FAMILY & HEALTH

SERVICES SUPPORT
PRESENTED @ STIKES AISIYAH YOGYAKARTA
Wednesday, 23-3-2016

ADOLESCENT SUPPORT

ROLE OF FAMILY IN

ADOLESCENT
DEVELOPMENT

Developmental theories view adolescence as a period

of growth in which identity formation is addressed
This can be interpreted to mean that the role of family
is lessening or that family have only a limited role in
the lives of young people at this time

ROLE OF FAMILY IN

ADOLESCENT
DEVELOPMENT

Research shows, however, that ongoing positive family

connections are protective factors against a range of health
risk behaviours.
The continuity of family connections and a secure emotional
base is crucial for the positive development of young people

ADOLESCENTS FEATURE IN NEW

HEALTH AGENDAS
Focus on the adolescent phase
of the life-course is crucial not
only for the unfinished MDG
agenda, but also for new public
health agendas.
The health-related behaviours
and conditions that underlie the
major noncommunicable
diseases usually start or are
reinforced during the second
decade:
tobacco and alcohol use,
diet and exercise patterns,
overweight and obesity.

These behaviours and conditions

have a serious impact on the
health and development of
adolescents today but
devastating effects on their health
as adults tomorrow.

ADOLESCENTS FEATURE IN NEW

HEALTH AGENDAS
one in every four
adolescents meets
recommended guidelines
for physical activity; as
many as one in every three
is obese in some countries;
at least half of younger
adolescent boys report
serious injuries in the
preceding year.
half or more of 15-yearolds who are sexually
active report do not use
condoms
cigarette smoking.

ADOLESCENCE IS A KEY PHASE OF

HUMAN DEVELOPMENT
The rapid biological and psychosocial
changes that take place during the
second decade affect every aspect of
adolescents lives.
These changes make adolescence a
unique period in the life-course in its
own right, as well as an important
time for laying the foundations of
good health in adulthood.

DISEASES AND HEALTHRELATED BEHAVIOURS DURING

ADOLESCENT

the epidemiological transition that takes place

during the second decade from infectious
diseases to noncommunicable conditions.
At the same time, health problems and
behaviours that arise during adolescence
chronic illnesses and alcohol use, for example
affect physical and cognitive development.
Adolescents evolving capacities affect how they
think about their health, how they think about the
future, and what influences their decisions and
actions.
All of this has implications for the types of
interventions needed and how programmes
should be implemented.

COMBINING FORCES FOR

ADOLESCENT HEALTH
Many sectors must participate
Adolescents are one of the groups that existing
health services serve least well.
Health services do have a key role to play in
responding to and treating health
problems and health related behaviours
and conditions that arise during the second
decade.
They should also be able to provide
information and respond to adolescents and
parents concerns about adolescent
development.

COMBINING FORCES FOR

ADOLESCENT HEALTH
Many sectors must participate
Prevention of adolescent pregnancy, HIV
prevention, treatment and care and the
provision of HPV vaccines are important
entry points for improving the provision
of health services to adolescents.
Now health services need to move
beyond these issues to address the full
range of adolescents health and
development needs.

COMBINING FORCES FOR

ADOLESCENT HEALTH
Many sectors must participate
Open communication between the health
professional and the adolescent is essential.
Physicians and other health professionals should
ensure that the adolescent has not voiced or
otherwise indicated to his or her partner that
sexual activity was unwanted or undesirable and
that the partner is not placing physical or
emotional pressure on the adolescent.
Physicians and other health professionals should
encourage communication about sexual
decision-making between adolescents and their
families, and should counsel sexually active
adolescents about potential health risks.

ADOLESCENTS NEED TO BE
INVOLVED IN DECISIONS AND
ACTIONS

Adolescents are a force for their own

health and for the health of their
families and communities. They are
actors for social change, not simply
beneficiaries of social programmes.
Their participation needs to be
advocated and facilitated, all the
more so since many of them are legally
minors, children in terms of the
Convention on the Rights of the Child.

ANTENATAL SUPPORT
Women undergo many emotional and physical changes
during pregnancy.
Family support can help lower down the anxieties associated
with pregnancy and provide a feeling of security for herself
and her baby

ANTENATAL SUPPORT
Remember that loving support from the family
can significantly contribute to a healthy
pregnancy, childbirth and parenting experience.
1. Identify member of
family who would
support.
2. Designate one member
of the family.
3. Pregnant woman must
be accompanied to
prenatal visits.
4. Pregnant woman must
not be alone at big

FAMILY SUPPORT

Family support can serve as the foundation of security and

growth for an expectant mother and baby.
Expert suggests that family support has a positive impact on
the attitude of pregnant women, including women with an
unwanted pregnancy.

FAMILY SUPPORT
MEMBER
Initially it is important to
identify a family member
who can be readily
available throughout the
entire pregnancy.
It can be the to-be father,
in-laws, parents or even a
close friend.
This person must be
committed and be with her
from the very start of
pregnancy i.e. as soon as
the pregnancy is
established.

PRENATAL VISITS

Ideally one or two members must accompany a pregnant

woman during every prenatal visits to her doctor. This will
even help the family members connect with baby and also lend

PRENATAL VISITS
Expectant mothers must
be accompanied for
prenatal visits to
gynecologist's or midwife's
office, prenatal classes,
tests during pregnancy and
finally, for labour and
delivery.

PRENATAL VISITS
Make sure to be with her
during big events. For
instance, when the first
ultrasound comes or at the
time when the unborn
baby's first heart beat is
detected. The magic of
these prenatal events
becomes even more
memorable when shared
with loved ones.

PRENATAL VISITS
Being physically present is
not enough. Family
members must try to know
about pregnancy and of
possible ways to support an
expectant mother and also
appear participative in
nature.

SUPPORTING WOMEN IN
LABOUR

Studies have suggested four dimensions to

the support that women want in labour:
emotional support; informational
support; physical support and
advocacy (Hodnett et al. 2011; MIDIRS 2008; NICE 2007).

SUPPORTING WOMEN IN
LABOUR
Midwives should support women in use
of coping strategies (breathing,
relaxation and positions) in labour as
use is associated with benefits in
terms of pain and womens
emotional experiences of labour
(Spiby et al. 2003; Spiby et al. 1999).

SUPPORTING WOMEN IN
LABOUR

Support from the midwife may include helping

the woman in her wish to avoid
pharmacological pain relief or helping her
choose among pharmacological and nonpharmacological methods of pain relief
(Enkin et al. 2000).

SUPPORTING WOMEN IN
LABOUR

Midwives should keep up to date with nonpharmacological methods of pain relief.

These include water, positions and
movement, massage, coping strategies and
alternative therapies (Simkin and Bolding
2004; Mander 1998).

INTRAPARTUM SUPPORTS
1. Emotional support, includes
presence, demonstrating an
effective caring attitude, positive
and calming verbal expressions and
non-verbal expressions, distraction,
use of humour.

INTRAPARTUM SUPPORTS
2. Physical support and
comfort measures, including
environmental control,
encouragement of different
positions and mobilisation,
touch, massage, application
of hot and cold packs,
hygiene, hydrotherapy,
promotion of urinary
elimination and nourishment.

INTRAPARTUM SUPPORTS
3. Information and advice, includes
listening to womens views, instruction
on breathing and relaxation,
information about routines, procedures
and progress.

INTRAPARTUM SUPPORTS
4. Advocacy, includes protecting the
client, assisting the client to make
informed choices, being the clients
voice when required and conflict
resolution.

POSTPARTUM SUPPORTS

The days and weeks following childbirth the

postnatal period is a critical phase in the lives
of mothers and newborn babies. Most maternal
and infant deaths occur during this time.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Number and timing of postnatal contacts
1. If birth is in a health facility, mothers
and newborns should receive
postnatal care in the facility for at least
24 hours after birth.
2. If birth is at home, the first postnatal
contact should be as early as possible
within 24 hours of birth.
3. At least three additional postnatal
contacts are recommended for all
mothers and newborns, on day 3 (48
72 hours), between days 714 after
birth, and six weeks after birth.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Home visits for postnatal care
Home visits in the first week
after birth are recommended
for care of the mother
and newborn.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Assessment of the baby
The following signs should be assessed during each postnatal care contact
and the newborn should be referred for further evaluation if any of the signs is
present:
stopped feeding well, history of convulsions, fast breathing (breathing rate
60 perminute), severe chest in-drawing, no spontaneous movement,
fever (temperature 37.5 C), low body temperature (temperature <35.5
C), any jaundice in first 24 hours of life, or yellow palms and soles at any age.

The family should be

encouraged to seek health
care early if they identify any
of the above danger signs inbetween postnatal care visits.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Exclusive breastfeeding
All babies should be
exclusively breastfed
from birth until 6
months of age.
Mothers should be
counselled and
provided support for
exclusive
breastfeeding at each
postnatal contact.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Baby Cord care
Daily chlorhexidine application to
the umbilical cord stump during
the first week of life is
recommended for newborns who
are born at home in settings with
high neonatal mortality (30 or
more neonatal deaths per 1000
live births).
Clean, dry cord care is
recommended for newborns born
in health facilities and at home in
low neonatal mortality settings.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Other postnatal care for the newborn
Bathing should be delayed until
24 hours after birth. If this is not
possible due to cultural reasons,
bathing should be delayed for at
least six hours.
Appropriate clothing of the baby
for ambient temperature is
recommended. This means one to
two layers of clothes more than
adults, and use of hats/caps.
The mother and baby should not
be separated and should stay in
the same room 24 hours a day.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Assessment of the mother
First 24 hours after birth

All postpartum women should have

regular assessment of vaginal
bleeding, uterine contraction, fundal
height, temperature and heart rate
(pulse) routinely during the first 24
hours starting from the first hour
after birth.
Blood pressure should be measured
shortly after birth. If normal, the
second blood pressure measurement
should be taken within six hours.
Urine void should be documented
within six hours.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Assessment of the mother
Beyond 24 hours after birth

At each subsequent postnatal

contact, enquiries should continue to
be made about general well-being
and assessments made regarding the
following: micturition and urinary
incontinence, bowel function, healing
of any perineal wound, headache,
fatigue, back pain, perineal pain and
perineal hygiene, breast pain, uterine
tenderness and lochia.
Breastfeeding progress should be
assessed at each postnatal contact.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Assessment of the mother
Beyond 24 hours after birth
At each postnatal contact, women should
be asked about their emotional wellbeing,
what family and social support they have
and their usual coping strategies for
dealing with day-to-day matters.
All women and their families/partners
should be encouraged to tell their health
care professional about any changes in
mood, emotional state and behaviour
that are outside of the womans normal
pattern.
Women should be observed for any risks,
signs and symptoms of domestic abuse.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Counselling
All women should be given information
about the physiological process of
recovery after birth, and that some
health problems are common, with
advice to report any health concerns
to a health care professional
Women should be counselled on
nutrition.
Women should be counselled on
hygiene, especially handwashing.
Women should be counselled on birth
spacing and family planning.
Women should be counselled on safer
sex including use of condoms.

2013 WHO RECOMMENDATIONS

ON POSTNATAL CARE
Iron and folic acid supplementation

Iron and folic acid supplementation

should be provided for at least three
months.*

HEALTH SERVICES SUPPORT

Advice and support to the woman and her family
for
developing healthy home behaviours and a birth
and
1. Increase awareness of maternal and newborn health
emergency preparedness plan to:

needs and self care during pregnancy and the postnatal

period, including the need for social support during and
after pregnancy
2. Promote healthy behaviours in the home, including
healthy lifestyles and diet, safety and injury prevention,
and support and care in the home, such as advice and
adherence support for preventive interventions like iron
supplementation..
3. Support care seeking behaviour, including
recognition of danger signs for the woman and the
newborn as well as transport and funding plans in case
of emergencies

HEALTH SERVICES SUPPORT

Advice and support to the woman and her family
for
developing healthy home behaviours and a birth
and and her partner
4. Help the pregnant woman
emergency
preparedness
plan to:for birth
prepare
emotionally
and physically
and care of their baby, particularly preparing for
early and exclusive breastfeeding and essential
newborn care and considering the role of a
supportive companion at birth
5. Promote postnatal family planning/birth
spacing