The right to a positive maternity healthcare experience at every stage
Each pregnancy is unique and clinical needs can change across the pregnancy, childbirth and postnatal periods. One thing that never changes is the right to a positive experience at every stage.
Achieving the best possible physical, emotional, and psychological outcomes for every individual and newborn requires health systems to take a human rights-based approach: not only preventing maternal death and morbidity, but prioritising person-centred
care and well-being.
WHO is developing new guidelines for a positive experience of postnatal care, due to be published next year. To inform these guidelines and ensure that postnatal services can better meet the needs of women and their babies, WHO undertook a qualitative
systematic review on what matters to women in the postnatal period.
Joys and challenges in the postnatal period
There is limited research about values and preferences in the postnatal period, defined by WHO as the first six weeks after childbirth. Studies have often focused on the results of specific postnatal interventions, rather than on the individuals who use
them.
‘What matters to women in the postnatal period: A meta-synthesis of qualitative studies,’ published in PLOS ONE, gives long-overdue respect to the authority of women’s own experiences. The authors review first-hand data from 15 countries
and 36 studies published after the year 2000 relating to women’s beliefs, expectations and values at this significant time of life.
These studies affirm that a positive postnatal experience can result in joy, self-confidence and enhanced capacity to thrive as both a person and a parent.
They are also vocal about the potential challenges of adjusting to a ‘new normal’ following childbirth, including changes in self-identity, relationships, and sexual behaviour.
What is a positive postnatal experience?
A positive postnatal experience for a woman will be one that responds to her specific context and preferences.
It will provide the confidence, knowledge and skills women need in the weeks following childbirth, supporting them to adjust to any changes in their intimate relationships and build new family ones. Women will be better equipped to navigate physical and
emotional challenges and to experience the dynamic achievement of personal growth.
This should be a shared responsibility, not a solitary one. Community has a critical role in enabling a positive postnatal experience, including partners, family and elders.
It is crucial that healthcare providers meet each woman’s needs, as well as those of their babies.
Supporting choices and rights to improve postnatal health outcomes
There are an estimated 303 000 maternal deaths annually, according to recent WHO figures. Most of these deaths occur postnatally.
The postnatal period is therefore a vital opportunity to improve both maternal and neonatal health and wellbeing: supporting healthy behaviors, providing life-skills education, facilitating breastfeeding, counselling women about family planning options,
supporting good mental health, preventing and treating childbirth-related complications.
Health care systems that empower individuals by supporting their values, preferences and rights are fundamental to improving maternal and newborn health outcomes.
WHO’s guidance for positive maternity care
WHO has recently released recommendations on antenatal care for a positive pregnancy experience, and on intrapartum care for a positive childbirth experience.
These publications made important clinical updates, including an increase from four to eight recommended antenatal contacts, and a revision to the decision-making process for interventions to accelerate labour.
They also uphold every woman’s right to a positive maternity care experience: one where her pregnancy does not erase her competency, autonomy and right to participate in decision-making for her own care and the care of her newborn.
Women’s choices and rights to sexual and reproductive health care, including maternity care, should be respected at every stage of the continuum of maternal and newborn care. This is true across all income settings, as well as in humanitarian settings
and during public health emergencies.
When WHO’s postnatal guidelines are released next year, they will complete the maternity care series built around what matters to women.
Rather than dividing care into three periods of antenatal, intrapartum and postnatal, these publications can be used to establish a model in which health systems support women, their baby and wider network physically, psychologically, socially and emotionally
through this significant life event.
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