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Introduction to maternal
 

Introduction to maternal

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    Introduction to maternal Introduction to maternal Presentation Transcript

    • Introduction to Maternaland Child health
    •  70% of the population of developing
      countries
       In India women of child bearing age (15-
      44 Yrs) are 19%
       Children under 15 years 40%
       Together 59%
       They are vulnerable or special –risk group
       Risk –connected with childbearing for
      women
       Growth development and survival
      -children
    •  50% of deaths are above 70 yrs of age
       Same among under-five children
       Maternal mortality rates vary from 13- 440 per
      100000 live births
       Sickness and deaths among mothers and children
      are largely preventable
       This have led to the formation of special health
      services for mother and children all over the
      world
       The present strategy is to provide maternal and
      child as an integrated package of “Essential
      health care” also known as “Primary health care”
    • Mother and child as one unit- because
      1. During the antenatal period , the fetus is part
      of the mother – development – 280 days,
      during this period fetus receives nutrition and
      oxygen from the mother
      2. Child health is closely related to maternal
      health; a healthy mother brings forth a
      healthy baby; there is less chances of
      premature, still birth or abortion
    • 1. Certain diseases and conditions of the
      mother during pregnancy ( eg. Syphilis,
      German measles, drug intake) are likely to
      have their effects on the fetus
      2. After birth, the child is dependant on the
      mother. Up to 6 - 9 months completely for
      feeding. The mental and social
      development is also dependant on the
      mother, if the mother dies the child's
      growth and development are affected
      (maternal deprivation syndrome)
    • 1. In the care cycle of women, there are few
      occasions when the service of the child is
      simultaneously called for . For instance
      post partum care is inseparable from
      neonatal care and family planning advice
      2. The mother is also the first teacher of the
      child
    • Obstetrics, Pediatrics and PSM
       In the past , maternal and child health services were rather fragmented and provided
      piecemeal “ personal health services” by
      different agencies, in different ways and
      separate clinics the current trend in many
      countries is to provide integrated MCH and
      family planning services as compact family
      welfare service
    •  This implies a close relationship of
      maternity health to child health, of
      maternal and child health to the health of
      the family; and of family to the general
      health of the community
       In providing these services , specialists in
      obstetrics and child health have joined
      hands , and are now looking beyond the
      four walls of hospitals into community to
      meet health needs of mothers and children
      aimed at positive health
    •  In the process they have linked to
      community medicine( preventive and
      social medicine ) and as a result , terms
      such as “social obstetrics” , “preventive
      pediatrics” and “social pediatrics” have
      come into vogue
    • Obstetrics
       Obstetrics is largely preventive medicine
       The aims are same, to ensure that throughout
      pregnancy and puerperium, the mother will have
      good health and that every pregnancy may culminate
      in a healthy mother and healthy baby
       The age old concept that obstetrics is now
      considered as a very narrow concept, and is being
      replaced by the concept of community obstetrics
      which combines obstetrical concerns with the
      concepts of primary health care
    • Social obstetrics
       Gained usage in recent years
       Defined as the study of the interplay of social
      and environmental factors and human
      reproduction going back to the
      preconceptional or even premarital period
    •  The social and environmental factors
      which influence human reproduction are a
      legion viz. age at marriage , childbearing,
      child spacing , family size , fertility
      patterns, level of education, economic
      status , level of education, economic
      status , customs and beliefs, role of women
      in society , etc.
       The social and obstetric problem in India
      differs from other developed countries
    •  While accepting the influence of
      environmental and social factors on human
      reproduction, social obstetrics has yet
      another dimension, that is influence of
      these factors on the organization, delivery
      of comprehensive MCH services including
      family planning so that they could be
      brought within the reach of the total
      community
    • Preventive pediatrics
       Like obstetrics pediatrics has a large component of
      Preventive and Social Medicine
       There is no other discipline that teaches the value of
      preventive medicine
       Recent years have witnessed further specialization
      within the broad field of pediatricsviz preventive
      pediatrics, social pediatrics, neonatology,
      perinatology, developmental pediatricspediatric
      surgery, pediatric neurology
    •  Preventive pediatrics comprises efforts to
      avert rather than cure disease and
      disabilities
       It has been broadly divided into antenatal
      pediatrics and postnatal pediatrics
       The aims of preventive pediatrics and
      preventive medicine are the same –
      prevention of disease and promotion
      physical , mental and social well being of
      children so that each child may achieve
      genetic potential with which he is born
    •  To achieve these aims , hospitals for
      children have adopted the strategy of
      “primary health care “ to improve child
      health care through such activities as
      growth monitoring, oral rehydration,
      nutritional surveillance, promotion of
      breast feeding, immunization, community
      feeding, regular health check ups etc.
       Primary health care with its potential for
      vastly increased coverage through an
      integrated system of service delivery is
      increasedly looked upon as the best
      solution to reach millions of children
    • Social pediatrics
       Defined as the application of the
      principles of social medicine to pediatrics
      to obtain a more complete understanding of
      the problems of children in order to
      prevent and treat disease and promote their
      adequate growth and development, through
      an organized health structure
    •  To study child health in relation to
      community, to social values and to social
      policy
       This has given rise to concept of social
      pediatrics it is concerned not only with the
      social factors which influence child health
      but also with the influence of these factors
      on the organization, delivery and
      utilization of child health care services
    •  In other words , social pediatrics is
      concerned with the delivery of
      comprehensive and continuous child health
      care services and to bring these services
      within the reach of the local community.
       Social pediatrics also covers various social
      welfare measures – local , national,
      international – aimed to meet the total
      health needs of the child
    • Contribution of Preventive and Social Medicineto Social Obstetrics and Pediatrics
      1. Collection and interpretation of community
      statistics, delineating groups “at risk” for special
      care
      2. Correlation of vital statistics ( eg., maternal and
      infant morbidity and mortality rates, perinatal and
      child mortality rates )with social and biological
      characteristics such as birth weight , parity, age,
      stature, employment etc., in the elucidation of
      etiological relationships
    • 1. Study of cultural patterns, beliefs and
      practices relating to childbearing and
      childrearing, knowledge of which might
      be useful in promoting acceptance and
      utilization of obstetric and pediatric
      services by the community
      2. To determine priorities and contribute to
      the planning of MCH services and
      programmes
      3. For evaluating whether MCH services and
      programmes are accomplishing their
      objectives
    • Maternity cycle - stages
      1. Fertilization
      2. Antenatal or prenatal period
      3. Intranatal period
      4. Postnatal period
      5. Inter - conceptional period
    •  Fertilization takes place in the outer part of
      the fallopian tube.
       Segmentation of the fertilized ovum begins
      at once and proceeds at a rapid rate
       The fertilized ovum reaches the uterus in
      8- 10 days.
       Cell division proceeds at a rapid rate
       By a process of cell division and
      differentiation, all the organs and tissues of
      the body are formed
    • Period of growth
      1. Prenatal period
      1. Ovum – 0-14 days
      2. Embryo - 14 days to 9 weeks
      3. Fetus – 9th week to birth
      2. Premature – 28 to 37 weeks
      3. Birth, full term – average 280 days
    • Antenatal care
    • Objectives
       To promote, protect and maintain the health
      of the mother during pregnancy
       To detect “high risk” cases and give them
      special attention
       To foresee complications and prevent them
       To remove anxiety and dread associated with
      delivery
    •  To reduce maternal and infant mortality
      and morbidity
       To teach the mother elements of child care,
      nutrition, personal hygiene and
      environmental sanitation
       To sensitize the mother to the need for
      family planning, including advice to cases
      seeking medical termination of pregnancy
       To attend to the under fives accompanying
      the mother
    • Antenatal visits
       Mother should attend AN clinics
       Once a month during first 7 months
       Twice a month during the next month
       Thereafter once a week in the ninth month
      If everything is normal
    • Minimum 3 antenatal visits
      1. At 20 weeks or as soon as pregnancy is
      known
      2. At 32 weeks
      3. At 36 weeks
      4. At least 1 home visit by health worker
    • Preventive services for the mothers
       Prenatal services ( before delivery)
       First visit should include following
       Health history
       Physical examination
       Laboratory examination
    • Lab tests
      1. Complete urine analysis
      2. Stool examination
      3. Complete blood count, including Hb
      estimation
      4. Serological examination
      5. Blood grouping and Rh determination
      6. Chest x- ray if needed, pap tests, Gonorrhea
      culture (Optional)
    • On subsequent visits
       Physical examination( weight gain, Blood
      pressure)
       Laboratory tests should include
      1. Urine examination
      2. Hemoglobin estimate
    •  Iron and folic acid supplementation
       Tetanus Immunization
       Group or individual instruction on
      nutrition, family planning, self care,
      delivery and parenthood
       Home visiting by female health worker /
      trained dai
       Referral services , where necessary
    • Risk approach
       Identify high risk cases from a large group of
      antenatal mothers and arrange them for
      skilled care, while continuing to provide
      appropriate care for all mothers
    • At risk mothers
      1. Elderly primi (30 years and over)
      2. Short statured primi ( 140 cms and over)
      3. Mal-presentations( breech, transverse lie)
      4. Ante-partum hemorrhage, threatened
      abortion
      5. Pre – eclampsia and eclampsia
      6. Anemia
    • 1. Twins, hydramnios
      2. Previous still birth, intrauterine death,
      manual removal of placenta
      3. Elderly grand multiparas
      4. Prolonged pregnancy( 14 days after
      expected date of delivery)
      5. History of previous cesarean or
      instrumental delivery
      6. Pregnancy associated with general
      diseases – cardiovascular disease, kidney
      disease, diabetes, tuberculosis, liver
      disease
    • Risk approach is a managerial tool
       Services for all but with special attention to
      those who need them the most
       Maximum utilization of all resources
      including some which are not involved in
      in such care – traditional birth attendants,
      community health workers, women groups
       Improvements in coverage & quality of
      health care
    • Maintenance of records
       Antenatal card- in first examination, thick paper to
      facilitate filing
       Registration number. Identifying data, previous
      health history, main health events
       Record is kept at MCH/FP center
       A link is maintained between the antenatal card,
      postnatal card and under-fives card
       Essential for evaluation and further improvement
    • Home visits
       Home visiting is the backbone of all MCH
      services
       Even if the expectant mother is attending the
      ante natal clinic regularly, she must be paid
      one home visit by the health worker female or
      public health nurse
       More visits are required if the delivery is
      planned at home
    • Prenatal advice
       Mother s more receptive to the advice
      concerning herself and her baby at this time
      than at other times
       The talking points should cover not only the
      specific problems of pregnancy and childbirth
      but also about family and child health care
    • Prenatal advice - diet
       Reproduction costs energy
       Pregnancy in total duration consumes
      about 60000 k cal over and above normal
      metabolic requirements
       Lactation demands about 550 kcal / day
       Child survival is correlated with birth
      weight
       Birth weight is correlated to the weight
      gain of the mothewrww .dsimuilimar.ciomng pregnancy
    •  On an average . A normal healthy women
      gains about 12 kg of weight during
      pregnancy
       Average poor Indian women gains 6.5 Kgs
       Thus pregnancy imposes extra calorie and
      nutritional requirements
       If maternal stores of iron are poor (as may
      happen after repeated pregnancies) and if
      enough iron is not available to the mother
      during pregnancy, it is possible that fetus
      may lay down insufficient iron stores
    •  Such a baby may show a normal Hb. at
      birth but will lack the stores of iron
      necessary for rapid growth and increase in
      blood volume and muscle mass in the first
      year of life
       Stresses in the form of malaria and other
      childhood infections will make the
      deficiency more acute, and many infants
      become severely anemic during the early
      months of life
       Therefore a balanced diet is necessary
    • Personal hygiene
       Personal cleanliness – bathe, clean clothes,
      hair
       Rest and sleep – 8 hrs sleep, 2 hrs rest after
      midday meals
       Bowels – constipation should be avoided by
      taking green leafy vegetables, fruits and extra
      fluids purgatives like castor oils should be
      avoided
    •  Exercise – light household work is advised
      but manual physical labour during late
      pregnancy may adversely affect the foetus
      Smoking – should be cut down, causes
      Intrauterine growth retardation, low birth
      weight babies.
       Vasoconstrictor action produces placental
      insufficiency.
       Mothers who smoke heavily produces on an
      average 170 g less weight babies at term.
       The perinatal mortality amongst babies
      whose mother smoked during pregnancy is
      10-40% higher
    •  Alcohol :alcohol causes fertility problems
      in mothers, pregnancy loss, various
      physical and mental problems in the child,
      causes fetal alcohol syndrome in the child
      – includes IUGR, developmental delay
       Dental care – oral hygiene
       Sexual intercourse – should be restricted
      especially in the last trimester
    • Drugs
       Drugs which are not absolutely essential
      should be discouraged
       Can cause fetal malformations – like
      thalidomide – more serious when taken 4-8
      weeks of pregnancy
       LSD produces chromosomal damage,
      streptomycin causing deafness, iodide causing
      congenital goitre
    •  Corticosteroids may impair growth
       Sex hormones – virilism
       Tetracyclines- growth of bones and enamel
      formation
       Anesthetics – pethidine administered
      during labour- can have depressant effect
      and delay the onset of respiration
       Certain drugs are excreted in breast milk
    • Radiation
       Exposure to radiation, X ray during
      pregnancy - mortality from leukemia and
      other neoplasms are significantly higher
       Congenital malformations such as
      microcephaly
       X rays should be avoided in the last 2 weeks
      preceding menstrual cycle
    • Warning signs
       Report immediately
      1. Swelling of the feet
      2. Fits
      3. Headache
      4. Blurring of vision
      5. Bleeding or discharge per vagina
      6. Any other unusual symptoms
    • Child care
       The art of child care should be learnt
       Special classes to be conducted
       Mother craft includes – nutrition education,
      advice on hygiene and childrearing, cooking
      demonstrations, family planning education,
      family budgeting etc.
    • Specific health protection – 1.anemia
       About 50% to 60% of mothers in India of
      low socio economic groups are anemic in
      the last trimester of pregnancy
       Etiology is iron and folic acid deficiency
       Associated with high incidence of
      premature births, postpartum hemorrhage,
      peuerperal sepsis and thromboembolic
      phenomena in the mother
       IFA supplementation is done by Govt. of
      India
    • Other nutritional deficiencies
       Protein, vitamin and minerals
       Especially vit A and iodine
       Milk should be supplemented, or skimmed
      milk should be given
       Capsules of vitamin A and D also supplied
      free of cost
    • Toxemias of pregnancy
       Presence of albumin in urine and increase in
      blood pressure
       Their early detection and management
    • Tetanus
       2 doses of adsorbed tetanus toxoid should be
      given
       First dose 16 – 20 weeks and second 20-24
      weeks of pregnancy
       Minimum interval between 2 doses should be
      1 month
       Second dose should be given at least 1 month
      before the EDD
    •  However , no dose of TT should be denied
      to the mother even in late pregnancy
       For a mother who have been immunized
      earlier, 1 booster dose will be sufficient
       When such booster doses are given it will
      cover subsequent pregnancies in the next 5
      years
       It is advised not to immunize the mother in
      every pregnancy in order to prevent hyperimmunization
    • Syphilis
       Important cause of pregnancy wastage in
      some countries
       Pregnancies in primary and secondary
      syphilis end in spontaneous abortion, still
      birth, perinatal death or birth of a child with
      congenital syphilis
       Syphilitic infection in pregnant women is
      transmissible to the foetus
    •  Neurological damage with mental
      retardation is one of the most serious
      consequences of congenital syphilis
       Infection of the foetus does not occur in 4th
      month of pregnancy
       it is most likely to occur after the 6th
      month of pregnancy by which time the
      Langhans cell layer has completely
      atrophied
       Infection of the foetus most likely in
      primary and secondary stage of syphilis but
      rare in late syphilis
    • German measles
       In a long-term prospective study done in
      Great Britain, when rubella is contracted to
      the mother in the first 16 weeks of
      pregnancy, foetal death or death during the
      first year of life occurred in 17% of
      offspring's
       Among survivors who were followed up
      the age of 8 years, 15 % had major defects
      like cataract, deafness and congenital heart
      diseases
    •  Risk of malformations is about 20% up to
      20 weeks of gestation
       In some countries all school aged children
      are vaccinated
       Before vaccinating the women of child
      bearing age should be made sure that they
      are not pregnant and they follow
      contraception for 8 weeks later to prevent
      risk of rubella to the fetus
    • Rh status
       The fetal red cells may enter the maternal
      circulation in a number of difficult
      circumstances, during labor, caesarean
      section, therapeutic abortion, external
      cephalic version and apparently
      spontaneously in the late pregnancy
    •  The intrusion of these cells, if the mother is
      Rh –ve and the child is Rh +ve, provokes
      an immune response in her so that she
      forms antibodies to Rh which can cross
      placenta and produces fetal RBC
      hemolysis
       The same response may be seen by the
      transfusion of Rh+ve blood
       In a pregnant woman, iso-immunisation
      mainly occurs in labour, so that the first
      child although Rh+ve, is unaffected except
      where the mother is already www.similima.com sensitized.
    •  In the second or subsequent pregnancies, if
      the child is Rh +ve, the mother will react to
      the smallest intrusion of fetal cells, by
      producing antibodies to destroy fetal blood
      cells causing hemolytic disease in the fetus
       Clinically hemolytic disease takes the form
      of Hydropsfetalis, icterus gravis
      neonatorum( of which Kernicterus is a
      common sequel) and congenital hemolytic
      anemia
    •  Routinely test the blood for rhesus type
      early in pregnancy
       If the women is Rh-ve and the husband is
      +ve , she is kept under surveillance for Rh
      antibody levels during antenatal care
       The blood should be further examined at
      28 weeks and 34-36 weeks of gestation for
      antibodies
       Rh anti D immunoglobulin should be given
      at 28 weeks of gestation so that
      sensitization during the first pregnancy can
      be prevented
    •  If the baby is Rh +ve, the Rh anti D
      immunoglobulin is given again within 72
      hrs of delivery
       It should also be given after abortion
       Post maturity should be avoided
       Whenever evidence of hemolysis in-utero
      is suspected mother should be shifted to
      special centers equipped to deal with such
      problems
       Incidence of hemolysis due to Rh factor in
      India is 1 for every 400- 500 live births
    • HIV infection
       HIV in child may occur through placenta,
      delivery, breast feeding
       1/3 of the children get infected through
      above routes
       Risk is higher if the mother is newly
      infected or she had already developed
      AIDS
       Voluntary prenatal testing for HIV
      infection should be done as early in
      pregnancy for all wmww.simoilimtah.coemrs
    • Prenatal genetic screening
       Prenatal genetic screening includes
      screening for chromosomal abnormalities
      associated with serious birth defects,
      screening for direct evidence of congenital
      structural anomalies, screening for
      hemoglobinopathies and other inherited
      conditions detectable by biochemical
      assays
       Universal genetic screening is generally
      not recommended
      www.similima.com 67
    •  Screening for chromosomal abnormalities
      and for direct evidence for structural
      anomalies is performed in pregnancy in
      order to take decisions regarding
      therapeutic abortions
       Typical examples are Down’s syndrome
      and severe neural tube defects
       Women aged above 35 years and those
      who are having afflicted child are at higher
      risk
    • Mental preparation
       It is also important
       A free and frank talks on all aspects of
      pregnancy and delivery
       Removing the fears about confinement
       The mother craft classes at the MCH centers
    • Family planning
       Related to every phase of maternity cycle
       Mothers are psychologically more
      receptive to the advice on family planning
      than at other times
       Motivation and education should be done
      during the antenatal period
       If the mother has had 2 or more children
      she should be motivated for puerperal
      sterilization
       All India post partum programme services
      are available
    • Pediatric component
       Pediatrician should be in attendance at all
      antenatal clinics to pay attention to the under
      fives accompanying the mother
    • Intranatal care
    •  Childbirth is a normal physiological process, but
      complications may arise
       Septicemia may result from unskilled and septic
      manipulationsand tetanus neonatorum from the
      use of unsterile instruments
       The need for effective in tranatal care is
      indispensable
       The emphasis is on cleanliness
       5 cleans - clean hands and fingernails,a clean
      surface for delivery, clean blade for cutting the
      cord, clean cord tie, clean cord stump and care of
      the cord
    •  Keep the birth canal clean by avoiding
      harmful practices
       Hospital and health centers should be
      equipped for delivery with midwifery kits, a
      regular supply of sterile gloves and drapes,
      towels, cleaning materials, soap and antiseptic
      solution, as well as equipment for sterilizing
      instruments and supplies
    •  There are delivery kits available with the
      items needed for basic hygiene for delivery
      at home, where a midwife with a
      midwifery kit is not likely to be present
    • AIMS
      1. Thorough asepsis
      2. Delivery with minimum injury to the
      infant and mother
      3. Readiness to deal with complications such
      as prolonged labour, antepartum
      haemorrhage, convulsions,
      malpresentations, prolapse of the cord
      4. Care of the baby at delivery- resusitation,
      care of the cord, eyes etc.
    • Domiciliary care
       Confinement can be in home if the conditions
      are satisfactory
       In such cases delivery may be conducted by
      the health worker female or trained dai
       This is called as domiciliary midwifery
      service
    • Advantages of domiciliary care
      1. The mother delivers in the familiar
      surroundings of her home and this may
      tend to remove the fear associated with
      delivery in a hospital
      2. The chances for cross infection are
      generally fewer at home than in
      nursery/hospital
      3. The mother is able to keep an eye upon
      other children and domestic affairs; this
      may tend to ease her mental tension
    • Disadvantages of domiciliary care
      1. The mother may have less medical and
      nursing supervision than in the hospital
      2. The mother may have less rest
      3. May resume her duties too soon
      4. Her diet may be neglected
      5. Many homes in India may be unsuitable for
      even a normal delivery
    •  Since 74% of India’s population live in
      rural areas, most deliveries will have to
      take place at home with the aid of female
      health workers and trained dai’s
       Female health worker who is a pivot of
      domiciliary care should be adequately
      trained to recognize the ‘danger signals’
      during labour and seek immidiate help in
      transferring the motherto the nearest
      Primary health center or hospital
    • Danger signals
      1. Sluggish pains or no pains after rupture of
      membranes
      2. Good pains for an hour after rupture off
      membranes but no progress
      3. Prolapse of cord or hand
      4. Meconium stained liquor or a slow irregular
      or excessively fast fetal heart rate
    • 1. Excessive ‘show’ or bleding during labour
      2. Collapse during labour
      3. A placenta not separated within half an
      hour after delivery
      4. Post partum hemorrhage or collapse
      5. A temperature of 38 deg C or over during
      labour
      There should be a close liaison between
      domiciliary and institutional delivery
      services
    • Institutional care
       About 1% of deliveries tend to be
      abnormal and 4% difficult requiring the
      services of a doctor
       Recommended for all high risk cases and
      where home conditions are unsuitable
       The mother is allowed to rest in bed on the
      first day after delivery, next day to be up
      and about, discharge after 5 days of lying
      period
    • Rooming in
       Keeping the baby’s crib by the side of the
      mother’s bed is called “rooming in”
       This arrangement gives an opportunity for the
      mother to know her baby
       Mothers interested in breast feeding usually find
      there is a better chance for success
       It also allays the fear in the mother’s mind that
      the baby is not misplaced in the central nursery
       It also builds up her self confidence
      www.
    • Post natal care
    •  Care of the mother and the newborn after
      delivery is known as postnatal care or post
      partal care
       Broadly this care falls into 2 areas - care of
      the mother ( primarily the responsibility of
      the obstetrician), care of the
      newborn( combined responsibility of the
      pediatrician and the obstetrician)
       The combined area of responsibility is also
      called perinatology
    • Care of the mother
      The objectives of postpartal care are
      1. To prevent the complications of postpartal
      period
      2. To provide care for the rapid restoration of the
      mother to the optimum health
      3. To check the adequacy of breast feeding
      4. To provide family planning services
      5. To provide basic health education to mother/
      family
    • Complications of the post partumperiod
      Should be recognized early and dealt with promptly
      1. Puerperal sepsis ; this is infection of the genital
      tract within 3 weeks after delivery
      2. This is accompanied by rise in temperature and
      pulse rate, foul smelling lochia, pain and
      tenderness in lower abdomen
      Prevented by asepsis before, during and after
      delivery
    • 2. Thrombophlebitis: infection of the veins of
      the legs, frequently associated with
      varicose veins
      The leg may become tender, pale and
      swollen
      3. Secondary hemorrhage : Bleeding from
      vagina anytime from 6hrs after delivery to
      the end of peurperium(6weeks ) is called
      secondary hemorrhage, and may be due to
      retained placenta or membranes
      4. Others UTI, mastitis
    • Restoration of the mother to optimumhealth
       Physical
       Psychological
       Social
    • Physical
      Postnatal examinations- health check ups must be
      frequent- twice a day during first 3 days and
      subsequently once a day till the umbilical cord
      drops off. At each of these examinations, the FHW
      checks temperature, pulse and respiration,
      examines the breasts, checks progress of normal
      involution of uterus, examines lochia for any
      abnormality, checks urine and bowels and adviseson perinatal toilet including care of the stitches, if
      any
    •  The immidiate postnatal complications, viz
      peurperal sepsis, thrombophlebitis
      secondary haemorrhage should be kept in
      mind
       At the end of 6 weeks , an examination is
      necessary to check up involution of uterus
      which should be complete by then
       Further visits should be done once a month
      during the first 6 months, and thereafter
      once in 2-3 months till the end of 1 year
    •  In rural areas only limited postnatal care is
      possible
       Efforts should be made by the FHWs to
      give at least3-6 postnatal visits
       The common conditions seen during the
      postnatal period are subinvolution of
      uterus, retroverted uterus, prolapse of
      uterus and cervicitis.
    • 1. Anemia – to be detected and treated
      2. Nutrition – breast feeding mothers should
      be given nutritious diet
      3. Postnatal exercises –are necessary to bring
      the stretched abdominal and pelvic
      muscles back to normal as quickly as
      possible
    • Psychological
       Fear and insecurity which is generally born of
      ignorance – to be eliminated by prenatal instruction
       Timidity and insecurity regarding the baby
       To endure cheerfully the emotional stresses of
      childbirth, she requires the support and
      companionship of her husband
       Postpartum psychosis - rare
    • Social
       Women to have a baby – part of the truth
       To nurture and raise the child in a
      wholesome family atmosphere
       She with her husband should develop her own
      methods
    • Breastfeeding
       Breast milk provides the main source of nourishment
      – first year of life and in India up to 18 months of
      life
       Feeding bottle is nutritionally poor and
      bacteriologically dangerous
       Indian mothers feed up to 2 years
       They secrete 400- 600ml of milk /day during first
      year
    •  Exclusive breast feeding up to 6 months
       Complementary or supplementary foods
      thereafter
       weaning
    • Family planning
       Related to every phase of maternity cycle
       Motivate mothers when they attend maternity clinics
       Spacing or terminal
       Post partum sterilization generally recommended on
      the second day
       Lactational amenorrhea cannot be relied on for
      contraception
    •  To ask the mother to come at first
      menstrual cycle may be too late
       Contraceptive should not affect lactation
       IUD and non hormonal are choice in first
      6months
       Oral pills to be avoided
       DMPA- successful without suppressing
      lactation, but causes irregular bleeding and
      prolonged infertility- so not recommended
      for general use
    • Basic health education
       Hygiene – personal and environmental
       Feeding – mother and infant
       pregnancy spacing
       Importance of check –up
       Birth registration