Table 2 2013 WHO Recommendations on Postnatal care
1. Discharge and timing of postnatal contacts |
 1.1. Timing of discharge from a health facility after birth   • After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 h after birth |
 1.2. Number and timing of postnatal contacts   • If birth is in a health facility, mothers and newborns should receive postnatal care in the facility for at least 24 h after birth   • If birth is at home, the first postnatal contact should be as early as possible within 24 h of birth   • At least three additional postnatal contacts are recommended for all mothers and newborns on day    • Day 3 (48–72 h)    • Between days 7–14 after birth    • 6 weeks after birth |
 1.3. Home visits for postnatal care   • First week after birth for care of the mother and newborn |
2. PNC for the new-born |
 2.1. Assessment for the baby   • Feeding   • History of convulsions   • Breathing, severe chest in-drawing   • Spontaneous movement   • Fever (temperature ≥ 37.5 °C), low body temperature (temperature < 35.5 °C)   • Jaundice in first 24 h of life, or yellow palms and soles at any age |
 2.2. Exclusive breast feeding   • All babies should be exclusively breastfed from birth until 6 months of age   • Mothers should be counselled and provided support for exclusive breastfeeding at each postnatal contact |
 2.3. Cord care: High neonatal mortality settings (30 or more neonatal deaths per 1000 live births)   • 4% chlorhexidine at delivery   • Daily chlorhexidine (7.1% chlorhexidine digluconate aqueous solution or gel) application to the umbilical cord stump during the first week of life recommended for newborns who are born at home in settings |
 2.4. Cord care: newborns in health facilities and at home in low neonatal mortality settings   • Clean, dry cord care for   • Use of chlorhexidine in these situations may be considered only to replace application of a harmful traditional substance, such as cow dung, to the cord stump |
 2.5. Other PNC services care for the newborn   • Bathing should be delayed until 24 h after birth. If this is not possible due to cultural reasons, bathing should be delayed for at least six hours   • Appropriate clothing of the baby for ambient temperature is recommended   • This means one to two layers of clothes more than adults, and use of hats/caps   • The mother and baby should not be separated and should stay in the same room 24 h a day   • Communication and play with the newborn should be encouraged   • Immunization should be promoted as per existing WHO guidelines   • Preterm and low-birth-weight babies should be identified immediately after birth and should be provided special care as per existing WHO guidelines |
3. Assessment of the mother |
 3.1. First 24 h after birth   • All postpartum women should have routine and regular assessment of the following during the first 24 h starting from the first hour after birth:    • Vaginal bleeding    • Uterine contraction    • Fundal height    • Temperature    • Heart rate (pulse)   • Blood pressure should be measured shortly after birth. If normal, the second blood pressure measurement should be taken within six hours   • Urine void should be documented within six hours |
 3.2. Beyond 24 h after birth   • Enquiries about general well-being and assessments regarding:    • Micturition and urinary incontinence    • Bowel function    • Healing of any perineal wound    • Headache    • Fatigue    • Back pain    • Perineal pain and perineal hygiene    • Breast pain    • Uterine tenderness    • Lochia    • Breastfeeding progress    • Emotional well-being    • Family and social support they have and their usual coping strategies for dealing with day-to-day matters    • All women and their families/partners should be encouraged to tell their health care professional about any changes in mood, emotional state and behaviour that are outside of the woman's normal pattern |
4. Counselling |
 4.1. All women should be counselled on:   • Nutrition   • Hygiene, especially handwashing   • Birth spacing and family planning. Contraceptive options should be discussed, and contraceptive methods should be provided if requested   • Safer sex including use of condoms |
 4.2. In malaria endemic areas, mothers and babies should sleep under insecticide-impregnated bed nets |
 4.3. All women should be encouraged to mobilize as soon as appropriate following the birth. They should be encouraged to take gentle exercise and make time to rest during the postnatal period |
5. Iron and folic acid supplementation  • Iron and folic acid supplementation should be provided for at least three months |
6. Prophylactic antibiotics  • The use of antibiotics among women with a vaginal delivery and a third or fourth degree perineal tear is recommended for prevention of wound complications  • There is insufficient evidence to recommend the routine use of antibiotics in all low-risk women with a vaginal delivery for prevention of endometritis |
7. Psychosocial support  • Psychosocial support by a trained person is recommended for the prevention of postpartum depression among women at high risk of developing this condition |