Professional Documents
Culture Documents
Maternal and Child Health
Maternal and Child Health
It refers to mother and child relationship to one another and consideration of the entire family as well as the nature of
socioeconomic environment as framework of the patient.
Goals
1. To ensure that every expectant and nursing mother maintains good health, learns the art of child care, has a
normal delivery and bears healthy children.
2. That every child, wherever possible lives and grows up in a family unit with love and security, in healthy
surroundings, receives adequate nourishment, health supervision and efficient medical attention, and is taught
the elements of healthy living.
The overall goal can be simply stated as “to ensure children are not only physically, mentally and emotionally well
born but also born well”
Philosophy
Pregnancy, labor and delivery and puerperium are part of the continuum of the total life cycle.
Personal, cultural and religious attitudes and beliefs influence the meaning of pregnancy for individuals to make
each experience unique.
Maternal-child nursing is family centered. The father of the child is as important as the mother.
MATERNAL CARE
PRENATAL CARE
Objective
To reach all pregnant women, to give sufficient care to ensure a healthy pregnancy and the birth of a full term
healthy baby.
Normal patient
Following the initial evaluation they will be given healthy instructions and counseling.
Micronutrient supplementation
Vitamins Dosage Schedule of giving Remarks
th
Vitamin 10,000 IU Twice a week starting on the 4 Do not give before the 4th month of
A month of pregnancy pregnancy- it might cause congenital
problem in the baby
Iron 600mg/400ug tablet Shall be given from the 5th month of
(100-200mg) pregnancy up to 2 months
postpartum (210 days)
IMPORTANCE OF VITAMIN A
Necessary for growth and development of skeletal and soft tissues through its effect upon protein synthesis and
differentiation of bone cells.
For good vision
Integrity of the skin
IMPORTANCE OF IRON
Carrier of oxygen needed for cellular respiration
Necessary for hemoglobin formation
Growth and development
In goiter endemic areas, all pregnant women shall be given one iodized oil capsule every year.
In malaria infested areas, all pregnant women shall be given prophylaxis in the form of chloroquine (150mg/tab),
2 tablets per week for the whole duration of pregnancy
“All birth attendants shall ensure clean and safe deliveries at home or at the facilities”
AT HOME
Home deliveries for normal pregnancies attended by licensed health personnel shall be encouraged. Trained
hilots (TBAs) may be allowed to attend home deliveries only in the following circumstances:
In areas where there are no licensed health personnel or maternal care
When at that time of delivery, such personnel is not available
At risks pregnancies and mothers who develop obstetrical complications during labor should be immediately referred to
the nearest facility or institution with capability to manage obstetric emergencies but obstetric first aid should be
administered first before transport.
Actively participating but untrained birth attendants (hilots) should be identified, trained and supervised by a personnel
of the nearest BHS/RHU trained on Maternal Care.
Second Stage
1. Cleanse vulva with soap and water/ mild disinfectant
2. Put on mask and scrub hands with clean brush in soap and water
3. Put on clean gown or apron
4. Wear sterile rubber gloves
5. Set up sterile area
6. Line Kelly pad with clean dressing towel
7. As the head crowns encourage the mother to bear down slowly to avoid sudden expulsion of the head and
prevent extensive laceration of the perineum.
8. Protect the perineum; do not press the head of the fetus to avoid injury of the brain
9. Grease hand on either side between extended fingers and palms of hands. Feel to determine if the cord is
around the neck. If it is loose, slip it over the shoulder or head. If it is tight, clamp it with clamps and cut in
between. Wipe mouth nose with dry gauze.
10. As head restitutes and rotates, give steady, gentle downward pull to allow the anterior shoulder to go under
the symphysis pubis, slowly give upward lift to allow the posterior shoulder to slide over the perineum.
11. After the trunks and legs are expulsed. Lay the baby on his/her right with a clean receiver on the abdomen of
the mother if he/she breaths readily. If not with face downward, hold up by the feet, remove mucus from the
throat with care as indicated.
Third Stage
1. Mother
a. Place placenta basin against the perineum and lay maternal end of the cord with the clamp in the basin.
b. Do not interfere with the delivery of the placenta. When signs of separation is present, apply fundal pressure
contraction and deliver the placenta.
c. Signs and symptoms of placental separation
1. Lengthening of the cord
2. Gushing of blood
3. Raising of the fundus 2 fingers above globular in shape
d. Note the amount of blood loss
e. Watch for hemorrhage at least one hour after delivery
f. Instruct member of the family to watch mother for hemorrhage for at least two hours just after the nurse or
midwife has left the house after delivery. The first two hours after delivery are dangerous due to atony of the uterus
g. Reiterate encouragement family planning
2. The Baby
a. As soon as the baby is breathing normally and pulsation of the cord ceases, clamp the cord with 2 clamps and
cut between them.
b. Wipe eyes of baby with cotton (from inner canthus, outward) and instill 10% ophthalmic ointment
c. Place baby in receiving blanket and have helper keeps him warm in a safe place.
d. Examine baby for trauma and malformation
e. Take and record weight, length, temperature and general condition
f. Dress cord aseptically
g. Spread vernix caseosa
h. Put dress of baby and keep him warm
i. Fill up birth certificate
APGAR SCORING
Apgar score provides a valuable index for evaluation of newborn infant’s condition at birth. It should be done at
1 minute and 5 minute after delivery.
Neonatal examinations are done right after delivery, after the baby is cleaned, at ages 1-3 days and at one
month age.
CRITERIA 0 1 2
HEAT RATE Absent Slow < 100bpm > 100bpm
RESPIRATORY Absent Weak cry, minimal cry Good, strong/vigorous
EFFORT cry
MUSCLE TONE Flaccid/ limp Minimal flexion Active motion
REFLEX No response Grimace, weak Good, strong/vigorous
(IRRITABILITY) cry
COLOR Blue/ pale all over Extremities are pale/bluish Completely pink
APGAR SCORING
0-3 poor Immediate resuscitation
4-6 fair condition Oxygenation and suctioning
7-10 Good Routine care
COMPLICATION OF LABOR
All health personnel and hilots should be well versed in the early recognition of a complicated labor.
The early recognition of prolonged labor is particularly important. It is almost certain that many infant deaths
occurring during the first 48 hrs. of life, and labelled as asphyxia and “congenital debility” are due to effects of
intrapartum anoxia and could have been averted by transfer of the mother to the hospital or clinic where she
could be admitted for delivery.
Normal pregnancies with labor progressing normally shall be encouraged to deliver in these facilities.
The basic services which will be delivered are: normal vaginal delivery and emergency obstetric measures for
common complications.
Delivery in Hospitals
The following risk pregnancies should be advised to deliver in the hospitals:
Pregnancy more than 4
Previous caesarian section
History of postpartum hemorrhage
Presence of medical illness such as heart disease, goiter, TB, DM, Severe anemia, Hypertension, bronchial
asthma
Placenta previa, Abruption plancenta
Multifetal pregnancies
Post term and pre term pregnancies
Previous uterine surgery
Nursing Care after Delivery
1. The cord must be cut between two clamps using sterile scissors or blade. Then the baby is immediately put to
the mother’s breast. The mother must be closely watched during the first 2 hrs. after delivery for bleeding.