Changes

February 2026 — reviewed. A literature search was conducted in February 2026 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

Update

Goals

To support primary healthcare professionals to:

• Provide a comprehensive postnatal check to women at 6 to 8 weeks postpartum.
• Offer appropriate advice and management for any physical, emotional, or mental health conditions, or other issues experienced in the postnatal period.
• Offer referral to appropriate healthcare professionals for ongoing specialist care if needed.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP — Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

Postnatal care

• Women who are transferring between services in the postnatal period have relevant information shared between healthcare professionals to support their care.
• Parents are given personalised information and advice about feeding their baby before transfer to community care or before the midwife leaves after a home birth.
• Parents are given information and advice, before transfer to community care or before the midwife leaves after a home birth, about symptoms and signs of serious illness in the baby that require them to contact emergency services.
• Parents receive face-to-face feeding support at each routine postnatal contact.
• Parents are given advice about safer practices for bed sharing at each routine postnatal contact.
• Women have a GP assessment 6 to 8 weeks after giving birth.
• Parents are given advice on introducing their baby to a variety of nutritious foods to complement breastmilk or formula milk.

[NICE, 2025a]

What is it?

• For the purposes of this CKS topic, 'postnatal care' refers to the routine postnatal care that women and their babies should be offered in the first eight weeks after the birth, in line with the National Institute for Health and Care Excellence (NICE) guideline on Postnatal care [NICE, 2025b].

What are common complications in the postnatal period and what are the risk factors?

Postnatal complications and their risk factors include [NICE, 2025b]:

• Iron deficiency anaemia.
  • Risk relates to peripartum blood loss, including postpartum haemorrhage (see below).
  • Can lead to fatigue, orthostatic hypertension, and depression [Evensen, 2017].
  • See the CKS topics on Anaemia - iron deficiency Depression - antenatal and postnatal and Tiredness/fatigue in adults for more information.
• Secondary postpartum haemorrhage [RCOG, 2016a].
  • Occurs between 24 hours and 12 weeks after delivery.
  • Risk factors include endometritis and retained products of conception.
• Mastitis.
  • Can lead to breast abscess and sepsis.
  • Risk factors include poor infant attachment to the breast and nipple damage.
  • See the CKS topics on Breastfeeding problems, Mastitis and Sepsis for more information.
• Maternal sepsis [RCOG, 2024; NICE, 2025b].
  • Can lead to significant morbidity and mortality.
  • Risk factors include:
    
    • Immunocompromise.
    • Amniocentesis or other invasive procedure, such as cervical cerclage, caesarean section, forceps delivery, or removal of retained products of conception.
    • Prolonged spontaneous rupture of membranes.
    • Close contact with people with group A streptococcal infection, for example, scarlet fever.
    • Obesity.
    • Diabetes in pregnancy.
    • Iron deficiency anaemia.
    • Maternal age > 35 years
    • Being from an ethnically marginalised group.
    • Renal/Cardiac/Liver disease.
    • History of pelvic infection.
    • Intravenous drug use.
    • Mastitis.
• Faecal incontinence and anal pain [RCOG, 2015].
  • Can lead to problems with daily functioning (including caring for the baby) as well as psychological issues and social isolation.
  • More common following obstetric anal sphincter injury (third- or fourth degree perineal tear).
  • For more information, see the CKS topic on Faecal incontinence in adults.
• Perineal pain [Bisson, 2019; NICE, 2025b].
  • Persisting or worsening perineal pain in the first few weeks after birth may be associated with depression, long-term perineal pain, problems with daily functioning (including caring for the baby), and psychosexual difficulties.
  • Risk factors include episiotomy, labial or perineal tear, assisted vaginal birth, wound infection or breakdown, and/or traumatic birth experience.
• Postnatal depression.
  • Can affect bonding with the infant and may increase the risk of self-harm and suicide.
  • Risk factors include history of depression or anxiety, lack of partner or social support, preterm birth, infant health problems, and sleep deprivation. 
    • The loss of a child, either by miscarriage, stillbirth or neonatal death, or a child being taken into care, has also been identified as a significant risk factor for peripartum mental health problems [MBRRACE, 2025].
  • See the CKS topic on Depression - antenatal and postnatal for more information
• Postpartum psychosis [Osborne, 2018; Friedman, 2023].
  • A rare condition, affecting one to two per 1,000 women.
  • Usually presents in the first two weeks after delivery, and deterioration may be rapid.
  • Risk factors include a previous diagnosis of bipolar disorder or a psychotic disorder.
  • Recurrence after subsequent deliveries is common.
  • Can be associated with increased risk of suicide. Distorted thoughts and behaviour may involve the baby, putting it at risk of harm.
  • See the CKS topics on Psychosis and schizophrenia and Self-harm for more information. 
• Maternal death during pregnancy and in the postnatal period is rare, affecting 12.8 per 100,000 women giving birth in the UK. HCPs should be aware that the most common causes are [MBRRACE, 2025]:
  • Thrombotic events.
  • Heart disease.
  • Mental health conditions, and related substance use and/or suicide.
  • Epilepsy and stroke.
• HCPs should be aware that general risk factors for maternal mortality during pregnancy and in the postnatal period in the UK include [MBRRACE, 2025]:
  • Social deprivation.
  • Being from an ethnically marginalised group.
    • There is an ongoing disparity in maternal mortality rates between women from black and Asian ethnic groups and white women. Compared with white women (12 per 100,000), the risk of maternal death during pregnancy and up to six weeks after birth is 2.3 times higher in black women (28 per 100,000), and 1.3 times higher in Asian women (16.7 per 100,000; does not include Chinese women).
  • Social services involvement.
  • Not speaking English.
  • Severe and multiple disadvantage.
• Enhanced postnatal monitoring is required to prevent complications in women with certain medical conditions during pregnancy, including :
  • Hypertension and/or pre-eclampsia — postpartum blood pressure monitoring is required, and a switch to a different antihypertensive may be advised after delivery. For further information, please see the CKS topic on Hypertension in pregnancy.
  • Intrahepatic cholestasis of pregnancy —  requires ongoing monitoring of liver function after delivery. For further information, please see the CKS topic on Itch in pregnancy.
  • Epilepsy — anti-seizure medication may need to be switched, or doses may need to be altered following delivery. For further information, please see the CKS topic on Epilepsy.
  • Gestational diabetes — follow-up blood tests after delivery are required to exclude persisting hyperglycaemia [NICE, 2026].
  • Pre-existing Type 1 or type 2 diabetes — antidiabetic drugs may need to be changed, or doses altered following delivery. Women who are insulin‑treated are at increased risk of hypoglycaemia in the postnatal period (especially when breastfeeding) [NICE, 2026].

How should I assess a postnatal woman?

Note: HCPs should be aware of the Risk factors for complications in the postnatal period, including maternal death.

Assessment of a woman in the postnatal period should include:

• Asking about:
  • Her birth experience, mode of delivery (normal or assisted delivery, or caesarean section), and any complications.
  • Her social situation, including:
    • Who has parental responsibility for the baby and the support available, including from a partner, family, friends, or other social networks.
    • Any concerns or difficulties, including relationship problems, risk of domestic violence or abuse, and any safeguarding concerns.
    • See the CKS topics on Domestic violence and abuse and Child maltreatment - recognition and management for more information.
  • Her mood, psychological and emotional wellbeing, including sleep, fatigue, and bonding/emotional attachment with the baby.
    • See the CKS topics on Insomnia, and Tiredness/fatigue in adults for more information.
  • Previous or current mental health concerns, including anxiety, depression, post-traumatic stress disorder, or psychosis.
    • See the CKS topics on Generalized anxiety disorder, Depression - antenatal and postnatal, Post-traumatic stress disorder, Psychosis and schizophrenia.
    • Be aware that early symptoms of postpartum psychosis may include insomnia, anxiety, irritability, or mood fluctuation before abnormal thoughts and/or behaviours may become apparent.
  • Infant care and feeding including feeding method (breastfeeding and/or formula feeding), frequency of feeds, and any problems including nipple and/or breast discomfort if breastfeeding.
    • See the CKS topic on Breastfeeding problems for more information.
  • Her lifestyle including nutrition and diet, physical activity, smoking, alcohol consumption, and recreational drug use. 
  • Any long-term health conditions or medications. Consider the need for investigations or monitoring.
    • Ensure the woman's cervical screening is up to date.
  • Her physical recovery from the birth, including:
    • Lochia, vaginal discharge, whether her periods have returned.
    • Bladder function including difficulty passing urine or episodes of urinary incontinence. See the CKS topic on Incontinence - urinary, in women for more information.
    • Bowel function including symptoms of constipation, faecal incontinence, or haemorrhoids. See the CKS topics on Constipation and Haemorrhoids for more information.
    • Perineal healing following vaginal birth, including perineal tears or wounds, perineal pain, swelling, wound breakdown, or offensive discharge. Consider using a validated pain scale to assess and monitor perineal pain.
    • Wound healing following caesarean section, including symptoms of wound infection.
    • Issues with sexual function and dyspareunia.
    • Awareness of the need for pelvic floor muscle training.
  • Contraception. See the CKS topic on Contraception - assessment for more information.
• Enquiring about symptoms or signs suggestive of:
  • Anaemia, such as dyspnoea, fatigue, headache, cognitive dysfunction, and restless leg syndrome. See the CKS topic on Anaemia - iron deficiency for more information.
  • Secondary postpartum haemorrhage, such as sudden, very heavy, increased, or persistant vaginal bleeding, and/or passing clots, placental tissue, or membranes.
  • Infection or sepsis, such as persistent severe abdominal, pelvic or perineal pain; fever, shivering, or offensive vaginal discharge.
    • See the CKS topics on Sepsis and Vaginal discharge for more information.
  • Mastitis, such as worsening reddening and swelling of breasts, persisting for more than 24 hours despite self-management.
    • See the CKS topic on Mastitis and breast abscess for more information.
  • Thromboembolism, such as leg swelling and tenderness, or chest pain and shortness of breath.
    
    • See the CKS topics on Deep vein thrombosis and Pulmonary embolism for more information.
• Examining the woman:
  • Check temperature if there is suspected infection and/or sepsis. See the CKS topic on Sepsis for more information.
  • Check blood pressure, pulse, and body mass index (BMI), and offer appropriate management if required. See the CKS topics on Hypertension, Hypertension in pregnancy, CVD risk assessment and management, and Obesity for more information.
  • Assess mood and mental state, including signs of anxiety, depression, post-traumatic stress disorder, or psychosis. See the CKS topics on Generalized anxiety disorder, Depression - antenatal and postnatal, Post-traumatic stress disorder, and Psychosis and schizophrenia for more information. 
  • Offer to examine the perineal area or caesarean section wound, depending on mode of delivery, if there are any concerns about wound healing, infection, breakdown, or pain.
  • Offer to perform an abdominal and/or pelvic examination if there is heavy vaginal bleeding and/or pain, suspected vaginal prolapse, and/or urinary incontinence, depending on clinical judgement. See the CKS topic on Incontinence - urinary, in women for more information.
• Considering arranging further investigations if clinically indicated, such as:
  • Blood tests for:
    • Fasting blood glucose or HbA1c if there is a history of gestational diabetes. See the section on Management of specific conditions for more information.
    • Urea, electrolytes, and renal function if there is a history of pre-eclampsia. See the CKS topic on Hypertension in pregnancy for more information.
    • Full blood count (FBC) and ferritin if there is suspected iron deficiency anaemia. See the CKS topic on Anaemia - iron deficiency for more information.
    • Monitoring of any long-term conditions, depending on clinical judgement.
  • A urinary dipstick test to check for 1+ proteinuria and/or urinary albumin:creatinine ratio (ACR) if there is a history of pre-eclampsia. See the CKS topic on Hypertension in pregnancy for more information.
  • Vaginal swabs if there is vaginal discharge or bleeding and suspected infection. See the CKS topic on Vaginal discharge for more information.

Postnatal care - management

From age 14 years onwards (Female).

Search strategy

Scope of search

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of Post Natal Care.

Search dates

September 2021 - February 2026

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

• perinatal period/ or exp postnatal care/
• postpartum period/ or peripartum period/
• (((first time or new) adj mother*) or nullipara* or peri natal* or perinatal* or postbirth or post birth or postdelivery or post delivery or postnatal* or post natal* or postpartum* or post partum* or primipara* or puerpera* or puerperium* or ((after or follow*) adj2 birth*)).ti,ab.

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• Health Protection Agency
• World Health Organization
• National Guidelines Clearinghouse
• Guidelines International Network
• TRIP database
• GAIN
• NHS Scotland National Patient Pathways
• New Zealand Guidelines Group
• Agency for Healthcare Research and Quality
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• University of Michigan Medical School
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• Patient UK Guideline links
• UK Ambulance Service Clinical Practice Guidelines
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work(occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Drug & Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium(HMIC)

Patient experiences

• Healthtalkonline
• BMJ - Patient Journeys
• Patient.co.uk - Patient Support Groups

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
• Consistency with other providers of clinical knowledge for primary care.
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• Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
• All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
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Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
• Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
• Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
  • Eligible population
  • Current interventions
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  • Cost of the current or new intervention mix
  • Impact on other costs
  • Condition-related costs
  • In-direct costs and service impacts
  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

• Personal financial interests
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Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

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Competing interests declared for this topic:

None.