MATERNAL AND CHILD HEALTH REYNALDO Q. JOSON, HDMATERNAL AND CHILD HEALTH LEARNING OBJECTIVES At the end of the course, the mothers and mathers-to-be should be able to demonstrate acquisition of knowledge, skills, and attitude relevant to the following aspects in maternal and child health: 4. Importance of a maternal and child health care program. 2. When a’ maternal and child health care program starts. 3. that a mother-to-be should do during pregnancy to promote maternal and child health. 4. What a mother-to-be should do before delivery of the childs 3. hat “a new mother should do for herself atter delivery of the child. 6. that a nea mother should do for her child atter delivery. What is the importance of a maternal and child health care progran? @ maternal and child health care program is a program that ains to promote and to protect the health of both the gather and her child during and after pregnancy. The goal of the program is to help develop a bealthy and a hapoy family which in turn will help develop @ healthy and happy society. When does a maternal and child health care program start? If one reads the objective of the maternal and child health care progran, one may rationally say that the program starts right after pregnancy occurs. However, in order to best achieve the | objective, the program should rightfully start even before pregnancy occurs. Thus, planning and preparing for a. pregnancy and its products or outcomes is part of a complute maternal and chile health care program. What are the plannings and preparations that a wonan has to do prior to getting pregnant? There are a lot. These come in three big headings: 1s Physical preparations 21 Mental preparations 31 Financial preparations 1Winat are the physical preparations that a woman has to do prior to getting pregnant? She must establish and maintain » physical bedy that is healthy snd strong to withstand the rigors of pregnancy and to biologically sustain a baby that will appear in her womb after conception. She must prevent contagious infections to develop in her body as these may subsequently infect and affect the baby in her won after conception. Before a woman gets pregnant, she must have an adequate nutritional status. She must remember that the baby in her womb, Will suck out nutrients trom her body in order ta stay alive and healthy. poorly nourished mother will. lead” to a poorly Rourished and poorly developed baby. poorly nourished mother Will not be able to withstand the rigors of pregnancy. Before a woman gets pregnant, she must not have any diseases whatsoever. "Tf she hes, she must have then treated first. prior to getting pregnant. Any disease that 1s present may complicate the pregnancy. this complication may result in one oF combination of the following: 2 deformed baby, a dead Baby, Sicklier mother, or dead mother. Contagious diseases which must be avoided prior to and during pregnancy are rubella (or what ie commonly known as Berman Measies) and. sexually transmitted diseases, notably AIDS. Cor Acute Inqunodeticiency Syndrome) « If the pregnant woman gets 2 rubella, expecially during the early stage of pregnancy, several abnormalities may be seen in the newborn, such as blindness, deatness, and heart defects. As a preventive measure, it is advisable for a woman who has not had Tubella before to have an immunization at least three (3) months prior “to. deciding to get pregnant, If a woman cannot recall whether she had rubella before, she can have her bleed tested to Get the answer. “If the blood test shows she had rubella before, then ‘she does not need any immunization against rubella. A Person who has rubella before usually will not have another bout of rubella. AIDS has no cure up to the present. AIDS can easily be transmitted from the pregnant woman to the baby in her. wombs Thus, a woman who has AIDS should nat get pregnant it ‘she “dows not want to see her baby afflicted and eventually die with ALDS+ A “woman who does not have AIDS should aveid getting AIDS 41 she does not want her baby to be afflicted with the disease,What are the mental preparations that a woman has to do prior to getting pregnant? She must establish a mind that knows the fellowings 4. How pregnancy comes about? 2. What’ is the goal of pregnancy? SI What are the signs of pregnancy? 4. What to do during pregnaney? 5! Hon to prepare far the delivery? 6. Uhat to da after delivery? To herself? To her baby? She must establish and maintain a mind that will unuaveringly state the fal lowing: 4, The pregnancy 1s wanted by me and my husband. Both of us are ready for the pregnancy. 2. Both my husband and I are financially prepared for ‘the pregnancy. 3. Both my husband and 1 are physically prepared for the rigors of = pregnancy. What are the financial preparations that are needed before a pregnancy is decided upon? First of 911, one has to remember that, nowadays, to live on earth is not free. Every human being incur an expense from the time of his conception to the time of his death. Between delivery and death, every human being has an expense on focds, clothings, shelter, wducation, and ather necessities to live lite on earth. Thus; prior to deciding on a pregnancy, a couple should bear in mind the expenses of creating and maintaining a human being. The couple should also know how much they have to spend for, the pregnancy, the pranatal medical care, delivery which can either be “vaginal er through a cesarean section, and. the postnatal medical care. The couple should be prepared for the expenses before embarking en a voyage ef pregnancy. What is the role of the husband in the maternal and child health care program? Sone are the days in which the husband just impregnates his wife, waits for the baby to be borned, and provides” financial Support. Nowadays, the Musband should play a role that is more than what is stated above.He is an active partner in the physical, mental, and financial preparations of his wife before they ‘decide for a pregnancy. He is an active partner in the promotion of his wife's and future baby's health during pregnancy: Before and during pregnancy, he aust equipped himself with the competencies of a father to his forthcaming child. After the pregnancy, he continues being an active partner in the promotion of his wife's and child's health. He fulfils, the duties and obligations of a husband and a father. How does @ pregnancy come about? A ‘pregnancy will result if a spermatozoa from a male successfully fertilizes an ovum from a female. A natural method ef incurring pregnancy requires @ deposition of sperms coming from the male into the vaginal vault of the female. This deposition occurs during sevual intercourse between a male and female when the male inserts his erected penis into the vagina of the female and” then ejaculates out fluid that contains the spernatozoas. After an avum from the ovaries of the female is fertilized by a spermatozoa, it usually implants itself on the inner Lining of the uterus or womb, where it resides and. grows into @ fetus or baby during the entire period ef pregnancy. — The average duration of @ complete pregnancy is 280 days ar 10° lunar onthe. What is the goal of @ pregnancy? The goal of @ pregnancy is to produce a human being, bopefully “a normal one, who will form part of tha family anitiated by the parents. What are the signs of pregnancy? For practical purposes, there are two signs that will lead ene to think that’ a pregnancy is probably present in a. Premenopausal woman." These signs are, namely: ‘nan-return of ense and abdominal enlargement. Practically al1 premenopausal women will have menses outside pregnancy. After a” sewual intercourse with a male, if the woman's mense does not cone back at a time when it ia supposed to be'back, then a pregnancy could have occurred:With a history of a sexual intercourse with a male, even Just one intercourse, if the mense dees nat cone back and the abdomen starts enlarging, then most probably, a pregnancy has aecurred. What should 2 woman do when she suspects she is pregnant? First, she should tell her husband: “We probably successfully made it occur. We now have to see physician. to confirm it." Second, she and her husband should see a physician. First, to confirm the presence of a pregnancy. Second, af -pragnancy is present, to start prenatal care under the guidance of a physician. If a woman is confirmed to be pregnant, what should she do to promote a maternal and child health? There are a lot of things to do. These things come in four headings! 1. Regular prenatal consultations with a physician. 2! Maintaining a healthy body. 3. Knowing the signs ef a complicated pregnancy. 4. Preparing for the delivery and care of the ‘forthcoming baby. Why is it important to have a regular prenatal consultation with a physician? In the regular prenatal consultation, the physician provides the pregnant woman with the following services: 1. Promotion of maternal and child health. 2. Prevention of diseases that may affect maternal and child health. 3. Treatment of diseases occurring suring pregnancy. 4. Preparations for a safe delivery. Tf the preanant woman and her husband think they are competent enough to carry aut a maternal and child health care program, then they do not have to consult a physician anymore. However; in reality, most, if not all, pregnant wonen need” the help of a physician to carry out an effective maternal and child health care program. If the pregnant woman and her husband want to have an effective maternal and child health care programs then 4 regular prenatal consultation with s physician is recommended.What is an ideal schedule for a regular prenatal medical visit? First 7 months = once @ month 7th and Sth months ~ every other week 9th month = every week What does @ physician usually do during the first prenatal visit? First, the physician confirms the presence of pregnancy. In the earlier stage of pregnancy in which the abdomen is" not” yet enlarged snd in which auscultation of fetal” heart sounds and palpation of fetal movements are not yet possible, the physician usually uses @ urine sample of the woman suspected to be pregnane to teat for positivity or negativity of pregnancy + After confirmation of the presence of pregnancy, the physician will calculate for” the age of pregnancy and the estimated date of delivery. The first day of the last. normal mense of the pregnant wonan is frequently used in” the calculation. "Thus, it is important for a wonan planning ons Pregnancy to take note of the first day af her last normal menses After estimating the age of pregnancy and the date of delivery, the physician then assesses the presence ot factors that may complicate the pregnancy, He sesesses the pregnent woman's present health status and he looks for risk factors that may be present. He inquires on the pregnant wonan's past. health Status," including previous pregnancies if any, to lok. for. any, Fisk factor. Examples of risk factors are diseases on hand (uch as hypertension, diabetes, hyperthyroidism, semually transmitted diseases, ete.) and complications in previols pregnancies. If there “are risk factors present, then the physician will try te help the pregnant woran eliminate them. If this is not possible the! physician will try to minimize or to essen the iil) effects, of the risk factors on the maternal and'ehild health. After assessing for the risk factors, the physician then give “health teachings in the promotion of maternal and” child healthy prevention of diseases that may affect maternal and child health, "and advices on how ta prepare for the delivery and. the: rere of the forthcoming baby. These will be discussed below. What does the physician do during the subsequent prenatal visits? Emsentially, he does the following: 1. He Monitors the progress of pregnancy. After every visit, he ends up with any of the followingFETAL DEVELOPMENT Asi The fetal development is progressing as expected. 4.2 The fetal development 4s not progressing as expected. Something has to. be done to solve the probien. MATERNAL CHANGES DURING PREGNANCY 4.5 The changes in the mother’s body brought about by the pregnancy are expected and not unusual. 4.4 The changes in the mother’s body brought about by the pregnancy are unusual, Something has 25 be done to solve the problem. MATERNAL HEALTH STATUS 1.5 The mother is apparently healthy. 316 The “mother has contracted a disease unrelated to changes in pregnancy and which may” affect, the fetus. Something has to be done to solve the problem. 2. He provides health teachings to promote maternal and child health. He reinforces health teachings dane in the previous visits. Below are examples of what the physician does in manitering fetal developmen’ He pelpates the top of the uterus or womb to determine ite location in’ relation to the navel. The ton of the wonb is usually at the level of the navel en the Sth manth of pregnancy. Tf it is not at this level at this particular age of pregnancy, ‘there may be something wrong gaing an. Another parameter used in fetal development monitoring is the so-called "quickening" or the first time a fetal movement is felt by the mother. This usually eccurs in the Sth month of pregnancy. Absence of quickening er fetal movement, say on the 7th” wonth of pregnancy, is a warning, af nat a danger” signal. The absolute cessation of fetal movement after quickening. has cccurred is a danger signal of possible fetal death. Another parameter used in fetal development monitoring is fetal heart sound. It usually becomes audible by. auscultation at about the Sth month of pregnancy, Loss of fetal heart sound after it has appeared is a danger sign.Below are some parameters which a physician assesses to determine maternal health status: 1. Weight 2. Blood pressure Si Presence or absence of pallor or anemia 4. Signs of diseases What are some changes that usually eccur in a pregnant woman? ‘The uterus enlarges. The cervix softens: ‘The vagina changes color from light pink to deep violet because of increased vascularity, ‘The abdominal wall stretches to accommodate the increasing Uterus. Pink or reddish streaks may appear on. the abdominal wall “because of rupture end atrophy of the Connective layer of the skin. There may be increased pigmentation or darkening of skin in Gertain areas of the body. The breasts increase in size as pregnancy progresses. What are some health tips for the pregnant woman? 4. Adequate rest and relavation. Avaidance of fatique. 2. Moderate exercises. Si Adequate, not excessive, and well-balanced diet. 4. General hygiene. 5. Dental hygiene. 6: Staying away” from persons with diseases, especially What are sone danger signs of pregnancy that a pregnant woman Should be aware of? 4. Vaginal bleeding. This may mean abortion. 2. Budden escape ef fluid trom the vagina. This may be an evidence of rupture of membranes which may herald infection or prolapsed cord. 3. Signals of toxenias af pregnancy. 3.1 Swelling of the face, hands, and feet. 3.2 Flashes of light or dots before the ayes; dinness or blurring of vision. 3.5 Severe, persistent headache. 4. Severe abdominal pains This may be due to a lot of causes, such as ‘appendicitis, ruptured ectopic pregnancy, ete. 85. Loss of fetal movement. This may be Sign of fetal death. Should any danger sign of pregnancy occur, the pregnant woman should seek immediate consultation with her physician. She Should not wait for her next scheduled prenatal visit. What are the general considerations in planning and preparing for the delivery? A pregnant woman should 1. Know the estimated date ot delivery. 21 Decide whore she wants to deliver. 31 Decide whon she wants to help her deliver. 3. Preparw her finances tor the expenses of deliver, 3. Prepare for her forthcoming baby's clothings and other needs. Wnen is it time to deliver? The estimated date of delivery is just an estimate. The exact date of delivery may not be on the estimated date. it may be before or after. The event that will signal that it is tine ta deliver is the onset of labor pains, True labor pains are pains caused by uterine contractions and these pains occur at regular progressingly diminishing intervals. Once labor pains occur, the pregnant woman should praceed to the hospital or clinic where she has decided to. deliver. She should contact the physician whom she has decided ta help her Ueliver. She should’ follow all pre-delivery instructions previously given by her physicians Majority of pregnant women deliver their baby thraugh the vaginal route. In some instances, the baby has to be delivered through cesarean suction or an operation through the abdomen opening the uterus to extract the baby, In instances where a, Pregnant woman will have to undergo cesarean section, the date and “time ef the operation will be communicated by the physician to her. Such date and time of operation will be the ‘tine to deliver: Why is it important to have postnatal consultation with ‘a physician? After the delivery of a baby, the mother tends to beabsorbed in the health of her baby and to neglect her own health. To maintain her health, the mother is advined to have s postnatal consultation with her physician. In the postnatal consultation, the physician will provide the mother with the following services: A. Assessment of the present health status, 2! Treatment of diseases that may be present that occurred during or right after pregnancy. S. Health tips on maternal health: 3.4 Dare of the external genitalia 5.2 Care of the breasts 3:3 Postnatal exercises 3g Postnatal diet 515 Planning on next pregnancy 4. Health tips on child health. 4.1 Importance of breast feeding 4.2 Inmanizations 4.2 Prevention of diseases and accidents 4.5 First-aid treatment of diseases and accidents If the mother thinks she is competent enough to take care of herselt and her child without the help of @ physician, then she does not have to go to the physician for a.” postnatal consultation. However, in reality, majority, af net all, new aiothers need the help of a physician to protect her health ae WeLL ae that of her baby. How doe: a couple plan for the next pregnancy? After a pregnancy, @ couple should decide whether to have another pregnsncy in the future or not. If the couple wants to have another pregnancy, they should decide when this will be Factors that will influence a decisien for not having another pregnancy can be the followin 1. The couple has enough children. 21 The couple finds 1t difficult to support anather childs 3. There are medical conditions in the mother that will endanger “her life and evan that of the fetus Lf another pregnancy should occur. Tf the couple wants te have another child, they should make plans for the pregnancy. They should first determine when the ent pregnancy should take place. They should also consult their physician as| to when will be the best time to have the nent pregnancy. "For every pregnancy contemplated, there should be a maternal ‘and child “health care program, which starts before Pregnancy and which has been autlined in this monograph.are ways to prevent pregnancy during sexual intercours fn the husband and the wife when the couple is not ready for for does not anymore want another child? The best wey to prevent pregnancy is to have sexual Intercourse during the time that the wife de not fertile. The Most reliable tine will be during the tine of the wife's mange or Fight after for one to two days. Sevual intercourse done in days other than those mentioned above carries the risk of pregnancy. The use of condom may be used to prevent. pregnancy Guring these risky days. What should a new mother do for her child atter delivery? A general statement on the duties and responsibilities Will be for the new mother, together with the help of the father, to promote and to protect the health of the child. Ways of promoting and protecting the health of the child essentially consist af the folloningr 4. Adequate and proper nutrition. 2. Prevention of contagious infectious diseases. 31 Prevention of accidents. How does a mother provide adequate and proper nutrition to the ehila? During the first 4 to 6 months of age, the easiest, the most superior, “and the least expensive way of providing adequate and proper niitritien is through breastteeding. Human breast milk is Superior to cow's milk in terms ot digestibility and allergenicity. “Compared to cow’s milk, human milk is more than just a food. It also contains substances that help protect the baby against many infections. ‘Thus, during the firet 4 to months ef age, the mother should breastfeed her baby. The breast milk contains all the hutrients that a baby newde during this time. Beginning at the Sth month of age, the mother should begin to give the baby mashed foods. These’ complenentary foods should always be introduced gradually ‘into the baby’s diet. At the same Cine, the mother should continue to breastfeed for as long as possible. How does a mother provide her child with protection against infections?) First, by providing the baby with breast milk especially during the'tirst & months of age. aaSecond, by promoting hygiene. The baby should always be clean and ail persons touching the baby should likewise be cleans Third, by shielding the baby from persons with contagious infectious diseasens Fourth, by providing immunizations against common and serious infection What are the usual immunizations recomended for a child under 12 months of age? Maninum Age No. of Mindnum at ist Dose Bose Interval Between Dones cs Barth or any (Anti~ tine after tuberculosis) birth 1 - (anti- eiphthersa, tetanus, pertussis 6 weeks 3 4 weeks POLIOMVELITIS, 6 weak 3 4 weeks MEASLES 9 months 1 - What should a mother do to prevent accidents that may caus injury to her child? Always keep @ watchful eye on the child, especially when he is awake. He may do womething that ill harm himselt. Keep him away from ar sources of accidents. or elements that are potential Keep dangerous elements away from the child. Avoid household accidents that may inflict injury to the chiad, Always protect the child from all possible accident that may a2What are the conmon accidents that usually occur in a child and what are the first-aid measures that can be done by the mother? Le Hounds: This is the most common accident that usually occur in achild. This may be due toa variety of causes, such as a cut by a sharp instrument or dag bites. Jt ean occur in any part of the body. The first thing te do when the wound is not profusely bleeding is to flush it with water, If an antiseptic soap is available, one can use it to clean the wound. After flushing and cleaning, cover the wound with 2 clean dressing. Consult a physician if necessary. It not, clean the wound gaily until it heals. If there is profuse bleeding, the first thing to do is to apply direct pressure over the wound with = clean hand to stop or to control the bleeding. A clean cloth may be used to cover the wound over whieh a direct pressure is applied. The next thing to do is to bring the child to a medical” facility with @ physician whe Will thon provide the definitive treatment. 2, Burns The first thing to do is flush and clean the burned Wounds With cold or tap water and antiseptic soap. Then Consult a physician as to what to de next. Do not apply any substance on the burned areas without prior consult with the physician. 3. Fall with injury te the extremity Fracture or broken bone may be present. Thus, donot move or manipulate the injured” area unnecessarily. Splint a mich as possible. Congult a physician whe wit decide “wnat to de nuxt. 4, Fall snvolving the head Skull or brain injury may be present. Check if there was loss of consciousness. With or without lose of Consciousness; consult a physician. a3ny is it important to have a regular medical consultation for the baby? Dust as it is important tor the mother to have a postnatal medical consultation to protect her health, it is likewise amportant’ for the mother to bring her child to a. physician ragularly tor the same objective, that of protecting the child's health. During the requiar medical consultation tor the baby, the physician Will provide the fellawing services: 1. He’ will monitor the progress of development of the child, whether normal or abnormal 2. He will examine for any disease that may be present. It any disease is present, he will treat it. 3. He will give snmunszations. 4. He "will give health teachings and advices, especially on nutrition, prevention of diseases, and prevention of accidents. A mother should maximize the meeting with the physician to learn on'hew to protect her child's health.