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