Addressing Postnatal Challenges: Effective Strategies for Postnatal Care

Abstract

Delivery of the placenta marks the end of pregnancy and the beginning of puerperium. Puerperium or postnatal period is a period of transition, it is the extended period between the completion of the third stage of delivery till 42 days (6 weeks) after childbirth. It is a critical time requiring the most attention on the mother, baby, and family members. Many mothers experience near-miss events and maternal and infant deaths occur during this time. However, it is a most overlooked period. Mothers experience numerous changes which include physiological, psychological economic and sociological changes and without the necessary knowledge and support could affect their ability to care for the newborn and themselves. Challenges mothers experience include the decision to breastfeed and care for the baby, medical conditions associated with pregnancy and puerperium, postpartum hemorrhage, preeclampsia, increased cesarean section rate and complications and high delivery cost. International health bodies have recommendations for postnatal care, this chapter will focus on strategies the mothers and care providers can adopt to overcome postnatal challenges.

1. Introduction

Pregnancy and its unique processes come with a variety of experiences and emotions. Due to the different physiologic makeup, adaptation, and responses, individual women respond differently to normal pregnancy processes. Women, therefore, need support to navigate the challenges of puerperium. Midwives are uniquely trained, skilled, and placed to meet these needs.

Delivery of the placenta marks the end of pregnancy and the beginning of puerperium. Puerperium or postnatal period is a period of transition, it is the extended period between the completion of the third stage of delivery up till 42 days (6 weeks) after childbirth. It is a critical time requiring the most attention on the mother, baby, and family members. Many mothers experience near-miss events and maternal and infant deaths occur during this time. However, the immediate postpartum period appears to be the most overlooked [1, 2, 3].

Challenges mothers experience include the decision to breastfeed and how to care for the baby, medical conditions associated with pregnancy and puerperium, postpartum hemorrhage, preeclampsia, increased cesarean section rate and complications, and high delivery cost. This chapter will provide suggestions for adjusting to the physiologic and psychological changes of pregnancy during puerperium.

2. Postnatal challenges and coping strategies

Mothers experience numerous changes which include physiological, psychological economic, and sociological changes, and without the necessary knowledge and support could affect their ability to care for the newborn and themselves.

2.1 Physiologic challenges

The human body witnesses several physiologic changes during pregnancy, some of which resolve or culminate in other conditions during the puerperium. There are increases in the activity of all organs from the cardiovascular to the respiratory, renal, endocrine, gastrointestinal, skeletal, and integumentary systems. These are characterized by increased cardiac output and heart rate (20–45%), 20% more oxygen demand, about 50% increased renal flow and function, delayed gastric emptying and reduced albumin level, 9–12 kg increase in body weight, relaxation of joints, reduced calcium, increased activity of the skin and mucus membranes [4].

These are normal changes during pregnancy, though may cause discomfort as the pregnancy advances. The woman must seek nursing and medical advice in cases of serious discomfort or interference with normal daily function. The advice comes in handy during antenatal sessions where the mother can ask pertinent questions and get clarifications as well as self-help advice from the midwife.

Physiologic challenges in puerperium may result from the reversal of some of the changes that occurred during pregnancy and cuts across all systems of the body as well. Firstly, the cardiovascular system experiences further increased cardiac volume from the contracting uterus which decreases within 24 hours and gradually returns to pre-pregnancy level in 4–6 weeks. There is increased body temperature from pain, fatigue, and increased blood flow, this also normalizes a few hours after birth. Pain on the episiotomy site and puerperal infection are notable causes of pyrexia [5].

Other physiologic challenges postpartum mothers experience include musculoskeletal disorder and or dysfunction. Pelvic floor dysfunction (PFD) and diastasis recti abdominis (DRA) are associated with pregnancy and childbirth. They have negative effects on the physical, psychological, and social life of the woman [6].

2.2 Psychological challenges

Pregnancy and puerperium come with multiple and numerous challenges for primipara and multiparous women. The task of caring for a new child, breastfeeding and combining it with work and family responsibilities can be enormous for women who are contending with drastic changes in their physics. Every woman responds differently and must develop adaptive skills to navigate these phases of motherhood.

The pregnant woman faces mixed emotional changes and psychological support is important to pull through the mood changes, exhaustion and or alternating elation, and need for affection, sexual. Pregnancy is a stressor to some women; the anxiety and emotional instability can lead to preterm labour and preterm delivery in a quarter to two-thirds of women affected. Therefore, pregnant women require more support from partners and social and medical teams. The absence of psychological support during pregnancy and through the postpartum period could lead to postnatal depression and an inability to cope with childcare, self-care, and independent economic life [7].

Evidence shows adopting a positive psychological attitude during pregnancy supports psychological well-being in the puerperium. Women must develop elevated levels of resilience to cope with the added stress during puerperium for adequate self-care, coping with the infant and other social duties as a wife and mother [8, 9].

Women sometimes experience several negative and positive emotions, anxiety and psychological symptoms during pregnancy which often are associated with hormonal factors and the need for relationships. The emotional instability is more pronounced during the stress of labour, initiating breastfeeding and fitting into the motherhood role postpartum. Measuring into the motherhood role is therefore challenging necessitating the psychological support by the midwife. Midwives must create a tranquil environment to support the mothers’ adjustments [10].

2.2.1 Causes of unstable psychological state in the puerperium

Many women are at risk of abnormal psychologic adjustment postnatally. Such women include mothers of babies diagnosed or born with birth defects [11], socio-demographic factors like low-income status, mode of delivery, and cultural practices with a preference for the male child [12], lack of social and psychologic support with bonding failures [13] positive history of prenatal psychologic symptoms and in clients with greater than one psychologic disorder [14] hereditary and family history of mental disorder [15].

Motherhood is a new role and can be challenging for multipara and first-time mothers. Social and societal norms are expected of new mothers. Childbirth is a social phenomenon; some women find it difficult to fit into these roles or function within acclaimed roles [16]. The ineffective social support during pregnancy affects the psychological state of mothers and could lead to failed bonding perinatally [13]. The inability to cope with the stress and challenges of breastfeeding affects mental health and adaptation to the new role. It may also result in delayed lactation, reduce the confidence to conduct breastfeeding and affect the newborn negatively [17].

2.2.2 Signs of altered postpartum psychologic state management

There exists a chasm between actual and perceived altered postpartum psychological state. It is one syndrome that is underreported and undiagnosed due to the level of health provider knowledge, skill and competence stigma attached [18]. Signs of altered psychological state include increased anxiety and fear, and poor maternal-infant bonding, poor maternal health and feeding [19, 20]. Low resilience and high stress perception are also associated with poor psychological coping [9].

Unidentified and untreated psychological concerns can interfere with the successful motherhood experience and social life of the woman [21]. Though midwives can identify and care for women with psychological disorders, they tend to refer such to other professionals. The psychological challenges encountered in puerperium could be managed effectively by maternity nurses [22].

Midwives play significant roles in screening, treating, and referring identified cases for expert management [23]. Other ways of managing postpartum psychologic challenges include hospital/facility-based care [24], and community and out-stationed care where networks and support groups are formed to help such clients [25]. The recent pandemic equally saw the introduction of mobile dyadic clinics to cater to the needs of such clients who would otherwise not assess care due to difficult social situations [26].

Another approach is by giving the client a voice, and an opportunity to express self and be heard. This will improve communication with the caregiver as the woman gains confidence, learns to trust, and relieves anxious feelings [27]. Moreover, providing both antenatal and postnatal counseling with reading/supportive literature, giving physical therapy like massage, and yoga, and through scheduled telephone calls from providers [28].

2.2.3 Importance of psychologic support during the postpartum

A stable maternal psychological state is a pre-requisite for effective coping, midwives must support and design/institute measures to enhance coping and prevent postpartum depression, anxiety, and stress. Some of the measures include providing information, creating opportunities to discuss fears and clarify doubts, and initiating breastfeeding early with support for women who do not lactate early. The midwife must explore the option of getting family presence and social support for women who demand it and for those without family presence.

It is also important to screen postpartum women to identify risk factors for psychological maladjustment and institute measures to mitigate them. There is also a need to encourage disclosures of untoward familial psychological states to enable early comprehensive assessment and treatment. Table 1 shows some psychological assessments and interventions midwives can give to postpartum women.

Midwives’ intervention	Actions
Informational support	Providing information about the care available through education, explanation, and clarification of doubts
Emotional support	Giving emotional support through verbal encouragement, attentive listening and providing answers to questions; Non-verbal care such as touch and hugs to emotionally unstable mothers who consent.
Providing self-care support	Self-care support like doing cord-care, bathing and changing baby’s clothes/diapers and feeding the baby
Psychologic assessment and screening	Routinely assess and document the psychological well-being of mothers to provide bases for action
Multisectoral approach	Encourage collaboration and consultation with the interdisciplinary team

Table 1.

Psychological interventions for postpartum women.

Adapted from Sangsawang et al. [29].

2.2.4 Strategies to overcome the postpartum psychological challenge

Midwives contribute to the psychological well-being of new mothers by providing adequate care and partner support during labour and immediate puerperium. Encouraging mind and physical relaxation, early ambulation and exercise, socialization and interaction with family, peers, and colleagues to gain support and overcome stress [30].

Midwives can provide improved rapport and social support during pregnancy and encourage others to do the same. They can introduce the women to support groups online where they can interact and share thoughts as they transit through puerperium [13]. Another approach is to enable midwife-family-mediated support. The midwife here serves as the go-between the woman and her family, providing information and support to the woman and family as well as galvanizing family support for the mother. They also reduce the cost of care by enlightening mothers on how to take advantage of family support [29].

It is not enough to theoretically teach the breastfeeding method. A step further demonstration of breastfeeding interventions will further build their confidence and help mothers internalize the education [17]. A fourth strategy is adopting a systematic approach to the care of postpartum women. Using empathy and love, the wholistic midwifery framework leaves no system out, the mother must be assessed at each contact with the health practitioner, communicating care and providing a prompt referral to a higher level of care once any deviation is envisaged.

Moreover, maintaining standards of care and education of midwives is necessary for rapid identification, diagnosis, and treatment of psychological deviations in postpartum women. Also ensuring all postpartum women have access to follow-up care will enhance their performance of the women [31].

Postnatal care is an aspect of maternal and child health care that appears to have received minimal attention. Midwives, postnatal mothers, and their families tend to disregard postnatal visits, assuming that physical recovery is always guaranteed when a mother has had a normal pregnancy and childbirth. Unfortunately, preventable complications occurred during this period [32]. Encourage and ensure routine postnatal attendance and screening of mothers and their babies.

Other strategies to help women adjust to postnatal challenges include building their capacity through formal education and self-empowerment of midwives and other caregivers.

2.3 Sociologic and economic challenge

Women are revered for their role in procreation, however, different social, psychological, economic, and environmental factors with the status of these women and the demands of pregnancy pose a challenge to them. Pregnancy and the process of childbearing have social implication that affects a woman. The current wave of diseases and social unrest complicates the struggles of pregnant and breastfeeding women, reducing their coping ability and susceptibility to psychological and social stress [33].

Howbeit the presence of strong social and economic support increases the coping capacity of women.

3. The role of the midwife in combating postpartum challenges

The International Confederation of Midwives [34] in a Core document stipulates the functions of a Midwife include safeguarding the health and rights of the mothers and their babies. Midwives support and promote natural birthing without interference. They provide respectful, anticipatory, and adaptable care that takes cognizance of the needs of the woman, her newborn, family, and community. And have the capacity for timely patient referral for appropriate secondary care with appropriate technology. With the additional role of informing and collaborating with others to provide essential care to the woman, her child and the family.

They provide pertinent education to mothers and support the ability to make informed decisions. Midwives empower women to be accountable and responsible for their health and those of their families. Provide improved care and service to the mother, baby, and family through inter and intra-professional collaboration and consultation. They must be accountable for individual and collective advancement of midwifery knowledge and care through involvement in continuing education and mentoring and teaching the future generation of midwives.

Midwives play pivotal roles in the health sector, the system benefits from a midwife-led team. Midwife-led teams promote cohesion and cooperation of members. The approach promotes increased benefits of continuity of care with good fetal and maternal outcomes, which are cost-effective and adaptable. Teamwork is enhanced among health workers and the comradery spirit and autonomy of members are promoted [35].

Professional midwifery practice contributes to a decline in infant and maternal illness and deaths [36, 37]. Improves maternal satisfaction and a willingness to continue in the care continuum [38]. The non-medicalization approach of midwifery care contributes to a reduction in the cost of healthcare across low and high-income nations. Countries can divert such funds to staff training and improvement of service [39].

A midwife (Accoucheuse) assesses and screens clients to identify risks, preventing and instituting early treatment for women at risk of psychological disorders. They also offer culturally sensitive care to women while integrating mental health services into basic maternal healthcare [40]. They give psychosocial support to the woman and relatives, enabling effective coping [29].

The education given during health and postnatal visits helps to empower the woman with information for decision-making, self-reliance, and self-determination [41]. This also improves the women’s skills in childcare and breastfeeding [17]. Moreover, midwives support women in achieving their fertility and contraceptive goals using contraceptives and family planning education [42].

Similarly, midwives support women to adopt healthy and healthful futuristic reproductive behaviors [43]. Midwives ensure the safety of women and their babies. They give quality maternal care during safe and unsafe periods, and their life and health are often sacrificed to preserve women and their babies. They identify and provide counseling to women at risk or are victims of intimate partner violence, providing anonymous and confidential treatment to victims [44].

During the postpartum period, it is essential and expected that the woman makes four (4) contacts with the midwife to provide continuous care. Care is divided into three stages: 24 hours after birth, 7 days after delivery and 6 weeks postpartum. However, care in the first 24 hours is critical and lays the foundation for subsequent care. Where the mother cannot make or afford all four meetings, receiving comprehensive midwifery care on the first day is a solid foundation [45].

3.1 Care within 24 hours of birth

3.1.1 First-hour postpartum care

Ensure the safety and comfort of the mother. The midwife must ensure that the woman is clean and comfortable and that all soiled or wet linen is replaced with clean, warm clothing. The delivery suite is tidy, and all sharps are discarded for the safety of patients and staff.

Examine the perineum and assess for damage. If any tear or episiotomy, the midwife must ensure they are promptly sutured, and the woman is educated on how to care for bruises and the suture site, asepsis must be maintained in care of these areas.

Take and record the woman’s vital signs including the record of blood loss. This is compared with the vital signs during labour and serves as a baseline for future vital signs reading to identify early deviation from normal.

Assess the woman’s physical and physiologic status: the nipple for readiness to breastfeed. An inverted nipple may be detected at this stage, though it might have been identified and care is taken to ensure its prominence.

The midwife must measure the symphysio-fundal height to rule out retained placenta/product or retained twin. Symphysio-fundal height of 22–24 cm or at the level of the umbilicus is normal. It should however decrease by 1 cm daily until it cannot be measured or returned to the pelvic cavity [46].

3.1.2 Skin-to-skin contact

The infant is brought in contact with the mother within one hour of birth to stimulate bonding, initiate early breastfeeding and lactation, overcome breastfeeding barriers, increase the temperature of the baby and ability to overcome the stress of delivery, initiate self-control, and cope with future stress [47].

3.1.3 Care of the child

The newborn is susceptible without skilled midwifery care, preventing and reducing neonatal and infant mortality. The midwife is the surest person to provide the utmost neonatal care for the neonate. The three essential needs of the neonate after establishing respiration are the need for warmth, protection from infection and nutrition. As early and sustained skin-to-skin contact provides warmth, the mother’s body temperature helps regulate the neonate’s temperature. Bonding begins early, comforting the newborn and initiating breastfeeding [48, 49].

3.1.4 Nutrition

Both mother and baby benefit from early breastfeeding. To the mother, suckling stimulates the release of endogenous oxytocin and uterine contraction thereby reducing the third stage of labour duration and regulating the neonates’ temperature, leaving the resuscitaire for use by preterm and critically ill neonates. Additionally, it helps to reduce postpartum hemorrhage and increases uterine involution. This also helps the development of mammary glands for milk secretion, helps breast emptying and prevents inflammation of the breast (Mastitis) [50, 51].

Correspondingly, initiating breastfeeding early can save millions of neonates, their gut gets colonized with good microbiota, which promotes the immune development of the child. It also promotes growth and prevents stunting. Therefore, the midwife must ensure the mother initiates breastfeeding within the first hour of birth [52, 53].

Equally important is the care of the cord. Being a key area for introducing infection to the child, asepsis must be maintained around the cord. Regulatory bodies recommend dry cord care until its detachment which is faster compared to the use of antibiotic gels. However, chlorhexidine gel is recommended for prevention in situations where strict sterility cannot be maintained, thus chlorhexidine provides the advantage of antibiotic cover. Handwashing is the single most effective means to prevent the spread of infection to both the mother and the child. The midwife must instruct the mother and all managing the baby on the importance of hand hygiene. Endeavor to wash hands before and after taking care of the infant, after a diaper change [54].

3.2 A guided approach to assessing the newborn

Midwives perform a newborn examination at birth detect abnormality early and institute treatment quickly. Mothers are gratified to know how well their baby is doing and might need to learn how to examine their babies It is thus expedient that the midwife conducts the following examination of the baby beginning from head to toe.

The head: most babies are born headfirst and so the head is subject to injury as it navigates the birth canal. The risk of caput succedaneum and cephalhematoma with bruises and sometimes scalpel injuries from cesarean section. Show the position of the sutures. And the time they close. The posterior fontanels close at 18 months. and the posterior fontanel fuses at six weeks. When the anterior fontanel is sunken Adequate feeding will prevent dehydration.

The eyes: check the appearance of the eyes and their movement. Teach mothers to look at the baby’s eyes while feeding. The newborn begins to follow objects at six meters and can see up to 12 meters.

The mouth: for tongue tie and false tooth which can fall off while feeding to prevent asphyxiation of the infant. The presence of cleft lip and palate and micrognathia [55]. For many mothers, it is a frightening experience. Therefore, they require the support of the midwife, family, and significant others. Following the examination, breastfeeding must begin within the first hour of birth. It provides nourishment and bonding between mother and baby [56].

Midwives concentrate on meeting the physiologic as well as the emotional and psychological needs of mothers, especially mothers of preterm and extreme preterm neonates. The distress of physical and emotional separation of mothers from their babies is traumatizing, contributing to emotional instability and depression [57].

Attention must be given to mothers of sick neonates to avoid losing them. Supported and informed mothers contribute better to the care of their newborns, and their well-being encourages lactation and the treatment of the neonate.

Note that the midwife conducts a complete physical examination of the child, and notifies the mother and results are recorded in the delivery notes [58].

3.2.1 The second hour postpartum

Reassess the woman and baby for bonding, any discomfort or bleeding. A heavily soaked pad is a sign of postpartum hemorrhage. The genital area should be reassessed under good lighting and if necessary, an ultrasound scan done to rule out any retained product. The perineal pad should be observed every 15 minutes until the lochia is normal. The midwife must ensure the bladder is empty with active management of the third stage of labour.

3.2.2 Observe breastfeeding and provide appropriate support

Adopting a proper breastfeeding position will encourage correct latching and the baby will get adequate nourishment and not suckle air. This will also reduce soreness or cracked nipples.

3.2.3 Nutrition

The mother should be given a warm nourishing meal with enough fluid. This will help replenish energy. Many mothers may eat little due to a mixture of emotions and fatigue. However, they should be encouraged to take liberal oral fluids to support lactation [59].

3.2.4 Sleep and rest

Most women sleep off immediately after delivery. They should be made comfortable in the lying-in wards to support rest from the strain of labour especially women with difficulty sleeping in the past. Early rest is necessary for the new mother to settle quickly into her new role of nourishing the infant. It may be difficult to restrain visitors [60].

3.2.5 Immunization

Colostrum is the first immunization the baby receives, therefore establishing breastfeeding early will ensure that. The midwife must ensure to give immunization according to local policy. The mother is educated on the importance of early childhood immunization and where and how to access same. Immunization against tuberculosis and hepatitis B is recommended within the first 24 hours. However, where that is not possible, the child should be immunized as soon as possible afterwards [61, 62].

3.2.6 Contraception

Contraceptives are a sure protection against unplanned and unintended pregnancies. And the postpartum period is the best time to make the most of its gains. Exclusive breastfeeding in the absence of menstruation amenorrhoea can guarantee protection from pregnancy.

Nevertheless, most contraceptives are safe and highly effective for use in the immediate postpartum period, the midwife can thus introduce mothers to them. Postpartum intrauterine contraception (PPIUC) can be inserted immediately to provide long-term protection. The woman enjoys the added benefit of immediate service, cost-saving from not having to return for the service. Where this is not readily available, the woman must be encouraged to return for family planning [63].

Commencing contraceptives in the immediate postpartum period is easier due to the ease and proximity to family planning services at the place of delivery. The woman ovulates 2 weeks before the next menstruation and because menses have not resumed, many women become pregnant within this period and are at risk of unintended, unplanned pregnancy and associated abortion risk. Therefore, encouraging early postpartum contraceptive uptake [64].

3.3 Subsequent care

Global health authorities recommend up to four postnatal visits: within 24 hours of birth, 3–7 days, 2 weeks, and 6 weeks postpartum. At each, both child and mother should be thoroughly examined, educated, and counseled on measures to cope with the phase of growth. Both the child and mother are examined, and results are recorded. Counseling on nutrition, exclusive breastfeeding, urination, lochia, and the uterus is assessed noting uterine height, involution, perineal and hand hygiene and how they are coping with childcare. The neonate is equally assessed for any deviation from normal. He is weighed and details are documented on the growth chart [45, 65].

4. Challenges to providing effective postpartum midwifery care

The postnatal period is challenging for clients and caregivers. Midwives as carers share in the emotions of their clients and experience the emotions of their clients and because they are empathetic to their plight, they suffer anxiety and psychological stress. This has the propensity to interfere with the quality of care they render. Midwives must adapt quickly, be resilient, communicate and foster support for the mothers. The inability to separate self from the problem would lead to a crisis or worsen the existing crisis. Communication is a key factor to support midwives experiencing the stress of caring for postpartum mothers. Effective communication with peers and support systems can reduce tension of this kind [66].

Midwives at the lead are associated with improved postnatal maternal outcomes, they protect and preserve the integrity of mothers, but experience decreased adverse events [67]. However, midwives still face challenges while rendering this care. Midwives encounter while giving postnatal the issues of continuity, collaboration, and communication quality. Though there are concerns relating to individual perceptions of midwives regards implementing midwifery-led actions, the accrued benefits to postpartum women and the ease of adapting such models are undeniable [68].

There are also challenges to providing care consistently in this model related to time constraints, the unpredictability of labour and the inconsistency of mothers. Other challenges include inadequate workforce and empowerment of midwives and lack of support from facility management [68].

Implementing quality midwifery care is preceded by adequate planning and implementation of care standards. Therefore, midwives must be conversant with unit and facility protocol and work at sustaining the same. Training midwives in that light will sustain the process and reduce distress [69].

5. Strategies to combat postnatal challenges

Recognizing that postpartum women sometimes abruptly get into this stage without adequate preparation, they require huge support mostly from their caregivers to overcome these challenges. And because women present with differing needs, a one-size-fits-all approach will not solve the problem. Adopting the individualized care approach will suffice [70]. This brief section will discuss client-related strategies and health worker-related strategies geared toward supporting the smooth transition and function of postpartum women.

While focusing on the client-related strategy, it is critical to improve the education of women/families by re-enforcing educational content through the provision of information leaflets with opportunities to clarify misconceptions and questions. This will increase women’s self-confidence, self-efficacy, and satisfaction [71]. Other educational care involves the need for compliance with medication, appointments, and follow-up care. Supportive care will enhance breastfeeding and the care of the baby [72].

On the other hand, changing times require improvement in care outcomes and input from workers. Midwives communicate skill, competence and professionalism while being sensitive to client’s needs and prioritize patient care rather than organizational priorities [73]. There appears increased progressive knowledge of the client due to the ease of assessing information and technological improvements. Caregivers must respond adequately and professionally to the information needs of clients, bridging the knowledge gap with effective learning and dissemination of life-preserving and lifesaving information [74].

Appropriate weight gain in pregnancy is beneficial to the health of the mother and fetus. Though prenatal and postpartum weight gain or loss appears associated with the sociodemographic characteristics of many women [75], lack of weight control is associated with obesity, and gestational diabetes that could complicate fetal and maternal pregnancy outcomes. Which could lead to stress, inadequate coping the development of Type II diabetes mellitus and poor health outcomes [76].

To prevent this, women are therefore advised to adhere to adequate nutrition during and after pregnancy. The combination of diet and exercise is a good strategy for maintaining ideal weight and health during postpartum [77]. Moreover, the maintenance of ideal weight contributes to self-esteem and confidence building. It portends better well-being and welfare for the mother and baby [1].

Paying special attention to caring for women with special needs or medical conditions, and building trusts is yet another strategy. Women with or without a history of pregnancy-induced hypertension can develop postpartum pre-eclampsia. A higher risk associated with pregnancy-induced hypertension occurs within 48 hours postpartum. Therefore, such women must receive closer blood pressure monitoring with laboratory investigations. They also will benefit from shorter and more frequent checks within seven days of delivery [78].

Strategy to cope with pain involves judicious and appropriate use of analgesics and increased rest periods, especially for women who had a cesarean section or instrumental deliveries [68, 79]. Exercise also promotes mental health as well as physiologic return and function [80]. Every visit allows a review of their emotional and psychological state will drive client-centred care. An attentive listener can decipher more information from the pieces of information obtained during conversations [65].

Improve the midwives’ attitude to clients. Many clients have developed negative impressions of the manner health workers deal with them. This goes a long way to determine their acceptance and adherence to treatment instructions. Safe delivery of their babies thus paves the way to escape from the facility and health workers. Midwives must develop a good work ethic and attitude toward patients. And desist from breaking the care continuum through negative attitudes [81].

Improved capacity for patient and patient information management is key to overcoming postpartum care challenges. So is the need for organizational buy-in institutionalizing patient care standards, policies, and protocols [32]. Health organizations and regulatory bodies must provide leadership and direction to achieve a safer healthcare system, and service. Ensure a conducive work environment with tools where providers can give competent and quality care that promotes maternal well-being and health that benefits the family and society. This is achievable with adequate budgetary provision and health financing [82].

6. Conclusion

Challenges that postpartum encounters can limit the full enjoyment of the childbearing experience. Psychologic concerns can be difficult to identify and manage. All mothers should be offered skilled maternity care regardless of economic, social, and environmental status. Postnatal mothers should be offered contraceptive counsel and service at each visit and given support. Make an informed contraceptive choice. Then women who have adopted a method are reviewed and asked how they are faring with their choice. Mothers will benefit from cervical cancer counseling and screening tests using the midwifery model of care.

Acknowledgments

I wish to acknowledge the special support and contributions of my husband Mr. Paul Ochala and to UNICAF University Zambia.

Conflict of interest

The author declares no conflict of interest.