By the year 2025, the major 9 components of birth preparedness and complication readiness in Nepal has been outlined in this slide.

1. Birth Preparedness &
Complication readiness
Presented by:
Pratiksha Rai

2. Introduction
The Ministry of Health and Population (MoHP) in Nepal has confronted
high rates of maternal and infant mortality during the past two decades
through various approaches.
The safe motherhood plan of the MoHP defines a range of
complementary interventions to improve maternal and newborn health,
one of which is the birth-preparedness package (BPP).
The BPP is a demand-creation intervention that promotes key messages
and behavior change via inter-personal communication through
community health volunteers.

3. Definition
Birth preparedness and Complication Readiness is a strategy that helps
women to consider all available maternal health care services during
pregnancy and prepare for potential complications.
There is evidence that promoting BPCR improves preventive behaviors,
improves knowledge of mothers about danger signs, and leads to
improved care-seeking during obstetric emergencies.

4. Aim
To increase use of skilled care at birth, and timely attendance at health
facilities for obstetric and newborn complications.

5. Approach
A multi-disciplinary approach is appropriate in establishing roles of
policymakers, facility managers, providers, communities, families and
women in ensuring that women and newborns receive appropriate,
effective and timely care.

6. Standard Statement
All pregnant women should have a plan for birth and dealing with
unexpected adverse events, such as complications or emergencies that
may occur during pregnancy, childbirth or the immediate postnatal
period.

7. https://www.youtube.com/watch?v=gS7fCvCIe1k

8. Factors affecting access to care
• Delays in deciding to seek care may be caused by failure to recognize
signs of complications, failure to perceive the severity of illness, cost
considerations, previous negative experiences with the health care
system, and transportation difficulties.
• Delays in reaching care may be created by the distance from a
woman’s home to a facility or provider, the condition of roads, and a
lack of emergency transportation.

9. Factors affecting access to care
• Delays in receiving care may result from unprofessional attitudes of
providers, shortages of supplies and basic equipment, a lack of
healthcare personnel, and poor skills of healthcare providers.
• The causes of these delays are common and predictable. However, in
order to address them, women and families and the communities,
providers, and facilities that surround them, must be prepared in
advance and ready for rapid emergency action.

10. Rationale for Birth preparedness plan
• It helps to ensure that all the arrangements for a clean and safe birth,
including the presence of a skilled provider, are made well in advance
of estimated date of childbirth.
• As all women are at risk of complication during the childbearing cycle
and most complications cannot be predicted, the women and her
family should be prepared to respond appropriately in an emergency.
Such preparation can help to prevent life threatening delays in
recognizing and responding in complications.

11. Rationale for Birth preparedness plan
• If the women and her family are well prepared for normal childbirth as
well as any possible maternal or newborn complications, woman and
baby is more likely to receive the skilled and timely care needed to
preserve health and ensure survival.
• All pregnant women should have a plan for birth and dealing with
unexpected adverse events, such as complications or emergencies that
may occur during pregnancy, childbirth or the immediate postnatal
period.

12. Components
1. Skilled provider
2. Items needed for clean and safe birth and newborns
3. Appropriate setting/ health care facility
4. Transportation
5. Funds
6. Decision making
7. Support
8. Blood donor
9. Danger signs

13. 1. Skilled Provider
• The nurse (health worker) should discuss the need for a skilled birth
personnel (SHP/SBA) during delivery to ensure that there will be safe
delivery and manage on time if complications arise.
• If the woman and family members are planning for home delivery,
then they should inform to SBA about estimated date of delivery. All
the equipment should also be ready for home delivery. If they are
planning for facility delivery, the best facility, with staff, adequate
equipment, supplies and drugs, should be selected.

14. 2. Items needed for clean and safe birth
and newborns
• The nurse should advice to woman and her family to prepare the
supplies for future mother and baby.
• It includes clean, dry and warm clothes or drying and wrapping the
baby, sanitary pad, and petticoat for mother, additional clean clothes
for both mother and baby, bhoto, topi, socks, baby blankets etc. for
baby.

15. 3. Appropriate setting/ health care facility
Health personnel should ensure that the woman has an appropriate
place for the birth to take place and for complication readiness,
assistance should be provided in choosing the appropriate health care
to go if danger signs arise.

16. 4. Transportation
Ensure that woman is familiar with local transportation systems & has
transportation to an appropriate place for birth. For complication
readiness, assist woman in choosing emergency transportation to an
appropriate health care facility if danger signs arise.

17. 5. Funds
• The nurse/health worker should discuss woman and her family
member about the money availability for following things.
i. Saving cost for delivery:
• Either home or hospital delivery, either normal or operative delivery,
money need to be ready for medicine, instruments, food and other
expenditure etc.
• Discuss with woman for fund available as from saving bank; if
government employee, from government, etc.

18. 5. Funds
• Putting aside even a small amount of money daily/ weekly or monthly
• Saving money from beginning of pregnancy.
• Family can save extra money and food.
• Talk with reliable relative or neighbor for financial support.
• Become a member of a saving group etc.

19. 5. Funds
ii. Saving cost for motherhood and child:
• Medicine and treatment during pregnancy and postpartum period.
• Manage to assist delivery by SBA (paying for birth attendant for
facility services)
• Transportation upto health care facility, additional food for the
pregnant and post-partum mother.
• Extra clothing for postpartum mother and newborn baby

20. 6. Decision making
• The maternal mortality is mostly enhanced by 3 delays. Among them,
delay in appropriate decision making in an emergency is main one.
• Therefore, the family member or woman should take on time and
prompt decision on where to go, what to do, what to manage, how to
go etc. on time if any danger signs arises.
• These all plans should be prepared during pregnancy with her family
member. The women also needs help in identifying an appropriate
facility to go when labor begins or if danger signs arises.

21. 7. Support
During delivery and after delivery, the woman needs supporting
personnel to accompany her, to take care of other children and
household activities for blood etc. therefore, the birth preparedness also
includes management of the supporting personal.

22. 7. Support
This includes:
• A companion to support her during childbirth as per woman’s choice.
• Someone to take care of the family, their children and household
activities in the absence of woman.
• Decision maker if the main family decision maker is absent in an
emergency.
• Personnel to manage community resources and other logistics.
• Personnel for blood donor in an emergency.
• One personnel to manage and support in hospital or home during and
after childbirth.

23. 8. Blood donor
• Identify an appropriate blood donor and ensure that this person will be
available in case of an emergency.

24. 9. Danger signs
• Ensure, that the women and her family members knows the danger
signs during pregnancy, during labor and postpartum.
• Also, the danger signs of newborn must be made aware of.

28. Conclusion
• BPCR can be measured by examining the mother's knowledge on
identifying danger signs and the state of their preparations to take
measures during emergency and normal obstetric care.
• When complications occur, the unprepared family wastes a great deal
of time recognizing the problem, getting organized, getting money,
finding transport, and reaching the appropriate referral facility.

29. MCQ
Evidence from systemic review and studies in low research settings such as
– Ethiopia, Bangladesh, Tanzania, Kenya, and Ghana—demonstrates that
BPCR interventions significantly improve’s maternal & neonatal outcomes.
What is one major documented outcome of promoting BPCR among
pregnant woman?
a. Reduced attendance in ANC visits
b. Decreased awareness about neonatal care
c. Improved knowledge of danger signs & seeking skilled care
d. Negative effects about HF delivery

30. Standard for the assessment of BPCR
status among women

32. References
• ANC to PNC Continuum of Care guideline, 2079, Family Welfare
Division, Teku, Kathmandu
• National Medical Standard for Maternal and Newborn Care, Volume
III, 3rd
Edition, July 2020, MoHP