The postnatal period is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time. Yet, this is the most neglected period for the provision of quality care. WHO guidelines on postnatal care have been recently updated based on all available evidence. The guidelines focus on postnatal care of the newborn.

Basic care for all newborns should include promoting and supporting early and exclusive breastfeeding, keeping the baby warm, increasing hand washing and providing hygienic umbilical cord and skin care, identifying conditions requiring additional care and counselling on when to take a newborn to a health facility. Newborns and their mothers should be examined for danger signs at home visits. At the same time, families should be counselled on the identification of these danger signs and the need for prompt care seeking if one or more of them are present. Newborns with who have preterm birth or low birth weight, who are sick or are born to HIV-infected mothers need special care.


After the birth

There are several procedures that are a routine part of post-natal care for your baby

In most cases, newborn babies stay with their mothers during the entire hospital stay. They are seen every day by the newborn healthcare team, which includes an attending physician, nurse practitioner, or a resident physician. They will examine your baby and talk to you about all the things you and your baby are learning to do.

We encourage all mothers to keep their babies close to them, especially if they’re breastfeeding.

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Skin-to-Skin Care

There are many benefits to keeping babies close together with their mothers. Mothers are encouraged to hold their newborn baby naked (except for a diaper) on your own skin, with a blanket covering you both, during your awake and alert times. Babies who are frequently held skin to skin are:

  • More likely to latch onto the breast and to breastfeed easily
  • Have more stable and normal skin temperatures, heart rates, and blood pressure
  • Have better blood sugars
  • Are less likely to cry

Apgar scoring

This is just a quick check by the midwife or attending doctor, more for them than you to help them decide how to proceed with your baby’s care and to identify babies at risk for complications from delivery.

A score of 7-10 is considered normal, while 4-7 might require some resuscitative measures, and a baby with a score of 3 and below requires immediate resuscitation (preferably still attached to the placenta with an unclamped cord).

Apgar Scoring System
0 1 2
Pale Blue Pink
Pulse Absent <100 >100
This is the annoyed response to suctioning (hopefully not needed) or foot stroking.
Absent Grimace Cry Active
Limp Some tone Active
How your baby is breathing
Absent Irregular Regular & Cry

Breastfeeding Support

Mothers are very much encourage to breastfeed their infants. Part of ensuring success is to avoid giving formula, bottles or pacifiers to healthy new borns. If there is a medical reason to give the baby a supplement, options will be discussed with you.

Vitamin K and Erythromycin Eye Ointment

Babies are routinely given a vitamin K injection very soon after birth in order to prevent a rare problem of bleeding into the brain in the first 12 weeks following birth. This is known as haemorrhagic disease of the newborn.

Vitamin K promotes blood clotting. In the uterus the baby has low levels of vitamin K as well as other factors needed in clotting. The baby’s body maintains very precise levels of vitamin K during the pregnancy and this does not change regardless of how many vitamin K rich foods the mother eats.

Toward the end of the pregnancy, the baby begins to develop some of the other clotting factors; developing two key factors just before it is ready for birth

Your baby will typically receive a Vitamin K injection and an antibiotic eye ointment shortly after birth. Vitamin K protects against rare but serious bleeding problems, and erythromycin prevents bacterial infections that can be present in the birth canal.

If you wish, you can delay these by an hour or so to keep your baby skin to skin. Because the Vitamin K protects the baby from bleeding problems in the first 24 hours, it’s best to give it as early as possible (within an hour after birth).

Bathing the baby

A creamy, protective substance called vernix is present on the skin of many newborn babies. Babies are intentionally not bathed in their first few days because leaving this substance to absorb into your baby’s skin helps protect against dryness and bacterial infections.

Right after birth, coconut oil or Sesame oil is applied gently and the baby bathed in warm water. The mother should shut the door and windows to prevent draught. Bathing baby should preferably be done in the afternoon. The Indian style of giving a bath is ideal. The mother sits on the ground with legs extended and touching each other. The baby is kept on the legs with its face towards the ground so that the face and tummy of the baby are touching the mother’s legs and the nose lies in between the legs. Bathing baby can also be done in a plastic tub.

The advantages of Indian style of bathing baby :

  • The position of the baby avoids entry of water into the nose and mouth.
  • Even if the baby becomes slippery after the application of soap, there is no question of fall as the baby is practically touching the ground between the legs of the mother. Both the hands of the mother are free to clean and wipe the baby.

Hepatitis B vaccination

Reasons For Vaccination

  • Infants are easier and cheaper to vaccinate than when they are older and at greater risk of contracting the virus.
  • Routine vaccination protects newborns of mothers who are carrying the virus
  • It is thought that immunising as a young baby will protect the child through its teenage years if they engage in risky behaviours.
  • By vaccinating every baby born, we are helping to prevent the spread of the disease while allowing for the fact that the vaccination is not effective for all those who receive it.
  • If given as a young child the vaccine is found to be effective in around 90% of people vaccinated but is much less effective in those over 30.

Danger Signs For NewBorn

Advise the mother and family to seek care immediately, day or night. They should not wait if the baby has any of these signs:

  • difficulty in breathing or indrawing
  • fits
  • fever
  • feels cold
  • bleeding
  • not feeding
  • yellow palms and soles of feet
  • diarrhoea

The mother and family should go to the health centre as soon as possible if a baby has any of the following signs:

  • difficulty feeding (poor attachment, not suckling well)
  • is taking less than 8 feeds in 24 hours
  • pus coming from the eyes or skin pustules
  • irritated cord with pus or blood
  • ulcers or thrush (white patches) in the mouth – explain that this is different from normal breast milk in the mouth




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