1. Maternal and Newborn Health Training Package
Session 7: Postnatal Care for the Mother and Essential Newborn Care

2. How many women die in the postpartum period and why?
In 2013, 289,000 women died during pregnancy or childbirth
Postpartum causes of maternal mortality include hemorrhage (bleeding), sepsis (infection of the genital tract) and infection
HIV-positive mothers are at greater risk of postpartum maternal death than HIV-negative women
WHO WHO Recommendations on Postnatal Care of the Mother and Newborn. Geneva: WHO and PMNCH Opportunities for Africa’s Newborns: Practical data, policy and programme support for newborn care in Africa. Geneva: WHO.
PMNCH Opportunities for Africa’s Newborns: Practical data, policy and programme support for newborn care in Africa. Geneva: WHO
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3. How many newborns die? Each year, 3 million newborn babies die
About two-thirds of infant deaths occur in the first month of life
Of those who die in the first month, about two-thirds die in the first week of life
Of those who die in the first week of life, two-thirds die in the first 24 hours of life
Beck, D., F. Ganges, S. Goldman, P. Long Care of the Newborn Reference Manual: Washington, DC: Save the Children

4. Why do newborns die?
4 out of 5 newborn deaths result from three preventable and treatable causes:
complications from preterm birth (including prematurity and low birth weight)
complications during childbirth (including birth asphyxia – deprivation of oxygen to a newborn infant)
newborn infections

5. Premature & Low Birth Weight (LBW) Babies
Each year, 15 million babies are born preterm and 32.4 million babies are born too small for gestational age: may be preterm or fullterm
Preterm birth and being small for gestational age are the reasons for LBW
LBW contributes to 60% to 80% of all neonatal deaths
Preterm birth occurs due to multiple pregnancies, infections, and chronic conditions such as diabetes and high blood pressure
LBW stems primarily from poor maternal health & nutrition
WHO Every Newborn Action Plan (Draft). Geneva: WHO

6. Quiz answers
Q ,000 women
Q 2. hemorrhage (bleeding), sepsis (infection of the genital tract) or infection
Q million newborns
Q 4. prematurity, low birthweight, birth asphyxia or other complications, infections
Q 5. Multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure
Q 6. Poor maternal health, poor maternal nutrition

7. Post Adaptation
Briefly review country statistics on postnatal maternal deaths, newborn deaths and premature and LBW babies as appropriate

8. Postpartum care and services
Identifying danger signs indicating the need to seek care
Nutrition counseling and services
Healthy behaviors
Birth spacing and postpartum family planning (PPFP) counseling
Support for early and exclusive breastfeeding and counseling for breastfeeding problems
PMTCT; special attention should be given to mothers who are HIV+
Emotional and psycho-social support to reduce stress and prevent depression
UNICEF State of the World’s Children. New York: UNICEF
PMNCH 2006 Op. cit. and
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9. Essential Newborn Care
Essential newborn care includes:
Immediate care at birth
Care during the first day (24 hours)
Care up to 28 days
Photo credit: Save the children (

10. Reading Task: Essential Newborn Care Handout
Take 5 minutes to read this handout. As you read:
Circle any points needing further explanation and clarification.
Name 3 ways that you could use this information on essential newborn care in your work with counterparts; for example, community health workers.

11. Postnatal Visits and Home Visits for the Newborn: Where and When
Where: facility, outreach services, home care visits by trained health worker or combination
When: If home birth, visit to a health facility for postnatal care as soon as possible after birth. If not feasible, home visit schedule by a skilled attendant
First home visit ASAP, not later than 24 hours after birth
Second home visit on day 3
Third home visit on day 7
Extra contacts for babies needing special care (low-birth weight, etc.)
WHO WHO/UNICEF Joint Statement: Home Visits for the newborn child: a strategy to improve survival. Geneva: WHO
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12. Post Adaptation
Share country-specific policies, guidelines and protocols for postnatal visits and who performs these.
If Volunteers support postnatal visits, share information.

13. Post Adaptation: Postnatal Care Programs and Volunteer Work
Describe relevant country-specific programs on:
Postnatal care, including postnatal visits
Counseling and education of mothers and family members on danger signs
Post-partum family planning
Referral systems pertinent to post-natal care; how a newborn or mother with danger signs are referred
What postnatal care is provided at what level
Communication efforts and campaigns regarding postnatal care
Share information on current or potential role of Volunteers in postnatal care at different levels of the continuum of care – household, community and outreach, health facilities

14. Volunteers and support for postnatal care
Volunteers can support postnatal care at all levels
Families play an important role; health outcomes determined by household decisions
CHWs often tasked to conduct postnatal visits; play crucial role to bridge health facility services and families; must be supported by a strong referral system
Community-based activities help address postnatal care of mothers and newborns
WHO Op. cit.
Gogia, S., HS Schdev “Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review.” Bulletin World Health Organization. Sep ; 88(9): ; and Kirkwood, B.R., A. Manu, AH ten Asbroek, et al “Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: a cluster randomized controlled trial”. Lancet. Jun ; 381(9884)