Jul 12, 2011

traditional postnatal services?

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i had mixed feelings when i read about this in The Star...

KOTA BARU: The first traditional and complementary postnatal service for mothers has been set up at a rural clinic here.

The service at Jalan Bayam provides postnatal massage as well as sauna and herbal treatment.

State health deputy director (Public Health) Dr Wan Mansor Hamzah said the centre was the first in the country that enabled mothers to obtain traditional treatment right after giving birth.

The setting up of the service at the clinic cost less than RM3,000 and packages are expected to cost around RM60.

To be honest, totally, postnatal service in Malaysia is probably the best, if not, up to standard of health care of a first world country, although, the third-world-mindset citizen who received such a privileged service wouldn't think so.

I did not comment the above from a medical doctor's perspective, but as a husband to my wife who received good postnatal service. The community nurse rode a RX5 and came to my rented house and did the necessary check up with her simple postnatal check up kit. All done within less than 30mins and she started her journey to other postnatal mothers' home.
Ladies are being spared off the painful walk with the perineal trauma to the clinics. Even the privates do not provide such service. But then, they are lacking in giving contraceptive advices.

Let me critically appraised the postnatal complementary service of massage, sauna and herbal treatment.

As it is complementary, the role of such service is not recommended by professional bodies, neither within or outside of country. Recommendation for postnatal care as recommended by NICE, UK is clearly summarized here.

Therefore, there are no clear evidence of benefits, but preliminary reports from reviews of such traditional services, shows that it will relax down and slim down the mothers.

The relaxation may be beneficial in improving maternal health, preventing postnatal depression. Slimming down the ladies will offer positive results in reducing maternal obesity and the well-fretful metabolic syndrome.

One of the downside of these traditional treatment is the unknown effect towards the practice and physiology of breastfeeding.

Secondly, financially channelling the cost of public health allocation to this unrecognized service will take away the necessary focus on some part of the postnatal care that is still very lacking such as contraception initiative.

The current contraception take-up rate in Malaysia is hovering around 30%, which is a very disappointing low rate. As the community failure of taking up adequate contraception, the public health postulated it was all due to our socio-cultural of being thankful for all God's gift, even if the gift means 12 kids, one year apart, nightmare adhesions after 4 C-Sections and a life-saving hysterectomy because of atony. Ever consider the invention of contraception as the God's gift?

Thirdly, the lack of transparency in selecting which traditional practitioners for the complimentary treatment concession is another questionable income flow within the public health expenditure.

Lastly, lacking of audit and control of the practice of this treatment may have detrimental effects. For instance, abdominal massage for patient post C-Section may induce uterine rupture. Wrongly given advice on putting traditional paste on the episiotomy wound to make it hasten healing may caused wound infection leading to wound breakdown.

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My sentiment really is when you're complimenting, supporting and approving non-evidence-based traditional practice, you offended the main practice of medicine.

At the very least, do your best in your primary duty, before embarking on additional stuff.
It is vital that focus and re-focus on contraception be stressed, to prevent more unplanned, unwanted pregnancy, and in a way, reduce maternal mortality as being advocated in our Millennium Development Goal 5.

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