Essential

1

• Essential
• Postpartum
• and
• Newborn
• Care
• MCH in Developing Countries
• January 23, 2007

2
Session Objectives

• Describe the importance of postpartum care
• Postpartum period purpose, components, and
  timing of focused PP care
• Describe the importance of newborn care
• Newborn period purpose, components, and timing
  of newborn care
• Discuss the importance of integrating the two

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Post Partum Critical Period for the Mother

• More than 50 of all maternal deaths occur within
  24 hours of delivery.
• Postpartum hemorrhage is the most important cause
  of these deaths
• 22.3 maternal deaths occur days 1-7
• 14.7 maternal deaths days 8-14
• 2.8 maternal deaths days 31-42

4
Postpartum Death by Cause and Time ()

• Hemorrhage 90.6 0-7 Days
• Sepsis 78.3 8-28 Days
• PIH Complications 100 0-7 Days
• Direct Causes 80.3 0-7 Days

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Postpartum care when and where?

• Timing (WHO recommendation)
• Six hours
• Six days
• Six weeks
• PP visits should occur
• In a private setting
• Where essential equipment and supplies available

6
Essential Components of PPC

• 1) Detection and treatment of problems
• Bleeding
• Sepsis
• Retained placenta
• Eclampsia
• Severe anemia

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2) Preventive measures, counseling

• Vitamin A supplement
• Early and exclusive breastfeeding and breast care
• Family planning
• Mother/newborn and family relations
• Nutritional support
• Danger signs for mother and baby
• Newborn care
• Discuss concerns of mother

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Newborn Care WHAT IS THE SITUATION OF THE
NEWBORN?EVERY MINUTE of the day

• 7
• babies die in their first week of life
• 10
• babies die in their first month of life

9
Neonatal Mortality

• Approximately 4 million neonatal deaths occur
  each year (98 in developing countries)
• For every neonatal death another is stillborn
• (4 million)
• Accounts for two-thirds of deaths of infants
• Two-thirds occur in the first week of life (3.6
  million)
• Two-thirds early neonatal deaths occur in the
  first 24 hours
• Accounts for 40 of deaths in children lt 5 yrs
• (Hyder et al, 2001)

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Relative Risk of Death per Month
The risk of dying is 10 times higher in the
first month of life than in subsequent months of
infancy
Newborn period 31 deaths per month
35
30
25
Post-neonatal period (1-11months) 2 deaths per
month
20
Deaths per 1000 live births
15
Children (12-59 months) 1 death per month
10
5
0
Average number of deaths per month in each period
of a childs life
From State of the Worlds Newborns 2001, State of
the Worlds Children 2001, WHO Publications
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Lifetime Risk of a Mother Experiencing a
Neonatal Death ()
Africa 21 Asia 9 Latin
America/Caribbean 5 North America lt1 Europe
lt1
12
Perinatal and neonatal mortality rates are
declining more slowly than other infant mortality
100
80
Post-neonatal mortality
60
Deaths/1000 births
Late neonatal mortality
40
Early neonatal mortality
20
0
1999
1983
-20
Stillbirths/1000 births
Developed Regions
-40
1999
1983
Developing Regions
-60
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First Hours of Life

• The newborn has major adjustments to make at
  birth and during the next few days and weeks to
  adapt to extrauterine life
• Establish breathing
• Change fetal circulation to newborn
• Body temperature regulation
• Feeding and digestion
• Immune system development

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Causes of Newborn Deaths

• Pregnancy-related complications
  (e.g., complications of prematurity,
  congenital anomalies)
  34

• Delivery-related complications
  (e.g., asphyxia, birth injury) 29

• Infectious diseases (e.g., neonatal
  tetanus, pneumonia,
  sepsis, meningitis, diarrhea) 32

WHO, 2001
15
Causes of Neonatal Deaths in the Community
(Bang AT, Lancet 19993541955-61)
(Bang AT, Lancet 19993541955-61))
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Essential Care for Newborn Health

• IMMEDIATE CARE
• Drying warming (wrapping)
• Assure adequate breathing
• Immediate, exclusive breastfeeding
• Cord care, prophylactic eye care, immunizations
  (BCG, OPV, Hep B?)

Labor Delivery Care
Antenatal Care
Immediate Newborn Care
Routine Newborn Care

• ROUTINE CARE
• Maintenance of temperature
• Exclusive breastfeeding
• Clean umbilical cord and skin care
• Early postnatal visit
• Danger signs to watch for (jaundice, color
  changes, breathing change, etc.

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Where should the focus be for perinatal/neonatal
interventions?

• Globally most births occur at home
• Most perinatal/neonatal deaths occur at home
  within the first week
• Sick babies are rarely identified by families and
  taken to health workers in time to prevent death
• Few health facilities are available to provide
  essential neonatal care

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Programs with a postpartum and newborn focus

• Based close to home, or in the home
• Two clients (mother and baby)
• First week is critical time for problems
• Local variables that support or hinder PP/NB
  care
• Access to care
• Recognition of problems
• Knowledge base of mother, family and providers
• Local customs/beliefs (postpartum seclusion,
  taboos)
• Financial factors

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Integration of PP and NB Care Immediate
Postnatal Monitoring

• Monitor closely for the first 6 hours
• Parameters for the new mother
• Pulse
• Vaginal bleeding
• Uterine firmness
• Blood pressure (/-)
• Parameters for the new baby
• respiratory rate, cry
• warmth
• bleeding from cord
• exclusive breastfeeding

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Thanks!