of Postpartum Care
at the Community Level
Based on WHO Guidelines
Prepared by:
May Post, M.D.
Reproductive Health Advisor
CATALYST Consortium
Acknowledgement
CATALYST Consortium was asked by USAID to prepare a short paper based on WHO
Postpartum Care (PPC) guidelines. The objective of this paper is to provide participants
at the community-based postpartum care network meeting with a short overview of
WHO’s guidelines related to PPC. The paper’s focus is on key elements of PPC at the
community level.
Much of the information in this paper is derived from two WHO publications:
• WHO, 2003. Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for
Essential Practice.
• WHO, 1998. Postpartum Care of the Mother and Newborn: A Practical Guide
WHO/RHT/MSM.98.3. Geneva, WHO
These reports can be downloaded from
www.who.int/reproductive-health/publications/listing_maternal_newborn.en.html
This paper focuses on basic postpartum care for the normal mother and newborn at the
community level. It is by no means comprehensive, and readers should refer to the full
WHO documents and other references (listed at the end) for more detailed information
including management of maternal/newborn complications and Prevention of Maternal to
Child Transmission.
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Key Elements of Postpartum Care at the Community Level Based on
WHO Guidelines
1. Introduction
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2. Care and Service Provision in the Postpartum Period
• Wipe baby with wet cloth and dry (Do not bathe)
• Monitor baby for breathing: listen for grunting, count breaths, look for chest in-
drawing. Respond immediately if problems identified.
• Ensure thermal protection—provide a warm environment, keep newborn in skin-to-
skin contact with the mother
• Weigh the baby
• Provide cord care
• Provide eye care
• Assess general well-being (movements, muscle tone, swelling/bruises at the
presenting part, malformations)
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• Identify complications (e.g., birth asphyxia) or danger signs and respond immediately
or refer
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• Encourage baby and mother to sleep under insecticide-treated bed net (in malaria
prone areas)
• Counsel and advise on the following and refer as necessary:
o Postpartum care and hygiene
o Breastfeeding
o Nutrition
o Birth spacing and family planning
o Immunization of mother and newborn
o Maternal and newborn psychosocial needs
o Voluntary counseling and testing of HIV and prevention of mother-to-child
transmission (PMTCT) practices as appropriate
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vaccine is also given in the first week as called for, as well as the first dose of oral
poliomyelitis vaccine (OPV).
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2.4 Advice and Counseling
2.4.1 Postpartum Care and Hygiene
• Emphasize the importance of hygiene and hand washing to prevent infection:
o Wash hands before handling baby
o Wash hands before feeding baby
o Wash perineum daily
o Wash hands after fecal excretion
o Wash hands before preparing food
o Change pads every 4-6 hours
o Wash the body daily
2.4.2 Breastfeeding
Include the following information in breastfeeding counseling:
• Keep newborn in skin-to-skin contact with mother soon after delivery.
• Initiate breastfeeding within ½ to 1 hour after birth.
• Give baby the first milk (colostrum), which is nutritious.
• Counsel on exclusive breastfeeding. WHO recommends that infants should be
breastfed exclusively from birth to at least 4 and if possible 6 months of age.
• Emphasize that breastfeeding should be given as often as the child desires, day and
night, at least 8 times in 24 hours.
• Teach correct positioning and attachment for breastfeeding.
• Give special support to preterm, and low birth weight babies with breastfeeding.
• Advise the mother to drink plenty of fluids, eat more, eat healthy foods and rest while
breastfeeding,
• Discuss benefits for the mother
o Postpartum bleeding can be reduced due to uterine contractions caused by
the baby’s suckling.
o Breastfeeding can help delay a new pregnancy.
• Talk about benefits for the baby
o Breast milk contains the water and the nutrients that a baby’s body needs
and is easily digested by the baby.
o Breast milk has unique antibodies that help protect the baby against
infections.
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2.4.3 Nutrition
2.4.3.1 General
• Women’s food intake should be increased by 10% to 20% during lactation. Advise
the woman to eat a greater amount and variety of healthy foods. Give examples of
types of food and the amount to eat.
• Determine if there are taboos about foods which are nutritionally healthy. Advise the
woman against all dietary restrictions.
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2.4.4 Birth Spacing and Family Planning
It is often stated that in the postpartum period one of the major concerns of the woman
(and her partner) is contraception. Contraceptive counseling is one of the most important
aspects of postpartum care. In the case of the parturient woman and her partner, a number
of different factors affect the decision about the contraceptive method. These include: the
physiological processes of the puerperium, when fertility returns and ovulation is re-
established, whether or not the women is exclusively breastfeeding, and what the
couple’s wishes are with regard to the resumption of sexual activity. Couples are
frequently unaware of the implications of these different factors and this is a major
argument for providing the opportunity to discuss family planning options at the earliest
opportunity after birth.
Couples may be unaware of the range of family planning methods (short-term, long-
acting, hormonal, barrier, temporary or permanent) available to suit their varying goals,
choices and needs. Counseling, advice on the range of FP methods, and the provision of
family planning services which accompanies it, must form an integral part of any
postpartum service.
• Counsel or refer to appropriate FP services for counseling on the importance of
family planning. Include the partner or another member of the family as appropriate.
Advice and counseling on birth spacing and family planning should include the
following:
o Explain that after birth, if a woman has sex and is not exclusively
breastfeeding, she can become pregnant as soon as four weeks after
delivery.
o Information on when to start a contraceptive method will vary depending
on whether a woman is breastfeeding or not.
o Advise the correct and consistent use of condoms for dual protection from
sexually transmitted infections (STIs) or HIV and pregnancy. Promote
condom use, especially if at risk for STIs and HIV.
o Advise her about birth spacing.
o Give advice on range of family planning methods available including
Lactational Amenorrhea Method (LAM).
o Explain different options available for the non-breastfeeding woman and
the breastfeeding woman.
o LAM: For the breastfeeding woman, who is no more than 6 months
postpartum and who is breastfeeding exclusively (8 or more times a day,
including at least once at night; no complementary foods or fluids), LAM
can be used as a temporary FP method. Emphasize that after six months
practicing LAM, she should choose another FP method to use alone or
together with LAM.
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2.4.5 HIV
• Provide key information on HIV
o What is HIV and how it is transmitted?
o Advantage of knowing HIV status in pregnancy to get appropriate care
and treatment
o Counsel on correct and consistent use of condoms
• Voluntary counseling and testing
o Where to go
o Confidentiality of the test
o Implications of test results (positive/negative)
o Benefits of involving and testing the male partner(s).
The following are selective recommendations by the WHO Technical Working Group to
strengthen the quality of postpartum care.
3.1 Policy
• Review the legislative/regulatory framework related to the scope and practice of
health care providers.
• Ensure availability and access to a comprehensive, continuous and integrated services
part of a reproductive health package.
• Strengthen vital registration systems.
• Stimulate communities to examine how their attitudes and practices support or
obstruct the opportunity for women and newborns to receive the best available care.
• Develop positive strategies for increased male involvement in the postpartum period.
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• Develop/provide home-based maternal record for all women and newborns.
• Ensure care at all levels: in the community, health centre (including domiciliary
services), and at the referral level.
• Develop, together with the community, a complete functional chain of referral from
community to the district hospital and back.
• Strengthen district hospitals and health centers to such a level as to be able to cope
with emergencies, including blood transfusion services.
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References
Indira Narayanan, Mandy Rose, Dilberth Cordero, Silvana Faillance, and Tina Sanghvi.
The Components of Essential Newborn Care. Published by the Basics Support for
Institutionalizing Child Survival Project (BASICS II) for the United States Agency for
International Development. Arlington, Virginia, June 2004.
WHO (World Health Organization). 2002. Improving Neonatal Health in South-East Asia
Region: Report of a Regional Consultation, New Dehli, India, 1-5 April 2002 SEA-
MCH-219
WHO (World Health Organization), 2003. Pregnancy, Childbirth, Postpartum and
Newborn Care: A guide for essential practice. www.who.int/reproductive-
health/publications/pcpnc/
WHO (World Health Organization). Postpartum Care of the Mother and Newborn: A
Practical Guide. www.who.int/reproductive-health/publications/msm_98_3/index.html
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