Maternal
Antenatal care
WHO recommendations for antenatal care interventions
Intervention | Contact | Timing during pregnancy |
Offer iron and folic acid supplements | First contact onward | Preconception to 12 weeks’ gestation (folic acid); throughout pregnancy (iron) |
Confirm pregnancy and offer routine blood tests (see table below) | First contact (booking) | 1st trimester (0–12 weeks) |
Ultrasound scan to estimate gestational age | First or second contact | 1st trimester (0–12 weeks) |
HIV, syphilis and hepatitis B screening | First contact (booking) | As early as possible |
Screening for congenital anomalies (where available) | Second contact or by 24 weeks | 1st or 2nd trimester |
Measure blood pressure, weight and BMI | Every contact | Throughout pregnancy |
Nutritional counselling | First and subsequent contacts | Throughout pregnancy |
Tetanus vaccination | Second contact onward | Throughout pregnancy |
Education on birth preparedness and complication readiness | All contacts | Throughout pregnancy |
Intermittent preventive treatment of malaria (IPTp) in endemic areas | Beginning at second trimester | Every contact after 13 weeks |
Screening for preeclampsia (blood pressure and proteinuria) | Every contact after 20 weeks | 2nd trimester onward (13–40 weeks) |
Blood glucose testing for gestational diabetes | Fourth or fifth contact | 24–28 weeks’ gestation |
Anti-D immunoglobulin for Rh-negative women | 28 weeks’ contact | 2nd trimester (13–27 weeks) |
Monitor fetal growth and fundal height measurement | Every contact after 24 weeks | 2nd and 3rd trimesters (13–40 weeks) |
Birth and emergency preparedness counselling | Third contact onward | 3rd trimester (28–40 weeks) |
Monitor fetal movements | Third contact onward | 3rd trimester (28–40 weeks) |
Counselling on postpartum family planning | Late antenatal care contacts | 3rd trimester (28–40 weeks) |
Group B Streptococcus (GBS) screening | Late antenatal care contacts | 35–37 weeks’ gestation |
Counselling on breastfeeding | Last one or two contacts | Late 3rd trimester |
| Routine blood tests | |
|---|---|
| Haemoglobin (Hb) testing | To detect anaemia, which is important for identifying the need for iron and folic acid supplementation |
| Blood group and Rh status | To identify Rh-negative women, who may require anti-D immunoglobulin to prevent Rh sensitization |
| HIV screening | To detect HIV and initiate antiretroviral therapy, if needed, to prevent mother-to-child transmission |
| Syphilis screening | For early detection and treatment to prevent complications for the mother and fetus |
| Hepatitis B surface antigen (HBsAg) testing | To identify mothers who may transmit hepatitis B to their baby during birth and to plan for postnatal hepatitis B vaccination for the newborn |
| Blood glucose testing | Screening for gestational diabetes mellitus, recommended between 24–28 weeks |
These tables include the major WHO-recommended antenatal care interventions, organized by the contact number and trimester. The guidelines referenced are available in the key WHO resources listed, in particular, WHO recommendations on antenatal care for a positive pregnancy experience (2016).
Intrapartum care
WHO recommendations for intrapartum care interventions during labour
| Intervention | Stage of labour | Level of care |
|---|---|---|
| Continuous support for the woman during labour | All stages | Community, primary, referral |
| Monitoring maternal and fetal heart rate | All stages | Primary, referral |
| Use of partograph to monitor labour progress | Latent and active phase | Primary, referral |
| Offer of oral fluids and food during labour | All stages | Community, primary, referral |
| Vaginal examination to assess cervical dilatation | Latent and active phase | Primary, referral |
| Maternal vital signs monitoring (blood pressure, pulse, temperature) | All stages | Primary, referral |
| Pain relief methods (non-pharmacological and pharmacological) | All stages | Primary, referral |
| Active management of the third stage of labour (oxytocin administration) | Third stage | Primary, referral |
| Immediate skin-to-skin contact after birth | Third stage | Primary, referral |
| Delayed umbilical cord clamping (1–3 minutes) | 3rd stage | Primary, referral |
| Assisted vaginal delivery (if indicated) | 2nd stage | Referral |
| Neonatal resuscitation (if required) | 3rd stage (immediately after birth) | Referral |
| Monitoring fetal heart rate (using intermittent auscultation) | Latent and active phase | Primary, referral |
| Manual removal of the placenta (if required) | 3rd stage | Referral |
| Caesarean section (if indicated) | 2nd stage | Referral |
| Prevention and treatment of pre-eclampsia/eclampsia | Latent and active phase | Referral |
| Antenatal corticosteroids (for preterm labour) | Latent phase (preterm labour) | Referral |
| Induction of labour (if indicated) | Latent phase | Referral |
This table details key
intrapartum care interventions, organized by stage of labour and level of care,
with reference to specific pages from WHO
recommendations: intrapartum care for a positive childbirth experience (2018).
Postnatal care
WHO recommendations for postnatal care interventions for the mother
| Intervention | Visit | Timing (day) |
|---|---|---|
| Assess maternal vital signs (blood pressure, heart rate, temperature) | 1st visit | Within 24 hours after birth |
| Assess uterine involution (uterus shrinking) and vaginal bleeding (lochia) | 1st visit | Within 24 hours after birth |
| Provide iron and folic acid supplementation | 1st visit | Within 24 hours after birth |
| Assess for signs of postpartum haemorrhage and infection | 1st visit | Within 24 hours after birth |
| Counsel on postnatal nutrition, breastfeeding and hygiene | 1st visit | Within 24 hours after birth |
| Counsel on danger signs (e.g. heavy bleeding, high fever) | 1st visit | Within 24 hours after birth |
| Assess maternal mood, screen for postpartum depression | 2nd visit | Day 3 (48–72 hours) |
| Monitor physical recovery (e.g. perineal healing, C-section wound care) | 2nd visit | Day 3 (48–72 hours) |
| Counsel on family planning and contraception options | 2nd visit | Day 3 (48–72 hours) |
| Assess maternal physical health (vital signs, uterine involution) | 3rd visit | Day 7–14 |
| Screen for postpartum depression and emotional well-being | 3rd visit | Day 7–14 |
| Screen for maternal infection (temperature, signs of mastitis, C-section wound) | 3rd visit | Day 7–14 |
| Counsel on postpartum nutrition, hygiene and breastfeeding support | 3rd visit | Day 7–14 |
| Comprehensive maternal physical assessment (including perineal or C-section wound healing) | 4th visit | 6 weeks postpartum |
| Assess maternal mental health (screening for postpartum depression or anxiety) | 4th visit | 6 weeks postpartum |
| Counsel on family planning and contraception options | 4th visit | 6 weeks postpartum |
| Provide long-term health education (e.g. nutrition, breastfeeding, maternal well-being) | 4th visit | 6 weeks postpartum |
This table outlines
WHO-recommended postnatal care interventions specifically for the mother,
organized by visit and timing. Full details are available in WHO recommendations on maternal and newborn
care for a positive postnatal experience (2022).
Midwifery
Improving quality of maternal and newborn care is critical for reducing mortality. It is estimated that 1 million newborn deaths and 150 000 maternal deaths could be averted annually through the provision of quality care. Midwifery models of care is an evidence-based cost-effective strategy to optimize maternal and newborn outcomes and reduce unnecessary medical interventions. This care ensures that women receive equitable, person-centered, respectful, integrated and quality care, provided and coordinated by midwives working within collaborative interdisciplinary teams. WHO, with partners, launched a global position paper with the first global definition of midwifery models of care, along with implementation guidance on transitioning to midwifery models of care.
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