HOME VISITS

ANTEPARTUM,
POSTPARTUM,
NEONATAL & INFANT
VISIT
SHARON J. CAGAS, RM,BSM
 OBJECTIVES

At the end of 4 hours lecture discussion, the learners will

be able to :
1. Define home visits and home service
2. Explain purposes of home visits and home health service
3. Describe phases and activities of home visits
4. List main areas to be assessed during home visits
 A home visit provides a natural
environment to educate the
pregnant/postpartum woman and
her family and enable them to
discuss their concerns and needs
HOME openly.
VISIT
Home visit is the only way to
obtain a comprehensive picture of
the family health status.
 • Home environment is the
most effective way of
increasing family’s
HOME VISIT understanding and
involvement in health
problems.
 HOME VISIT – DEFINITION

Home visit / home health service is the component of a continuum of a

comprehensive health care in which health services are provided to
individuals, and families in their place of residence for the purpose of:
a. promoting maintaining or restoring health
b. maximizing the level of independence
c. minimizing the effect of disability and illness, including terminal
illness.
IT IS IMPORTANT FOR THE
MEMBERS OF THE HEALTH
TEAM TO BE GOOD LISTENERS
OF A FAMILY, ASK RELEVANT
QUESTIONS, UNDERSTAND THE
FAMILY’S CONCERNS, PROVIDE
RELEVANT INFORMATION ON
HEALTH MATTERS, AND HELP
THE FAMILY MAKE A GOOD
DECISION.
 PURPOSES OF HOME VISIT/ HOME
HEALTH SERVICES
1. Afford the opportunity to gain more accurate
assessment of the family structure and behavior in the
natural environment.
2. Provide opportunity to make observations of the home
environment and to identify both barriers and supports
for reaching family health promotion work.
PURPOSES OF HOME VISIT/ HOME HEALTH
SERVICES
3. Meeting the family on their
home ground may also
contribute to family’s sense of
control and active participation
in meeting their health needs.
4. To maximize clients level of
independence.
 ADVANTAGES

1. The family is seen in a familiar atmosphere which is relaxed

and makes communication easier than at the hospital or clinic.

2. All family members can be seen & assessed by one person at

one visit.
3. The health workers, who know the neighborhood, are aware
of local problems, priorities, customs, difficulties, &
resources.
 ADVANTAGES

4. High risk families can be identified & visited as a priority.

5. The health workers, can observe, assess, & act up on obvious and
present health problems.
6. Much can be assessed at one time.
Ex: personal hygiene, water supply, sanitation, waste disposed, food
storage.
 ADVANTAGES

7. More accurate assessment is done.

8. Better understanding & good
relationship is established with the
family members.
9. Advice will be practical and suited
to the family’s needs.
 PHASES OF HOME VISIT

1. PHASE I – INITIATION PHASE

 Clarify source of referral for visit
 Clarify purpose of visit
 Share information on reason and
purpose of home visit
 PHASES OF HOME VISIT

2. PHASE II - PRE VISIT PHASE

 Initiate contact with family
 Establish shared perception of
purpose with family
 Determine family’s willingness
for home visit
 Review referral & family record
PHASES OF HOME VISIT

3. PHASE III – ON HOME

VISIT
 Introduction to self
 Establish midwife client
relationship
 Implement health care
process
 PHASES OF HOME VISIT

4. PHASE IV – TERMINATION PHASE

 Review the visit
 Plan for future visit
5. PHASE V – POST VISIT PHASE
 Record visit
 Plan for next visit
 It is an agreement between the family or
individual family member and the health
worker, to each engage in certain activities
aimed at resolution of mutually defined
FAMILY – problem. Together the health worker and
MIDWIFE family discuss and analyze.
CONTRACT
What stage the
What needs to What goals
goals will be
be changed? should be set?
re-negotiated?
 PURPOSES OF FAMILY – MIDWIFE
CONTRACT

To enhance and support the To help client accomplish the health

client’s active role in health care. related goals.
ANTEPARTUM VISIT
 OBJECTIVES OF
ANTEPARTUM
CARE
To detect diseases which may
complicate pregnancy

Educate women on danger and

emergency signs & symptoms

Prepare the woman and her

family for childbirth
 SCHEDULE OF HOME VISITS
• The CHT members conduct home visits to two types of client:
(a)pregnant women; (b) postpartum women and (3) newborns. For
each type of client, they are expected to conduct 4 home visits.

1st Home visit 1st Trimester (1 – 3 months)

2nd Home visit 2nd Trimester ( 4 – 6 months)
3rd Home visit 3rd Trimester ( 7 – 8 months)
4th Home visit 3rd Trimester ( 9 months)
 MOTHER & CHILD BOOK
• The Mother and Child Book (MC
Book) is to be given to each family
during the first prenatal visit and to be
used until the child becomes 6 years
old.
• It is a comprehensive tool that consists
of the mother’s record, the child’s
record and key health information.
 PURPOSE OF THE MC
BOOK

1. Record important health

information
2. Serve as a guide
3. Teach essential child care tips
4. Serve as a referral tool
5. Serve as a valued childhood
souvenir
 A. What kind of care will be given at
a health facility during a prenatal
I. care visit?
IMPORTANCE 1. Examination of the pregnant
OF woman.
ANTEPARTUM 2. Provision of iron with folic acid
VISIT tablets to prevent anemia and
strengthen her blood.
3. Immunizations to prevent Tetanus.
 Advice on home care for the
pregnant woman and ensuring
healthy growth of the baby.

Preparation for birth at a health

I. center.
IMPORTANC
E OF Information on the danger signs, the
ANTEPARTU importance of seeking early care, family
planning, and feeding an infant and a
M VISIT young child.

Testing for infections such as HIV,

STI’s, and providing treatment and
care if needed.
B. WHY SHOULD A MOTHER DELIVER HER BABY AT
A HEALTHY FACILITY?

1. All women are at risk of complications at childbirth

2. We cannot predict who among the pregnant women will
develop complications.
3. Most maternal deaths occur during labor, delivery, and the
immediate postpartum period.
 How old is the patient?

Past Medical History

Obstetric History: Gravidity? LMP? AOG?

FIRST Alcohol/ Drug/ Substance abuse?

VISIT
Ask about or check record for prior pregnancies:

• Convulsions
• Stillbirth or death in the first day
• Heavy bleeding during or after delivery
• Prior cesarean section, forceps or abortion
 Check Check duration of pregnancy (AOG).

Ask
Ask for bleeding/danger signs during
this pregnancy
Check record for previous treatments
Check
received during this pregnancy
ON ALL
VISITS Prepare Prepare birth and emergency plan

Ask Ask patient if she has other concerns

Give education and counseling on family

Give
planning and breastfeeding
THIRD TRIMESTER
1. Leopold’s exam, fetal heart beat
2. Give education & counseling on
family planning
 HEALTH INFORMATION

Nutrition Self-care Effect of Breast- Birth & Schedule of

during tobacco, feeding Emergency appoint-
pregnancy alcohol & situations ment
drugs
 CHT members should be able to
recognize the danger signs of the
woman during pregnancy, and refer
the client to a health facility
immediately when such cases are
DANGER identified.
SIGNS
DURING
PREGNANC They are also expected to educate
Y pregnant women on the warning
signs during pregnancy.
 Vaginal bleeding

Convulsions

Severe headache
DANGER
SIGNS Severe abdominal pain

Fast or difficult breathing

Fever or burning urination

 II. BIRTH AND EMERGENCY
PLAN
The Birth and Emergency Plan is a mother’s detailed plan of action
for her pregnancy and childbirth. The MC Book contains a “Birth
and Emergency Plan” for each pregnancy.
It allows family to:
• Think ahead and know what needs to be prepared for a safe
delivery
• Decide how to overcome any difficulties they may face.
 II. BIRTH AND EMERGENCY
PLAN
• The plan will be first developed by a pregnant woman
through active consultation with the midwife during her first
prenatal check-up.
•“The
CHT members
Birth and will confirm and
Emergency re-confirm
Plan the planinvolve
should always with the
pregnant woman and members of her family at the community
the woman’s
during husband, partner and family members”
a home visit.
• CHT members will continue to follow up on the status of each
item in her birth plan until the time of her delivery.
 THE BIRTH PLAN
CONTAINS INFORMATION ON:
 the woman’s condition during pregnancy
 preferences for her place of delivery
and choice of birth attendant
 available resources for her childbirth
and newborn baby
 preparations needed should an
emergency situation arise during
pregnancy, childbirth and postpartum.
 EMERGENCY PLAN
Advise on danger signs
Where to go?
How to go?
Who will go with you to the health center?
How much will it cost? Who will pay? How will you pay?
Start saving for these possible costs now
Who will care for your home and other children when you are
away?
POST PARTUM VISIT
 I. IMPORTANCE OF POST PARTUM VISIT

A. Why should the mother attend postnatal care at a health

facility or by a Midwife?
1. Health professionals would examine the mother and 
the  baby to prevent and detect any problem.
2. The mother would receive iron with folic acid tablets 
and advice on family planning. 
3. The baby can receive the necessary vaccinations to protect him/
her from  illness. 
 II. DANGERS SIGNS OF A
POST PARTUM WOMAN
• CHT members should be able to
recognize the danger signs of the
postpartum woman and the newborn,
and refer them to a health facility
when such cases are identified.
 Monitoring and assessment of
Maternal and neonatal well – being

Support for good

caregiving practices
ROUTINE
POST NATAL
CARE Prevention, detection and
treatment of complications

Providing information and

counselling
 WHO’S 12 RECOMMENDATIONS

1. Timing of discharge from a health facility

After an uncomplicated vaginal birth in a health facility,
healthy mothers and newborns should receive care in the
facilities for at least 24h after birth.
For the Newborn immediate assessment at birth, a full clinical
examination around 1 hour after birth and before discharge .
 WHO’S 12 RECOMMENDATIONS

2. Number and timing of postnatal contacts

1st Home visit Within 24 hours
2nd Home visit 1st week (preferably 2 – 3 days
after delivery)
3rd Home visit 2 – 3 weeks
4th Home visit 4 – 6 weeks
WHO’S 12 RECOMMENDATIONS
3. Home visits in the first week
after birth
 care must be done by the
Midwives, other skilled
providers or well- trained and
supervised community health
workers.
 WHO’S 12 RECOMMENDATION

4. Assessment of the baby

5. Exclusive breastfeeding
6. Cord care
7. Other postnatal care for the
newborn
8. Assessment of the mother
9. Counselling
10. Iron and Folic Acid Supplement
11. Prophylactic Antibiotics
12. Psychological support
 OTHER POSTNATAL CARE

*Bathing should be delayed

to after 24 hours of birth. During each postnatal
visit, the newborn should
If this is not possible at all be assessed for signs of
due to cultural reasons, illness and referred if any
bathing should be delayed for sign is present.
at least 6 hours.
ANY QUESTIONS??

THANK YOU!!