CHAPTER ONE
Introduction
Background of the Study
In Africa, at least 125,000 women die every year and 870,000 newborns die in the first week after birth, yet this is when coverage and programmes are at their lowest along the continuum of care. According to Warren, DaIly, Toure, Mongi, (2005) 18 million women in Africa currently do not give birth in a health facility. This poses a lot of challenges for planning and implementing postnatal care (PNC) for women and their newborns. According to WHO (2012), up to two-thirds of the 3.1 million newborn deaths that occurred in 2010 can be prevented if mothers and newborns receive known, effective interventions. A strategy that promotes universal access to antenatal care, skilled birth attendance and early postnatal care will contribute to sustained reduction in maternal and neonatal mortality. A little less than half of all mothers and newborns in developing countries do not receive skilled care during birth, and over 70% of all babies born outside the hospital do not receive any postnatal care (WHO, 2012).
Basic care for all newborns should include promoting and supporting early exclusive breastfeeding, keeping the baby warm, increasing hand washing and providing hygienic umbilical cord and skin care, identifying conditions requiring additional care and counselling on when to take a newborn to a health facility. Newborns and their mothers should be examined for danger signs during home visits. At the same time, families should be counselled on identification of these danger signs and the need for prompt care seeking if one or more of them are present (WHO, 2012). Regardless of place of birth, mothers and newborns spend most of the postnatal period (the first six weeks after birth) at home.
The post natal period begins one hour after the birth of the placenta and stretches to six weeks after childbirth (Liu, 2006). During this period the uterus and other reproductive organs and structures return to their pre-gravid state. The period is marked by physiological and psychological adjustments following a normal or traumatic delivery. The postnatal period marks the birth of the baby, which can be a time of great joy as well as enormous stress (Northern Rivers General Practice Network, 2008). The woman is stressed following pains accompanying labour and blood loss which can lead to shock and possible exhaustion. During the postpartum period the mother is at risk for such problems as infection, hemorrhage, pregnancy induced hypertension, blood clot formation, the opening up of incisions, breast problems, and postpartum depression. The postnatal period is often marked by cultural practices that keep the mothers and their babies in doors. Majority of mothers are contented and happy, some are anxious, apprehensive and sensitive (Ojo and Briggs, 2006). Some are contented and happy if their expectations concerning childbirth were met especially in terms of sex preference. Some are anxious because of transition from pregnancy to parenthood. Whatever the state a woman finds herself during the post natal period, the care she receives will either affect her positively or negatively.
The postnatal care practices essential for all mothers are checking and assessing bleeding and temperature, breast feeding support and observations of the breast for mastitis. Promoting nutrition and managing anaemia, encouraging mothers to use insecticide treated bed nets and provision of vitamin A supplementations, counseling of mothers for family planning, dangers signs and home care, refer for complication (sepsis), postnatal depression and care of the newborn (Warren, DaIly, Toure, Mongi, 2005). Other practices include personal hygiene to prevent body odour, lochia (vaginal loss) management to prevent infection and promote involution, stress management to enhance emotional stability, rest and exercise for proper body mechanism and healing of perineal wounds. Drug intake to prevent wound breakdown and spiritual care to enhance connectedness with self, others and higher power (Erb and Kozier, 2008). Childbirth poses a lot of challenges to the mother, family, community and health facility where the woman delivered. These challenges range from self-care, parenting roles and official roles in life endeavours. Postnatal care practices will either assist the woman to adjust faster or may pose more challenges to her general wellbeing. Postnatal care practices should aim at promoting the mothers speedy return to physical, mental and social wellbeing. Every activity must be carried out to return the mother to her pre-pregnancy state and prevent postpartum complications from developing and survival of the newborn.
The major focus of postpartum care is ensuring that the woman is healthy and capable of taking care of the new born, equipped with all information she needs about breastfeeding, reproductive health and contraception and the imminent life adjustment. Information on post natal care practices that are useful to the general wellbeing of the mother should be made available to the mother on discharge where the woman delivers in the hospital, but where the mother delivers at home, it is the responsibility of the midwife or community health nurse to give them health education in their homes and traditional birth attendant’s home. Quality postnatal care practices are needed in the rural communities where majority of births take place outside health facilities (Nigerian Partnership for Safe Motherhood, 2004). Even where the births take place in the health facilities in the rural areas, the health providers are mostly inexperienced junior community health extension workers. These categories of care providers are ill-equipped and may not have adequate information on post natal care practices that are useful and necessary for the total wellbeing of the mother. Hence there is increased risk of postnatal complications resulting from inexperience.
Since the practices vary from family-to-family, community-to- community, country-to-country, and even among ethnic groups it was important to investigate the various practices in each community because some practices can affect the woman’s wellbeing and hinder her return to her pre-pregnancy state and vary with availability of resources, beliefs and educational level (Nigerian Partnership for Safe Motherhood, 2004).