postnatal care after giving birth

1. Preparation for
Postnatal Care
By C Settley

2. • Home visits: the best opportunity to provide postnatal care
• Barriers to facility-based postnatal care
• Social and cultural barriers: The tradition of keeping mothers and newborn babies indoors for
a few days after the birth in a period of seclusion, and certain community rituals during this
period, hinders mothers from going to health facilities for PNC. You should gradually explore
these barriers in your locality and work together with the community leaders to change these
practices.
• Geographic barriers: Walking across mountains, crossing rivers without bridges during the
rainy season, and lack of roads, are some of the geographical barriers that hinder mothers
from accessing health facilities for PNC (Figure 4.1).
• Physical access: Even though some mothers would prefer to go to a health facility, the
nearest health centre or hospital is not within a reachable distance on foot or with available
transport.
• Financial barriers: In Ethiopia, health services for labour and delivery and postnatal health
services are considered to be free of charge, but in reality families have to pay for transport
for the woman to the health facility, and for consumables including drugs and surgical gloves.
These extra costs remain a major barrier to facility-based care.
• Quality barriers: After reaching the health facility, the mother and newborn may not get the
expected quality of PNC service because of lack of adequately trained health workers, or
shortages of equipment or drugs. Poor quality services reduce confidence in other mothers in
the community, who are less likely to make the effort of going to the health facility.

3. The recommended frequency of home visits
should be as follows:
• The first visit should take place within 24 hours of the birth; whenever
feasible do the visit as early as possible.
• The second visit is on the third day after the birth.
• The third visit is on the seventh day after the birth.
• 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.

4. Preparations for a postnatal home visit
• Personal hygiene
• Equipment for a postnatal home visit: Salter scale to weigh the baby,
Blood pressure measuring apparatus, A stethoscope, Thermometer,
Wrist watch or timer, to help you count the mother’s pulse and the
baby’s respiration rate, Soap for washing your hands, A clean towel to
dry your hands, Vitamin A capsules, Iron and folate tablets,
Tetracycline eye ointment, Counselling card and screening card for
PNC, Record book, referral form and pen.

5. Key steps to follow while conducting a home
visit
• Know and show that you respect the local beliefs, culture and norms
during communication.
• Greet everyone using the local terms.
• Explain the reasons for the visit to the mother and family members,
using simple words in local language.
• Allow enough time for general conversation and confidence building.
• Act with confidence, and speak confidently with a gentle tone and
voice.
• Be respectful to every member of the family.

6. Counselling mothers during the postnatal
period
• Ask & listen
• Advise
• Praise
• Check understanding
• Health issues to counsel the mother on
• Identification of general danger signs
• Emotional support
• Support for maternal nutrition
• Establishing optimum breastfeeding
• Hygiene and infection prevention
• Support for family planning
• Special care for HIV-infected mothers
• Early care seeking for the mother and the newborn baby if problems arise
• Routine care of a normal baby.

7. • You are on your second visit to a mother of a newborn baby
delivered at home. She tells you the baby is crying a lot, that
she has had little sleep, and is feeling sore and very run
down. What do you do?
• You are planning the postnatal care of a mother with a
preterm baby who is also a low birth weight baby. Define
these classifications. Then set out your planned schedule of
care indicating how (and why) it differs from the schedule of
care that you would plan for a normal weight, full term baby.