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Analysis of current newborn care in
hospital birth: Midwives can make a
difference
Prof. Dr. Nilima Sonawane
Institute of Nursing Education ,Mumbai
MY BIG SALUTE TO THIS
REVOLUTIONARY WOMEN
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
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.
What are the Causes of Neonatal Mortality in India
State wise NMR
0
5
10
15
20
25
30
35
40
45
50
India Ke TN Hr HP Pb Kn JK Mh Gj WB Bi AP Rj MP Or As UP
39
11.5
19.1
23.6
27.3
28
28.9
29.8
31.8
33.5
37.6
39.8 40.3
43.9
44.9 45.4 45.5
47.6
NMR
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
What Has Worked ..Situational Analysis
Community awareness
What has worked …..
What has worked …….
Decreased
misconception
Increased institutional
delivery
What has worked …….
Govt. programmes focused
mainly on post neonatal
period
- Diarrheal Disease
Control
- ARI
- Immunization
Focus of essential newborn
component
What has worked …….
• 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 …….
Analysis of current newborn care in Hospital settings
Analysis of current newborn care in Hospitals..
Input Process Output
Input:
• Essential equipments
• Adequate health professionals
• Child specialist at birth
• Delivery by SBA
• Process :
• Suctioning
• Stimulation
• APGAR scoring
• Warming
• Cord clamping
• Milk bank
• Thermoregulation
Analysis of current newborn care in Hospitals..
Process:
• Breastfeeding
• Immunization
• Tagging
• Hand washing
• Mothers education
• Kangaroo mother care
Analysis of current newborn care in Hospitals..
Output :
Analysis of current newborn care in Hospitals..
Malnourished
Adolescent girls
Factors contributing to Newborn death…
Factors contributing to Newborn death
• Underweight
antenatal
mother
• Inadequate
antenatal care
• Lack of proper
referral services
Factors contributing to Newborn death…
Factors contributing to Newborn death…
• Inadequate health
resources
• Lack of awareness about
health services
• Nurse-population ratio not
maintained well
• No competent health
workforce
• Lack of knowledge
about health
programmes
• Trained in non -
attending nursing
schools
Factors contributing to Newborn death…
• Health seeking
behavior of the
people and
delayed family
decision
• Self medication
Factors contributing to Newborn death…
Midwives can make a difference
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
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
 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…
• 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
• 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
• 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
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
• 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
• Delayed bathing
• Early initiation of Breast feeding
• Hygiene to prevent infections
• Vit K
• Neonatal Resuscitation
• Immunization
Role of a midwives in immediate Newborn care
• 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
• Exclusive breast feeding
• Clean postnatal practices
• Immunizing
• BCG
• OPV
• Hepatitis-B
Role of a midwives in care of healthy Newborn…..
• 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…
• 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…
Role of a midwives in care of beyond newborn
survival
• Screening for
birth defect
• Failure to thrive
• Follow-up visits
• Investigation
• Counseling
• Referral services
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
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
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?
Questions?
47
Thank you

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Analysis of newborn care in india

  • 1. Analysis of current newborn care in hospital birth: Midwives can make a difference Prof. Dr. Nilima Sonawane Institute of Nursing Education ,Mumbai
  • 2. MY BIG SALUTE TO THIS REVOLUTIONARY WOMEN
  • 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
  • 6.
  • 7.
  • 8. State wise NMR 0 5 10 15 20 25 30 35 40 45 50 India Ke TN Hr HP Pb Kn JK Mh Gj WB Bi AP Rj MP Or As UP 39 11.5 19.1 23.6 27.3 28 28.9 29.8 31.8 33.5 37.6 39.8 40.3 43.9 44.9 45.4 45.5 47.6 NMR
  • 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
  • 10. What Has Worked ..Situational Analysis Community awareness
  • 12. What has worked ……. Decreased misconception
  • 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 …….
  • 16. Analysis of current newborn care in Hospital settings
  • 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..
  • 19. Process: • Breastfeeding • Immunization • Tagging • Hand washing • Mothers education • Kangaroo mother care Analysis of current newborn care in Hospitals..
  • 20. Output : 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…
  • 27. Midwives can make a difference
  • 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?
  • 46.