Counselling during pregnancy

Counselling during pregnancy & CPHC-HWC

1. COUNSELLING DURING PREGNANCY Presented by- Rohit Tongariya Anmtc, katihar

2. Learning Objectives At the end of the session, the learner will be able to understand about- 1. Nutritional counselling during pregnancy. 2. Counselling regarding importance of breastfeeding. 3. Sex during counselling. 4. Counselling regarding Prevention of domestic violence. 5. Counselling regarding post natal family planning.

3. NUTRITIONAL COUNSELLING DURING PREGNANCY Counselling messages for pregnant women- Maintaining good nutrition and a healthy diet during pregnancy is critical for the health of the mother and unborn child. Nutrition education and counselling is a widely used strategy to improve the nutritional status of women during pregnancy. The strategy focuses primarily on: At least 4 ANC checkups along with one additional check up on 9th of every month under the PMSMA during entire pregnancy should be attended • Benefits of ANC registration including timely identification and treatment of pregnancy related problems , information on safe institutional delivery , nutrition and lifestyle, provision of IFA , calcium and deworming tablets, tetanus diphtheria vaccination, government entitlements should be explained • To achieve optimal weight gain (10-12kg) during pregnancy, at least one food item from all five food groups (pulses, milk and milk products, non-vegetarian food, fruits and vegetables along with cereals) should be consumed.

4. At least 3 main meals and 2 nutritious snacks should be consumed, second trimester onwards During early months, pregnant women often suffer from morning sickness due to the hormonal and physiological changes. So small amounts of foods with increased frequency (5–6 times a day) should be advised Solid carbohydrate rich foods like bread, biscuit and fruits given in the morning or before meals help to relieve nausea. Also fried, rich, strongly flavoured and spicy foods need to be avoided. Supplementary nutrition provided by the Anganwadi center should be consumed regularly along with daily diet Sufficient fluid intake including 8–12 glasses of water per day . During pregnancy consumption of iron-folic acid (red colored) tablet prevents anemia . Consumption of vitamin C rich foods like lemon, guava, orange and amla facilitates absorption of iron • Consumption of calcium (white colored) tablets prevents pre-eclampsia/eclampsia (high blood pressure, convulsions).

5. Consumption of double fortified salt is beneficial for the cognitive development of the baby Vitamin A is helpful in improving the eyesight, increasing immunity of body. Foods rich in vitamin A such as green leafy vegetables, yellow and orange colored fruits, milk and milk products, tomato, egg, liver etc. should be consumed Personal hygiene should be maintained to prevent infections Importance of family support during pregnancy should be emphasized Adequate rest for 2 hours in the day and 8 hours of sleep at night daily and heavy objects should not be lifted At least thirty minutes of brisk walking/ light exercise should be done Consumption of alcohol, beedi, cigarette, gutka, tobacco should be avoided At least 3 years gap should be maintained between 2 pregnancies using family planning methods that are available free of cost at any public health facility Early (within 1 hour of birth) and exclusive breastfeeding (till 6 months) should be done. Information on government schemes like JSSK, ICDS, NRLM/SRLM, PDS and JSY should be given.

6. Counselling messages for high risk pregnant women: Anaemia Increasing intake of iron and dietary folate rich foods including green leafy vegetables (bathua, chaulai), lotus stem, whole grain cereals (bajra), pulses (black channa ), legumes, nuts. Iron fortified foods should be included in the diet Intake of heme iron sources including meat, fish, poultry products Intake of fruits rich in vitamin C like papaya, guava and citrus fruits Fermented foods (e.g., idli , dosa ) and sprouted pulses Coconut milk, if used extensively in cooking, inhibits iron absorption.

7. Hypertension At least 4 servings of calcium-rich foods like dairy products (milk, paneer, curd), soya milk, whole pulses, whole cereals, green leafy vegetables and ragi/nuts Potassium-rich foods like ragi, wheat, Bengal gram, cowpea, moong, peas, red gram, colocassia, coriander seeds, fenugreek seeds, musambi, apricots, banana, cherries, etc. Small and frequent meals should be taken Avoid fasting or missing any meal Plenty of water (2–3 litres /day) should be taken to keep the bowels regular Intake of processed foods, rich in fat, salt and sugar should be restricted Keep salt intake to less than 6 grams/day (approximately 1tsp full/ day) Regular physical activity should be done (e.g., yoga, walking, etc.) for 30 minutes

8. Gestational Diabetes Mellitus Refined carbohydrate foods like sweets, fruit juices, table sugar, starchy vegetables, etc. should be avoided Carbohydrate foods should be spread through the day over 3 small meals and 2–3 snacks each day to maintain blood glucose levels Fried foods should be avoided. Instead serve steamed, boiled or sautéed food Whole fruits should be preferred over juices Prefer fish or chicken over red or organ meat

9. Gestational Diabetes Mellitus Fiber should be increased in the diet by including salad, beans, non- starchy vegetables, whole fruit, whole grain cereals, whole pulses, flax seeds and oat bran as they help control blood sugar levels. Drink water, buttermilk, soups, and other unsweetened healthy beverages instead of soda or fruit juices. Intake of processed foods, rich in fat, salt and sugar should be restricted specially pickles, chutneys, murabbas. Regular physical activity must be encouraged (e.g., yoga, walking, etc.) like 30 minutes of walk, two times a day.

10. Counsel regarding Breastfeeding Key messages on breastfeeding to mothers: • Initiate breastfeeding especially colostrum feeding within an hour of birth. • Do not give any pre-lacteal feeds. • Ensure good attachment of the baby to the breast. • Exclusively breastfeed the baby for six months. • Breastfeed the baby whenever he/she demands milk. • Follow the practice of rooming in. • Seek support if mother faces any problem in breast feeding (You may refer to the module on newborn, infant and child health services for details of breastfeeding and management of breast-feeding problems)

11. Sex During Pregnancy It is safe to have sex throughout pregnancy, as long as the pregnancy is uncomplicated. Some women experience a decreased desire for sex during pregnancy. The husband should be informed that this is normal and the woman's consent should be sought before engaging in sex. Some couples find engaging in sex uncomfortable during pregnancy. The husband must see to the comfort of the woman while engaging in sexual activities. Advice couples to have safe sex and use condoms especially if the woman has discharge or itching in the vaginal area or the husband has urethral discharge or experiences burning while urinating. The couple should be advised to abstain from having sex during the first six weeks postpartum or longer if the perineal wounds have not healed by then.

12. Domestic Violence The husband and family members of the pregnant woman should be briefed about the serious consequences that violence could have on the pregnancy, on the woman’s health and on the physical and mental health of the child to be born. The woman herself should be counselled in private, and enabled to access support systems from within or outside the family, during and after the pregnancy. Health workers should be alert to signs of continuing violence even in the post-partum period

13. Family Planning Pregnancy is the best period for family planning counselling as it gives the couple time to think about and choose the method they would want to use after the birth of their baby. Ask about the couple’s plans for having more children. If they desire more children, then advise them that a gap of 3–4 years between pregnancies is healthy for the mother and the child. The couple should be given advice on the range of contraceptive methods available to them. CHO, ASHA and MPWs can explain about the suitable contraceptive methods during pregnancy based on the details provided in family planning module.