Domicilary/Puerperal Service...(Community !!!!)

Goodnite....(Good afternoon....)

If you are not aware already.....I am slowly integrating the terms that are used in Jamaica....."Good nite " is a term that is used instead of our 'Good evening"...I actually prefer it...lol...

Focusing back to my day in community....I shall start from the background....
Puerperal....The period from child birth to 6-8 weeks to complete involution of the uterus and healing of pelvic structure (as quoted in the hand book that was handed to me at 7am )

Aim of Puerperal Service (PS)....to prevent maternal and infant morbidity and mortality . To promote breastfeeding and healthy living for the mother and her family.

Admission to P S......Once the woman and baby have been discharged from the postnatal ward, they are given an option to take up the PS (which is free of charge).
Visits are made on the 2nd, 3rd, 5th and 7th day and then weekly for up to 6 weeks (8 if there is a problem).
Visits...At each visit the woman is assessed for coping mechanism in the home environment, furthermore...breasts, fundus, perineum, Lochia, Blood pressure, Temperature, pulse and respiration's on mother are checked.

The women are advised prior to visit to have the area cleaned for visit, to have a newspaper to hand or the back of a calender (every house hold has an A5 cardboard calender in their house?????), cotton wool and cotton buds, and to have either liquid hand wash or a bar of soap that is not opened ready for the midwife's visit. Fact!!! Midwifes visit in twos and are chauffeur driven to each destination(this promotes safety..).

Each Baby has a head to toe assessment, documenting their nutritional status, weight, skin colour, turgor(dehydration pinch), Integrity(if skin is broken) and umbilicus(once the cord and clamp have dropped off, the umbilicus is thoroughly cleaned daily with a cotton bud dipped in 70% white alcohol.....OUCH!!!

The baby's immunisation is also checked and referred to child health clinic.Fact!!!!Breastfeeding is the norm in this country.....every woman engages in it ....and it facilitated anywhere...and every where  ; )

Talks are also given to reinforce self care, nutrition,rest,home breastfeeding using various positions and how to express and store expressed milk....family education r.e: medication,vitamins and minerals (up until recently the mothers were told to sun in the baby,,,,where the baby was left in the sun for 20minutes, but an incident happened where a child was left too long....and.....I won't go down that road with you...but the hospital got sued!!)

My mentor for the day was Sis Bonnick, who was happy to share that she had qualified in England as a nurse and went on to qualify as a Midwife...surprise surprise. She explained to me that Midwifery was an acquired skill that had to be learnt over years of experience......she later confirmed her experience and skill!!!

Between 7 and 9 the PS was opened for hospital visits (there is an area that is circled on the Jamaica map....in comparison to our London waiting area..), and women who are outside the area have to come in to the hospital for their SP visit as some of the areas are to risky and difficult to get to via car.

The woman that attend all seem to know the procedure of what to do when they arrive....they enter the room, put their baby in to an empty cot that is on a table , then walk behind a divider curtain and take their bottom clothing off to be examined...they are also quizzed about the care they have been given to their baby and how they are feeding, what they are washing their baby with and how many nappies are changed a day, it is quite amusing to watch the banter between the midwife and the patient. The mother then takes both breasts out so they can be examined by the midwife, and then she has to prove that she can breastfeed and express....It is comical to watch!!!

Then the home visits commence.I'm sure you were wondering what the newspaper/calender was needed for....well....it is used to put the equipment on whilst in the house. Whilst in the house you are not allowed to sit down or except drinks...(reduce cross infection???) furthermore baby's could be in anything from a cot to a box'container' made up like a little bed. Every woman who has had perennial stitches have to have an inspection to eliminate infection ect, and every woman has a thorough breast check to eliminate unusual lumps.

I am really tired and the heat is making me drowsy...so...goodnight and share soon.

Miss p xx