In developed countries virtually all women and their infants receive postpartum and postnatal care, albeit the nature and frequency of this care varies considerably. In developing countries the need for care and support after birth was, until recently, less well recognized. Despite its importance, this period is generally the most neglected. Rates of provision of skilled care are lower after childbirth than during pregnancy or childbirth, even though both the risks for illness and the potential to improve longer-term outcomes are as great (2).
There are few data on early postnatal care specifically, but clearly many women do not receive optimal care. Many women who give birth in facilities are discharged within hours after childbirth without any indication where they can obtain further care or support. Also, harmful health care practices are still prevalent and contribute to mortality. For example, care providers or institutions may not promote, protect and support early initiation of breastfeeding, and they may even delay or discourage breastfeeding, thus undermining successful exclusive breastfeeding. More than half of infants are not exclusively breastfed (9), contributing to malnutrition and infections.
Current models of postpartum care in developed countries originated in the beginning of the 20th century in response to the high maternal and neonatal mortality rates of the time (2). Postpartum care for the mother has conventionally focussed on routine observation and examination of vaginal blood loss, uterine involution, blood pressure and body temperature. Guidance for health-care professionals on other postpartum practices has been limited (10). Similarly, postnatal care for the baby has conventionally focussed on cord care, hygiene and weight monitoring and feeding and/or immunizations, without systematic, comprehensive assessment and care of newborns.
The timing and content of this care has remained more or less unchanged since the beginning. Only recently have there been any suggestions for change. Attention to the dramatic reduction in maternal and newborn mortality rates in developed countries that occurred around the middle of the 20th century, accompanied by the increased involvement and participation of women themselves in the nature of their care, has led to interest in revising the current remit for provision of care.
Research into the current coverage and content of postpartum and postnatal care has been limited. The average and the range in the number of visits or contacts that women and their infants have with their health-care providers are not well documented. Even in developed countries there has been little evaluation to assess whether current models of care meet individual women’s and babies’ physical and emotional health needs and whether they make the most appropriate use of the skills and time of the relevant health care professionals and of financial resources. The needs of fathers/partners have not been thoroughly evaluated. Neither have the concerns of women from diverse cultures been adequately explored. Nor has there been comprehensive study of the requirements of women with specific needs, such as women with physical disabilities or following complications of childbirth.
The major purposes of postpartum and postnatal care are to maintain and promote the health of the woman and her baby and to foster an environment that offers help and support to the extended family and community for a wide range of related health and social needs. These needs can involve physical and mental health as well as social and cultural issues that can affect health and well-being. Also, new parents need support for parenting and its responsibilities. Thus, the conceptual framework for guidance on postpartum and postnatal care should place the woman and her baby at the centre of care provision. This concept promotes the appreciation that all postpartum and postnatal care should be delivered in partnership with the woman and her family and should be individualized to meet the needs of each mother-infant dyad.
While this concept of care does not directly relate to the management of a condition or an acute situation, recognizing danger signs and taking timely action if they appear are crucial. Delays can be fatal. Therefore, guidance also should reflect the epidemiological pattern of health conditions occurring in the postpartum and postnatal period and thus address important public health needs at the appropriate times.
It is important to identify the essential, or core, care that every woman and her newborn baby should receive during the first six weeks after birth, based upon the best evidence available. Besides clinical interventions, core care will include providing information to support the woman in caring for herself and her baby and also building the support of family and community. For most women and babies the postpartum and postnatal periods are uncomplicated. Still, core postpartum and postnatal care also should include recognizing, evaluating and intervening appropriately if any deviation occurs from the expected course of events after childbirth.
In broader context, most care in the postpartum and postnatal period takes place at home, where the woman is caring for herself and her baby, supported by her family. One objective of postpartum and postnatal care delivered through the health system is to encourage mothers and families to adopt evidenced-based practices at home and to build sustaining community support for these practices.
Increasingly, women (and mothers) are formally employed. These women need maternity protection, which should include maternity leave. Maternity Protection Conventions of the International Labour Organization (11) specify the maternity benefit package, which includes 14 weeks of paid maternity leave to ensure exclusive breastfeeding. For women who have given birth but do not have a live infant, the Conventions specify six weeks of paid maternity leave.
