SAFE MOTHERHOOD AND NEWBORN HEALTH (THIRD PART)

Childbirth is the most critical period for the mother and her baby. Every pregnant woman must have a skilled birth attendant, such as a midwife, doctor or nurse, assisting her during childbirth, and she must also have timely access to specialized care if complications should occur.

Every pregnancy deserves attention because there is always a risk of something going wrong with the mother, baby or both. Many dangers, illnesses or even death can be avoided if the woman plans to give birth attended by a skilled birth attendant, such as a doctor, nurse or midwife, and makes at least four prenatal visits to a trained health worker during the pregnancy. 

The likelihood of the mother or the baby becoming ill or dying is reduced when childbirth takes place in a properly equipped health facility with the assistance of a skilled birth attendant, who also checks regularly on the mother and baby in the 24 hours after delivery. 

When the pregnant woman is ready to give birth, she should be encouraged to have a companion of her choice accompany her to provide her with continuous support during childbirth and after birth. In particular, the companion can support the woman in labour to eat and drink, use breathing techniques for different stages of childbirth, and arrange for pain and discomfort relief as needed and advised by the skilled birth attendant. 

During and immediately following childbirth, the skilled birth attendant will:

● assess and follow the progress of labour and pay attention to danger signs that indicate help is needed immediately

● advise the woman and her family if specialized care is needed and if a transfer to a hospital or maternity centre is necessary 

● reduce the risk of infection by keeping hands, instruments and the delivery area clean, and by using gloves at appropriate times

● encourage the woman to walk during the first stage of labour and support her choice of position for childbirth 

● assist the different stages of labour and the birth of the baby 

● cut the umbilical cord at the appropriate moment and care for it

● care for the baby and keep her or him warm after birth

● guide the mother to put her baby on her chest for immediate skin-to-skin contact and initiation of breastfeeding soon after birth

● deliver the afterbirth (placenta) safely and care for the mother after the baby is born

● examine and weigh the baby and put recommended drops in the baby’s eyes to prevent blindness and infection

● manage newborn health problems and refer or transfer the baby with the mother to an appropriate health provider or health facility, if necessary.

Post-natal care for the mother and child reduces the risk of complications and supports mothers and fathers or other caregivers to help their new baby get a healthy start in life. The mother and child should be checked regularly during the first 24 hours after childbirth, in the first week, and again six weeks after birth. If there are complications, more frequent check-ups are necessary.

Post-natal care assisted by a skilled birth attendant is important to help ensure the survival and health of the mother and her newborn. During the first hours after childbirth and the first week and month of life, newborn babies are particularly vulnerable. 

After childbirth the skilled birth attendant will:

● check the mother’s and baby’s health regularly during the 24 hours after birth, during the first week, and again six weeks after birth 

● advise and support the mother on how to continue breastfeeding the baby 

● advise the new parents on how to prevent or delay another birth 

● advise the mother on nutrition, rest, hygiene, immunizations, sleeping under an insecticide-treated mosquito net in malarial areas, regular health check-ups and how to care for herself and her baby; advise the father to be supportive of these needs of the mother and child 

● explain potential danger signs for the mother and her baby 

● support the mother, father and family in preparing an emergency plan in the event complications arise

● advise mothers and fathers on STIs, including HIV, and if they are infected with HIV, how to care for themselves and their child and how to practice breastfeeding in a way that reduces the risk of infecting the child

● counsel the mother who is HIV-positive and her partner to help them make informed decisions on future pregnancies and contraceptive methods (refer to the HIV chapter for more information)

● schedule the next follow-up visit for the mother and her baby. 

For the mother and/or child with complications, the skilled birth attendant will:

● explain to the mother any complications she or her baby had and the treatment received and how she should continue to care for herself and her baby at home

● provide the mother with medications if necessary and instructions on how, when, and for how long to administer them

● identify and administer missing immunizations to the mother, including tetanus toxoid 

● advise the mother and father or other caregivers on how to best care for their baby if born too soon or too small, or with other special needs 

● schedule frequent follow-up visits to assess the health of the mother and her baby.

The first days and weeks are especially risky for low-birth weight babies. The majority of newborn deaths occur in low-birth weight babies. Many of these babies could be saved with post-natal care provided by a skilled birth attendant who will:

● identify and address the danger signs in a timely manner

● provide extra support for breastfeeding, including expressing milk and cup feeding

● ensure the baby is warm by helping the mother or other caregiver use skin-to-skin care, also known as the ‘Kangaroo Mother Care’ method

● refer the baby for emergency care if the infant is unable to breastfeed or accept expressed milk.

OUR THANKS TO UNICEF