ABSTRACT This document reports the outcomes of a technical consultation on the full range of issues relevant to the postpartum period for the mother and the newborn. The report takes a comprehensive view of maternal and newborn needs at a time which is decisive for the life and health both of the mother and her newborn. Taking women’s own perceptions of their own needs during this period as its point of departure, the text examines the major maternal and neonatal health challenges, nutrition and breastfeeding, birth spacing, immunization and HIV/AIDS before concluding with a discussion of the crucial elements of care and service provision in the postpartum. The text ends with a series of recommendations for this critical but under-researched and under-served period of the life of the woman and her newborn, together with a classification of common practices in the postpartum into four categories: those which are useful, those which are harmful, those for which insufficient evidence exists and those which are frequently used inappropriately. WHO/RHT/MSM/98.3 Dist.: General Orig.: English CONTENTS Page EXECUTIVE SUMMARY .......................................................................................................1 1 INTRODUCTION .........................................................................................................6 1.1 Preamble ............................................................................................................6 1.2 Background........................................................................................................7 1.3 Defining the postpartum period .........................................................................7 1.4 The needs of women and their newborns ..........................................................8 1.5 The focus and content of this report ................................................................10 2 WOMEN’S PERCEPTION OF POSTPARTUM PROBLEMS..................................11 2.1 Epidemiological studies on maternal morbidity ..............................................11 2.2 Frequency and nature of health problems........................................................12 2.2.1 Infections .............................................................................................12 2.2.2 Bladder problems.................................................................................12 2.2.3 Backache..............................................................................................13 2.2.4 Frequent headaches..............................................................................13 2.2.5 Pelvic pains..........................................................................................13 2.2.6 Haemorrhoids.......................................................................................13 2.2.7 Constipation .........................................................................................13 2.2.8 Depression, anxiety and extreme tiredness ........................................13 2.2.9 Perineal pain........................................................................................14 2.2.10 Breast problems ...................................................................................14 2.2.11 Anaemia ...............................................................................................14 2.3 Sexual relations in the postpartum period........................................................14 2.4 Conclusion .......................................................................................................15 3 MAJOR MATERNAL HEALTH CHALLENGES IN THE POSTPARTUM PERIOD15 3.1 Postpartum haemorrhage .................................................................................15 3.2 (Pre)eclampsia .................................................................................................17 3.3 Puerperal genital infection...............................................................................17 3.4 Thromboembolic disease.................................................................................18 3.5 Complications of the urinary tract ...................................................................19 3.5.1 Retention of urine ................................................................................19 3.5.2 Incontinence.........................................................................................20 3.5.3 Infection ...............................................................................................20 3.6 Complaints about the perineum and the vulva.................................................20 3.7 Puerperal mastitis.............................................................................................21 3.8 Psychological problems in the postpartum period...........................................21 4 MATERNAL NUTRITION.........................................................................................22 4.1 Introduction......................................................................................................22 4.2 The outcome of pregnancy, childbirth and postnatal period, related to the nutritional status of the woman........................................................................23 4.3 Diet during pregnancy and postpartum............................................................23 4.3.1 Interventions by nutritional supplementation ......................................23 4.3.2 General diet postpartum.......................................................................24 4.4 Prevention of micronutrient deficiencies.........................................................24 4.4.1 Iodine deficiency..................................................................................24 4.4.2 Vitamin A deficiency...........................................................................25 4.4.3 Iron and folate deficiency ....................................................................25 5 INFANT HEALTH CHALLENGES IN THE POSTNATAL PERIOD .....................26 5.1 General considerations.....................................................................................26 5.2 Life threatening infant morbidity ...................................................................26 5.2.1 Preterm birth........................................................................................26 5.2.2 Smallness for gestational age...............................................................27 5.2.3 Congenital anomalies...........................................................................27 5.2.4 Severe bacterial infection.....................................................................28 5.2.5 Neonatal tetanus...................................................................................28 5.2.6 Newborns suffering from birth trauma ................................................29 5.3 Other serious infant morbidity.........................................................................29 5.3.1 Disturbance of thermoregulation .........................................................29 5.3.2 Jaundice ...............................................................................................30 5.3.3 Ophthalmia neonatorum .....................................................................30 5.3.4 Neonatal herpes infection ..................................................................30 5.3.5 Hepatitis B .........................................................................................31 5.3.6 Human immunodeficiency virus (HIV) infection ..............................31 5.4 Conclusion .......................................................................................................31 6 BREASTFEEDING .....................................................................................................31 6.1 The importance of breastfeeding .....................................................................31 6.2 Initiation of breastfeeding................................................................................32 6.2.1 Early suckling......................................................................................32 6.2.2 Positioning and attaching the baby to the breast .................................32 6.2.3 The need to avoid supplementary feeds...............................................33 6.3 The practice of breastfeeding...........................................................................33 6.3.1 Rooming-in and unrestricted feeding ..................................................33 6.4 Promotion of breastfeeding..............................................................................33 6.4.1 Commercial discharge packs ...............................................................33 6.4.2 Ten steps to successful breastfeeding ..................................................34 6.5 Lactation suppression......................................................................................34 6.6 Obstacles to breastfeeding ...............................................................................35 7 BIRTH SPACING.......................................................................................................35 7.1 Introduction......................................................................................................35 7.2 Lactational amenorrhoea method (LAM) ........................................................36 7.2.1 Criteria for LAM use ...........................................................................36