The scene is familiar. Five days after a caesarean section, a woman in one of our cities is at home with a newborn, a painful surgical wound, and a folder of papers. The papers list the baby’s feeding schedule, immunisation dates, and the paediatrician’s phone number. There is one line about her own care, a follow-up visit in six weeks. She is bleeding more than she expected. She has not slept longer than ninety minutes at a stretch. Her mother tells her this is normal. It is extremely common.
But “common” does not mean harmless.
A check before discharge and continuity after it are not the same thing, and the indicator cannot tell them apart. The World Health Organization’s postnatal care guidance sets a minimum of four contacts. Each is meant to assess the mother as well as the baby. India’s headline statistic largely overlaps with the first of those four contacts. But no headline national indicator shows whether women received the complete schedule, or what those contacts assessed. Read as medicine rather than ritual, it is a structured plan for recovery. It feeds her at a time when she is depleted and breastfeeding. And it does the thing our health system finds hardest to implement—treating the weeks after birth as a distinct state requiring care, rather than a return to ‘normal’ life. The ASHA’s job is to look for excessive bleeding, high temperature, foul-smelling discharge, cracked nipples, and engorged breasts. The mother, in other words, is written into the design. The findings suggest that support may be an important factor, and our households have supplied it for generations. What the customs cannot do is examine the mother. They cannot detect persistently high blood pressure or determine whether anaemia is contributing to the exhaustion everyone is calling normal. Some customs and practices are not actual care; indeed, they may actively prevent a woman from being taken to a doctor when she is bleeding heavily or running a fever. A good postnatal system would add an examination to the help that supportive households give. What would it take to consider the mother’s condition as well as the baby’s? The schedule already exists and so do the workers. What is missing is scope, ownership, and measurement. Visits to the mother and baby after discharge should assess the mother’s recovery as well as her danger signs. Responsibility for the mother’s follow-up should rest with a designated healthcare provider or service, which should document her care after the delivery record is closed. A structured review can begin in minutes. It should ask about bleeding, pain, and her surgical wound. It should include measuring her blood pressure, particularly if she was hypertensive in pregnancy. It should test for anaemia when her tiredness, or her pregnancy, points that way. It should ask if she is experiencing changes in mood or sleep and whether she’s been having frightening or intrusive thoughts. It should ask about feeding difficulty, urinary leakage, prolapse, and whether she’s experiencing pain during sex.
More Indian women are therefore recovering from major abdominal surgery in flats and small houses, with a newborn, some of them without the extended household support that older arrangements assumed. The NFHS-6 reports that 82.8% of mothers received postnatal care within two days of delivery. The postnatal care recorded within 48 hours of an institutional delivery may well be a check that occurs before the mother leaves the hospital. Additionally, the caesarean section rate increased from 21.5% at NFHS-5 to 27.2% at NFHS-6. A qualitative systematic review of 51 studies of traditional postpartum practices across more than 20 countries found the same elements recurring: organised support for the mother, a prescribed period of rest, particular foods, and additional help with the baby. Home-Based Newborn Care in India schedules an ASHA to visit the house on days 3, 7, 14, 21, 28 and 42. National guidance is explicit that the visits on days 3, 7 and 42 are for the mother as well as the baby. Among 403 women in Gujarat, those with low social support had about two-and-a-half times the odds of postnatal depression compared with women who had strong support. It should arrange a follow-up glucose test for the woman who had gestational diabetes and now carries a substantial lifetime risk of type 2 diabetes.
