International Journal of Trend in Scientific Research and Development (IJTSRD)

Volume 9 Issue 1, Jan-Feb 2025 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470

Post-Partum Care: A Systematic Review

Esther Ngueng Nti1, Mary Bi Suh Atanga2, Fongang Landis3, Nana Celestin4
1,2,3
University of Bamenda, Bamenda, Cameroon
4
Foundation of Applied Statistics and Data Management (FASTDAM), Buea, Cameroon

ABSTRACT How to cite this paper: Esther Ngueng

Purpose Nti | Mary Bi Suh Atanga | Fongang
To determine the effectiveness of post-partum care to enhance Landis | Nana Celestin "Post-Partum
mothers and newborn safety. Care: A Systematic Review" Published
in International
Data sources Journal of Trend in
Electronic search of PubMed, Google Scholar, CAS Google Scholar, Scientific Research
Yahoo, Cochrane, Research Gate of post-partum care websites and and Development
bibliographies of included articles and key journals. (ijtsrd), ISSN:
2456-6470,
Study selection Volume-9 | Issue-1, IJTSRD73833
English and French language studies published between January February 2025,
2009 and August 2024 that measured the effectiveness of post- pp.691-698, URL:
partum care using quantitative or qualitative measures of good www.ijtsrd.com/papers/ijtsrd73833.pdf
practices, mother and new-born safety. Studies included were survey,
quasi-experimental, systematic review, task force analysis based on Copyright © 2025 by author (s) and
essentially on experts’ professional experience, phenomelogical, International Journal of Trend in
Scientific Research and Development
retrospective and one case-control.
Journal. This is an
Data extraction Open Access article
Data extraction and critical appraisal were conducted by three distributed under the
system-internal and one independent reviewer, the statistician, for terms of the Creative Commons
ethical consideration. Study design, intervention, level of application, Attribution License (CC BY 4.0)
(http://creativecommons.org/licenses/by/4.0
setting, study participants, post-partum care standards, measures and
implementation and impact lessons were extracted from the included articles.
Results of data synthesis
Over 600 articles were screened for inclusion, of which 25 full text articles were included in data synthesis.
Among them, 14 survey, 2 quasi-experimental, 4 systematic review, 1 task force analysis based essentially on
experts’ professional experience, 1 phenomelogical, 2 retrospective and one case-control studies met the
inclusion criteria (figure 1) and cut-across the specific objectives of the study. As for the qualitative studies, they
were 2.
Conclusions
The WHO’s guide for essential practice in pregnancy, childbirth, postpartum and new-born care remain the most
broad standards employed by health facilities across the world for post-partum care and it is supported by the
WHO standards for improving quality of maternal and new-born care in health facilities. Post-partum care
processes have been highly standardized over the past decades with the provision of more comprehensive
guideline to help health facilities in this respect. There is sufficient evidence as depicted by the literature for a
strong face validity of these guides and their effectiveness has been proven through numerous scientific
evidences. However, these guides have been contextualized on some specific areas to suit the requirements of
specific settings. Governments and organisations are advised to consider the socio-cultural and political realities
of their countries while using these guides which of course at several levels have open brackets for such
contextualization.
KEYWORDS: Pregnancy, childbirth, postpartum, mother, new-born, Care, systematic review
INTRODUCTION
The postpartum period begins immediately after the mortalities occur during this period, therefore, proper
birth of the baby and extends up to six weeks (42 maternal management and care are vital. It is a critical
days) after birth, majority of maternal morbidities and phase in the lives of mothers and their families.

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During this time, a wide range of postpartum effectiveness was based on published standards and
complications occur, in turn proper maternity based- guidelines, survey studies, randomised controlled
care is needed to prevent maternal morbidities and trials (RCTs), non-RCTs or quasi-experimental
mortalities. To solve this problem, our study aims at studies, controlled before and after studies,
investigating the elements that must be included in interrupted time series, historically controlled studies,
the framework of the maternity care for women in the longitudinal and cross-sectional studies, multi country
postpartum period as this will help render proper care studies. Studies in reference health facilities, frontline
to women in their postpartum period, prevent health facilities and in communities were included.
maternal morbidities and mortalities and alleviate the Both quantitative and qualitative studies were
suffering of the women, their families and the nation considered. Information were extracted from peer-
at large. Based on these scientific evidences, there is reviewed journals, abstracts, websites, and cited
growing interests on improving post-partum care authors within articles.
given the numerous setbacks that take place after Exclusion criteria:
birth and in some cases where delivery went on very All studies not dealing with post-partum care were
well due to negligence or inadequate follow up of the excluded except inspirations from other systematic
mother during the post-partum period. This is review works not dealing with the same topic but that
reflected in the growing number of peer-reviewed were in the frame of health care for structural reasons
articles, guidelines and standards as well as other and for comparing approaches of systematic review.
literature reports on post-partum care. Mother and All studies before 2009 were excluded.
new-born safety have been a cause for concern and
Data extraction and analysis
governments, organizations and even jurisdictions
Data extraction and critical appraisal of included
have made it key components of their health and
studies were conducted by four independent
safety policies. The growing attention paid to mother
reviewers (NNE, FL and NC), with disagreements
and new-born safety has prompted for numerous
settled by a fourth reviewer (MBSA). Implementation
scientific researches both prospective and
data and data from studies using mixed method
retrospective that over decades have helped improved
evaluations were also extracted and reviewed. A
and further standardize guideline for mother and new-
meta-analysis was not possible due to insufficient
born safety during the post-partum phase.
homogeneity (populations, interventions, outcome
METHODS measures and follow-up periods) of studies but where
Data sources it could apply, it was done and reported.
An electronic search was conducted of the PubMed, Consequently, analysis considered essentially
Google Scholar, CAS Google Scholar, Yahoo, common themes, conceptual and analytical trends and
Cochrane, ResearchGate,. Medical subject heading presented in a narrative format.
search terms and keywords were used notably ‘post- RESULTS
partum care’ and ‘Post-natal follow up’. Additionally, Over 600 articles were screened for inclusion, of
bibliographies of included articles and key journals which 25 full text articles were included in data
were hand searched. The search languages were synthesis. Among them, 14 survey, 2 quasi-
English and French. In French, the main search experimental, 4 systematic review, 1 task force
keywords were ‘Suivi post-partum’ and ‘suivi analysis based on essentially on experts’ professional
médical de la mère après l'accouchement’. This was experience, 1 phenomelogical, 2 retrospective and
important and peculiar to this study context given that one case-control studies met the inclusion criteria
the official languages used in Cameroon are English (figure 1) and cut-across the specific objectives of the
and French as this gave room for the exploitation of study. As for the qualitative studies, they were 2 were
both English and French literatures. Included studies were conducted in several countries
Duration in Africa, in USA, Iran, Pakistan, Palestine, Tanzania,
The duration of the systematic review was 11 months, Cameroon, Kenya, Iran and India. A study by WHO
from October 2023 to August 2024. was conducted in 33 different African countries. The
period for the systematic review ranged from 15 to 24
Study selection years. As for the retrospective study, the period
Inclusion criteria: considered ranged from 16 to 24 years. The duration
English and French language studies published for the cross-sectional survey was generally three
between January 2009 and to August 2024 focusing months or less. Surveys that used adapted
on post-partum care with particular reference to questionnaire or relied on existing mode such as
mother and new-born safety were considered as to Person-Centered Maternity Care (PCMC) or self-
cover a period of 15 years. Assessment of developed questionnaire.

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Figure 1: Flow chart of search result

SUMMARY AND DISCUSSION OF STUDY received magnesium sulfate) and maternal mortality
FINDINGS in health facilities. Studies also show that high-quality
Priority issues care requires appropriate use of the available
WHO opined that much progress has been made infrastructure, staff and commodities to ensure
during the past two decades in coverage of births in effective case management . High-quality care
health facilities; however, reductions in maternal and requires appropriate use of evidence-based clinical
neonatal mortality remain slow. With increasing practices and non-clinical interventions, strengthened
numbers of births in health facilities, attention has health infrastructure and optimum skills and a
shifted to the quality of care, as poor quality of care positive attitude of health providers. Lack of
contributes to morbidity and mortality. The period supportive care and respectful behavior experienced
around childbirth is the most critical for saving the by pregnant women can act as a barrier to the
maximum number of maternal and newborn lives and utilization of health care services .
preventing stillbirths . Person-Centered Maternity Guidelines and standards
Care (PCMC) is known as one of the most important
The World Health Organization recently released new
components of maternal care. Every woman has the guidelines on postnatal care, which include
ultimate right of respectful health care. The WHO
recommendations for immediate postpartum
Multicountry Survey on Maternal and Newborn monitoring. In light of the new guidelines, this
Health, with data on more than 300 000 women
presented an opportune moment to address the gaps in
attending 359 health care facilities in 29 countries, postpartum monitoring in low- and middle-income
showed a poor correlation between coverage of
countries. The World Health Organization (WHO)’s
“essential interventions” (e.g. the proportion of the
new postpartum care guidelines, published in March
population who had received an indicated
2022 (40) to update and expand on the 2014
intervention, such as women with eclampsia who

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guidelines, bring a renewed focus to the importance As for training or capacity building, the competency-
of prompt identification and management of based education (CBE) program, was recommended
complications in the immediate postpartum period. as well as the PDCA model . The PDCA cycle is
Motivated by the high burden of postnatal maternal divided into four stages, plan (P), execution / Do (D),
and newborn mortality and by the quality revolution check (C), and action (A).
in global health; the new guidelines emphasize the
Duration of post-partum
importance of high-quality postnatal care—including
concluding with a comprehensive postpartum visit no
continuous care and monitoring during the critical
later than 6 weeks after birth while recommending
first 24 hours after childbirth, followed by at least 3
that all women have contact with their obstetrician–
postnatal care contacts during the first 6 weeks after
gynecologists or other obstetric care providers within
delivery—and of ensuring a positive postnatal
the first 3 weeks postpartum . The postpartum period
experience for women and their newborns. The
can be seen as the “fourth trimester,” and has been
release of these guidelines makes this an opportune
described as a “critical transition period with unmet
time to address gaps in the quality of immediate
maternal health needs” thus aligning with the former
postpartum care in LMICs.
who recommended a comprehensive post-partum visit
The first recommendation in the WHO's 2022 not later than 12 weeks, thus aligning with the
postnatal care guidelines states that, following timeframe of a trimester here stated. These equally
childbirth, all women should have “regular corroborate these authors that recommended that all
assessment of vaginal bleeding, uterine tonus, fundal women should ideally have contact with a maternal
height, temperature, and heart rate (pulse) routinely care provider within the first 3 weeks postpartum.
during the first 24 hours, starting from the first hour This initial assessment should be followed up with
after birth.” Although the specific recommendations ongoing care as needed, concluding with a
on postnatal assessment have not changed—it still comprehensive postpartum visit no later than 12
holds that women should be monitored 4 times during weeks after birth .
the first hour after delivery . In the same perspective
Gaps in practice
with the following 2016 guide, the 2015 guide aimed
However, the efficiency and effectiveness of post-
was to provide evidence-based recommendations to
partum care differ across nations (44). It was
guide health care professionals in the management of
highlighted differences in performance across nations
women during pregnancy, childbirth and postpartum,
with respect to post-partum care which could be
and post abortion and newborns during their first
attributed to the difference in culture and the
week of life, including management of endemic
relevance to clinical practice as corollary of the
diseases like malaria, HIV / AIDS, Tuberculosis and
structure of the health system (44). The WHO
anaemia . This guide comprises eight standards of
guidelines presented an opportune moment to address
care and 31 quality statements are listed below . This
the gaps in postpartum monitoring in low- and
2016 guide supplement the previous one entitled
middle-income countries. Although most women
‘Pregnancy, Childbirth, Postpartum and Newborn
remain in the health facility after delivery for at least
Care: A guide for essential practice’ which third
the WHO-recommended 24 hours, the care provided
edition was published in 2015 which followed the
during this postpartum stay is minimal. Across 33
2004 version. It is this 2004 version that is
LMICs with available Demographic and Health
recommended referred on the website of the Ministry
Survey (DHS) data from 2000 to 2016, only 66% of
of Public Health of Cameroon notably the French
women who delivered in health facilities reported that
Version ‘Prise en charge des complications de la
they received at least 1 postpartum health check
grossesse et de l'accouchement: Guide destiné à la
during their postpartum. Recent paradigm shifts in
sage-femme et au médecin’. Earlier in 2011, WHO
postpartum care have conceptualized the “fourth
published ‘Counselling for Maternal and Newborn
trimester” as a critical transitional period requiring
Health Care: A Handbook for Building Skills’ . The
tailored, ongoing health care. However, this concept
American College of Obstetricians and Gynecologists
presents challenges for providers, especially in low-
(ACOG) provided guidelines to optimize Postpartum
resource settings . Adequate post-partum care for all
(41) while the Centers for Disease Control and
individuals will require societal and environmental
Prevention (CDC) made available Postpartum Care
changes, such as access to transportation, childcare,
and Resources (42). providers in network, or universal insurance. These
However, it was found limited adherence to changes require significant efforts on the policy side,
guideline-recommended which poses major such as recent efforts to expand Medicaid coverage to
challenges to the outcome of post-partum care. 1 year postpartum .

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Optimizing post-partum care coordination of care; (vii) for a woman who has
Health policymakers were requested to collaborate experienced a miscarriage, stillbirth, or neonatal
with midwifery staff to contextualized and optimized death, it is essential to ensure follow-up with an
post-partum care . In the same vein, it was opined that obstetrician–gynecologist or other obstetric care
incorporating the perspective of health system provider; (viii) optimizing care and support for
administrators and other health care team members postpartum families will require policy changes.
may offer further insights on barriers and potential Changes in the scope of postpartum care should be
solutions . Other studies centered on health care facilitated by reimbursement policies that support
providers resolved that the nature of the factors which postpartum care as an ongoing process, rather than an
influence health worker attitudes and behaviours isolated visit; and (ix) Attributes of health care
suggests that strengthening health systems, and managers to foster maternal health care were
workforce development, including in communication highlighted and include : Promoting supportive
and counseling skills, are important . In the same supervision of MHCPs by facility managers;
perspective, it was highlighted that optimizing care professional development planning for MHCPs;
and support for postpartum families will require ensuring accountability to professional standards and
policy changes . Several recommendation were then ethics at all levels of the health system; improving
made to refine policy in post-partum care (43) : (i) patients’ understanding of medical practices and their
It was generally emphasized the need to educate all rights; and raising providers’ knowledge of local
health staff in this regard to provide high-quality cultural practices in relation to pregnancy and
postnatal care. In the same vein, these authors argued childbirth.
that the lack of nurses’ knowledge was because the Several studies indicated a strong link between
hospital administration did not provide them with any demographic characteristics of mothers and their
refreshment and training programmes on quality of perception of post-partum care. Mothers’ perceptions
nursing performance during the postpartum period of the quality of postnatal were associated with their
nor provide them with care standards for the education level . Some studies expressed the
postpartum period, nor with nursing procedures relationship between the mothers’ satisfaction and
manuals which help in guiding their action; this lack method of feeding, age, parity, and gravidity.
of knowledge, of course, result in poor quality
Satisfaction with the health personnel was an
nursing performance ; (ii) to optimize the health of important determinant of the mothers’ perception of
women and infants, postpartum care should become
postnatal care . Other studies have also revealed the
an ongoing process, rather than a single encounter, relationship between women and care providers as
with services and support tailored to each woman’s one of the important factors affecting the mothers’
individual needs, this aligning with PCMC earlier satisfaction with postnatal care . These results further
recommended which equally strengthened this stressed the importance of PCMC (105). Manager in
argumentation that pertained that the timing of the
some settings remarked that midwives were more
comprehensive postpartum visit should be
likely to get angry at women who were primiparous
individualized and woman centered ; (iii) prenatal
and didn’t have ‘experience’ with childbirth . Change
discussions should include the woman’s reproductive is required to optimize postpartum care, as providers
life plans, including desire for and timing of any identified areas in which both providers and patients
future pregnancies. A woman’s future pregnancy require additional support. This support may come in
intentions provide a context for shared decision-
the form of administrative assistance, structural
making regarding contraceptive options; (iv) the changes in clinic flow, support for care coordination,
comprehensive postpartum visit should include a full
and increased access to educational resources for all
assessment of physical, social, and psychological parties . In a nutshell, changes require significant
well-being; (v) women with pregnancies complicated efforts on the policy side, such as recent efforts to
by preterm birth, gestational diabetes, or hypertensive
expand Medicaid coverage to 1 year postpartum.
disorders of pregnancy should be counseled that these
disorders are associated with a higher lifetime risk of Research gaps
maternal cardiometabolic disease; (vi) women with The limited available evidence on the quality of
chronic medical conditions, such as hypertensive postpartum monitoring in LMICs paints a concerning
disorders, obesity, diabetes, thyroid disorders, renal picture.
disease, mood disorders, and substance use disorders, CONCLUSION
should be counseled regarding the importance of This systematic review highlighted critical points that
timely follow-up with their obstetrician– should be considered in having a comprehensive view
gynecologists or primary care providers for ongoing of post-partum care, challenges and opportunities.

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These range from priority issues to be considered in [10] Emma Clarke-Deelder, Kennedy Opondo,
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