Inadequate Postpartum Care

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InadequatePostpartum Care

Abstract

Postpartumcare is an abandoned part of women`s healthcare as shown by the factthat there exist limited objectives and data regarding the latter.Missed opportunities for improving care for the women occur in thebroad spectrum of postpartum care (Moaddab,McCullough, Chervenak, Fox, Aagaard, Salmanian &amp Shamshirsaz,2015). The existing differences in the perceptions of the needs ofnew mothers between nurses and the parents have also contributedmajorly to the inadequate care (Sandall,Soltani, Gates, Shennan, &amp Devane, 2013).It is therefore recommended that the government ensures that there issufficient collection of data regarding postpartum maternalmorbidity. It should also review the postpartum care policies,improve the flexibility of care provided to postpartum parents,create awareness on the need for family support and taking part insupport groups and developing education programs related to theformer.

Keywords:postpartum,healthcare

Postpartumcare is the period that begins immediately after a child`s birth, andit extends to one and a half months (Abdul‐Kadir,McLintock, Ducloy, El‐Refaey,England, Federici &amp James, 2014).During the period, a woman is allowed time to bond with her babywhile still receiving much care from her doctor and family. Careduring this time is vital to the latter’s health. However,insufficient national statistics regarding postpartum careutilization or problems encountered by the parents exist(Gazmararian,Elon, Yang, Graham &amp Parker, 2014).More so, analysts argue that the content and degree of postpartumcare is too limited to meet the needs of the mothers. The care alsoends as the mothers are still struggling to become accustomed tonewer family environments and role changes. Nurses are in the bestpositions to come up with healthcare policies and practices that maylead to an improvement in the caring for these mothers. The topicproved to be the best option since maternal mortality rate is on therise. It has become a controversial issue as medical practitioners,especially nurses have been asked to evaluate their practices. Thisresearch paper is projected towards identification of the importanceof such care and the inadequacies associated with it. The paper willalso present recommendations to improve attention and servicesprovided to the mothers.

TheImportance of Postpartum Health Care

Resultsfrom research carried out by analysts have shown that there is a 76%prevalence of fatigue after two months of giving birth in the US(Cheng &amp Pickler, 2014). Also, many mothers experience pain insome parts of their bodies including the perineum, back, and head.The pain causes discomfort to the mothers and also obstructs amother`s quick response to her baby`s cry. In the long run, thesituation leads to delays in meeting a child`s needs. The mother`shealth is also affected by the physical conditions of lowerprevalence. The resulting conditions include hemorrhoids, urinaryincontinence, constipation and lack of enough sleep, severe disordersand lack of sexual desire (DiBari,Yu, Chao &amp Lu,2014). Active postpartum care involves treatment of such.

Emotionalchanges are also evident. These include transient postpartum blues,postpartum depression, and mental disorder. Those experiencingpostpartum depression are characterized by intolerable lonelinessbecause they feel like people do not understand their needs. Somemothers isolate themselves because they are attacked byuncontrollable anxiety which makes them feel like they areapproaching insanity. They develop hatred towards themselves and havethoughts of hurting themselves or the babies just to escape fromdepression. It becomes impossible to sleep at night as they cannotstop thinking about how bad they are in taking care of their newbornbabies.

Newmothers go through the process of developing an attachment with theirinfants and also attaining motherly identity. The process involvesdiscovery, learning, appreciation and acceptance of the mother`snew-fangled role. It results in a valuable experience. Nevertheless,lack of sufficient care makes the women feel as if they have lostcontrol of their lives and that they do not have adequate time andspace to address their issues. The responsibilities and lack ofknowledge associated with childcare bring about frustrations andfatigue for them. Adequate care serves as the best option for thetreatment and prevention of the same.

Methodology

Thekind of research that was used in this study was the quantitative andqualitative research. The qualitative study was aimed at bringingtogether an in-depth understanding of postpartum care and theinadequacies associated with it. The six-week care was also examinedthrough the use of observations made on numerical-based presentationsand procedures involving statistical analysis. Also, apart fromadministering of questionnaires to various respondents, we conductedinterviews with experts in the healthcare sector. Postpartum relatedwebsites and books also served as our sources of information.

SamplingMethod

Toobtain a scientific result that would represent the whole population,random sampling was used. A list of medical facilities includingprivate and public hospitals and maternity clinics was obtained fromthe City Hall. From 20 districts, three centers were randomly picked.These then served as the sources of the respondents for our research.We contacted medical centers to obtain verbal consent to givequestionnaires to new mothers. The facilities` administrations weregiven letters, copies of the questionnaires together with ourresearch protocol. A letter was also sent to City Health Officer whoprovided us with an endorsement to carry out our research activitiesin the districts and to distribute questionnaires to the women in theareas.

Respondents

Therespondents mainly came from the New York City specifically from therandomly selected Manhattan District. New York City proved to be thebest option because of its socio-economic conditions,which wererelevant to the research. Also, the city fitted our researchtimeframe and the resources that we had. Every responded was askedfor consent and approval to be interviewed or answer thequestionnaires. Experts were also requested to give their opinionsregarding postpartum healthcare.

Questionnaires

Thequestionnaires were used to obtain information regarding thesocio-economic and demographic background of the respondents. Theyalso had questions related to the mother`s previous postpartumexperiences after they delivered.

Findings

Currently,most nurses have limited their 6- week routine check-up to vaginalexamination and education regarding contraception. One-third of newmothers felt like some of their concerns were not being addressed.The check-ups are not identifying common problems that occur duringthe postpartum periods. Moreover, mothers who need information aboutchildbirth and pregnancy prefer getting the same from medicalprofessionals rather than family members. The availability andwillingness of the physician are questionable thus making the newmothers feel unprepared for the consequences of the pregnancies.

Someward routines such as switching on lights early in the morning andkeeping them on until late in the night were not well perceived bysome women. They concluded that the routines were put in place tofavor the needs of the nurses than their own. They also complainedthat some routines did not allow them to have enough rest. Thequality and breastfeeding advice depended on the individual the newmother had met. Although in some cases it was excellent, some womenreported that some members of staff were unhelpful and they left themwith the impression that they did not want to promote breastfeeding.Some mothers confessed that their priorities for postpartum carediffered from those of the nurses. Some mothers were more concernedwith self-care problems and needs than those for infant care.

Mostresponses were stimulated by low self-esteem and lack of satisfactionwith their body images. From the research, we also found out that thenew mothers want to learn more about diet, nutrition, fatigue, how tocalm a crying baby and illness recognition. However, the commonpostpartum practice is mainly involved with the women`s physicalchanges and care, which are primarily based on medicines. The mothersfeel that their newer emotional issues are not addressed and thatthey are not given enough information on how to resume daily life andtend to the babies` day-to-day needs. Information gathered frominterviews with professionals from the healthcare sector also showedthat there are insufficient studies regarding postpartum studies. Itwas also evident that psychosocial care of the new mothers was notadequate and rather, the primary focus was on breastfeeding andmedical care.

Accordingto results from research carried out by the Center for DiseaseControl, around 15% of new mothers each year have depression symptomslinked to inadequate postpartum care (Martin,Hamilton, Osterman, Curtin &amp Matthews,2015). This meant that 600,000 women of the total 4 million livebirths are affected by PPD annually in the United States. In Fact,the statistics show that more women will suffer from illness annuallythan the combined number of reported cases of men and females who getTuberculosis, Multiple sclerosis, Parkinson`s, Leukaemia, Epilepsyfor the first time. The number is of course much higher since thereport is mainly based on data for women from all the states whoself-reported the symptoms of PPD. It could be possible that some ofthem failed to report due to the shame associated with postpartumdepression. Also, some may have felt that the symptoms that weredescribed by the nurses did not match their experience.

Itis evident from some studies that the rate of PDD in high povertyareas is more than 25 % (Gaillard,Le Strat, Mandelbrot, Keïta, &amp Dubertret, 2015).Only 15% of all these women receive professional treatment. Around850, 000 new mothers who are affected do not get the help they need(Gaillard, et al. 2015).The situation could be attributed to the factthat many physicians do not do not screen. Another reason could bethat the affected mothers experience stigma and it prevents them fromasking for help. Women who are not treated do not bond well withtheir children. Sometimes they indulge in drug abuse, and they mayend up being victims of chronic anxiety or depression.

Gapsin Postpartum Health Care in the USA

Aneffective response to health needs of new mothers requires pertinentnational health goals, systems to be used for scrutiny and careprograms. Based on the USA, the Healthy People 2010 objectives aremainly associated with pregnancy itself and the immediate outcomes.Other postpartum complications are significant but the Healthy People2010 only mentioned postpartum depression (People, 2013).Recommendations of the World Health Organisation in regard topostpartum care are incomplete. The organization proposed thatmaternal healthcare could be holistic, individualized,family-centered and de-medicalized. Also, World Health Organisationsuggested that medical care should include assessment of postpartumhitches, the attachment between a mother and a baby, breastfeeding,family planning, community and partner support and visits during theperiod of hospitalization (World Health Organization. 2013).Nevertheless, the issues regarding discomforts associated with theformer, emotional disorders and role attainment difficulties were notaddressed.

Toprovide a well-built foundation for healthcare, surveillance of thestatus of postpartum care is needed. The Pregnancy Risk AssessmentMonitoring System, which was developed by Centre for Disease Controland Prevention monitors behaviors and experiences for new mothers.However, not all states participate in PRAMS. The PRAMSquestionnaires also do not include questions involving depression andthe utilization of the postpartum care.

Inconsistentfindings have resulted from the lack of an extensive, nationalreporting system that handles postpartum healthcare data. Forexample, estimates of the prevalence of postpartum depression varywidely. In the postpartum care utilization rates, there is evidenceof the former, for instance, a survey carried out by the organizationcalled Listening to Mothers showed that all mothers reportedreceiving at least one follow-up visit during their postpartumperiod. However, results from a study conducted by the Office ofPublic Insurance Counsel and Centre for Health Statistics of theState of Texas in 2004 indicated that 65.2% of women covered by anyinsurance policy got their check-ups 21 and 56 days postpartum theprevious year. Also, a report by the Health Quality Alliance of Texasshowed contradicting results which indicated that only 25% of all themembers of Medicaid Managed Care had a postpartum follow-up visit.

Recommendations

Thereis a need for an expansion of the objectives of the national healthobjectives to put into consideration other maternal morbidities(Gaillard,2014).The focus should also be directed towards the development of nationaldata collection and the use of better methods of collection of thesame. Studies based on the population of the US provide guidance forwhat is to be included in the national database maternal postpartumstatus. The data can also provide the professionals with guidelineson how to effectively promote maternal health while still preventingmorbidity.

Thegovernment and private organizations that focus on postpartum healthshould use new data to create newer programs and to develop resourcesthat will be employed by the women. An example of support for suchprograms is the action taken by the Governor of Texas, Greg Abbott in2016. He proposed additional funding to enable the screening andtreatment for postpartum related illnesses. He also encouraged everycitizen to create awareness and increase the likelihood of earlydetection. As the law requires, healthcare facilities shoulddistribute lists of professional organizations that providecounseling and assistance to a new mother (O’connor,Rossom, Henninger, Groom &amp Burda,2016). In addition, Legislators should come up with ways throughwhich organisationswhichprovide maternal care can coordinate.

Thehealth concerns associated with the postpartum period vary amongwomen due to cultural diversity. For example, (Stewart, 2013) foundthat in addition to the lack of social support, Chinese mothers areconcerned about their babies` sex and appearance. They also do notprefer to be helped by their mothers-in-law and are also greatlystressed when they have conflicts with the latter during thepostpartum period.

Thecontent of postpartum care needs to re-evaluated (Mousa,Blum, Abou, Senoun, Shakur &amp Alfirevic, 2014).As mentioned previously in the report, the discomforts that mothersgo through are not only physical, but also psychological.Consequently, the examination during check-ups should also includethe screening for mental disorders and progression regarding maternalrole adaptation. Also, changes should be made to the time limits foroffering postpartum care. The period for check-ups and insurancecoverage should be increased to around one year. Moreover, thereshould be flexibility in the time for postpartum visits. In this way,the new mothers can visit the healthcare providers at their ownconvenient time.

Someof the postpartum problems can be prevented from developing duringthe pregnancy period. For example treating prenatal depression mayreduce the chances of postpartum occurrence (Meyer,2014).Some people often overlook the prenatal symptoms and view the latteras normal emotional fluctuations. Weight gain monitoring duringpregnancy would help reduce chances of the occurrences of postpartumweight retention incidences, which is a major contributor to obesityfor new mothers.

Apartner`s or a husband`s participation in childcare is recommended.This is mostly important to a mother`s mental health, and therefore,the partners and spouses need to be included in all educationprograms regarding postpartum issues.This program may help them tolearn massage skills to help the mothers relax. Finding a balancebetween work, childcare and a spouse`s intimate relationship is alsoimportant. The social network of the new mothers should also beevaluated. Support from family and friends is critical in helping thelatter to achieve their maternal role. Social workers may be allowedto pay visits to the mothers to strengthen the social-service featureof the care program. People, who the parents view as important shouldalso be invited into the care plan. Nurses should act as a linkbetween the mothers and individuals who may be willing to supportthem. These people may be involved in the childcare needs.

Accordingto the World Health Organisation, healthcare institutions shouldensure that postpartum women are subjected to regular assessment oftheir vaginal bleeding, contractions in the uterine wall and pulseduring the first 24 hours after birth (WorldHealth Organization, 2013).If their blood pressure is normal during the first assessment, asecond measurement should be taken after 6 hours. Two to six weeksafter birth, assessment nurses should inquire if the mothers haveresumed sexual intercourse and as part of the former`s overallwell-being.

Conclusion

Inconclusion, there is an inadequacy in the care provided tomothers.Adequate postpartum health care is important both to the mother andthe baby. Much emphasis is put on postpartum depression, and thusother issues are not well addressed. The government should expand itsobjectives to capture more needs of new mothers. Also, it shouldconduct more research through various agencies to ensure that allissues, both physical and psychological are addressed. Everyindividual has a role to play in making the postpartum period of amother stress-free.

References

Abdul‐Kadir,R., McLintock, C., Ducloy, A. S., El‐Refaey,H., England, A., Federici, A. B., … &amp James, A. H. (2014).Evaluation and management of postpartum hemorrhage: consensus from aninternational expert panel. Transfusion,54(7),1756-1768.

Cheng,C. Y., &amp Pickler, R. H. (2014). Perinatal stress, fatigue,depressive symptoms, and immune modulation in late pregnancy and onemonth postpartum. TheScientific World Journal,2014.

DiBari,J. N., Yu, S. M., Chao, S. M., &amp Lu, M. C. (2014). Use ofpostpartum care: predictors and barriers. Journalof pregnancy,2014.

Gaillard,A., Le Strat, Y., Mandelbrot, L., Keïta, H., &amp Dubertret, C.(2014). Predictors of postpartum depression: Prospective study of 264women followed during pregnancy and postpartum. Psychiatryresearch.

Gazmararian,J. A., Elon, L., Yang, B., Graham, M., &amp Parker, R. (2014).Text4baby program: an opportunity to reach underserved pregnant andpostpartum women?. Maternaland child health journal.

Martin,J. A., Hamilton, B. E., Osterman, M. J., Curtin, S. C., &ampMatthews, T. J. (2015). Births: final data for 2013. Nationalvital statistics reports: from the Centers for Disease Control andPrevention, National Center for Health Statistics, National VitalStatistics System.

Moaddab,A., McCullough, L. B., Chervenak, F. A., Fox, K. A., Aagaard, K. M.,Salmanian, B., … &amp Shamshirsaz, A. A. (2015). Health carejustice and its implications for current policy of a mandatorywaiting period for elective tubal sterilization. Americanjournal of obstetrics and gynecology.

Meyer,U. (2014). Prenatal poly (i: C) exposure and other developmentalimmune activation models in rodent systems. Biologicalpsychiatry.

Mousa,H. A., Blum, J., Abou El Senoun, G., Shakur, H., &amp Alfirevic, Z.(2014). Treatment for primary postpartum haemorrhage. TheCochrane Library.

O’connor,E., Rossom, R. C., Henninger, M., Groom, H. C., &amp Burda, B. U.(2016). Primary care screening for and treatment of depression inpregnant and postpartum women: evidence report and systematic reviewfor the US Preventive Services Task Force.

People,H. (2013). Conclusion and future directions: CDC health disparitiesand inequalities report—United States, 2013. CDCHealth Disparities and Inequalities Report—United States, 2013.

Sandall,J., Soltani, H., Gates, S., Shennan, A., &amp Devane, D. (2013).Midwife‐ledcontinuity models versus other models of care for childbearing women.TheCochrane Library.

StewartJr, W. R. (2013). Chinese postman problem. In Encyclopediaof Operations Research and Management ScienceSpringer US.

WorldHealth Organization. (2013). Programming strategies for postpartumfamily planning.

WorldHealth Organization. (2013). WHO recommendations on postnatal care ofthe mother and newborn. In WHOrecommendations on postnatal care of the mother and newborn.