11
Personal hygiene care for women
Good personal hygiene is of paramount importance in maintaining good health. Maternity clients are not usually ill but are vulnerable to infection. In addition, the maternity population is becoming increasingly high risk, with rising numbers of women entering pregnancy with a pre-existing medical condition and/or requiring delivery by caesarean section. Sepsis in pregnant or newly delivered women can have fatal results.
General advice
Personal hygiene care addresses care of the whole woman, including oral hygiene, nail care and hair care. It may also include cleanliness of clothing. Women who are self-caring should be advised to shower or bathe regularly and also change their clothes regularly. Hand washing before and after using the toilet or changing sanitary pads is essential. The woman should be made aware of the signs of infection so that she can seek help early. Midwives who suspect infection in a pregnant or newly delivered woman should refer her for medical attention as soon as possible.
Women who are unable to attend to their own personal hygiene should be offered assistance with this aspect of care.
Bed bathing
Purpose: To maintain comfort, reduce infection risk and maintain morale.
Procedure: Two people are required if the woman is unable to move herself. The woman should be offered a bedpan and analgesia before the procedure and any specific personal or cultural requirements are noted (Table 11.1). In the interests of comfort and dignity, if the woman can wash herself she should be encouraged to do so, the assistant passing clean flannels and towels as needed. Equipment such as washing bowls should be disposable if possible. If not disposable, they should be thoroughly cleaned before and after use. The water should be changed at least once during the procedure to maintain warmth and cleanliness. During the procedure any vaginal loss such as amniotic fluid, or blood/lochia should be noted and recorded.
Equipment:
- Clean nightwear/clothing
- Sanitary pads if needed
- Clean bed linen, including disposable bed pads
- Laundry skip
- Apron, gloves and clinical waste bag
- Washing bowl
- Soap and two disposable cloths or flannels
- Toiletries as requested by the woman
- Two towels
- Hairbrush or comb.
Additional equipment may include oral care items, nail care items, slide sheet or other manual handling equipment, and antiembolism stockings, as necessary.
The procedure is outlined in Table 11.1.
Once the bed bath is completed the woman should be asked about her comfort level and if she has any other care needs. All personal care is documented in the notes.
Oral hygiene
Purpose: To promote comfort and wellbeing, remove food particles and protect the health of oral tissues.
Procedure: The assistance may be limited to be offering the required equipment; if the woman is not able to carry out her own oral care this should be done for her to avoid oral infections such as candidiasis (thrush). Poor oral hygiene has an impact on general health and wellbeing. Women who are nil by mouth, who are vomiting, who have a nasogastric tube in situ or who are having oxygen therapy are in particular need of attention to oral hygiene.
Key points:
- Maintain privacy and dignity – screen the bed.
- Use the woman’s own toothbrush and toothpaste if possible.
Equipment: toothbrush, toothpaste, towel, water to rinse, receiver to spit into.
Emollients such as lip balm may help if the lips are dry or cracked. Petroleum-based products must not be used if the woman is having oxygen therapy as there is a theoretical risk of burns. Water-based products are safer and the pharmacist will advise on which is suitable.
If the woman is unable to self-care
Equipment: towel, small, soft-bristled toothbrush, toothpaste, water to rinse, lip balm, receiver to spit into, clinical waste bag, disposable gloves and apron. A small torch and a spatula are useful to inspect the oral cavity. Foam sticks are not recommended as they do not clean the mouth effectively. If they detach from the holder they are a choking hazard.
Procedure:
- Collect equipment, ensure privacy, wash hands and put on gloves and apron.
- Inform the woman and gain consent.
- Position her on her side, with the towel beneath her head.
- Observe the state of the oral tissues.
- Apply a small (pea-sized) amount of paste to the (dry) toothbrush and gently clean the teeth, gums and tongue.
- Ask the woman to rinse her mouth with water and spit into the receiver. If she is unable to, rinse the toothbrush and use the wet brush to rinse the mouth.
- Dry the lips and face.
- Apply lip balm if required (and if not receiving oxygen therapy).
- Reposition the woman.
- Clean and dry the toothbrush; dispose of equipment.
- Document.
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