Evidence base

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

WHO recommendations on maternal and newborn care for a positive postnatal experience [Internet]. Geneva: World Health Organization; 2022.

Cover of WHO recommendations on maternal and newborn care for a positive postnatal experience

WHO recommendations on maternal and newborn care for a positive postnatal experience [Internet].

Show details

Contents

< PrevNext >

Web SupplementEvidence base

Acronyms and abbreviations

25(OH)D: 25-hydroxyvitamin D (vitamin D)
AF: antisecretory factor
ALTE: apparently life-threatening event
CI: confidence interval
CMDs: common mental disorders
DID: difference-in-difference
EB: evidence base
GRADE: Grading of Recommendations Assessment, Development and Evaluation
HR: hazard ratio
ITT: intention-to-treat
IU: international units
MD: mean difference
NSAID: nonsteroidal anti-inflammatory drug
OR: odds ratio
PBHL: permanent bilateral hearing loss
PFMT: pelvic floor muscle training
PSBI: possible serious bacterial infection
RCT: randomized controlled trial
RR: risk ratio
SMD: standardized mean difference
SIDS: sudden infant death syndrome
SUDI: sudden unexpected death in infancy
TcB: transcutaneous bilirubinometry
TSB: total serum bilirubin
UNHS: universal newborn hearing screening
VAS: visual analogue scale

The standardized criteria used in grading the evidence and the GRADE tables have been published in this separate Web Supplement. These evidence tables are referred to within this document by number, prefixed with “EB” (for evidence base), for ease of reference.

A. MATERNAL CARE

A.2. Interventions for common physiological signs and symptoms

EB table A.2.1. Local cooling for perineal pain relief

Comparison 1: Perineal local cooling compared with no pain relief or usual care (PDF, 272K)

Comparison 2: Perineal local cooling compared with other forms of non-pharmacological interventions (PDF, 265K)

EB table A.2.2. Oral analgesia for perineal pain relief

Comparison 1: Single-dose oral analgesic (any dose) compared with placebo (PDF, 420K)

Comparison 2: Single-dose oral analgesic compared with a higher single dose of the same analgesic (PDF, 332K)

Comparison 3: Single-dose oral analgesic compared with a single dose of an alternative oral analgesic (PDF, 287K)

EB table A.2.3a. Pharmacological relief of pain due to uterine cramping/involution (pharmacological interventions compared with placebo)

Comparison 1: Paracetamol (oral, single-dose) compared with placebo (PDF, 192K)

Comparison 2: NSAIDs compared with placebo (PDF, 243K)

Comparison 3: Opioids compared with placebo (PDF, 192K)

EB table A.2.3b. Pharmacological relief of pain due to uterine cramping/involution (pharmacological interventions compared with other pharmacological interventions)

Comparison 1: Lower dose of an oral analgesic compared with a higher dose of the same analgesic (PDF, 209K)

Comparison 2: An oral analgesic compared with an alternative oral analgesic of the same class (PDF, 213K)

Comparison 3: An oral analgesic compared with an alternative oral analgesic from a different class (PDF, 265K)

EB table A.2.4. Postnatal pelvic floor muscle training (PFMT) for pelvic floor strengthening

Comparison 1: Postnatal PFMT compared with no intervention or usual care for (mixed) prevention or treatment of incontinence (PDF, 213K)

Comparison 2: Postnatal PFMT compared with no intervention or usual care for treatment of incontinence (PDF, 191K)

EB table A.2.5. Non-pharmacological interventions to treat postpartum breast engorgement

Comparison 1: Cabbage leaf extract cream compared with placebo (PDF, 184K)

Comparison 2: Cold cabbage leaves applied directly to the breast compared with usual care (PDF, 176K)

Comparison 3: Cold gel packs applied directly to the breast compared with usual care (PDF, 175K)

Comparison 4: Warm herbal compresses compared with usual care (including warm compresses without herbs) (PDF, 174K)

EB table A.2.6. Pharmacological interventions to treat postpartum breast engorgement

Comparison 1: Subcutaneous oxytocin compared with placebo (PDF, 180K)

Comparison 2: Proteolytic enzymes compared with placebo (PDF, 218K)

A.3. Preventive measures

EB table A.3.1. Non-pharmacological interventions to prevent postpartum mastitis

Comparison 1: Probiotics compared with placebo (PDF, 219K)

Comparison 2: Hydrothermally processed cereal with anti-secretory factor-inducing properties compared with standard cereal (serving as a placebo) (PDF, 172K)

Comparison 3: Specialist breastfeeding education compared with usual care (PDF, 193K)

Comparison 4: Acupoint massage compared with usual care (PDF, 209K)

EB table A.3.2. Pharmacological interventions to prevent postpartum mastitis

Comparison 1: Oral prophylactic antibiotics compared with placebo or usual care (PDF, 187K)

Comparison 2: Topical prophylactic antibiotics compared with usual care (breastfeeding advice) (PDF, 171K)

EB table A.3.3. Prevention of postpartum constipation

Comparison: Laxatives compared with placebo (PDF, 213K)

A.4. Mental health interventions

EB table A.4.1. Screening for postpartum depression and anxiety

Comparison: Screening for common mental disorders (CMDs: depression, anxiety) in the postpartum period compared with no screening or usual care (PDF, 242K)

EB table A.4.2. Prevention of postpartum depression and anxiety

Comparison: Interventions to prevent common mental disorders (CMDs: depression, anxiety) in the postpartum period, delivered at any time, compared with no intervention or usual care (PDF, 239K)

B. NEWBORN CARE

B.1. Newborn assessment

B.2. Preventive measures

EB table B.2.1. Timing of first bath to prevent hypothermia and its sequelae

Comparison 1: Delayed first bath (after 24 hours) compared with early first bath (at or before 24 hours) (PDF, 219K)

Comparison 2: Delayed first bath (after 6 hours; i.e. at or after 9, 12 or 24 hours) compared with early first bath (at or before 6 hours) (PDF, 177K)

EB table B.2.2. Use of emollients for the prevention of skin conditions

Comparison: Topical emollients compared with no intervention or skin care without emollients (PDF, 202K)

EB table B.2.3. Application of chlorhexidine to the umbilical cord stump for the prevention of neonatal infection

Comparison: Routine application of chlorhexidine to the umbilical cord stump compared with dry cord care or usual care (PDF, 252K)

EB table B.2.4. Sleeping position for the prevention of sudden infant death syndrome

Comparison: Supine (back) sleep position compared with non-supine (prone or side) sleep position (PDF, 261K)

B.3. Nutritional interventions

EB table B.3.1. Neonatal vitamin A supplementation

Comparison: Neonatal vitamin A supplementation compared with placebo or no vitamin A supplementation (PDF, 227K)

EB table B.3.2. Vitamin D supplementation for breastfed, term infants

Comparison: Vitamin D supplementation for breastfed, term infants compared with placebo or no supplementation (PDF, 190K)

Subgroup analysis by neonatal risk status (high risk or low risk) (PDF, 188K)

Subgroup analyses by neonatal active form (Vitamin D2 or D3), dosage (single oral dose of 50 000 IU or 400 IU daily), time of administration (from birth, from one month age), and duration of supplementation (single, oral 50 000 IU at birth, 1–2 months or > 6 months) (PDF, 204K)

B.4. Infant growth and development

EB table B.4.1. Whole-body massage

Comparison: Whole-body massage compared with no massage (PDF, 277K)

C. HEALTH SYSTEMS AND HEALTH PROMOTION INTERVENTIONS

EB table C.1. Schedules for postnatal care contacts

Comparison 1: Schedules involving four postnatal home visits (3, 7, 28 and 42 days after birth) compared with one postnatal home visit (at about 42 days after birth) (PDF, 209K)

Comparison 2: Schedules involving two postnatal visits (3–5 and 10–14 days after birth) compared with one outpatient visit (10–14 days after birth) (PDF, 172K)

EB table C.2. Length of stay in health facilities after birth

Comparison 1: Early discharge following vaginal birth compared with usual discharge (PDF, 215K)

Comparison 2: Early discharge following caesarean birth compared with usual discharge (PDF, 190K)

Ad-hoc analyses by time of discharge and mode of birth (PDF, 251K)

EB table C.4. Approaches to strengthen preparation for discharge from the facility to home after birth

Comparison 1: Written education booklets for women compared with control leaflets (PDF, 221K)

Comparison 2: Discharge education by a designated nurse compared with usual care (PDF, 208K)

EB table C.5a. Home visits for postnatal care contacts compared with usual care

Comparison: Home visits for postnatal care contacts compared with usual care (evidence source 1) (PDF, 228K)

Comparison: Home visits for postnatal care contacts compared with usual care (evidence source 2) (PDF, 170K)

EB table C.5b. Home visits for postnatal care contacts compared with routine outpatient postnatal care

Comparison: Home visits for postnatal care contacts compared with routine outpatient postnatal care (PDF, 223K)

EB table C.9. Involvement of men in postnatal care and maternal and newborn health

Note: Study author names are provided in each of the GRADE tables to distinguish studies in cases where meta-analyses were not possible.

Comparison 1: Couples education compared with no intervention or usual care (PDF, 266K)

Comparison 2: Couples education compared with women’s education alone (PDF, 174K)

Comparison 3. Men’s education compared with no intervention or usual care (PDF, 229K)

Comparison 4. Father as a labour companion compared with no companion (PDF, 175K)

Comparison 5. Father as a labour companion compared with a female friend as a labour companion (PDF, 171K)

Comparison 6. Multi-component interventions compared with no intervention or usual care (PDF, 239K)

: Note: The labelling convention in this document (e.g. “EB table A.2.1”) aligns with the evidence and recommendations of the guideline. GRADE tables are shown only where applicable for new and/or updated recommendations (not integrated recommendations); therefore, numbers may not be presented in consecutive order in this document.

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see https://www.who.int/copyright.

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.

Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.

Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/).

Bookshelf ID: NBK579659

Contents