post natal care update
DESCRIPTION
o&g update course 2012 hospital segamatTRANSCRIPT
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POSTPARTUM CARE
SECTION 4
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The postpartum period
(puerperium) is from
the end of labour until
the genital tract has
returned to normal. It
usually last for 42 days.
INTRODUCTION
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The Aims of Postpartum Care:
Support mother and family
Prevention, early diagnosis and treatment
of complications
Referral
counselling
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The Aims of Postpartum Care:
Support of breastfeeding
Educate on nutrition, and supplementation
Counselling contraception and the
resumption of sexual activity
Immunization of infant
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Is to increase the awareness of warning signal and appropriate
intervention at all level.
About 2/3 of the maternal deaths occur during the postnatal period
RATIONALE
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NEEDS OF WOMEN AND NEWBORN
1.Information/counselling on:
Herself-Health
Self care
Sexual life
Nutrition
Contraception
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NEEDS OF WOMEN AND NEWBORNNEEDS NEEDS OF WOMEN AND NEWBORN
2. Support on physical & psychological from :
Health care providers
Partner and family
Employer
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NEEDS OF WOMEN AND NEWBORN
3.Health care for suspected or occurring complications eg PPH/Fever
4. Time to care for the baby (esp if on bottle feeding)
5. Help with domestic tasks
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NEEDS OF WOMEN AND NEWBORN
6. Social reintegration into
her family and community
7. Protection from
abuse/violence Women
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WOMEN MAY FEAR
Inadequacy ( physical and Emotional )
Loss of marital intimacy -
Isolation
Constant responsibility for care for the baby and
others
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NEEDS OF NEWBORN
Information/counselling
Care of the baby
*Special Needs refer to Neonatal Care
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NEEDS OF NEWBORN
Information/counselling
Breastfeeding
*Special Needs refer to Neonatal Care
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NEEDS OF SPECIAL GROUPSNO. Problems Steps to be taken
Women staying in Remote area
Maternal Mortality Ratio (MMR) is higher compared to the general population
Higher incidence of pregnancy problems
Mobile group and inaccessible
Delay discharge from the hospital
Discharge to ‘pusat transit’/ any other health facilities and keep them there
Education of patients and support group
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NEEDS OF SPECIAL GROUPS
NO. Problems Steps to be taken
Urban poor
Poor ante natal care leading to postpartum problems
Non-compliance to post natal care plan/ defaulter
Inaccessibility
Cost and implications
Education regarding the importance of post natal care especially those with problems
Reassurance, care is totally health directed
Availability of services at all centres
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NEEDS OF SPECIAL GROUPS
NO. Problems Steps to be taken
Single mothers
They have poor social support
They are usually financially unstable
The pregnancy may be unwanted
Delay discharge They should be encouraged to see a social workers
Fees can be waived
Counselling should be given
Option on adoptions / social support should be given from the hospital
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NEEDS OF SPECIAL GROUPS
NO. Problems Steps to be taken
Illegal immigrants
Poor ante natal care leading to postpartum problems
Non-compliance to post natal care plan/ defaulter
InaccessibilityCost and implication
Legal/ immigrant implication
Education regarding the importance of post natal care especially those with problem
Reassurance, care is totally health directed.
Waving charges for indicated care (Refer to fee act)
Availability services to all centres
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FREQUENCY OF POSTNATAL CARE
1.Day 12.Day 2
3. Day 34.Day 45. Day 66.Day 107. Day 20
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PLACES FOR POST NATAL CARE
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Every visit
MotherHealth and well-being. Symptoms of abnormal lochia, Chest pain, Difficulty in breathing, Redness and inflammation of lower limbsCalf swelling and tenderness.
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Every visit
Mother
Examination ofvital signs breast abdomenPerineum
These should be recorded in the Rekod Kesihatan Ibu KIK/1(a)/96 and KIK/1(b)/96 .
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Ask Mother about Baby:Health and well-being. Feeding Bowel opening Passed urine Other concerns.
Every visit
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Assessment On Baby
body weightbody temperatureeyes, skin umbilical cord. If the mother accompanies her baby in the
ward, the postnatal care should be continued for the mother by the hospital staff as scheduled.
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When Necessary
Observe the feeding
Help the mother to improve the technique of breast feeding.
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CHECK LIST TO IDENTIFY HIGH RISKS
Senarai semak bagi mengesan factor risiko semasa post
natal digunakan oleh anggota jururawat/ pegawai perubatan ketika menjalankan jagaan postnatal.
Ibu diberikan pemeriksaan post natal mengikut senarai semak dan carta alir adalah seperti dalam rajah 1.
Jika ibu tersebut diberi kod merah, kes tersebut haruslah
dirujuk ke hospital dan cara pengendaliannya adalah sepert
dalam jadual 1.
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CHECK LIST TO IDENTIFY HIGH RISKS
Jika ibu tersebut diberi kod warna kuning, kes
dirujuk kepada pegawai perubatan/ Pakar Perubatan
Keluarga (FMS) klinik kesihatan atau hospital dan
cara pengendaliannya adalah seperti jadual 2.
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Carta Alir Pengendalian Kes postnatal
JADUAL 1: PENGENDALIAN KES-KES BERISIKO KOD MERAH
JADUAL 2: PENGENDALIAN KES-KES BERISIKO KOD KUNING
APPENDIX 7
SENARAI SEMAK PEMERHATIAN PENYUSUAAN
STANDARD OPERATING PROCEDURE
FLOW CHART FOR INVESTIGATION AND REVIEW OF MATERNAL DEATH
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NUTRITION
Motherseat a healthy balanced diet vitamins minerals.
plan simple and healthy meals that include choices from all of the recommended groups from the food pyramid.
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Resumption of sexual activity post natally
Some Studies shown By eight weeks postpartum 71% of
respondents had resumed intercourse, and by ten weeks 90% of the women who had partners had resumed intercourse (Glazener 1997).
Another factor that influences sexual behavior post partum is pain related to perineal damage and sutures, caused by vaginal tears and episiotomies (Glazener 1997).
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Resumption of sexual activity cont..
Mother and her partner should decide together
Sexual intercourse may be resumed after mother’s vaginal bleeding has stopped and stitches are healed (usually within 4- 6 weeks)
Be aware that sex first few times following birth may be painful – Advised for lubricants and comfortable positioning.
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Contraception:
Counseling to all postnatal mothers regarding the risk of next pregnancy.
Should be started before any sexual activity.Offered to all Postnatal mothers especially
those high risk cases.Method as in MEC (MOH 2006)All high risk mothers should be registered in
both PPC and FP Clinic.
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POSTNATAL EXERCISE
1. Pelvic floor exercise Start soon after birth. Reduce the possibility of stress incontinence and
restore the pelvic floor muscle strength.
2. Position Sitting, standing or crook lying
3. Steps Imagine you are trying to hold back a stream of
urine and tighten your muscles to prevent leaking.
Breath normally, hold for 5 seconds. Do not tighten the gluteal and thigh muscles Relax for 10 seconds Repeat 10 times
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ABDOMINAL EXERCISE
Benefits: Strengthen the abdominal muscle Improve abdominal stabilization in the
activities of daily living.
Position: Lie on the floor with your knees bent
and head supported
Steps: Breath in, then breath out as you pull
in your abdomen and push your lower back down into the floor.
Hold for 5 seconds and relax/ Repeat 5 times.
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PELVIC EXERCISE
Benefits: To maintain mobility of the pelvis To tone the natural abdominal corset Improve posture Prevent and relieve backache
Position: Lie down with the back supported, arm
by the side, knees bent together.
Steps: Tighten the abdominal muscles and
move the coccyx forward. Hold for 5 seconds. Repeat 5 times.
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ARM EXERCISES
Benefits: Relieve heartburn. Improve circulation Improve breathing and lung expansion.
Position: Stand upright
Steps: Stand straight with feet apart. Keep
your shoulders back. Lift both arms as far back as you can
reach without bending your elbows. Move your arms forward by 180 .
Swing arms back again and repeat 5 times.
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ANKLE EXERCISES
Benefits: Improve circulation Maintain range o motion.
Position: Long sitting – sitting on the floor with
both legs straight. Sitting – on the chair with the leg
supported or elevated.
Steps: Lift one foot off the floor and circle the
ankle several times, first one way the the other.
Don’t move your knee. Repeat with the other leg
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WARNING SIGNS TO TERMINATE EXERCISE
Dyspnoea before exertion Dizziness Headache Chest pain Muscle weakness Calf pain or swelling (to rule out
thrombophlebitis)
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COPING WITH DEATHS
GRIEF:
Emotional and somatic responses felt by an individual on the death of another individual.
More intense if the death occurs in a person who is closely related.
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NORMAL GRIEF REACTION
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MORTALITY BEREAVEMENT
Maternal Death
Stillbirth
Neonatal death
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COUNSELLING
Death (Maternal or Stillbirth or Neonatal Death) The bereaved persons needs:
- talk about the loss
- express feelings of the sadness, guilt or anger
- understand the normal course of grieving
Help needed:
- to accept that loss is real
- to work though stages of grief
- to adjust to life without the deceased
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GUIDELINES ON COUNSELING
Provide an environment and circumstances for feeling hurt ,guilty, angry or other strongly negative feelings.
Allow the spouse and relatives to ventilate.Validate the extent of grief.Be sensitive for the need for postmortem in cases
of sudden death.Encourage spouse to built a support network of
family and friend.Be alert for suicidal intention or behavior.Remember that grief takes time.
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THE "DO"THE "DO" THE “DON’T”THE “DON’T”
Express sympathy
Talk about deceased by name
Elicit question about
circumstances of the death.
Elicit question about feeling
and about the death has
affected the person.
Have a casual or passive
attitude
Give statements that death is
for the best
Assume that the bereaved is
strong and will get through this
Avoid discussing the death
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TEAR
T - To accept the reality of the loss
E - Experience the pain of the loss
A - Adjust to the new environment
without the lost object
R - Reinvest in the new reality
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FORMATS USED FOR INVESTIGATION AND REVIEW OF MATERNAL DEATHS.
KIK/K1-1 -Penyiasatan Kematian Ibu Mengandung pind.Jul.91
KIK/K1-2 -Investigation of Maternal Deaths
KIK/K1-3 -Borang Maklumat Kes Kematian Ibu.
KIK/K1-4 -Feedback format on Maternal Deaths from State to the
District to State Level.
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KIK/K1-5 Reporting Format to QA health Services Committee by technical Committee for Investigation and review of Maternal Deaths at District, State and National levels
KIK/K1-6 Borang Maklumat bedahsiasat Atas Kes Kematian Ibu
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TERIMA KASIH