Subject Name : Community

Medicine
Topic Name: Introduction to
Maternal & Child Health

FACULTY NAME: Dr Sumitra Pattanaik

DEPARTMENT NAME: Community Medicine
INSTITUTE NAME: IMS & SUM Hospital,
Bhubaneswar
SIKSHA O ANUSANDHAN
Introduction to
preventive methods in
Obstetrics, Maternity cycle &
Maternal and Child health
Programme
 Preventive Medicine &Obstetrics
 Obstetrics is concerned with the aim of ensuring the good health of
the mother throughout the pregnancy, puerperium and that every
pregnancy may culminate in a healthy mother and a healthy baby.

 This has given rise to a new concept called Social obstetrics which
deals with the social and environmental factors and human
reproduction going back to the pre-conception/premarital period.

Preventive medicine
in Obstetrics

Antenatal care Intranatal care Postnatal care

Antenatal care
This period begins soon after pregnancy
and continues throughout pregnancy.

objectives

1)Promote,protect and maintain health during

pregnancy.
2)Detect high risk cases and give attention.
3)Foresee preventable complications.
4)Remove anxiety and dread associated with delivery.
5)Reduce maternal and infant mortality and morbidity.
6)Teach the mother elements of child care, nutrition, personal hygiene and
environmental sanitation.
7)Educate the mother about family planning, medical termination of pregnancy etc.
 Antenatal Care Delivery
Antenatal visits

Prenatal advice

Specific health
Antenatal care
protection

Mental preparation

Family planning

Pediatric component
Health problems faced during pregnancy

Problem during Urban* Rural* Total*

pregnancy
Night blindness 6.4 13.7 12.1
Blurred vision 17.0 23.2 21.8
Convulsions for from 11.0 15.2 14.3
fever
Swelling of legs, body 28.2 25.8 26.3
or face
Excessive fatigue 43.6 43.3 43.4
Anemia 27.1 26.3 26.5
Vaginal Bleeding 3.1 3.6 3.5

( * )  % of live births.

From - NFHS 2- 1998-99

 Reasons for not receiving ante-natal
check-up

Source: NFHS 2 1998-99

Reason % of births
Not necessary 59.5
Not customary 4.3
Costs too much 14.7
Too far/ no transport 3.7
Poor quality of service 0.8
No time to go 1.8
Family did not allow 8.5
Lack of knowledge 4.1
No health worker visited 1.5
Other 1.2
 Intranatal
Care
The care taken
during child birth.
objectives

1)Thorough asepsis.
2)Minimum injury to the mother/child.
3)Dealing with complications such as prolonged
labour,antepartum,hemorrage,convulsions,malpresentations,
prolapse of the cord,etc.
4)Care of the baby during delivery-resustication, care of the cord,
care of the eyes,etc.
Domiciliary care:
Mothers with normal obstetric history may be advised to have their confinement
in their own homes .Delivery may be conducted by health worker female or
trained dai .This is known as “domiciliary midwife service”.

Institutional care:
About 1% of the deliveries tend to be abnormal,4%”difficult” thus requiring the
services of the doctor. institutional care is recommended for all “high risk cases.
The mother is allowed to rest one day after delivery and discharged after five
days.

Rooming in:
Keeping the baby’s crib by the mother's side is known as rooming in. this
arrangement gives the mother to know her baby and also gives a sense of
security. there are higher chances of success in breast feeding.
Place of delivery
One of the most important aspects of intranatal care is the
place of delivery.
 Post natal
care
• It is the care of the
mother and he new born after
delivery.
• Care of the mother is primarily
the responsibility of the obstetrician
and the care of the new born is the
combine responsibility of the
obstetrician and the pediatrician.

Care of the mother:

1)prevent complications of the postpartal period.
2)Provide care for rapid restoration of mother to optimum health.
3)Check adequacy of breast feeding.
4)Provide family planning advice.
5)Provide basic health education to mother and family.
 FERTILIZATION ANTENATAL PEROID

MATERNITY INTRANATAL PERIOD

CYCLE
INTER CONCEPTIONAL PERIOD

POSTNATAL PEROID
Fertilization takes place in the fallopian tube. Segmentation proceeds at a rapid rate. The
fertilized ovum reaches the uterus in 8-10 days organs and tissues are formed by cell
division and differentiation.
1) Pre natal period :
(a) ovum - 0 – 14 days
(b) embryo - 14days to 9 weeks
(c) fetus - 9th week to birth
2) Pre mature infant - 28 to 37 weeks
3) Birth full term - 280 days on average
MATERNAL AND CHILD
HEALTH PROGRAMME
 The main causes of maternal mortality may be divided into 3 categories -

(1) Among the social causes are:

early marriage and pregnancy,
repeated childbirth,
preference for sons,
anemia,
lack of information about danger signs and symptoms,
delay in referral.
(2) Among the medical causes are:
obstructed labor,
hemorrhage, (ante-natal, during labor and postnatal)
toxemia and
infection or sepsis.
(3) Among availability of health care facilities are:
lack of essential supplies and trained health personnel at the centers,
non-sympathetic attitude of health personnel,
deficient medical treatment of complications and inadequate action taken by
medical personnel.
(Source: Safe Motherhood in India,; The Need for Comprehensive Policy and Programmes
1994).
CHILD HEALTH PROBLEMS
1) Low birth weight: Babies born with a birth weight of < 2.5 kgs.

2) Malnutrition: Protein energy malnutrition ,vitamin def.,iodine

def.,etc.

3) Infections and parasitosis: HIV, malaria ,measles, pertusis, polio,

tetanus etc.

4) Accidents and poisoning: trauma, burns, poisoning etc.

5) Behavioral problems: child abandoned by families etc.

Evolution of maternal and child health Programmes in India:
YEAR MILESTONES

1952 Family planning programme adopted by the government of India.

1961 Department of family planning created in the ministry of health.

1971 Medical termination of pregnancy act.

1977 Renaming of family planning to family welfare.

1978 Expanded programme on immunization.

1985 Universal immunization programme + national oral rehydration

therapy programme.
1992 Child survival and safe motherhood programme.

1996 Target free approach.

1997 Reproductive and child health programme – 1.

2005 Reproductive and child health programme – 2.

Reproductive and Child
Health programme – II

Reproductive and Child Health

Programme – II :

• Focus on overall Reproductive Health

• Integration of Maternal & Child Health

with Family planning and RTI/STI.

• Community Needs Assessment Approach

• No Targets for contraceptives

MATERNAL HEALTH:
(a) Essential Obstetric Care:
It consists of 
􀂾 Early Registration (12-16 wks).
􀂾 3 Antenatal Check-ups.
􀂾 Prevention & Treatment of anemia.
􀂾 Institutional /Safe Deliveries.
􀂾 Postnatal Check-up.
(b) Emergency Obstetric Care:
It consists of 
􀂾 Establishment of First Referral
Units (FRUs) at sub-district level
health institutions.
􀂾 1748 FRUs were identified by the States.
􀂾 13 different types of equipment were
provided for carrying out procedures like
laprotomy. C. section, blood transfusion,
newborn care and anesthesia
management.
(c) 24 Hours Delivery Services at
PHCs/CHCs:
To promote institutional deliveries,
provision has been made under the
current RCH programme to give
additional honorarium to the staff to
encourage round the clock delivery
services at PHCs and CHCs. This is to
ensure that at least one medical officer,
nurse, and cleaner are available
beyond normal working hours.
(d) Improve Institutional
Deliveries :
Up gradation of labor rooms in
PHCs.
Funds for 24 hr delivery services at
PHCs.
Involvement of Private sector :
Gynecologists/ lady doctors on
hiring basis for visiting PHCs on
weekly basis.
(e) Referral Transport: Time is an important factor for obstetric emergencies.
Women who undergo deliveries at home and develop complications often find it
difficult to be transported to a referral unit. Under the current RCH programme
provision has been made to assist women from indigent families in 25% of the
subentries in selected states to provide a lump sum corpus fund to the Panchayat
through District Family Welfare Officers. Since 2000-2001 the scheme has been
extended to all the states.

(f) Medical Termination of Pregnancy: Various steps have been taken to

expand and strengthen safe abortion services under RCH programme. In order

to increase availability and accessibility to abortion services, MTP equipments

are being procured centrally and provided to district hospitals, CHCs, and PHCs
wherever required.
(g) Prevention, Management and Control of Reproductive Tract Infections: In
order to ensure that there is a RTI/STI clinic readily accessible to the community,
RTI/STI clinics in FRUs are being set up in the country in a phased manner.

(h) Integrated Financial Envelope: The purpose of the envelope is to provide flexibility
to better performing states to design a package of interventions to address the
problem of maternal health care instead of tying them to national scheme.
 CHILD HEALTH
Programme Interventions in Child Health:

• Universal immunization Programme: Under the Immunization Programme, vaccinations given

to infants and pregnant women are for controlling vaccine preventable diseases namely, childhood
tuberculosis, diphtheria , pertussis, poliomyelitis, measles and neo-natal tetanus.

• Neonatal Tetanus Elimination: In order to achieve early elimination of Neo-natal Tetanus, ICMR
has advised that efforts should be made to cover all women in reproductive age group with three
doses of Tetanus Toxoid vaccine through a campaign approach.

• Urban Measles Campaign: The emphasis is on covering all unprotected children up to the age of
3 years with in single dose of measles vaccine.

• Surveillance of Vaccine Preventable Diseases: Considerable efforts have gone into developing
a reliable surveillance system, immediate report of cases of poliomyelitis has been made
mandatory. There has been a significant decline in the reported incidence of these diseases
compared to the incidence in 1987.

• Availability of Vaccines Used for Immunization:

The country is self-sufficient in all vaccines except BCG and oral Polio Vaccine (OPV).
• Acute Respiratory infections (Pneumonia): Control Pneumonia is a leading cause of deaths of
infants and young children in India accounting for about 30 per cent of the under-five deaths. The
ARI strategy was developed during 1989 and implemented in 26 districts on a pilot basis in 1990.

• Prevention and Control of Vitamin 'A' Deficiency Among Children:

Vitamin 'A' deficiency, which can lead to blindness, has been widely prevalent in the country,
especially among the pre-school children. It is estimated that a large number of children suffer from
sub-clinical levels of Vitamin-'A' deficiency. Under the Programme ,doses of Vitamin-'A' are
administered to all children under three years of age.

• Baby Friendly Hospital Initiative Scheme for NGOs:

A Scheme for Baby Friendly Hospital Initiative for financial assistance to NGOs for promoting
Breast feeding practices exists under RCH Programme.

• Polio Eradication (Pulse Polio Immunization)