The postnatal period, or puerperium, begins immediately after the delivery of the placenta and extends for six full weeks. This phase is a critical transition window where both the mother and the newborn undergo rapid physiological adaptations. Postnatal and neonatal surveillance refers to the structured, ongoing clinical assessment and supportive care provided during these crucial weeks to prevent, detect, and manage complications that could lead to maternal or infant morbidity and mortality.
In many Nigerian communities, traditional practices emphasize caring for the newborn while the mother's own recovery is sometimes overlooked. Midwives bridge this gap by educating families that maternal health directly impacts infant survival. Surveillance is not a single event but a continuum of care that requires proactive home visits, facility-based check-ups, and clear communication between healthcare providers and the family unit.
The first 24 hours following childbirth carry the highest risk for life-threatening complications, particularly primary postpartum hemorrhage. Immediate surveillance involves continuous monitoring of vital signs, uterine tone, and vaginal bleeding.
To catch complications early, the World Health Organization and national guidelines recommend a specific schedule of postnatal contacts. Midwives must ensure women and babies are seen at these critical milestones:
Involution is the physiological process by which the uterus returns to its pre-pregnant size and weight. Midwives assess this through abdominal palpation, noting the height of the fundus daily in the early days, until it becomes a pelvic organ and is no longer palpable abdominally by about two weeks postpartum.
| Postpartum Day | Expected Uterine Fundal Height |
|---|---|
| Day 1 | One centimeter below the umbilicus |
| Day 5 | Midway between the umbilicus and symphysis pubis |
| Day 10 | Pelvic organ, no longer palpable abdominally |
Midwives also inspect lochia—the postpartum uterine discharge. Lochia changes character over time: lochia rubra (red, days 1-4), lochia serosa (pinkish-brown, days 5-9), and lochia alba (whitish-yellow, from day 10 onward). A sudden return to bright red bleeding or a foul odor suggests retained products of conception or infection.
Midwives must educate mothers and their family members to recognize critical danger signs that require immediate return to a health facility. Postpartum hemorrhage, puerperal sepsis, thromboembolism, and hypertensive disorders can arise after discharge.
Regular temperature checks and perineal inspections during home and clinic visits help catch these conditions early before they become life-threatening emergencies.
Neonatal surveillance ensures the baby is transitioning smoothly to extrauterine life. The midwife performs a head-to-toe examination at every contact.
Check the umbilical stump for signs of redness, moisture, or foul odor. Inspect the skin for jaundice, rashes, or birthmarks. Assess newborn reflexes like Moro and sucking.
Feeding support is paramount. Exclusive breastfeeding on demand for the first six months is the gold standard. Midwives evaluate latch, positioning, and swallowing to prevent nipple trauma and ensure the baby receives adequate nutrition. Weight checks are vital; newborns normally lose up to 10% of their birth weight in the first week due to fluid shifts, but they should regain their birth weight by day 10 to 14.
The hormonal shifts, physical fatigue, and emotional adjustments following childbirth leave many women vulnerable to psychological distress. Midwives must distinguish between normal postpartum experiences and clinical conditions.
Asking open-ended, non-judgmental questions about how the mother is coping emotionally is a routine responsibility during every postnatal visit.
Postnatal visits provide a vital window for preventive health interventions. Midwives educate mothers on infant immunization and discuss future reproductive health.
At birth, babies receive the BCG vaccine against tuberculosis and the oral polio vaccine (OPV zero dose), along with Hepatitis B immunization. Midwives explain the schedule for subsequent routine immunizations at 6, 10, and 14 weeks.
Family planning counselling must begin before hospital discharge and be reinforced during postnatal visits. Ovulation can return before the resumption of menstruation, even in exclusively breastfeeding women. Midwives discuss options ranging from progestin-only pills, injectables, and barrier methods to long-acting reversible contraception, ensuring the mother makes an informed choice.
Accurate record-keeping ensures continuity of care between home visits, community clinics, and tertiary referral centers. Midwives must document all findings in both the mother's and infant's health records, noting vital signs, feeding status, and any counselling provided.
When complications arise that exceed primary care capabilities, clear referral pathways must be activated promptly. This involves contacting the receiving facility, stabilizing the patient, organizing safe transport, and sending a comprehensive referral note.
Discharge planning from the postnatal surveillance program culminates at the six-week visit. The midwife ensures the mother knows where to access routine child welfare clinics, family planning services, and emergency care whenever needed in the future.