ABSTRACT
Reports show
that most maternal deaths occur during the post natal period, yet this is when coverage and programmes of
maternal and child health are at their lowest along the continuum of care in
the local government, state, country and African region at large. Therefore it
is important to investigate postnatal care practices carried out by mothers to
reduce the trend. The aim of this is study was to assess postnatal care
practices with respect to, perineal wound care, breast-feeding, nutrition, the
management of vaginal loss and Personal hygiene practices of mothers.
The study was descriptive
non-experimental cross sectional design. Purposive sampling technique was used
to select two hundred and seven nursing mothers who met the inclusion criteria
and gave their consent to participate in the study. A self-developed structured
questionnaire was used to collect data. Data was analyzed using Chi-square
tested at 0.05 level of significance. Result was presented using descriptive
statistics, averages and percentages.
The result revealed that majority
(82.1%) of the respondents delivered out of health facility and 61.8% sustained
tear. 52.8% of the respondents accepted that they were taught how to take care
of the wound daily using sitz bath and 38.7% of
them were taught that wounds should be kept clean.
Majority of the respondents (74.5%) cared for the wound at home by cleaning the
area with hot water only while 11.3% respondents
cared for the wound daily using sitz bath, 10.4% respondents
applied ointments and 2.8% respondents applied herbs. Most of the respondents (70.0%) started breastfeeding immediately after
delivery and gave the first yellowish fluid to their baby after birth while (30%) gave the yellowish fluid six hours after birth.
When breast milk was not enough 73.9% respondents gave water to their babies and
60.9% respondents drank palm wine to stimulate breast milk. Majority of the
respondents (70.0%) had particular food they ate after delivery such as hot
pepper soup with rice or yam, tea with milk and pounded yam/garri with
vegetable soup. Most of the respondents (71.0%) took fruits and vegetables
after delivery, but some of the respondents (56.4%) took them from the fourth
day after delivery and (29.0%) did not take fruits and vegetables for reasons
that it was not presented to them and (16.7%) said it purges them. 31.4% of the
total respondents had heavy bleeding; to stop the
bleeding, (15.4%) respondents drank palm oil, 24.6% took herbs, while 26.2% were given
injection. Majority of the respondents (60.4%) took their bath twice a
day and 58.0% changed their pads twice a day. A total of 46.6% of the
respondents met the World Health Organization (WHO) standard of best practices.
Place of delivery was a significant factor (p < 0.05) influencing perineal
wound care practices.
Respondents’ occupation influenced their feeding practices (p <
0.05). There was a
significant variation (p < 0.05) in the management of vaginal loss among the
various communities. Personal hygiene practices and socioeconomic status was
only significant (p < 0.05) based on respondent’s occupation.
It was
discovered that bestpractices exist that must be emphasized and harmful
practices capable of increasing morbidity and mortality also exist and need to
be stopped. The study has helped in emphasizing postnatal care practices as a
point of concern to health care professionals. It is recommended that Post
natal care should be integrated as a routine health care activity and build
partnership with communities, families and individuals.
The post natal period should be utilized maximally
at community and health care facilities where health providers have contact
with nursing mothers and their babies to educate them on healthy post natal
care practices.
TABLE OF CONTENTS
Cover
page
Title page – – – – – – i
Approval page – – – – – – – ii
Certification – – – – – – iii
Dedication – – – – – – – iv
Acknowledgement – – – – – – v
Abstract – – – – – – – – – vi
Table of contents – – – – – vii
List of tables – – – – – – – x
CHAPTER ONE:
INTRODUCTION
Background of the study – – – – – 1
Statement of problem – – – – – – 4
The purpose of study – – – – – 5
Research questions – – – – – – 5
Hypotheses – – – – – – – – – 6
Significance of the study – – – – – 6
Scope
of the study – – – – – – – – 7
Operational definition of terms – – – 7
CHAPTER TWO: LITERATURE
REVIEW
Concepts Related to Postnatal Care Practices – – 9
Perineal Wound Care Practices – – – 12
Breast feeding practices – – – – 16
Post Natal Nutritional practices – – – – 19
Management of vaginal loss – – – 21
Personal hygiene practices. – – – – – 23
Theoretical framework – – – – 25
Empirical review – – – – – 28
Summary of Literature Review. – – – 35
CHAPTER THREE: RESEARCH
METHOD
Research design – – – – – 36
Area of the study – – – – – – 36
Population of the study – – – – – 37
Sample – – – – – – 37
Sampling Technique – – – – – – 38
Instrument for data collection. – – – 38
Validation of instrument – – – – – 38
Reliability of the instrument – – – – – 39
Procedure for Data Collection – – – 39
Ethical Consideration – – – – – 40
Data Analysis – – – – – – 40
CHAPTER FOUR: PRESENTATION AND
INTERPRETATION
OF DATA – – – – – – – 41
Summary of Findings – – – – – 58
CHAPTER FIVE: DISCUSSION OF
FINDINGS
Implication of the study – – – – – 64
Conclusion – – – – – – 65
Summary – – – – – – 66
Recommendation – – – – – – 67
Limitation of study – – – – – – 67
Suggestion for further studies. – – – – 68
References – – – – – – – – 69
Appendices
Questionnaire – – – – – – – 74
Approval Letter for Research Ethics
Committee
Consent form
Letter of Introduction
LIST
OF TABLES
Table 1 Demographic Data – – – – – 41
Table 2 Perineal Wound Care Practices in Different Birth Place – 43
Table 3 Chi-square tests for objective one – – 45
Table 4 Breastfeeding Practices – – – – 46
Table 5 Chi-square tests for Breastfeeding Practices – 47
Table 6 Nutritional Practices – – – – 48
Table 7a: One way descriptive for mean nutritional practices — 49
Table 7b: ANOVA Result for Mean nutritional practices 49
Table 8: Vaginal Loss Management – – – 50
Table 9a: one
way Descriptive for Mean Vaginal Loss Management – – 51
Table 9b: ANOVA Result for Mean Vaginal Loss Management 51
Table 10: Personal Hygiene Management – – 52
Table 11a: One
way Descriptive Personal Hygiene Management (Age Group) 53
Table 11b: ANOVA Personal Hygiene Management (Age Group) – 53
Table 12a: One way Descriptive for Personal Hygiene
Management (Religion) 54
Table 12b:
ANOVA Result for Personal Hygiene Management (Religion) 54
Table 13a: One way Descriptive for Personal Hygiene
(Educational Level) 55
Table 13b: ANOVA Result for Personal
Hygiene Management (Educational Level) 55
Table 14a: One way Descriptive for Personal Hygiene Management (Marital Status)
56
Table 14b: ANOVA Result for Personal Hygiene
Management (Marital Status) 56
Table 15a: One way Descriptive for Personal Hygiene
Management (Occupation) 57
Table
15b: ANOVA Result for Personal Hygiene Management (Occupation) 57
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).
Statement
of Problem
POSTNATAL CARE PRACTICES AMONG MOTHERS IN THREE RURAL COMMUNITIES OF YAKURR LGA OF CROSS RIVER STATE
