Self-Assessment Questions (SAQs) for Study Session 2

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the questions below. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 2.1 (tests Learning Outcome 2.1)

Which of the following statements is false? In each case (i) explain what is incorrect, and (ii) define the term that is in bold.

A  A woman during the puerperium will not normally produce lochia after the birth.

B  Initiation of lactation and production of colostrum follows soon after delivery of the baby.

C  Breast engorgement is a sign that breastfeeding can be initiated.

D  The endometrium can take seven weeks to heal after the birth.


A  False: all postnatal women will have watery, coloured vaginal discharge (lochia) for around five weeks after the birth. This is about the same time as the puerperium – which is the postnatal period of physiological changes occurring during the five to six weeks after childbirth.

B  True: initiation of lactation – i.e. the production of colostrum (a creamy yellow nutrient rich ‘first milk’ which also contains the mother’s antibodies), follows automatically soon after delivery of the baby and then true milk begins after about three days.

C  Not quite true: breast engorgement is a response to the initiation of the milk supply and usually happens about three days after the delivery. Mothers are encouraged to initiate breastfeeding within one hour of the birth.

D  False: the endometrium (which is the inner lining of the uterus) heals rapidly and by the seventh day is normally restored except at the placental site.

SAQ 2.2 (tests Learning Outcomes 2.2 and 2.3)

You are seeing a woman who gave birth to her second child 14 days ago. She looks reasonably well, but she seems a bit worried. Briefly describe all the checks you would do to make sure that everything is OK and she is recovering normally.


There are many checks that you could do – here are some of the key ones:

  • By palpating below the women’s umbilicus, you can see if the uterus has shrunk at the normal rate.
  • Ask her whether she has a lot of vaginal discharge and what colour it is.
  • By doing a vaginal examination, check that the cervical opening has shrunk to less than one finger width.
  • Examine whether the swelling of the vagina and vulva is going down or has nearly gone.
  • If the perineum was cut or torn during the birth, make sure it is healing properly, and if so encourage the mother to start exercising her perineum muscles.
  • Check if she has difficulty breastfeeding, or (if she has decided not to breastfeed) that she is managing to reduce her milk production.
  • Check that the baby is neither too hot nor too cold, is feeding well and passing stools regularly.
  • Ask, tactfully, if the mother feels any pressure from her partner to resume sexual intercourse before she feels ready to do so.
  • Try and assess whether she may be taking on too much work too soon.
  • With the physical checks there are key signs which will tell you whether the puerperium is progressing normally, and if it is, you can reassure your worried mother. What she feels able to say to the more personal questions will be more difficult to assess. You will have to use all your sensitivity and tact in order to judge whether something else may be going wrong.

Summary of Study Session 2