RJHS 11(4).cdr Postnatal home visit: An effective strategy to a successful postnatal care 1 2 3 4 Akinbowale, B.T. , Ademuyiwa, O. , Akinyele, A.A. , Akinwale, O.D. Abstract Home visiting is a crucial aspect of postnatal care services as recommended by the WHO, but it appears to be the most neglected service. This is due to various challenges like a shortage of manpower, inadequately skilled or trained health care workers, the non-availability of assessment tools and resources, and a lack of community awareness of the importance of postnatal care. However, it's the responsibility of health care workers, especially the midwives, to carry out postnatal home care visits to ensure the well-being of both the mother and the neonates, as well as the assessment of the environment where the newborn will be nurtured. Therefore, to ensure effective postnatal home care visits, there should be availability of adequate tools and resources for the services, training of health care personnel, allocation of experienced health care workers, and community awareness of the importance of postnatal home care visits. This review thus explained the concept of postnatal home care visits, the timing of visits, who should conduct postnatal home visits, what to look out for in mothers, babies, and environments. Keywords: home visits, postnatal care, strategies, health care personnel *Corresponding author Akinbowale, B.T. Email: busayoakinbowale2@gmail.com 1 Department of Nursing, Babcock University, Ilishan-Remo, Nigeria 2 Department of Nursing, Lagos State University, Lagos, Nigeria 3 Department of Obstetrics and Gyneacology, State Hospital, Ilesha, Nigeria 4 Department of Nursing, Osun State University Teaching Hospital, Osogbo, Nigeria Received: February 24, 2023 Accepted: June 17, 2023 Published: December 15, 2023 Review Article Research Journal of Health Sciences Research Journal of Health Sciences subscribed to terms and conditions of Open Access publication. Articles are distributed under the terms of Creative Commons Licence (CC BY-NC-ND 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v10i4.11 Res. J. Health Sci. Vol 11(4), December 2023 377 Visite postnatale à domicile: une stratégie efficace pour une prise en charge postnatale réussie 1 2 3 4 Akinbowale, B.T. , Ademuyiwa, O. , Akinyele, A.A. , Akinwale, O.D. Résumé Les visites à domicile sont un aspect crucial des services de soins postnatals recommandés par l'OMS, mais il semble que ce soit le service le plus négligé. Cela est dû à divers défis comme une pénurie de main- d'œuvre, des travailleurs de la santé insuffisamment qualifiés ou formés, la non-disponibilité d'outils et de ressources d'évaluation et un manque de sensibilisation de la communauté à l'importance des soins postnatals. Cependant, il est de la responsabilité des travailleurs de la santé, en particulier des sages- femmes, d'effectuer des visites de soins postnatals à domicile pour assurer le bien-être de la mère et des nouveau-nés, ainsi que l'évaluation de l'environnement où le nouveau-né sera nourri. Par conséquent, pour assurer des visites de soins postnatals à domicile efficaces, il devrait y avoir la disponibilité d'outils et de ressources adéquats pour les services, la formation du personnel de santé, l'affectation de travailleurs de la santé expérimentés et la sensibilisation de la communauté à l'importance des visites de soins postnatals à domicile. Cette revue a donc expliqué le concept des visites postnatales à domicile, le moment des visites, qui devrait effectuer les visites postnatales à domicile, ce qu'il faut surveiller chez les mères, les bébés et les environnements. Mots-clés : Visites à domicile, soins postnatals, stratégies, personnels soignants *Corresponding author Akinbowale, B.T. Email: busayoakinbowale2@gmail.com 1 Department of Nursing, Babcock University, Ilishan-Remo, Nigeria 2 Department of Nursing, Lagos State University, Lagos, Nigeria 3 Department of Obstetrics and Gyneacology, State Hospital, Ilesha, Nigeria 4 Department of Nursing, Osun State University Teaching Hospital, Osogbo, Nigeria Received: February 24, 2023 Accepted: June 17, 2023 Published: December 15, 2023 Article Aperçu Research Journal of Health Sciences Research Journal of Health Sciences subscribed to terms and conditions of Open Access publication. Articles are distributed under the terms of Creative Commons Licence (CC BY-NC-ND 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). http://dx.doi.org/10.4314/rejhs.v10i4.11 Res. J. Health Sci. Vol 11(4), December 2023 378 INTRODUCTION Post-natal care is the care given to women and their newborns after delivery within the first six weeks, which is also considered important as other natal care because complications could arise if both the baby and mother are not closely monitored (1). As part of the responsibilities of midwives, postnatal home visiting helps the healthcare professionals achieve the purpose of ensuring that mother and baby go through the normal changes of this phase without any danger or discomfort to the mother or the child (2, 3, 4). The World Health Organization (5) recommended that mothers and their newborns have at least four postnatal visits scheduled for the first day (first 24 hours), third day (48–72 hours), 7–14 days, and six weeks after birth. Some of those recommendations include a full assessment of the baby, health talk on breastfeeding, thermal care, care of the cord, and harmful signs (6). H o w e v e r , d e s p i t e t h e s e recommendations, in 2016, it was estimated that about 2.6 million babies die annually within the first 28 days after birth (7, 8). Evidence suggested that accessibility, knowledge of the health extension worker, and their availability are challenges faced in ensuring strategic home visits (9, 10, 11). Therefore, the purpose of this review is to provide effective strategic postnatal home visiting based on the WHO guidelines on postnatal care for both mothers and babies so as to prevent the incidence of neonatal death and postnatal complications. Timing for home visits based on WHO guidelines The first six (6) weeks postpartum are the most crucial and sensitive time for both mother and newborn, as they are prone to various health challenges (12, 13). Home visiting during this period, especially the first 2-3 days following delivery, is important because about 7,000 neonates die every day, with about one-third occurring within the first few weeks of life (14). Studies had shown that factors associated with neonatal mortality could be averted through postnatal inspections and examinations of both mothers and babies. More so, postnatal care (PNC) for the newborn and mother is as important as the birth experiences of the baby, and as such, it is an important opportunity to look out for danger signs such as jaundice, fever, lethargy, breastfeeding problems, and fast breathing, among others, during this period (5, 6). Mothers can also be counseled on how to identify and deal with danger signs and the importance of exclusive breastfeeding in the first six months of life (15). Who should conduct postnatal home visits? Traditionally, postnatal care services should be done by skilled health personnel because they are trained to perform all the necessary care needed by both mother and baby. In many health care facilities, however, this is often not possible because of a shortage of skilled health workers, lack of passion, lack of transportation, or excessive workload that prevents them from making time for the visits. Otherwise, the postnatal care home visits can be conducted by trained health assistants, community health extension workers, and other trained community health workers who are part of the healthcare delivery system. What are the things to look out for in mothers, babies, and the environment? During postnatal home care visits, there are certain things the health personnel have to look out for to ensure the wellbeing of the new mother and baby. For mothers Postnatal home visits require regular evaluation and examination of vaginal bleeding, uterine tonus, fundal height measurement, and checking of heart rate during the first 24 hours after delivery (16). Blood pressure should also be measured immediately after birth and 6 hours after delivery. After the first 24 hours, inquiries should be made to know the general wellbeing of the mother in the following areas: bowel function, healing of stitches if any, headache, fatigue, breast pain, lochia, and uterine tenderness (5, 6, 16). However, in areas prone to HIV, the mother should be tested to know her status, especially for those who missed it during the antenatal visit. Screening for postpartum depression should be carried out, and she should be encouraged to eat healthy foods and continue with iron supplements and/or folic acid up to 6–12 weeks after delivery (17). Additionally, the importance of rest should be emphasized, and mothers should be encouraged to do mild exercise that does not stress the body. Also, information on contraceptive use and services should be provided, as well as information on breastfeeding. In other words, mothers should be counseled and provided with support for exclusive breastfeeding at each home visit (5). Postnatal visit: An effective strategy to a successful postnatal care Akinbowale et al. Res. J. Health Sci. Vol 11(4), December 2023 379 For newborn Newborns should be assessed for danger signs such as fast breathing, jaundice, fever, no spontaneous movement, severe chest in-drawing, convulsions, abnormalities in the eye, etc. (18, 19). Screening for neonatal hyperbilirubinemia and checking of the umbilical cord should be done, and regular cleaning of the cord (21, 22). Assessment of the sleeping position of the baby (back to sleep) to prevent Sudden Infant Death Syndrome (SIDS) (23, 24) Furthermore, the use of routine drugs for newborns should be discouraged except on rare occasions of complications. Gentle body massage for the baby and exclusive breastfeeding for the first 6 months of life should be encouraged. Health care personnel on visit should provide adequate knowledge on the importance of immunization for the newborn (25, 26). The environment The environment should be assessed for cleanliness and whether it is appropriate for a newborn, because babies are easily prone to infection. The families and those around the new mother should be encouraged to ensure proper hygiene around the baby. The room where the baby would be staying should be properly arranged, with just enough ventilation for a newborn (5, 6, 27). Expected role of health care personnel on postnatal home visit The health personnel must be adequately prepared for what is needed for both the mother and the newborn (28). They should have sufficient knowledge of the care needed to be given to a new mother. It is the role of health care personnel to explain the immunization schedule to the mothers and encourage them not to miss any appointments. They should encourage the mother to get to the hospital if she notices anything unusual in her body or her baby and help the woman with different breastfeeding styles to ensure proper latching of the baby as well as a comfortable position for mother and baby. Health care personnel should also discuss the best time to resume sex with her husband. Most mothers may not feel comfortable discussing this in the hospital, but a home visit will afford them the opportunity to open up and ask for help. The health personnel should guide her on the best contraceptives to use in preventing unwanted pregnancy (29, 30). Moreso, it is the responsibility of health care personnel to counsel the new mother on nutrition and advise her on what to eat. Foods such as vegetables, meat, beans, a lot of water, and fruits should be encouraged. Also, they are to inform the mothers about the best foods to eat to enhance lactation and breastfeeding (28, 29). Additionally, healthcare providers are required to check for danger signs in both mother and baby, check for postpartum depression in the mother, and ensure she is adequately cared for by her family or people around her. Finally, they are to encourage new mothers to enjoy the newborn period, which can be stressful, but once they do things they enjoy, it can be easy for them. Emphasis must be laid on the importance of rest and sleep when the baby is sleeping (5, 6, 17, 29). Challenges of a postnatal home visit Postnatal care visits appear to be one of the components of maternal and child care services that is poorly utilized despite being a critical period for the survival of both mother and baby (10). Research has shown that rates of provision, uptake, and quality of skilled postnatal care are generally lower than those of other maternal healthcare services (10, 11). More emphasis and resources tend to go to antenatal and intrapartum care (10, 11). This may be due to poor infrastructure, a shortage of skilled healthcare workers, poor access to services, and poor knowledge, among others. It was also reported that postnatal care visits had the lowest m e d i a n n a t i o n a l c o v e r a g e o f r e l e v a n t interventions among the various maternal and child health services (5, 6). Solution to the challenges of postnatal home visits Training the healthcare personnel: Regular training of healthcare personnel is very important in ensuring the effective practice of postnatal home visits. (10) Evidence has shown that most healthcare personnel do not know the importance of home visits during the postnatal period, and it would be helpful if the government could make enough resources and equipment available for these services (10). The provision of enough healthcare personnel would also go a long way in ensuring the effective and smooth running of postnatal care home visits, adequate coverage of postnatal homecare visits, and improved postnatal outcomes (29, 33, 35). Availability of adequate postnatal care tools and resources at all levels of health facilities Evidence suggests that 10–15% of postnatal mothers experience mental derailment and Postnatal visit: An effective strategy to a successful postnatal care Akinbowale et al. Res. J. Health Sci. Vol 11(4), December 2023 380 depressive symptoms, which are not discovered early due to inadequate physical examination by healthcare workers. However, if the right tools are available in healthcare facilities and accessible to health care workers to screen expectant and postpartum mothers, it will be easier to identify those that are prone to mental illness after delivery and also institute appropriate treatment on time (16). Allocation of experienced healthcare workers or midwives for postnatal home care visits: Most healthcare facilities only allocate one healthcare worker to care for mothers and neonates in postnatal wards. As a result, care is compromised, and there is no allocation for home visits after they are discharged from the health facility (5, 6). More so, the healthcare workers are overworked and exhausted at the end of the day. However, WHO recommends that standards of care for mothers and newborns should be provided in health facilities according to WHO guidelines, which should also extend to home visits shortly after discharge (5, 16). Awareness in the community of the importance of postnatal home visits The health care personnel have a significant role to play in ensuring that the community members are aware of the importance of postnatal care home visits (30). This is very important, as most people in the community do not even know that they are entitled to postnatal care and visits after delivery. Collaborating with community members may help individuals, families, and the community to embrace these activities as a form of health promotion and illness prevention after delivery (19, 30). CONCLUSION Home visit is an important aspect of postnatal care, and the WHO recommends that home visit for postnatal mothers and their babies be conducted in the first week after birth and continued until 6 weeks postpartum. These visits are crucial for assessing general wellbeing as well as identifying postnatal challenges and dealing with them early. However, to increase and encourage postnatal home care visits, it is important to increase community awareness of the importance of PNC and improve health facility roles in conducting postnatal home visits. It is therefore recommended that efforts be made to ensure that mothers and health care professionals are well trained on the benefits and importance of postnatal home visits, as documented by the WHO. Conflict of interest: The authors declare no conflict of interest. Acknowledgement: Nil REFERENCES 1. Wudineh, KG., Nigusie, AA., Gesese, SS, et al. Postnatal care service utilization and associated factors among women who gave birth in Debretabour town, North West Ethiopia: a community- based cross-sectional study. BMC P r e g n a n c y C h i l d b i r t h 2 0 1 8 1 8 , 5 0 8 . https://doi.org/10.1186/s12884-018-2138-x 2. Horowitz JA, Murphy CA, Gregory K, et al. Nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2013; 42(3):287-300. 3. Aston M, Price S, Etowa J. et al. The power of relationships: Exploring how public health nurses support mothers and families during postpartum home visits. Journal of Family Nursing. 2015; 21(1):11-34. 4. Barboza M, Kulane A, Burström B, Marttila A. A better start for health equity? Qualitative content analysis of implementation of extended postnatal home visiting in a disadvantaged area in Sweden. International journal for equity in health. 2018; 17(1):1-9. 5. Wo r l d H e a l t h O r g a n i z a t i o n . W H O recommendations on postnatal care of the mother and newborn. Geneva; Highlight from World Health Organization 2013 guidelines. RHR/15.05;2015. 6. World Health Organization, Special Programme of Research, Research Training in Human Reproduction (World Health Organization). WHO recommendations on maternal and newborn care for a positive postnatal experience. World Health Organization; 2022 Mar 29. 7. Ayete-Nyampong J, Udofia EA. Assessment of knowledge and quality of essential newborn care practices in La Dade Kotopon Municipality, Ghana. Plos one. 2020; 15(8):e0237820. 8. Jahan F, Foote E, Rahman M, Shoab AK, Parvez SM, Nasim MI, Hasan R, El Arifeen S, Billah SM, Sarker S, Hoque M. Evaluation of community health worker's performance at home-based newborn assessment supported by mHealth in rural Bangladesh. BMC pediatrics. 2022; 22(1):1-2. 9. Aboubaker S, Qazi S, Wolfheim C, Oyegoke A, Bahl R. Community health workers: A crucial role in newborn health care and survival. Journal of global health. 2014 Dec;4(2). 10. McPherson R, Hodgins S. Postnatal home visitation: lessons from country programs operating at scale. Journal of global health. 2018; 8(1). 11. Amare Y, Scheelbeek P, Schellenberg J, Berhanu D, Hill Z. Early postnatal home visits: a Postnatal visit: An effective strategy to a successful postnatal care Akinbowale et al. Res. J. Health Sci. Vol 11(4), December 2023 381 qualitative study of barriers and facilitators to achieving high coverage. BMC public health. 2018;18(1):1-8. 12. Bako, B., Audu, B.M., Peter, A. and Kawuwa, M.B. Knowledge, Attitude and Practice of Postnatal Home Visit among Healthcare Workers in IDP Camps and Host Community Clinics in Jere And Maiduguri, Nigeria: Knowledge, Attitude and Practice of Postnatal Home Visit among Healthcare Workers in Maiduguri, Nigeria. Tropical Journal of Obstetrics and Gynaecology, 2022; 39(1),18-25. 13. Woolhouse H, Gartland D, Mensah F, Brown SJ. Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG: An International Journal of Obstetrics & Gynaecology. 2015; 122(3):312- 21. 14. Yonemoto N, Dowswell T, Nagai S, Mori R. Schedules for home visits in the early postpartum period. Evidence- based child health: a Cochrane review journal. 2014; (1):5-99. 15. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, Sankar MJ, Blencowe H, Rizvi A, Chou VB, Walker N. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet. 2014; 384(9940):347-70. 16. Wo r l d H e a l t h O r g a n i z a t i o n . W H O recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee. World Health Organization; 2017. 17. Adams, J.B., Kirby, J.K., Sorensen, J.C. et al. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. matern health, n e o n a t o l a n d p e r i n a t o l 2 0 2 2 ; 8 ( 4 ) . https://doi.org/10.1186/s40748-022-00139-9 18. Abdulrida HN, Hassan RJ, Sabri MM. Knowledge and health-seeking practices of mothers attending primary health-care centers in Baghdad Al-Karkh sector about danger signs in newborns. Mustansiriya Med J. 2018; 17(1):29. 19. World Health Organization, World Health Organization. Reproductive Health, World Health Organization. Dept. of Reproductive Health, Family, Community Health. Pregnancy, childbirth, postpartum, and newborn care: a guide for essential practice. World Health Organization; 2003. 20. Lee SM, Kim DY, Cho S, Noh SM, Park HL, Lee G. Correlations between the Status of the Umbilical Cord and Neonatal Health Status. Child Health Nursing Research. 2020; 26(3):348. 21. van Rossum HH, de Kraa N, Thomas M, Holleboom CA, Castel A, van Rossum AP. Comparison of the direct antiglobulin test and the eluate technique for diagnosing haemolytic disease of the newborn. Practical Laboratory Medicine. 2015; 3:17-22. 22. Shinohara E, Kataoka Y, Yaju Y. Effects of timing of umbilical cord clamping on preventing early infancy anemia in low-risk Japanese term infants with planned breastfeeding: a randomized controlled trial. Maternal Health, Neonatology and Perinatology. 2021: 7:1-2. 23. Camerota M, Propper CB, Teti DM. Intrinsic and extrinsic factors predicting infant sleep: Moving beyond main effects. Developmental Review. 2019; 53:100871. 24. Priyadarshi M, Balachander B, Sankar MJ. Effect of sleep position in term healthy newborns on sudden infant death syndrome and other infant outcomes: A systematic review. Journal of Global Health. 2022;12. 25. Bhosale V, Radha V, Shelar S, Ingale S, Shinde A, Gadekar N. Newborn at a Distance in Hospital: Review on Positive Effect of Humanized Care on Developmental Outcome Parameters. Innov J Nurs Healthc [Internet]. 2020;6(2):24-8. 26. Tiwari S, Bharadva K, Yadav B, et al. Infant and young child feeding guidelines, 2016. Indian pediatrics. 2016; 53:703-13. 27. Davis KF, Parker KP, Montgomery GL. Sleep in infants and young children: part two: common sleep problems. Journal of Pediatric Health Care. 2004; 18(3):130-7. 28. Dahlberg U, Haugan G, Aune I. Women's experiences of home visits by midwives in the early postnatal period. Midwifery. 2016; 39:57- 62. 29. Aune I, Voldhagen H, Welve I, Dahlberg U. Early discharge from hospital after birth: How Norwegian parents experience postnatal home visits by midwives–A qualitative study. Sexual & Reproductive Healthcare. 2021; 30:100672. 30. Aaserud TG, Tveiten S, Gjerlaug AK. Home visits by midwives in the early postnatal period. Sykepleien. 2016;2. 31. Shaban IA, Al-Awamreh K, Mohammad K, Gharaibeh H. Postnatal women's perspectives on the feasibility of introducing postpartum home visits: a Jordanian study. Home health care services quarterly. 2018 37(3):247-58. 32. Sacks E, Langlois ÉV. Postnatal care: increasing coverage, equity, and quality. Lancet Glob H e a l t h . 2 0 1 6 J u l ; 4 ( 7 ) : e 4 4 2 - 3 . d o i : 10.1016/S2214-109X(16)30092-4. Epub 2016 May 13. PMID: 27185467. 33. World Health Organization. Community health worker programmes in the WHO African region: Evidence and options—Policy brief. 34. Olds DL, Henderson Jr CR, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics. 1986; 77(1):16-28. 35. Modi D, Dholakia N, Gopalan R, Venkatraman S, Dave K, Shah S, Desai G, Qazi SA, Sinha A, Pandey RM, Anand A. mHealth intervention “ImTeCHO” to improve delivery of maternal, neonatal, and child care services—A cluster- Postnatal visit: An effective strategy to a successful postnatal care Akinbowale et al. Res. J. Health Sci. Vol 11(4), December 2023 382 randomized trial in tribal areas of Gujarat, India. PLoS Medicine. 2019; 16(10):e1002939. 36. Sakala B. An evidence-based policy brief: improving the quality of postnatal care in mothers 48 hours after childbirth. Malawi Medical Journal. 2019; 31(2):164-8. 37. Nishimwe C, Mchunu GG. Exploring health provider's knowledge on the home-based maternal and neonatal health care package in Rwanda. BMC pregnancy and childbirth. 2022; 22(1):1-2. 38. Allender J, Rector C, Rector C, Warner K. Community & public health nursing: Promoting the public's health. Lippincottwilliams & wilkins; 2013. Postnatal visit: An effective strategy to a successful postnatal care Akinbowale et al. Res. J. Health Sci. Vol 11(4), December 2023 383