Safe__motherhood_and_newborn_related_care_CHN[1][2].pptx

Safe motherhood and pregnancy

1. Safe motherhood and newborn related care 1

2. Group Membrane: Ahmad Shabbir (TL) Waseem Khan Hamid Niaz Adeela Aziz Denaria Shehzadi Faisal Hussain Ali Hassan 2

3. General guidelines for presentation: Listen to the presentation attentively. Keep your phones on silent mode. Avoid useless conversations during the presentation. Avoid using mobile phones during the presentation. If you have any question, write it down and ask it at the end of the presentation. 3

4. Objectives: 1. Describe the guidelines for antenatal assessment, care and teaching. 2. Explain the preparation of mothers for home delivery. 3. Discuss Home Delivery process and its management. 4. Discuss the postnatal complication. 5. Describe the nursing guidelines for post partum assessment, care and teaching. 6. Explain the care of newborn baby at home and emphasize on Breast Feeding. 4

5. Antenatal Assessment Anthropometry : At each visit, the pregnant women is weighed to see whether the gain in weight is normal. Blood Pressure Recording: At each visit, the blood pressure is recorded. If the blood pressure is < 140/90 mm Hg, diagnosis of PIH is made. Fundal Palpation: The height of fundus is examined to determine if the uterus is enlarging normally. BT BASAVANTHAPPA,COMMUNITY HEALTH NURSING,1998,PAGE#963 5

6. Fetal Heart Rate: From the 20th week of gestation onwards the fetal heart sounds are heard through auscultation. The normal rate is 120-140 per minute . Laboratory Examination : Urine is examined for sugar and albumin for detecting diabetes and PIH, respectively. Serologic test for syphilis (STS) is done at each visit to detect syphilis. Tetanus Examination: Pregnant women who give the history of immunization more than 5 years ago are given two doses of tetanus toxoid, 0.5 mL each, intramuscularly. the first dose at 20-22 weeks, and the second between 32 and 36 weeks. 6 BT BASAVANTHAPPA,COMMUNITY HEALTH NURSING,1998,PAGE#963

7. Antenatal Care Definition : Antenatal care is the preventive and promotive care of a pregnant woman during the antenatal period that is the period from the day she gets her pregnancy confirmed till the onset of true labor pains. The aims of antenatal care are: Early detection of complication Prophylaxis against tetanus and anemia Promotion of nutrition Imparting advice about spacing or sterilization Motivating them to attend antenatal clinic regularly BT BASAVANTHAPPA,COMMUNITY HEALTHNURSING,1998,PAGE#962 7

8. Antenatal Teaching For some category of pregnant women nutritional supplementation in the form of milk or mid-day meal is carried out. The pregnant women are advised to increase the proportion of green leafy vegetables, pulses and milk in their diet, and, additionally take a handful of germinating seeds every morning. These measures meet the increased nutritional requirements during every morning. These measures meet the increased requirements are proteins 14 g and energy 300 kcal. A women is explained that the additional requirements during the second half of pregnancy (over and above the normal diet) are cereals 35 g, pulses 15 g, milk 100 mL and sugar 10 g. BT BASAVANTHAPPA,COMMUNITY HEALTHNURSING,1998,PAGE#964 8

9. Preparation for home delivery Home Delivery by skilled attendant: Check emergency arrangements. Keep emergency transport arrangements up-to-date. Carry with you all essential drugs 3 records, and the delivery kit . Delivery Care: Follow the labour and delivery procedures. Observe universal precautions. Give Supportive care. Involve the companion in care and support. Maintain the partograph and labour record . Provide newborn care. Refer to facility as soon as possible if any abnormal finding in mother or baby. World Health Organization, Department of Reproductive Health and Research (RHR), led by Jerker Liljestrand and  Jelka   Zupanc , Page No D29 9

10. Immediate postpartum care of mother: Stay with the woman for first two hours after delivery of placenta. Examine the mother before leaving her. Advise on postpartum care, nutrition and family planning. Ensure that someone will stay with the mother for the first 24 hours. Post partum care of newborn: Advise on breastfeeding and breast care. Immunize the baby if possible. Examine the baby before leaving. Advise the family about danger signs and when and where to seek care. If possible, return within a day to check the mother and baby. Advise a postpartum visit for the mother and baby within the first week. World Health Organization, Department of Reproductive Health and Research (RHR), led by Jerker Liljestrand and  Jelka   Zupanc , Page No D29 10

11. Birth companion: Encourage support from the chosen birth companion throughout labour. Describe to the birth companion what she or he should do: Always be with the woman. Encourage her. Help her to breathe and relax. Rub her back, wipe her brow with a wet cloth, do other supportive actions. Give support using local practices which do not disturb labour or delivery. Encourage woman to move around freely as she wishes and to adopt the position of her choice. Encourage her to drink fluids and eat as she wishes. Assist her to the toilet when needed. World Health Organization, Department of Reproductive Health and Research (RHR), led by Jerker Liljestrand and  Jelka   Zupanc , Page No D7 11

12. Home Delivery without a skilled attendant: If the woman has chosen to deliver at home without a skilled attendant, review these simple instructions with the woman and family members. Give them a disposable delivery kit and explain how to use it. To ensure a clean delivery surface for the birth. To ensure that the attendant should wash her hands with clean water and soap before/after touching mother/baby. She should also keep her nails clean. To, after delivery, place the baby on the mother's chest with skin-to-skin contact and wipe the baby’s eyes using a clean cloth for each eye. To cover the mother and the baby. To use the ties and razor blade from the disposable delivery kit to tie and cut the cord. The cord is cut when it stops pulsating. World Health Organization, Department of Reproductive Health and Research (RHR), led by Jerker Liljestrand and  Jelka   Zupanc , Page No C18 12

13. To dry the baby after cutting the cord. To wipe clean but not bathe the baby until after 6 hours. To wait for the placenta to deliver on its own. To start breastfeeding when the baby shows signs of readiness, within the first hour after birth. To NOT leave the mother alone for the first 24 hours. To keep the mother and baby warm. To dress or wrap the baby, including the baby's head. To dispose of the placenta in a correct, safe and culturally appropriate manner (burn or burry). World Health Organization, Department of Reproductive Health and Research (RHR), led by Jerker Liljestrand and  Jelka   Zupanc , Page No C18 13

14. Explain supplies needed for home delivery: Warm spot for the birth with a clean surface or a clean cloth. Clean cloths of different sizes: for the bed, for drying and wrapping the baby, for cleaning the eyes, for the birth attendant to wash and dry her hands, for use as sanitary pads. Blankets. Buckets of clean water and some way to heat this water. Soap. Bowls: 2 for washing and 1 for the placenta. Plastic for wrapping the placenta. World Health Organization, Department of Reproductive Health and Research (RHR), led by Jerker Liljestrand and  Jelka   Zupanc , Page No C14 14

15. Home delivery process and management Definition of Labour: The onset of labour can be defined as the presence of strong regular painful contractions resulting in progressive cervical change Stages of labour: Stage 1: This describes the time from the diagnosis of labour to full dilatation of the cervix (10 cm). The first stage of labour can be divided into two phases. Latent phase is the time between the onset of regular painful contractions and 3-4 cm cervical dilatation. Active phase describes the time between the end of the latent phase (3-4 cm dilatation) and full cervical dilatation (10 cm). LOUISE C KENNY and JENNY E MYERS,Obstetrics,2017 ,PDF# 407-408 15

16. Stage 2: This describes the time from full dilatation of the cervix to delivery of the fetus or fetuses. The second stage of labour may also be subdivided into two phases. Passive phase describes the time between full dilatation and the onset of involuntary expulsive contractions. The second phase is called the active second stage . Stage 3: Third stage is the time from delivery of the fetus or fetuses until complete delivery of the placenta(e) and membranes. The placenta is usually delivered within a few minutes of the birth of the baby. A third stage lasting more than 30 minutes is defined as abnormal, unless the woman has opted for 'physiological management' (see below under Management of third stage), in which case it is reasonable to extend this definition to 60 minutes LOUISE C KENNY and JENNY E MYERS ,Obstetrics ,2017,PDF# 408-409 16

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18. Management of normal labour Women are advised to contact their local labour suite or their community midwife if they think their waters may have broken (SROM) or when their contractions are occurring every 5 minutes or more. It is important to recognize that women have very different thresholds for seeking advice and reassurance. The need for pain relief may result in admission to hospital before either of these two criteria is reached Whether at home or in hospital, the attending midwife will then make an assessment of the situation based on the history and on clinical examination, and the preferences of the woman. LOUISE C KENNY and JENNY E MYERS,Obstetrics,2017 ,PDF# 413 18

19. The mechanism of labour 1. Engagement 2. Descent 3. Flexion 4. Internal rotation 5. Extension 6. Restitution 7. External rotation 8. Delivery of the shoulders and fetal body LOUISE C KENNY and JENNY E MYERS,Obstetrics,2017 ,PDF# 409-412 19

20. Postnatal complication Bowel movement Sleep Burning micturition Pain in lower abdomen Legs are inspected for swelling Breast for engorgement and tenderness Nipples for cracks and eversion Hemoglobin is estimated for diagnosing anemia BT BASAVANTHAPPA,COMMUNITY HEALTH NURSING,1998,PAGE#965 20

21. Nursing Guidelines for Post Partum: Assessment: The temperature of the women is taken everyday for the first 10 days of delivery. Postnatal visits are carried out first on 2nd day of delivery, then twice at intervals of 2-3 days. During these visits, the lochia as absorbed on to the pad(s) is inspected for color and smell or for evidence of vaginal bleeding. The number of pads used in 24 hours is counted. Diminished and foul-smelling lochia are diagnostic of postpartum sepsis BT BASAVANTHAPPA,COMMUNITY HEALTH NURSING,1998,PAGE#965 21

22. Care : Postnatal care is the care given to the mother after birth of the baby up to the end of puerperium.Promote the mother's speedy return to physical, mental and social normalcy. Detect complications in the mother as early as pos- sible and treat them if minor or if major, refer her to the referral center. Motivate her for spacing the next child or for sterilization . Initiate the mother into the principles of good parentcraft. BT BASAVANTHAPPA,COMMUNITY HEALTH NURSING,1998,PAGE#965 22

23. Teaching: The woman or her husband is motivated to undergo sterilization, if they already have a child. The new mother is made to start breastfeeding within half-an-hour of delivery. She is informed about 'exclusive breastfeeding. She is discouraged from giving prelacteal feeds (which lower the child's appetite) and pacifiers. She is made aware that the baby needs her love, affection and physical cuddling as much as food. The mother is adviced to get the baby fully immunized against tuberculosis, poliomyelitis, diphtheria, pertussis and tetanus (DPT) and measles. BT BASAVANTHAPPA,COMMUNITY HEALTH NURSING,1998,PAGE#965 23

24. Care of New Born and Breast Feeding: Care of the newborn baby commences with the cutting of the umbilical cord. The right time to do this is when the cord pulsation has ceased. It is cut leaving three fingers' breadth of stump. Next the baby's mouth and nose are wiped clean. It is raised up by its feet. Its eyes are cleaned with a piece of sterile gauze and a few drops of penicillin put into them. The infant is given a bath with mild soap and warm water, face being washed before the body; this frees its skin of meconium, vernix and blood clots. The height, weight and head circumference are measured and recorded. BT BASAVANTHAPPA,COMMUNITY HEALTH NURSING,1998,PAGE#965 24

25. Breastfeeding: Breastfeed tend to decide before or very early in their pregnancy. This decision is usually based on previous experience, influence of family, culture and custom. The most common reasons mothers give for abandoning breastfeeding are inadequate milk production and sore and cracked nipples. Both these problems can be overcome by correct positioning of the baby on the breast. The mouth should be placed over the nipple and areola so that suction created within the baby’s mouth draws the breast tissue into a teat that extends as far back as the junction of the soft and hard palate. The tongue applies peristaltic force to the underside of the teat against the support of the hard palate. In this way, there should be no to-and-fro movement of the teat in and out of the baby’s mouth, thus minimizing friction 25 LOUISE C KENNY and JENNY E MYERS, Obstetrics,2017 ,PDF# 571-573

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27. Breast Feeding Education: Breastfeeding protects against diarrhea and common childhood illnesses such as pneumonia. Breastfeeding has also been associated with a higher intelligence quotient (IQ) in children. (WHO) recommends initiation of breastfeeding within an hour of birth, exclusive breastfeeding for the first 6 months of life and continued breastfeeding beyond 6 months and at least up to 2 years of age. Baby-friendly hospital support in the health system was the most effective intervention to improve rates of any breastfeeding. Early education in pregnancy about breastfeeding is advocated to improve uptake and engage pregnant women with breastfeeding services to allow them to prepare. 27 LOUISE C KENNY and JENNY E MYERS, Obstetrics ,2017,PDF# 407-408

28. Advantages of Breastfeeding : Readily available at the right temperature and ideal nutritional value. Cheaper than formula feed. Has a contraceptive effect with associated amenorrhea. In the longer term it is associated with: reduced necrotizing enterocolitis in preterm babies; reduced childhood infective illnesses, especially gastroenteritis; reduced atopic illnesses (e.g. eczema and asthma); reduced juvenile diabetes; reduced childhood cancer, especially lymphoma; reduced premenopausal breast cancer. 28 LOUISE C KENNY and JENNY E MYERS, Obstetrics ,2017,PDF# 574