Strengthening the Evidence on Postnatal Care

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By: Annie Kearns, Project Manager, Maternal Health Task Force, Women and Health Initiative

WHO has released new Recommendations on Postnatal Care of the Mother and Newborn. This publication replaces an edition from 1998, and provides guidelines on fundamental postnatal care (PNC) which are particularly applicable to resource-limited settings in low- and middle-income countries. The guidelines apply to home births as well as those in health facilities, and can be adapted to meet particular needs in different regions. Some of the key recommendations include:

  1. All mothers and newborns should receive at least one PNC visit within 24 hours of birth, whether birth is in the home or a health facility. At least three additional contacts are recommended: three days after delivery, between seven and 14 days after birth, and six weeks after birth. Home visits are recommended during the first week after birth.
  2. Mothers should receive counseling and support for exclusive breastfeeding at each postnatal visit, and should continue exclusive breastfeeding from the child’s birth until 6 months of age.
  3. Daily chlorhexidine use is recommended for cord care in regions with high neonatal mortality (30 or more deaths per 1,000 live births), but clean, dry cord care is advised in areas with lower neonatal mortality.
  4. In the first 24 hours after birth, all women should have regular assessment of vaginal bleeding, uterine contraction, fundal height, temperature and heart rate. Blood pressure should be measured shortly after birth. At each subsequent contact, assessments should be made of any perineal or abdominal wounds and the provider should inquire about general and emotional well-being.
  5. Women should receive information on the physiological process of recovery after birth, including signs and symptoms of postpartum haemorrhage, pre-eclampsia/eclampsia, infection, and thromboembolism. They should also be counseled on good nutrition and hygiene practices as well as birth spacing and family planning.
  6. Psychosocial support is recommended for women considered at high risk of postpartum depression. A woman who has lost her newborn should be given additional supportive care.

With more specificity compared to the 1998 guidelines, this new publication gives health providers and policymakers greater support in developing care protocols tailored to their region’s needs. These recommendations are important for fueling discussion around PNC and moving towards a standard of care for mothers and newborns. Health systems which are properly staffed with professionals who are adequately trained and equipped can use these guidelines to administer postnatal care knowing that they are following best practices to reduce maternal and newborn morbidity and mortality.

It is worth mentioning that global conversation and funding devoted to care in the postnatal period have paled in comparison to that devoted to pregnancy and delivery care, particularly for mothers. With little funding, new techniques and delivery models for PNC have been slow to develop, and those that exist have not routinely been subject to the randomized control trials and other rigorous evaluation methods which better-funded areas of maternity care have undergone.

With 60% of maternal deaths in the developing world occurring postpartum (Middleberg 2003; Li 1996), the maternal health community must intensify its effort to build evidence of best practices in postnatal care. More research on effective postnatal care practices, successful care delivery models, and innovative approaches to strengthening maternal and newborn care across the continuum are sorely needed. The evidence base regarding the number and timing of postnatal visits, particularly for mothers, is lacking. While many of the WHO guidelines on the content of PNC for newborns are built on high- or moderate-quality evidence, there has not been adequate focus on the content of PNC for mothers and thus few evidence-based changes have been made to WHO’s recommendations since 1998.

What are your experiences with providing postnatal care? How do you think the maternal health community can work to expand the evidence base regarding PNC? What innovative approaches have you seen successfully used for delivering PNC? Let us know!

For further information on postnatal care, please visit our topic page.