Excerpts from an unpublished thesis 1

DEVELOPING THE BACKGROUND OF THE STUDY

Birth is a crucial stage in the reproductive life of a woman. It is an
affirmation of the life-giving function of the human species and a
celebration of life itself. Yet, it can be life-threatening when complications
occur during or after birth. Thus, many hold the popular belief that a mother
has an odds of 50:50 against her life during delivery: she has a 50%
chance of surviving and a 50% risk of not making it.
Problems may arise during or after birth that can threaten the life of
both mother and child. The worst result of this is maternal mortality. Note how the
Mortality statistics paint a bleak picture about maternal and child health opening paragraphs
globally. Each year, more than 500,000 women worldwide die from set the stage for
complications related to pregnancy. Yet, most of these deaths that tend to
occur among low and middle-income countries are preventable. discussing the
Unfortunately, cost-effective health care that could save the lives of millions problem situation
of mothers is not always available to those who need it most (Yin, 2016).
Even developed countries are not spared from this situation. The
maternal mortality rate in the United States is so far the highest according
to the report of the Center for Disease Control and Prevention ’s (CDC)
National Center for Health Statistics. The U.S. maternal mortality rate was
13 deaths per 100,000 live births in 2018. The rate was 12 deaths per
100,000 live births in 2016. This was the first time that the maternal death
rate was more than 10 since 1977. A total of 540 women were reported to
have died of maternal causes in 2004. This was 45 more than what was
reported in 2003. (“Kaiser Daily Women’s Health Policy”.2019)
In Africa, Nigeria demonstrates one of the worst mortality ratios in
the world. Nigeria accounts for about 1.7% to the global population. It is not
surprising that it also contributes about 10% of the global maternal deaths
attributable to pregnancies. In terms of figures, the World Health
Organization (WHO) reported that 529,000 women died from complications
of pregnancies and labor annually. If Nigeria contributes about 10%, this
means that Nigeria loses about 59,000 women annually due to Note the description
complications of pregnancy and delivery. (“Nigeria’s Maternal Mortality of the problem in
Rate Alarming-Oladapo”, Daily Independent, online edition). general terms from
In Asia, the United Nations Children’s Fund (UNICEF) reported that
in India alone, a woman dies every five minutes from pregnancy and
the macro level to
childbirth related complications. In spite of the collaboration of the Union the micro level by
government with international organizations, the efforts have not paid off citing documentary
well in reducing the maternal mortality rates over the years. India posts as and statistical
high as 540 maternity deaths per 100,000 births with the states of Assam, indicators
Madhya Pradesh and Uttar Pradesh recording a high death rate of 700 or
more. The situation is equally worse in the other states like Orissa,
Rajasthan, West Bengal and Bijar. (www.usaid.gov). The same source
also cited the case of Bangladesh where the hospital maternal mortality
rates varied from 760 at Dhaka to 1615 in Chittagong and 951 in Sri
Lanka.
In the Philippines, there are about 2.3 million Filipino women who
become pregnant per year. An estimated 2 million would give birth per
year. The 1993 National Safe Motherhood Survey (NSMS) shows that the
perinatal mortality rate for 10 years is 27.1 per 1000 births, while the
maternal mortality rate is 179.74 per 100,000 live births. The main causes
of maternal deaths remain to be due to hemorrhage, hypertensive
complications and sepsis that usually occur in the postpartum period.
The lifetime risk of dying from maternal causes is about 1 in every
100 Filipino women (National Statistics Office, (NSO) et al., 1999; UNFPA,
2019). In Region I, there were 86 documented cases of maternal deaths in
the year 2000 while there were two (2) maternal deaths recorded in 2006 in
San Fernando City alone. Maternal deaths made up less than 1 percent of
the total deaths in the country in 1988, but these contributed about 14
percent of all deaths of women aged 15-49 (NSO 2018). High incidence of
high-risk births, inadequate prenatal care, and lack of information to
manage complications in difficult pregnancies all account for much of the
increased risk of dying during pregnancy and childbirth.

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Excerpts from an unpublished thesis 2

The postpartum period is a social as well as a personal event and

has meanings well beyond the simple physiological events. For the most
part it holds no great dramas and is a reason for celebration and a sense of
achievement (WHO 2018).
A mother is usually discharged from the hospital 24 to 48 hours
after giving birth. On the part of the new mother and her family, the
experience of a new baby takes most of their time that little is given to an
equally important aspect of giving birth which is caring for one ’s self and the
infant after discharge.
The number of health problems reported in the first months after
This links the
delivery is high. A number of serious complications and the majority of
maternal deaths occurred during the postpartum period especially in general problem
developing countries. Among the major postpartum maternal health with the specific
challenges recorded include haemorrhage, eclampsia, puerperal genital intention of the
infection, thromboembolitic disease, complications of the urinary tract (such study
as retention of urine, incontinence and infections), complaints about the
perineum and vulva, puerperal mastitis, and psychological problems.
Thus, the postpartum period is very crucial to both the welfare of
mother and child. More often than not, the postpartum period is often
neglected in maternity care. Inadequate or lack of postpartum care ignores
the fact that the majority of maternal deaths and disabilities occur during
this period accounting for high early neonatal mortality.
This special phase in a mother’s reproductive life involves special
needs. Research on the needs of women and the new born during the
postpartum period provides scanty data. Of significance were studies done
by Woollet and Dosani- Matwala(1990) and Rossiter (1992). They found out
that generally, migrant women of different ethnic descent experienced great
differences between their cultural heritage and the care they received in This links the
foreign hospitals. This is parallel to situations experienced by women in the present study
local situation. Women from different ethno-linguistic groups in the province with other
deliver their babies in urban centers. After their release they go back home studies
after where the cultural elements take over. There can be a difference in the
health teachings they received from health workers and the traditional
practices prescribed by their cultures.
During the postpartum period women need information/counseling
on care of the baby and breastfeeding, what happens with and in their
bodies - including signs of possible problems, self care, hygiene and
healing, sexual life, contraception and nutrition. Furthermore they need
emotional and psychological support from health care providers and partner
and family, health care for suspected or manifest complications, time to
care for the baby, help with domestic tasks, maternity leave, social
reintegration into her family and community, and protection from
abuse/violence. This sets the
It is therefore important for health workers to take advantage of the stage for justifying
limited stay of the new mother at the health facility to educate her on the the need for the
necessary aspects of self and infant care after discharge. Postpartum study
services should be based on the needs and health challenges of both the
mother and the infant. Further, should incorporate all the essential elements
required for the health of the mother and her newborn, and should be
provided in an integrated fashion. Skilled care and early identification of
problems could reduce the incidence of death and disability, together with
the access to functional referral services with effective blood transfusion
and surgical capacity. With regard to timing of postnatal visits, there seem
to be "crucial" moments when contact with the health system or caregiver
could be instrumental in identifying and responding to needs and
complications. These can be resumed in the formula (which should not be
interpreted rigidly) of "6 hours, 6 days, 6 weeks and 6 months".

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Excerpts from an unpublished thesis 3

To contribute to the pool of knowledge regarding local postpartum

realities, this study assessed the extent of implementation of post discharge
care of new mothers. The purpose of the study was two fold: to provide
general knowledge based on real time experiences of mothers and to
generate a data base for an action plan that will enhance the school-based
Maternal and Child Health Program that is community-based in perspective.
The researcher believes that the output of this study will strengthen the
practice of maternal and child health care in the community because it will
appropriately guide the activities of instructors, nurses, midwives,
caregivers and students in delivering community services to new mothers.
Schools offering health- related courses are partners of the
government in implementing maternal and child health services through
health education and provision of health care by their instructors and
students in the community during their community health nursing practice.
This is a part of the related learning experience of students in their
community exposure. However, the community health nursing practice of These justify the
instructors and students are more often not properly guided because of the need for the study
lack of specific plan of activities geared towards responding to real needs in
the real situation. The guide for activities is usually the daily activities of the
midwives or barangay health workers. In addition, the focus of Community
Health Nursing practice is community organizing since the application of
maternal and child health care is relegated mostly in the hospital
specifically, in the obstetric ward and nursery.
In the training of student nurses, there seem to be a gap between
theory and practice. In the classroom setting, nursing students are
introduced to a multiplicity of concepts regarding health care. These are,
however, very theoretical in nature and only serve to give background
information to students. What students need however, is information about
the real world or clinical evidences that would provide the context of what
they would be expecting once they are deployed in the field. This will
enhance their readiness to respond by way of providing the right care at the
right time to the right patients.
This study was thus, conceived to not only to provide a data base
for academic processes or administrative decision-making but to add “local
color” to classroom discussions on health care by presenting the actual
situations that would act as clinical evidence that could enhance programs
and practice.
The findings of the study can benefit the following agencies and
personalities in planning, decision-making and program development
concerning the health care system:

School Administrators. The findings of the study serve as an

information base in planning and enhance existing school-based maternal
and child health programs in the community.

Clinical Instructors. This study provides real time insights to clinical

instructors in the development of learning resources in the classroom and
the clinical area. This significantly strengthens the knowledge and skills of These establish
students particularly on post discharge care of new mothers and their
newborn in the local context. the significance of
Paramedical Students. This study gives paramedical students the the study
much needed information on the current state of maternal and child care in
the area so as to devise responsive programs and activities that are
responsive to the real needs of mothers.
Other Researchers. This study provides other researchers with
significant data needed to conduct further studies regarding maternal and
child health.
Researcher. This study provided the researcher with the
opportunity to conduct an independent investigation on her area of
expertise and has benefited tremendously from the process and experience
in the conduct of the study. Furthermore, the researcher has learned a lot
from the findings that would definitely strengthen her teaching of community
health nursing. Also, finishing this thesis would mean better professional
opportunities for the researcher in the exercising her functions both in the
classroom and the community

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Excerpts from an unpublished thesis 4

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