📋 Key Information Summary
- The 6-week postnatal check is a cornerstone of Australian primary care — screen for mood, pelvic floor function, continence, wound healing, contraception, and immunisation catch-up using the RANZCOG-aligned checklist.
- All women should complete the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks, 3 months, and 6 months postpartum; scores ≥13 warrant further clinical assessment.
- Breast engorgement is managed with frequent feeds or expression, cold compresses, and analgesia; it typically resolves within 24–48 hours.
- Lactational mastitis — continue breastfeeding or expressing; first-line antibiotic is flucloxacillin 500 mg PO QID for 10–14 days (eTG); if MRSA suspected, use trimethoprim + sulfamethoxazole or clindamycin.
- Cracked nipples are managed with expressed breast milk application, lanolin, and correct latch assessment; nipple shield use may be a short-term bridge.
- Secondary postpartum haemorrhage (PPH) occurs between 24 hours and 12 weeks postpartum — always assess for retained products of conception, endometritis, or coagulopathy.
- Normal lochia progresses from rubra (red) → serosa (brown/pink) → alba (white/yellow) over 4–6 weeks; foul-smelling lochia with fever suggests endometritis.
- Secondary PPH investigation includes FBC, coagulation screen, group & hold, β-hCG, pelvic ultrasound, and endocervical swab; treat retained products with surgical evacuation if haemodynamically unstable.
- Postnatal depression affects 10–20% of Australian women; sertraline and paroxetine are first-line SSRIs compatible with breastfeeding (eTG).
- Postnatal psychosis is a psychiatric emergency (onset usually within 2 weeks of delivery) — requires immediate specialist admission; lithium and antipsychotics may be used with lactation advice.
- All postnatal women should have rubeolla, influenza, and pertussis (dTpa) immunisation status reviewed — dTpa is funded under the NIP for each pregnancy.
- Aboriginal and Torres Strait Islander women face significantly higher rates of postnatal complications, perinatal depression, and reduced access to continuity-of-care models — culturally safe MBS Item 715 health checks should be offered.
Introduction & Australian Epidemiology
The postnatal period — traditionally defined as the first 6 weeks following birth, though many clinical frameworks extend this to 12 months — is a time of significant physiological recovery and psychosocial transition. Postnatal care in Australia is delivered across a continuum from the maternity hospital through to community-based general practice, child and family health nursing services, and lactation consultant networks. The quality of this care has direct implications for maternal morbidity, breastfeeding continuation, infant bonding, and the early detection of potentially life-threatening complications.
In Australia, approximately 300,000 women give birth each year (AIHW, 2023). The majority experience an uncomplicated postnatal recovery, but a significant minority develop problems that require active management:
- Breastfeeding difficulties: While 96% of Australian mothers initiate breastfeeding, rates drop to approximately 60% at 3 months and 25% at 6 months (Australian National Breastfeeding Strategy 2019–2025). Engorgement, mastitis, and nipple trauma are the most common reasons for early cessation.
- Lactational mastitis: Affects 10–33% of breastfeeding women; recurrence is common. In Australia, community-acquired MRSA (CA-MRSA) is an increasingly recognised cause, particularly in northern and remote communities.
- Secondary postpartum haemorrhage: Occurs in approximately 1–2% of deliveries. Retained products of conception are the most common cause. Caesarean section and prolonged rupture of membranes are key risk factors in the Australian context.
- Postnatal depression: The 2022 Australian Institute of Health and Welfare report indicates that perinatal depression and anxiety affect up to 1 in 5 women. In Aboriginal and Torres Strait Islander communities, rates may be 2–3 times higher, compounded by intergenerational trauma, social disadvantage, and reduced access to culturally safe mental health services.
- Maternal mortality: Australia's maternal mortality rate remains low (~6 per 100,000), but deaths from postpartum haemorrhage, thromboembolism, and mental health conditions remain preventable in a proportion of cases (AIMS Report, ANZ Perinatal Society).
The postnatal 6-week check is the single most important scheduled encounter. It is recommended by the Royal Australian College of General Practitioners (RACGP) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). It provides an opportunity to assess maternal physical and psychological recovery, address breastfeeding, initiate long-term contraception, review immunisations, and screen for conditions that may have been masked during pregnancy.
6-Week Postnatal Check (Checklist)
The 6-week postnatal visit is typically conducted by the woman's GP and may be complemented by a midwife or child and family health nurse visit. It should be booked before hospital discharge. The following checklist is aligned with RACGP Red Book and RANZCOG recommendations.
Safety-critical screening: Postnatal mood screening (EPDS) and assessment for domestic and family violence should be performed at every postnatal contact — not only at the 6-week check. If EPDS ≥13 or item 10 (self-harm ideation) is endorsed, urgent mental health referral is indicated.
Comprehensive 6-Week Postnatal Checklist
| Domain | Assessment | Action / Referral |
|---|---|---|
| General wellbeing | Fatigue, sleep, nutrition, social support | Sleep hygiene advice; refer to MCHN if not yet linked |
| Mood & mental health | EPDS (Edinburgh Postnatal Depression Scale); screen for anxiety, PTSD, psychosis | EPDS ≥13 → clinical interview; item 10 positive → urgent referral; discuss PANDA helpline 1300 726 306 |
| Domestic & family violence | Direct questioning in private; validate and offer support | Refer to 1800RESPECT (1800 737 732); safety planning; consider Children's Court if child at risk |
| Breastfeeding | Latch, frequency, supply concerns, pain | Refer to lactation consultant (IBCLC) or Australian Breastfeeding Association (ABA) 1800 686 268 |
| Perineum / Caesarean wound | Episiotomy / tear healing (1st–4th degree); Caesarean scar integrity; signs of infection | Wound swab if infection suspected; refer to physiotherapy for 3rd/4th-degree tears; check obstetric notes for suture type |
| Bleeding / lochia | Volume, colour, odour; ongoing heavy bleeding raises concern for retained products | FBC, β-hCG, pelvic USS if abnormal; refer to obstetric team |
| Bladder & bowel | Urinary incontinence (stress, urge, overflow); faecal incontinence; constipation | Pelvic floor exercises; refer to continence physiotherapy; consider MBS Item 10950 |
| Thromboembolism risk | Calf pain, swelling, dyspnoea — especially post-caesarean | Duplex USS if clinical suspicion; CTPA for PE; refer to ED if acute |
| Blood pressure | Especially if pre-eclampsia / gestational hypertension in pregnancy | If BP persistently ≥140/90, commence/continue antihypertensive; postnatal pre-eclampsia review at 6 weeks |
| Bloods | FBC (if anaemic at delivery); HbA1c (if GDM); thyroid function (if perinatal thyroiditis suspected) | Iron supplementation if Hb <100 g/L; GDM women: 75 g OGTT at 6–12 weeks |
| Contraception | Discuss plans; LARC (IUD, implant) — can be inserted at Caesarean or 4–6 weeks postnatal | Progesterone-only methods safe in breastfeeding from 6 weeks; combined OCP contraindicated <6 weeks and relative caution <6 months if breastfeeding (thrombotic risk); vasectomy discussion |
| Immunisations | Influenza (yearly), dTpa (each pregnancy, funded NIP), rubella (if non-immune), COVID-19 | Administer if not given antenatally; rubella non-immune → MMR postnatal (contraception advised for 28 days); funded under NIP |
| Infant review | Weight gain, jaundice, hip screening (USS at 6 weeks if risk factors), developmental hip exam | Referral to paediatrician if hip click/asymmetry; schedule newborn screening (heel-prick) if not done |
Postnatal Bloods — When to Order
| Test | Indication | Timing |
|---|---|---|
| FBC + ferritin | Anaemia at delivery; symptomatic fatigue; significant PPH | 6 weeks |
| 75 g OGTT | Gestational diabetes mellitus | 6–12 weeks postpartum |
| TSH, fT4 | Symptoms of thyroid dysfunction; postpartum thyroiditis (peaks 2–6 months) | 6 weeks–6 months |
| Rubella serology | If antenatal serology showed non-immunity | Post-MMR vaccination to confirm seroconversion |
| Vitamin D | Dark skin, limited sun exposure, symptoms of deficiency | 6 weeks if indicated |
MBS Billing tip: The 6-week postnatal check can be billed as a standard consultation (MBS Items 23 or 36). If incorporating a mental health assessment and care plan, MBS Item 2715 (GP Mental Health Treatment Plan) may be applicable. Aboriginal and Torres Strait Islander women may be eligible for a comprehensive MBS Item 715 health assessment.
Breastfeeding Problems
Breastfeeding problems are among the most common reasons for postnatal GP and emergency presentations. The majority are manageable in primary care with supportive measures and, where indicated, antibiotics. Early intervention preserves breastfeeding duration and reduces the risk of progression to abscess formation or psychological distress.
Breast Engorgement
Engorgement typically occurs on days 3–5 postpartum when lactogenesis II begins. It presents as bilateral breast fullness, tightness, and discomfort. The areola may become taut, preventing effective latch. Distinguish from simple milk stasis (unilateral, in a specific ductal segment).
Mild
Physiological Engorgement
Bilateral fullness, mild discomfort, no erythema, no fever. Latch achievable with gentle expression to soften areola first.
Setting: Home — midwifery / GP advice
Moderate
Significant Engorgement
Persistent fullness causing latch difficulty, localised warmth, discomfort affecting feeding. May be associated with oversupply.
Setting: GP — lactation consultant referral
Severe
Engorgement with Complications
Systemic symptoms (fever, malaise), widespread erythema, risk of progression to mastitis or blocked duct. Inability to feed.
Setting: GP / ED — consider ultrasound exclusion of abscess
Management of Engorgement
- Feed on demand — at least 8–12 times per 24 hours; do not restrict feed times.
- Warm compresses for 2–3 minutes before feeds to promote let-down; cold compresses (ice packs wrapped in cloth) between feeds for 10–15 minutes to reduce oedema and pain.
- Gentle hand expression or reverse pressure softening (pressing on the areola for 1–2 minutes) to allow latch if areola is too taut.
- Analgesia: ibuprofen 400 mg PO TDS PRN (preferred — anti-inflammatory; compatible with breastfeeding) or paracetamol 1 g PO QDS PRN.
- Avoid excessive pumping (may worsen oversupply). Express only to comfort.
- Well-fitting, supportive bra — avoid underwire.
Lactational Mastitis
Lactational mastitis is inflammation of the breast parenchyma occurring during lactation, usually within the first 12 weeks but possible at any time during breastfeeding. It presents with a triad of breast pain, erythema, and flu-like symptoms (fever, myalgia, malaise). A palpable, tender, wedge-shaped area of induration is typical.
Red flags — suspect breast abscess if: persistent mass (>48 hours of antibiotics), fluctuance, worsening pain despite appropriate therapy, or ultrasound showing collection. Abscess requires needle aspiration or incision & drainage under ultrasound guidance — refer to breast surgeon or ED. Continue breastfeeding from the unaffected side; feeding on the affected side is usually safe unless the abscess is close to the nipple.
Continue breastfeeding or expressing during mastitis. Abrupt cessation increases the risk of abscess formation. If latch is too painful, express by hand or pump to maintain drainage. Refer to a lactation consultant (IBCLC) for ongoing support.
Aetiology & Microbiology
- Most commonly caused by Staphylococcus aureus (including CA-MRSA in up to 10–15% of cases in some Australian centres).
- Milk stasis from blocked ducts, infrequent feeding, nipple damage, or ill-fitting bras is the primary predisposing factor.
- Other organisms: Streptococcus spp., coagulase-negative staphylococci (in immunocompromised), and rarely Escherichia coli.
Antibiotic Management (eTG Antibiotic)
Flucloxacillin
Staphylex® · Generic · First-line for MSSA mastitis
Adult dose
500 mg PO QID for 10–14 days
Paediatric dose
N/A — maternal treatment
Renal adjustment
eGFR <10: reduce to 250–500 mg QID; dose interval unchanged
Breastfeeding
Compatible — very low levels in breast milk
PBS status
✔ PBS General Benefit
Cefalexin
Keflex® · Generic · Penicillin allergy (non-anaphylaxis)
Adult dose
500 mg PO TDS–QID for 10–14 days
Renal adjustment
eGFR 10–30: 250–500 mg TDS; eGFR <10: 250 mg BD–TDS
Breastfeeding
Compatible
PBS status
✔ PBS General Benefit
Trimethoprim + Sulfamethoxazole
Bactrim® / Resprim® · MRSA cover / severe penicillin allergy
Adult dose
160/800 mg (DS) PO BD for 10–14 days
Breastfeeding
Compatible — avoid in neonates with jaundice or G6PD deficiency (theoretical risk); monitor infant
Renal adjustment
eGFR 15–30: reduce dose by 50%; avoid if eGFR <15
PBS status
✔ PBS General Benefit
Clindamycin
Dalacin C® · MRSA cover if TMP-SMX not tolerated
Adult dose
450 mg PO TDS for 10–14 days
Breastfeeding
Compatible — may cause infant diarrhoea; monitor
PBS status
✔ PBS General Benefit
When to send a milk culture: Consider culture and sensitivity if the woman is not responding to 48 hours of appropriate antibiotics, if there is recurrent mastitis, or if MRSA is suspected (prior colonisation, CA-MRSA endemic area, previous treatment failure). Express mid-stream sample into a sterile container.
Nipple Problems
Nipple pain and damage are extremely common in the first 1–2 weeks of breastfeeding but should improve with correct positioning and latch. Persistent pain beyond 2 weeks warrants evaluation.
Cracked / Fissured Nipples
- Most commonly caused by improper latch — shallow latch, tongue-tie in the infant, or positional issues.
- Management: correct latch assessment (IBCLC referral); apply expressed breast milk to nipples after feeds and air-dry; pure lanolin cream (e.g., Lansinoh®) is safe and evidence-based.
- If a white spot (bleb) is present, gentle abrasion with a warm cloth before feeds may help; persistent blebs may require needle puncture by a clinician.
- Secondary infection — if nipples are erythematous, weeping, or have a yellow crust, consider candidal infection (oral thrush in infant + nipple pain) — treat with miconazole 2% gel to infant's oral mucosa and clotrimazole 1% cream to nipples after feeds.
- Nipple shields may be used as a short-term bridge for severely damaged nipples, but should be used under IBCLC supervision with a plan to wean.
Candidal Nipple Infection (Thrush)
- Presents as burning or stinging nipple pain (often described as "shooting" pain through the breast), often bilateral; may follow antibiotic use.
- Treat mother: clotrimazole 1% cream to nipples TDS after feeds. If severe or resistant: fluconazole 150 mg PO stat, then 50–100 mg PO daily for 10–14 days (off-label; compatible with breastfeeding).
- Treat infant: miconazole oral gel applied to oral mucosa QID; sterilise dummies and bottle teats.
- ✔ PBS General Benefit for clotrimazole cream, miconazole gel, and fluconazole.
Secondary Postpartum Haemorrhage & Lochia
Secondary postpartum haemorrhage (PPH) is defined as abnormal or excessive bleeding from the genital tract between 24 hours and 12 weeks after delivery. It must be distinguished from normal lochia and from other causes of postnatal bleeding (e.g., trauma, coagulopathy). It affects approximately 1–2% of deliveries and requires prompt assessment to exclude potentially life-threatening causes.
Normal Lochia
Understanding the progression of normal lochia is essential to identify pathological bleeding.
| Type | Colour / Appearance | Duration | Characteristics |
|---|---|---|---|
| Lochia rubra | Red / dark red | Days 1–3 | Blood, placental site debris; moderate volume; small clots normal |
| Lochia serosa | Brown / pink-brown | Days 4–10 | Decreasing volume; serous exudate with old blood |
| Lochia alba | White / pale yellow | Days 10–42 | Leucocytes, mucus; scant volume; may persist up to 6 weeks |
Abnormal lochia — seek urgent review: Return of bright red bleeding after lochia serosa has commenced; foul-smelling lochia (suggests infection); passage of large clots (>5 cm); soaking >1 pad per hour; persistent rubra beyond 7–10 days.
Causes of Secondary PPH
| Cause | Mechanism | Features |
|---|---|---|
| Retained products of conception | Placental fragments preventing uterine involution | Most common cause; heavy bleeding ± cramping; USS shows echogenic material in uterine cavity |
| Endometritis | Infection of the decidua / uterine lining | Fever, uterine tenderness, foul lochia; risk factors: prolonged ROM, manual removal of placenta, caesarean |
| Uterine involution failure | Myometrium fails to contract effectively | Boggy uterus on examination; associated with overdistended uterus (macrosomia, polyhydramnios) |
| Coagulopathy | Inherited or acquired bleeding disorder unmasked postpartum | Consider in primary PPH also; check FBC, coagulation, fibrinogen |
| Genital tract trauma | Unrecognised tears, wound dehiscence | Speculum examination; examine vaginal walls, perineum, cervix |
| Trophoblastic disease | Gestational trophoblastic neoplasia | Rare; elevated β-hCG; refer to specialist centre |
Investigation & Management
Immediate Assessment (GP or ED)
- ABC approach — haemodynamic assessment: HR, BP, respiratory rate, capillary refill.
- Establish IV access; take bloods: FBC, coagulation screen (INR, APTT, fibrinogen), group & hold / crossmatch 2 units, β-hCG, CRP.
- Speculum examination: visualise cervix, exclude trauma, identify products at os.
- Bimanual examination: uterine size, tenderness (suggests infection), masses.
- Pelvic ultrasound: first-line imaging — assess endometrial thickness, retained products (echogenic intrauterine material), vascularity on Doppler.
Definitive Management
1
Haemodynamically Stable + Retained Products
Antibiotics (see below) + medical management with misoprostol 400–600 mcg PR/SL stat (off-label); repeat in 24 h if needed. Arrange outpatient surgical review if not responding within 48 h.
2
Haemodynamically Unstable OR Medical Management Fails
Urgent surgical evacuation (suction curettage) under anaesthesia. Resuscitate with crystalloids / blood products as needed. Crossmatch available.
3
Endometritis (no retained products)
Antibiotics: amoxicillin 500 mg PO TDS + metronidazole 400 mg PO TDS for 7–10 days. If severe: IV ampicillin 2 g QID + gentamicin 5 mg/kg IV OD + metronidazole 500 mg IV TDS (triple therapy).
Amoxicillin + Metronidazole
Amoxil® + Flagyl® · Mild-moderate endometritis (oral)
Adult dose
Amoxicillin 500 mg PO TDS + Metronidazole 400 mg PO TDS for 7–10 days
Breastfeeding
Both compatible — metronidazole may alter infant stool colour
PBS status
✔ PBS General Benefit
Secondary PPH can be life-threatening. Do not dismiss recurrent heavy bleeding as "normal postnatal changes." Any woman soaking ≥1 pad per hour, passing large clots, or feeling dizzy/tachycardic should be assessed in the ED with resuscitation capacity. Ensure group & hold is taken early.
Postnatal Depressive Disorders
Perinatal mental health disorders are a leading cause of maternal morbidity in Australia. The term "perinatal" encompasses the antenatal and postnatal periods; postnatal depressive disorders present most commonly within the first 3 months but can emerge at any time in the first postnatal year.
Classification & Diagnostic Features
Mild
"Baby Blues"
Affects up to 80% of women. Onset days 2–5; resolves within 2 weeks. Tearfulness, mood lability, irritability. No treatment required beyond support and reassurance. Distinguish from early depression.
Setting: Home — midwifery observation
Moderate
Postnatal Depression (PND)
Persistent low mood, anhedonia, guilt, fatigue, sleep disturbance beyond baby blues timeframe. EPDS ≥13. Impairs bonding and daily functioning. Affects 10–20% of Australian women. May co-exist with anxiety.
Setting: GP — counselling ± pharmacotherapy
Severe
Postnatal Psychosis
Psychiatric emergency. Onset usually within 2 weeks of delivery. Confusion, disorganisation, hallucinations, delusions (often about the infant), mania, lability. History of bipolar disorder is major risk factor. Risk of infanticide.
Setting: ED — immediate psychiatric admission
Postnatal psychosis is a medical emergency. If a woman presents within the first 4 weeks postpartum with confusion, bizarre behaviour, auditory hallucinations, or fixed delusions about the infant, do not leave her alone with the baby. Arrange immediate transfer to an inpatient psychiatric unit with mother-baby capacity. Call the crisis assessment team (CAT) or present to ED. Contact Perinatal Anxiety & Depression Australia (PANDA) 1300 726 306 for advice.
Screening — Edinburgh Postnatal Depression Scale (EPDS)
- 10-item self-report questionnaire; takes 5 minutes to complete.
- Recommended at: antenatal booking, 6 weeks, 3 months, and 6 months postpartum (RACGP, RANZCOG, COPE).
- Cut-off ≥13 = probable depression; undertake clinical interview to confirm diagnosis.
- Item 10 (self-harm thoughts): Any positive endorsement requires immediate clinical assessment regardless of total score.
- The EPDS is available in multiple languages and is freely downloadable from cope.org.au.
- Note: the EPDS does not diagnose — it screens. It does not capture all anxiety disorders or PTSD, which are common comorbidities. Consider the GAD-7 for generalised anxiety.
Management of Postnatal Depression
Non-Pharmacological
- Mild–moderate PND: Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) have strong evidence. Accessible via GP Mental Health Treatment Plan (MBS Item 2715 — up to 20 sessions per calendar year).
- Mother-infant interventions: Video interaction guidance, Circle of Security programs — available through some child and family health services.
- Peer support: PANDA (1300 726 306), Gidget Foundation, Trescope (Mumspace), and local postnatal groups.
- Exercise: moderate physical activity (30 min, 5 days/week) has antidepressant effects.
Pharmacological — Antidepressants
Pharmacotherapy is indicated when non-pharmacological measures are insufficient, when symptoms are moderate–severe, or when the woman prefers medication. SSRIs are first-line. Choice considers breastfeeding compatibility, side-effect profile, prior response, and patient preference.
Sertraline
Zoloft® · First-line SSRI in breastfeeding
Adult dose
50 mg PO OD initially; titrate to 100–200 mg PO OD over 2–4 weeks
Breastfeeding
Compatible — very low breast milk levels; most studied SSRI in lactation
Onset
2–4 weeks for initial response; full effect at 6–8 weeks
Key side effects
Nausea, headache, insomnia, sexual dysfunction; GI effects may be reduced with food
PBS status
✔ PBS General Benefit
Paroxetine
Aropax® / Paxtine® · Alternative first-line SSRI
Adult dose
20 mg PO OD initially; titrate to 40–50 mg PO OD
Breastfeeding
Compatible — low breast milk levels; no known adverse infant effects at standard doses
Caution
Avoid in first trimester (possible cardiac malformation risk); more anticholinergic effects; significant discontinuation syndrome — taper slowly
PBS status
✔ PBS General Benefit
SSRI choice in breastfeeding: Sertraline and paroxetine have the lowest infant plasma levels among SSRIs and are preferred first-line (eTG). Fluoxetine has higher milk transfer and longer half-life — use only if there has been a documented excellent prior response. All breastfeeding mothers starting an SSRI should be counselled to monitor infant for irritability, poor feeding, and excessive drowsiness.
Pharmacological — Severe / Refractory / Psychosis
Lithium
Lithicarb® / Priadel® · Postnatal psychosis / bipolar relapse
Adult dose
250 mg PO BD–TDS; titrate to serum level 0.6–1.0 mmol/L
Breastfeeding
Compatible with monitoring — infant serum lithium levels, thyroid, renal function
Monitoring
Serum lithium 12 h post-dose at 5–7 days, then every 3–6 months; renal function, thyroid, calcium at baseline, 3 months, then 6-monthly
PBS status
✔ PBS General Benefit
Olanzapine
Zyprexa® · Atypical antipsychotic for acute psychosis
Adult dose
5–10 mg PO OD initially; titrate to 10–20 mg PO OD as needed
Breastfeeding
Limited data; may be compatible with monitoring — discuss risks/benefits with perinatal psychiatrist
Key side effects
Weight gain, metabolic syndrome, sedation
PBS status
⚠️ PBS Authority Required
Perinatal Anxiety Disorders
Perinatal anxiety is at least as common as depression (prevalence 15–20%) but is under-recognised. It includes generalised anxiety disorder, panic disorder, obsessive-compulsive disorder (particularly intrusive thoughts about harm to the infant), and post-traumatic stress disorder (following traumatic birth).
- Intrusive thoughts about harm to the infant are common in new mothers and do NOT indicate psychosis or intent. Distinguish from obsessional thoughts (ego-dystonic, distressing) vs. delusional beliefs (ego-syntonic, held with conviction).
- CBT is first-line; SSRIs (as above) if pharmacotherapy needed.
- Screen with GAD-7 and consider the Perinatal PTSD screening.
Australian Support Services
| Service | Contact | Description |
|---|---|---|
| PANDA (Perinatal Anxiety & Depression Australia) | 1300 726 306 (Mon–Fri 9am–7.30pm AEST) | National helpline; counselling, information, referral |
| Lifeline | 13 11 14 (24/7) | Crisis support; suicide prevention |
| Beyond Blue | 1300 22 4636 (24/7) | Depression and anxiety counselling; online forums |
| Gidget Foundation | 1300 851 746 | Free psychological services for expectant/new parents (telehealth available) |
| COPE (Centre of Perinatal Excellence) | cope.org.au | Clinical guidelines, EPDS downloads, provider resources |
Special Populations
Pregnancy (Subsequent)
Women with gestational diabetes (GDM) have a 50% lifetime risk of developing type 2 diabetes — ensure 6–12 week OGTT is completed and arrange annual fasting glucose / HbA1c.
Women with pre-eclampsia / gestational hypertension have increased lifetime cardiovascular risk — ensure BP review at 6 weeks and ongoing GP monitoring.
Contraception counselling is essential — inter-pregnancy interval <6 months is associated with adverse outcomes. LARC is recommended (IUD insertion at Caesarean or 4–6 weeks; implant insertion from 4 weeks).
Folic acid supplementation (500 mcg/day) should be recommenced if planning another pregnancy.
Paediatrics / Neonatal
Medication safety in breastfeeding: The LactMed database (NIH) is the gold-standard reference. Most commonly prescribed psychotropic and antibiotic medications are compatible with breastfeeding at standard doses.
Monitor breastfed infants for adverse effects: excessive drowsiness, poor feeding, irritability, rash, diarrhoea — particularly when mothers start new medications.
Infants of mothers with untreated PND may show altered attachment patterns, sleep disturbance, and developmental delay — early maternal treatment benefits infant outcomes.
Breastfeeding support: Australian Breastfeeding Association (ABA) 1800 686 268 — 24/7 helpline; IBCLC lactation consultants accessible via community health.
Adolescent / Young Mothers
Higher rates of postnatal depression, social isolation, and disengagement from health services.
Ensure access to youth-friendly services; consider HEADSS assessment.
Contraception: LARC preferred (high efficacy, user-independent); Etonogestrel implant (Implanon NXT®) is PBS-listed and highly effective.
Immunisation catch-up may be required; refer to state immunisation provider.
Renal Impairment
Pregnancy-related AKI is rare but can complicate severe PPH, pre-eclampsia, or sepsis — check UEC, creatinine trends.
Medication dose adjustments: reduce flucloxacillin, cefalexin, and lithium doses for eGFR <30 mL/min.
NSAIDs (ibuprofen) — avoid in severe CKD (eGFR <30); use paracetamol for analgesia.
Aminoglycosides (gentamicin) — dose by ideal body weight; monitor trough levels; risk of nephro- and ototoxicity in prolonged courses.
Hepatic Impairment
Intrahepatic cholestasis of pregnancy (ICP) may not fully resolve postpartum — check LFTs if pruritus persists.
Paracetamol remains safe at standard doses; avoid excessive doses. Most SSRIs do not require hepatic dose adjustment at mild–moderate impairment.
Metronidazole: use with caution in severe hepatic impairment (reduced clearance); consider dose reduction.
Clindamycin: primarily hepatic metabolism — use standard dose in mild impairment; caution in moderate–severe.
Immunocompromised
HIV-positive mothers on ART can safely breastfeed in Australia (Australian guidelines now align with WHO); discuss with infectious diseases specialist. Infant prophylaxis and maternal viral load monitoring are essential.
Women on biologic DMARDs (e.g., anti-TNF agents): many are compatible with breastfeeding — discuss with rheumatologist. Certolizumab has minimal transfer; infliximab has higher levels.
Mastitis in immunocompromised patients may progress rapidly — lower threshold for ultrasound and broad-spectrum antibiotics.
Live vaccines (MMR, varicella) are contraindicated in severely immunocompromised women; postnatal MMR for rubella-non-immune should only be given if not significantly immunosuppressed.
Aboriginal and Torres Strait Islander Health Considerations
Aboriginal and Torres Strait Islander Health
📚 References
- 1. Australian Institute of Health and Welfare (AIHW). Maternal deaths in Australia 2023. Canberra: AIHW; 2023.
- 2. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Postnatal care: clinical guideline. Melbourne: RANZCOG; 2022.
- 3. Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice (Red Book). 9th ed. Melbourne: RACGP; 2018 (updated 2023).
- 4. Australian Health Ministers' Advisory Council (AHMAC). Clinical Practice Guidelines: Antenatal Care — Module 2. Australian Government Department of Health; 2020.
- 5. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–786.
- 6. Centre of Perinatal Excellence (COPE). National Guideline for the Assessment and Diagnosis of Perinatal Mental Health Conditions. Melbourne: COPE; 2022.
- 7. Amir LH; Academy of Breastfeeding Medicine. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeed Med. 2014;9(5):239–243.
- 8. National Health and Medical Research Council (NHMRC). Australian Dietary Guidelines. Canberra: NHMRC; 2013.
- 9. Australian Government Department of Health. Australian National Breastfeeding Strategy: 2019 and Beyond. Canberra: Commonwealth of Australia; 2019.
- 10. Royal Australian and New Zealand College of Psychiatrists (RANZCP). Perinatal mental health clinical practice guidelines. Melbourne: RANZCP; 2021.
- 11. Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2021.
- 12. National Aboriginal Community Controlled Health Organisation (NACCHO). Providing culturally safe maternity care for Aboriginal and Torres Strait Islander women. Canberra: NACCHO; 2022.
- 13. Drugs and Lactation Database (LactMed). National Library of Medicine (US). Bethesda, MD: NLM; updated 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
- 14. Hanley GE, et al. Lactational mastitis: a population-based study. Aust N Z J Obstet Gynaecol. 2022;62(1):63–69.
- 15. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: maternity care. Canberra: AIHW; 2023.