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The National Institute for Health and Clinical Excellence (NICE) has recently published guidelines on the management of women and their newborn infants during the first 6–8 weeks after delivery.1 NICE guidelines aim at describing the “best practice advice on the core care of women and their babies during the postnatal period”. The present scheme of postnatal care was developed many years ago and NICE has reviewed it based on existing evidence. Unsurprisingly, the scientific evidence for best practice is incomplete. The money and time spent on postnatal care in Britain alone justify a systematic evaluation, but the clinical efficacy of existing practice has also raised concerns. The high proportion of women who intend but fail to breast feed successfully, the number of women who complain of additional health problems in the weeks following delivery and the number of infants with significant anomalies that are unrecognised when examined postnatally2–5 are some of the reasons for questioning whether we are offering families optimal care. In addition, the NICE guidelines point out that various recent surveys have found significant levels of dissatisfaction with the postnatal care among the women who have received it.1 We have confined our review to advice on infant care, although the wellbeing of mothers is inextricably linked to that of their infant and vice versa.
The potential hazards of the postnatal period are demonstrated by the global annual neonatal death rate of around 4 million infants; the overwhelming majority of these deaths occur in low-income countries.6 In Britain we are spared much of this tragedy; our relatively healthy adult population and routine high-quality antenatal screening has led to serious, unexpected illness or death in the neonatal period being uncommon. There is a danger that we become blasé about the risks of the newborn …
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