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Post natal care update

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o&g update course 2012 hospital segamat

o&g update course 2012 hospital segamat

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  • 1. POSTPARTUM CARE SECTION 4
  • 2.  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
  • 3. The Aims of Postpartum Care: Support mother and family Prevention, early diagnosis and treatment of complications Referral counselling
  • 4. The Aims of Postpartum Care: Support of breastfeeding Educate on nutrition, and supplementation Counselling contraception and the resumption of sexual activity Immunization of infant
  • 5. 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
  • 6. NEEDS OF WOMEN AND NEWBORN 1.Information/counselling on: Herself-Health Self care Sexual life Nutrition Contraception
  • 7. NEEDS OF WOMEN AND NEWBORNNEEDS NEEDS OF WOMEN AND NEWBORN 2. Support on physical & psychological from : Health care providers Partner and family Employer
  • 8. 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
  • 9. NEEDS OF WOMEN AND NEWBORN 6. Social reintegration into her family and community 7. Protection from abuse/violence Women
  • 10. WOMEN MAY FEAR Inadequacy ( physical and Emotional ) Loss of marital intimacy - Isolation Constant responsibility for care for the baby and others
  • 11. NEEDS OF NEWBORN Information/counselling Care of the baby *Special Needs refer to Neonatal Care
  • 12. NEEDS OF NEWBORN Information/counselling Breastfeeding *Special Needs refer to Neonatal Care
  • 13. NEEDS OF SPECIAL GROUPS NO. 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
  • 14. 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
  • 15. 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
  • 16. 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 Inaccessibility Cost 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
  • 17. FREQUENCY OF POSTNATAL CARE 1.Day 1 2.Day 2 3. Day 3 4.Day 4 5. Day 6 6.Day 10 7. Day 20
  • 18. PLACES FOR POST NATAL CARE
  • 19. Every visit Mother Health and well-being. Symptoms of abnormal lochia, Chest pain, Difficulty in breathing, Redness and inflammation of lower limbs Calf swelling and tenderness.
  • 20. Every visit Mother Examination of vital signs breast abdomen Perineum These should be recorded in the Rekod Kesihatan Ibu KIK/1(a)/96 and KIK/1(b)/96 .
  • 21. Ask Mother about Baby: Health and well-being. Feeding Bowel opening Passed urine Other concerns. Every visit
  • 22. Assessment On Baby body weight body temperature eyes, 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.
  • 23. When Necessary Observe the feeding Help the mother to improve the technique of breast feeding.
  • 24. 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.
  • 25. 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.
  • 26.  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
  • 27. NUTRITION Mothers eat a healthy balanced diet vitamins minerals. plan simple and healthy meals that include choices from all of the recommended groups from the food pyramid.
  • 28. 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).
  • 29. 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.
  • 30. 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.
  • 31. 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
  • 32. 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.
  • 33. 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.
  • 34. 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.
  • 35. 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
  • 36. WARNING SIGNS TO TERMINATE EXERCISE  Dyspnoea before exertion  Dizziness  Headache  Chest pain  Muscle weakness  Calf pain or swelling (to rule out thrombophlebitis)
  • 37. 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.
  • 38. NORMAL GRIEF REACTION
  • 39. MORTALITY BEREAVEMENT  Maternal Death  Stillbirth  Neonatal death
  • 40. 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
  • 41. 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.
  • 42. 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
  • 43. 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
  • 44. 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.
  • 45. 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 
  • 46. TERIMA KASIH