Postnatal care and safe motherhood are essential aspects of the modern society. The postnatal care entails the medical attention that is given to mothers and their newborn babies immediately after giving birth. This is a critical period for the survival of the mother and the newborn especially hours after birth.  Generally, the time for postnatal care runs up to a period of eight weeks. It is unfortunate that most nations do not give the necessary consideration to postnatal care. Consequently, many lives are lost unnecessarily. In some cases, the newborns attract more medical attention as the mothers get to be ignored. Such trends have led to a gross, unnecessary loss of mothers shortly after delivering their newborns. On the other hand, safe motherhood is a series of initiatives, practices, protocols and service delivery guidelines designed to ensure that women receive high quality gynecological, family planning, prenatal, delivery and postpartum care for optimal health to the mother, fetus, and the infant during pregnancy, childbirth and postpartum. This paper explores a wide spectrum of postnatal care on the safety of the mothers in the United Kingdom, Saudi Arabia and the world as a whole.

Epidemiology of the Maternal and Newborn Deaths in the Kingdom of Saudi Arabia

Maternal and Newborn Health (MNH) refers to the health of women and babies during pregnancy, childbirth, and after childbirth. Provision of quality care during this period is very critical for the health and very survival of mother and infant. According to the latest estimates, around half a million maternal and about four million newborn deaths are mainly caused by the lack of quality antenatal care, safe and clean delivery, and post-natal care for mother and infant (Ramirez 2009). Up to date, the Kingdom of Saudi Arabia has endeavored at giving their maternity facilities the best quality to their patients to assist in reducing these rates. In the world standings, those of a few developed nations such as the UK and the US only better the rates of the epidemiology of the maternal and newborn deaths in the Kingdom of Saudi Arabia. Part of these progresses has been anchored on a steady continuous improvement of medication in Saudi Arabia.

Meanwhile, maternal and newborn health is a serious concern to the World health Organization member countries where Saudi Arabia is a member. Every year around 0.2 million women and 2.4 million babies die from avoidable causes related to pregnancy and childbirth in the developing countries such as Saudi Arabia and other African countries. A good number of these deaths are occurring in member countries located mainly in Sub-Saharan Africa and the Asian region. According to the latest estimates, these two regions accounted for 90 percent of maternal and 80 percent of neonatal deaths (dying within first four weeks of life) according to world health organization. The higher prevalence of maternal and newborn mortality in these regions reflects inequities in access to health services across all the developing countries and underlines the gap between high income and low-income member countries (Romm 102).

Provision of good Maternal and Newborn Health services is stressed in the Millennium Development Goals (MDGs). Over the years, many developing countries made considerable progress to attain the targets. However, some members, specifically in Sub-Saharan Africa and South Asia, are still chasing behind in increasing coverage of Maternal and Newborn Health. According to the research findings by WHO, most of the maternal and newborn deaths are avoidable by ensuring good care and counseling before and during pregnancy, at the time of delivery and after childbirth. Therefore, member countries must take all necessary measures both at national and inter- organization level, to ensure safe and secure motherhood and childhood across all the states despite their economic status (Nery 134).

Precise comparisons indicate that the Kingdom of Saudi Arabia is performing progressively in dealing with the maternal and child death that conspicuously has plagued most of their neighbors. According to the latest estimates (WHO, 2011), around 134 million babies are born every year. Moreover, roughly 99% of these births are happening in developing countries. Mainly due to the lack of proper maternity care and poor health conditions, 2.5 million babies are stillborn in these nations whereas 3.2 million die within the first four weeks of their life (neonatal deaths). In 2009, both stillborn and neonatal deaths contributed to 96 percent (42 percent and 54 percent respectively) of total infant deaths across the globe. Almost all of these deaths are occurring in low-income developing countries (http://www.who.int/maternal_child_adolescent/documents/postnatal-care recommendations/en/)

In the developing countries, more than 41 million babies are born every year, equivalent to 31 percent of the world and 34 percent of the emerging countries total. In 2009, about 1.1 million were stillborn whereas 1.3 million perished within the first four weeks of their life. About 44 percent of world total stillborn were recorded in the developing countries whereas 40 percent of world total neonatal deaths happened in member countries in 2009 (World Bank 1).

In line with the global drifts, infant mortality situation has been improved in the developing countries and infant mortality rate exhibited a downward trend since 90’s. The average infant mortality rate in the developing countries has declined from 87 deaths per 1000 live births back in 1990 to 58 in 2009, corresponding to a decrease of approximately 33 percent. However, despite this inspiring progress, infant mortality rate in member countries remained higher than the developing countries and world averages (Nery 134). In 2009, one in every 17 children died before their first birthday in the organization of developing countries compared to one in 22 children in developed countries, one in 24 children in the world and one in 218 children in developed countries.

A similar trend can be observed in the case of neonatal mortality rate as well. It is worth noting that average neonatal mortality rate in the organization of  Gulf Conference countries declined from 41 deaths per 1000 live births in 1990 to 30 in 2009, corresponding to a decrease of 18 percent. However, despite this positive trend, the neonatal mortality rate in member countries remained higher than in the other regions. In 2009, one in every 33 newborns died within the first four weeks of birth in the organization of Gulf Conference countries compared to one in 39 newborns in developing countries, one in 42 newborns in the world, and one in 349 newborns in developed countries (Nery 251).

Impact of Evidence Informed Postnatal Period in Mothers

Evidence-based maternity care employs the best available research studies that touch on the effectiveness and safety of specific practices to assist in guiding maternity care decisions and to facilitate the desired optimal outcomes in children, or mothers as in this case.  Notably, various paths that can be pursued in given situations often have very different harm profiles or benefits. Thus, this explains the massive variations in the impacts that a chosen path may land the practitioners into (Byrom, Grace and Debra 221). However, evidence-based maternity care gives priority to care avenues that bear positive impacts and are least invasive, with limited or no harm whenever possible. Therefore, this practice involves the framework of traditional enjoinment of practitioners to “first, do no harm” and consideration of undesirable consequences of good intentions (Chowdhury 378).

Adequate care with the least harm may come with its impacts under the umbrella of two calories. First, the practices with plausible or established adverse effects should be avoided in cases where research identities have not established the justification for their application. For instance, a proactive may be avoided with the determination that either cesarean section or labor induction are not justifiably right (Romm 109). The impacts of such a move may be the minimization of the risks associated with either avenue thereby opting for the least risky, well researched, avenue.

Evidence-based framework as well impacts the question of wisdom that is manifested in employing interventions with expected marginal benefits that are overshadowed by greater risks of established harms. Examples of such situations may include induction of labor in a clear absence of a medical rationale. The two principles mentioned above may have impacts in a range of ways. Thus, these principles for evidence-based postnatal care bear potential benefits in the long-term adverse health effects. They may as well assist in the creation of postnatal standards that in the end creates value in protecting the lives of new mothers (Gill 343).

Factors Contributing to Maternal Mother’s Morbidity or Mortality in Postnatal Periods

Excessive bleeding after childbirth is a leading cause of maternal deaths worldwide, and it has gained international attention among medical and research communities for decades. Hemorrhage, whether antepartum (APH) or postpartum (PPH), abortion or ectopic pregnancy-related, remains some of the chief killers of childbearing women all over the world.

Primary PPH is defined as loss of more than 500 ml of blood per vaginum in the first 24 hours following childbirth. It is one of the leading causes of maternal mortality and its related complications. There are 600,000 maternal deaths reported worldwide every year and 99% of these occur in developing countries. Among them, 25% of deaths in developing world are due to postpartum (World Bank 1).

Other causes of these deaths entail a range of infections that an individual gets exposed to after giving birth. A hospital-based study in the US reported the risk factors for postpartum reproductive tract infection that include maternal age less than 17 years, postpartum anemia, manual removal of placenta, and prolonged labor. Practices such as the use of warm clothes pressed against the vagina for six weeks were also associated with vaginal infections (Byrom, Grace and Debra 221). From an analytical point of view, all these causes are avoidable.

One specific factor that accounts for the biggest percentage of these deaths is prolonged labor. Prolonged labor has repeatedly been found to be associated with postpartum in this study, as also reported by others agencies. Possible reasons for prolonged labor leading to postpartum are atonia of the uterus at the time of delivery. The remaining factors that could be rendered as significant in these deaths entail rhesus incompatibility, effects of smoking, induced labor, and precipitous labor as has been studied. Prolonged labor leading to postpartum could also be because of multigravida. However, studies have not found any significant link between multigravida and postpartum. In simpler analyzes, and as it happens in most developing nations, lack of adequate resources, technology, or personnel can be termed as some of the conspicuous contributors to these deaths.

Role of Nurses in Providing Evidence Postnatal Care

Nurses are direct stakeholders in matters that concern provision of postnatal care. To this effect, they are obligated to play a central role in determining the best possible avenues to exploit in postnatal care. The first role of the nurses is offering platforms through which common assumptions can be questioned (https://www.nct.org.uk/professional/research/pregnancy-birth-and-postnatal-care). It is notable that maternity care practices based on the opinions of the public, the experts, or even traditions can be unreliable platforms for decision-making in postnatal care (Ward, Hisley and Amy108). Also, these views on cares are based on a range of unreliable guides that have to be analyzed before put in practice. To avoid the occurrences of poor outcomes or wastage of resources, critical stakeholders such as nurses have to get a proper involvement.

It is the duty of the nurses to look for the gold standards. When available, well- conducted and well-designed systematic reviews of research form critical sources of decision making in postnatal medical approaches. In cases where systematic data might be missing, randomized pieces of information may be analyzed to assist in coming up with the best possible outcomes. It is the sole duty of the nurses to consider the assertions of other related studies that can be suitable in swift decision-making (Ward, Hisley and Amy108). The involvement of the nurse in postnatal care is as well anchored on the fact that the success of such procedures lies firmly on how best the guidelines are followed. The nurses stand a better chance of following the guidelines for taking care of the procedures. Creation of awareness on misleading claims as well as the provision of platforms for guided decisions is some of the critical factors that make the involvement of nurses in postnatal cares a critical issue (http://www.indexmundi.com/g/r.aspx?v=2223).

Conclusion

Postnatal period is a crucial period for the life of the mother in as much as it is as well necessary to the life of the newborn. Given the exceptional extent to which the deaths of mothers occur in the first days after birth, the early postnatal period is the ideal time to deliver interventions to improve the health and survival of both the newborn and the mother and not ignoring either. As is evident in most studies, there could be many causes of deaths to mothers after birth. All these causes are avoidable if adequate resources are put in place to assist in curbing the causative factors. Essential among the resources here is the input of the nurses, which is desired in the entirety of the postnatal period.

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