This presentation is the analysis of current newborn care in India. It focuses on the Hospital birth scenario and Factors contributing to newborn death. It further highlights , how the Midwives can make a difference.
3. Presentation outline
Magnitude of newborn
deaths
What has worked in
Newborn care
Present Hospital birth
scenario
Factors contributing to
newborn death
Midwives can make a
difference
4. Who is Newborn/Neonate
• A newborn infant, or neonate, is a child under 28
days of age. During these first 28 days of life, the
child is at highest risk of dying.
5. What are the Causes of Neonatal Mortality in India
9. Timing of the Neonatal Death
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%
Week 4
Week 3
Week 2
Day 7
Day 6
Day 5
Day 4
Day 3
Day 2
Day 1
Week 1
4.2%
8.7%
13.8%
3.0%
2.7%
5.6%
5.6%
10.2%
6.7%
39.5%
73.3%
Timing of neonatal deaths
14. Govt. programmes focused
mainly on post neonatal
period
- Diarrheal Disease
Control
- ARI
- Immunization
Focus of essential newborn
component
What has worked …….
15. • Importance to newborn health
• Reproductive and Child Health – II
- IMNCI: Community & facility
- Skilled care at birth
-Essential newborn care for health professionals
- Home based newborn care
- Up gradation of health facilities
What has worked …….
17. Analysis of current newborn care in Hospitals..
Input Process Output
Input:
• Essential equipments
• Adequate health professionals
• Child specialist at birth
• Delivery by SBA
18. • Process :
• Suctioning
• Stimulation
• APGAR scoring
• Warming
• Cord clamping
• Milk bank
• Thermoregulation
Analysis of current newborn care in Hospitals..
22. Factors contributing to Newborn death
• Underweight
antenatal
mother
• Inadequate
antenatal care
23. • Lack of proper
referral services
Factors contributing to Newborn death…
24. Factors contributing to Newborn death…
• Inadequate health
resources
• Lack of awareness about
health services
• Nurse-population ratio not
maintained well
25. • No competent health
workforce
• Lack of knowledge
about health
programmes
• Trained in non -
attending nursing
schools
Factors contributing to Newborn death…
26. • Health seeking
behavior of the
people and
delayed family
decision
• Self medication
Factors contributing to Newborn death…
28. Qualities required for midwives ……
• Knowledgeable And Skillful
• Patience
• Good Listener
• Management Skills
• Good Emotional/ Mental Strength
• Good Observational Skills
• Ability To Act On Own Initiative
• Be Willing To Take Responsibility
• Be Able To Stay Calm In Stressful Situations
• Have A Mature Approach
• Ability to work with all kind of people
29. Role of a midwives before conception
Educate on-
Special Care of female child
Adolescent reproductive health
Planned parenthood
Delay age of marriage and birth
Adolescent friendly health services
Prevention of Anemia
30. Reproductive health and family welfare
Genetic counseling
Birth spacing
Immunization
Nutritional counseling
Folic/ iron supplementation
Prevention of STI
Avoidance of alcohol tobacco /substance
Prevention against malaria
Role of a midwives before conception…
31. • Early registration
• Four antenatal visits
• T.T. immunization
• Maternal calcium supplementation
• BP Monitoring
• ITCT
• Counseling on birth preparedness
Role of a midwives in Antenatal care
32. • Maternal screening for anemia
• Prevention and management of maternal
Anemia
• Screening for APH
• Consumption of ionized salt
• Prevention of vector borne diseases
• Detection and treatment of syphilis
Role of a midwives in Antenatal care
33. • Preparation of delivery room
• Universal precautions
• Developing standard operating protocols
• Essential Articles as per IPHS
• Transport facilities
• Guidelines
• Cleanlliness
Role of a midwives in preparation of delivery
room
34. Care during labour and child birth
• Institutional delivery
• Skill attendance at delivery
• The policy decision ,,,use of specific drugs and
carry out emergency intervention
• Emergency obstetric care
• Early detection of the problems at birth and
referral services
• Treatment of problems
35. • Assessment
• Delayed cord cutting
• Essential preventive care of new born
• Prevent hypothermia
• Immediate drying
• Head covering
• Skin to skin care
Role of a midwives in immediate Newborn care
36. • Delayed bathing
• Early initiation of Breast feeding
• Hygiene to prevent infections
• Vit K
• Neonatal Resuscitation
• Immunization
Role of a midwives in immediate Newborn care
37. • Home visits till 6 weeks by
AHSA
• Counseling
• Prevention of hypothermia
• Early identification of
danger signs
• IMNCI interventions
• Prompt appropriate referral
Role of a midwives in care of healthy Newborn
38. • Exclusive breast feeding
• Clean postnatal practices
• Immunizing
• BCG
• OPV
• Hepatitis-B
Role of a midwives in care of healthy Newborn…..
39. • Thermal care -KMC
• Breast feeding
• IMNCI strategies
• Use of oral antibiotics
• Injectable Gentamycine by ANM to prevent sepsis
• Referral services
Role of a midwives in care of small and sick
newborn…
40. • Follow-up visits
• Treatment
• Monitoring growth and development
• Referral and treatment
• NICU Admission
• Assisted Ventilation
• KMC
Role of a midwives in care of small and sick
newborn…
41. Role of a midwives in care of beyond newborn
survival
• Screening for
birth defect
• Failure to thrive
• Follow-up visits
• Investigation
• Counseling
• Referral services
42. 1. Pregnancy Home Visits
Home based maternal and newborn careCommunity model
Pregnancy - 2 Home Visits
Community Health Worker
registers all pregnant women
refer to ANC
Key interventions
health/nutrition education
birth preparedness
danger sign awareness
breastfeeding preparedness
provide insecticide treated bednet
(where appropriate)
FOCUSED ANC
Tetanus Toxoid
Iron and Folic Tablets
BP and urine test for protein
Foetal Lie
Syphilis (and other STI)
detection and treatment
IPT if indicated
PMTCT if indicated
Management or referral of
obstetric complications
(EmOC)
2. Delivery
Delivery under skilled care
Temperature management
Dry, wrap and skin to skin
Resuscitation if required
Immediate and exclusive breastfeeding
Cord Care
Temperature of newborn
Birthweight
Refer if necessary
43. 3. Post Delivery Care – 2-3 home visits during first week
Home based maternal and newborn careCommunity model
Care of Newborn using checklist:
Assess newborn
weight
temperature
feeding
cord care
Assess for sepsis - refer if required
Counsel parents on thermal control, exclusive
BF, danger signs
Refer for vaccination
Birth registration
If Low Birth Weight:
give extra care with 2 additional
home visits
Kangaroo mother care
Keep warm
Assist with feeding if needed
Attention to hygiene
Review danger signs
Care of Mother using checklist:
Assess mother
check bleeding
check temperature
breast problems
Discuss danger signs
Nutrition counseling and family planning
Refer if necessary
44. Case scenario
• Baby of Archana was born to a Primigravida
mother at term, baby is now 20 hours of age
noticed to have yellowness of face and trunk.
What is the problem?
What action you will take?