Postpartum is the period after childbirth during which the mother’s body, including hormone levels, returns to a non-pregnant state. Women’s vulnerability is at its peak during this period and can last for around 40 days from the first hour of delivery. In many countries postpartum care is neglected and its effects on women’s physical and mental health is not considered. According to the World Health Organization, 830 women die from pregnancy or childbirth-related complications around the world every day, complications after childbirth account for 75% of these deaths and 99% of them occur in developing countries. Women can experience various physical traumas from excessive hemorrhage to random infections. Physiologically, many women experience postpartum sadness within few days of delivery: crying and feeling sad, irritable or overwhelmed. This can lead to depression if not treated. According to the Healthy Children Organization, 1 in 7 women may experience postpartum depression and it can present anytime within the first year after giving birth. It is very common and can be treated within a short period if only identified and supported. Not addressing postpartum depression can affect the process of breastfeeding and the physical and mental development of the baby.
The health and well-being of mother and newborn are inter-dependent and their care should be managed together. Therefore, efforts to plan and implement postnatal care for newborns should include postpartum care for their mothers, too. Emotional and social support from care providers and family members is inevitably critical in this period. Health education must emphasize the significance of postpartum care in pregnancy as complications can be life-threatening. Involving men and mothers-in-law is also important as they play an important role in women’s health in most developing countries. Health education should also target influential community leaders to support the provision of services. Community involvement is vital because informed communities – that are aware of the potential dangers of the postpartum period – can demand quality services. Informed communities can be more easily mobilized to facilitate the implementation of such services and more effectively engaged to support positive health outcomes.
According to the World Health Organization, the capacity to provide postpartum care by skilled health workers for women in the first 24 hours of childbirth is scarce in most developing countries. Therefore, training health professionals and community health workers including traditional birth attendants (TBAs) and community midwives (CMWs) to provide basic care during this period is crucial to fill the gap. These health workers should be able to identify, monitor, address and refer cases that need immediate action.
Policies for postpartum care should be vigorous and enforced by ministries of health. In fact, most countries have such policies but need to be updated and implemented in health facilities. Health related organizations and other stakeholders concerned with maternal health should be regulated and educated to include postpartum care in their objectives.
Providing effective postpartum services to the community requires a partnership of political, educational, religious and other community leaders. Scaling up will require investment, political commitment and collaborative action between the government and nongovernmental organizations (NGOs), and close collaboration with the health sector.
Success Stories for Postpartum Care Implementation:
There are many examples of countries which have successfully implemented postpartum services that have had an immense impact on their maternal health indicators. Examples in two developing countries, Nepal and Egypt, display how postpartum services can be implemented with limited resources and the support of the community. Such success can occur in any developing country (including Yemen) as they fall under the four rules of health service provision: acceptance, appropriateness, acceptability and affordability.
In Nepal, a programme established in five villages in the Kailali district has shown the feasibility of training volunteers to provide effective home-based postnatal/postpartum care of reasonable quality and coverage, as long as adequate referral care and supervision by health care professionals exists. The community volunteers were trained to provide the service within their villages and reported to their local health units/districts. A survey at the end of the programme showed that 60% of mothers had received postpartum care, 98% of which was received at home. Additionally, facility-based visits increased and recognition of the issue and subsequent referrals were impressively high. This all contributed to a massive decline in neonatal and maternal mortality in those areas.
In Egypt, a project for 68 communities in five different governorates was implemented within the reproductive health/family planning programme which focused on mobilizing the entire community around the importance of postpartum care, the danger signs signaling a postpartum emergency and the need to respond to emergencies with immediate action. Community mobilization and training included community leaders, local and private health providers, non-health workers (i.e. community outreach workers and volunteers) and media professionals. The results demonstrated an increase in postpartum visits from 26% to 60%, an increased knowledge among men and women about postpartum care and the inclusion of postpartum care in ministry of health guidelines and the training curriculum.
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