POSTNATAL CARE

Care of the mother and newborn after delivery is known as postnatal care or postpartal care. This
involves care of the mother, which is primarily the responsibility of the obstetrician and care of
the newborn, which is the combine responsibility of the obstetrician and paediatrician. The
combined responsibility is also known as perinatology.

OBECTIVES OF POSTNATAL CARE

The objectives of postnatal care are;

 To prevent complication of postpartal period

 To provide care for rapid restoration of mother to optimum health

 To check adequacy of breastfeeding

 To provide family planning services

 To provide basic health education to mother/family.

COMPLICATIONS DURING POSTNATAL PERIOD

1. Puerperal Sepsis: Infection of genital tract within 3 weeks after delivery. this is
accompanied by rise in temperature and pulse rate, foul-smelling lochia, pain and
tenderness in lower abdomen

2. Thrombophlebitis: An infection of the veins of the legs frequently associated with

varicose veins. The leg may become tender, pale and swollen

3. Secondary haemorrhage: Bleeding from vagina any time from 6 hours after delivery to
the end of the puerperium (6 weeks).

4. Other infections: Urinary tract infection and mastitis are common in postpartum period.
It is important to look for these complications and prevent or treat them promptly.

FAMILY PLANNING

Generally family planning means planning the size of the family in accordance with the physical
and socio-economic resources of the parents and also conducive to the well being of the family
members. According to WHO, family planning refers to the practices that help individuals to
attain certain objectives like;
 (i) to avoid unwanted births

(ii) to bring down wanted births

(iii) to regulate interval between pregnancies

(iv) to determine number of children in the family

Family planning is related to every phase of maternity cycle. Every attempt should be made to
motivate mothers during postnatal clinics to adopt suitable method for spacing the next birth or
for limiting the family size as the case may be.

The various family planning methods used to control family size can be broadly categorized into
three types:

i) Reversible (spacing /temporary methods)

ii) Irreversible (permanent methods)

iii) Emergency contraception

REVERSIBLE CONTRACEPTIVES (Spacing or Temporary Methods)

There are mainly three types of reversible contraceptive methods such as condom, oral pills and
IUCD.

i). Condoms: condom is a male contraceptive method. In recent years female condoms are also
available in many countries.

Advantages

a) Use of condom by the husband is the easiest option for spacing between two children. This
also ensures male participation, which is desirable.

b) Condoms are easily available, cheap and easy to carry; they are available at health institutions
or at the common village shops.

c) No prescription is required for issue of condoms; hence, it is not only easily accessed by the
couple but also helps to maintain privacy.

d) It prevents entry of semen into the uterus, thus avoiding pregnancy as well as prevents
infections including HIV/AIDS.

Disadvantages

a) It may tear off or slip of during intercourse.

b) Condoms may deteriorate in too much heat or light or if stored for more than 3 years.
ii) Oral Contraceptive Pills

Oral pills are used by women to prevent pregnancy and maintain gaps between the pregnancies.
However, women needed to be advised properly when and how to start using oral pills. Women
should start using pills on day 5 of menstruation, day 1 of abortion: nursing mother (i.e. a woman
who is breastfeeding) after 6 months of delivery and not lactating woman after 6 weeks of
delivery.

A few points for health education or counseling for oral contraceptive pills are prescribed below.

(a) The woman has to take one tablet daily for 28 days;

(b) The first 21 tablets are white hormonal tablets and the remaining are colored iron tablets that
maintain the continuity of use;

(c) The first course should be started on the fifth day of the menstrual cycle (counting the first
day of bleeding) as Day One, by taking the pill from the pack marked as START;

(d) On subsequent days, one pill a day should be taken from the pack in the order indicated by
the arrows, till all the pills in that pack are finished;

(e) The contraceptive pill should be taken every day at a fixed time, preferably while retiring to
bed;

(f) The next pack should be started the very next day by taking the first pill from the pack
marked as START.

Advantages:

a) It is good for maintaining gaps between pregnancies.

b) It is available free in the health center and easy to use.

c) It helps in facilitating regular occurrences of menstrual cycle.

d) It helps in reducing iron deficiencies during menstrual cycle.

Disadvantages

a) There are side effects of nausea, vomiting and headache.

b) It does not offer any protection to sexually transmitted diseases.

c) There is complain of weight gain by pill users.

iii) IUCD/ Copper –T

IUCD is, an intra-uterine contraceptive device i.e., a devise used by the woman for spacing the
birth of her children. It is inserted in the uterus (womb). The doctor or nurse puts an IUCD in the
uterus after a proper examination.

Indication for IUCD insertion

It should be promoted in couples having two children when the age of the younger child is less
than five year.

Contraindications:

Women should not get IUCD inserted in the following conditions:

a) Pregnancy

b) Anaemia with haemoglobin less than 8 gm per cent

c) Genital tract infection

d) Previous history of ectopic pregnancy (pregnancy in fallopian tubes)

e) Previous history of caesarean section.

f) Medical disorders like heart disease, diabetes etc.

Advantages

a) This method is reliable for 10 years.

b) It is cost effective

Disadvantages

a) It causes side effects in some women.

b) It does not give protection against sexually transmitted diseases

c) It may injure during filling

IRREVERSIBLE METHODS OF CONTRACEPTION

Sterilization: Sterilization is a permanent method of contraception. In this surgical procedure, a

person becomes infertile, so that pregnancy cannot occur. The Sterilization procedure can be
performed on male and female clients.

 Sterilization performed on male clients is termed vasectomy.

 Sterilization performed on female clients is termed tubectomy.

It is necessary to satisfy certain conditions before sterilization can be performed. These
conditions are meant to minimize complications and improve the quality of care.

The tubectomy facility may be provided with the following two criterions:

(a) Within 7 days after the menstrual period is completed;

(b) After delivery, sterilization should preferably be done within 48hours to 7 days. However, the
procedure may be performed at any other time provided there is no infection or any other
medical contraindications.

Eligibility criteria for sterilization (both male and female) are as follows:

i) The client must be married, and living with the spouse.

ii) The male client preferably should be below age 60 years.

iii) The female client preferably should be below 45 years and above 22 years.

iv) The number of children must not be a criterion for determining the eligibility for
sterilization acceptors. However, it is preferable that the couple should have at least
one child over a year old.

v) The client or spouse must not have undergone previous sterilization. (This condition
may be waived in case of failure of the previous sterilization surgery).

vi) The client must be in the proper state of mind to understand the full implication of the
sterilization surgery.

vii) A psychiatrist must certify mentally ill clients and the legal guardian or spouse should
give consent in such cases.

Advantages:

(a) Permanent method,

(b) Safer than other temporary method,

(c) Provided free of cost in government hospitals.

Disadvantages

a) There is risk in surgery especially among women.

b) It does not protect from sexually transmitted diseases.

c) The reversal in tubectomy is not possible.

 EMERGENCY CONTRACEPTIVE PILLS (ECP)

Emergency contraceptive pills are pills to be taken within 72 hours of unprotected sex. These
pills are taken only in some emergency situations and help to provide protection against
unwanted pregnancy. These pills are especially useful for those women who have been
subjected to unprotected sex, slippage or bursting of condoms during sex or sexual violence.
These pills will not work if the woman is already pregnant. She should take two tablets
within an interval of 12 hours

OTHER FAMILY PLANNING METHODS ARE,

1.Traditional method of family planning: These are made up of devices such as native drugs..
wooden craft and herbes, arm/waist bands and barrier method of traditional family planing

2- Modem method of femily plerining:- these include: natural family planning method, hormonal
devices, Barrier method, intrauterine Contracep five devices (lucas) and Voluntary Surgical
method.

Traditional family planning method

This type of family Planning me have been in existence from time immemorial, the method
differs from Countines the continents from one town to town and from tribe to another.

a.polygamy :it's a practice where by the men marries more than one wife and it is a marne ost
achieving abstinence.

b.charms: A wenden dull (idol) is placed under the pillow of the womam during Coitus, This
assumed that the spirit of the wooden dull would prevent pregnancy.

c.Laya and Guru: Laya is a form of charm that is either held in the mouth or kept under the
pillow during the act and guru is tired around the waist before coitus to prevent pregnancy.

d.Kambu (hand bend):is tried round the upper am during Coitus,it is used by the man to prevent
pregnancy.

e.Ring :a ring mounted with native concussion is to be worn by the woman during the acts to
prevent pregnancy.

f.Magun: This is Common with Yorubas it is a key with padlock, it is done by the husband and
the woman Can not be penetrated by another man, this is done when the man is suspecting his
wife. Magun is for any man rather than the husband able to penetrate the woman will not be able
to withdraw his penis after the intercourse or the man dies suddenly after the intercourse.

g.Locked padlock: this is a locked padlock within cantation that should remain locked
throughout the period the couple do not want pregnancy.

Advantages of traditional family planning

1. it is used when the other family Planning methods were not available.

2 the method is accessible to the grassroots.

3. It supports the existing believe systems.

Disadvantages

1.Effectiveness can not be messured.

2. Some of the substances used are injurious to the body e.g potash, blue alum Powder, water
from dead body etc.

4. Some of the methods are inessersible especially when there is a mistake or not obeying the
instruction given by the traditional herbalists.

5. Some methods are exhibited in unhygienical way.

Modern family planning Method

A. Barrier method of modem family planning: this method prevents Spermatozoa from
enterimg the uterus by Chemical action or by Mechanical obstruction (Condoms).

Chemical barrier method: Spermicide are chemical Contraceptives placed in the vagina to
immobilize or destroy sperm. They can be used alone or in combination with mechanical barrier
Such as Condoms & diphragms Spermicides are available in different forms such as Creams,
Jellies, Vaginal foaming tablets etc.
Technique of use

1. Wash hand with soap and water, clean with clean towel.

2. Insert the tablet or apply the cream or jelly high of into the vagina near the cervix using
Comfortable position i.e lying down or squarting.

3. Wait for 10-15 mins after insertion before coitus.

Advantages

1. it is available without prescription

2. It is safe to use with very few side effects.

3. It is reasonably cheap.

4. it is used only when needed

5. It has no effect on breast milk

6. it serves as a lubricant

Disadvantages

1.irregular bleeding.

2.Breast tenderness.

3.Change in appetite or weight gain:

4.Depression.

5.Hair loss or increased hair on face or body..

6.Nausea.

Change in sexual desire.Conclusion

Family planning makes it more likely people can have their desired number of children and helps
them determine the spacing between pregnancies. It also helps people prevent pregnancy through
a variety of contraceptive methods and services.