Integrated Maternal and Newborn Care Basic Skills Course ...

CHAPTER 10: Postnatal Care of the Newborn, at the
Facility and During Postnatal Visits
Some use the words postpartum and postnatal synonymously. Others use the word postpartum
(after delivery) for the mother and the word postnatal (after birth) for the baby. In this session
the word postpartum will be used for the mother and the word postnatal for the baby, for easy
differentiation.
The postnatal/postpartum period starts after the delivery of the placenta and extends to 6 weeks
after birth. Guidelines for assessment and care may be followed during specific time intervals,
as with the WHO classification: at birth, the first hour, around 6 hours, after 6 days, and after 6
weeks. However, the length of the stay in the delivery room and the postnatal ward and the day
of discharge vary considerably in different countries and at different levels of facilities. Thus,
these intervals, especially the hourly ones, may at times be difficult to identify and adhere to.
An alternative classification—with specific, easily identifiable times for specific activities rather
than just the period of time that has elapsed—may be easier to use. This classification is as
follows:
• at birth (in the delivery room)
• before the mother and baby leave the delivery room
• every day during the stay at the facility
• at discharge from the facility
• at the postnatal visits
TIMING OF MOST NEONATAL DEATHS
As noted in the introduction, 50 percent of deaths in the newborn period take place within 24
hours of birth and 75 percent by the end of the first week of life.
There are currently no specific recommendations based on evidence for the timing and numbers
of contacts in the postnatal period at the facility and in the community. There is some evidence
to suggest that home visits by community health workers on day two have been correlated with
a decrease in neonatal mortality. However, in view of the high mortality during the first week, it
is clear that these recommendations for the postnatal period need to focus on this period,
especially the first 48-72 hours.
COMPONENTS OF POSTNATAL CARE
The postnatal period has been the most neglected period in the pregnancy/delivery/postnatal
continuum of care. Both health workers and mothers/families are not, in general, aware of the
potential dangers and high mortality in the early postnatal period. Mothers and babies tend to
stay home after a delivery, and there is also a lack of motivation among families to bring
mothers and babies for early and regular check-ups, especially if the babies or mothers seem
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Integrated maternal and newborn care
Basic skills course