Worldwide, more than three women and babies in 10 currently do not receive postnatal care in the first days after birth, the period in which most maternal and infant deaths occur. In that time frame, the physical and emotional consequences of childbirth – from injuries to recurring pain and trauma – can be debilitating if left untreated, though they are often very easy to treat if the right care is given at the right time.
“Once the baby is born, it is still necessary to offer quality care to the mother and the newborn,” said the Dr. Anshu Banerjee, Director of the WHO Department of Maternal, Newborn, Child and Adolescent Health and Aging. “Indeed, the birth of a baby is a very life-changing event, in which feelings of love, hope and excitement are mixed, but it can also cause unprecedented stress and anxiety. Parents – especially women, whose needs are too often neglected after the baby is born – need strong health care and support systems.”
In addition to addressing immediate health issues, the first few weeks after birth are critical for bonding and behaviors that impact long-term infant development and health. The guidelines include recommendations for breastfeeding advice – for example, facilitating anchoring and positioning in the lactation setting – and for helping parents provide tailored care for their newborn babies.
In total, the new guidelines bring together more than 60 recommendations that help shape a positive postnatal experience for women, babies and families. Here are some of the recommendations:
- Quality care in health facilities for all women and babies for at least 24 hours after birth, with a minimum of three additional postnatal checkups in the first six weeks. This should include home visits, if possible, so that the health worker can facilitate the transition to care at home. If the birth has taken place at home, the first postnatal visit should be as soon as possible, and no later than 24 hours after the birth.
- Measures to detect and respond to danger signs that require urgent medical attention, whether it is the woman or the baby.
- Treatment, support and advice to facilitate recovery and manage common problems women may experience after childbirth, such as perineal pain and breast engorgement.
- Screening of all newborns for eye abnormalities and hearing impairments, and administration of appropriate vaccinations at birth.
- Support to help families interact with babies and respond to their signals, and stay in close contact with them and offer them warmth and comfort.
- Advice on exclusive breastfeeding, access to contraception and postnatal health promotion, in particular the practice of physical activity.
- Promoting the participation of the couple, so that they are present at check-ups, for example, and provide support to the woman and take care of the newborn.
- Screening for postpartum depression and anxiety in the mother, with referral and treatment services if needed.
The recommendations specify the minimum duration of hospital stay after birth and offer guidance on the criteria for discharge, although it is indicated that the time required will depend on each woman and each baby, the social context, the experience of the childbirth and the existence of any health problem. Additional postnatal visits are recommended for healthy women and newborns between 48 and 72 hours after delivery, between seven and 14 days, and during the sixth week. If health risks are detected, further consultations will probably be required, with treatment that may need to be continued beyond the first six weeks.
“The data shows that women and their families want and need a positive postnatal experience that helps them overcome the immense physical and emotional challenges that occur after the birth of babies, as well as boost their confidence as parents,” said the Dr. Mercedes Bonet, Medical Officer of the Department of Sexual and Reproductive Health and Related Research of the WHO and the United Nations Special Program on Human Reproduction (HRP). “Specialized postnatal services must provide vital physical and mental health support, and help caregivers do their best by providing appropriate care for their newborns.”
These recommendations culminate a trilogy of WHO guidelines for quality maternity care during pregnancy, childbirth and the postpartum period that focus on meeting the needs of all women giving birth and their babies. The guidelines uphold the rights to a positive health care experience, where people are treated with dignity and respect and can actively participate in making health decisions that affect them.
Grades
The guidelines include 63 recommendations, some of which are already existing and still relevant, and 31 new or updated recommendations. These guidelines are now the official WHO reference point for all aspects of postnatal care.
WHO guidelines on antenatal care and delivery can be accessed at the following links:
Guidelines on care during childbirth