Discharge from hospital

In the best-case scenario of an uncomplicated vaginal birth, discharge of the healthy mother and baby from a health facility can occur within 24 hours, often around 4hrs, of postnatal care being received.¹ A pilot study from the World Health Organization (WHO) provides a checklist of criteria that should be met before discharge, which includes: the mother’s bleeding should be controlled, neither mother nor baby should have signs of infection and the baby should be breastfeeding well.^1–4 If the birth occurs at home, the first contact with a qualified healthcare professional should be as early as possible within the first 24 hours of birth.¹

If mother or baby need ongoing care after the birth, they’ll be admitted to a postnatal ward at a local hospital.^5,6 This may involve at least one night at the hospital if the mother had: a c-section, either elective or emergency an assisted birth with forceps or ventouse cap extensive tearing which requires stitching in theatre or monitoring a pregnancy condition, e.g. pre-eclampsia, or if baby needs monitoring due to trouble feeding.’

Contact in the immediate postnatal period

WHO guidelines stipulate that all babies and mothers should receive at least four more postnatal visits, ideally at home, to assess their physical wellbeing and support with care of the new baby on day 3, day 5 and 14 and 6-8 weeks after birth⁷. Key topics for discussion with parents include, emotional wellbeing, bonding and attachment, feeding, safe sleep, immunisations, social support and coping strategies for managing the day-to-day and maternal physical wellbeing.^1,2

At 10–14 days after birth, all women should be asked about their mental wellbeing, including anxiety and depression based on the NICE guidance⁸ and repeated at every contact. Consideration should be given to partner mental wellbeing due the impact on overall families health.

A joint statement from the WHO and the United Nations International Children’s Emergency Fund (UNICEF) sets out just how beneficial home visits can be for both mother and baby. Home visits can also be used to advise on new-born care including supporting breastfeeding, keeping the baby warm, promoting hand washing and hygienic care of the umbilical cord and skin care, safe sleep, immunisations. These care recommendations include, but are not limited to:^1,8

• Clean, dry cord care

• Delay of bathing until at least 24 hours after birth (or for at least six hours if 24 hours is culturally unacceptable)

• Appropriate clothing of the baby for ambient temperature is recommended. This means one to two layers of clothes more than adults, and no hats/caps to be worn in doors

• Safe sleep

• Immunisations

• Feeding

Assessment of the newborn

When assessing the baby at each postnatal contact, the WHO recommends that referral for further evaluation should be made if any of the following signs are present, and the family should be encouraged to seek help if they identify them between visits:^1,2

Feeding

The WHO and UNICEF continue to recommend that infants are exclusively breastfed for the first six months of life.¹ To facilitate breastfeeding, it is recommended that newborns who are able to breastfeed are put to the breast as soon as possible after birth, ideally within the first hour, if the mother and baby are ready.^1,9,10 The Baby-friendly Hospital Initiative describes how mothers can be supported to breastfeed, including the following steps for after discharge home:¹⁰

• Provide infant feeding counselling during all postnatal contacts

• Offer community support, including mother support groups and community-based health promotion and education activities

Immunisation

The WHO continues to strive to ensure that every person is protected from vaccine-preventable diseases.¹² In the UK, immunisations should be offered to all children and their parents. General practices and child health record departments maintain a register of children under five years, invite families for immunisations and maintain a record of any adverse reactions on the GP record.

Where necessary, local planning should aim to target excluded or at-risk families (including refugees, the homeless, travelling families, very young mothers, those not registered with a GP and those who are new to an area). The current routine immunisation schedule, together with additional vaccines recommended for some groups, can be found on the NHS immunisation page.

Supporting perinatal mental health

Health visitors are ideally placed to promote maternal and partner mental health; 1 in 4 women will experience perinatal illness. Health visitors are able to assess for risk and signs of mental health problems, supporting mild to moderate perinatal mental illness and referring on to more specialist care when needed¹³ Mood changes, irritability and episodes of tearfulness are common after giving birth. These symptoms are often referred to as the “baby blues”, which affect around half of new mothers and lasts 5 to 10 days.¹³

If these symptoms of low mood and anxiety are more persistent, then it is possible it could be post-partum depression.¹³ Perinatal mental health problems such as depression and anxiety can impact 1 in 4 women during pregnancy and the first year after having a baby.¹⁴ Symptoms include those of depression such as crying, feelings of helplessness, loss of appetite, as well as acute panic and anxiety, and can in some instances lead to self-harm and suicide.¹³

During postnatal visits with new parents, women and their partner should be asked about their experience of becoming a parent and explore feelings and expectations. Health visitors can play an important role by educating both mothers and partners about postnatal depression and anxiety so that they are able to access help if they notice any of the signs and symptoms in themselves or their partners.¹³

Ensuring optimal infant mental health

Promoting maternal mental health is key to a healthy baby-parent relationship. Babies need parents to attend to their feelings to help them grow into healthy adults²⁰. Children’s brains develop fastest and are at their most ‘plastic’ in the womb and early years of life. During this period, the brain is primed for learning and growing; it is a time of rapid cognitive, linguistic, social, emotional and motor development. Holding, cuddling and talking to the child both stimulate brain growth and promote emotional development. Being kept close to the parents and nursed on demand ensures the infant feels a sense of emotional security.^21,22

Parent-infant relationships are vitally important and health visitors play an important role during their interactions to ensure optimal social, emotional and mental development of a baby. Health visitors can help provide practical guidance to new parents on cues to understand a baby’s needs and how to soothe and nurture their development from birth.²¹

To learn more about caring for and nurturing newborns’ skin, read about common neonatal and infant skin concerns here.