UNIT IV: SAFE MOTHERHOOD

AND NEWBORN RELATED

CARE
Presenters:
Mustajab Khan
Usman Ghani
Ameer hamza
M.Salman
Arbaz Khan
Mian Usman
 OBJECTIVES
At the end of this session the students will be able to:

•Discuss the Objectives MCH Services and get the introduction to the concept of
Reproductive Health

•Discuss the physiological Changes During Pregnancy

•Identify minor Ailments during Pregnancy and Discuss their

Management

•Discuss the Causes of Maternal Mortality in Pakistan

•Identify High Risk Mothers and discuss the need of referral

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 OBJECTIVES
•Describe the Guidelines for Antenatal Assessment, Care and Teaching

•Explain the Preparation of mothers for Home Delivery

•Discuss Home Delivery Process and its Management

•Discuss Postnatal Complication

•Describe the nursing guidelines for postpartum assessment, care and Teaching

•Explain the Care of Newborn at home and emphasize on Breast Feeding

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 REPRODUCTIVE HEALTH
Definition:
“ A state of complete physical, mental, and social well being in all matters relating
to the reproductive system, at all stages of life’’.

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 REPRODUCTIVE HEALTH
• Good reproductive health implies that people are able to have a satisfying and safe
sex life, the capability to reproduce and the freedom to decide if, when, and how
often to do so.
• Men and women should be informed about and have access to safe, effective,
affordable and acceptable methods of family planning of their choice.

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 MATERNAL & CHILD HEALTH

• According to WHO (1976):

Maternal and child health services can be defined as “ Promoting,
preventing, therapeutic or rehabilitation facility or care for the
mother and child”.
Thus maternal and child health service is an important and
essential service related to mother and child’s overall
development.

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COMPONENTS OF
MATERNAL CHILD
HEALTH
• Maternal health
• Family planning
• Child health
• School health

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MATERNAL & CHILD
HEALTH

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 SAFE MOTHERHOOD
• Safe motherhood is one of the important components of
reproductive health. It means ensuring that all women receive
the care they need, to be safe and healthy throughout
pregnancy and childbirth. It is the ability of a mother to have
safe and healthy pregnancy and child birth.

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 Physiological changes During
Pregnancy
• The changes that take place in the maternal organ system in response to
pregnancy.
• To accommodate the pregnancy and to prepare the woman for Labor.

Changes are due to alterations in:

• Hormonal production
• Circulation
• Metabolism

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 CHANGES TO BODY SYSTEM
 First Trimester
• Baby begins to grow
• Increased urination
• Changes with skin and hair
• Thickening waistline
• Nausea/fatigue
 Second Trimester
• Baby’s weight increases
• Heartburn
• Leg cramps

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 Third Trimester
• Baby has more rapid
growth & weight gain
• Backaches
• Breathlessness
• More frequent
urination

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SIGNS OF PREGNANCY

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SIGNS OF PREGNANCY

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SIGNS OF PREGNANCY

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 MATERNAL MORTALITY IN
PAKISTAN
•According to WHO, Pakistan has the highest mortality rate in Asia that is
340/100,000.
•In this advance era of science and technology, it is very alarming that women in
prenatal and postnatal period are dying due to preventable reasons.
•Highest mortality is a sign of low treatment opportunities available for
women health
•A maternal death is the death of women as a result of pregnancy, from the first
stage of gestation up to 42 days after the completion of pregnancy or its
management.
•Maternal death is categorized as: Direct obstetric death due obstetric problem and
indirect obstetric death which may be due to previously standing reason provoked by
the physiological effects of gestation

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CAUSES OF MATERNAL MORTALITY IN
PAKISTAN

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Pakistan Maternal Mortality Survey (2019 PMMS)
 HIGH RISK MOTHERS
Mothers with High Risk Pregnancy.
• A high-risk pregnancy is one that threatens the health or life of the
mother, her fetus or both.
• It often requires specialized care from specially trained providers.
• Some pregnancies become high risk as they progress, while some women are at
increased risk for complications even before they get pregnant for a variety of
reasons.
• Early and regular prenatal care helps many women have healthy pregnancies
and deliveries without complications

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 RISK FACTORS FOR A HIGH-RISK
PREGNANCY
• Existing health conditions: such as high blood pressure, diabetes, or
being HIV Positive
• Overweight and obesity. Obesity increases the risk for high blood pressure,
preeclampsia, gestational diabetes, stillbirth, neural tube defects, and cesarean
delivery.
• Multiple births. The risk of complications is higher in women carrying more
than one fetus (twins and higher-order multiples). Common complications
include preeclampsia, premature labor, and preterm birth.
• Young or old maternal age. Pregnancy in teens and women age 35 or older
increases the risk for preeclampsia and gestational high blood pressure
• Lifestyle factors. Including smoking, drug addiction, alcohol abuse and
exposure to certain toxins

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 ANTENATAL ASSESSMENT, CARE
AND TEACHING
• Antenatal care, the care that a woman receives during pregnancy, helps
to ensure healthy outcomes for women and newborns (WHO/UNICEF
2003).
• Antenatal care remains an important intervention in maternal care because it
provides an opportunity to detect problems and be prepared to handle them.
• The primary objective of antenatal care is to;
• Establish contact with the women,
• Promote, protect and maintain the health of mother during pregnancy.
• Identify and manage current and potential risks and
complications.
• Health education of mothers.
• To reduce maternal and infant mortality.

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 ANTENATAL ASSESSMENT, CARE
AND TEACHING
Prenatal care generally consists of:
• Monthly visits during the first three trimesters (from week 1– 28)
• Biweekly from 28 to week 36 of pregnancy
• Weekly after week 36 (delivery at week 38–40)

The World Health Organization (WHO) recommends four antenatal care

visits for women whose pregnancies are progressing normally, with the:
• First visit in the first trimester (ideally before 12 weeks but no
later than 16 weeks)

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 ANTENATAL ASSESSMENT, CARE
AND TEACHING
• Second visit: 24–28 weeks
• Third visit: 32 weeks
• Fourth visit: 36 weeks

However, it is the quality of the visits rather than the number of visits that is of primary
concern.

• WHO guidelines recommend that antenatal care includes, at a minimum, the

measurement of blood pressure, testing of urine for bacteriuria and proteinuria, and
blood tests to detect syphilis and severe anemia.

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 ANTENATAL ASSESSMENT, CARE
AND TEACHING
Health Education: The following topics should be part of the educational
activity related to antenatal care:

• Birth Preparedness plan (choosing the safest place for delivery;

identifying the danger signs and where and when to seek care for
complications)
• Exclusive breastfeeding;
• Maternal nutrition;
• STD/ HIV/ AIDS prevention;
• Immunization; and
• Family planning.

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 HOME DELIVERY
• Every pregnancy is at risk for complications, most of which can be managed
successfully if recognized and addressed in a timely manner.
• WHO recommends that all women are assisted at birth by a trained birth attendant.
• However, the fact that the majority of births in developing countries occur outside
hospitals and other health care facilities presents special challenges
• In many countries the majority of deliveries occur at home, attended by
grandmothers, mothers and other relatives, or traditional birth attendants.
• Typically they occur without the assistance of a skilled birth attendant.

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 HOME DELIVERY
Reasons families choose to give birth at home include:
• Local tradition and/or customs
• Greater comfort and privacy
• Trust in the daya who is often known and respected in the local community.

Two Major Factors that Contribute to Maternal and Neonatal Mortality and
Morbidity at Home:
• Harmful practices by providers
• Delays in recognizing complications and seeking & receiving
care.

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 HOME DELIVERY
Counseling for Home Birth: Women should be counseled on the importance of a
facility-based delivery.However, if the woman is insisting on delivering at home,
then she needs to be counseled on the importance of ensuring the following:
• A family birth plan
• Birth preparedness
• Complication readiness

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 HOME
DELIVERY
Birth Plan: Every family should have a "birth plan" that addresses
the following topics, regardless of where they plan to deliver:
1.Communication: How will the person attending the birth
(daya,
midwife, or physician) as well as the support people be contacted?
• Who decides? Who will make the decision to seek help and/or
transport the woman to the referral center, if necessary (for example:
father, mother-in-law)?
• Identify support people to help with transportation, to take care of
the children and/or household, and to accompany the woman to a
health facility in an emergency
2. Transportation. How will the woman be transported to a health
facility when needed?
• Where? Where will the woman be transported and is there an 30
arrangement with a referral facility and/or provider (private doctor)?
 HOME DELIVERY
3. Antenatal Care Card. This card contains important prenatal
and medical history data, such as blood type, obstetrical
history, history of the present pregnancy, vital signs, and
immunizations. It should be carried with the pregnant woman
at all times.
4. Cost. What is the cost of transportation and of care at the
referral facility? How will it be paid (for example: family
savings, a loan)?
5. Blood donation. Who will donate blood, if necessary?

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 HOME DELIVERY
Birth Preparedness: Despite local traditions, it is critical that pregnant women and
their families be prepared for any possibility of birth and an emergency.
• Being prepared for a safe home delivery yet ready for a prompt transfer in case of
an emergency will reduce these life threatening delays and save the lives of both
mother and newborn.
• Birth preparedness includes the following plan for the woman and her family:
– Know what to expect during pregnancy, including self- care (e.g., nutrition
and workload) and the expected date of delivery.
– Plan the appropriate location within the home for the delivery.

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 HOME DELIVERY
– Choose a skilled provider (PHC physician,
nurse/midwife), or at an absolute minimum when a
skilled provider is not available in the area, a trained birth
attendant.
– Have the needed supplies to conduct a clean and
safe delivery. Use a birth kit.
– Clean surfaces in room where woman will give birth
– Light for birth attendant
– Clean items for mother and baby
– Source of heat (if cold)

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POSTPARTUM ASSESSMENT, CARE
AND TEACHING
• The postpartum period is from the end of labor until the genital tract has return to
his normal position, its usually last for 42 days.
• During this time period care delivered to the mother is called
postnatal care
• The postnatal period is a critical phase in the lives of mothers and newborn
babies.
• Most maternal and infant deaths occur during this time.
• Yet, this is the most neglected period for the provision of quality care

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POSTPARTUM ASSESSMENT, CARE
AND TEACHING
Objectives of postnatal care are:
– To prevent complications of postnatal period.
– To provide care for the rapid restoration of mother to
optimum health.
– To ensure good newborn care
– To check adequacy of breast feeding.
– To provide family planning services.
– To provide basic health education to mother/family

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POSTPARTUM ASSESSMENT, CARE
AND TEACHING
All postpartum women should have at least 2 routine postpartum visits.

• 1st visit: 1st week postpartum, preferably within 48 -72 hours.

• 2nd visit: 6 weeks postpartum

•Women who do not return for postpartum visits should be visited at home.

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POSTPARTUM ASSESSMENT, CARE
AND TEACHING
Postnatal care for Mother
• Assess and check for bleeding, check temperature
• Support breastfeeding, checking the breasts to prevent
mastitis
• Manage anemia, promote nutrition.
• Complete tetanus toxoid immunization, if required
• Provide counseling and a range of options for family planning
• Refer for complications such as bleeding, infections, or postnatal
depression
• Counsel on danger signs and home care

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POSTPARTUM ASSESSMENT, CARE
AND TEACHING
Danger Signs for Mother
• Excessive bleeding
• Foul smelling vaginal discharge
• Fever with or without chills
• Severe abdominal pain
• Excessive tiredness or breathlessness
• Swollen hands, face and legs with severe headaches or blurred vision
• Painful, engorged breasts or sore, cracked, bleeding nipples

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POSTPARTUM ASSESSMENT, CARE
AND TEACHING
Postnatal care for Newborns
• Assess for danger signs, measure and record weight, and check
temperature and feeding
• Support optimal feeding practices, particularly exclusive
breastfeeding
• Promote hygiene and good skin, eye, and cord care
• If prophylactic eye care is local policy and has not been given, it is still
effective until 12 hours after birth

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POSTPARTUM ASSESSMENT, CARE
AND TEACHING
• Promote clean, dry cord care
• Identify superficial skin infections, such as pus draining from umbilicus,
redness extending from umbilicus to skin.
• Ensure warmth by delaying the baby’s first bath to after the first 24 hours,
 practicing skin-to-skin care, and putting a hat on the baby.
• Encourage and facilitate birth registration
• Refer for routine immunizations
• Counsel on danger signs and home care

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 POSTPARTUM ASSESSMENT, CARE
AND TEACHING
Danger Signs for the Baby
• Convulsions
• Movement only when stimulated or no movement.
• Not feeding well
• Fast breathing (more than 60 breaths per minute), grunting or severe chest in-
drawing
• Fever (above 38°C)
• Low body temperature (below 35.5°C),
• Very small baby (less than 1500 grams or born more than two months early)
• Bleeding

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POSTPARTUM ASSESSMENT, CARE
AND TEACHING
Complications
• Post Partum Hemorrhage
• Puerperal infection
• Mastitis
• Anemia
• Puerperal cystitis
• UTI
• Thromboembolic disease
• Puerperal psychiatric disorder

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POSTPARTUM ASSESSMENT, CARE
AND TEACHING
Teaching
• Postpartum care and hygiene
• Wash hands before handling baby
• Wash perineum daily
• Have enough rest and sleep
• Avoid sexual intercourse until perineal wound heals.
• Eat a greater amount and variety of healthy foods
• Teaching on the importance of breastfeeding
• Birth Spacing and its importance

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 REFRENCES
•https://pjmhsonline.com/2021/march/613.pdf
•https://www.ncbi.nlm.nih.gov/books/NBK304191/

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THANK
YOU

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