This document outlines components of maternal and child health care services including antenatal care, intranatal care, and postnatal care. It discusses the objectives and services provided at each stage of care. Antenatal care aims to promote the health of the mother and baby during pregnancy through regular checkups and health education. Intranatal care focuses on a clean delivery through aseptic measures. Postnatal care monitors for complications and provides family planning services after birth. The document provides details on the services, advantages, and disadvantages of care delivered at home or in institutions.

2. COMMUNITY HEALTH NURSING-II
• By:
• ANWAR ALI MALIK,
• BSN (G) M.ED, MPH
• V.PRINCIPAL
• HIMAS CON

3. OBJECTIVES;
At the end of this session, learners will be able to undeerstand;
1. Maternal and Child Health Care Service and it’s Components.
2. Antenatl Care, Intranatl Care & Postnatal Care aims, objectives,
services, advantages, disadvantages and Complications.

4. MOTHER & CHILD HEALTH CARE (MNCH)
• It is a branch of public health, which is planned for health
supervision of the mother and child, not only physical but
mental and emotional health.
• AIMS:
• Making available the best possible care for women during
pregnancy, labour and puerperuim.
• Best possible care to childen while they are growing and are
valnurable.

5. COMPONENTS OF MNCH
1. Antenatal/Prenatl Care
2. Intranatal Care
3. Postnatal Care
4. Infant Care
• under five years
• Immunization.
• Nutritional disorders
5. Training Programs.
6. Health Education.

6. 1. ANTENATAL/PRENATAL CARE
It means care of mother during pregnancy.
AIMS:
• The aim of antenatl care is to achieve healthy mother and
healthy baby at the end of pregnancy.
• OBJECTIVES:
• To promote, protect and maintain health of the mother
during pregnancy.
• To detect high-risk cases and give them special attention.
• To assess complications and prevent them.

7. Antenal Care Objectives....
• To reduce anxiety associated with delivery.
• To reduce maternal and fatal mortality and morbidity.
• To sensitize mother to the need for family planing.
• To teach the mother elements of child health care,
nutrition, personal hygiene and environmental
sanitation.
• To attend the under five years accompanying the
mother.

8. COMPONENTS OF ANTENATAL/PRENATAL CARE
1. Antenatal care clinic.
2. Home visits.
3. Labortary and diagnostic facilities.
4. mental prepration and family planing.
5. making referrals and follow-up.

9. 1. Antenatal/Prenatal Care Clinic
• Carefull and complete obstretic history.
• Medical Examination.
• Consultation.
• Health education classes.
Routine Visits;
• 1st visit as soon as possible.
• After every 4 weeks till 28 weeks.
• After every 2 weeks till 36 weeks.
• Once a week till she delivers.

10. Minimum Visits;
• 1st visit- before 12 weeks to confirm pregnancy.
• 2nd visit at 24 weeks for baseline health profile.
• 3rd visit at 32-34 weeks to find-out position and presenting
part.
• Last visit at 36 weeks to decide where to deliver the baby.

11. 2. Home Visits
• It is the backbone of MCH services, 1/3 of the visits must be
home visits, if mother is attending antenatal clinic.
It’s aims are;
• Health education.
• To observe home environment (nutrition sanitation, personal
hygiene).
• Follow-up services.

12. Routine at 1st Visit;
• Confirm pregnancy.
• Know the baseline health status (Vitals).
• Complete general physical examintion.
• Routine investigations (blood complete picture, urine DR
(detailed report), BP.
• Special investigations ( blood sugar random, Rh factor, etc).

13. Routine at consequent Visits
• Fundal height, to check duration of pregnancy.
• Blood pressure and weight.
• Breast examination.
• Fatal heart rate.
• Urine examination for sugar and albumin.

14. Antenatl/Prenatal Advice
• It is a major component pf prenatal/antenatl care.
A. Diet;
• Weight gain should be 10-12 kg and 60,000 kcal for total duration
of pregnancy.
B. Personal Hygiene;
• Light work is advised but heavy work is not recommded.
• 8 hours of sleep with 2 hours after mid-day meals.
• Avoid smoking.
• Proper dental hygiene.
• Sexual intercourse is restricted especially during last trimester.

15. C. Drugs;
• Some drugs cause congenital abnormalties, so they are
contraindicated, eg. tetracycline, streptomycin,
corticosteroids.
D. Immunization;
• Immunization of mother for Tetanus Toxoids.

16. 3. Labortary & Diagnostic Facilties
There are helpful in detection of special health problems related with
pregnancy.
• Anemia:
• It means Haemoglobin Hb level is less than 11gm/dl.
• Majority of women during pregnancy suffer from anemia.
• Rh Factor: It is an essential aspect to detect antibody.
• In order to prevent Rh sensitization/reaction in all women at risk (Rh
negative women with Rh positive husband or Rh positive fetus).
• I/M administration of 200-300 microgram of Rh Ig (immunoglobulin) at 28-
34 weeks.
• Second dose is given after delivery, if baby is Rh positive.

17. TOXIMIA OF PREGNANCY:
The presence of albumin in urine, an increased BP, and edema
indicates toximia of pregnancy.
GERMAN MEASLES:
• It is characterized by fever and malaise for a day or two.
• If mother suffers from german measles during first trimester, the
infant maybe born with congenital abnormalities.
• In such cases, termination of pregnancy is suggested.

18. 4. MENTAL PREPARATION AND FAMILY PLANING
• Mental preparation is very important.
• Mother must be informed about all aspects of pregnancy and
delivery.
• During pregnancy, mother is more acceptive to advice on family
plannig than at other times.
• She must be informed about problems of large sized family.
• She is motivated to limit her family to 2 to 3 children.

19. 5. MAKING REFERRALS AND FOLLOW UP
• This is very important component for high-risk
people.
• Complicated cases should be referred to specialist
where adequate facilities are provided.
• There must be follow up visit to know the postpartum
complications.

20. 2. INTRANATAL CARE
• It means care of mother during child birth and also of child.
• Childbirth is a normal physiological process but complications
may rise.
• Therefore, need for intranatl care is necessary.

21. AIMS:
• Clean delivery through aseptic measures. It is achieved by;
• Clean delivery.
• Clean hands.
• Clean cutting and care of the cord.
• Delivery with minimum injury to infant and mother.
• Ready to deal with complications such as prolonged labour,
antipartum hemorrhage, convulsions, mal presentations, etc.
• Care of the baby at the time of delivery.

22. INTRANATAL SERVICES:
1. The above aims of intranatal care are achieved by following services;
2. Domicilliary midwifery care.
3. Intitutional care.
4. Home helps.
5. Maternity homes.
6. Transport facilities for midwives.
7. Ambulance services
8. Blood transfusion services.
9. Diagnostic and labortary facilities.
10.Arrangments for consultation and refferals.

23. 1. Domiciliary Care:
• The care provided at home is called domiciliary care.
• Mothers with normal obstretric history may be advised to have
domiciliary care.
• In such cases, delivery is conduced br trained Dai/Midwife (one
midwife is for 100 births or 3000 population).

24. ADVANTAGES:
• Domiciliary care is less expensive.
• No tension of going to hospital.
• mother is delivered in familiar sorroundings.
• It is convenient and psychological satisfactory.
• Mother keep an eye upon her children and home affairs,
• Chances of cross infection are rare.
• No chance of mixing of children

25. DISADVANTAGES:
• Less medical care at home.
• Less rest for women, she may resume her duties earlier.
• her diet maybe neglected.
• Not fully safe.

26. 2. INSTITUTIONAL CARE:
The care provided in a institutional (hospitals, maternity homes,
etc.) is called institutional care.
• Institutional care is recommended for all high-risk cases and
where homes conditions are not suitable.
• Mother is allowed to rst in bed on first day after delivery.
• From next day she is allowed to sit.
• After 3-4 days, she is discharged.

27. ADVANTAGES:
• Aseptic measures.
• Better medical service.
• Safe for high-risk cases.
• Diet and health is properly looked after.
• Emergency conditions and complications are managed.

28. DISADVANTAGES:
• More expensive.
• Psychological tension of goint to hospital.
• Chances of cross infections.
• Chances of mixing of children.

29. DANGER SIGNALS DURING LABOUR:
• Sluggish /slow or no repair after rupture of memranes.
• Prolonged of first stage labour.
• Obstructed labour.
• Meconuim stained liquor MSL has been considered a
sign of fetal distress due to hypoxia.
• (Meconium is the early stool passed by a newborn soon
after birth, before the baby starts to feed and digest
milk or formula).
• Post-partum hemorrhage.

30. ROOMING IN & ITS ADVANTAGES:
• ROOMING IN;
• Keeping the baby’s crib by the side of mother’s bed is called
rooming in.
• ADVANTAGES:
• This gives mental satisfaction to mothet.
• She can easily breast feed her child.
• She has no fear of misplacement of her child and this builds up
her self-confidence.
• Child gets familiar with mother.

31. 3. POSTNATAL CARE
• The care of the mother after deliver is known as postnatal or
postpartal care.
• After birth, care of mother is the responsilbilty of obstetrician
and peadiatrician.
• This combined area of responsibilty is called neonatology.

32. OBJECTIVES:
• To prevent postnatal complications.
• To provide family planning services.
• To check adequacy of breastfeeding.
• To provide basic health education to mother, e.g.
postnatal exercises.

33. SERVICES OF POSTNATAL CARE
• Home visiting program by health visitors:
• Day 1-3 twice a day.
• Daily for 7 days.
• Last visit at the end of 6 weeks.
• Welfare centres for supply of milk, etc.
• Providing consultation and health education.
• Postnatal clinic for mothers.
• Hospital beds for complicated cases.
• Family Planning Services.
• Referral’s and Follow up.

34. POSTNATAL COMPLICATIONS:
• Puerperal sepsis (it is an infection of the genital tract occurring at
any time between rupture of membrane or labour and 42 days
postpartum or after miscarriege).
• Thrombophlebitis (is an inflammatory process that causes a
blood clot to form and block one or more veins, usually in the
legs).
• Secondary Postpartum Haemorrhage (is defined as any
significant vaginal bleeding that occurs between 24 hours after
placental delivery and during the following 6 weeks).

35. • Mastitis (Mastitis is an inflammattion of breast, with or
without a bacterial infection. The symptoms are red, painful,
hot, swollen breasts, and sometimes fever, chills and flu-like
symptoms).
• Urinary Tract Infection.
• Air Emblosim (Postpartum pulmonary embolism can also be
caused by obstructions, amniotic fluid* due to pregnancy
complications, air when placing a central venous catheter into
the blood, tissue, fat, and air bubbles.. .enters the bloodstream
and then travels to the lungs during caesarean section).
• Amniotic fluid* is the fluid that surrounds your baby during
pregnancy.

36. CARE OF NEW BORN
• continue.....