DME.111 Domiciliary care – Nurses Online Discussion

Diploma in Midwifery

Domiciliary care is obstetric care provided to a woman in her own home during pregnancy, labor, and the postpartum period (puerperium).

Type 1: Continuity of Care:
- A single midwife provides comprehensive care at home throughout the entire maternity cycle (antenatal, delivery, postnatal).
- Hospital visits only occur when specialized care or equipment is needed.
- Also called “fragmented care.”
Type 2: Integrated/Centralized Care:
- Care is divided between home and a health facility.
- For example, antenatal care and delivery might be in a hospital, while postpartum care is at home.
- Commonly used in midwifery training programs.
Type 3: Independent Practitioner:
- A midwife practices privately in the community, not necessarily limited to one woman.
- May have a maternity center or combine it with one-on-one community midwifery.
- Most common type of domiciliary care in Uganda.

Forms of Domiciliary Care Depend On:

Objectives of Domiciliary Care

Care Before Conception:
- Health education for young girls (nutrition, hygiene, life skills).
- Tetanus toxoid immunization.
- Adolescent counseling (reproductive health, social issues).
Care During Pregnancy:
- Immunization.
- Antenatal check-ups.
- Treatment of minor issues.
- Health education on pregnancy complications.
Care During Labor:
- Labor support and monitoring.
- Use of a partograph.
- Delivery of the baby.
- Infection prevention.
Care After Delivery:
- Immunization.
- Mother and baby care.
- Postnatal exercises.
- Family planning.

Enhanced Midwife-Mother Relationship: Reduces fear and promotes trust.
Continuity of Care: Close supervision, contributing to reduced maternal/infant morbidity and mortality.
Increased Access: Services are brought directly to the woman.
Cost-Effective: Potentially reduces unnecessary expenses.
Increased Accessibility: Bringing midwifery care closer to the community.
Family Involvement: Encourages participation and support from partners and family members.
Reduced Workload for Midwives: Allows for focused care on one woman at a time.
Reduced Hospital Overcrowding: Lessens the burden on health facilities.
Mutual Understanding: Fosters better communication and understanding between the midwife and the woman.
Maintains Woman’s Home Responsibilities: Allows women to continue supervising their homes.
Peace of Mind: Provides comfort and reassurance to the family.
Woman-Centered Care: Promotes choice, control, and continuity of care.
Privacy and Security: Respects the mother’s privacy and minimizes interference.
Improved Communication: Facilitates open and relevant information sharing.
Midwife Autonomy and Job Satisfaction: Empowers midwives and increases job satisfaction.
Professional Development: Enhances creativity, problem-solving skills, and experience.

Historically: Women have relied on skilled individuals (often other women) for childbirth assistance.
United Kingdom: Midwives’ roles are expanding into public health.
Uganda:
- 1960s: Midwives provided home-based antenatal, delivery, and postnatal care.
- 1970s: Due to political instability and insecurity, deliveries shifted to hospitals and maternity units, but midwives continued postnatal home visits.
- Present: Practiced by private midwives and student midwives.

Group 1: Low-Risk Women:
- Women who have had 1-4 previous deliveries (gravida 2-4) without major complications.
- Can receive complete care (antenatal, labor, postpartum) in the community.
Group 2: Women with Potential Complications:
- Primigravida (first-time pregnancy), grand multipara (more than 4 deliveries), women under 152 cm tall, history of complications (e.g., cord prolapse).
- May receive partial domiciliary care depending on assessed risk.
Group 3: High-Risk Mothers:
- Women with obvious complications or high risk of developing them (e.g., multiple pregnancy, cardiac disease, diabetes, sickle cell disease).
- Generally, not suitable for domiciliary care.

Common Drugs Used in Domiciliary Care

Booking:

Criteria for Home Delivery:
- Normal pregnancy without risk factors (e.g., CPD, grand multiparity, multiple pregnancy).
- Adequate home environment:
  - Well-ventilated, uncrowded.
  - Clean, hygienic.
  - At least 4 bedrooms, toilet, kitchen.
  - Cemented floor.
  - Tap water.
  - Means for boiling water.
- Sufficient supplies for mother and baby.
- Willingness of both husband and wife.
- Home within 2 miles of a hospital.

Qualified senior student midwife or registered midwife with sufficient knowledge.
Friendly and respectful, understanding she is a guest in the family’s home.
Flexible and adaptable to the family’s routine.
Avoids giving orders, provides advice instead.
Shows interest in the family.
Avoids embarrassing the mother.
Adheres to professional code of conduct.
Makes quick and accurate judgments.

Domiciliary Bags: Essential equipment for the midwife, including:

Care in Uganda:

Mothers are typically delivered in the hospital.
Postpartum care is provided at home for 7 days (including the first day in the hospital).

Antenatal Care:

Booking typically occurs at the first visit around 12 weeks.
The midwife assesses the home environment.
Care continues until delivery in the hospital, followed by 2 days of hospital care and 5 days of home care.

Daily home visits by the midwife.
Additional visits if complications arise or extra support is needed.
Assessment of the mother’s physical and mental well-being.
Inquiries about the baby’s feeding, sleeping, and elimination.
Emotional support and problem-solving.
Monitoring of vital signs and postpartum physical examination (breasts, abdomen, lochia, perineum).
Postnatal exercises are taught and encouraged.
Assistance with bathing on the first day, then the mother manages independently.
Emphasis on rest, sleep, and hygiene.
Daily baby examination (skin, eyes, mouth, cord, feeding, elimination).
Advice on when to return to the postnatal clinic and health clinic.
Health education and demonstration of postnatal exercises

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