INTRODUCTION

The postpartum period starts about an hour after the delivery of the placenta and includes the
following six weeks. Several studies in both high and low income countries have identified
the importance of the postpartum period for acute short-term, long-term, and chronic
morbidity 1. Moreover, up to two thirds of maternal deaths occur after delivery. Therefore, the
World Health Organization suggests that health care should be provided at 6 hours, 6 days, 6
weeks, and 6 months post delivery, in order to ensure women's physical and mental health
and well-being.
Despite this recommendation, seven out of ten women do not receive any postpartum care,
based on Demographic and Health Surveys conducted in 30 low income countries between
1999 and 2004 2.Low utilization of postnatal care has been related to women's lack of
knowledge about its importance, their lack of perceived need (especially if they are feeling
well), their low level of education, poverty, lack of access to health care facilities that provide
postnatal care, lack of appointments or recommendations from health care providers to obtain
postnatal care, poor attitudes of the health care providers, or women's tendency to give
priority to the health needs of their infants rather than their own 3.

BACKGROUND OF THE STUDY

Globally, women in labor and delivery undergo enduring experiences of painful discomfort,
fear, anxiety and tensions. In a bid to ameliorate these experiences, several studies have been
conducted to establish the relationship between companionship by either medical personnel
or spouses. These studies have shown that practices of professional support caregivers to
support women in postnatal duration produce an ameliorative effect on psychology of mother
during postnatal duration 4. For purposes of this review, support is interpreted as a continuous
non-medical care of a postnatal mother. It includes physical comforting such as touching,
massaging, bathing and emotional support such as companion, reassurance, encouragement,
etc. These supports are either done by the medical personnel, family members, spouse or a
hired hand5 .

In different parts of the world, more especially in developed countries such as UK and
Denmark, spousal participation is common practice during intranatal and postnatal care of
mothers and delivery with about 95% attendance. Studies conducted in these developed
countries shows that women who had continuous spousal support are reassured, comforted
and emotionally encouraged to overcome pain associated with and delivery.6 Furthermore, a
similar review has shown that women with continuous support by spouses also experience
relaxed and easy to adjust with the change.
NEED OF THE STUDY
Developing countries account for 99% of global maternal deaths.7In Sub-Saharan Africa, for
example, a woman's lifetime risk of dying from preventable or treatable complications of
pregnancy and childbirth is 1 in 39, compared to 1 in 3800 in the developed regions.8 The
1994 International Conference on Population and Development advocated for the active
inclusion and shared responsibility of men in reproductive health.9 Male involvement, an allencompassing term which refers to the various ways in which men relate to reproductive
health problems and programmes, reproductive rights and reproductive behaviour, is
considered an important intervention for improving maternal health.10In many developing
countries, men are the key decision-makers and chief providers, often determining women's
access to economic resources. This practice has implications for maternal health as it
determines the nutritional status of women during pregnancy women's access to maternal
health services since healthcare systems in most developing countries require out-of-pocket
payments and women's chances of receiving emergency obstetrics care, which is vital in
averting maternal mortality.
Many studies have reported positive benefits of male involvement in maternal health in
developed and developing countries, which include: increased maternal access to antenatal
and postnatal services discouragement of unhealthy maternal practices such as smoking
improved maternal mental health increased likelihood of contraception usage and allayment
of stress, pain and anxiety during delivery. However, arguments on the downsides of male
involvement have also been highlighted such as increased male dominance in decisionmaking and the potential for escalating labour difficulty when husbands become anxious in
delivery rooms.

Evidence suggests that male involvement may be beneficial to maternal health;

however, the magnitude of the association is not clear. There have also been speculations on
possible negative impacts if men were involved in maternal health, hence it is necessary to
undertake a systematic review to reconcile these opposing views. However, it is paramount
that the review focuses on developing countries since they bear the greatest burden of global
maternal deaths and men's dominant roles in these regions have been shown to influence
health outcomes. Previous systematic reviews have focused on developed regions; the review
was restricted to maternal outcomes in order to have a much more focused research question.
In addition, improved maternal health is one of the Millennium Development Goals in which
progressis falling short, thus necessitating research on alternative interventions.
Every minute at least one woman dies from complications related to pregnancy or
childbirth that means 529000 women a year. In addition, for every women who dies in
childbirth, around 20 more suffers from injuries, infections or diseases which accounts for 10
million women in each year. Five direct complications account for more than 70% of
maternal deaths. They are due to hemorrhage (25%), infection (15%), unsafe abortion (13%),
eclampsia (12%) and obstructed labour (8%). The MMR ratio in India is 407/100000 live
births.11
After delivery the women begins to experience physiological and psychological changes in
her body during which the reproductive organs revert back to pre-pregnant state. These
changes usually occur without any difficulty. However factors such as blood loss, trauma
during delivery, infection or fatigue can place the postpartum mother at risk or even death. So
adequate education is required according to the needs of the postnatal mothers to enable them
to handle changes during postpartum period and meet these demands.12
During puerperal period, MMR accounts for the greatest proportion of deaths among women
of reproductive age in most of the developing world. India is also one among those countries
which have a very high MMR. In India more than 100000 women die each year due to
pregnancy related causes. It is mainly due to large number of deliveries conducted at home by
un trained persons and also there are other causes such as lack of adequate referral facilities
to provide emergency care for complicated cases including postnatal complications. This also
contributes to high maternal mortality and morbidity.13
It is to note that about 80% of maternal deaths are direct causes i.e. obstetric complication of
pregnancy, labour and puerperium to intervention or incorrect treatment. Most maternal

deaths are preventable. The low status of the women in the society are coupled with their low
literacy levels prevents the women from taking postnatal care even if services are available.
Hence the women knowledge regarding postnatal care and complication so of neglected
postnatal care can reduce the MMR.14
Most women who deliver vaginally at hospital usually go home within 24-48 hrs after
delivery. This challenges the nurse caring for the women in the early postnatal period to do
thorough assessment to pick up any complications that might be developing and to use every
available opportunity to teach regarding self and newborn care. Midwife therefore brings
changes of care provision. This would facilitate them in providing care which is satisfying for
themselves, the women and the community care. The time of transition is an important point
of contact when women are experiencing enormous changes and keen to receive the support
and information in order to manage it well.15
Women need not die in childbirth. We must give enough information and support to the
spouse regarding her needs to control her reproductive health, help her through pregnancy
and give care for her and for her newborn. The vast majority of maternal deaths could be
prevented if the spouse have necessary knowledge and skill regarding pregnancy, child birth
and during puerperium. Thus the researcher would like to assess the knowledge among the
spouse regarding the postnatal care during puerperium in order to prevent maternal deaths.16
PROBLEM STATEMENT
A quasi experimental study to assess the effectiveness of informational booklet on
knowledge and attitude regarding postnatal care among spouse of Postnatal Mothers in a
selected hospital of Delhi.
Objectives
1. To assess the pre test knowledge and attitude score regarding postnatal care among
spouse of postnatal mothers
2. To develop informational booklet on postnatal care
3. To evaluate the effectiveness of informational booklet
4. To assess relation with knowledge and attitude
5. To seek relationship between knowledge and selected demographic variables
a) Age
b) Educational qualification
c) Family income
d) Socio economic background
e) Religion
f) Sex of the newborn

g) Occupation

REFRANCES
1.

World Health Organization: Reproductive halth publications (1998). [http://www.

who.int/reproductive-health/publications/msm_98_3/msm_98_3_1.html] 2008.

2.

Alfredo LF. MTKTMA N.: Postpartum Care: Levels and Determinants in

Developing Countries. Calverton, Maryland, USA, Macro International Inc 2006.

3.

Bryant AS, Haas JS, mcelrath TF, mccormick MC: Predictors of compliance with the
postpartum visit among women living in healthy start project areas. Matern Child Health
J 2006, 10:511516.

4.

Umeora OU, Ukkaegbe CI, Eze JN, Masekoameng AK. Spousal companionship in
labour in an urban facility in South East Nigeria. Anatol J Obstet Gynecol. 2011;2:1.

5.

Somers-Smith MJ. A place for the partner? Expectations and experiences of support
during childbirth.Midwifery. 1999;15:1018.

6.

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during
childbirth. Cochrane Database Syst Rev. 2007;3:CD003766.

7.

World Health Organisation. Maternal mortality.

http://www.who.int/mediacentre/factsheets/fs348/en/index.html

8.

World Health Organisation. MDG 5: Improve maternal health.

http://www.who.int/topics/millennium_development_goals/maternal_health/en/index.html

9.

United Nations Department of Public Information. International Conference on

Population and Development, ICPD 94: Summary of the programme of action. 1995.
http://www.un.org/ecosocdev/geninfo/populatin/icpd.htm

10.

United Nations Population Fund. Male involvement in reproductive health, including

family planning and sexual health.
1995.http://snap3.uas.mx/RECURSO1/unfpa/data/docs/unpf0074.pdf

11.

Samuel E. Anya. Opportunity for Information and Education about antenatal nutrition,
Journal of Bio Med. Central, 2008 March 14.(6)

12.

Elizabeth Kamau. To determine diet quality and common food source of various
nutrients of pregnant Kenyan women. Journal of nutrition, metabolic diseases and dietetics,
Vol.51.4, 2007, Page No.87-90.

13.

Browne JC, Scott KM, Silvers KM. Fish conception in pregnancy and omega-3 after
birth is not associated with postnatal depression. J Affect Disord 2005; 15(5) 137-138

14.

Grundy L. The role of midwife in perineal wound care following childbirth. Br J

nurse 2002;4(4):100-104

15.

J Allergy Clin Immunol. Breast-feeding reduces the risk of asthma during the first 4
years of life. Stockholm County Council.2005 Jun;115(6):1324. Available from Sweden.
Inger.kull@sma.sll.se

16.

Su LL, Chong YS, Chan YH,et al. Antenatal education and postnatal support
strategies for improving rates of exclusive breast feeding. Singapore, 2007
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