Maternal and child

Heath
Jay Pee C. Malibiran
Nurse 1 RN
DEFINITION

 Maternal and child heath (MCH) refer to a package of

comprehensive healthcare services which are developed
to meet promotive, preventive, curative, rehabilitative
needs of pregnant woman before, during and after
delevery and of infants and pre school children from birth
to five years.
OBJECTIVES OF MCH

 Reduce maternal mortality and morbidity.

 Reduce per natal and neonatal mortality and morbidity.
 Regulate fertility so as to have wanted and healthy children when
desired.
 Provide basic maternal and child health care to all mother and
children.
 Promote and protect health of mothers.
 Promote and protect physical growth and psycho-social development
of children.
COMPONENT OF MCH CARE:

 Maternal Health
 Child Health
 Family Planning
MATERNAL HEALTH CARE

 Maternal health care include care of women

during pregnancy, child birth and after child
birth. It also includes treatment of child-less
couples.
MATERNAL RISK FACTOR:

 Maternal risk is define as the probability of dying or expercising

serious enjury as a result of pregnancy or child birth.
1.
 Young pirmi i.e. Below 19 years:
There is grave risk to both mother and the child because the teenage
mother:
It still growing and its not adequately equipped to cope the pregnacy and
labour. $ is not psychologicaly prepared for the responsibilities of marriage.

2.
 Elderly pirmi i.e. 30 years and over: having babies to late in life, leads to
increase risk of complications in pregnancy and labour.
 Having too many babies: when the mother bears more than 3 babies, she is
at high risk of developing problems due to repeatedn pregnancies and labour.
This is due to weakening to tissues, depletion of nutrients and overall poor
physical health of the mother.

 Having too close pregnancies: When the interval between the two
pregnancies is less than 3 years, It can create problems during the pregnancy.
It is because mother did bot get enough time to cover completely and fully
from the stress and strain of the previous pregnancy.
Other conditions of mothers: These
includes:
1. Mothers with short height i.e. Less than 145cm, having a small and
inadequate pelvis.
2. Mother having less than 40kg of weight: usually under weight mothers are
malnourished and anemic and have high risk of developing complications in
pregnancy.
3. Mothers having more than 70kg of weight having defficulty during child birth.
4. Mothers having malnutrition and anemia.
These mother are weak and find it defficult to tolerate the stress and strain
of pregnancy of the child birth.
 Associated medical conditions: These include; heart disease, high blood
pressure, kidney disease, tuberculosis, diabetes, repeated attacks of malaria,
hepatic disorder etc.
Maternal Health Components:

 Maternal healthcare component include:

a. Antenatal Care
b. Natal Care
c. Postnatal Care
ANTENATAL CARE

 Antenatal care is care during pregnancy period.

OBJECTIVES OF ANTINATAL CARE:
 To promote, protect and maintain health of mother during pregnancy.
 To ensure the birth of mature and healthy baby.
 To identify high risk mothers and given them an appropriate prevent
complication.
 To prepare the mother of confinement.
 To prepare the mother to care her baby.
ESSENTIAL ANTENATAL CARE SERVICES
1. Registration of pregnant women: the mother must be registered within 12
weeks of pregnancy.
2. Antenatal visit: ideally the mother should attend the antenatal clinic once a
month during the first 7 months, twice a month during the second month, and
thereafter, once a week, if everything is normal.
3. Care during first contact:
 Taking health history.
 Physical examination.
 General medical examination
 Obstetrical examination.
 Laboratory examination
(4) Immunization against to tetanus: second doses of tetanus toxoid should be
given. First dose at the 16-20 weeks and second dose 20-24 weeks of pregnancy.
4. Iron and Folic acid tablet: mother is given one tablet of iron and folic acid twice a day for
at least 100 days to prevent anemia in mother an to promote proper growth of fetus.
5. Health education during pregnancy:
 Diet during pregnancy, a well balanced diet is required during pregnancy for the proper
growth and development of fetus and for the optimum health of mother.
 A pregnant wormen should be educate reganrding presonal hygiene.
 Smoking and drinking, mother should be advised to avoid smoking and drinking alcohol. It
lead to low birth weight and retardation.
 Drugs, the mother should be advise not to take any medicine unless it is prescribed by the
doctor.
 Radiation, the mother should be adviose to avoid abdominal xray it predisposes child to
risk of lukemia and mother cancers.
 Protection from infection and illness, and expected mother should be instructed to protect
herself from the risk of infections especially measles and syphilis because these infection
can cause spontaneous abortion, malfomation, mental retardation, still birth etc.
Sexual activities: avoid coitus during the first and last trimester it increases the risk of
abortion and last trimester it predisposis to infection.
Travel avoid during first and last trimesters
 Reporting of untoward sign and symptoms: the mother should be instructed to
report to health personal if there is unusual pain, bleeding from vagina,
swelling in the feet, hand or face, headache, blurred vision, dizziness, high
fever babies movement not being felt.
 Childcare: the mother should be educated on various aspects of childcare.
 Follow-up visits: mother must be educated about the need for regular visit
and proper care during pregnancy.

7.) Preparing for confinement: the preparation for safe delivery is very
important. It should be done well in advance to avoid any type of defficulty for
emergency which might occur at time of delivery.

8.) Psychological preparation of the mother: the expectant mother, especially

the primary paramother has fear and axiety about child birth, its outcome,
complication etc., it is very imoortant to discuss various aspects and pregnancy
and delivery. This help in overcoming thier fears and axieties.
9.) Family Planning: When the mother is pregnant she is more receptives because
she experiencing the impact and burden of child birth. The mother should be
educated and motivated for small family norm and spacing of children
NATAL CARE

 Natal care refers to care during confinement/delivery/birth of a child.

OBJECTIVE:
The objectives of natal care:
1. To prevent infections,
2. Prevention injury to both mother and baby,
3. To detect and deal with any complications e.g. Ante partum and post-partum
hemorrhage, prolongged labour, Malpresentation, prolapse cord etc.,
4. To resuscitate the baby and to provide immediate care of the baby.
CARE DURING NATAL
 Preparation of place and sorrounding of confinement.
 Preparation of equipment and supplies required during delivery.
 Physical and psychological preparation of the mother.
 Examination of mothers physical condition abdominal palpation,monitoring
fetal heart sound, observation of vital signs, labour pain and uterine
extractions ect.
 Conducting delivery, watchful about any problem and helping mother in
taking pains.
 Referal of mother immediately incase any such problems.
 Giving immediate care to mother and baby after delivery.
 Giving instruction to the mother and family members.
 Maintenaning record and reporting of birth to authority.
 POST-NATAL CARE
 It refer to care which is rendered to both mother and the baby fater delivery.
OBJECTIVES:
 To restore, promote and maintain health of mother and baby.
 To promote breast feeding.
 To prevent complications.
 To established good nutrition’s of the baby.
 to prevent infections and identify any health pronblem/disorder in the baby.
 To support and strengthen the parents confidence and their role within their
family and cultural environment.
 To motivate for planned and small family norms.
 To educate mother and family on various aspects of mother and child care.
IMMEDIATE CARE OF THE NEW-BRON

CLEARING OF AIRWAY: Immediately after birth the baby should cry and breathe.
In order to promote breathing the airway needs to be cleared of mucus and any
other secretions.

MAINTENANCE OF BABY TEMPERATURE: The new born baby has the risk of
hypothermia because of immature heat regulating system. The risk of
hyphothermia is greatly reduced if the new born baby is immediately and
carefully dried with towel or clean cloth, wrapped in a clean cloth, kept close to
the mother for skin to skin contact and breast fed as soon as possible preferably
within an hour nof birth.
CARE OF THE EYES: The care of eyes include wiping of each eye from inside to out
side with boil cooled swabs, one for each eye as the child is boprn before he opens
the eyes.
CARE OF THE UMBILICAL: The cord should be legated in two places, 6cms and 9cms
from the umbilicus/blade and tied with sterilized cord tie to prevent tetanus. The
cord should be kept dry. Special instructions should be given to the mother and
family not apply anyything e.g. Any oil, ash, or cow dung on the cord. Such customs
increase the danger of tetanus infection.
APGAR SCORING: Apgar scoring is a device to monitor physical condition of the
baby. It is determined by immediate observation of the heart rate, respiration,
muscles tone, reflex response and colour of the infant. The observation is done at 1
minute and again 5 minutes after birth.
CARE OF THE SKIN: the care of the skin is very imoortant to protect the child form
any infection and kept the baby clean and warm. The vernix on the baby’s body is
protective in nature. Therefore if culturally acceptable, the bathing soon after can
be postpone for 12-24hours.
PHYSICAL EXAMINATION: The physical examination of the baby should be done by
health worker assisting mother in delivery soon after the birth to identify any birth
injury, malformations and general helatrh condition of the baby.
BREAST FEEDING: The breast feeding should be started as soon as posible
preferably within an hour of the birth.
IMMEDIATE CARE OF THE MOTHER

After the baby is born and placenta is delivery, it is very important that mother
is made comfortable and watched for any complication.
 The fundus is palpated, clots are expressed, and fundal height is measured.
 The perineum is inspected for any laceration for tear, perineal care is given,
napkin fixed.
 Mother is made comfortable by removing the soiled linen, through cleaning
and by keeping her warm etc.
 Hot drink is given thereafter.
 The vital signs are recorded.
The following instructions are given to mother and family:

REGARDING MOTHER: To rest, to watch for bleeding, to maintain perineal

hygiene, to take normal diet, to report incase there is any problem.

REGARDING BABY: To let the baby sleep and handle as little as possible, watch
for bleeding from cord, to breastfed the child, not to give anything else even the
water, not to apply anything on the cord, to report, incase there is any problem.
POST NATAL VISIT AND CARE
It is very important to give regular and frequent visit to post-natal mother when the delivery is conducted
in home.
The health worker is expected to follow the under mentioned schedule:

 1st visit-within 24 hours (on the 2nd of delivery was conducted by her)
 2nd visit-5th or 6th day
 3rd visit-10th day
 4th visit-2nd to 4th week
 5th visit-6th to 8th week (the visit is done in the clinic).
During the visit, both mother and baby are giving care to meet their health
needs.
CARE OF THE MOTHER
During each visit the following actions are generally performed.

 General observation of the mother and the sorrounding to assess overall

health status of the mother, cleanliness etc.
 Observation temparature, pulse and respiration.
 Examination of breast, involutions of uterus, lochia, perineum for any kind of
abnormality.
 Observation of any abnormality in the abdomen likes painful and hard
abdomen.
IT SHOULD BE SEEN THAT THE MOTHER:
 Takes adequate nutritious diet.
 Takes sufficient rest and sleep.
 Keeps herself clean and protect from infections
 Breast feeds her baby.
CARE OF THE NEW BORN
During each post natal visit the following actions are generally performed to take of the new born
baby.

 General observation of the baby and how is he/she.

 Observation of temperature, heart rate and respiration.
 Observation of eyes for any kind of abnormality such as watering of eyes or any
discharge etc.
 Observation of skin for change in colour.
 Observation of cord stump.
 The weight is check and recorded.
 Observation of any sign of abnormality is abdomen such as distension, tenderness etc.
 It should be seen that the baby is.
 Adequately cloth, kept clean.
 Breastfed on demand
 Allow to sleep and rest most of the time and handled only when is necessary.
 Not given bottle feeds.
 Mother should be enquired about any problem regarding baby.
CHILD HEALTH CARE

 Child health care refer to care of children from conception to birth til the age
of 5.
OBJECTIVE:
 Every children recieve adequate care and proper nourishment.
 Every child is immunize and protect from the disease.
 To monitor growth and development.
 To identify ailments and treated without delay.
 To educate the mother and family members to give proper care to thier
children.
CARE OF CHILD:
PERSONAL CARE OF CHILDREN: every child must get proper personal care to
protect the child from any kind of injury. It include maintenance of personal
hygiene, maintenance of body temperature, rest and sleep, exercises,training of
child regarding health habits etc.
FEEDING OF THE CHILD: adequate the proper feeding is very important.
BREAST FEEDING: For the first few months (6months) of life, breast feeding is the
best food which is made available by nature for healthy growth and develpment.
SUPPLEMENTARY FOOD: For the first 6 months, breast feed alone is sufficient for
normal growth and development. Beyond 6 months baby required additional food to
meet body requirements. Therefore it is necessary to introduce various other food
items suitable for the age of the child. These are called supplementary food.
MONITORING OF GROWTH & DEVELOPMENT: It is very important to monitor grwoth
and development of children regularly. It indicates health and nutrition status of
the child. It helps in identification of any deviation from normal. Ideally weight it is
measure and recorded once in month upto one year, once in two months upto two
years and once in the 3 months upto 5 years.
IMMUNIZATION OF CHILDREN: The child needs to be protected from 6 infectious
and vaccine preventable diseases. There diseases include tuberculosis, tetanus,
diphtheria, wooping cough, measles and poliomyelitis. It is very important that
health workers must educate all the mothers about the importance of
immunization and must explain them about the immunation schedule so that
they will bring the child for immumization according to the schedule.
SAFETY AND SECURITY OF CHILDREN: Safety and security can be ensured by
providing clean, safe and comfortable physical envirinment. The water, milk,and
food supply must be free from infectious agents and/or toxins. Disease carrying
insects must be controlled. Accidents hazards need to be remove or controlled in
order to prevent accidents such as falls, burns, poisoning, drowning, aspiration of
foreign objects, cuts and abrasions etc.
EARLY RECONITION AND TREATMENT OF AILMENTS: There are number of
ailments which can occur in children from 1 month to 5 years and cause
morbidity and mortality. The most common ailments includes diarrheal diseases,
acute respiratory infection, vaccine preventable diseases, nutritiounal deficiency
problems. Its is very imoortant recognize these ailments as early as possible so
that timely treatment and care can be taken at the famnily and health centre
level.
THE PACKAGE OF SERVICES

For the mothers

 TT Immunization
 Prevention and treatment of anemia
 Antenatal care and early identification of maternal complication.
 Deliveries of by train personnel
 Promotion of institutional deliveries
 Management of obstetric emergencies
 Birth spacing
FOR THE CHILDREN

 Essential New Born Care

 Exclusive Breast Feeding and weaning
 Immunization
 Appropriate management of diarrhea
 Appropriate management of ARI
 Vitamin A prophylaxis
 Treatment of anemia
FOR ELIGIBLE COUPLES
-Prevention of pregnancy
-Safe abortion

RTI/STD

 Prevention and treatment of reproductive track

infection and sexual transmitted disease.
DELIVERY OF MCH SERVICES:
- The MCH services are rendered to both urban and rural area.

RURAL AREA:
Village health post: is at the village level. It is manned by village health guide
and trained dai. Village health guide is trained in primary health care for a
period of 3 month to render simple mother-child and family planning services.
Dais are trained for 1 month to provide safe hygienical services during antenatal,
natal and post natal period. They can also provide family planning services.
o Sub centre level: sub centre is manned by multi-purpose health worker (male
and female).
 Contacting eligible couples and motivating for small family norms.
 Registration for all pregnant women.
 Providing essential antenatal and post natal care.
 Immunization of mother and children.
 Nutrition and health education.
 Ensure safe delivery through trained birth attendant.
PRIMARY HEALTH CENTRE LEVEL: MCH and family planning services
rendered from PHC are:
 It rendered all those services which are rendered from sub centre.
 Planning, organizing and implementing MCH prog.and services.
 Coordinating the work of all sub centres.
 Ensuring the entersectoral coordination.
 Training and continuing education program of material and child
health teams.

COMMUNITY HEALTH CENTERS: the centre manned by four specialist

and 21 health personnel (including 7 nurse medwives) and other staff. It
serves first refer unit and provided specialist services for mother and
children.
URBAN AREA:
In urban areas the MCH services are available through:

 District family welfare units/centres.

 District and states level hospital.
 Urban MCH Centers, clinics, maternity homes, hospitals.
 Urban family welfares and centres
The non government organization from MCH are:
 Nursing homes and hospitals.
 Voluntary organizations and charitable trust.
 Private pratitioners of all systems.
Thank You
REFERENCES:

JayPee Carandang Malibiran

Nurse 1 RN
DSPH