❖ Safemotherhood

Safe motherhood means creating the circumstances within which a women is enabled to choose
whether she will become pregnant, and if she does, ensuring she receives care for prevention and
treatment of pregnancy complications, has access to emergency obstetric care if she needs it, and care
after birth, so that she can avoid death or disability from complications of pregnancy and childbirth.

Safe motherhood means creating the circumstances within which

● a woman is able to choose whether she becomes pregnant

● if she does, ensuring she receives care for pregnancy along with the prevention♣ and treatment of
the pregnancy related complications
● has access to trained assistance
● emergency obstetric care if she needs it
● care after birth so that she can avoid death or disability from complications of pregnancy and
childbirth.

❖ Why Safe Motherhood?

• Maternal mortality major cause of death & disability in women of reproductive age.
• 600,000 women die every year from complications related to childbearing.
• Women are injured from childbirth complications.
• Maternal mortality & morbidity adversely affect the health and welfare of children,
families, and communities.
• Healthy pregnancy
• Safe delivery
• Healthy postpartum period
• Healthy newborn
How to make motherhood safe?
• Antenatal care
• Maternity care
• Postnatal care
• Essential newborn care
• FP services
• Human rights and social justice for women

❖ Historical perspective of safe motherhood services in Nepal

 ✔ 1968: Family planning, maternal and childhood program started as vertical projects
✔ 1981:Maternal health Task force covered plan of operation document
✔ 1987:International safe motherhood conference, Nairobi, Kenya
✔ 1987:Maternal Health Task Force focus on TBA
✔ 1990:Nepal began addressing Safe Motherhood¬ 1991:National health Policy priority for
safe motherhood
✔ 1993:Preparation of the National Safe Motherhood Program (National Safe Motherhood
plan of Action 1994-1997 Safe Motherhood Policy formulation)
✔ 1997:Commencement of the Safe Motherhood Program
✔ 1997:National safe motherhood program launched, Pilot study on three districts Kailali,
Surkhet, Baglung
✔ 1998: Reproductive health strategy and safe motherhood policy formulated.
✔ 2001-2004:Second phase, (Nine districts) commencement
✔ 2002-2017:National safe motherhood plan (15 years plan) Establishment of BEOC services
in 50 hospitals within 10th Five year plan.
❖ Objectives of Safe motherhood Program
• To increase the accessibility, availability and use of SM services.
• To improve knowledge and skills of all categories of health workers, working for women’s health.
• Increase the availability and use of temporary methods of FP
• Create awareness on SM among general population
• Improve the legal, social and economic status of women

❖ PURPOSE OF SAFE MOTHER HOOD IN NEPAL

The purpose of the National Safe Motherhood Program is:
• To reduce maternal and neonatal morbidity and mortality
• To improve the maternal and neonatal health through preventive and promotive activities
as well as by addressing avoidable factors that cause death during pregnancy, childbirth
and postpartum period.
NOTE: Evidences suggest that three delays are important factors behind the maternal and
new born morbidity and mortality

❖ SCOPE OF SAFE MOTHER HOOD

1. Ante-Natal services
2. Intra-Natal services
3. Post-Natal services
4. Neo-Natal services
5. Family Planning services
6. Woman Rights
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 7. Social Justice

● ANTENATAL CARE
Antenatal care(ANC) is the care of the women during pregnancy.
✔ The primary aim of ANC is to achieve at the end of a pregnancy aϖ healthy mother
and a healthy child.
✔ Ideally, this care should begin soon after conception and continue throughout
pregnancy.
✔ A minimum of 4 visits (recommended by WHO and Government of Nepal):
● First at 4th month
● Second at 6th month
● Third at 8th month
● Fourth at 9th month

OBJECTIVES OF ANC
✔ To promote, protect and maintain the health status of mother during pregnancy.
✔ To detect high risk cases and give them special attention.
✔ To foresee complications and prevent them.
✔ To reduce maternal and infant mortality and morbidity.
✔ To teach the mother elements of child care, nutrition, personal hygiene, family
planning and environmental sanitation.

▪ ANTENATAL CARE AT HEALTH POST LEVEL

• Antenatal care at health post should be provided on a regular basis as a part of the clinic
schedule or as required.
• Take a thorough medical history to screen for high risk cases.
• Conduct a physical examination of the pregnant woman, including assessment of
general health, palpation and auscultation as appropriate.
• Check the pulse, blood pressure, temperature, weight and height of the pregnant
women.
• Test blood for hemoglobin ( Hb%) and for malaria in suspected cases.
• Test urine for albumin and sugar.
• Administer tetanus toxoid immunizations.
• Provide iron and folate tablets.
•Identify and treat anemia, TB, worm infestation, malaria, STDs, and UTIs in pregnant
women and make sure that no contraindicated medicines are given during pregnancy.
•Record all antenatal visit details on the card.
•Maintain institutional records and send reports to the district health office as scheduled.

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 •Talk to the pregnant woman about the place she will deliver and how to prepare for a
clean and safe home delivery if there are no risk or danger signs evident.
•Discuss about the presence of a skilled birth attendant at delivery if the woman is high
risk or is showing danger signs.
•Advise the pregnant woman about diet, rest, preparation for breastfeeding and family
planning.
•Advise pregnant woman about danger sign and complications. Explain what to do if they
occur.
•Detect high risk and danger signs of pregnancy like antepartum hemorrhage and
eclampsia. Manage and refer as appropriate.
•Provide oral rehydration therapy and antiemetic for excessive vomiting, and refer the
woman to the PHC or district hospital. If the woman dehydrated, start intra venous fluids.
•Manage threatened or complete abortion and refer other complications of abortion.
•Manage mild pre-eclampsia and refer the woman to the PHC or hospital for delivery.
•Provide first aid and arrange transport for obstetric emergencies during pregnancy and
delivery that cannot be handled at the health post (septic abortion, signs of ectopic
pregnancy, antepartum hemorrhage, eclampsia, prolonged and obstructed labor)

● INTRA NATAL CARE (DELIVERY CARE)

✔ Intra-natal care is a care of pregnant women during labor.
✔ It includes assessment of labor stage, monitoring the progress, supportive care
during labor, assistance during delivery and immediate care of newborn.
✔ Intra natal care emphasizes on :
- Clean surrounding of the labor room and the other rooms connected to it.
- Clean hands.
- Following safe and hygienic delivery practices.
- Maintaining highest standards of sterility of tools and instruments.
✔ The safety to be undertaken during this period can be explained by the “6 Cleans”
which are:
1) Clean hands
2) Clean surface
3) Clean perineum
4) Clean instruments
5) Clean thread and ties
6) Clean umbilicus

PURPOSE OF INTRANATAL CARE

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 o Make necessary arrangement for clean and hygienic delivery conditions.
o Conduct safe delivery with minimum injury to the infant and mother.
o Emphasize on early preparedness to deal with complications such as
prolonged labor, antepartum hemorrhage, convulsions, malpresentations,
prolapse of the cord etc.
o Provide essential new born care.

INTRANATAL CARE AT HEALTH POST LEVEL

1. Care for the mother:
- The health post staff (ANM) should attend normal deliveries at health institutions or at
home and complicated deliveries when called upon.
The ANM should provide care as below:
-Detect and assess danger signs during labor and delivery, and manage or refer the
woman after providing obstetric first aid.
-Perform an episiotomy if necessary.
-Do a manual removal of a retained placenta, if other methods fail.
-Repair minor perineal tears.
-Catheterize distended bladder if the woman cannot pass urine. –
- Treat post partum hemorrhage with oxytocins.
-For severe hemorrhage, do external bimanual compression and, if required, an internal
bimanual compression.
-Provide first aid and manage eclampsia and refer to a PHC or hospital in case of any
complications.
2. Care of the Newborn :
The Health post worker, particularly the ANM, should provide immediate essential
newborn care as following:
-Identify and treat hypothermia.
- Detect and assess complications early after birth, including birth injuries, and congenital
abnormalities.
- Refer the newborn to the appropriate facility for emergencies or danger signs that
cannot be handled at the healthpost.
Five essential care of newborn:
-Wipe with clean, dry and soft clothes
–Keep the umbilicus dry
-Skin to skin contact with mother
-Breastfeeding within 1 hour of children and exclusive to 6 months
-Bathing only after 24 hrs

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