WHO guidelines on the care of the newborn and mother in the postpartum and puerperium.

The new guidelines dictated by the World Health Organization (WHO) concerning the post-natal care of the mother and the newborn date back to October 2013.

The guidelines are summarized in 12 recommendations covering the first 6 weeks after childbirth (the puerperium) which are the most problematic . In fact, most maternal and neonatal deaths occur in this period of time.

The guidelines have a special focus on developing countries where, unfortunately, the critical issues related to childbirth are the order of the day.

1. The mother and baby should receive hospital care for at least 24 hours after delivery if it was vaginal and without complications. (Currently in most Italian hospitals there is a tendency to discharge the mother and the newborn 48 hours after a vaginal birth)
2. Number of post-natal contacts: if the birth takes place in hospital, the mother and the child must receive first aid within the first 24 hours after birth. The same goes for home births: a doctor must visit the mother and the baby within the first 24 hours. Other postnatal contacts are then required approximately 48-72 hours after delivery, after 7-14 days and again 6 weeks after birth. The frequency of these checks is due to the fact that 40% of neonatal deaths have been seen to occur in the first 24 hours of life.
3. Home visits: during the first week after birth, home medical visits are recommended for the care of the mother and the newborn (this recommendation is valid above all for developing countries, although it would not be a bad thing if a midwife provided this service at the expense of of the SSN here too)
4. During each postnatal visit, the newborn should be evaluated according to precise parameters: if he feeds well, if convulsions have occurred, if rapid breathing occurs (respiratory rate ≥ 60 al

   minute), severe chest indentation, lack of spontaneous movement, fever (temperature ≥ 37.5°C), low body temperature (temperature <35.5°C), jaundice. The family must be informed so that they can request assistance in the event of one of these listed situations.

5. Exclusive breastfeeding is recommended up to 6 months of age. Mothers should be provided with breastfeeding support.
6. In countries with high neonatal mortality (30 or more infant deaths per 1000 live births), the WHO recommends the use of a chlorhexidine-based disinfectant for the daily hygiene of the umbilical cord stump during the first week of life. In other countries where mortality is very low, however, care and hygiene of the umbilical cord stump is recommended to avoid the onset of infections.
7. Other recommended neonatal care: Bathing should be delayed for at least 24 hours after birth. If due to country-specific traditions it is not possible to delay it that much, it is advisable to wait at least 6 hours after delivery. Clothing suitable for the ambient temperature is recommended . This means one or two layers of clothing more than adults and the use of a cap. Babies should be kept with their mother 24 hours a day . Communication and play with the baby should be encouraged. Vaccination must be promotedaccording to existing WHO guidelines. Babies born preterm or with low birth weight should be promptly identified for special care according to existing WHO guidelines.
8. Doctor visits to the mother: all women in the first 24 hours after delivery should be visited to evaluate vaginal bleeding, uterine contractions, body temperature and heart rate. Blood pressure should be measured soon after birth. If normal, the second measurement should be taken within the next six hours. Urination should be verified within six hours of delivery.  During checks after 24 hours of delivery, general well-being must be assessed and in particular: urination and urinary incontinence, bowel function, healing of any perineal wound, headache, fatigue, back pain, perineal pain and perineal hygiene, breast pain, uterus situation and bleeding. Breastfeeding progress should be assessed at each meeting. The woman’s psychological well-being, support from family and social background must also be assessed. All women, their families (  including partners ) should be encouraged to tell  any mood disorders, abnormal behavior which could be indications of postpartum depression. 10-14 days after delivery, breastfeeding and any signs of depression or maternity blues should be reassessed. If there are  indications  to do so, the woman should be evaluated further. All women should also be observed on the basis of signs of any domestic abuse.
   An overall assessment of the woman’s psycho-physical well-being should be made 2-6 weeks after delivery. If there are reasons for concern, the woman should be managed according to specific WHO guidelines   .
9. Counseling : All women should be provided with comprehensive information regarding the normal physiological recovery process after childbirth. They should be aware that some health problems are common but that special situations should be reported to medical personnel such as:  sudden heavy or persistent bleeding, increased bleeding, weakness, dizziness, palpitations / tachycardia. The symptoms referable to Pre-eclampsia are important to  report  : headache accompanied by one  or more symptoms such as visual disturbances, nausea, vomiting, epigastric pain,  fainting sensation, convulsions (in the first days after birth). Signs of infection:  Fever, chills, abdominal pain, vaginal discharge. Signs and symptoms of thromboembolism: one-sided calf pain, redness or swelling  of the calves, shortness of breath or chest pain.
   Women also need to be well informed about proper nutrition, hygiene rules (particularly hand washing), birth control and family planning, and therefore contraceptive methods. In some countries where malaria is present, it is recommended that mothers and babies sleep with bed nets on.
   Women must be encouraged to exercise gently and to take the right amount of rest during the post-natal period
10. Iron and folic acid intake : women are recommended to supplement with iron and folic acid for the first three months after childbirth
11. Taking antibiotics: Women who have had a natural birth with third or fourth degree perianal tears are recommended to take antibiotics to avoid complications
12. Psychological support: Psychological support is recommended especially for women at high risk of experiencing postpartum depression. Support must also be guaranteed to women who have lost their child.