HELMS Journey - Mother & Child | KK Women's and Children's Hospital

For mother

Welcome to motherhood! At this point of your journey, it is important to care for yourself so that you will be at your best to care for your newborn. In this visit, we will check in on you and provide you with the necessary postpartum support.

Initiate and establish breastfeeding
Provide post-delivery wound care
Provide guidance on physical recovery from birth, includes discharge advice about lochia, pain relief, constipation, urinary incontinence, and urinary retention
Rebuild physical health through postnatal exercises and pelvic floor exercises
Provide necessary supplements
Perform blood collection
Collect placenta

For baby

Measure weight, length and head circumference
Perform cord blood tests for G6PD, TSH and blood group
- Glucose 6 Phosphate Dehydrogenase (G6PD): Detects the levels of G6PD, an important protein enzyme in the blood, to help red blood cells function normally
- Thyroid Stimulating Hormone (TSH): Detects abnormal thyroid function
Perform newborn blood test for IEM (inborn errors of metabolism)
National Expanded Newborn Screening: This is a heel prick blood test to screen for IEM .
Perform newborn physical screening examination, hearing screen and SpO2 screening
- Universal Newborn Hearing Screen: Before hospital discharge, your baby will undergo a hearing test called Automated Auditory Brainstem Response (AABR) test. Early detection of hearing loss allows for timely intervention and treatment which are crucial for speech development.
- Pulse Oximetry (SpO2) Screening: A pulse oximetry device (a soft plastic sticky tape probe) is used to read the oxygen level in your baby’s blood. This is to exclude heart or lung conditions that some babies may have. The reading will be performed by the nurses when baby is 22 – 36 hours old over the right hand and one foot (right or left), and will take 10 – 15 minutes to complete.
Provide necessary supplements (vitamin D drops)
Give Vitamin K injection and vaccinations (BCG and HepB vaccines)
- Vitamin K will be administered via an intramuscular injection to your baby within the first few hours of life. This helps to prevent neonatal haemorrhagic disease (a bleeding disorder which can be caused by Vitamin K deficiency).
- Hepatitis B virus can potentially cause severe liver damage.
- Bacillus Calmette-Guerin (BCG) is a vaccine given to protect against Tuberculosis (TB) infection, which is still common in Asia. It reduces the risk of developing all forms of TB by 50% and deadly forms of TB by up to 80%.
Collect stool
Collect cord blood

For mother

Welcome back for your second visit after delivery! At today’s visit, we will be checking up on you and monitoring your postpartum progress to ensure that you have a smooth recovery. This will be the point when we encourage you to resume your regular activities and help you rebuild your physical health.

Measure height, weight, blood pressure, and do a urine test
Review lactation (with breast assessment) and milk feeding
Examine episiotomy or caesarean wound; perform bowel and bladder assessments
- Bowel and bladder assessments: Check for fecal and urinary incontinence
Perform physical activity risk assessment
- Physical activity risk assessment: Check for safe return to exercise after delivery
Continue guidance on physical recovery from birth, wound care, lochia, after pains and pain relief - (See “At Birth” section)
Provide guidance to rebuild physical health rest, exercise (postpartum and Kegel)
Provide guidance to resume regular activities sleep, sex, contraception, and birth spacing
Provide postpartum healthcare well women’s check, mental and emotional health, blood pressure and sugar, postnatal management of chronic diseases
Review supplement intake
Collect breast milk

For baby

Measure weight, length and head circumference
Review umbilical cord
Review BCG injection site
Perform jaundice check
- Jaundice check: Transcutaneous or serum bilirubin test will be performed. If bilirubin level is high, phototherapy will be required to treat jaundice. In very severe jaundice, exchange transfusion might be necessary. High bilirubin may cause brain damage.
Review supplement intake
Collect stool

For mother

Welcome to your third postpartum visit! If you had diabetes in this pregnancy, this will be the time to recheck your blood sugar levels. We will continue to monitor your postpartum progress and provide you with advice on how to care for you and your newborn.

Measure height, weight, blood pressure, and do a urine test
Review lactation (with breast assessment) and milk feeding
Examine episiotomy or caesarean wound; perform pain assessment; bowel and bladder assessments
Discuss about contraception plans
Perform blood test for OGTT
- Oral glucose tolerance test (OGTT) is done by blood draw at fasting and 2-hour after taking the sugar drink.
Perform physical activity risk assessment
Perform mental health assessment
- Mental health assessment: Assess for the risk of postnatal depression.
Review lifestyle practices
Review supplement intake
Collect stool and breast milk

For baby

Measure weight, length and head circumference
Perform developmental assessment
Give vaccinations (Hep B, DTaP, IPV and Hib vaccines; optional for Rotavirus vaccine)
- Diphtheria, tetanus and acellular pertussis (DTaP) vaccine: Diphtheria is a serious throat infection that can block the airway and cause severe breathing problems. Tetanus (lockjaw) is a nerve disease that caused by toxin-producing bacteria contaminating a wound. Pertussis (also called “whooping cough”) is a respiratory illness with cold-like symptoms that lead to severe coughing.
- Inactivated poliovirus (IPV) vaccine: Polio causes permanent muscle paralysis which may involve one or both arms and /or legs as well as the muscles used to breathe and swallow.
- Haemophilus influenza type b (Hib) bacteria was the leading cause of meningitis in children younger than 5 years old until the Hib vaccine became available. It also used to be a common cause of infections in the ears, lungs, blood, skin, and joints in children.
- Rotavirus vaccine is administered by putting drops in the baby’s mouth to protect from Rotavirus disease that can cause diarrhoea.
Review supplement intake
Collect stool

For mother

Welcome to your fourth month postnatal visit! At this stage you should be able to resume your normal pre-pregnancy activities. Like the last visit, we will be monitoring your physical and mental health.

Measure height, weight, blood pressure, and do a urine test
Review milk feeding (breast assessment as required)
Perform physical activity risk assessment
Perform mental health assessment
Review lifestyle practices
Review supplement intake
Collect breast milk

For baby

Measure weight, length and head circumference
Perform developmental assessment
Discuss SWAP
- SWAP: Structured Weaning Action Plan
Give vaccinations (DTaP, IPV, Hib and PCV; optional for Rotavirus vaccine)
- Pneumococcal conjugate vaccine (PCV) protects against a type of bacteria that is a common cause of ear infections. This type of bacteria can lead to meningitis (inflammation of the membranes covering the brain and spinal cord) and bacteremia (infection in the blood stream).
Review supplement intake
Collect stool

For mother

Congratulations on coming this far! Like the last visit, we will monitor your physical wellbeing and provide you with advice as required.

Measure height, weight, blood pressure, and do a urine test
Review milk feeding (breast assessment as required)
Review lifestyle practices
Review supplement intake
Collect breast milk

For baby

Measure weight, length and head circumference
Perform developmental assessment
Initiate SWAP
Give vaccinations (HepB, DTaP, IPV, Hib and PCV vaccines)
Review supplement intake
Collect stool

For mother

We are almost at the end of the HELMS journey! If you are planning for another pregnancy, this will be a good time to discuss pre-pregnancy care in preparation for your next pregnancy.

Measure height, weight, blood pressure, and do a urine test
Provide pre-pregnancy care in preparation for next pregnancy
Review lifestyle practices
Review supplement intake
Collect breast milk

For baby

Measure weight, length and head circumference
Perform developmental assessment
Initiate SHaPe
- SHaPe: Shaping healthy Habits and Practices
Give vaccinations (PCV, MMR and VAR vaccines)
- Measles, mumps and rubella (MMR) are infections that can lead to serious illness. More than 95% of children who receive the MMR vaccine will be protected from the three diseases throughout their lives.
- Varicella (VAR) vaccine helps prevent chickenpox, a common and very contagious childhood viral illness.
Review supplement intake
Collect stool

For mother

Welcome to your last visit of this HELMS journey! We will continue to monitor your postnatal progress at this visit and provide advice as necessary. Thank you for embarking on this journey with us and we look forward to seeing you again at your next pregnancy journey!