics before skin incision (e.g. cefuroxime).
  • Steroids for planned caesarean before 39 weeks (consider).
  • VTE prophylaxis — stockings, LMWH for most after surgery.
  • Usually spinal anaesthetic; low transverse (Pfannenstiel) incision; lower segment uterine incision.
• Risks:
  • Mother — bleeding, infection (wound, endometritis), VTE, bladder or bowel injury, longer recovery; future placenta praevia and accreta, uterine rupture.
  • Baby — transient tachypnoea (breathing problems, especially before 39 weeks), small skin cuts.
• Recovery — early eating and walking; catheter removal after about 12 hours; avoid heavy lifting; can drive when able to do an emergency stop comfortably; wait at least 12–18 months before another pregnancy.

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Perineal Tears and Episiotomy

• Obstetric anal sphincter injury (OASI) — third and fourth degree tears:
  • Risk factors — first vaginal birth, forceps, large baby (over 4 kg), OP position, prolonged second stage, shoulder dystocia, South Asian ethnicity.
  • Examine the perineum and rectum after every vaginal birth.
  • Repair in theatre by an experienced clinician; IV antibiotics; laxatives; analgesia (avoid codeine — constipation).
  • Follow-up — pelvic floor physiotherapy; review at 6–12 weeks (faecal incontinence, pain); future birth plans (endoanal ultrasound and manometry).
  • Prevention — hands-on control of the head, warm compresses, mediolateral episiotomy at instrumental birth.
• Episiotomy — a mediolateral cut (at about 60° from the midline when the head is crowning) for instrumental birth or fetal compromise; not routine.
• Other — labial and periurethral tears; vulval haematoma (severe pain, swelling after birth — drain); obstetric fistula (prolonged obstructed labour, low-income countries).

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The Third Stage and the Newborn

• Active management of the third stage (recommended — halves PPH risk):
  • Oxytocin 10 IU IM as the baby's anterior shoulder is born or straight after birth (Syntometrine — oxytocin with ergometrine — can be used if no hypertension).
  • Deferred cord clamping — wait at least 1 minute (and up to 5 minutes) if the baby is well.
  • Controlled cord traction after signs of separation.
  • Placenta usually delivered within 30 minutes.
• Physiological third stage — no drugs, placenta delivered by maternal effort; prolonged if over 1 hour.
• Retained placenta — not delivered within 30 minutes (active) or 1 hour (physiological): IV access, bloods, empty bladder; manual removal in theatre (regional anaesthetic); antibiotics. Heavy bleeding — emergency.
• Check the placenta is complete (missing parts — retained tissue, PPH).
• Newborn care:
  • Skin-to-skin contact; dry and keep warm; early breastfeeding.
  • Apgar score at 1 and 5 minutes (heart rate, breathing, tone, reflex irritability, colour).
  • Vitamin K (IM or oral) to prevent haemorrhagic disease of the newborn — with consent.
  • Newborn physical examination within 72 hours (see the Neonatology chapter).

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Postnatal Care

• Normal changes:
  • Lochia — blood loss: red for a few days, then brown and pale; up to about 6 weeks.
  • Uterine involution — the womb shrinks back into the pelvis by about 2 weeks; "afterpains" (worse with breastfeeding).
  • Breast milk — colostrum first, milk "comes in" at day 2–4.
  • "Baby blues" — tearful, emotional days 3–10; settles by 2 weeks.
• Postnatal checks (NICE NG194):
  • Midwife visits at home in the first days; health visitor from 10–14 days.
  • BP (pre-eclampsia can start after birth), temperature, pulse, bleeding, perineum or wound, bladder and bowels, legs (VTE), breasts, mood, pain.
  • Passed urine within 6 hours of birth — if not, bladder scan or catheter (retention).
  • 6–8 week GP check — physical and mental health, contraception, cervical screening if due, pelvic floor, BP, diabetes test after GDM.
• Warning signs to tell women about:
  • Heavy or sudden increase in bleeding, clots, smelly discharge.
  • Fever, rigors, feeling very unwell (sepsis).
  • Headache, visual changes, epigastric pain (pre-eclampsia).
  • Calf pain or swelling, breathlessness, chest pain (VTE).
  • Thoughts of self-harm, feeling very low, unusual or frightening thoughts.
• Other advice — pelvic floor exercises; sex when comfortable; safe sleep for the baby; vitamin D; immunisation (MMR if not rubella immune).

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Contraception After Birth

• Fertility returns as early as day 21 after birth — contraception is needed from then.
• Lactational amenorrhoea method (LAM) — over 98% effective if all three apply: fully (or nearly fully) breastfeeding, no periods, and baby under 6 months.
• Progestogen-only methods — the pill, implant — can start any time after birth (including straight away); safe with breastfeeding. Injection can also start any time (but may increase heavy bleeding if given early).
• Combined hormonal contraception:
  • Breastfeeding — avoid until 6 weeks (UKMEC 4 before 6 weeks).
  • Not breastfeeding — avoid before day 21 (VTE risk); from 21 days if no other VTE risk factors (from 6 weeks if risk factors).
• IUD or IUS — within 48 hours of birth (including at caesarean), or from 4 weeks after birth (not in between — higher expulsion and perforation risk).
• Sterilisation — usually not at caesarean (regret higher; less effective than LARC) unless planned well in advance.
• Pregnancy spacing — ideally at least 12–18 months between birth and the next conception.

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Breastfeeding

• WHO and UK advice — exclusive breastfeeding for around 6 months, then continued alongside solid foods.
• Benefits for the baby — fewer infections (gastroenteritis, chest and ear infections), lower risk of sudden infant death, NEC (preterm babies), obesity and diabetes.
• Benefits for the mother — lower risk of breast and ovarian cancer, type 2 diabetes, cardiovascular disease; helps bonding; free.
• Good attachment — baby's mouth wide open, chin touching the breast, more areola visible above the top lip, cheeks full, rhythmic sucking and swallowing; feeding shouldn't hurt.
• Signs of good feeding — at least 6 wet nappies a day after day 5, yellow stools, weight regained by about 2 weeks (babies can lose up to 10% of birth weight in the first days).
• When not to breastfeed — HIV (unless supported and virally suppressed), some drugs (e.g. cytotoxics, lithium without specialist plan), galactosaemia in the baby, active untreated TB (until treated for 2 weeks).
• Formula feeding — support all feeding choices; teach safe preparation (water at 70 °C or more, sterile bottles); responsive feeding.
• UNICEF Baby Friendly Initiative standards in UK maternity units.

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Breastfeeding Problems and Mastitis

• Sore, cracked nipples — usually poor attachment; get feeding support; check for tongue-tie (frenotomy if it causes feeding problems).
• Engorgement — full, hard, painful breasts (days 3–5); frequent feeding, hand expression, cold compresses, paracetamol or ibuprofen.
• Blocked duct — tender lump; keep feeding, massage towards the nipple.
• Mastitis — painful, red, hot wedge of breast, with fever and flu-like symptoms:
  • Keep breastfeeding (or expressing) from the affected side; analgesia (ibuprofen is fine).
  • Antibiotics — flucloxacillin 500 mg four times daily for 10–14 days (erythromycin or clarithromycin if allergic) if symptoms don't improve within 12–24 hours, if there is a cracked nipple that looks infected, or if culture is positive.
  • Admit if septic.
• Breast abscess — a tender, fluctuant mass; ultrasound; needle aspiration or drainage plus antibiotics; breastfeeding can usually continue.
• Nipple thrush — burning, shooting pain after feeds, shiny skin; baby has oral thrush: treat both (miconazole for mother's nipples, miconazole or nystatin for the baby).
• Low milk supply — usually from infrequent feeds or poor attachment; feeding support.
• Persistent lump — after treatment, breast cancer can present in pregnancy or breastfeeding: ultrasound.

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Postnatal Complications

• Secondary PPH — abnormal bleeding from 24 hours to 12 weeks after birth:
  • Causes — retained placental tissue and endometritis (infection).
  • Management — observations, swabs, FBC, CRP; ultrasound; antibiotics; surgical evacuation if retained tissue and heavy bleeding.
• Endometritis — fever, lower abdominal pain, offensive lochia, tender womb; more common after caesarean; IV or oral antibiotics (e.g. co-amoxiclav, or clindamycin with gentamicin); think group A streptococcus if very unwell.
• Wound infection after caesarean — redness, discharge; swab, antibiotics, check for collection.
• Urinary retention — after epidural or instrumental birth; catheterise (prevents long-term bladder damage).
• Urinary and faecal incontinence — pelvic floor exercises; OASI follow-up.
• VTE — highest risk in the first 6 weeks.
• Postnatal pre-eclampsia — BP checks.
• Headache — post-dural puncture, pre-eclampsia, cerebral venous sinus thrombosis, subarachnoid haemorrhage, migraine — investigate new severe headache.
• Sheehan's syndrome — pituitary infarction after massive PPH: failure to lactate, tiredness, amenorrhoea, low BP and sodium (adrenal insufficiency) — see the Pituitary chapter.
• Postpartum thyroiditis, peripartum cardiomyopathy — see the Medical Problems in Pregnancy chapter.

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Perinatal Mental Health

• Why it matters: Mental illness affects up to 1 in 5 women in pregnancy and the year after birth. Suicide is a leading cause of maternal death in the UK in the first year after birth (MBRRACE-UK).
• Ask at every contact — mood, anxiety, sleep, past history (especially bipolar disorder or previous puerperal psychosis), family history.
• Baby blues — days 3–10; up to 80% of women; tearful, labile mood; settles within 2 weeks; reassurance and support.
• Postnatal depression:
  • About 1 in 10 women; usually within the first few months (can start in pregnancy).
  • Low mood, loss of interest, poor sleep (even when baby sleeps), guilt, anxiety about the baby, poor bonding, thoughts of self-harm.
  • Screening — Whooley questions; Edinburgh Postnatal Depression Scale (EPDS); GAD-2 for anxiety.
  • Treatment — support, guided self-help, CBT or interpersonal therapy; SSRIs (sertraline is often used in breastfeeding).
  • Also affects fathers and partners.
• Puerperal (postpartum) psychosis — a psychiatric emergency:
  • About 1–2 in 1,000 births; usually within the first 2 weeks (often days 3–7).
  • Rapid onset — confusion, agitation, mania, delusions (often about the baby), hallucinations, severe insomnia, rapidly changing mood.
  • Highest risk — bipolar disorder (about 1 in 4), previous puerperal psychosis, family history.
  • Same-day psychiatric assessment; admission to a mother and baby unit; antipsychotics, mood stabilisers, sometimes ECT; risk assessment for mother and baby; safeguarding.
  • Prevention — pre-pregnancy and antenatal plans with the perinatal mental health team for women at high risk.
• Other conditions — perinatal anxiety, OCD (intrusive thoughts of harming the baby — distressing but not acted on), PTSD after traumatic birth (debrief, trauma-focused therapy), tokophobia (fear of birth), eating disorders.
• Red flags for urgent review:
  • Recent significant change in mental state or new symptoms.
  • New thoughts or acts of violent self-harm.
  • New and persistent feelings of being incompetent as a mother or estranged from the baby.
• Medicines in pregnancy and breastfeeding — weigh the risks of untreated illness; avoid valproate; specialist advice for lithium.

⚠️ Safety Pearl: Rapidly changing mood, confusion or strange beliefs in the first weeks after birth — especially with a history of bipolar disorder — is puerperal psychosis until proven otherwise. Arrange same-day psychiatric assessment.

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Drug Reference Table

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Spot the Diagnosis

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Exam-style Scenarios

1. A 27-year-old in her first labour has been fully dilated and pushing for 2 hours. The head is 0/5 palpable, at +1 station, OA position, with an epidural. CTG shows recurrent variable decelerations.
Answer: Delay in the second stage with suspected fetal compromise.

• Prerequisites met — instrumental birth (ventouse or forceps) with consent, empty bladder.
• Check for OASI afterwards; single-dose co-amoxiclav; bladder care.

2. A woman in established labour on oxytocin has a CTG with baseline 150, variability 3 for 60 minutes, and late decelerations with most contractions.
Answer: Concerning CTG suggesting fetal hypoxia.

• Stop or reduce oxytocin; left lateral position; check maternal BP and temperature.
• Senior obstetric review; expedite birth if no improvement (instrumental if fully dilated, otherwise caesarean).

3. A 31-year-old on day 10 after birth has a painful, red, hot area on the left breast and a temperature of 38.4 °C. She is breastfeeding.
Answer: Mastitis.

• Continue breastfeeding or expressing; analgesia; check attachment.
• Flucloxacillin if not improving within 12–24 hours (or infected cracked nipple).
• Ultrasound if a fluctuant lump (abscess); admit if septic.

4. A woman with bipolar disorder is brought in by her partner on day 6 after birth. She hasn't slept, is talking rapidly and says the baby is not hers.
Answer: Puerperal psychosis.

• Same-day psychiatric assessment; don't leave her alone with the baby; risk assessment.
• Admission to a mother and baby unit; antipsychotic or mood stabiliser.
• Safeguarding; plan for future pregnancies.

5. A 25-year-old, fully breastfeeding, 3 weeks after birth, asks about contraception.
Answer: Postnatal contraception.

• LAM is effective while fully breastfeeding, no periods and baby under 6 months.
• Progestogen-only pill or implant can start now.
• Avoid combined methods until 6 weeks; IUD or IUS from 4 weeks.

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Key Points

• Established labour starts at 4 cm with regular contractions; delay is under 2 cm in 4 hours.
• Delay in the first stage: amniotomy, then oxytocin with continuous CTG, then caesarean if no progress.
• Second stage: birth expected within about 3 hours (first labour) or 2 hours (later labours) of active pushing.
• CTG: baseline 110–160, variability 5–25; late decelerations and reduced variability are concerning; interpret in context.
• Epidural: most effective; longer second stage and more instrumental births; low BP, fever, PDPH.
• Instrumental birth needs full dilatation, head 1/5 or less palpable, known position, analgesia, empty bladder and consent.
• Caesarean categories: 1 (within 30 min), 2 (within 75 min), 3, 4 (planned from 39 weeks).
• OASI: third and fourth degree tears — repair in theatre, antibiotics, laxatives, physiotherapy.
• Active third stage: oxytocin 10 IU IM, deferred cord clamping, controlled cord traction.
• Fertility returns from day 21; progestogen-only methods any time; no combined methods before 6 weeks if breastfeeding.
• Mastitis: keep breastfeeding; flucloxacillin if not improving.
• Secondary PPH: retained tissue or endometritis — antibiotics ± evacuation.
• Puerperal psychosis is an emergency — same-day psychiatry and mother and baby unit; highest risk with bipolar disorder.

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Guidelines and Further Reading

• NICE NG235: Intrapartum care
• NICE NG229: Fetal monitoring in labour
• NICE NG192: Caesarean birth
• NICE NG194: Postnatal care
• RCOG Green-top Guideline 26: Assisted vaginal birth
• RCOG Green-top Guideline 29: Third- and fourth-degree perineal tears
• NICE CG192: Antenatal and postnatal mental health
• FSRH guideline: Contraception after pregnancy
• UNICEF UK Baby Friendly Initiative; MBRRACE-UK reports
• BNF — for current doses

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