RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DESSERTATION

1. Name of the candidate and address Monica Sharma

I year M. Sc(N)

Koshys College of Nursing

Sy. No. 31/1, Hennur-Bagalur Road,

Kadusonnappanahalli,

Kannur Post,

Bengaluru-562149

2. Name of the institution Koshys College of Nursing

3. Course of study and subject I year M. Sc. Nursing

4. Date of admission 14.09.2009

5. Title of the topic “A study to assess the knowledge of

care givers regarding immediate

postnatal care in a postnatal hospital

unit, Bangalore

1

6. BRIEF RESUME OF THE INTENDED WORK.

INTRODUCTION

Postnatal care is the care provided a woman following the birth of a child. The word “care” means a cause for

feeling concern, an anxious feeling; provide care for. The word “Postnatal” in Latin means 'after birth'. From

“post” meaning "after" and “natalis” meaning "of birth". It is the period beginning immediately after the birth of a

child and extending for about six weeks. It is the time after birth, a time in which the mother's body, including

hormone levels and uterus size, returns to prepregnancy conditions, the body tissues, in particular the genital and

the pelvic organs, return to the condition they were in pre-pregnancy. This post delivery period of change

continues till about 6 weeks (42 days) from delivery

The number of the health problems reported in the first month after delivery is high. In India 23% indicated

problems, and in Bangladesh nearly 50% reported symptoms 6 weeks after delivery, while in England 47% of the

women reported at least one symptom.

Life can be cheap, and cheaper still if it is a woman’s. What could be a greater tragedy than dying while giving

life, especially when death is preventable. The causes of maternal mortality are well-understood and interventions

to prevent these deaths have been successfully implemented in many developed and developing countries.

In India and South Asia have not been successful, in putting in place effective health infrastructure.

Consequently, maternal mortality ratios in South Asia are among the highest globally. Maternal mortality ratios

remain at very high levels in India (450) and other South Asian countries such as Nepal (830), Bangladesh (570)

and Pakistan (320). If Sri Lanka can achieve an MMR of 58 per 100, 000, so can India.

The Janani Suraksha Yojana launched in April 2005, provides incentives to mothers for institutional delivery

so that they can have access to care during delivery and the postpartum period. Evaluations suggest that it has

indeed succeeded in increasing about 69% the number of institutional deliveries and use of ante-natal care

services in some states.

Patricia L. Tomsko, MD, and Sandy Padwo Rogers Caregivers know all too well the feelings of helplessness

that often accompany their role of caring for a loved one with a chronic illness. When a hospitalization is

involved, it is not uncommon to feel as though you have lost all control. There are steps you can take to ease the

stress of a hospitalization and to ensure that you remain a part of the health care team should a hospital stay take

place

2

Even with normal vaginal birth there is a risk of death of about 1 in 10, 000 women. This risk may be more in

women with pre-existing medical conditions like anemia, hypertension or heart diseases. It is also more with

operative deliveries 84%. Hence adequate medical care and antenatal visits from the family and social support

can reduce the stress of the postnatal mothers.

Nurse as a caretaker during their role in the health team incorporates with the family in teaching, assign the

postpartum mothers. Primary responsibilities of the nurse in a postpartum setting are to assess BUBBLE the

postpartum patient, provide care and teaching, and, if necessary, report any significant findings it is imperative

for nurses to distinguish normal and abnormal findings and to have a clear understanding of the nursing care

necessary to promote the mother's health and well-being.

According to the malay culture. Once the baby is delivered, the mother has almost no time to care for the

recovery of her own body back to full health as the baby-induced changes subside. In many Asian cultures, the

new mother is helped with this task by traditional methods devised for application specifically by birth at tenders

or elderly care givers this period called the confinement period lasts for 44 days and includes a range of

traditional methods that the elders devised to enrich various aspects of the body and soul. These include the use

of various herbs and healing substances in the daily bath water as well as food management principles that are

administered by "confinement ladies" who are the care givers are well versed with these methods.

Bergamot method of massage its origins are Italian. Pressed fresh peel of a small orange, and Earl Grey Tea with

distinctive flavour, Used in bath or massage oil by traditional care givers to the postnatal mothers for reviving lift

to stressed bodies, minds and emotions. Provides relief of post natal stress but it is not used before exposure to

sun. usually practiced in the home setting.

Clary-Sageis the traditional method, Originally used in the Mediterranean, promotes relaxation, enhances

conversation, Add to massage or body oil to relieve tensionsthis traditional massage is followed towards the

newer generation. the massage has a special procedure done by graneys of the village who are the care

consultants they solve the womens problems.. It helps overcome post natal depression, menstrual pain, and the

"blues" that often accompany illness.

If the post natal mothers had stitches on perineum there are a few things she need to do, particularly in the first

week, to make herself comfortable and keep healthy .the parents or the care givers should monitor the mothers for

any signs identified with abnormalities.

Pain relieving methods such as hot seitz baths, hot water washes or hot water bag may be useful. For a seitz bath

you need a round tub large enough for your bottom to fit in, in which hot water with dilute antiseptic solution is

3

kept. These measures make you feel better; usually the mother, the mother in law or a family member who take

care of the postnatal mother will help in providing this.

Laura J. Flynn (2001), After a normal vaginal delivery, postnatal mother will be able to resume to her daily

personal care activities within a day and her household routine within a week. Help from the care givers;

involvement of the partner and others available to make her life easier. After a complicated childbirth or after a

caesarean delivery recovery may take twice as much time, so the care including self care and supportive care are

extended by the care givers. In Asian countries the rituals and belief help the postnatal mother to rebuild her

health by adequate rest, where she is taken care in her mother’s house till 40-45 days of postnatal period. A

healthy diet will have long term health benefits for the postnatal mother and her family. The mother, the parents

or the grandparents takes up the role of the caregivers and provide healthy diet to enrich energy, and maintain

health.

Looking after a newborn baby will be very tiring and trying to lose weight after baby’s birth can make more

tiring and hard work than it needs to be. Adequate care to the postnatal mother and the baby is essential, which is

provided by the family and supporters.

Roger H. Solomon (1999), Post natal mother will still need more calories to meet the demands of breastfeeding

and her appetite may increase as well. The Department of Health advises you to have an extra 450 calories a day

during the first month, an extra 530 during the second month and an extra 570 calories in the third month to meet

the needs of the baby. Postnatal mothers are likely to feel very thirsty while breastfeeding, particularly during the

feed itself encourage her to drink water rather tea or coffee.

Check with the health care team before starting exercising after the birth. If post-natal exercises were not taught

in the hospital, the midwife or the care takers can help in doing or assist in doing them. The exercises will help to

improve your shape and strengthen your muscles.

Secker –Walker(2000) Looking after a newborn baby is demanding. Postnatal mother’s body is also recovering

from the rigours of pregnancy and also if she is feeding through the night, she may become exhausted. It is

essential that she has to rest. It may be tempting to use the time when the baby sleeps during the day to catch up

with chores, but it is very important that she have a sleep or rest. so the care givers takes up the action on

providing time limits and look on the baby care when the mother rests or sleeps.

Brian S. Skelly, Joan M.; et al American Journal of Preventive Medicine. Vol 11(2), Mar-Apr 1995, 86-93. In

the postpartum counseling not only the spouse but the care givers were also involved in the scheme of

counseling. Postpartum counseling can be invaluable in preparing for the birth of your child especially for those

4

women who have had a traumatic first birth involving a cesarean section, unexpected emergency, or other

disturbing situation. These counselors can include hypnotherapy, marriage and family counseling, or other types

of counselors.

Changes in hormone levels may make mother feel tearful, irritable, depressed and tired. Often, between three and

five days after the birth she may feel particularly low and emotional. This time is referred to as the 'baby blues'

and thought to be caused by sudden changes in the hormone levels. It should only last for a few days. Try to

provide rest as much as she can, eat healthily and accept offers of help to make her secured. Postnatal mothers to

cope up with these situations make it adapt with the family, spouse and the care providers.

. Support and reassurance are essential, particularly in the early days and weeks of postnatal period. It will be

beneficial and enjoyable to talk to other new mothers. The health visitor can tell you about local mother and baby

groups. If the mother feels depressed and despondent over a long periods of weeks or months take her to the

health care team.

6. 1. NEED FOR THE STUDY

Only scanty research data are available on the needs of women in the postpartum period. Victoria 1989,

Australia, in a population based survey of women who gave birth in a one week period in, a survey has been

carried out of their experiences during pregnancy. Data were collected about depression, social context of

motherhood, work and family. The study identified that the young postnatal mother 52% and nuclear family

mothers 46% had psychosocial symptoms with inadequate supportive care.

WHO (2002) report of postnatal statistical data says that after delivery.In India 2. 3% of the respondents reported

symptoms of depression among postnatal mothers. The main predictors were located within the domestic

environment. depression were more common among young mothers, and less common among postnatal mothers

with social, family, supportive health care and security.

Lana Peterson (2000) A birth at home can be an immensely empowering experience and women who choose

this option do so to have complete autonomy during labor and birth, the safe & familiar setting of home, to the

feeling of being uninhibited and unrestricted.. Worldwide research has shown that homebirths done by skilled

practitioners with good obstetric backing on “low-risk” pregnant women, WITH ADEQUATE social support,

have as safe and safer outcomes. for which they will need to find an independent midwife or a care taker to offer

you this service and she will help you arrange the services of a back-up obstetrician in either the public or private

sector as a precautionary measure. High-risk pregnancies should not be attempted in a homebirth setting

5

Most labour mothers enter the hospital, with a stress today and threatening acute event, there may be a great deal

of uncertainty involved with her prognosis.. By being proactive, prior to any hospitalization, she will ensure that

loved one have a voice when it counts that she has a great support with spouse, family or care givers

Federic (2001) conducted a study in Delhi. The study was to determine the breast problems of postnatal mothers

in the urban community.33% of all the women experienced breast problems in first two weeks post partum and

28% thereafter. Some of the women may have considered these problems as baby feeding problems. Apart from

overt mastitis, a relatively rare condition, the problems were 40% having comprised engorgement, and sore,

cracked, bleeding or inverted nipples. The result identified that the investigator also concluded that these problem

needed a proper technique of assessment or care by the family or the care givers earlier could reduce the breast

problems.

Pregnancy is a very exciting time in your life and it is very important to consider you and your baby’s health.

Counseling is directed to all pregnant women their partners and care givers. Mothers are also encouraged to get

early medical attention support of the family and have regular physician visits. The community health nurse and

community health representative promote community members, follow up participants, assist mothers with

registration of infants for Health Care Coverage and provide support health education and counseling to parents

and care givers on the care of mothers and the baby. The antenatal mother herself has the rights to select the type

of labour, child care offers and the care givers which she feels in comfortable with.

In developing countries, about 480 women die for each 100, 000 live births, a ratio almost 18 times higher than in

developed countries. Africa, which has only 20 percent of the world's births, accounts for about 40 percent of all

maternal deaths which are preventable with early dedection.

In India the Hindu culture, the puerperium was traditionally considered a period of relative impurity (asaucham)

due to the processes of childbirth, and a period of confinement of 10 days (known as sutakam) was recommended

for the mother. During this period, she was exempted from usual household chores and religious rites. The father

was purified by a ritual bath after visiting the mother in confinement. In the event of a stillbirth, the period of

impurity for both parents was 24 hours.

In traditional Chinese culture child bearing and the postpartum time is a time where the mother is nurtured.

There is a cultural practice of peiyue –which is a post-partum custom of mandated family support. Usually

considered to be provided by a female family member and the care takers for 4 or more hours per day for 4-6

weeks postpartum

6

Women are going for institutional deliveries in large numbers but hospitals and health centres are poorly

equipped to take on the increased demand for services. Consequently, women are discharged too soon after

delivery and do not receive postnatal care. Maternal and neonatal death rates are highest in the postnatal period,

almost 60 per cent. This experience once again underscores that there are fundamental problems with India's

health service system. These range from basic issues of inadequate lack of trained manpower, inadequate

knowledge of care givers and inadequate supplies for emergency obstetric care. These provision of quality

reproductive health services needs to be recognized as a human right which governments should be held

accountable for.

CARE GIVERS, NURSES, PARENTS or family members can be taught to assess the firmness of the fundus and

to provide massage in the event of a boggy uterus or excessive bleeding in a postnatal assessment. Assessment of

the bowel is important for all postpartum mothers, however, it is vital for patients following a C-section. Assess

the patient's bowel sounds, return of bowel function, and flatus, as well as color and consistency of stool.

Administer prescribed stool softeners or laxatives as needed to treat constipation and ease perineal comfort

during defecation. These teaching can be given to them even after the hospital discharge. The community health

care visitor has to maintain a record of her visit on to the postnatal assessment.

Many healthcare providers prescribe topical ointments and sprays to ease the discomfort of a sore perineum.

Instruct patients to use the sitz bath and then apply the suggested topical agent for best results. Analgesics are

often prescribed for pain. Instruct patients to avoid tampons and sexual activity until the perineum has healed.

Completing Kegel exercises are an important component of strengthening the perineal muscles,, the lower

extremities should be assessed for the presence of hot, red, painful, and edematous areas, all indicative of a DVT.

Ambulate the postnatal mothers as soon as possible after delivery to improve circulation and prevent the

development of thrombi. the care givers should Teach them not to cross their legs for long periods of time and to

keep the legs elevated while sitting.

Karlstrom and colleagues (2007), Mothers who deliver via C-section have some addition assessment needs

during the postpartum period, including incision status, pain, respirations, and lung and bowel sounds. The

incision should be well approximated and without signs and symptoms of infection, including significant redness,

edema, and drainage. There should be minimal to no drainage from the incision. If drainage is present, it should

not have a foul odor. the parent or the care givers should attend to the warning sign as early identified. It is

important to teach mother to examine their incision each day with a mirror or have a family member monitor the

incision for them. Instruct patients to report any abnormal findings to their healthcare provider.

7

This limited overview data from large studies gives indication of the extent of postpartum problems as they are

experienced by women. On account of above stated matters the researcher understood that appropriate care is

very important for healthy living through the prevention thus be always effective in the promotion of happy

living. Thus it was a motivation for the researcher to conduct this study.

6. 2 REVIEW OF THE LITERATURE

Review of the literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly

publication, unpublished scholarly print materials, audiovisual materials and personal communications.

In this study the reviews of literature is presented under following headings:

a) Literature related to immediate postnatal care given by care givers.

b) Studies related to immediate postnatal care given by care givers.

Literature related to immediate postnatal care given by care givers

J P Richards (1990) conducted a demographic study on postnatal depression and it’s adversely

affect .Depression affects 5-22% of women after childbirth. Some women with postnatal depression will

experience a prolonged or relapsing illness that may last until their children enter school. It had 40% of adverse

effects upon the coping abilities of women, their relationships with their infants, partners and social networks and

may adversely affect the educational attainment, the researcher concluded that the knowledge of care givers and

family will reduce 70% of the effects of postnatal depression have obvious economic consequences both for their

families and their employers. This article discusses the association between depression and the puerperium with

the evidence for vulnerability factors. The study suggested that women with, or vulnerable to, postnatal

depression can be identified and helped by supportive care and adequate postnatal care.

Cheryl Levitt, (1999) conducted a randomized controlled research; on the anticipation towards the care of the

mothers with the ultimate goal is to provide evidence‐based guidelines on the use of routine postpartum

interventions. The care of mothers among 68% got relived of the symptoms of depression and anxiety as 20%

and proper medical disorders were reduced to 22%. Proper training and supportive care of the mothers in

nutrition, proper breast feeding assistance, encouragement of exercises and early newborn contact were effective

by educating family, and the care givers to promote towards the postnatal mothers and reduced the complication

among them for about 48%.

8

KACZOROWSKI Janusz (2000) conducted a study on randomized controlled trials that met the selection

criteria .the objective of the study was to identify the postpartum perineal pain management by the care givers.

The study focused on establishing effectiveness of knowledge among care givers in pain management techniques.

The investigator gave health talk on various pain management methods of postnatal mothers such as massage, oil

bath, hot applications and traditional methods .the effects were analyzed when they practiced on the postnatal

mothers. The result was identified by questioner provided to the mothers in their care giving by care givers and

their experience of pain relief. The result showed that the knowledge gained by the care givers in pain

management was effective in their pain reduction up to 80%.

Amanda M Rosecrans (1998) Emotions are an essential element of the postpartum assessment. Patients

typically exhibit symptoms of the "baby blues, " demonstrated by tearfulness, irritability, and sometimes

insomnia. The postpartum blues are caused by a multitude of factors, including hormonal fluctuations, physical

exhaustion, and maternal role adjustment. Implement appropriate interventions to protect the patient and infant;

the care takers should be with the mothers and express positive attitude and provide security to her as this

behavior falls under the category of postpartum depression. The care takers take concern in Encouraging mothers

to rest regularly and to allow family members to care for them during the postpartum period.

Abdullah H Baqui (1997), During the postpartum period, it is very important that nurses or the family members

taking care of the mother continually assess patient's for pain, taking into account the patient's acceptable pain

levels. They should look for pain in all areas of the body, including the head, chest, breast, back, limbs, abdomen,

uterus, perineum, and extremities. Just as important, patients should also be assessed for emotional pain and

treated accordingly. The health visitor or the parents can also follow nonpharmacologic methods of pain relief to

the postnatal mother. Some of these methods include the application of hot or cold packs, massage, progressive

relaxation, and meditation.

Elsevier (2009) conducted a study to determine the satisfaction of postnatal mothers and new fathers on the post

natal stay. Thirty-four percent of the mothers were dissatisfied with the overall postnatal care. 280 new fathers

and postnatal mothers completed the questionnaire asked on satisfaction of hospital stay. The strongest associated

factors for new mothers’ dissatisfaction were: unfriendly and unhelpful staff, lack of support from staff new

fathers not permitted to stay overnight, but satisfaction with postnatal care givers was 62% and satisfaction with

practical breast-feeding support was 51% .63% of the fathers were given the option of spending the night at the

postnatal ward. After the analysis of the results the investigator concluded that proper attention towards the care

of the postnatal mothers and new fathers is essential. Investigator also recommended that knowledge of the

nurses in the postnatal ward and the support of the care givers will increase satisfaction of the postnatal hospital

stay.

9

Gamble (2004) describes that of postpartum counseling and debriefing are generalized and nonspecific; they

provide minimal direction for postpartum counseling models, lack necessary detail for replication, may require

psychotherapeutic training and therefore be unsuitable for use by caregivers, and are often based on opinion with

little empirical evaluation. Further research is needed to develop counseling models for use by health

professionals with women who report a distressing birth experience.

SHAW Elizabeth (2006) This review examined the published evidence of the effectiveness of postpartum

support programs to improve maternal knowledge, attitudes, and skills related to parenting, maternal mental

health, maternal quality of life, and maternal physical health among care givers during the postnatal period.

Studies were categorized based on the above outcomes. Data were extracted in a systematic manner, and the

quality of each study was reviewed. Statistically it had significant improvements 70% in maternal-infant

parenting skills in low-income primiparae women, With effective care givers suppor. nurse home visits combined

with case conferencing can produce a improvement in home environment quality

Kelly bertuo (2004) For most women pelvic girdle pain resolves in weeks after delivery but for some it can last

for years resulting in a reduced tolerance for weight bearing activities. About 45% of all pregnant women and

25% of all women postpartum suffer from pain. During postnatal period serious pain occurs in about 25%, and

severe disability in about 8% of patients. support on body posture and rest and sleep will reduce the bad progness.

Wei Yin Wong (2008) In the industrialized Western world, much attention is showered on the mother during

pregnancy. But once the baby is born, the attention dwindles as 40%. From then on, much of the focus is on the

baby. These mums are actually better cared for during the postpartum period. The author also found that many

postpartum problems, including postpartum depression, reduced by proper care provided by the family and care

givers.

Darryl B. Sneag, (2007) An enduring debate in pregnancy care is whether low back pain is an inevitable or

perhaps even essential component of a healthy pregnancy. Some have suggested that low back pain may perform

a functional role as a protective agent by focusing women’s attention on the physical stresses their bodies are

undergoing, thereby making them more cautious during pregnancy. Regardless, diagnosis and treatment of low

back pain present formidable challenges to patients and their health care providers.

Shu-Ming (2003). Backache can occur during pregnancy, in labor, and postpartum; different stages should be

managed differently. Backache related to pregnancy is a significant problem. Education is still the first line of

intervention for preventing backaches related to pregnancy.68% of postnatal mothers got relief through family

traditional care. Both allopathic and complementary medicines are frequently used as treatments for backache

related to pregnancy

10

Matthew F Chersich(2009). Over 50% of women in postnatal period had anemia (Hb <11 g/l;), with even higher

levels 83% of anemia in those who had a caesarean section or had not received iron supplementation during

pregnancy, the first year after childbirth, women had high levels 64% of morbidity. Interface with health workers

and care givers should be used for treatment of anemia, screening providing these services during visits to

antenatal health clinics, which have high coverage both early and late in the year after childbirth, could make an

important contribution towards improving women's health.

Studies related to immediate postnatal care given by care givers.

Summer 1997, Vol. 17, No 24 . Conducted a retrospective study on causes and factors of maternal death More

than 60 percent of maternal deaths occur in the postpartum period, when prevention strategies are often lacking.

The study identified that Of the 585, 000 women who die each year from pregnancy-related causes, about one in

every four dies from hemorrhaging, Infection (sepsis) leads to about one of every six deaths. Other major causes

include eclampsia and other hypertension-related disorders, and obstructed labor. 1 Most of these deaths are in

developing countries, and most could be prevented with access to good pregnancy-related care. The study

concluded that intervention efforts use to decline in the maternal mortality ratio is an indication of success.

Proper monitoring of the warning signs and care during postnatal period can reduce the maternal death.

Gary L Darmstadt, (2006) conducted a survey covering the catchment area of one Finnish university hospital.

The objective of the study was to identify the knowledge on postnatal care among family and care givers at

maternity clinics. Research has shown that postnatal depression (PND) affects 10-15% of mothers in Western

societies. As a whole families participating with the care givers in the study were reported to be good. the study

identified that the Knowledge of the family and the care givers support will increase the postnatal mothers

recovery among 72%from the hospital and reciprocally reduces up to 40%the time period of the hospital stay. 80

% of Depressed mothers and their families need support to be able to make family dynamics as good as possible

Helen Castle, Pauline Slade, Maria Barranco-Wadlow, Maeve Rogers August 2008 The prospective study

conducted in NewJercy investigated whether antenatal social support and attitudes to emotional expression are

associated with postnatal distress in new parents. The Edinburgh Postnatal Depression Scale (EPDS) was also

used to measure depressive symptoms in the postnatal period.. Perceptions of emotional support for fathers and

both practical and emotional social support for mothers decreased postnatal distress towards 68%. social support

with the effective care given by care givers relieved the postnatal depression in 76% of mothers.

Ishtiaq Mannan, Syed M Rahman, Nazma Begum, Arif B A Mahmud(2009) conducted a survey on visits

of trained health workersto the postnatal home. 9211 live births were included. Neonatal and postnatal

Mortality was 67% lower in those who received a visit on day one than in those who received no after the second

11

day of life were associated with reduced mortality. In communities especially where home delivery with

unskilled attendants is common, postnatal home visits within the first two days of life by trained community

health workers can significantly reduce neonatal and postnatal mortality up to 12%.

Helen Igobeko Lugina [2001] cohort Study was conducted in Dar es Salaam, Tanzania to explore the

postpartum concerns of mothers and midwives' views on their role in postpartum care.. Mothers with a minimum

of seven years primary education were sub-divided into two groups. A total of 49 midwives participated. Trends

of increasing worry and decreasing confidence among mothers were observed with respect to family

relationships. Midwives also identified that first time and younger mothers need more professional as well as

family and social support. Postpartum programmes that consider such issues are useful in addressing the specific

needs of mothers. The study of midwives' viewed that reflecting, defining abilities, integrating, balancing, dealing

with reality, and caring become the role of care givers. The core category of them was to becoming a good

resource and support person for postpartum woman

Anita J. Gagnon Geoffrey Dougherty, MDCM, FRCPC Vania Jimenez, MD, Nicole Leduc(2002) conducted

A randomized, controlled trial was conducted at a university teaching hospital (3700 births/y) and affiliated

community health centers. The main outcomes measured were based on acceptance of motherhood, baby care

breastfeeding frequency and infant weight gain assessed at 2 weeks of postpartum. Significant effect was

identified among 60% of mothers who had supportive care from care givers, spouse, and family than with other

mothers.

Kearney MH, Cronenwett LR According to his study done in china (1998) in Asian societies, recently delivered

women are still regarded as vulnerable, and are exempted from their household duties for an extended period.

Such exemption is usually made possible by the continual presence of a designated elder female care givers,

mostly the woman’s mother 56%or mother-in-law 48%. The researcher concluded that This practice, called

peiyue in the Chinese culture, consolidates and formalizes post-partum support, guaranteed passage of child-

rearing knowledge, and protects the 90% of mother from exhaustion and sleep deprivation”., “ also 75% of

mothers were prevented from social isolation and postnatal depression”.

Barrett JA(1999)conducted a study on with the objectives to determine the domiciliary visits of health

workers in the promotion of breast feeding of postnatal mothers. Breast-feeding duration was examined to

see whether they have problem in breast-feeding in the first week of postpartum. One hundred and twenty-eight

families who prenatal committed to breast-feeding for at least 6 weeks comprised the sample. The families were

randomly assigned to one of two groups. Breast-feeding events most commonly experienced as problems in

prime mothers 69%, lower satisfaction 42% with first breast-feeding, and group assignment were weakly

predictive of the Breast-feeding mothers on breast feeding was identified as they had poor support on care and

12

decreased knowledge on breast feeding techniques. The negative effect of hospital bottle use was greater for

women in the bottle-restricted group than for women in the planned-bottle group.

WALDENSTRÖM U(2004) conducted a study on effectiveness of the teaching towards care givers Besides

hospital policies regarding length of stay (residential area) and number of domiciliary visits, early discharge was

associated with the following maternal characteristics, older, multipara, positive experience of the first

breastfeeding after birth; low education, economic problems, smoking, lack of support from family and partner.

There was a significant relation with the visit of health care provider who under went teaching schedule and

prognosis of mother. the researcher concluded that the early prognosis was based on the role of the domiciliary

health care visitor who took measures to solve them

Charlene M. Prather(2007) conducted a descriptive study on support by fathers regarding Perceived social

support and adaptation new child, in Italy. Protective for 90% which linked between the psychological health of

new fathers and the transition of the couple to a family the study concluded that 82% fathers with adequate

supportive therapy, counseling, and follow up education. the study identified that the father should also be

included in the supportive care therapies even in natelperiod.

Jain prakash, besheer (2007) An Analytic survey done in Maharashtra showed that a majority 74. 8% of

husbands were knowledgeable about prenatal, delivery and postnatal care. the survey result showed that Men

were often excluded from participating in routine care because the medical system does not accommodate them

and the community considers maternal care as exclusively women's domain. The investigator also found crucial

to include husbands involved, since they are often the decision-makers, the ones who have to accompany the

young woman to a clinic and the ones who pay for care.

S Arulkumaran (1998) India, conducted a study on prevalence of anemia. In developing countries like India The

prevalence of anaemia at delivery was 15. 3%. The most common cause of anaemia in pregnancy was due to iron

deficiency (81. 3%). The occurrence of anaemia in pregnancy is related to the socio-economic status of the

women. Multiparous women of the lower socio-economic class who tend to book late in pregnancy were found to

have the highest risk of anaemia. It is the responsible of the family members,the mother or the mother-in –law-

who are the care givers to take attentionin providing the mother good diet even on the natel period which can be

compensated during the blood loss of the labour.

Nathan Wei(2004) conducted a prospective study to determine disappearance of pain within a month after

delivery. Two years after parturition 8. 6% were still suffering from pelvic joint pain Persistence of pain was

found to vary significantly from one classification group to another. Having pain 6 months after delivery in

comparison to the 21 %, of those were diagnosed with pelvic girdle syndrome. This study shows that pregnancy-

related pelvic joint pain had an excellent postpartum prognosis in three out of four mothers. The women with 13

pelvic girdle syndrome (pain in all 3 pelvic joints) had a markedly worse prognosis 23% than the other women

groups. The investigator identified that early mobilization and awareness of pelvic floor exercises during post

natal period is the reason for pain. He also recommended that early mobilization in the normal deliveries .advice

and teaching the care givers to promote exercise techniques in the discharge teaching is the held responsibility of

the hospital nurse.

6. 3 STATEMENT OF THE PROBLEM

“A study to assess the knowledge of care givers regarding immediate postnatal care in a postnatal hospital unit,

Bangalore”

6. 4 OBJECTIVES OF THE STUDY

The objectives of the study are to

a) Determine the knowledge of care givers regarding immediate postnatal care among the clients.

b) Find the knowledge on postnatal care and knowledge on prevention of problems

d) Identify the association between the knowledge of care givers on postnatal care and selected variables (breast

problems, perineal pain, constipation…etc…)

e) Identify the association between the knowledge on postnatal care with selected demographic variables like

(age, parity, education of mother, occupation, type of family, socio economic status etc..)

6. 5 HYPOTHESIS

H1: there is a significant relationship between knowledge of postnatal care givers and postnatal care provided

H2: there is a significant association between the knowledge of caregivers on postnatal care and its prevention

with selected variables.

6. 6 OPERATIONAL DEFINITIONS OF TERMS

DETERMINE

To come to a decision concerning the knowledge on prevention of postnatal problems by reasoning or

investigation

14

KNOWLEDGE

The fact, information and skills that a person has acquired through experience and education regarding postnatal

care

CARE GIVER

An individual, such as a physician, nurse, domiciliary care provider,family member, health care agent employee,

social worker, who assists in the identification, prevention, or treatment of an illness or disability.

POST NATEL CARE

It refers to the care provided to the problems which are faced during postnatal period as pain, constipation,

bladder problems, breast problems,anemia, back ache, bladder problem, depression,etc.

6. 7 ASSUMPTIONS

# Caregivers has certain knowledge on postnatal care.

# Health talk can improve the knowledge of the care givers.

6. 8 DELIMITATIONS

1. The study is limited to the mothers admitted in the postnatal ward in selected hospitals of Bangalore.

2. the study is limited to mothers who gave birth to live baby and in the 1-10 days period of postnatal .

7 MATERIALS AND METHODS

7. 1 SOURCE OF DATA

Caregivers who are present in the selected hospital with the postnatal mothers, Bangalore

7. 2 METHODS OF DATA COLLECTION

Research method : descriptive study

Research design: non experimental descriptive design.

Sampling technique :purposive sampling

15

Sample size : 50 caregivers from selected hospitals

Setting of the study : selected hospitals at Bangalore

7. 2. 1 CRITERIA FOR SELECTION OF SAMPLES

care givers from selected hospitals at Bangalore

Who can understand and speak English or kannada

Who are available at the time of data collection

Who are willing to participate in this study

EXCLUSION CRITERIA

This study excludes caregivers

Who are not willing to participate in the study

Who can’t understand English or Kannada

Who are not available at the time of data collection.

7. 2. 2 DATA COLLECTION TOOL

A questionnaire will be prepared to assess the knowledge regarding immediate postnatal care among the

caregivers. A planned teaching programme will be prepared on postnatal care. Content validity of the tool will be

ascertained in consultation with guide and experts from various fields like obstetrics& gynecology and nursing.

Prior to the study written permission will be obtained from the concerned authority. Further consent will be taken

from the samples regarding their willingness to participate in the study.

7. 2. 3 DATA ANALYSIS METHOD

Data analysis will be done by descriptive and inferential statistics. Frequency and percentage distribution will be

done to analyze demographic variables. Mean and standard deviation will be done to assess the knowledge of

caregiver regarding immediate postnatal care. A chi square test(X) will be done to find out association between

the mean knowledge score with selected variables.

16

7. 3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE

CONDUCTED ON CAREGIVERS

YES only a planned teaching programme and questionnaire will be used. No other intervention which causes

any physical harm will be used in the study

7. 4 HAS ETHICAL CLEARANCE BEEN OBTAINED

YES

a. confidentiality and anonymity of the subjects will be maintained

b. consent will be taken from the samples before the study

c. A written permission from the concerned authority will be obtained prior to the study

17

8. REFERENCES

1. "With Women, Midwives Experiences: from Shift work to Continuity of Care, David Vernon, Australian

College of Midwives, Canberra, 2007 ISBN p17f.

2. World Health Organization (WHO): Maternal mortality in 2000: estimates developed by WHO, UNICEF and

UNFPA.

3. Koblinsky MA, Tinker A, Daly P: Programming for safe motherhood: a guide to action.

Health Policy Plan 1994, 9:252-266. Pub Med Abstract

4. United Nations Family Planning Association (UNFPA). : Population Issues: Safe Motherhood: Maternal

Morbidity. Surviving Childbirth, but Enduring Chronic Ill-Health. UNFPA; 2004.

5. Bryant AS, Haas JS, McElrath TF, McCormick MC: Predictors of compliance with the postpartum visit among

women living in healthy start project areas.

6. Shaw E, Levitt C, Wong S, Kaczorowski J: Systematic review of the literature on postpartum care:

effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical

health.

7. Shariff A, Singh G: Determinants of Maternal health Care in India: Evidence from a Recent Household

Survey. In Working papers series 85. NCAER Publications, New Delhi, India; 2002

8. World Health Organization (WHO): Maternal mortality in 2000: estimates developed by WHO, UNICEF and

UNFPA. WHO, Geneva 2003.

9. National Collaborating Centre for Primary Care. Postnatal care. Routine postnatal care of women and their

babies. London (England): Royal College of General Practitioners; 2006 Jul. 392 p.

10. Chama CM, El Nafaty AU, Idrisa A: Caesarean morbidity and mortality at Maiduguri, Nigeria. J Obstet

Gynaecol 2000, 20:45-48.

11. Fikree FF, Ali T, Durocher JM, Rahbar MH: Health service utilization for perceived postpartum morbidity

among poor women living in Karachi. Soc Sci Med 2004, 59:681-694.

12. Freeman MP, Wright R, Watchman M, Wahl RA, Sisk DJ, Fraleigh L, Weibrecht JM: Postpartum depression

assessments at well-baby visits: screening feasibility, prevalence, and risk factors. J Womens Health (Larchmt )

2005, 14:929-935.

18

13. Koblinsky MA, Tinker A, Daly P: Programming for safe motherhood: a guide to action. Health Policy Plan

1994, 9:252-266

14. Nama V, Karoshi M, Kakumani V: The single unit transfusion in post partum hemorrhage: A new

perspective. Int J Fertil Womens Med 2006, 51:58-63.

15. Prual A, Huguet D, Garbin O, Rabe G: Severe obstetric morbidity of the third trimester, delivery and early

puerperium in Niamey (Niger). Afr J Reprod Health 1998, 2:10-19.

16. Ronsmans C, Achadi E, Cohen S, Zazri A: Women's recall of obstetric complications in south Kalimantan,

Indonesia. Stud Fam Plann 1997, 28:203-214

17. United Nations Family Planning Association (UNFPA). : Population Issues: Safe Motherhood: Maternal

Morbidity. Surviving Childbirth, but Enduring Chronic Ill-Health. UNFPA; 2004.

18. Waterstone M, Wolfe C, Hooper R, Bewley S: Postnatal morbidity after childbirth and severe obstetric

morbidity. BJOG 2003, 110:128-133

19. Ronsmans C, Graham WJ: Maternal mortality: who, when, where, and why. Lancet 2006, 368:1189-1200.

20. Alfredo LF. MTKTMA N.: Postpartum Care: Levels and Determinants in Developing Countries. Calverton,

Maryland, USA, Macro International Inc; 2006.

21. El-Mouelhy M, El-Helw M, Younis N, Khattab H, Zurayk H: Women's understanding of pregnancy related

morbidity in rural Egypt. Reprod Health Matters 1994, 4:27-34.

19

9. SIGNATURE OF THE

CANDIDATE

10. REMARKS OF THE GUIDE This study focus on the

knowledge of care givers

who are the key persons in

the postnatal care.

11. NAME AND DESIGNATION

11. 1 GUIDE

11. 2 SIGNATURE

11. 3 HEAD OF THE

DEPARTMENT

11. 4 SIGNATURE

Mrs. Ahitha

Mrs. Ahitha

12. REMARKS OF THE

PRINCIPAL

Adequate knowledge of

the caregivers in the

postnatal care can give

better prognosis of

Mothers.

20