The process of birth is associated with emotional and physical challenges for the mother and the newborn, particularly vaginal delivery. Studies show that women undergo numerous post vaginal complications such as vaginal discomfort caused by an episiotomy or vaginal tears that occur during the delivery, occasional afterpains that occur in the form of contractions, and vaginal discharge associated with the shedding of the mucous membrane in the vagina. Some women lose bladder control when coughing, laughing, or sneezing caused by the stretching of or damage to the pelvic muscles. Other women also experience hemorrhoids, bowel movements, hair loss, skin change, and sensitivity of the breasts. Women often undergo postnatal care after delivery to monitor them and their babies’ health and behavior. However, there are concerns over the decline in women who attend these programs, leading to postpartum depression.
The issue of reproductive health in women is a key indicator in the Healthy People 2020 initiative, seeking to improve access to reproductive healthcare services and improve on medical healthcare costs such as family planning, HIV and STD treatment and control, prenatal and postpartum care. The goal of this initiative is to increase the number of sexually active women between the ages of 15 and 44 who access reproductive healthcare. The purpose of this paper, therefore, is to mitigate the risk of postpartum depression as well as improving postpartum healthcare for mothers and their newborn babies.
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Description and context of a health issue the community faces
Over the last five years, there has been an increase in the number of young mothers who seek medical attention concerning postpartum health-related issues. In Florida, over fifty percent of all postpartum patients are young mothers in their first or second vaginal birth experience ( McKinney, Keyser, Clinton, and Pagliano, 2018) . Thus, in Florida, over 50% of all young mothers in the ages between 18-30 years in their first or second vaginal delivery experience postpartum complications. Women from low-income brackets like Hispanics and blacks are more prone to postpartum complications. At the national level, only twenty-eight percent of the total women who experience virginal delivery report postpartum complications while state-level the percentage is higher at fifty percent ( McKinney, Keyser, Clinton, and Pagliano, 2018) . At the local level, the hospital records at Cleavan Martin Health Clinic cases reported indicating a slightly lower percentage of young women (at 42%) who experience postpartum complications after successful virginal delivery (Cleavan Martin Health clinic, 2019). Surprisingly the trend of developing postpartum complications, including postpartum depression, has been on the rise mainly due to external social issues hence the need to address postpartum to present the increase of postpartum depression among young mothers.
Impact of the Economy on Reproductive Healthcare
Achieving gender equality is difficult without proper access to reproductive healthcare. Economists argue that an increase in economic strategies in reproductive health benefits not only women but the economy at large. However, the US government has restricted women’s access to reproductive healthcare by enacting policies that affect all women, including the Global Gag rule that cuts funding meant for reproductive healthcare to foreign nongovernmental organizations (O’Mahony, 2017). This policy negatively affects global health funding by limiting access to an approximated $8.8 billion. The wages women earn through their economic participation equally affects the quality of healthcare received. For example, Hispanic and African American women would disregard healthcare after vaginal birth, mainly because of the limited wages they earn economically. Most of these women do not have insurance covers, and if they do, the insurance benefits do not include a postpartum healthcare plan for them to use.
Political Influence on Postpartum Healthcare
Political influence on postpartum healthcare remains a concern in the United States, despite numerous attempts to create an environment where women can have increased access to medical care after childbirth. Redrafting the American Health Care Act posed a threat to access to treatment for patients with postpartum depression for new mothers and mothers already undergoing treatment. The Senate argued that such a condition affects the ability of an individual to pay for insurance, especially since it is a preempted condition (O’Mahony, 2017). However, postpartum depression poses a threat both to the mother and their families and should be treated as a psychiatric emergency. Generally, the proposed redraft affects marginalized women, especially those affected by the social divide in the American economy. However, policies such as the 21 st Century Cures Act seeks to safeguard the safety of these women in dealing with the conditions associated with postpartum care by increasing access to medical care but would be limited in terms of funding to cover all women in America (O’Mahony, 2017).
Socio-Cultural Influence
The aspect of culture and social norms has majorly impacted healthcare in general. The fact remains that depression is considered nonexistent, and the thought of counseling and special treatment is often considered as an insult to an individual's mental state (Stewart & Vigod, 2016). For this reason, it is hard to find mothers seeking professional healthcare after delivery, mainly because they rely heavily on their traditional norms regarding childbirth. Society has ranked therapy as a social vice, one that makes people wary about getting help. Stigmatization, as a result of racism and ethnicity, plays a role in affecting reproductive healthcare as well.
Population description
One of the leading indicators of attaining the Health People 2020 goal is the subject of reproductive sexual health. Postpartum depression and other postpartum issues result in a high level of sexual and reproductive health issues as a public health problem. Postpartum affects over half of the women population who experience virginal delivery. Through interviews of 100 postpartum patients who visited the Cleavan Martin Health Clinic, postpartum complications lead to poor mental health among young mothers.
Community resources and partnerships
Currently, the Cleaveland community does not have enough resources to provide adequate and consistent postpartum checkups to all mothers who undergo virginal delivery. The Cleavan Martin Health Clinic is the main postpartum services and care provider in the locality. The clinic provides care in partnership with the American College of Obstetricians and Gynecologists. This field project shall ensure that the clinic provides the community with continuous postpartum checkups and evaluations to all women who undertake virginal delivery until one year after delivery.
Community diagnosis
Postpartum depression is a common problem among young mothers in Cleaveland. Among the three women who underwent virginal delivery, one experiences postpartum care related issues that lead to emotional effects. All women in the Cleaveland community who underwent virginal delivery qualify for consideration for postpartum care that the project intends to undertake.
Outcomes and goals
The project's desired outcome is to educate and provide consistent postpartum care to all women who undergo virginal delivery. The young mothers shall have all the relevant information on the different challenges associated with virginal delivery to know how to deal with any of the challenges. Evaluation of the young mothers with noted postpartum problems shall be done periodically to ensure there is improved postpartum health and behavior for babies and mothers.
Health intervention
To ensure the field project is a success, various interventions shall be adopted. First is community surveillance to establish the target population for the interventions. Second shall be an investigation of the different postpartum challenges faced by the population. Health teaching, outreach, case finding, and screening, as well as case management in terms of follow-ups and referrals, shall also be made ( Krans, Cochran and Bogen, 2015) . Other interventions shall include advocacy, counseling, free consultation, and coalition building with the community.
Evaluation plan
The project shall involve handling women with postpartum challenges at the clinic and individual homes. There shall be a collaboration between the clinic, the individual patients, and other agencies in the program ( Forster, McLachlan, Davey, Biro, Farrell, Gold and Waldenström, 2016) . A tracking log shall be maintained to ensure the continuous intervention is provided to all women with postpartum related challenges. The outcome shall be evaluated on the level of cases of postpartum depression reported after the project.
Nursing Theorist
Dorothea Orem’s Self-Care Deficit Theory
Patients are often required to present themselves at their best despite their illness or condition, a factor that helps them become more independent after therapy sessions or medical care provided by nurses and physicians. Dorothea Orem’s Self-Care theory is one that covers general concepts in the field of nursing. The theory defines the act of assisting others in an attempt to improve or maintain human function at the basic level of society, their homes (Naz, 2019). It focuses on one’s ability to take care of themselves in maintaining their lives, health, and well-being. What mandates nursing in adults is the inability to maintain a constant flow of self-care, which is important when coping with life changes, diseases, or injury. Regarding women suffering from postpartum depression, self-care deficit is necessitates nursing intervention, especially since these women are emotionally and mentally incapable of caring for themselves. Help granted to these women is in the form of support, guidance, empathy, creating a healthy personal development environment, and learning from one another (Naz, 2019).
Conclusion
Reproductive healthcare remains a key issue in the world, affecting all women regardless of their political or social upbringing. Postpartum conditions occur in one out of seven women, with the likelihood of these numbers increasing because of the continued deteriorating state of the economy. Women who undergo vaginal delivery face the likelihood of suffering emotional turmoil and physical challenges, affecting their socio-economic relationships in general. As such, the need to mitigate this problem remains a task that would require political, economic, and socio-cultural intervention through counseling, advocacy, and training.
References
Forster, D. A., McLachlan, H. L., Davey, M. A., Biro, M. A., Farrell, T., Gold, L., ... & Waldenström, U. (2016). Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum, and postpartum care: results from the COSMOS randomized controlled trial. BMC pregnancy and childbirth , 16 (1), 28.
Krans, E. E., Cochran, G., & Bogen, D. L. (2015). Caring for opioid-dependent pregnant women: Prenatal and postpartum care considerations. Clinical obstetrics and gynecology , 58 (2), 370.
McKinney, J., Keyser, L., Clinton, S., & Pagliano, C. (2018). ACOG Committee Opinion no. 736: Optimizing postpartum care. Obstetrics & Gynecology , 132 (3), 784-785.
Mayo (2019). Labor and delivery, postpartum care. Available at: https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/postpartum-care/art-20047233
Naz, S. (2019). Application of Dorothea Orem’s Theory into Nursing Practice. Journal of Rehman Medical Institute, 3(3-4).
O’Mahony, J. (2017). Critical Ethnography: A Pragmatic Research Methodology to Explore Experiences of Immigrant Women Seeking Help for Postpartum Depression. SAGE Publications Ltd.
Stewart, D. E., & Vigod, S. (2016). Postpartum depression. New England Journal of Medicine , 375 (22), 2177-2186.
Yee, L. M., Martinez, N. G., Nguyen, A. T., Hajjar, N., Chen, M. J., & Simon, M. A. (2017). Using a patient navigator to improve postpartum care in an urban women's health clinic. Obstetrics and gynecology , 129 (5), 925.
