Duration: 1 hour 30 minutes

Overall Objective

To educate the expectant mothers and partners regarding the care of the mother and infant in the post partum period.

Objectives

Clients will be able to:

1. Describe briefly changes in the mother during the post partum period.
2. Describe briefly the importance of family planning and list 3 methods of contraceptives.
3. List 3 reasons why a birth certificate is important.
4. List the places where a baby’s birth can be registered.
5. Demonstrate how to bathe a baby.

Introduction

The postpartum period is significant in that it is the period in which the organs involved in childbirth return to normal. It is also a time when the family adjusts to the new baby.

A new baby changes family life forever. Is there any truth in this statement?
Allow clients to share their views.

Body

The uterus which had grown to the size of a watermelon, returns to the size of a pear over this period. During this time the lining of the uterus that was prepared to receive the foetus and help maintain it, is passed out through the vagina as a discharge. Following delivery this discharge is like a period. It changes from red to brown to a whitish colour and is finished by about the tenth day.

The breasts also begin to produce more milk. The infant sucking stimulates the production of milk. During breastfeeding a hormone is released that helps the uterus return to normal.

If you do not develop any complications, you will be discharged from hospital within 12 hours if you have had a baby before; and within 24 hours if you are having your first baby. While in hospital and up to the tenth day you and your baby will be checked to ensure that all is well. Your temperature, blood pressure and pulse will be checked. Additionally, your abdomen is checked to assess that the womb is returning to normal. The discharge is also checked so as to ensure that the amount, colour and odour are normal. You will be assisted with breast feeding and shown how to bathe your baby. Assessment of the baby’s breathing, skin colour and passing of urine and stool will be done; also how well the baby is feeding.

Before your discharge from hospital, you may commence a method of birth control; otherwise this can be done at the time of your postnatal check. The postnatal check-up is done at your community clinic four weeks following delivery. It is very important to keep your appointment for your postnatal check-up, so that we can make sure that you are in good physical health. Before you commence any method of contraception you will have a complete physical examination including breast examination, Pap Smear and a test for sexually transmitted disease.

Upon discharge from the hospital, you will receive an appointment for your postnatal check up, medication for pain and an iron supplement. If needed, a follow up appointment is given for any STIs. Additionally you will receive a Child Health Clinic appointment for your baby at 1 month of age. Your baby’s birth can also register at the Maternity Ward; otherwise you will be given a birth registration card to have your infant registered at the office of the Registrar General within 21 days.

If you are HIV Positive or have hepatitis B, your baby will be given medication to help control the condition. Mothers will also be instructed on how to give the medication to the infant.

Doctor will also complete your National Insurance Form prior to discharge so that you can apply for your Maternity Benefit.

A nurse from the Post Natal Service will visit you in hospital to obtain information about your delivery and a detailed address. She will visit you at home up to your tenth day following delivery.

Doctor will examine you and the Paediatrician will examine your baby before discharge to make sure that all is well.

Home Visits

Visits to you at home by the Nurse from the Post Natal Service will commence the day following your discharge from hospital.

At each visit the Nurse will examine you and the baby. You will be taught/advised about:

• Breast feeding.
• Problems that might come up with the baby such as fast breathing, jaundice, bleeding from the umbilical cord and fever.
• Eating a proper diet (a balanced diet, including lean meats, starches, fruits, vegetables, dairy and cereal) and drinking adequate fluids (at least 8 glasses daily).
• Getting adequate sleep and rest (rest during daytime while infant is sleeping).
• Personal hygiene and abnormal conditions such as heavy bleeding, fever or engorged breasts (see vocabulary).
• Simple exercises such as raising your legs while lying in bed on your back and pelvic floor exercises, for example, holding your urine in mid flow.
• The possibility of feeling a little depressed about the eighth day which is mainly due to the hormonal changes. If the feeling persists for more than a couple of days advise your healthcare provider.
• Birth registration if you have not already done so in the Maternity Ward.
• Infant immunization.
• The various methods of family planning.
  

It is important for you to take all medication as prescribed by your Doctor.

You will receive a visit by a Nurse from your Community Health Clinic within one month of your delivery. Your management will then be continued by your Community Health Clinic. If any problems develop, you and your infant will be referred to hospital for further care.

If you have not yet done so, you and your partner should make arrangements for the care of your baby on your return to work. You can have the person(s) come in while you are at home to give your instructions regarding your baby’s care and to observe their performance.

An annual physical examination is encouraged which includes exams for early detection of cervical and breast cancer and sexually transmitted infections. Male partners are also encouraged to have annual physical exams which include exams for testicular and prostate tumors. It is very important that you return for your results in 2 weeks to ensure that all is well.

Family Planning
(see Vocabulary for definition)

Methods of Contraceptives:

(i) Abstinence
Not having sexual intercourse for a period of time

(ii) Natural Family Planning (NFP) Fertility Awareness Method (FAM)
Woman learns to recognize her fertile days. She does not have sex or uses birth control during fertile days

(iii) Barrier Methods
Foams, suppositories, contraceptive sponge, diaphragm and condoms

(iv) Intrauterine Devices
A small device is put inside the uterus by a health care provider. For example, a coil

(v) Birth Control Pill
Tablets taken daily, made of artificial hormones

(vi) Injections
Injection of hormones given every month, every 2 months or
once every 3 months.

(vii) Subdermal Implants
A minor surgical procedure where the hormones are placed under the skin. This provides continuous contraceptive
protection for up to 5 years.

(viii) Sterilization
Permanent birth control for both men and women.
Vasectomy - male sterilization
Tubal Ligation - “Tying the Tubes” or “Tubes Tied,” female sterilization

Birth Registration

Each mother is given a birth registration card while in hospital and given instructions to register the infant within 21 days. This can be done in hospital between 9:00 am and 12 noon, Monday to Friday, or at the office of the Registrar General on weekdays. Family Island clients can also register their infants at the Administrator’s Office.

Registering the infant’s birth is important as it:

1. Provides a means of identification.
2. Verifies one’s date of birth.
3. Is necessary to obtain a Bahamian Passport.
4. Is a requirement to enter school.

If a child’s birth is not registered within a year of its birth the parent has to pay a registration fee.
After a period of 3 years a child can no longer obtain a birth certificate, but has to have an Affidavit prepared which is used in place of a birth certificate.

Resources

• Posters of: 
  1. Types of contraceptives.
  2. The breasts.
  3. Female reproductive organs.
  4. Male reproductive organs.
  5. Breast self-examination.
  6. Birth registration
• Pamphlets: 
  1. Breast Self-examination.
  2. For Men Only, Self-examination of Testicles.
  3. For Men Only, The Prostate.
  4. Contraceptive Methods.
  5. Birth Control Facts.
  6. Tubal Ligation.
  7. Birth registration.
  8. Immunization.
  9. Breast Feeding
• Display of contraceptives (where available).
• Baby’s bath tub.
• Towel and washcloth.
• Soap and shampoo.
• Lotion.
• Doll and clothing.
• Cotton balls and alcohol.
• Pencils for clients.
• Writing pads or paper for clients.

Summary

Postpartum is the period following delivery up to six weeks. Organs involved in childbirth return to normal and the breasts begin to produce milk. Throughout this period the mother and infant are continually checked by the Nurse.

Following discharge from hospital clients are visited by a Nurse from the Post Natal Service up to the tenth day following delivery. A Nurse from the client’s Community Health Clinic also makes a home visit within a month of delivery.

Clients are encouraged to register their infants birth within twenty-one days. Birth registration is very important.

All clients are given an appointment to have a postnatal check up by Doctor at their Community Clinic four weeks following delivery. Male partners should also have annual physical exams.

All infants are also given one month appointments to attend the Child Health Clinic.
Family planning is important as it helps persons to plan their families as it relates to timing, spacing and family size.

There are several family planning methods so that families can select the method best suited to them. These include Barrier Methods, Intrauterine Devices, The Birth Control Pill, Injections, Subdermal Implants and Sterilization.

Evaluation