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According to the Sample Registration System (SRS) Bulletin, the Infant Mortality Rate (IMF) in India declined from 37 per 1000 live births in 2015 to 34 per 1000 live births in 2016. The total number of estimated infant deaths too came down from 9.3 Lakhs in 2015 to 8.4 Lakhs in 2016. Lack of proper care for the new mother can cause unseen complications and ultimately cause deaths that could have been easily avoided.

On the bright side, another bulletin issued by the SRS stated that the Maternal Mortality Rate declined to 130 in 2014-16 from 167 in 2011-13, a significant decrease that added to the country’s overall growth and progress. Dr. Ajay Khera, Deputy Commissioner, Child Health, Health Ministry stated that around 80% of all women in India are giving birth in hospitals – either private or public (www.hindustantimes.com). Although the IMF and MMR have decreased significantly, there is still a lot of scope for growth and development. To ensure that more babies see the light of day and more new mothers too live to see their babies, we must understand the pressing importance of postnatal care for the mother and the newborn.

What is postnatal care?

Postnatal care is the care given to the mother and her newborn baby for the first six weeks. Even without this period of time, postnatal care during the first seven days is extremely important can make a huge difference in the health of both the baby and the mother. However, one must keep in mind that the neonatal period – from birth to the 28th day after birth is risk prone time.

For a preterm baby or a baby born with defects, postnatal medical care is even more important. If your baby or you are faced with a life-threatening condition, effective postnatal care must be deployed in the first few hours or days, or it might be too late. Thorough and detailed postnatal care should ideally ensure that these medical conditions are detected at the earliest and managed as soon as possible.

Simply put, the primary objective of providing postnatal care to the mother and baby is to prevent both and maternal and neonatal deaths along with long-term complications.

Why is the postnatal period a risky one?

The first 6 hours after delivery are considered to be a critical time period as complications are most common at this time. Complications may arise due to excessive blood loss during delivery, rupture of the uterus or a haemorrhage. These problems can threaten the lives of both the mother and baby, especially if the baby doesn’t get the required amount of oxygen and nutrients.

It is quite normal for women to lose some amount of blood while delivering a baby. However, as mentioned above, excessive blood loss can lead to problems. During the period of labour, women tend to lose body fluids as well in the form of vomiting and sweating. If they aren’t kept sufficiently hydrated after giving birth, physiological complications are more likely to occur.

WHO recommendations on postnatal care for the mother and the newborn

The guidelines prescribed by the World Health Organisation (WHO) focus on postnatal care of mothers and newborns for low and middle-income countries. Although the guidelines were designed primarily for health professionals who are responsible for providing postnatal care to women and newborns, there is a lot we can learn from it as well.

Highlights of the postnatal care guidelines recommended by the WHO

• All newborns should be exclusively breastfed as soon as possible and continued till the baby is 6 months of age.
• Helpful tips and correct ways to keep the baby warm.
• Increasing hand washing and providing hygienic umbilical cord and skin care.
• Learning how to identify medical conditions that needs instant or additional care.
• During home visits, the mother and the newborn should be examined for danger signs.
• If danger signs exist, they should be attended to immediately.
• Special care should be given to preterm babies, babies with low birth weight, babies who are sick, or are born to HIV-infected mothers.
• The mother and the baby should stay in the hospital for at least 24 hours, if not 48 after delivery.
• Postnatal visits should be scheduled.
• In case of a home birth, a visit to a health facility for postnatal care as soon as possible is recommended.
• In areas, where health care and facilities are limited, both the WHO and UNICEF recommend at least two home visits for all home birth. The first visit should occur within hours after birth and the second visit should be on Day 3.

Postnatal care for the mother and newborn in the hospital

As mentioned above, the first 48 hours after delivery a baby are the most crucial ones and that is why is important to stay in the hospital. Let’s take a look at what you can expect from postnatal care in the hospital:

#1. Postpartum bleeding

It is the doctor’s duty to discuss post-delivery bleeding with you – how much is normal, what they can expect and for how long. If bleeding is not normal and excessive, special care should be given instantly.

Discussion of normal postpartum bleeding and lochia – discuss with women how much blood loss they can expect, for how long. When bleeding is more than normal, they should seek care urgently.

#2. Skin contact

Right after your baby is born, you will be transferred to the Maternity Ward if all goes well. At this point of time, midwives will familiarise you with the “Skin-to-Skin” contact. It helps you and your baby bond better, regulates your baby’s breathing and temperature and also reduces the risk of infections.

#3. Breastfeeding

As soon as your baby has been cleaned and handed to you, midwives will encourage you to breastfeed your baby. WHO recommends exclusively breastfeeding your baby for the first 6 months. If you are having a hard time trying to breastfeed your baby, you will be taught helpful techniques along with latching tips.

#4. Baby care

Before you head home, you will be taught everything you need to know about taking care of your baby’s skin, including how to massage him.

#5. Self-care

Along with the well-being of your baby, midwives and doctors will advise you to schedule visits, give your dietary tips and introduce your to the benefits of massaging your own body as well. If you feel like you are suffering from postpartum depression, please do talk to your doctor about it. He/she will help your identify the symptoms and also how you can ease the emotional pain of depression.

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