Mother and Baby Friendly Care: Introduction
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Mother and Baby Friendly Care: Introduction



Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any ...

Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.



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Mother and Baby Friendly Care: Introduction Mother and Baby Friendly Care: Introduction Document Transcript

  • Motherand BabyFriendly CareA learning programmefor professionalsDeveloped by thePerinatal Education
  • VERY IMPORTANTWe have taken every care to ensure that drugdosages and related medical advice in this bookare accurate. However, drug dosages can changeand are updated often, so always double-checkdosages and procedures against a reliable,up-to-date formulary and the given drug‘sdocumentation before administering it.Mother and Baby Friendly Care:A learning programme for professionalsVersion 1.0.1 (updated 1 April 2009)First published by EBW Healthcare in 2008Text © Perinatal Education Programme 2008Getup © Electric Book Works 2008ISBN (paperback): 978-1-920218-24-9ISBN (PDF ebook): 978-1-920218-56-0All text in this book excluding the tests andanswers is published under the Creative CommonsAttribution Non-Commercial No DerivativesLicense. You can read up about this license at multiple-choice tests and answers in thispublication may not be reproduced, stored in aretrieval system, or transmitted in any form or byany means without the prior permission of ElectricBook Works, 87 Station Road, Observatory, CapeTown, 7925.Visit our websites at www.electricbookworks.comand
  • ContentsAcknowledgements 5 Mother friendly care after delivery 34 Case study 1 36Introduction 7 Case study 2 37 Aim of the Perinatal Education Case study 3 38 Programme 7 Perinatal education 7 3 Principles of Kangaroo Mother Care 40 Perinatal Education Programme books 7 Introduction to kangaroo mother care 40 Format of the Perinatal Education Advantages of kangaroo mother care 43 Programme 9 Case study 1 49 Study groups 10 Case study 2 49 The importance of a caring and Case study 3 50 questioning attitude 10 Case study 4 51 Copyright 10 Final assessment 11 4 Practice of Kangaroo Mother Care 52 Obtaining an exam code 11 Promoting kangaroo mother care 52 Managing your own course step-by-step 11 The method of kangaroo mother care 54 Updating of the programme 12 Kangaroo mother care in the nursery 56 Using the book as a work manual 12 A Kangaroo Mother Care ward 58 Perinatal Education Trust 13 Ambulatory Kangaroo Mother Care Further information 13 at home 60 Comments and suggestions 13 Kangaroo mother care for transport 62 Case study 1 621 Mother friendly care during Case study 2 63 pregnancy 15 Case study 3 63 Mother friendly care for pregnant Case study 4 64 women 15 Case study 5 64 Women and their pregnancies 17 Managing pregnant women in a 5 Baby friendly care 66 mother friendly way 18 Introduction to baby friendly care 66 Mother friendly health workers 21 Care of the infant immediately after Case study 1 23 delivery 68 Case study 2 24 Care of the infant in the nursery 69 Case study 3 24 Care of infants in an intensive care unit 74 Care of infants in the postnatal ward 752 Mother friendly care during labour, Care of the infant at home 76 delivery and the puerperium 26 Baby Friendly Hospital Initiative 77 Introduction to mother friendly care 26 Touch therapy 77 Mother friendly care during labour 27 Case study 1 78 Mother friendly care during delivery 30 Case study 2 79
  • 4 MOTHER AND BABY FRIENDLY CARE Case study 3 80 Case study 4 81Tests 82
  • AcknowledgementsWe acknowledge all the participants of Editors of Mother and Baby Friendly Care:Primary Newborn Care courses who have Prof D. L. Woods, Prof G. B. Theronmade suggestions and offered constructive Contributors: Dr A.-M. Bergh, Dr N. Bergman,criticism. It is only through constant feedback Dr F. Bonnici, Sr K. Christie, Dr M. Hann,from colleagues and participants that the Prof J. Hofmeyr, Dr S. Honikman,content of Perinatal Education Programme Prof G. Kirsten, Sr M. Kreft, Mrs E. Ryan,courses can be improved. Mrs A. Strydom.Editor-in-Chief of the Perinatal EducationProgramme: Prof D. L. Woods
  • IntroductionAIM OF THE PERINATAL is not possible to send teachers to all these rural areas for long periods of time whileEDUCATION PROGRAMME staff shortages and domestic reasons make it impractical to transfer large numbersThe aim of the Perinatal Education Programme of doctors and nurses from primary- and(PEP) is to improve the care of pregnant women secondary-care centres to centralised tertiaryand their newborn infants in all communities, hospitals for training.especially in poor periurban and rural districts Ideally all medical and nursing staff shouldof southern Africa. Although the Programme have regular training to improve and updatewas written as a distance-learning course for their theoretical knowledge and practical skills.both midwives and doctors in district and One way of meeting these needs in continuingregional health care facilities, it is also used in education is with a self-help, outreachthe training of medical and nursing students. educational programme. This decentralisedThe authors of the Perinatal Education method allows health care workers to takeProgramme consist of nurses, obstetricians and responsibility for their own learning andpaediatricians from South Africa. This ensures professional growth. They can study at a timea balanced, practical and up-to-date approach and place that suits them. Participants in theto common and important clinical problems. programme can also study at their own pace.Many colleagues in South African universities The education programme should be cheapand health services were also consulted with a and, if possible, not require a tutor.view to reaching consensus on the managementof most perinatal problems. PERINATAL EDUCATIONPERINATAL EDUCATION PROGRAMME BOOKS Initially the Perinatal Education ProgrammeIf all three levels of perinatal care are to was presented as two books only. The first PEPbe efficiently provided within a perinatal book, Maternal Care, deals with problemshealth care region, continuous education and experienced by women during and aftertraining of all professional staff is essential. pregnancy while the second PEP book,Unfortunately this often is achieved in the Newborn Care, deals with problems in thelarge, centralised tertiary-care hospitals only newborn infant. Both books should be studiedand not in the rural secondary- or primary- to improve your knowledge of all aspects ofcare centres. The providers of primary care in perinatal care.rural areas usually have the least continuingeducation as they are furthest away from Now six additional, supplementary books havethe training hospitals in urban centres. It been prepared to address further common and
  • 8 MOTHER AND BABY FRIENDLY CAREimportant problems related to both pregnant countries, increasing the maternal and infantwomen and their newborn infants. mortality rates, and adding to the financial burden of providing health services to allBook 1: Maternal Care communities. Nowhere is the devastating effect of this infection more obvious than inThis book addresses all the common and the transmission of HIV from mothers toimportant problems that occur during their infants. In order to decrease this risk, allpregnancy, labour and delivery, and the health care workers dealing with HIV positivepuerperium. It includes booking for antenatal mothers and infants will need to receivecare, problems during the antenatal period, additional training. Perinatal HIV/AIDS wasmonitoring and managing the mother, fetus written to address this challenge.and progress during labour, medical problemsduring pregnancy, problems during the This book will enable midwives, nurses andthree stages of labour and the puerperium, doctors to care for pregnant women and theirfamily planning after pregnancy, and infants in communities where HIV infectionregionalised perinatal care. Skills workshops is present. Special emphasis has been placedteach the general examination, abdominal on the prevention the mother-to-infantand vaginal examination in pregnancy and transmission of HIV.labour, screening for syphilis and HIV, Chapters have been written on HIV infection,use of an antenatal card and partogram, antenatal, intrapartum and infant care, andmeasuring blood pressure and proteinuria, counselling. Colleagues from a number ofand performing and repairing an episiotomy. hospitals and universities in South AfricaMaternal Care is aimed at professional health were invited to review and comment on thecare workers in level 1 hospitals or clinics. draft document in order to achieve a well balanced text. It is hoped that this trainingBook 2: Newborn Care opportunity will help to stem the tide of HIVNewborn Care was written for health infection in our children.professionals providing special care for infantsin regional hospitals. It covers resuscitation Book 4: Primary Newborn Careat birth, assessing infant size and gestational This book was written specifically for nursesage, routine care and feeding of both normal and doctors who provide primary care forand high risk infants, the prevention, newborn infants in level 1 clinics and hospitals.diagnosis and management of hypothermia, Primary Newborn Care addresses the care ofhypoglycaemia, jaundice, respiratory distress, infants at birth, care of normal infants, care ofinfection, trauma, bleeding, and congenital low birth weight infants, neonatal emergencies,abnormalities, as well as communication and important problems in newborn infants.with parents. Skills workshops addressresuscitation, size and gestational age Book 5: Mother and Baby Friendly Caremeasurement, history, examination andclinical notes, nasogastric feeds, intravenous With the recent technological advances ininfusions, use of incubators, measuring modern medicine, the caring and humaneblood glucose concentration, insertion of aspects of looking after mothers and infantsan umbilical catheter, phototherapy, apnoea are often forgotten. This book describesmonitors and oxygen therapy. better, gentler, kinder, more natural, evidence-based ways that care should beBook 3: Perinatal HIV given to women during pregnancy, labour and delivery. It similarly looks at improvedThe HIV epidemic is spreading at an methods of providing infant care with analarming pace through many developing emphasis on kangaroo mother care and
  • INTRODUCTION 9exclusive breastfeeding. A number of medical FORMAT OF THE PERINATALand nursing colleagues in South Africacontributed to this book. EDUCATION PROGRAMMEBook 6: Saving Mothers and Babies Throughout this Programme the participant takes full responsibility for his or her ownSaving Mothers and Babies was developed in progress. This method teaches participants toresponse to the high maternal and perinatal become self-reliant and confident.mortality rates found in most developingcountries. Learning material used in the book is 1. The objectivesbased on the results of the annual confidentialenquiries into maternal deaths and the Saving At the start of each chapter the learningMothers and Saving Babies reports published in objectives are clearly stated. They help theSouth Africa. It addresses the basic principles participant to identify and understand theof mortality audit, maternal mortality, important lessons to be learned.perinatal mortality, managing mortalitymeetings, and ways of reducing maternal and 2. Questions and answersperinatal mortality rates. This book shouldbe used together with the Perinatal Problem Theoretical knowledge is taught by a problemIdentification Programme (PPIP). solving method which encourages the participant to actively participate in the learning process. An important question is asked, orBook 7: Birth Defects problem posed, followed by the correct answerThis book was written for health care or explanation. In this way, the participantworkers who look after individuals with is led step by step through the definitions,birth defects, their families, and women who causes, diagnosis, prevention, dangers andare at increased risk of giving birth to an management of a particular problem.infant with a birth defect. Special attention It is suggested that the participant cover theis given to modes of inheritance, medical answer for a few minutes with a piece of papergenetic counselling, and birth defects due or card while thinking about the correct replyto chromosomal abnormalities, single to the question. This method helps learning.gene defects, teratogens and multifactorial Simplified flow diagrams are also used, whereinheritance. This book is being used in the necessary, to indicate the correct approach toGenetics Education Programme which has diagnosing or managing a particular problem.been developed to train health care workers in Copies of these flow diagrams may be of valuegenetic counselling in South Africa. in the labour ward or nursery.Book 8: Primary Maternal Care Different forms of text are used to identify particular sections of the Programme:This book addresses the needs of health careworkers who provide both antenatal and Each question is written in bold, like this,postnatal care but do not conduct deliveries. and is identified with the number of theThe content of these chapters is largely taken chapter, followed by the number of thefrom the relevant chapters in Maternal question, e.g. 5-23.Care. It contains theory chapters and skillsworkshops. This book is ideal for staffproviding primary maternal care in level 1 Important practical lessons are emphasized bydistrict hospitals and clinics. placing them in a box like this.
  • 10 MOTHER AND BABY FRIENDLY CARE NOTE Additional, non-essential information is STUDY GROUPS provided for interest and given in notes like this. These facts are not used in the case studies or included in the multiple-choice questions. It is strongly advised that the Programme courses are studied by a group of participants3. Case problems and not by individuals alone. Each group of 5 to 10 participants should be managed by aA number of clinical presentations in story- local co-ordinator who is usually a member ofform are given at the end of each chapter so the group, if a formal trainer is not available.that the participant can apply his/her newly The local co-ordinator orders the books andlearned knowledge to solve some common then arranges the time and venue of the groupclinical problems. This exercise also gives the meetings (usually once every three weeks).participant an opportunity to see the problem At the meeting the chapter just studied isas it usually presents itself in the clinic or discussed and the pre-tests and post-tests arehospital. A brief history and/or summary of done. The skills workshops should also bethe clinical examination is given, followed by demonstrated and practiced at the meetings.a series of questions. The participant should In this way the group manages all aspects ofattempt to answer each question before reading their course. The principles of peer tuitionthe correct answer. The knowledge presented and co-operative learning play a large part inin the cases is the same as that covered earlier the success of the chapter. The cases, therefore, serve toconsolidate the participant’s knowledge. THE IMPORTANCE4. Multiple-choice questions OF A CARING ANDAn in-course assessment is made at thebeginning and end of each chapter in the QUESTIONING ATTITUDEform of a test consisting of 20 multiple-choicequestions. This helps participants manage their A caring and questioning attitude isown course and monitor their own progress encouraged. The welfare of the patient is ofby determining how much they know before the greatest importance, while an enquiringstarting a chapter, and how much they have mind is essential if participants are to continuelearned at the end of the chapter. The correct improving their knowledge and skills. Theanswer to each question is provided at the end participant is also taught to solve practicalof the book. This exercise will help participants problems and to form a simple, logicaldecide whether they have successfully learned approach to common perinatal problems.the important facts in that chapter and willalso draw the participants’ attention to theareas where their knowledge is inadequate. COPYRIGHTIn the multiple-choice tests the participantis asked to choose the single, most correct To be most effective, the Perinatal Educationalanswer to each question or statement from Programme course should be used underfour possible answers. A separate loose sheet the supervision of a co-ordinator. Using partshould be used to record the test answers of the Programme out of context will be ofbefore (pre-test) and after (post-test) the limited value only, while changing part of thechapter is studied. The list of correct answers Programme may even be detrimental to thealso indicates which section should be participant’s perinatal knowledge. Therefore,restudied for each incorrect post-test answer. copyright on all PEP materials means that no portion of the Programme can be altered. However, for teaching and management
  • INTRODUCTION 11purposes only, parts or all of the Programme MANAGING YOUR OWNmay be photocopied provided that recognitionto the Programme is acknowledged. If the COURSE STEP-BY-STEProutine care in your clinic or hospital differsfrom that given in the Programme, you shoulddiscuss it with your staff. 1 Before you start each chapter, take the test for that chapter at the back of the book. Do theFINAL ASSESSMENT test by yourself even if you are studying with a group of colleagues. Choose the best answerOn completion of each book, participants for each multiple-choice question and notemay apply to write a formal multiple-choice your answers on a piece of loose paper. This isexamination on the course website to assess called your ‘pre-test’ for that chapter. There isthe amount of knowledge that they have an answer sheet that you should use to markacquired. All the questions will be taken your completed pre-test. Record your pre-testfrom the tests at the end of each chapter. mark out of a possible 20.The content of the skills workshops will notbe included in the examination. Successful 2examination candidates will be able to print Now work through the chapter. Read eachtheir own certificate which states that they question and answer, and make sure youhave successfully completed that course. Credit understand it. Pay particular attention tofor completing the course will only be given if the facts in grey boxes as these are the mainthe final examination is successfully passed. A messages. Read the case studies to checkseparate examination is available for each book whether you have learned and understand theand a certificate will be given to participants important information.who pass each final examination. A mark of80% is needed to pass the final examinations.Any official recognition for completing a PEP 3course will have to be negotiated with your If you are part of a study group, use thislocal health care authority. opportunity to discuss with your colleaguesTo write the examination on the website, a any difficulties you may have experienced.participant first has to obtain an exam code, Talking about what you have read is a verywhich can be obtained through the course important part of the learning process. Ifwebsite. the book includes skills workshops, these should be conducted at the time of the group meetings. Invite an experienced colleague who can help you master the particular skill.OBTAINING AN EXAM CODE 4To obtain an exam code, visit this website: When you have learned all the knowledge in that chapter, take the same test again. ThisAn exam code is a unique number for one second test is called your ‘post-test’. Nowparticipant and one course. An exam code mark the post-test and compare your pre-testenables a participant to test their knowledge and post-test marks. Your marks should haveand write the final examination online. improved considerably. In the answers sectionThe fee and how to pay for exam codes is of the book, opposite each correct answer, is theexplained on the website. number of the section where the question was taken from. Re-read and learn the sections for
  • 12 MOTHER AND BABY FRIENDLY CAREany post-test answers you got incorrect. Now Tipsyou are ready to move on to the next chapter. • Work through the course with a group of friends or colleagues.5 • One person in your group (your co-Repeat steps 1 to 4 for each chapter as you ordinator or ‘convenor’) should takework your way through the book. This enables responsibility for organising meetings toyou to obtain the knowledge, monitor your discuss each chapter before you write theprogress, and measure how much you are post-test.learning. Most people will take about 2 to 4 • Set yourself targets, such as ‘two units aweeks per chapter. month’. • Keep your book with you to read whenever6 you have a chance. • Write the examination only when you feelOnce you are confident that you have ready.mastered all the main lessons in the book,you can write the final examination online To write the final UPDATING OF THEexamination you will need to have an examcode. This is a unique number that entitles PROGRAMMEyou to write the examination for a course. Ifyou don’t have one yet, you or your group can Based on the comments and suggestionsbuy exam codes. The fee and how to pay is made by participants and other authorities,described on the website. This exam code will the chapters and skills workshops of theonly work once for one examination. Programme will be regularly edited to make them more appropriate to the needs ofYou will be able to write the examination, perinatal care and to keep the Programmeconsisting of 75 multiple-choice questions, up to date with new ideas and developments.on the website. You will only have a limited Everyone studying the Programme is invitedtime to answer each question and you will to write to the editor-in-chief with suggestionsnot be able to go back and check previous as to how the books could be improved. Youquestions. Set aside at least an hour to can also send your comments on parts of thewrite the examination. When you write the books on the website, do not use the book to look upthe correct answers. Remember, you are yourown teacher, so be strict with yourself! USING THE BOOK AS A7 WORK MANUALYour examination answers will automaticallybe marked as soon as you have completed It is hoped that as many participants asthe last question. If you get 80% or better you possible will use these books as work manualshave passed and will be able to print your after they have completed the course. Theown certificate which states that you have flow diagrams should be most useful insuccessfully completed the course. However, managing difficult problems and for planningif you have failed to achieve 80%, you can management. A further benefit of the bookspurchase another exam code to write the will be to standardise the documentation andexamination again. management of certain clinical problems. This is particularly useful when patients are referred within or between health care regions. It is further hoped that all those who use these
  • INTRODUCTION 13books will enjoy learning about new and better By emailmethods of caring for mothers and newborn Every opportunity to share knowledgewith both patients and colleagues should beused. By doing this you will find your career Onlinemore fulfilling and you will help to improve www.ebwhealthcare.comthe perinatal care in your region. EDUCATION COMMENTS ANDTRUST SUGGESTIONSBooks developed by the Perinatal EducationProgramme are provided as cheaply as possible. The Perinatal Education Programme has beenWriting and updating the Programme is both produced by a group of perinatal specialistsfunded and managed on a non-profit basis by in South Africa, after wide consultationthe Perinatal Education Trust. with colleagues who practice in both rural and urban settings, in an attempt to reach consensus on the care of mothers and newborn infants. The Programme is designedFURTHER INFORMATION so that it can be improved and altered to keep pace with current developments in healthFurther information on the Perinatal care. Participants using books developedEducation Programme can be obtained in the by the Programme can make an importantfollowing ways: contribution to its continual improvement by reporting factual or language errors,By post by identifying sections that are difficult toThe Editor-in-Chief, Perinatal Education understand, and by suggesting improvementsProgramme, P O Box 34502, Groote Schuur, to the contents. Details of alternative or betterObservatory 7937, South Africa forms of management would be particularly appreciated. Please send any comments or suggestions to the Editor-in-Chief at theBy fax above address.• 021 671 8030 (from South Africa)• +27 21 671 8030 (from outside South Africa)By phoneFrom within South Africa:• 021 671 8030 (PEP Distribution Manager)• 021 786 5369 (Editor-in-Chief)