Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Examination of the Puerperal Client

The puerperal examination assesses recovery after birth, uterine involution, lochia, perineum or wound, breasts, bladder, bowel, emotional wellbeing, vital signs, and warning signs. It combines physical assessment with postnatal education and family-planning support.

Purpose

  • Assess normal postpartum recovery
  • Detect haemorrhage, infection, hypertension, wound problems, thromboembolism, and emotional distress
  • Provide individualized postnatal care and education

Indications

  • Routine postnatal review
  • Symptoms after vaginal or caesarean birth
  • Before discharge or at a postnatal follow-up visit

Equipment

  • Private examination area and drapes
  • Vital-sign equipment
  • Hand-hygiene supplies and gloves
  • Abdominal, perineal, breast, and wound assessment supplies
  • Postnatal record and referral materials

Preparation

  • Review birth and discharge records and provide an interpreter or chaperone when needed.
  • Ensure emergency referral contacts are available.

Procedure steps

  • Confirm identity, birth history, mode of birth, complications, medicines, feeding, and the woman’s concerns.
  • Assess general appearance, vital signs, pain, mobility, hydration, sleep, nutrition, and emotional wellbeing.
  • Assess uterine involution, fundus, abdominal tenderness, lochia amount and odour, bladder and bowel function.
  • Inspect perineum or caesarean wound with consent for healing, pain, discharge, separation, swelling, or infection.
  • Assess breasts, nipples, feeding, and signs of engorgement or mastitis.
  • Ask about headache, visual symptoms, breathlessness, chest pain, calf pain or swelling, fever, and heavy bleeding.
  • Discuss contraception, sexual health, immunization, medicines, mental health, safeguarding, and social support.
  • Provide education, arrange investigations or referral, and confirm follow-up.
  • Escalate abnormal findings promptly.
  • Document assessment, education, referrals, treatment, and plan.

Precautions

  • Use consent and privacy for intimate examination.
  • Treat heavy bleeding, severe headache, chest pain, breathlessness, unilateral calf symptoms, fever, or wound breakdown urgently.
  • Do not dismiss postnatal sadness, anxiety, or thoughts of self-harm.
  • Use clean technique and appropriate PPE.

Aftercare

  • Give written or verbal warning signs and a follow-up date.
  • Coordinate lactation, mental-health, contraception, wound, or medical referrals.

Nursing considerations

  • Assess the whole woman, not only the uterus and lochia.
  • Use respectful, trauma-informed postnatal care.

Patient education

  • Teach postnatal hygiene, feeding, medicines, contraception, mobility, wound care, and danger signs.
  • Seek care for heavy bleeding, fever, severe headache, breathlessness, chest pain, or worsening wound pain.

Documentation

  • Record maternal observations, uterine and lochia findings, perineum or wound, breasts, emotional health, education, referrals, and follow-up.
  • Document urgent escalation.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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