postpartum

CHAPTER I
INTRODUCTION
1.1 Background
The postpartum or puerperium is a stage that produces changes and adaptations in women, couples and family. Effective coping, during this stage, depends on the relationship between the demands of stressful or difficult situations and the recourses that the puerperal individual has. Roy (2004), in her Middle Range Theory about the Coping and Adaptation Processing, defines Coping as the ''behavioral and cognitive efforts that a person makes to meet the environment demands''. For the puerperal individual, the correct coping is necessary to maintain her physical and mental well being, especially against situations that can be stressful like breastfeeding and return to work. According to Lazarus and Folkman (1986), a resource for coping is to have someone who receives emotional support, informative and / or tangible.
Early detection and adequate treatment is required. Approximately 25% - 85% of postpartum women will experience the "blues" for a few days. Between 7% and 17% may experience clinical depression, with a higher risk among those women with a history of clinical depression. Rarely, in 1 in 1.000 cases, women experience a psychotic episode, again with a higher risk among those women with pre-existing mental illness. Despite the wide spread myth of hormonal involvement, repeated studies have not linked hormonal changes with postpartum psychological symptoms. Rather, these are symptoms of a pre-existing mental illness, exacerbated by fatigue, changes in schedule and other common parenting stressors.
The unmet need for safe and effective contraceptive services throughout the world is staggering. Despite their desire to avoid or delay pregnancy, roughly 215 million women in developing countries rely on traditional methods only, which have a high failure rate, or do not use any contraceptive method at all. According to a recent survey of 65 countries, the unsatisfied demand for contraceptives exceeds actual use in at least 30 countries.
At least one in four women seeking to avoid pregnancy is not using an effective contraceptive method. Women with unmet need for modern contraceptives account for 82 per cent of unintended pregnancies. Addressing the unmet need for contraceptive information and services would result in roughly 22 million fewer unplanned births, 25 million fewer induced abortions, and 150,000 fewer maternal deaths each year.
Lack of access to modern contraceptive information and services means that women and adolescents are often unable to protect themselves from HIV and other sexually transmitted infections (STIs) or to control their fertility and reproduction. Both of these situations carry negative consequences for women’s and adolescents’ health and lives. Worldwide, approximately 33 million people are living with HIV, and 340 million new cases of curable STIs (such as syphilis, gonorrhea, chlamydia, and trichomoniasis) in adults aged 15–49 years occur annually. Of the approximately 80 million women who annually experience unintended pregnancies, 45 million have abortions. In countries where abortion is highly restricted or inaccessible, women often resort to clandestine abortions, which are frequently unsafe and pose a serious risk to their health and lives. Complications from unsafe abortions are a leading cause of maternal morbidity, and approximately 68,000 women die from unsafe abortions each year. Satisfying the current unmet need for contraceptives could prevent roughly 150,000 maternal deaths and 25 millioninduced abortions worldwide annually (UNFPA, 2010).
When no contraception is used by presumably fertile sex partners, about 90% of the women will conceive within 1 year. Women who do not want to become pregnant are best advised to use contraception whenever they become sexually active, no matter how young. At least some girls-perhaps the majority-ovulated before their first menstrual period. For older women aged 40-50, ovulation was shown in one study to be more closely related to regularity of menstruation than to age (Gant, 1993).
There are so many kinds current methods of contraception. In this study we talking about barrier method of contraception.
This study contains the review of the issue of the puerperium as a process of coping and adaptation, considering that this stage involves psychological adaptations for women and explaining about the barrier method of contraception.

1.2 Problem
1.3 Destination
Manage the normal puerperium.
Assess a patient at the six-week postnatal visit.
Diagnose and manage the various causes of puerperal pyrexia.
Recognise the puerperal psychiatric disorders. 1.4 Purpose the need to recognize the puerperium as a stage that requires comprehensive care is evident, where midwifes must be protagonist with the care offered to women and their families, considering the specific demands of this situation and recourses that promote effective coping and the family, education and health services.