What post-delivery follow-up care should be provided to mothers and infants after an episode of shoulder dystocia?

While the provided guidelines do not specifically detail follow-up care for shoulder dystocia, they outline general postnatal care for mothers and infants that would address common complications associated with such a delivery.

For the Mother:

• Perineal Health: If the mother or healthcare professional has concerns about perineal healing, or if the mother requests reassurance, an examination of the perineum by a midwife or doctor should be offered or arranged ². Persistent or worsening perineal pain within the first few weeks after birth may be associated with symptoms of depression, long-term perineal pain, problems with daily functioning, and psychosexual difficulties ². Risk factors for persistent postnatal perineal pain include episiotomy, labial or perineal tear, assisted vaginal birth, wound infection or breakdown, and a birth experienced as traumatic ². If the perineal wound breaks down or there are ongoing healing concerns, the woman should be referred urgently to specialist maternity services (to be seen the same day in the case of a perineal wound breakdown) ². Available pain relief options should be discussed, taking into account if the woman is breastfeeding ².
• Bowel Symptoms: If there are ongoing bowel symptoms, appropriate management should be offered ¹. If there is ongoing pain or anal incontinence at follow-up, referral to a gynaecologist or colorectal surgeon should be considered, depending on clinical judgement ¹.
• Sexual Function: Advice should be given on the resumption of sexual activity and intercourse after giving birth, and on the management of dyspareunia ¹. If there are ongoing issues, referral for psychosexual counselling and/or to a gynaecologist may be offered if needed, depending on clinical judgement ¹.
• Mental Health: If a woman has a suspected postnatal mental health problem, such as anxiety, depression, or post-traumatic stress disorder, support should be offered and managed appropriately ¹. A birth experienced as traumatic is a risk factor for persistent postnatal perineal pain ².

For the Infant:

• General Wellbeing and Assessment: At each postnatal contact, parents should be asked if they have any concerns about their baby's general wellbeing, feeding, or development ². The baby's history should be reviewed, and their health assessed, including physical inspection and observation ². If there are any concerns, appropriate further action should be taken ².
• Physical Examinations: A complete examination of the baby should be carried out within 72 hours of the birth and again at 6 to 8 weeks after the birth ². These examinations are important for identifying any potential injuries that may have occurred during delivery ².