Every woman and newborn should be closely monitored together after childbirth; both should be checked every 15 minutes for the first 2 hours and then regularly for the next 24 hours. The early postpartum period is a critical time for the onset of PPH in the mother. The baby needs to be monitored for respiration, temperature, breastfeeding, and bleeding from the cord.[i]
The mother and newborn must be assessed carefully before they are discharged from the facility or before the care provider leaves the mother’s home to detect any high-risk factors or potential problems that might need closer observation. Newborns delivered in health facilities should not be sent home in the critical first 24 hours after birth.[ii] Mothers who deliver at home should be checked within the first 24 hours. Subsequent checks, regardless of delivery location, should take place on Day 3 after birth, in the first 2–3 weeks, and at 6 weeks.[iii]These checks are also an opportunity for the care provider to counsel the mother and family members on preventive care, detect danger signs, and encourage appropriate care seeking.
The following components are part of routine PNC[iv]:
- Check health of mother and newborn.
- Counsel the mother on FP methods and provide the method the mother chooses.
- Counsel on the mother breastfeeding,[v] nutrition,[vi] hygiene, rest, and infant care, including cord care.
- Counsel the mother on danger signs (see the following paragraphs) and care-seeking.
- Counsel the mother on sleeping under an ITN in malaria-endemic areas.
- Promote birth registration and timely immunization according to national schedules for the newborn (see immunizations in later paragraphs).
- Promote daily maternal iron and folate supplementation for 3 months in areas where anemia prevalence among pregnant women is greater than 40%. In other areas, promote daily maternal supplementation until the woman has consumed 180 tablets if she did not complete 6 months of daily iron and folate supplementation during pregnancy.
Mothers should be counseled on the following maternal danger signs:
- Excessive bleeding
- Feeling very weak
- Breathing difficulties
- Foul-smelling discharge
- Painful urination
- Severe abdominal or perineal pain
Mothers should be counseled on the following newborn danger signs:
- Poor sucking or inability to suck
- Inactivity or lethargy
- Fast breathing, difficulty in breathing, chest or subcostal retraction
- Fever or body too cold;
- Vomiting or abdominal distention
- Signs of umbilical infection (pus discharge at base, surrounding redness or swelling, foul smell)
Newborns should receive vaccines according to national immunization guidelines. BCG should be given as soon as possible after birth; OPV0 should be given between birth and 2 weeks of age. Perinatal transmission of Hepatitis B (HB) is common, and HB vaccine, if given before infection, can prevent disease and keep nearly all individuals, including infants, from becoming carriers. The vaccine is most effectively used as a routine part of the infant immunization schedule, although it can be used at any age.
Postnatal Care at the Community Level
Healthy women and their newborns should stay at a health facility at least 24 hours, but after that, postnatal care (PNC) does not need to be facility-based. In many settings, properly trained health providers or CHWs can provide basic PNC at home.[i] Regardless of where the birth took place, mothers and babies need at least four postnatal visits in the first 6 weeks: (1) within the first 24 hours, (2) 3 days after birth, (3) between 1 and 2 weeks (Days 3–14) after birth, and (4) 6 weeks after birth. Traditional practices often keep the mother and her baby at home for variable periods up to 6 weeks after birth. Thus, CHWs can play a role in making home visits in the postnatal period. Community mobilization and home visits by CHWs, in synergy, would increase coverage of newborn care practices and reduce neonatal deaths. Both timing of visits and treatment interventions are critical.[ii],[iii]
In addition to defining the timing and number of PNC visits, it is essential to state content clearly so that each visit is goal-oriented. A newborn care package can be tailored to specific contexts, depending on variables, such as the availability, accessibility, and utilization of skilled providers and health facilities or the primary causes of neonatal mortality in a region.
It is important to consider that more women receive ANC than PNC, and women and their families should be knowledgeable about newborn danger signs, newborn care, and postpartum family planning before the baby is born. Mothers and their families should learn about these topics and the importance of PNC in the antenatal period, and these lessons should be reinforced during the postnatal period.
Key Resources for Postnatal Care:
- WHO, 2010. Essential Newborn Care Course
- WHO, 2013. WHO Recommendations of Postnatal Care of the Mother and Newborn
- WHO 2012. Caring for the Newborn at Home: A Training Course for Community Health Workers
- Save the Children, 2014. Ending Newborn Deaths: Ensuring Every Baby Survives
- American Academy of Pediatrics, 2014. Essential Care for Every Baby.
- Chlorhexidine Working Group, 2014. Chlorhexidine for Umbilical Cord Care
- WHO, 2003. Kangaroo Mother Care: A Practical Guide
- WHO, 2006. Optimal Feeding of Low-Birth-Weight Infants
- WHO, 2003. Managing Newborn Problems
- CORE Group, 2011. Taking Care of a Baby at Home After Birth
- Save the Children, 2009. Newborn Care Charts: Management of Sick and Small Newborns in Hospital
[i] MCHIP and Save the Children, 2012. Postnatal Care Home Visits: a review of the current status of implementation in five countries. https://www.mchip.net/sites/default/files/Postnatal%20Care%20Home%20Visits.pdf
[ii] Lancet series on neonatal survival, 2005. https://www.thelancet.com/series/neonatal-survival
[iii] Nair, N., et al. Improving newborn survival in low-income countries: community-based approaches and lessons from south asia. Plos Med 2010;DOI: 10.1371/journal.pmed.1000246.
 In high-risk settings, apply antiseptic (selected antiseptic is 4% chlorhexidine) after cutting cord, apply Chlorhexidine to the cord’s tip, stump, and around stump base. Repeat daily in the first week or until cord separates—whichever comes first.
[i] For timing and purpose of postnatal visits, see WHO/UNICEF, 2009. Joint Statement Home Visits for the Newborn: A Strategy to Improve Survival. http://www.who.int/maternal_child_adolescent/documents/who_fch_cah_09_02/en/
[ii] WHO, 2010. Newborn Care at Birth.
[iv] PNC content is under review: see WHO, 2010. Technical consultation on postpartum and postnatal care. http://whqlibdoc.who.int/hq/2010/WHO_MPS_10.03_eng.pdf
[v] Also see LINKAGES, 2006. Feeding low-birthweight babies. http://www.linkagesproject.org/media/publications/FFF_LBW_3-30-06.pdf
[vi] Also see LINKAGES, 2004. Breastfeeding and maternal nutrition FAQ. http://www.linkagesproject.org/media/publications/frequently%20asked%20questions/FAQMatNutEng.pdf and CORE Group and LINKAGES, 2004. Maternal nutrition during pregnancy and lactation. https://coregroup.org/storage/documents/Workingpapers/MaternalNutritionDietaryGuide_AED.pdf