Protocol · WHO postnatal care
Postnatal care of mother and baby
Most maternal and newborn deaths happen in the days just after birth, yet this is when care is most often missed. WHO recommends at least four postnatal contacts for every healthy woman and baby. At each one, look for danger signs in both, support breastfeeding, ask about mood, and plan contraception.
- Based on WHO postnatal care
- For midwives, nurses, clinical officers, doctors and community health workers
- Reviewed October 2026
1Who / when
- Every woman and newborn for the first 6 weeks after birth.
- Birth in a facility: stay at least 24 hours after a vaginal birth. Birth at home: first contact as early as possible within 24 hours.
- Then at least three more contacts: day 3 (48 to 72 hours), days 7 to 14, and week 6. Home visits count.
2Red flags: refer now
Mother: come at once, day or night
- Heavy bleeding (2 or 3 pads soaked in 20 to 30 minutes) or bleeding that increases.
- Convulsions; headache with blurred vision; BP 160/110 or more.
- Fast or difficult breathing; chest pain; calf pain, redness or swelling.
- Fever and too weak to get out of bed; severe abdominal pain.
Baby: refer for any of these
- Not feeding well; convulsions; no spontaneous movement.
- Fast breathing (more than 60 per minute); severe chest indrawing.
- Temperature over 37.5 °C or under 35.5 °C.
- Jaundice in the first 24 hours, or yellow palms and soles at any age.
3Assess
| Mother | Baby | |
|---|---|---|
| First 24 hours | Bleeding, uterus firm, fundal height, temperature and pulse often from the first hour; BP soon after birth and again within 6 hours; passed urine within 6 hours | Danger signs, breathing, warmth, feeding, cord. First bath delayed at least 24 hours |
| Every later contact | General well-being, bleeding and lochia, urine and bowels, perineum or wound, breasts, headache, back pain, fatigue, BP, mood | Danger signs, feeding and weight, cord, jaundice, eyes, skin, immunisation |
| Also | HIV catch-up test if missed in pregnancy (high-burden areas); TB screening where your programme does it | Eye check; hearing screen and jaundice check where available |
4Classify
| Finding | Classify | Action |
|---|---|---|
| Any red flag in mother or baby | Emergency | First treatment per your protocol and refer urgently |
| Fever, foul lochia, painful breast, wound or perineal infection, urine problems, BP 140/90 or more, pallor, low mood | Problem needing treatment | Treat or refer per protocol; see again in 2 days to 2 weeks |
| Well mother, well baby feeding exclusively at the breast | Routine | Preventive care and counselling; next scheduled contact |
5Treat
- Pain: paracetamol first line for perineal pain; ice or cold packs can help; an oral NSAID for cramping pain if needed.
- Iron: where anaemia in pregnancy is common, continue iron (with or without folic acid) for 6 to 12 weeks after birth, at the same dose as in pregnancy.
- BP: continue antihypertensives started in pregnancy; treat severe postpartum hypertension (see the pre-eclampsia protocol).
- Breast engorgement: frequent responsive feeding, good attachment, expressing milk, warm or cold compresses. No routine antibiotics to prevent mastitis.
- Baby cord: keep it clean and dry. Chlorhexidine 7.1% (delivering 4%) daily for the first week only where harmful substances are often put on the cord.
- Immunisation: give the birth doses in your national schedule.
No routine antibiotics after an uncomplicated vaginal birth, and no routine laxatives. Deworming for postpartum women only where your programme gives it.
6Follow-up
- Routine: day 3, days 7 to 14, week 6.
- Problems: fever, urine infection or perineal infection, return in 2 days; hypertension, 1 week; severe anaemia or postpartum blues, 2 weeks; moderate anaemia, 4 weeks.
- Screen for depression and anxiety with a validated tool (your programme may use EPDS or PHQ-9) and make sure there is somewhere to refer women who screen positive.
7Counsel
- Breastfeed only, day and night, until 6 months; feed when the baby shows hunger.
- Keep the baby warm; put the baby to sleep on the back.
- Contraception: offer full information and methods before she goes home and at every contact.
- Eat well, rest, and return to physical activity gradually (aim for 150 minutes a week).
- Danger signs in her and in the baby, and where to go.
Come back on day 3, at 1 to 2 weeks and at 6 weeks. Come at once if you bleed heavily, have a fit, a bad headache, fever, or trouble breathing, or if the baby stops feeding, is very hot or cold, turns yellow or breathes fast.
8When to refer
- Urgently: any maternal or newborn danger sign.
- BP 160/110 or more, or 140/90 or more with symptoms.
- Severe anaemia, or anaemia not improving.
- Thoughts of self-harm, or depression not improving with support.
- Baby not gaining weight, or a feeding problem you cannot solve.
9Sources
- World Health Organization. WHO recommendations on maternal and newborn care for a positive postnatal experience. 2022 (ISBN 9789240045989).
- World Health Organization. Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice, 3rd edition. 2015. Used for maternal danger signs and follow-up intervals.
- World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. 2011.
- World Health Organization. Daily iron supplementation in postpartum women (e-Library of Evidence for Nutrition Actions). 2016.
Adapted from WHO guidance; not endorsed by WHO. This page paraphrases and adapts the WHO publications listed under Sources, which are licensed CC BY-NC-SA 3.0 IGO; the adapted text is shared under the same licence for non-commercial education. Reasoning GP is not affiliated with WHO or any other organisation named here. Use it alongside your national guidelines, essential medicines list and formulary, and your clinical judgement. Doses are given only where they come from a WHO source; otherwise follow your national guideline or formulary.