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
Half of all postnatal maternal deaths occur during the first week after the baby is born, and majority of the deaths occur during the first 24 hours after child birth (Warren, Daily, Toure, Mongi, 2005). Yet postnatal care programmes are among the weakest of all reproductive health programmes in the local government, state, country and African region.
In cross River State maternal mortality ratio is l200/100,000 higher than national figure 1100/100,000 (Nigerian Partnership for Safe Motherhood, 2004).In 2008 it dropped to 831/100,000. However, the figure rose slightly to 940.6 / 100,000 live births at the end of 2009 (Agan, Archibong, Abeshi, Edentekhe, Bassey, 2010) as against national rate of 545/100,000 live births which is still highly unacceptable. The very poor maternal health indices from Cross River State has been attributed to poor antenatal, intra-natal and postnatal practices, and to various socio-economic factors which place women at risk of adverse maternal health outcomes. The paradox remains that most of the deaths are preventable by simple, affordable and available technologies as well as attitudinal change, but the circumstances under which women become pregnant and deliver babies in the country remain a huge challenge.
Findings/observations made by the researcher from clinical practice show that some women in communities of Yakurr Local Government Area die during pregnancy and childbirth especially early postpartum. Within one month up to four deaths were reported during routine activities in the area of study. The rural women are prone to several health problems after child birth including their new born.
Researcher observed that several health problems are prevalent in some communities which range from perineal wounds that are painful, stinking and offensive. Pale, tired and malnourished ill looking mothers, breast engorgement, breast abscess, prolonged vaginal loss with offensive odour. These problems are all preventable problems. According to Witt (2006) untreated complications during postnatal period may result in increased morbidity and mortality of the mother. Based on the observed health problems and high mortality rate it was necessary to carry out this research to investigate the postnatal care practices mothers adopt in communities studied.
Purpose of the Study
The purpose of the study was to investigate postnatal care practices among mothers in three rural communities of Yakurr Local Government Area of Cross River State. The specific objectives were to:
- Determine perineal wound care practices in different places of birth of rural mothers in
- Examine breast-feeding practices of mothers in three rural communities in Yakurr
- G. A.
- Identify nutritional practices of mothers in Yakurr L.G.A.
- Determine the management of vaginal loss of rural mothers in Yakurr LGA.
- Find out personal hygiene practices of mothers in rural communities of Yakurr LGA.
– What are the perineal wound care practices of rural mothers in different places of birth at
– What are breast-feeding practices of mothers in Yakurr?
– What are the nutritional practices of mothers in Yakurr LGA?
– What is the management of lochia (vaginal loss) of rural mothers in Yakurr LGA?
– What are the personal hygiene practices of rural mothers in Yakurr LGA?
- Place of delivery is not a significant factor influencing perineal wound care practices.
- Occupation is not a significant factor influencing the infant feeding practice in the
- There is no significant difference between respondents’ level of education and their
personal nutritional practices.
- There is no significant difference in management of vaginal loss among mothers in
- There is no significant difference in personal hygiene practices of mothers based on
their socio economic status.
Significance of the study
Women have more contacts with health care providers during postnatal period than other times yet these contacts are not utilized to monitor and assess the quality of life of the postnatal mothers but only used to provide immunization for their babies. Therefore the study will help health care providers use these contacts to identify practices women adopt during post natal period. Develop a collaborative framework for management of postnatal mothers and their families. Improved management will enhance the wellbeing of mothers and their families. It will also provide data that will be used for developing health promotion strategies in rural communities for postnatal mothers. It will provide a framework for diagnosis of harmful practices in the community in relation to postnatal period and enhanced health education that will discourage such practices. The study will enable stakeholders develop an evidence based postnatal care package that will build, reinforce links between the community and health care facilities and health care providers. This will ultimately reduce maternal/newborn morbidity and mortality. It will also improve available information to guide in decision making in the community, State and country at large. It will also generate information that will strengthen existing postnatal care into health centers in local government areas by building evidenced based health education in the facilities. It may provide information that may trigger a large study.
Scope of the Study
The study was delimited to women who had given birth to full term babies in the past six months. It will cover such postnatal care practices like perineal wound care practices, nutritional practices, management of vaginal loss (lochia), personal hygiene and breast-feeding practices among mothers in Yakurr LGA.
Operational Definition of Terms
Postnatal: The period after child birth to six weeks after delivery.
Postnatal care: The care of the mother for at least six weeks after childbirth. Postnatal care is the care given to the mother after birth of the baby up to the end of purperium, which is the postnatal period (Rao, 2006).
Care: Meeting the health needs of mothers. It involves maintaining and initiating behaviours that promote healthy living and total wellbeing.
Practices: Actions that are taken for a particular purpose.
Postnatal care practices: These are routine activities carried out to meet the needs of the mother after childbirth within six weeks. The activities involve perineal wound care, breastfeeding, nutrition, lochia management and personal hygiene.