**3. The role of the midwife in combating postpartum challenges**

The International Confederation of Midwives [34] in a Core document stipulates the functions of a Midwife include safeguarding the health and rights of the mothers and their babies. Midwives support and promote natural birthing without interference. They provide respectful, anticipatory, and adaptable care that takes cognizance of the needs of the woman, her newborn, family, and community. And have the capacity for timely patient referral for appropriate secondary care with appropriate technology. With the additional role of informing and collaborating with others to provide essential care to the woman, her child and the family.

They provide pertinent education to mothers and support the ability to make informed decisions. Midwives empower women to be accountable and responsible for their health and those of their families. Provide improved care and service to the mother, baby, and family through inter and intra-professional collaboration and consultation. They must be accountable for individual and collective advancement of midwifery knowledge and care through involvement in continuing education and mentoring and teaching the future generation of midwives.

Midwives play pivotal roles in the health sector, the system benefits from a midwife-led team. Midwife-led teams promote cohesion and cooperation of members. The approach promotes increased benefits of continuity of care with good fetal and maternal outcomes, which are cost-effective and adaptable. Teamwork is enhanced among health workers and the comradery spirit and autonomy of members are promoted [35].

Professional midwifery practice contributes to a decline in infant and maternal illness and deaths [36, 37]. Improves maternal satisfaction and a willingness to continue in the care continuum [38]. The non-medicalization approach of midwifery care contributes to a reduction in the cost of healthcare across low and high-income nations. Countries can divert such funds to staff training and improvement of service [39].

A midwife (Accoucheuse**)** assesses and screens clients to identify risks, preventing and instituting early treatment for women at risk of psychological disorders. They also offer culturally sensitive care to women while integrating mental health services into basic maternal healthcare [40]. They give psychosocial support to the woman and relatives, enabling effective coping [29].

The education given during health and postnatal visits helps to empower the woman with information for decision-making, self-reliance, and self-determination [41]. This also improves the women's skills in childcare and breastfeeding [17]. Moreover, midwives support women in achieving their fertility and contraceptive goals using contraceptives and family planning education [42].

Similarly, midwives support women to adopt healthy and healthful futuristic reproductive behaviors [43]. Midwives ensure the safety of women and their babies. They give quality maternal care during safe and unsafe periods, and their life and health are often sacrificed to preserve women and their babies. They identify and provide counseling to women at risk or are victims of intimate partner violence, providing anonymous and confidential treatment to victims [44].

During the postpartum period, it is essential and expected that the woman makes four (4) contacts with the midwife to provide continuous care. Care is divided into three stages: 24 hours after birth, 7 days after delivery and 6 weeks postpartum. However, care in the first 24 hours is critical and lays the foundation for subsequent

care. Where the mother cannot make or afford all four meetings, receiving comprehensive midwifery care on the first day is a solid foundation [45].

#### **3.1 Care within 24 hours of birth**

#### *3.1.1 First-hour postpartum care*

Ensure the safety and comfort of the mother. The midwife must ensure that the woman is clean and comfortable and that all soiled or wet linen is replaced with clean, warm clothing. The delivery suite is tidy, and all sharps are discarded for the safety of patients and staff.

Examine the perineum and assess for damage. If any tear or episiotomy, the midwife must ensure they are promptly sutured, and the woman is educated on how to care for bruises and the suture site, asepsis must be maintained in care of these areas.

Take and record the woman's vital signs including the record of blood loss. This is compared with the vital signs during labour and serves as a baseline for future vital signs reading to identify early deviation from normal.

Assess the woman's physical and physiologic status: the nipple for readiness to breastfeed. An inverted nipple may be detected at this stage, though it might have been identified and care is taken to ensure its prominence.

The midwife must measure the symphysio-fundal height to rule out retained placenta/product or retained twin. Symphysio-fundal height of 22–24 cm or at the level of the umbilicus is normal. It should however decrease by 1 cm daily until it cannot be measured or returned to the pelvic cavity [46].

### *3.1.2 Skin-to-skin contact*

The infant is brought in contact with the mother within one hour of birth to stimulate bonding, initiate early breastfeeding and lactation, overcome breastfeeding barriers, increase the temperature of the baby and ability to overcome the stress of delivery, initiate self-control, and cope with future stress [47].
