The days and weeks following childbirth – the postnatal period – is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time. Yet, this is the most neglected period for the provision of quality care. WHO's Postpartum care of the mother and newborn: a practical guide (WHO/RHT/MSM/98.3) was published in 1998. Guidance from this document was included in the WHO guideline Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice, published in 2004 (http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf). In keeping with the WHO Handbook on development of guidelines, these documents needed to be updated to include current best evidence-based practices.

To initiate the guidelines update process, WHO convened a technical consultation in October 2008. At this consultation, existing WHO and other agency guidelines related to postnatal care were reviewed for best practices and supporting evidence. Areas were identified where guidance was non-existent or conflicting, and these were prioritized for further work. The process of evidence review synthesis and establishment of a Steering Group and Guidelines Development Group (GDG) was taken up during 2011–2. Systematic reviews were commissioned to address the timing and content of postnatal care and contacts for the mother and newborn following normal childbirth. The GDG consultation to formulate recommendations was held in Geneva from 3–5 September 2012.

The primary audience for these guidelines is health professionals who are responsible for providing postnatal care to women and newborns, primarily in areas where resources are limited. These health professionals include physicians, midwives, nurses and auxiliary nurse-midwives providing primary health care in facilities and at home. The guidelines are also expected to be used by policy-makers and managers of maternal and child health programmes, health facilities, and teaching institutions to set up and maintain maternity and newborn care services. The information in these guidelines will be included in job aids and tools for both pre- and in-service training of health professionals to improve their knowledge, skills and performance in postnatal care.

The guidelines focus on postnatal care of mothers and newborns in resource-limited settings in low- and middle-income countries. The critical maternal health outcome considered was maternal morbidity (including haemorrhage, infections, anaemia and depression). The two critical neonatal outcomes were neonatal mortality and morbidity. Other important outcomes included growth, cognitive development and breastfeeding status.

The guidelines address timing, number and place of postnatal contacts, and content of postnatal care for all mothers and babies during the six weeks after birth. The guidelines include assessment of mothers and newborns to detect problems or complications, but the management of these conditions is addressed in other WHO documents (e.g. management of a mother with postpartum haemorrhage – PPH – or infection, care of a preterm or low-birth-weight newborn or a newborn with infection).

Through 2011–12, the Department of Maternal, Newborn, Child and Adolescent Health coordinated efforts to review and synthesize the evidence on the priority questions. The process included targeted systematic reviews of relevant literature, preparation of GRADE¹ profiles, and analysis of the benefits and risks, values and preferences, and costs of implementation. The systematic reviews, meta-analyses and GRADE profiles were conducted by different expert groups using the methodology recommended by the Guidelines Review Committee.

In drafting the recommendations, the WHO Steering Group used the summaries of evidence for the critical outcomes, quality of evidence, risks and benefits of implementing the recommendations, values and preferences and costs. The draft recommendations, evidence summaries, GRADE tables and information on benefits and risks, values and preferences, and costs were presented to the GDG at its meeting held at WHO headquarters in Geneva, Switzerland, in September 2012. The GDG reviewed and discussed this information to finalize the recommendations. Individual members of the GDG filled in a worksheet to comment on the quality of evidence and the draft and strength of the recommendation before discussing these as a group. Where the GDG determined that there was insufficient evidence, consensus within the group was used as the basis of the recommendation. The decisions on the final recommendations and their strengths were made by consensus or, where necessary, by vote.

The recommendations for postnatal care of mothers and newborns are summarized in the table below. These recommendations will be regularly updated as more evidence is collated and analysed on a continuous basis, with major reviews and updates at least every five years. The next major update will be considered in 2018 under the oversight of the WHO Guidelines Review Committee.