Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
normal. Skilled health workers do not generally carry out home visits in most countries; in some
areas, it may be difficult to have community health workers make home visits at suitable times.
Promotion of early postnatal visits is essential, but it is likely that strategies to deal with the
different scenarios that exist and for “covering” the first week of life, including the first 2-3 days,
are even more important. The possible scenarios for this critical period include the following.
• Deliveries may take place at home, and both the mother and the baby may remain there
throughout the neonatal/postpartum period, bound frequently by strong cultural practices
that, in general, prevent them from going outside their homes.
• Where deliveries take place at the facility level, the stay for a normal delivery may vary
considerably, from a few hours to 2-3 days. Too early a discharge is frequently
associated with inadequate time for evaluation, care, and counseling. Longer stays are
associated with overcrowding, potential risk of nosocomial infections, increased costs,
and poor compliance by families.
• Chances of an early first visit to the health center after a home delivery and return after
discharge from a facility birth depend on the degree of motivation, constraints due to
challenges in family finances and transport, resulting in poor access, quality, and the
cost of the care provided.
Thus strategies for postnatal assessment and basic care need to include both facility and
community components, involving trained skilled health workers and community health workers
(CHWs), with links between the two. These may include home visits by CHWs and visits by
mothers and babies at the facility, depending on the above scenarios.
Through community mobilization and communication strategies, including interpersonal
communication and traditional methods and use of mass media, families at home can learn
about basic preventive care, identifying danger signs, and seeking appropriate care. Trained
CHWs making home visits can also contribute to the latter components. It is far more difficult in
most countries for skilled birth attendants to make home visits. Good links between community
and facility level workers can help promote referrals to health centers as required.
In facility deliveries, after birth, it is critical to ensure careful examinations of the mother and
baby by the skilled birth attendant, with appropriate actions at three points:
• just before transferring them out of the delivery room to the rooming-in ward
• at least once a day during their stay at the facility
• just before discharge
These evaluations will help to identify special risk factors or problems in the early stages that
may necessitate some treatment, a longer stay at the facility, special advice, and/or an earlier
follow-up appointment. Proper counseling, especially at discharge, on preventive care at home,
identifying danger signs, and appropriate care seeking are also extremely important.
Content of the Postnatal Visit
In addition to having an early visit/contact at the appropriate time, the content and quality of the
visit need to be considered. Key components are noted below:
• courteous, supportive behavior towards the mother/family
Integrated maternal and newborn care
Basic skills course
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