**7. Role of adverse events (AEs)**

Good postnatal care is crucial to prevent adverse maternal and neonatal outcomes and provide support during motherhood adjustment for first-time mothers. Adverse events (AEs) are outcomes of treatments below the current expected medical standard that result in temporary or permanent harm to patients. Unplanned, adverse events during labor or delivery may generate a negative response during the early postpartum period, resulting in disruption of usual functioning and mood. Most maternal and neonatal adverse events occur in the immediate postnatal period [34]. The provision of evidence-based postnatal care with adequate quality during this period is vital to ensure uncomplicated recovery of the mother and the baby. In some low- and middle-income countries, AEs episodes were identified among both mothers and newborns with an overall prevalence of 12.7% [35].

High levels of maternal depressive symptoms during the postnatal period are associated with parenting, infant attachment, behavioral problems, and cognition [36]. In many low- and middle-income countries, woman's dissatisfaction status with their own childbirth experience was less likely reported, however, the severe depressive state could be noticed as accompanying emotional unwillingness to have another baby due to such malpractices occurring either in healthcare settings or in-home births [32, 33]. Such preventable adverse events were reported as complicating the postnatal period including the postpartum length of stay for more than 3 days after vaginal birth and delayed intervention in case of postnatal hemorrhage (PPH) with a decision-delivery time of more than 30 minutes [37]. Prolonged (labor) second stage was found strongly associated as a risk factor during childbirth with multiparous mothers, the use of uterine fundus pressure as one of the intervention methods during labor was associated with AEs among mothers [35, 38].

Many women recognized the specific challenges of the postnatal period and emphasized the need for emotional and psychosocial support in addition to clinical care. Postnatal care programs and related research should consider these multiple drivers and multifaceted needs, and the holistic postpartum needs of women and their families should be studied in a wider range of settings [32].
