Postnatal care

Context

Approximately 700,000 women give birth in England and Wales each year. For women, their partners and their babies, this is a major life event that means considerable emotional and physical adjustment. It applies to all births but is perhaps most marked for those having their first child. Healthcare professionals have the responsibility to help families adjust to their new life, but at the same time they have to be able to spot and care for the families where complications arise.

Postnatal care has for long been regarded as a 'Cinderella service' where in comparison with some other European countries, provision is scanty and inadequate. This approach risks missing an opportunity to have a profoundly beneficial effect on the lives of the babies and their families, now and in the future. In a National Childbirth Trust (NCT) survey: left to your own devices – the postnatal care experiences of 1,260 first-time mothers, 1 in 8 women were highly critical of their postnatal care. Their feedback reflects fragmentation of care, poor planning and communication between healthcare professionals, and insufficient advice about emotional recovery. Furthermore, women continue to report receiving insufficient or inconsistent information on baby's feeding, particularly after giving birth to their first baby.

This guideline addresses the organisation and delivery of postnatal care, including the relationship between the different agencies that share the responsibility for postnatal care; assessment and health of women; assessment and health of babies; how to help parents form strong relationships with their babies; and babies' feeding. It specifically does not cover issues covered by other NICE guidelines, in particular problems of mental health, preterm birth or specialist care (care beyond routine postnatal care), but refers to other NICE guidelines, where appropriate.

This guideline covers the postnatal period up to 8 weeks after birth. However, the sections on babies' feeding and emotional attachment also address the antenatal period because discussion around these is essential already during pregnancy. The postnatal period of course does not end at 8 weeks. A time point of 8 weeks was agreed in order to focus the guideline on the most critical early weeks after birth. The remit for some of the topics in this guideline was to address the needs of families giving birth to twins and triplets in addition to single babies. The evidence specific to twins and triplets was lacking and the consensus was that healthcare professionals and families dealing with twins or triplet births should use the recommendations of the guideline within the constraints of the changed circumstances of having to care for more than 1 child.

The committee were aware of the higher postnatal mortality rates among women of black, Asian and minority ethnic origin and women living in deprived areas reported in the MBRRACE-UK report: saving lives, improving mothers' care (2020). Black women in particular had an over four‑fold increase in maternal mortality rates compared with white women. The MBRRACE-UK report: perinatal mortality surveillance report (2020) also highlights the higher neonatal mortality rates for babies of black and Asian ethnicity and babies born to mothers living in deprived areas. It is important that clinicians are aware of these inequalities in clinical practice.

This guideline was written with the hope that healthcare professionals can use it to provide consistent and high-quality care, while taking into consideration each family's individual situation and needs, in order to reduce morbidity and mortality and to support families in this new phase.