A Pre-Discharge Checklist for Improving Facility-Based Postnatal Care for Mothers and Newborns
The day of birth can bring great joy to families. It is also a time when mothers and newborns face significant risks. Globally, 45% of postpartum maternal deaths occur on the day of birth, and 66% take place during the first week after birth. In 2012, an estimated 36% of all neonatal deaths occurred on the day of birth, and 73% of all neonatal deaths occurred within the first week of life.
USAID’s flagship Maternal and Child Survival Program (MCSP) is working to improve the quality of maternal and newborn care during this critical time period. The Program has developed a point-of-care postnatal care (PNC) pre-discharge checklist and poster to help providers recognize danger signs in mothers and newborns and to remind providers of key health interventions to promote best practices for mothers and families.
The checklist is grounded in the 2013 World Health Organization (WHO) Guidelines for PNC for Mothers and Newborns, which address both the timing and content of PNC interventions for mothers and newborns, with a focus on resource-limited settings. The pre-discharge checklist and poster support adherence to WHO guidelines for high-quality, evidence-based postnatal care.
Providers must administer many essential interventions for mothers and newborns during the pre-discharge period, including ensuring prompt recognition of life-threatening complications. The checklist is designed to be a simple, user-friendly “bedside” tool to help health care workers provide efficient, integrated, high-impact care for the mother-baby dyad during this important phase. Health care workers can incorporate the checklist into their workflow by using it as a visual aid when caring for women and newborns.
The simple, two-page checklist guides providers through the assessment of specific danger signs in the mother and newborn and the provision of essential interventions and counseling needed by all mothers and newborns before discharge. Illustrative checklist items include the following:
- Identifying abnormal bleeding in the mother,
- Recognizing breathing problems in the newborn,
- Assessing and supporting breastfeeding,
- Administering newborn immunizations,
- Providing postpartum family planning counseling and services, and
- Reminding mothers about follow-up PNC
The poster acts as a prompt for key PNC interventions for providers as well as for women and their families, encouraging families to be engaged in the PNC process.
Using and adapting the pre-discharge checklist in Rwanda
In Rwanda, MCSP staff report that providers are using the checklist and poster to ensure that women and newborns receive high-quality, essential care before leaving the facility. This pre-discharge care is particularly crucial given that only 43% of women in Rwanda currently receive PNC within two days of birth, and only 19% of newborns receive such care within two days of birth.
Given the low rates of postnatal visits, the MCSP/Rwanda team has found the PNC checklist and poster to be useful for encouraging mothers and newborns to stay in facilities for at least 24 hours and complete their first post-discharge PNC visit. To suit the needs of Rwandan providers, the team adapted the pre-discharge checklist (pictured at left) by adding delivery date/hour and release date/hour fields to the checklist and translating it into French to make the tools accessible to Francophone providers.
Dr. Beata Mukarugwiro, MCSP/Rwanda’s Technical Director, acknowledged that completing checklists and forms can be challenging in facilities that already face extensive data entry and reporting requirements as well as time constraints. MCSP designed these tools to be simple and concise to lessen this burden on providers, enabling them to cover essential PNC practices efficiently and effectively.
“We are committed to improving PNC through the use of these resources,” Dr. Mukarugwiro said. “The Program’s Maternal Health and Essential Newborn Care teams are supporting providers in health facilities to incorporate the checklist and poster into their routine care practices.”
Laudably, the checklist has been adapted by the Ministry of Health through MCSP support. The Program continues to work with the Ministry to implement and scale up the use of the checklist in facilities and communities. Moreover, these efforts have been supported and accompanied by corresponding national updates to the PNC register used by facilities to track PNC.
Globally, MCSP will continue to support use of the pre-discharge checklist and poster to improve essential PNC practices for mothers and newborns. The tools are currently being used in Nigeria and Pakistan, and an adapted version of the PNC checklist with Zika-specific content will soon be introduced in Haiti.
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Photo credit: In the postpartum room of Nzige Health Center in Rwanda, a mother and newborn are attended by an MCSP-trained midwife (Guido Dingemans/Jhpiego)