Improve Maternal Health Articles

Improve Maternal Health Articles

Mothers and children not only constitute a large group, but they are also vulnerable or special group.

They comprise 71.4 percent of the population of the developing countries.

In India, women of childbearing age (15-44 years constitute 22.2 percent and children under 15 years of age about 35.3 percent of a total population together 57.5 percent of population consists of mothers and children.

Globally, about 800 women die every day of preventable causes related to pregnancy and childbirth, 20 percent of these women are from India.

Annually it is estimated that 55,000 women die due to preventable pregnancy-related causes in India. Mothers in the lowest economic bracket have about a two and a half times higher mortality rate.

The Maternal death rate has fallen from about 390 to 212 deaths per 100,000 lives birth in about 10 years, 67 percent decrease.

However, for every woman dying in childbirth, there are about 20 women who suffer long lasting and debilitating illnesses which are completely neglected.

“Maternal is the health of women during pregnancy childbirth and the postpartum period.

It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling experience in most cases and reduce maternal morbidity and mortality in other cases“.

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.

Problems Affecting Maternal Health

Malnutrition, Infection, Uncontrolled reproduction, Hemorrhage, high blood pressure, unsafe abortion, and obstructed labour

Practices are deeply scarred in our own homes and may take years to eliminate. Therefore, it is important to know the value of each individual in the family.

Home is the basic unit of a society; everything starts from the home and ends here.

The home being the microcosm of the society is vitally essential to meet the demands of each member thereby, facilitating respect and honour between the sexes irrespective of status and power. If the home fails, history collapses.

Pregnancy detection

Symptoms during pregnancy

Discomfort, Nausea and Vomiting, Heartburn Constipation, Increased frequency of urination

Symptoms indicating that a complication may be arising

Fever, vaginal discharge, palpitations, easy fatigability, Breathlessness at rest, generalised swelling of the body, puffiness of the face, passing smaller amounts  of urine, Virginal bleeding, Increased or absent foetal movements, Leaking of watery fluid per vaginam ( P/V)

High-Risk Pregnancy

Elderly primi ( mother age of more than 30 years for the first pregnancy), previous stillbirth or neonatal loss, history of three or more spontaneous consecutive abortion, birth weight of the previous bay 4500 g, hospital admission for hypertension or preeclampsia/ eclampsia in the previous pregnancy, previous surgery on the reproductive tract, Iso-immunization ( Rh-ve) in the previous pregnancy.

Complication Readiness

Danger signs: the potential danger signs during pregnancy, delivery and the postpartum period. If any of the following symptoms are present during pregnancy, delivery or postpartum/postabortion one should immediately visit a hospital or health centre, without delay be it day or night.

Any bleeding P/V during pregnancy, and heavy (>500 ml) vaginal bleeding during and following delivery

  • Severe headache with blurred vision
  • Labour lasting longer than 12 hours
  • Failure of the placenta to come out within 30 minutes of delivery
  • Preterm labour ( labour starting before 8 gestational months)
  • Premature or pre-labour rupture of membranes ( PROM)

Care of the Mother during and After Delivery

During pregnancy (antenatal care)

Antenatal Visit

Ideally, the mother should attend an antenatal clinic once a month during the first 7 months; twice a month, during the next month and thereafter once a week if everything is normal.

The suggested schedule is as follows:

[1st Visit- within 12 weeks preferably as soon as the pregnancy is suspected for registration of pregnancy and first antenatal check up]

[2nd visit between 14 and 26 weeks]

[3rd visit between 28 and 3 weeks]

[4th visit between 36 weeks and term]

Diet and Rest

The woman should eat more than her normal diet throughout her pregnancy. Remember a pregnant woman needs about 300 extra kcal per day compared to her usual diet.

She needs these extra calories for; maintenance of the health as a mother, the needs of the growing fetus, successful lactation.

Infant And Young Child Feeding

Pregnancy is the ideal time to learn the benefits of breastfeeding the baby.

Though breastfeeding is almost universal in India a few points need to be emphasized.

Initiating of breastfeeding: Breastfeeding should ideally be initiated within half an hour of a normal delivery (or within two hours of caesarean section or as soon as the mother regains consciousness, in case she undergoes a caesarean section)

It is common practice in India to delay initiation colostrums (The first milk) is thrown away and pre-lacteal feeds are given instead. This has obvious disadvantages.

  • Exclusive breast feeding: only breast milk and nothing but breast milk should be given to the baby for the first 6 months.
  • Demand feeding: This refers to the practice of breastfeeding the child whenever he/she demands it, as can be made out by the child crying. The practice of feeding the child by the clock should be actively discouraged. After a few days of birth most children will develop their own hunger cycle and will feed.
  • Complementary feeding at 6 months: The mother should be told that after 6 months of age, breast milk alone does not meet the baby’s nutritional requirements. The baby needs supplementary food in addition to breast milk; begin with semi-solid soft food devoid of spices, supplemented with a small amount of ghee/butter/oil. The frequency of feeds and the quantity of each feed should be increased gradually. Over a period of time the baby may be given solid foods. A one year old child should start eating from the family pot and should have an intake that is about half the adult diet. Feeding bottles should be strictly discouraged.

Rooming in

This refers to the practice of keeping the mother and baby in the same room and preferably on the same bed. This is usually practiced in the Indian setting.

This practice should be encouraged as it has certain advantages.

  • Makes demand feeding easier to practice as the mother can hear the child cry
  • Keeps the baby warm thus preventing hypothermia in the newborn
  • Helps build a bond between the mother and the baby.

Institutional Delivery

Every pregnant woman should be encouraged to go in for an institutional delivery. There are situations when complications arise and a home deliver may be risky and potentially life threatening.  

 

Postpartum Care and Hygiene

Important post partum cares are as follows:

  • To always have someone near the mother right after delivery respond to any change in her condition
  • Not to insert anything into the vagina
  • TO wash the perineum daily and after passing faeces
  • To change the perineal pads every 46 hours or more frequent if there is heavy lochia
  • If cloth pads are used wash the pads with plenty of soap and water and dry them in the sun
  • To bathe daily
  • TO have enough rest and sleep
  • To avoid sexual intercourse until the perineal wounds heals
  • To wash her hands before handling the baby

Nutrition

  • The woman should eat a greater amount and variety of healthy foods
  • Normal food can be eaten. The woman should eat enough and avoid heavy physical work.

Contraception

  • Birth spacing or limiting should be plan. Desirably a gap of 2-4 years between pregnancies is healthier for the mother and the child
  • Abstain from sex if the perineal wound has not healed

Postpartum Visit

  • The first postpartum visit should be within the first 48 hours
  • The second postpartum visit should be planned within 7 days of the delivery.

Danger signs

  • Excessive vaginal bleeding, i.e. soaking more than 2 or 3 pads in 20 to 30 minutes after deliver, or bleeding increases rather than decreases after the delivery
  • Convulsions, fast or difficult breathing
  • Fever and weakness that she cannot get out of bed
  • Severe abdominal pain, swollen, red or tender breast or sore nipple
  • Dribbling of urine or painful micturition
  • Pain in the perineum or pus draining from the perineal area, foul smelling lochia
  • For the above symptoms or signs the woman should be advised to visit a PHC as soon as possible

Conclusion

Effective antenatal care (ANC) can improve the health of the mother and give her a chance to deliver a healthy baby. Regular monitoring during pregnancy can help detect comp0lications at an early stage before they become life-threatening emergencies.

However, one must realize that even with the most effective screening tools currently available, one cannot predict which woman will developed pregnancy related complications. Hence, every pregnant woman needs special care.

It should recognize that every pregnancy is at risk and utmost care should be taken for a health mother and child which in turn lead to healthy society.

Improve Maternal Health Articles is contributed by Avishene Jonah, NEIGRIHMS 

 

 

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