WHO TRADITIONA BIRTH ATTENDANTS TRAINING Vol3 (part2)

This book is about training of traditional birth attendants so that they can contribute to the prevention of maternal-infant morbidity and mortality by managing obstetrical and neonatal emergencies in order to save lives in their communities.

2. 19. PUTTING THE BABY TO THE BREAST IMMEDIATELY AFTER BIRTH

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION
m A woman has placed the baby to the w Why should the baby be placed to the breast before the delivery
breast before the placenta is expelled, of the placenta?

= Are there any other advantages of this practice?

POINTS TO REMEMBER

Placing the baby on the breast even before the placenta Is delivered helps the womb to contract. This Is useful
for the expulsion of the placenta. The practice of breast feeding also helps in controlling bleeding.

Breast feeding immediately after birth helps the baby to get warmth from the mother’s body. It is also useful
in encouraging the early secretion of milk.

4. 20. CHECKING THAT PLACENTA IS COMPLETE

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

= A complete placenta with membianes a Why is it important to check whether the placenta is completely
and a part of the umbilical cord. delivered or not?
= How can a TBA ensure that the placenta is complete?

= What should be done if the placenta is not completely delivered?

POINTS TO REMEMBER

m Check the placenta as soon as it is delivered.

m Ensure that the placenta is complete. For this, hold the placenta in the palms of the hands (palms should be
Kept flat) and look for blobs as shown in the illustration. There should be no Irregularities on the margins.

im if the placenta is not completely delivered, the woman must be referred immediately since the incomplete
delivery of the placenta is responsible for continued bleeding.

6. 21. CONTROLLING EXCESSIVE BLEEDING FROM A TEAR AFTER CHILD BIRTH

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION
= Atear below the birth canal during child mn which women are tears common?
birth.

= What is the danger of tears?

= A TBA putting pressure on the
perineum with a pad made out of cloth
to control bleeding from the tear.

How can tears be prevented?
How can a TBA control excessive bleeding from a tear?

For how long is pressure required to control bleeding?
What should be done if bleeding caused by a tear does not stop?

POINTS TO REMEMBER

m Tears below the birth canal are common in women who are delivering for the first time. They are more common
if support to the birth canal is not provided during child birth.

m Tears can cause persistent bleeding and can be dangerous.
= The TBA should provide support to the perineum when the baby Is being born to prevent tears.

m/f there is severe bleeding from a tear, pressure must be applied continuously for more than 5 minutes (count
to 100 seven times).

m Refer the woman immediately to a hospital If severe bleeding from the tear does not stop with pressure,
because a blood transfusion, repair of the tear or an operation may be required.

8. 22. CONTROLLING EXCESSIVE VAGINAL BLEEDING AFTER CHILD BIRTH

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

m ATBA applying pressure on the womb m What are the different ways by which a TBA can control bleeding
by extemal compression to control after child birth?
bleeding,

= When should the TBA try external bimanual compression of the
womb?

= How is bimanual compression done?
= How does bimanual compression control bleeding?

POINTS TO REMEMBER
u. Raise the foot end of the bed, perform a gentle massage of the womb, place the baby at the breast as soon
as it is born, check for tears in the birth canal and make sure that the placenta is completely delivered.

w If bleeding continues after child birth, or the womb feels timp and does not contract well or when the TBA
suspects that some portion of the placenta Is not delivered, bimanual compression of the womb should be
tried.

w. External bimanual compression is best done by keeping one hand above the womb and the other. ‘just above
the pubis. Then the TBA must try to roll the womb between her two hands.

m. Bimanual compression helps in stimulating a womb to contract. It also helps to close the openings of the.
blood vessels from which blood is oozing out.

10. 23. BREECH DELIVERY

THIS ILLUSTRATION SHOWS

m= À baby’s foot and leg coming out from
the birth passage first.

ı A baby being born with buttocks as the
presenting part.

POINTS FOR DISCUSSION

What should the TBA do during delivery if she sees a foot or a
hand coming out first?

What are the dangers of a delivery in which the buttocks are
delivered first?

What should the TBA do if buttocks come out first?

experienced. person: 's help.

_ suction apparatus with her.

POINTS TO REMEMBER E =

m The TBA should refer the woman immediately if the baby’s hand or foot comes out frat:
w In such cases an operation may be required to deliver the baby.
= Bicth may be difficult it the buttocks are delivered first, f the TBA suspects this problem, she should seek an

m Such bables can get injured ‘and get choked. on thelr: en

Do not pull out such a baby. The TBA should. relieve any, ‚pressure onthe Fr and remove the secretions.on
delivery of the head by pressing on the chin and: acen ts} mouth or sucking: ‘out the secretions if she: has

12. 24, RECOGNITION OF THE BABY WHO DOES NOT CRY

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION
= Anewborn baby lying imp immediately m How should the TBA assess newborn babies who do not cry or
after birth. It does not appear to have breathe soon after birth?
any signs of life. m What should be done if the baby does not cry or breathe after being
bom?

POINTS TO REMEMBER
m Check breathing in bables who do not cry. Bables who do not cry or breathe soon after birth may be blue or:
pale. They appear limp and their heart beat may be slow or absent,
u Stimulate babies who do not cry or breathe by flicking their soles gently.

= The TBA should drain or suck out the secretions sticking In the mouth or throat of bables who da not cry and
Provide mouth to mouth breathing if they fail to respond to clearing of the secretions.

1 Itis Important to keep these bables warm by wrapping them in several layers of cloth soon after birth,

14. 25. CLEARING THE SECRETIONS FROM THE MOUTH IN THE NEWBORN
WHO DOES NOT CRY

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

A TBA clearing the mouth and throat of
a newborn in order to make him/her
breathe or cry. The finger is wrappedin
a piece of gauze.

m Whatis the importance of clearing secretions in newborn babies?

m When should the TBA clear the secretions with her finger wrapped
in a gauze piece?

= What are the other ways of clearing secretions?

POINTS TO REMEMBER

Secretions which may be blocking the breathing passage of a newborn baby can prevent him/her from crying
or breathing well.

The TBA should clear the secretions with her finger wrapped in a piece of gauze when the newborn baby does
not cry and breathe or when she thinks that the baby has thick secretions blocking his/her breathing passages.

Other ways of clearing the secretions are by holding the baby with Its head slightly lower than its body with
face turned sideways and flicking the soles, or sucking out the secretions by using a mouth operated mucus
‘Suction apparatus with a trap.

16. 26. MOUTH-TO-MOUTH BREATHING IN THE NEWBORN WHO DOES NOT CRY

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

= A TBA providing mouth to mouth m= When should the TBA provide mouth to mouth breathing to a
breathing to a baby who did not cry or newborn baby?
breathe at birth.

m What precautions should the TBA observe while providing mouth
to mouth breathing?

POINTS TO REMEMBER

= Mouth-to-mouth breathing Is given to a baby who does not cry or breathe even after the secretions blocking
his breathing passages have been removed. =

m For effective and safe mouth-to-mouth breathing, the TBA should extend the baby’s head with her hand and
Place arolled cloth underneath his neck. She should keep a piece of gauze on the baby's mouth. While blowing
in she must maintain a tight seal on the baby's mouth and nose. She should blow well. She must observe the
baby's chest move up each time she blows in. After blowing in a couple of times, she must catch her own
breath so that she is not tired. A

18. 27. KEEPING A NEWBORN BABY WARM

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION
= Anewborn baby being dried with a soft m What harm can occur tonewborn babies if they are not kept warm?
cloth.

= Why should babies be dried immediately after being born?
m Keeping the newborn baby warm by
wrapping him/her in several layers of
cloth. = What are the other ways of keeping newborn babies warm?

u Whatis the benefit of wrapping the baby In several layers of cloth?

Breast feeding a newborn baby.

POINTS TO REMEMBER

| “m Newborn babies are very delicate. They can get very sick and even dle if they are not kept warm. :

Babies are born wet. Therefore, they can get cold very quickly. immediately ate birth, they must be dried
with a clean dry cloth.

u After arying, newborns must be wrapped in several layers of clean soft cloth. Alr gets trapped between the
= + layers of cotton and becomes warm. This can keep babies warm. |

| n A thin light appilcation of oll, covering the baby’s body, arms and legs and keeping the baby In skin-to-skin
[contact with the mother are other methods of keeping newborn babies warm.

20. 28. WEIGHING A NEWBORN BABY

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION
= Anew born being woighed by the TBA. = Whyisitnecessary to weigh every newborn baby soon after birth?
Reading of normal birth weight on the m Whatis the correct method of weighing newborns?

scale. What is normal birth weight and what is low birth weight?
m Reading of! tow" rth safe con the: Ifa weighing scale is not available, what should the TBA do?

POINTS TO REMEMBER

m Weighing newborn babies Is simple and sate.

m Weight assessment helps In the Identification of ‘at risk’ low birth weight bables who need special care either
at home or at the hospital/health centre.

= A baby who welghs more than 2500 g at birth Is of normal birth welght and a baby who welghs less than 2500
y at birth Is of low birth weight.

m Ifa weighing balance Is not available, an arm band tape to measure the arm circumference can be used.

22. 29. RECOGNITION OF TETANUS IN THE NEWBORN

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

= An 8-day old newborn baby with lock = What do these signs indicate?
jaw (clenched mouth) and a stiff body
that is arched like a bow.

= How is tetanus recognized in newborn babies?
m Whatis the first symptom of tetanus?

POINTS TO REMEMBER

m. The first symptom of tetanus in a newborn Is refusal of the breast or refusal to suck.
m The baby’s mouth is clenched and it appears to be smiling when It has tetanus.
= A baby with tetanus will have spasms In which the body becomes stiff and arched like a bow.

24. 30. RECOGNITION OF CONGENITAL MALFORMATIONS

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

= A baby with cleft lip. = Whatis the importance of recognizing congenital anomalies?

= A baby with abnormal legs and feet = Enumerate some other congenital anomalies that TBAs have
(club foot). seen

= Can congenital anomalies be prevented?

POINTS TO REMEMBER

m There may be other congenital anomalles present when one or more are visible: The non-visible anomalies a
inside the body may be dangerous. Somé of these can be responsible for death. dE

m= A lump on the back of the head or the back, deformed ears, a small or very large head, are a few examples of
congenital anomalies other than those shown In the illustrations.

m Some congenital anomalies can be prevented by the timely immunization of. girls against rubella (German
measles). Consumption of drugs and tmnecessary x-ray exposure during the first 3 months of pregnancy
should be avoided. These can. Pravent some congenital defects. E

26. 31. EATING MORE FOOD THROUGHOUT BREAST FEEDING

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

= Abreast feeding mother eating more of = Why should a breast feeding mother eat more food?
what she normally eats.

= What are the benefits for the baby?
= What are the benefits for the mother?

POINTS TO REMEMBER

m. A woman who Is breast feeding her baby must eat more food to make up for the Increased needs.
m. A mother who eats well will have enough milk of good quality to breast feed her baby.

m Food requirements are Increased in women who breast feed thelr babies. They must eat more of what they.
‚normally eat to maintain strength and vigour.

= Women who breast teed their babies must eat about 50% (hall) more than what they normally eat daily.

28. 32. MANUAL EXPRESSION OF BREAST MILK

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION
= Steps for the manual expression of milk = When is the manual expression of breast milk advised?
from breasts.

m How is manual expression of breast milk carried out?

POINTS TO REMEMBER

= Breasts which become too full with milk can become painful, Feeding also becomes. ‘painful when the nipples
| become sore or cracked. Sometimes the baby is too werk to suck well. In all these cases the breasts must be
= eniptied by manual expression. =

Hold the breast with both hands and move the hands forwards towards the nipple while pressing the breast.
Squeeze the milk out by. pressing the skin between thumb and finger behind the areola of the nipple.

m The milk expressed manually should not be thrown away. It is safe and nutritious, Therefore it should be given
: to. au e baby.

30. 33. ENGORGEMENT OF BREASTS AND CRACKED NIPPLES

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION
m An engorged breast and a cracked = Why do breasts get engorged?
nipple.

m What are the problems related to cracked nipples?

m What can the TBA do to prevent breast engorgement and cracked
nipples?

m: Breast engorgement occurs if the baby is not put to the breast often.

Im Breast feeding becomes painful and engorgement becomes worse If nipples are cracked.
m: The TBA should advise frequent breast feeding to prevent engorgement.
= The TBA should advise cleanliness and hygiene of the breast during pregnancy and lactation.

32. 34. METHODS FOR CHILD SPACING

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

=. Different contraceptive devices used for m Why is spacing of births advised?
spacing births. These include the N eres
Condon IUD (copper) jelly, ciaphragm, m What advice should be given about optimum birth interval?
vaginal foam tablets and the oral = What are the different ways by which pregnancies can be spaced?
contraceptive pil.

= What is the role of the TBA in promoting child spacing?

= POINTS TO REMEMBER

m For the health of the mother and the child, parents should walt until thelr youngest child Is at least 2 years
old before having another baby,

m If birth spacing is less than 2 years, the risk of a low birth welght baby Is Increased, and the baby's growth
and development are affected, the mother Is unable to regain her health and the risk of death for the baby and
the mother is increased.

m The couple should be advised to adopt any of the available safe and effective methods for birth spacing. These
include the oral contraceptive pill, UD, condom, jelly, diaphragm and vaginal foam tablets,

m For breast feeding mothers all methods except the oral contraceptive plil can be safely used.

m TBAs have an important role in explaining to the family the value of pregnancy spacing, the methods that are
available and in helping the family adopt these methods by providing the necessary Information.

34. 35. SEXUALLY TRANSMITTED DISEASE IN MEN AND WOMEN

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

m Sores on male genitals. = What does the presence of sores on the private parts of the man
and woman indicate?

= Sores on female genitals.

m What are the other symptoms which may follow the sores?

w Discuss the dangers which men and women may suffer if they
don'ttake timely treatment?

= How can these problems be prevented?

POINTS TO REMEMBER

m A pimple, blister or an open sore on the male or female genitals which ls paintess can Indicate the possible
presence of a sexually transmitted disease (STD).

m. Pain during urination, similar sores on lips, fingers or mouth, pus or discharge from private parts and strange
skin rashes can occur in cases of STD.

Infertility, repeated abortions, still births and blindness of the newborn are serlous complications of STDs In
women.

& The prompt recognition and treatment of STDs Is Important for thelr control.

m Men and women should be advised about safer sex i.e. by avoiding multiple partners and by using condoms: |

during sex to prevent STDs.

36. 36. RECOGNITION AND CARE OF AIDS

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

A wasted, thin and weak person with = How is AIDS recognized?
fever who is suffering from AIDS.

m What can a TBA do to help in the prevention/control of AIDS?

POINTS TO REMEMBER

AIDS may be present without any symptoms. Once the symptoms are present, they progress and lead to
death. It is an incurable disease.

Patients with AIDS may have fever, wasting, bumps In the neck, skin rashes, pneumonia, or cancer.

Pregnant women with AIDS can pass the disease to newborn babies. Therefore women with AIDS should
avoid becoming pregnant.

TBAs should advise families about safer sex Le. by avoiding multiple partners and by using condoms during
sex to prevent AIDS.

Infected syringes and needles transfer the infection. Controlling drug addiction and screening blood donors
is important for the prevention of AIDS.

TBAs should use new blades everytime for cutting the cords of newborns to prevent AIDS.

38. 37. RECOGNITION OF PNEUMONIA

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

m Ababy having severe chest indrawing. m How is chest indrawing recognized?
He is refusing to suck the breast
because of severe breathing difficulty

= Why do children with severe chest indrawing refuse feeding?

= What is the importance of severe chest indrawing in newborn
babies?

POINTS TO REMEMBER

m A baby has chest indrawing If while breathing, his chest goes in and the abdomen (tummy) bulges eut. In
. severe chest indrawing, a deep hollow groove appears between the lower. teats and the tummy avery time
the baby breathes In.

m Bables with severe chest indrawing have difficulty in breathing and. therefore ar are t00 tinea! to suck the breast,

m Since newborn bables have a soft chest, they may have some chest Indrawing normally. Only severe chest
indrawing indicates pneumonia in a newborn baby.

m Babies with pneumonia should be immediately referred for treatment.

40. 38. RECOGNIZING SIGNS OF DEHYDRATION

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

w À TBA feeling the soft spot (fontanel) m How is a slow skin pinch recognized?
sone heed ote Baty: = What does a slow skin pinch indicate?

m A TBA pinching the skin on the side of

baby's tummy. = What may happen to the soft spot on the head of-a baby with

diarrhoea?

m After releasing the pinchi, the skin
slowly returns to normal.

POINTS TO REMEMBER
m When the skin of a baby is pinched and released, it returns to normal immediately. If the pinched skin does
not return to normal immediately, a slow skin pinch is present.
m Slow skin pinch in a child with diarrhoea indicate dehydration.
m Denydration means lack of water and salts in the body.
w: Babies with diarrhoea who are dehydrated have a depressed soft spot on the head.
=

Some other signs of dehydration are sunken eyes, dryness In the mouth and excessive thirst. The baby will
not have tears while crying. He may not pass urine or pass very little urine.

m A baby with dehydration must be referred immediately tc a hospital.

42. 39. KEEPING DRINKING WATER SAFE

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

Clean water stored in a bucket and = Why should drinking water be kept covered?

ia prnl cali e hanging by m Whatis the importance of a dipper in keeping drinking water clean?

m What harm is caused by drinking water that is not clean?

POINTS TO REMEMBER

It the drinking water is not clean, the baby may get diarrhoea and many other serious diseases.
Drinking water must always be kept covered to protect it from dirt, flies, animals and birds which can make

It dirty.
The use of a dipper prevents water from getting spolit from dirty hands being dipped Into the bucket.

44. 40. PREVENTING DISEASES BY IMMUNIZATION

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION

= Achild with polio paralysis. The lower = How Is polio paralysis recognized?
legis thin, wasted and deformed.

m Can polio be prevented?

m What is the role of the TBA in helping the prevention of selected
childhood illnesses?

POINTS TO REMEMBER

m Children with polio can be permanently disabled because of wasted muscles.

m Polio can be prevented by 3 doses of the polio vaccine. The doses are given by mouth, one month apart,
starting when the baby Is one and a half month’s old or even earlier, as advised by the doctor or the health
worker.

w Six childhood illnesses Le. polio, diphtheria, tetanus, whooping cough, tuberculosis and measles = can be
Prevented by timely immunizations during infancy.

m The TBA must explain to the mothers or the families, the importance of timely immunization and howto obtain
the services from a health worker.

46. 41. EDUCATING THE COMMUNITY

THIS ILLUSTRATION SHOWS POINTS FOR DISCUSSION
= A TBA discussing the importance of m What role can a TBA play to increase community involvement in
women’s nutrition in her community. improving MCH and family planning services?
m Whose assistance should the TBA seek for the success of her
work?
POINTS TO REMEMBER

=. Inaddition to providing nutrition education duting pregnancy, TBAs must help families to obtain appropriate
Services, This will help in pregnancy spacing, immunizations, treatment of illnesses and promote safe
motherhood and child survival.

m. TBAs should utilise all resources available In the community such as community leaders, women's groups
and other agencies concerned with community development. This can be done by interacting with people and

groups frequently .
m TBAs should interact with people and educate them about the essentials of health care.