Postnatal Care Module: Introduction
As you already know from the previous Modules on Antenatal Care and Labour and Delivery Care, the time immediately following childbirth is a period of high risk for mothers and newborns. Around 65% of maternal deaths and 75% of newborn deaths occur in the first seven days after the birth, and around half of these deaths occur in the first 24 hours. A newborn baby is about 500 times more likely to die in the first day of its life than at one month of age. Thus, the postnatal period is a time when your close attention and care can make a huge improvement in the life chances of women and children in your community.
Early neonatal mortality (deaths of newborns in the first seven days) significantly contributes to the overall under-five child mortality of a nation. UNICEF has shown that early neonatal mortality alone accounts for about 40% of deaths of children aged under five years, and nearly 60% of deaths of infants aged under one year. Newborns whose mothers have died during labour and delivery, or in the postnatal period, have an even greater chance of dying themselves, partly due to the lack of postnatal maternal care, but also because the causes of maternal mortality and morbidity also pose a high risk to the baby.
Therefore, the skilled care provided during labour and delivery has to continue during the immediate postnatal period for both the mother and the baby – ideally with the same health care provider. This continuum of care should include counselling mothers on how to identify problems that need urgent attention in themselves or their babies, and practical help to ensure quick access to emergency maternal and newborn care if needed. This means creating good linkages between new mothers, their families and the nearest higher-level health facilities, and between the health facilities and the community, to strengthen the continuum of care and the early identification and referral of postnatal problems.
In practice, whether the woman delivers her baby at home or in a health facility, in the majority of cases postnatal care services are not routinely available in Ethiopia. Even if postnatal care is available, it is often not practiced properly, due to lack of knowledge and skill by the health workers, and at times due to lack of essential equipment and supplies. This Postnatal Care Module is designed to fill the knowledge gap by teaching you the basic information and skills to give immediate postnatal care to the mother and newborn, and to extend the awareness of effective postnatal care to others in the home and in the community at large. It has nine study sessions focusing on community involvement in postnatal care, normal and abnormal signs in the mother and newborn in the postnatal period, newborn evaluation and care, counselling on breastfeeding, keeping the baby warm, infection prevention and other issues, and special care for preterm and low birth weight babies. It ends with guidance on establishing an effective two-way referral link between yourself in the community and staff in the higher-level health facilities, so that more specialized postnatal assessment and intervention can happen quickly if required.
All of the principles and techniques taught in this Module will be reinforced and expanded in your practical skills training and also in the later Module on Integrated Management of Newborn and Childhood Illness (IMNCI). Blending the theory and practice of postnatal care and IMNCI will enable you to support the health and the survival of mothers, newborns, infants and older children in your community.