4.2  Schedule for postnatal home visits

Currently, there is enough evidence and full consensus on key elements of essential postnatal care to improve the health and survival of newborns and mothers. However, it is still difficult to find evidence-based recommendations that can be taken as a standard for the optimal timing and frequency of postnatal care contacts. Different South Asian countries have evaluated different timings, but almost all of them have visited mothers at least two to three times in the first week after the birth. In all cases the first visit was within 24 hours after the delivery of the baby.

As you already know from Study Session 1 of this Module, the first 24 hours and the first seven days are the crucial times when most mothers and newborns die. Based on the available information from the experiences of other countries, and the feasibility of applying each option in Ethiopia, the World Health Organization has recommended a schedule of visits for postnatal care. For all normal deliveries with an outcome of a full term and normal birth weight baby, the recommended frequency of home visits should be as follows:

1. The first visit should take place within 24 hours of the birth; whenever feasible do the visit as early as possible.
2. The second visit is on the third day after the birth.
3. The third visit is on the seventh day after the birth.
4. The fourth visit is during the sixth week after the birth.

Additional visits are needed on the fifth and tenth day after the birth in special circumstances, for example in:

• preterm babies, i.e. those delivered before 37 weeks of gestation
• low birth weight babies, i.e. those weighing less than 2.5 kg
• all sick mothers and newborn babies
• HIV-positive mothers.

Family members should also send for you to come immediately if a mother or the baby has a problem at any time during the postnatal period. Some families may be reluctant to bother you, so it is important that you always reassure each family that contacting you is the right thing to do if they become worried about the health of the mother or the baby.