Much attention goes to pregnancy and birth, but the postnatal period, the six weeks after birth, is a time of high risk for mothers. A large share of maternal deaths occur in the first days and weeks after childbirth, from haemorrhage, infection, hypertensive disorders, blood clots and other causes. Yet postnatal care is often the most neglected part of maternity services. Nurses and midwives can change that.
WHO recommended postnatal contacts
WHO recommends that women and newborns stay in the facility for at least 24 hours after an uncomplicated vaginal birth, and receive at least four postnatal contacts: within 24 hours, between 48–72 hours, between days 7–14, and during week 6.
What to check
- Vital signs: temperature, pulse, blood pressure, respiratory rate.
- Uterus: firmness and height (involution); tenderness.
- Vaginal bleeding (lochia): amount, colour, smell, clots.
- Perineum or caesarean wound. See perineal care and caesarean care.
- Bladder and bowels: urinary retention is common after birth and after epidurals.
- Breasts: feeding, engorgement, nipple pain, mastitis.
- Legs: swelling or pain suggesting DVT.
- Mood and mental health. See perinatal mental health.
- Anaemia symptoms; continue iron and folic acid as advised.
- Family planning: discuss contraception options. See family planning.
- Domestic violence: ask privately.
Danger signs to teach every mother
Mothers and families should seek care immediately for:
- Heavy bleeding: soaking a pad in an hour, passing large clots, or sudden increase in bleeding.
- Fever, chills, or foul-smelling vaginal discharge (signs of infection or sepsis).
- Severe headache, blurred vision, swelling of face and hands, or fits (postnatal pre-eclampsia can occur up to 6 weeks after birth).
- Difficulty breathing or chest pain (possible blood clot in the lungs).
- Painful, swollen, red leg.
- Severe abdominal pain.
- Wound that is red, painful, oozing or opening.
- Thoughts of harming herself or the baby, or feeling unable to cope.
- Painful, red, hot area on the breast with fever.
Recovery and support
- Encourage rest, good nutrition and fluids.
- Support breastfeeding. See breastfeeding support.
- Pelvic floor exercises.
- Gentle mobility and VTE awareness.
- Involve partners and family in practical support. See rekindling romance after a baby.
- Address harmful cultural practices sensitively (e.g. hot water baths that scald, restricting nutritious foods).
Based on WHO recommendations on maternal and newborn care for a positive postnatal experience (2022) and NICE NG194 (Postnatal care). Educational content: follow local guidelines.