MCH

Maternal & Child HealthLIFELONG HEALTH : 

Maternal & Child HealthLIFELONG HEALTH “Children are the future of society, and their mothers are guardians of that future” Pregnancy and childbirth are two very important life change events for the mother, newborn and the family. The health of women and children has always been an important social goal of all societies. Mother and Child: A Single Entity At childbirth, both mother and child are at risk for complications. Health of the child and the mother are closely linked. TORCH infections ---congenital defects. Some specific health interventions jointly protect pregnant women and their babies –e.g. Inj T.T., Iron & Folic acid After birth, the newborn is solely dependent on mother for breastfeeding, care and development. The postpartum care of the mother is inseparable from newborn care, immunization and family planning advice.

STATE OF MATERNAL & CHILD HEALTH : 

STATE OF MATERNAL & CHILD HEALTH

ANTENATAL CARE : 

ANTENATAL CARE The care of women during pregnancy is called antenatal care. This begins soon after conception. The ultimate objective is to have a healthy mother and a healthy child at the end of pregnancy. To promote , protect and maintain health of the mother To detect ‘ at risk’ cases and provide necessary care To provide advise on self care during pregnancy To educate women on warning signals, child care, family planning To prepare the woman for labour and lactation To allay anxiety associated with pregnancy and childbirth To provide early diagnosis and treatment of any medical condition/ complication of pregnancy To plan for “ Birth” and emergencies / complications ( where, how, by whom, transport, blood ) 10. To provide care to any child accompanying the mother OBJECTIVES ANC includes visit to antenatal clinic – min 3 Examination- weight, BP, Per abdomen, Investigations- urine, blood count, Hb, blood group, HIV, VDRL, HBs Ag Immunization- Inj TT x2 doses supplements (Iron, Folic acid, Calcium, Nutritional) and interventions as required. HIGH RISK PREGNANCY Bleeding PV at any point Excessive vomiting Hypertension, proteinuria Severe anemia Abnormal weight gain Multiple pregnancy, hydramnios, oligohydramnios Abnormal presentation in 9th month Preterm Labour, PROM Pre-eclampsia, eclampsia WARNING SIGNS Swelling of feet Convulsions/ unconsciousness Severe headache Blurring of vision Bleeding or discharge per vaginum Severe abdominal pain any other unusual symptom

INTRANATAL CARE : 

INTRANATAL CARE Objectives of Intranatal care Thorough Asepsis (“The Five Cleans” - clean hands, surface, blade, cord, tie) Minimum injury to mother and child To deal with any Complications Care of the Newborn Mild pre-eclampsia PPH in the previous pregnancy More than 5 previous births or a primi Previous assisted delivery Maternal age less than 16 years H/o third-degree tear in the previous pregnancy Severe anaemia Severe pre-eclampsia/eclampsia APH Transverse fetal lie or any other Malpresentation Caesarean section in the previous pregnancy Multiple pregnancies Premature or pre-labour rupture of membranes (PROM) Medical illnesses such as diabetes mellitus, heart disease, asthma, etc. Pregnancy in women who are HIV positive BIRTH PLANNING Where is the birth going to take place? Who will conduct the delivery? Are adequate arrangements available in case of an emergency? What is the arrangement for transportation? If required, what is the arrangement for blood? What is the arrangement for any neonatal resuscitation? Who is going to be the attendant with the mother and child? Is financial support available? INSTITUTIONAL CARE IS MUST IF - Explain all the procedures Praise the woman, encourage her and reassure her that things are going well. Encourage the woman to bathe or wash herself and her genitals at the onset of labour. Always wash your hands with soap and water before examining Ensure cleanliness of the birthing area. Enema should be given only when needed. Encourage the woman to empty her bladder frequently. Non-pharmacological methods of relieving pain during labour ROLE OF BIRTH ATTENDANT

POSTNATAL CARE : 

POSTNATAL CARE The Puerperium is characterized by – 1. Return of generative organs to pre-gravid state, 2. initiation of lactation and 3. Recovery from physical, hormonal and emotional experience of the parturition. Puerperium begins after the placenta is expelled and lasts for 6-8 weeks. AIM The postpartum care is aimed at achieving a Puerperium which is free of any complications and to ensure a healthy newborn. OBJECTIVES 1. Restoration of mother to optimum health 2. To prevent complications of puerperium 3. Provide basic postpartum care and services to mother and child 4. Motivate, educate and provide family planning services 5. To check adequacy of breast feeding HELP IS NECESSARY IF FOLLOWING OCCUR - Bleeding increases. Feels dizzy. Severe headache. Visual disturbance. Epigastric distress. Breathlessness. increased abdominal or perineal pain Puerperal sepsis Urinary tract infections Breast infections Venous thrombosis Pulmonary thromboembolism Puerperal haemorrhage Incontinence of urine Psychiatric disorders POSTNATAL COMPLICATIONS Family Planning methods Postnatal exercises Sexual intercourse Immunization of the Baby Nutrition Rooming in Breastfeeding POSTNATAL ADVICE

Breastfeeding : 

Breastfeeding “The baby at the breast represents the common language of mothering. It is a small miracle, belonging rightfully to mothers, babies, and families the world over.” Risk of neonatal mortality according to time of initiation of breastfeeding Six times more risk of death Children Not Exclusively Breastfed for Six Months are -- Are about: 40% more likely to develop Type 1 diabetes. 25% more likely to become overweight or obese. 60% more likely to suffer from recurrent ear infections. 30% more likely to suffer from leukemia. 100% more likely to suffer from diarrhea. 250% more likely to be hospitalized for respiratory conditions and infections like asthma and pneumonia. Nurse as soon as possible after birth Breastfeed every 1½ -3 hours Do not offer a pacifier for the first 3-4 weeks or until breastfeeding is well established and then use it occasionally “Rooming in” or keeping the infant in the room as much as possible No supplemental bottles of formula or water unless medically indicated Babies are more likely to be alert and ready to feed in the first few hours after birth Frequent feeding establishes milk supply. Babies who use pacifiers in the early weeks and use Them regularly feed less often and their feedings are Shorter,interfering with establishing milk supply These arrangements facilitate frequent nursing and Establishing a good milk supply Supplemental feedings in the early days of Breastfeeding interfere with building milk supply SIGNS OF EFFECTIVE BREASTFEEDING --- Weight loss less than seven percent of birth weight. Three or more bowel movements per day after day one. Seedy, yellow bowel movements by day five. At least six wet diapers per day by day four. Satisfied baby. Audible swallowing. No weight loss after day three; gaining weight by day five. Back to birth weight by day 10. Early Initiation Through Skin-to-Skin Contact SOFTLY – S-Skin to skin contact O-Open eye to eye contact Fingertip touching Time together

Reproductive & Child Health : 

Reproductive & Child Health Reproductive Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity in all matters relating to reproductive system and its functions and processes. “W.H.O.” OBJECTIVES OF RCH- To ensure health & longevity of Mothers & Children To ensure stable population PRINCIPLES OF RCH – Need based, Client centered, Demand driven, High quality Integrated services COMPONENTS - Family Planning MCH Safe abortion services Control of STI/RTI Prevention & Management of Infertility Prevention, detection & treatment of reproductive tract cancers INTERVENTIONS Assistance for administration – funds through SCOVA District projects – Cat A/B/C districts Immunization - Drug & Equipment kits Essential obstetric care Emergency obstetric care Essential newborn care 24 hours delivery services Referral transport Blood supply at FRU MTP services RTI/STI clinics Civil works ISM promotion Programs for slums, tribals & Adolescents Research & Trg IEC NGOs participation MIS Inputs for EsOC - Trg of ANMs & prov of eqpt & drugs - Sup of eqpt to PHCs - Supply of EsOC drug kits to Cat ‘B’ & ‘C’ districts. - To engage PHN/Staff nurse on contract basis to PHCs in Cat ‘C’ districts - In cat ‘C’ dist in remote sub-centres provision of one additional ANM on contract basis - 25% of ANMs of sub centres to be provided loan for mopeds to facilitate movement Inputs for (EmOC) - Strengthening of FRUs – supply of drug kits worth 1.65 lakh to 3 cat ‘B’ & 3 cat ‘C’ districts annually - Provision for appt of contractual staff i.e. PHN/Staff Nurse/ANMs/Lab Tech - Provn of Laparoscope at dist & sub-dist hosp/FRUs - Provn of blood for cases needing surgery at FRU level - Provn of consultant anaesthetist for EmOC (Rs.500 per case) - Funding for Dip in Anaesthesia Essential Newborn Care - Supply of eqpt to all Dist Hosps/FRUs CHCs/PHCs - Trg of med & paramed pers - Provision of basic facilities for care of LBW babies in FRUs/Dist Hosp - Use of low cost, effective & locally available eqpt for new born care - Improvement of maternal care & promotion of birth spacing MTP - Need based trg on MTP at NIHFW - Supply of MTP eqpt to Dist Hosp/CHSc/PHCs - Assistance for engaging doctors trained in MTP at PHCs – Pay Rs.500/- per day & also utilize their services fro ANC & PNC - Supply of MTP eqpt to private clinics if they have OT facilities RTI/STI Clinics - All Dist Hosp, 3 FRUs in cat ‘A’ dists, 2 FRUs in cat ‘B’ dists & 1 FRU in cat ‘C’ dists will be assisted for setting up RTI/STI clinics - Trg through NIHFW - Supply of drug kits

Care of Infant “The greatest risks to life are in its beginning” : 

Care of Infant “The greatest risks to life are in its beginning” Neonatal deaths are caused by - Low birth weight & prematurity Birth injury & difficult labour Sepsis Congenital anomalies Hemolytic diseases of newborn Conditions of placenta & cord Diarrheal diseases Acute respiratory infections Neonatal tetanus Postneonatal mortality caused by - Diaarheal diseases Acute respiratory infection Other communicable diseases-measles, malaria Malnutrition Congenital anomalies Accidents DIRECT INTERVENTIONS - Safe and clean delivery with skilled birth attendant Essential Care of the newborn at birth Newborn resuscitation Infection control measures Exclusive Breastfeeding Early diagnosis and management of complications Special care for the preterm and premature infants ORT and antibiotics for diarrhea and ARI respectively Immunization . INDIRECT INTERVENTIONS Family planning- timing, spacing births, limiting family size Prenatal nutrition of mothers Education of the mother on pregnancy and child care Antenatal care Growth monitoring of child Prevention of malnutrition- weaning practices Breast feeding Vit A prophylaxis Improved Sanitation and safe water Access to primary health care Overall socio-economic development Aims of Neonatal care at birth – Establishment of respiration Prevention of hypothermia Establishment of breastfeeding Prevention of infection Identification of at risk neonates NEONATAL CARE - Warm Chain – prevent hypothermia Examination Care of cord Care of eyes Screening for life threatening anomalies Check patency of orifices DANGER SIGNALS NEWBORN Lethargy, Bleeding from any site, Appearance of jaundice within 24 hours of age or yellow staining of palms or soles, Failure to pass meconium within 24 hours or urine within 48 hours, Persistent vomiting or diarrhea, Poor feeding, excessive weight loss (>10% in term and 15% in preterm), Excessive crying, drooling of saliva or choking during feeding, respiratory difficulty, Apneic attacks or cyanosis, Sudden rise or fall in body temperature, Seizures Evidences of superficial infections such as conjunctivitis, pustules, umbilical sepsis or oral thrush. The word “Infant” is derived from the Latin word, “infans,” meaning “unable to speak.” Perinatal period- Perinatal period extends from 28th weeks of gestation to less than 7 days of life, after birth. Neonate- A child in 1st month [under 4 weeks of age(<28 days)]. Early Neonatal Period- First week of life (<7days or <168 hours). Late Neonatal period extends from 7th to 28th day. Post-Neonatal period- Period of infancy from 28 days to under 365 days (<1 year)

JANANI SURAKSHA YOJNA : 

JANANI SURAKSHA YOJNA JSY is a 100 % centrally sponsored scheme and it integrates cash assistance with delivery and post-delivery care among the poor families. Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The Yojana, launched on 12th April 2005, by the Hon’ble Prime Minister, is being implemented in all states and UTs with special focus on low performing states. MICRO BIRTH PLAN Identification of beneficiary Motivating for institutional delivery Informing mother about birth plan Identifying the referral centre ROLE OF ASHA OR OTHER LINK HEALTH WORKER ASSOCIATED WITH JSY   F     Identify pregnant woman as a beneficiary of the scheme and report or facilitate registration for ANC, F     Assist the pregnant woman to obtain necessary certifications wherever necessary, F     Provide and / or help the women in receiving at least three ANC checkups including TT injections, IFA tablets, F     Identify a functional Government health centre or an accredited private health institution for referral and delivery, F     Counsel for institutional delivery, F     Escort the beneficiary women to the pre-determined health center and stay with her till the woman is discharged, F     Arrange to immunize the newborn till the age of 14 weeks, F     Inform about the birth or death of the child or mother to the ANM/MO, F     Post natal visit within 7 days of delivery to track mother’s health after delivery and facilitate in obtaining care, wherever necessary, F     Counsel for initiation of breastfeeding to the newborn within one-hour of delivery and its continuance till 3-6 months and promote family planning

WAY FORWARD : 

WAY FORWARD

KANGAROO MOTHER CARE : 

KANGAROO MOTHER CARE Skin-to-skin contact is between the baby front and the mother's chest. The more skin-to-skin, the better. For comfort a small nappy is fine, and for warmth a cap may be used. Skin-to-skin contact should ideally start at birth, but is helpful at any time. It should ideally be continuous day and night, but even shorter periods are helpful. Exclusive breastfeeding means that for an average mother, expressing from the breasts or direct suckling by the baby is all that is needed. For very premature babies, supply of some essential nutrients may be indicated. Support to the dyad means that whatever is needed for the medical, emotional, psychological and physical well being of mother and baby is provided to them, without separating them. This might mean adding ultramodern equipment if available, or purely intense psychological support in contexts with no resources. The Four Basic Biological Needs are… 1. Oxygenation 2. Warmth 3. Nutrition 4. Protection KMC – OXYGENATION Oxygen saturation improves on Kangaroo Mother Care Heart rate and breathing of an infants stabilizes on KMC. KMC – WARMTH Minute by minute temperature are higher and stable. A mother’s core temperature can rise two degrees °C. If baby is cold and falls if baby is hot. KMC - NUTRITION Infants on Kangaroo Mother Care eat more and more often. Nutrition is improved, both with respect to the mother’s ability to breastfeed, and the newborn’s ability to better utilization of the milk already fed. Even without increased milk intake, with the vagal stimulation the infant receives, the gut is better able to use the milk provided and baby grows faster. KMC - Protection Preterm infants experience prolonged severe stress with tenfold increases in stress hormones. Stress hormones at such levels are neurotoxic. Improved Immunity against diseases and infections. Kangaroo Baby… - has physical protection from Mother - has immune protection from Mother’s milk - has neurological protection from stress - has better immunity later in life Definition: A universally available and biologically sound method of care for all newborns, but in particular for premature babies, with three components ... 1. Skin-to-skin Contact 2. Exclusive breastfeeding 3. Support to the mother infant dyad. This has been defined as "intra-hospital maternal-infant skin-to-skin contact". KC is generally started later, and on stabilized prematures, and is used an adjunct to technological care. Continuation of Skin-to-Skin contact improves the infants: ♥ State organization ♥ Temperature regulation ♥ Respirations ♥ Oxygen saturation ♥ Weight gain ♥ Earlier discharge from Hospital ♥ Ability to get colostrum/breastmilk ♥ Ability to stimulate a combinations of hormonal responses (oxytocin/cuddling and prolactin/mothering) in mother which increases bonding instincts Skin-to-Skin reduces: ♥ Apnea ♥ Hypothermia ♥ Hypoglycemia