Antenatal Visits & Postnatal Care — WHO’s latest guidance
Introduction
Quality antenatal (before birth) and postnatal (after birth) care are cornerstones of healthy pregnancies and safer transitions to parenthood. The World Health Organization (WHO) has shifted global guidance in recent years to emphasise not just clinical outcomes (reducing stillbirth and maternal/neonatal mortality) but also the quality of the pregnancy and postnatal experience: respectful care, continuity, and attention to mental and social needs as well as medical ones. This article summarises the most important WHO recommendations, practical steps for pregnant people and their families, what clinicians should prioritise, and how health systems can support a positive pregnancy and postnatal experience.
Why WHO updated the guidance: moving beyond “checklists”
Historically, antenatal care guidance focused on minimum contacts and discrete clinical checks. New WHO guidance reframes care around the woman-centred concept of a “positive pregnancy experience” and a “positive postnatal experience” — outcomes that include emotional wellbeing, supported decision-making, and a safe clinical course for mother and baby. The shift includes more contacts, personalised counselling, and specific clinical updates (for example, routine early ultrasound for dating and detection).
Key headlines you should know (quick summary)
• Antenatal contacts: WHO recommends a schedule of at least 8 antenatal contacts during pregnancy to reduce perinatal mortality and improve mother–baby outcomes and experience. Early contact (first trimester) increases likelihood of completing recommended contacts.
• Early ultrasound: Updated guidance includes routine imaging/ultrasound before 24 weeks to improve dating and identify important conditions.
• Postnatal care: WHO released comprehensive recommendations in 2022 emphasising routine postnatal contacts, integrated mother–newborn care, mental health screening, breastfeeding support, and continuity of care for at least the early weeks after birth.
• Quality & equity: The focus is not just “more visits” but on quality, respectful, rights-based care and solutions tailored to local systems and social contexts.
Antenatal care — what WHO recommends and why it matters
1. Timing & number of contacts
WHO recommends a minimum of 8 contacts across pregnancy rather than the older 4-visit model. These contacts are spaced to increase opportunities for prevention, timely detection of complications, education, and psychosocial support. Evidence showed that increased contacts are associated with lower perinatal deaths and higher satisfaction with care. Early booking (in the first trimester) is especially important — it makes completion of the contact schedule more likely.
Typical timing (illustrative):
• Contact 1: within the first 12 weeks (booking)
• Contact 2: 20 weeks
• Contact 3: 26 weeks
• Contact 4: 30 weeks
• Contact 5: 34 weeks
• Contact 6: 36 weeks
• Contact 7: 38 weeks
• Contact 8: 40 weeks (or as advised)
(Exact scheduling can be adapted by local guidelines and individual risk profiles.)
2. What happens at antenatal visits — essential components
• Each contact should include a blend of clinical checks, preventive interventions, and counselling:
• Medical assessment & screening: blood pressure, urine testing (protein), weight/growth checks, haemoglobin (anemia screening), infectious disease screening (HIV, syphilis, hepatitis as locally indicated), blood group/Rh when relevant.
• Fetal assessment: fetal heart rate, fundal height measurement and — when available and appropriate — early ultrasound before 24 weeks for dating and detection of major anomalies and multiple pregnancy.
• Preventive treatments: iron and folic acid supplementation, tetanus immunisation where indicated, antimalarials or malaria prevention in endemic areas, and prophylactic measures per local protocols.
• Risk assessment: identify preeclampsia risk, gestational diabetes screening (per national guidance), and other red flags.
• Counselling & psychosocial support: birth preparedness, danger signs (bleeding, severe headache, decreased fetal movements), nutrition, mental health screening, family planning options, and breastfeeding counselling.
3. Person-centred care
WHO emphasises respectful, non-judgmental care, clear communication, informed consent, and involvement of families where the pregnant person wants this. The aim is to support autonomy and reduce barriers to attendance.
The role of ultrasound in antenatal care (WHO update)
WHO’s more recent updates include a recommendation for at least one ultrasound scan before 24 weeks where feasible. The scan helps with accurate dating (crucial for appropriate timing of interventions), detection of multiple pregnancies and major anomalies, and reduces inductions for post-term pregnancy due to dating uncertainty. Implementation should be mindful of local capacity, training, and follow-up systems.
Practical antenatal tips for pregnant people and families
• Book early: aim to have your first contact in the first trimester. Early booking improves monitoring and outcomes.
• Plan for 8 contacts: ask your clinic to explain the antenatal schedule so you can plan time off work/transport.
• Keep a birth plan and records: record medications, supplements, ultrasound reports, vaccination records, and any test results.
• Ask questions: about warning signs, birth location options, pain relief, and postpartum support.
• Mental health: tell your provider if you feel anxious, depressed, or overwhelmed — screening and support are part of WHO’s recommended approach.
• Postnatal care — WHO’s 2022 framework for a positive postnatal experience
• WHO’s 2022 postnatal recommendations broaden the scope of routine care for mothers and newborns, with a set of contacts, clinical checks, and supportive actions designed to improve short- and long-term outcomes and wellbeing. Key elements include:
• Routine postnatal contacts: WHO recommends proactive postnatal follow-up contacts during the first 6 weeks (for example: within 24 hours, at 3 days, at 1–2 weeks, and at 6 weeks), with further tailored visits depending on risk and need. These help identify bleeding, infection, breastfeeding problems, neonatal feeding and weight issues, and early signs of mental health problems.
• Integrated mother–newborn care: treat the mother–baby dyad together rather than in isolation — e.g., breastfeeding support, cord care, and maternal recovery checks.
• Mental health & social support: routine screening for postpartum depression/anxiety, counseling, and referral pathways for specialist care.
• Attention to long-term issues: WHO highlights that postpartum problems may persist beyond 6 weeks (urinary or anal incontinence, sexual health problems, chronic pain) and should be acknowledged with pathways for longer-term follow-up where needed. Recent commentary and research call for longer-term postnatal surveillance to capture these issues.
What is checked during postnatal visits?
Mother:
• Vital signs (BP, temperature), uterine involution, bleeding assessment, wound checks (if cesarean or episiotomy), screening for infections, anemia check and contraception counselling.
• Mental health screening (mood, bonding, suicidal ideation screening when scored).
• Counselling on rest, nutrition, pelvic floor exercises, and returning to sexual activity and work.
Newborn:
• Weight, feeding assessment, jaundice check, thermoregulation, cord site, immunisation start (e.g., BCG, Hep B per national schedule), and newborn danger signs (poor feeding, lethargy, fever).
• Support for exclusive breastfeeding and addressing latch or milk supply concerns.
• (Exact content and timing may vary by country and individual risk factors.)
• Implementation challenges & solutions
Low attendance for 8+ contacts
Multiple studies (including recent analyses from low- and middle-income settings) document low adherence to the 8-contact schedule. Barriers include late booking, transport and cost barriers, cultural/practical constraints, and limited health workforce. Programs that increase early booking, provide outreach or community-based contacts, remove financial barriers, and use reminders or mobile health interventions show higher adherence.
Workforce and training
Scaling early ultrasound access and delivering quality postnatal mental health screening requires trained staff. Task-sharing (training mid-level providers), telehealth support, and clear referral pathways are practical strategies.
Equity focus
WHO guidance stresses equity: reach marginalized, rural, or adolescent pregnant people with tailored services, including community outreach and culturally competent care.
How clinicians and health systems can align with WHO guidance
1. Promote early booking: community outreach and public messaging that pregnancy care starts early.
2. Adopt the 8-contact model, adapted locally: ensure scheduling flexibility and track no-shows.
3. Provide at least one early ultrasound where feasible: invest in training and equipment or referral links for dating scans.
4. Formalise structured postnatal contacts: ensure proactive scheduling (24 hr, 3 days, 1–2 weeks, 6 weeks) and accessible follow-up.
5. Integrate mental health services and breastfeeding support: routine screening, counselling, and referral systems.
6. Track quality metrics: patient experience, maternal and neonatal outcomes, and equity indicators.
Common FAQs (SEO-friendly)
Q1: How many antenatal visits does WHO recommend?
A: WHO recommends a minimum of 8 antenatal contacts spread across the pregnancy to improve outcomes and the pregnancy experience.
Q2: When should the first antenatal visit occur?
A: Ideally in the first trimester (within 12 weeks). Early booking increases chances of completing recommended care.
Q3: Do I need an ultrasound? When?
A: WHO recommends at least one ultrasound before 24 weeks (when available) for accurate dating, to identify multiple pregnancies and major anomalies.
Q4: What postnatal visits are recommended?
A: Proactive contacts in the early postpartum period — for example, within 24 hours, around day 3, 1–2 weeks, and 6 weeks — with integrated checks for both mother and newborn.
Q5: How long does postnatal care last?
A: Routine postnatal care guidance emphasises the first 6 weeks as critical, but WHO and recent research note that some issues may persist long-term and require follow-up beyond 6 weeks. Health systems should provide pathways for later follow-up if problems arise.
Real-life checklist — what to bring to an antenatal/postnatal visit
Personal ID and health card
• Previous medical and pregnancy records, ultrasound reports
• List of current medicines and supplements (iron/folic acid)
• Questions for the provider (birth preferences, breastfeeding, vaccinations)
• Contact numbers for emergency transport and a birth companion
• Measuring success: what to monitor
Health systems should monitor:
• Coverage of 8+ ANC contacts and timing of first visit.
• Proportion receiving an early ultrasound where offered.
• Postnatal contact coverage within 24 hours, 3 days, 1–2 weeks, 6 weeks.
• Patient-reported experience and respectful care measures.
Conclusion — a positive experience matters as much as clinical outcomes
WHO’s recent approach to antenatal and postnatal care asks health systems and clinicians to treat pregnancy and postpartum periods as experiences to be optimised: clinically safe and emotionally supportive. The combination of increased contacts (minimum 8), targeted screening (including early ultrasound), person-centred counselling, and comprehensive postnatal follow-up can reduce adverse outcomes and improve wellbeing for families. Implementation will require investment in workforce, equipment, equity-focused outreach, and tracking quality — but the potential gains are substantial: healthier mothers, safer newborns, and stronger families.
Selected references & further reading (WHO and evidence summaries)
• WHO — Recommendations on antenatal care for a positive pregnancy experience (2016 and related updates).
• WHO — Recommendations on maternal and newborn care for a positive postnatal experience (March 2022).
• WHO — Antenatal care area page and updates (maternal & perinatal health).
• Recent evidence on compliance with the WHO 8+ ANC contacts (PLOS/PMC studies, 2024).
• BMJ Global Health commentary and implementation papers on strengthening the maternal–newborn continuum.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)