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TitleSaving Mothers' Lives
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Page 85



“An understanding of precisely where to concentrate effort in each setting is the key
to achieving safe motherhood” 1

Mona K. Moore, 2000

“Postpartum hemorrhage is the single most common cause of maternal death. It kills
150,000 women each year. Nearly 9 out of 10 postpartum maternal deaths take place
within four hours of delivery”… During this period prevention strategies are often
lacking”. 2

WHO, 1998

“Ironically, the traditional time for the first postpartum visit by a mother and baby is
six weeks, a time when there is no longer very much danger of maternal death.” 3

FHI, 1997

The Role of Postpartum Care in Reducing Maternal Mortality

Evidence indicates that the postpartum period is the most critical time for both maternal and
neonatal survival (see figure 2). Yet it remains the most neglected component in maternal and
infant care. In this chapter, we focus on the postpartum period: the first hour after delivery of
a baby and placenta and up to the 42nd day after delivery. This period also includes the neonatal
period: the newborn’s first 28 days of life. If we shift our programmatic concentration to ensuring
effective care to mother and newborn within the first 24 hours and up to the first 2 weeks, this
could be – along with having functional EmOC services available and utilized – the most strategic
means of reducing maternal and neonatal mortality.

Figure 4: When women die - time of maternal deaths in developing countries,
(Adapted from WHO 1998)

Page 86


Magnitude of the Problem in India

Many women in India are vulnerable to complications in the postpartum period because they lack
effective care. Although 60 percent of all maternal deaths occur after delivery, only 1 in 6 women
receive care during the postpartum period. More women in India access maternal health services
during pregnancy than during delivery or after childbirth.

NFHS data indicate that among the births that took place in non-institutional settings in India, where
postpartum care is particularly important, only 17 percent were followed by a checkup within two
months of delivery. Shockingly, among those who deliver at home only 2% receive postpartum care
within 2 days of delivery and only 5% receive care within the first 7 critical days.4

Often the entire range of information and services is not provided to women during a postpartum
visit. According to NFHS figures, only 38 percent of the women who did not deliver at a facility
but received postpartum care had an abdominal examination and a mere 27 percent were given
family planning advice. Information on breastfeeding and care was more routinely provided, with
around 4 out of 10 postpartum women receiving this advice. This was in spite of the fact that a
significant number of women reported health problems in the first months after delivery. The
same NFHS data show that 23 percent of women reported problems six weeks after delivery, of
which the most frequently reported were lower abdominal pain (4.4 percent), high fever (5.3
percent) and foul discharge (0.5 percent). Massive vaginal bleeding and very high fever during the
two months after delivery —symptoms of possible postpartum complications—were reported for
11 percent and 12.6 percent of births, respectively. 5 However we must remind ourselves that
these data were collected from the survivors.

Postpartum Best Practice: Shifting Interventions to the First 24
hours and First 7 Days to Reduce Maternal and Neonatal Deaths

From the recent evidence, it has become clear that the first 24 hours is perhaps the most critical
period for postpartum and newborn care. Women regardless of where they deliver – at home or in
an institution – and their newborns need to be closely monitored for the first 24 hours. Those who
deliver in an institution should remain for observation for the first 24 hour period while those who
deliver at home need to ensure that the birth attendant provide close monitoring for the first 24
hours for signs of an emergency.

During this critical 24-hour period, the birth attendant needs to monitor for signs of any serious
complications in the mother and newborns such as6:

• Hemorrhage
• Atonic uterus
• Retained placenta
• Shock/fainting – cool/clammy
• Convulsions – may be preceded by severe headache /visual disturbance
• Tears/lacerations
• Urine output decrease

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