Birth prepardeness

1. Birth Preparedness
• Birth preparedness is advance planning
and preparation for delivery.
• Birth preparedness helps ensure that
women can reach professional delivery
care when labour begins.

2. Contd…
• In addition, birth preparedness can help
reduce the delays that occur when women
experience obstetric complications, such
as recognizing the complication and
deciding to seek care.
• Reaching a facility where skilled care is
available and receiving care from qualified
providers at the facility.

3. Key elements of birth preparedness
include:
• Attending antenatal care at least four
times during pregnancy;
• Identifying a skilled provider and making
a plan for reaching the facility during
labour;
• Setting aside personal funds to cover the
costs of travelling to and delivering with a
skilled provider and any required supplies.

4. Contd…
• Recognizing signs of complications.
• Knowing what community resources- emergency
transport, funds, communications, etc. are
available in case of emergencies;
• Having a plan for emergencies i.e. knowing what
transport can be used to get to the hospital,
setting aside funds; identifying person(s) to
accompany to the hospital and/or to stay at
home with family; and identifying a blood donor.

5. • Because life-threatening complications
can occur during the early postpartum
period, birth preparedness also includes
preparing/planning for accessing
postpartum care during the first week
after delivery and at six weeks after
delivery.

6. Barriers to use of skilled care
• Uncertainty about expected due date.
• Lack of knowledge about costs of
transport to health facility (during day and
during night hours).
• Lack of information about the costs of
delivery care at health facilities.
• Lack of information/knowledge about
when plans should be made.

7. Contd…
• Concerns that planning for delivery or
preparing for an emergency may invite
misfortune.
• Taboos against buying items for a baby
that has not been born.
• Lack of knowledge about the specific
items that will be needed during delivery
or where to obtain them.

8. Antenatal counseling
• Attending antenatal care each month
throughout pregnancy.
• Preparing for delivery and possible
emergencies.
• Risks associated with pregnancy, delivery and
the postpartum period; danger signs of
obstetric complications.
• The importance of early postpartum care and
when to attend postpartum check ups.

9. • Antenatal counseling should also address
HIV/AIDS to ensure that women are
informed of the increased risks of
HIV/AIDS during pregnancy, how to
protect themselves against HIV/AIDS and
where to go for voluntary counseling and
testing (VCT) services

10. Complication readiness and emergency
planning
 As noted earlier, complication readiness is the
process of anticipating the actions needed in
case of an emergency and making an
emergency plan. Pregnancy-related disorders
such as high blood pressure and bleeding can
begin any time between visits for antenatal
check-ups, and any other illness may occur
during the pregnancy. If such conditions are
suspected at any stage, you should refer the
woman immediately, and repeatedly counsel
her to report to you or seek medical care
quickly if danger symptoms are seen.

11. In an emergency
 Make sure the woman and her husband and
other family members know where to seek help.
 Alert them to plan for transportation with vehicle
owners.
 Advise them to save money for transportation,
drugs and other treatments.
 Decide who will accompany her to the health
facility.
 Decide who will care for her family while she is
away

12.  A pregnant woman may bleed massively
(hemorrhage) during or after delivery and
may need blood to be given to her. You
should make sure that she or her husband
identifies two healthy adult volunteers
who agree to act as blood donors if she
needs it. Reassure the potential blood
donors that they will not be harmed by
giving blood, and their general health will
be assessed before donating.

13. Causes of delay in getting emergency
help
There are three types of delay, all of
which can be serious for the mother and
her baby:
Delay in healthcare-seeking behaviour
(delay in deciding to seek medical care),
Delay in reaching a health facility
Delay in getting the proper treatment.

14. Ten essential points that women and their
families need to know to adequately prepare
for birth:
• Expected due date: Woman needs to know expected
due date and that it is only an approximate or
estimated date-labour may start before or after the
expected due date.
• Planning and preparation are life-saving: Woman
needs to know that many obstetric complications are
unpredictable and can arise suddenly and without
warning. Planning or preparing for delivery does not
invite such events to happen.

15. • Obstetric risks and appropriate facility for
delivery: If the woman is at higher risk she needs to
understand why it is crucial to deliver at a health
facility and she needs to know when she should go
(e.g. before her expected due date? When labour
starts?) To which facility should she go?
• Even if the woman does not have serious risk factors,
she still needs to be able to recognize signs of serious
complications. She also needs to know that a health
facility is the safest place to deliver.

16. • Basic supplies needed: The woman needs to know
basic items that she should have ready for delivery,
how much they may cost, and where they can be
obtained.
• Facility charges for normal delivery and costs of
early postpartum care: The woman needs to know
what charges she can expect for a normal delivery.
She also needs to know the costs associated with a
caesarean section, especially if it is likely to occur
given her obstetric history.

17. • Available transport options and associated costs:
The woman needs to know available options for
reaching a facility where she can deliver her baby at
night or during the day. She needs to know the
approximate travel time to the facility as well as the
costs involved.
• Total anticipated expenses: The woman needs to
know the sum total that supplies, service delivery
charges and transport to the facility are likely to cost
so she can set aside sufficient funds.

18. • Possible sources of funds: The woman needs to
realistically assess whether she/her family will be
able to put aside the required funds or brainstorm
other possible sources of support.
• When to start birth preparations: Whether she is
in her 2nd or her 8th month of pregnancy, the woman
needs to be motivated and empowered to start
preparing for skilled care during delivery and the
early postpartum period as soon as possible.

19. The birthing supplies that a pregnant woman
and her family should be advised to prepare
before the delivery are listed below.
 Very clean cloths to put under the mother and
for drying and covering the newborn.
 New razor blade to cut the cord.
 Very clean and new string to tie the cord.
 Soap, a scrubbing brush and (if possible) medical
alcohol for disinfection.
 Clean water for drinking and for washing the
mother and your hands.

20.  Three large buckets or bowls.
 Supplies for making rehydration drinks,or
tea.
 Flashlight if there is no electricity in the
area.

22. Introduction
 Adoption is essentially a social process by
which the reciprocal need of childless
parents and an orphan(or parent-
deprived) child is satisfied.
 It may be defined as ‘Transfer of rights
and responsibilities concerning the child
from biological or birth parents to the
adoptive parents irrevocably’.

23.  Adoption is also an instrument through
which one can ensure the following
important children’s rights accepted by
the United Nations, Conversation of Rights
of Children and the world community at
large.

24. Contd…
These are:
 Inherent right to survival and development.
 Right to name and nationality.
 Child’s interest being always a primary
consideration.
 Special protection from physical harm and
neglect.
 No discrimination through universal
brotherhood.
 Social security through education,
employment and earning.
 Special attention to disabled children.

25.  In India, two laws govern the process of adoption.
First ‘The Hindu Adoption and Maintenance Act, 1956’.
 This Act applies-
(a) to any person, who is a Hindu by religion in any
of its forms or developments
(b) to any person who is a Buddhist,Jaina or Sikh by
religion and
(c) to any other person who is not a Muslim, Christian,
Parsi or Jew by religion, unless it is proved that any
such person would not have been governed by the
Hindu law

26.  the second,
“The Guardians and Wards Act of 1890”
governing adoptions by parents who are
not Hindus by religion. In intercountry
adoptions children are given for adoption
under this act in foster care till they are
finally adopted according to the law of the
country of adoptive parents.

27. Making up a decision to adopt
 Childless couples who are involuntarily
childless have a desire for parenthood
combined with complex set of emotions
ranging from guilt of infertility to
apprehensions to fears related to social
status, family acceptance, unforeseen
elements of taking home child borne by
parents not known and their own capabilities
regarding coping up with a new challenge in
life.

28. Preparation for adoption
• Preparation for adoption should be
mentally, physically, procedure and
document wise.
• The ideal age difference between at least
one parent and the baby to be adoptive
should be not more than 40years so that
they have enough time and physical
strength on their side to look after the
baby till it becomes a young adult.

29. Contd…
Parents should be equipped with the following
documents:
o Marriage certificate
o Proof of age
o Income certificate
o Bank balance
o Property certificates
o Doctors certificate regarding their health and
their infertility status, references and
photographs when they go to apply for a
baby for adoption.

30. Medical Investigations
• Clinical examination consists of
identification data, anthropometry,
systemic examination, detection of
any gross deficiency disorders and
anomalies.
• Standard investigations include
urinalysis, X-ray chest, stool
examination for parasites, tests for
VDRL,HIV, Hepatitis-B, and any other
tests with special reference to
hypothyroidism, chromosal anomalies
etc.

31. Follow up and Post adoption
counselling
 Follow up after adoption is necessary for
advice and care in the following crisis
situations which are likely to arise in some
of the babies:
a) Sudden change crisis where the baby
may take long time to cope up with the
suddenness of change in environment,
climate, living conditions that may results
into anxiety, rejection or aggression.

32. Contd…
b) Behavior crisis is likely manifest after
first few years and may be as a result of
pampering and overprotection by
parents.
c) Communication and identity crisis may
come at any at any age if the child’s
sense of security is not well ensured by
the parents. and other family members.

34. References
 A Parthasarathy ‘IAP Textbook of Pediatrics’
4thedition,Jaypee Publications; volume1:226-228.
 www.wikipedia.com/adoption/application of act
 Myles. Textbook for Midwives.15th edition.
Elsevier Publications:519-20
 Article by skilled care initiative on Birth
Preparedness: An Essential Part of ANC
Counselling
 Study by Johns Hopkins Bloomberg School by
Public Health on “birth preparedness and
complication readiness”.

35. Recaptulization
Fill in the Blanks:
 Birth preparedness is advance _______ and _________
for delivery.

 The Hindu Adoption and Maintenance Act comes in _____.
True/False
 The ideal age difference between at least one parent and
the baby to be adoptive should be not more than 30year.
 The Guardians and Wards Act of 1890” governing
adoptions by parents who are not Hindus by religion.