MATERNAL AND CHILD HEALTH PROGRAMMES:INTRODUCTION:

Mothers and chlidern not only constitute a large group,but they are also vulnerable
or special group.they comprises 71.4 % of population of the develpoing countries,in
india ,women of child bearing age (15-44 years) constitute 22.2% and chlidern under
15 years of age about 35.3% of total population, togther 57.7% of population consists
of mothers and chliderns.

The present strategy is to provide mother and chlid health services an integarted package of
essential health care also known as primary health care.
DEFINITION: Maternal and child health refers to the promotive, preventive ,curative and rehabilitative
health care for mothers and children, child health, family planning, school health,
handicapped children adolescence and health aspects of children in special setting such as
day care.
THE SPECIFIC OBJECTIVES: Reduction of maternal ,perinatal, infant, and childhood mortality and morbidity
Promotion of reproductive health
Promotion of physical and psychological develpomaent of the adlosecent within the
family.
ANTENATAL CARE:Antenatal care is the care of the women during pregnancy. The primary aim of antenatal care
is to achieve at the end of a pregnancy a healthy mother and a healthy baby. Ideally this care
should begin soon after conception and continue throughout pregnancy. In some countries,
notification of pregnancy is required to bring the mother in the prevention care cycle as early
as possible.
OBJECTIVES OF ANTENATAL CARE :

To promote protect and maintain the health of the mother during pregnancy

To detect: high risk cases and special attention

To foresee complications and prevent them

To remove anxiety and dread associated with delivery

To reduce maternal and infant mortality and morbidity

To teach the mother elements of child care, nutrition ,personal hygiene and
environmental sanitation

To sensitize the mother to need for family planning.

To attend to the under fives accompanying the mother

The above objectives are achieved by the following programme of health care services:ANTENATAL SERVICES:Antenatal visits: ideally mother should attend the antenatal clinic once a month during the
first 7 months, twice a month, during the next month and there after once in week if
everything is normal, a minimum of 4 visits covering the entire peroid of pregnancy should
be
1st visit within 12 weeks, preferably as soon as the pregnancy is suspected, for
registration of pregnancy and first antenatal check up
2nd visit between 14 and 26 weeks
3rd visit between 28 and 34 weeks
4th visit- between 36 weeks and term
It is advisable for the woman to visit medical officer at the Primary Health Center for an
antenatal check up during the period of 28-34 weeks (3rd visit). Besides this, she may be
advised to avail investigation facilities at the nearest PHC/CHC/FRU.
PREVENTIVE SERVICES FOR MOTHERS( BEFORE DELIVERY)
a. The first visit, irrespective of when it occurs, should include the following
components:
Health history:- during the first visit, a detail history of the women needs to be taken
to confirm the pregnancy, to identify whether there were complications during any
revious pregnancy, identify any current medical / surgical or obstetric condition,
recording the date of 1st day of last menstrual period and calculate the expected date
of delivery by adding 9 months and 7 days to the last menstrual period.
Physical examination
Abdominal examination
Laboratory examination
b. On subsquent visits:
-Physical examination
- Laboratory tests
c. Iron and folic acid supplementation

d. Immunisation against tetanus

e. Instruction on nutrition, family planning ,self care,delivery and parenthood
f. Home visiting by a female health worker
g. Referral services
Risk approach for high risk cases like elderly primi, malpresentations, antepartum
hemorrahage , pre-eclampsia, anemia, twins, h\o previous ceasaerian delivery, and general
diseases like kidney disease, diabetics, tuberculosis, liver diseases etc
Maintenance of records: the antenatal care is prepared at the first examination, it inculde
regitration number, identifying data, previous health history, and main health events.
Home visits: is back bone of mch services. home visit by the health worker female or public
health nurse.
2.PRENTAL ADVICES:
A. Diet: lactation demand about 550 kcal a day. Total weight gain 12kg , at 1st trimester 2
kg, 2nd trimester 5 kg& 3rd trimester 5kg of weight
B. Personal hygiene:- of equal importance is advice regarding personal hygiene
Personal cleanliness:- the need to bathe every day and to wear clean clothes should
be explained. The hair should be kept clean and tidy.
Rest and sleep: 8 hrs sleep and 2 hrs rest:- 8 hours sleep and 2 hours rest after mid
day should be advised.

Bowels:- constipation should be avoided by regular intake of green leafy vegetables,

fruits and extra fluids. Purgatives like castor oil should be avoided to relieve
constipation.
Exercise:- light household work is advised, but manual physical labour during late
pregnancy may adversely affect the foetus.
Smoking and alcohol should be avoided
Dental care:- advice should also be given about oral hygiene
Sexual inter course:-this is restricted especilly during last trimester
C. Drugs:- the use of drugs that are not absolutely essential should be discouraged.
Certain drugs taken by the mother during pregnancy may be affect the foetus
adversely and cause foetal malformation

D. Warning signs:- the mother should be given clear cut instructions that she should
report immediately in the case of the following warning signals: swelling of the feet,
fits, headache, blurring of the vision, bleeding or discharge per vagina.
E. Child care special classes mother carft education consists of nutrition education
advices on hygiene and child rearing etc.
3.SPECIFIC PROTECTION:

Anemia
Nutritional deficiences
Toxemias of pregnancy
Tetanus
Syphillis
German measles
Rh status
HIV infection
4.Mental preparation: mother craft classes at mch centres help a great deal in achiving this
objective
5.Family planning
6. Paediatric component: all antenatal clinics to pay attention to the under-fives
accompanying the mothers

INTRANATAL CARE:Child birth is a normal physiological process ,but complications may arise, septicemia may
arise result from unskilled and septic manipulations, and tetanus neonatorum from the use of
unsterilized instruments .The emphasis on the cleanliness.it entails clean hands and fingernail.
clean surface for delivery
clean cutting and care of cord
There are delivery kits available with the items needed for basic hygiene for delivery at
home, where a midwife with a midwifery kit is not likely to be present. The aims of good
intranatal care are:AIMS OF INTRANATAL CARE:-

 Thorough asepsis
Delivery with minimum injury to the infant and mother
Readiness to deal with complications such as prolonged labour, antepartum
hemorrhage, convulsions, malpresentations ,prolapse of cord etc

Care of the baby at delivery-resuscitation, care of the cord, care of the eyes.

DOMICILLARY CARE:Mother with normal obstetric history may be advised to have their confinement in their own
homes, provided the home conditions are satisfactory. In such cases the delivery may be
conducted by the health worker female or trained dai this is known as domicillary
midwifery service.
ADVANTAGES OF DOMICILLARY SERVICE:1) The mother delivers in the familiar surroundings of her home and may this may tends
to remove the fear associated with delivery in a hospital.
2) The chances of cross infection are generally fewer at home than in the nursery
/hospitals.
3) The mother is able to keep an eye upon her children and domestic affairs, this may
tends to ease her mental tension.
DISADVANTAGES:
1)
2)
3)
4)

The mother may have less medical and nursing supervision than in the hospital.
The mother may have less rest.
She may resume her domestic duties too soon.
Diet may be neglected.

RESPONSIBILITIES OF FEMALE HEALTH WORKER IN DOMICILLARY CARE:The female health worker, who is a pivot of domicillary care, should be adequately trained to
recognize the danger signal during labour and seeks immediate help in transferring the
mother to the nearest Primary Health Center or Hospital. The danger signals are:

Sluggish pains or no pains after rupture of membranes

Good pains for an hour after rupture of membranes, but no progress
Prolapse of the cord or hand
Meconium- stained liquor or a slow irregular or excessively fast foetal heart
Excessive slow or bleeding during labour
Collapse during labour
A placenta not separated within half an half an hour after delivery.
Post-partum hemorrhage or collapse

 A temperature of 38 0C or over during labour. There should be a close liaison between

domiciliary and institutional delivery services
INSTITUTIONAL CARE:
At about 1% of deliveries tend to be abnormal and four percent difficult, requiring the
services of a doctor institutional care is recommended for all high risk cases and where
home conditions are unsuitable.
The mother is allowed to rest in bed on the first day after delivery. From the next day, she is
allowed to be up and about. The current practice is to discharge the woman after 5 days lyingin period after a normal delivery.
ROOMING IN:
Keeping the babys crib the side of the mother s bed is called rooming-in. this
arrangement gives an opportunity for the mother to know her baby. Mothers interested in
breast feeding usually find there is a better chance for success with rooming-in. It also allays
the fear in the mother mind that the baby is not misplaced in the central nursery.

POSTNATAL CARE:Care of the mother( and the new born ) after delivery is known as postnatal or post-partal
care. Broadly this care falls into two area: care of the mother which is primarily the
responsibility of the obstetrician; and care of the newborn, which is the combined
responsibility of the Obstetrician and Pediatrician. This combined area of responsibility is
known as perinatology.
OBJECTIVES :The objectives of postpartal care are:

To prevent complications of the postpartal period.

To provide care for the rapid restoration of the mother to optimum health.

To check adequacy of breast feeding.

To provide family planning services.

To provide basic health education to mother/family.

COMPLICATIONS OF POSTPARTUM PERIOD:Certain complications may arise during the postpartal period which should be recognized
early and dealt with promptly measures:

Puerperal sepsis

Thrombo-phelbitis

Secondary hemorrhage

Urinary tract infection and mastitis

.

RESTORATION OF MOTHER TO OPTIMUM HEALTH:

a)

b)

c)

d)

PHYSICAL:Postanatal examinations:- Soon after delivery ,the health check-up must be

frequent .i.e twice a day during the first 3 days and subsequently once a day till
umbilical cord drops off. The female health worker checks vitals, breasts, check
progress of normal involution of uterus, examines lochia for any abnormality,check
urine and bowels and advises on perineal care. Further visits should be done once in 2
or 3 months during first 6 months, and after once in 2 or 3 months till the end of one
year.
Anaemia:- Routine haemoglobin estimation should be done during postnatal visits,
when anemia discovered.if it should be treated. In some cases, it may be necessary to
continue treatment for a year or more
Nutrition:- The nutritional needs of the mother must be adequately met. Often the
family budget is limited; the mother should be shown the means how she can eat
better with less money.
Postnatal exercises:- Postnatal exercises are necessary to bring the stretched to
abdominal and pelvic muscle back to normal as quickly as possible. Gradual
resumption of normal house-hold duties may be enough to restore ones figure.
PSYCHOLOGICAL:

The next big area of postnatal care involves a consideration of the psychological factors
peculiar to the recently delivered woman. One of the psychological problems are timidity and
insecurity regarding the baby. Fear and insecurity may be eliminated by proper prenatal
instruction.
BREAST FEEDING:Postnatal care offers an excellent opportunity to find out how the mother is getting along with
her baby, particularly with regards to feeding. For many children, breast milk provides the
main sources of nourishment in the first year of life. A great assets in India is that an average
Indian mother, although poor in nutritional status, has a remarkable ability to breast feed her
infant for prolonged periods, sometimes extending to nearly 2 years and beyond.
FAMILY PLANNING:Family planning is related to every phase of maternity cycle. Every attemptshould be made to
motivate mothers should attend postnatal contacts to adopt a suitable method for spacing the
next birth. Postpartum sterilization is generally recommended on the second day after
delivery.
BASIC HEALTH EDUCATION:-

Health education during the postnatal period should cover the following broad areas:
hygiene- personal and environmental, feeding for mother and infant, pregnancy spacing,
importance of health check-up ,birth registration.

NEONATAL CARE:this aspect of family health services has been termed as neonatology. This branch of medicine
is perhaps, more than any other, dependent on teamwork in which disciplines of obstetrics
and gynecology, pediatrician , preventive and social medicine, community health services and
nursing have an important part to play, if any impact is to be made on the vast problems of
perinatal and neonatal morbidity and mortality. The pediatrician has a key role as a
coordinated and guide for the whole team.
EARLY NEONATAL CARE:
The first week of life the most crucial period in the of an infant. In India, 61.3 % of all infant
deaths occur within the first month of life. The risk of death is the greatest during the first 2448 hours after birth. The problem is more acute in rural areas where expert obstetric care is
scarce, and the home environmental condition in which the baby is born, are usually
unsatisfactory.
Objectives:The objectives of early neonatal care is to assists the newborn in the process of adoption to an
alien environment which involves:
1. Establishment & maintenance of cardio- respiratory functions
2. Maintenance of body temperature
3. Avoidance of infection
4.

establish of satisfactory feeding regimen

Early detection and treatment of congenital and acquired disorders.

IMMEDIATE CARE:1.Clearing the Airway:To help to establish breathing ,the airways should be cleared mucus and other secretions.
Positioning the baby with his head low may help in the drainage of secretions. This process
can be assisted by gentle suction to remove mucus and amniotic fluid
2. Apgar Score:
It requires immediate and careful observation of the heart rate, respiration, muscles tone,
reflex response and color of infant. It is taken 1 minute & again at 5 minutes after birth.
3. Care Of The Cord:

In case of normal infant, the umbilical cord should be cut & tied when it has stopped
pulsating. The advantages is that the baby derives about 10ml of extra blood, if the cord is cut
after pulsation ceases. This is particularly important in india, where anemia is frequent.Care
must be taken to prevent tetanus of newborn by unsterilised instruments nad cord ties
4. Care Of The Eyes:
Before the eyes are open, the lid margins of the newborn should be cleaned with sterile wet
swabs, one for each eye from inner to outer side.
5. Care Of The Skin:
When a baby is a few hours old,the first bath is given with soap and warm water to remove
vernix, meconium and blood clots. Some prefer to apply warm oil before the bath. Te first
bathing is done by the nursing staff. Thereafter no further bathing is necessary until the day
before discharge.

6.MAINTENANCE OF BODY TEMPERATURE:

The normal body temperature of a newborn is between 36.5 0C to 37.5 0C. A new born
baby is projected out of the warm womb of the mother to the environment which may be 10
to 20 0C cooler especially in the winter month in India. It is important that immediately after
birth the child is quickly dried with a clean cloth and wrapped in warm cloth and given to the
mother for skin-to skin contact and breast feeding.
7.BREAST FEEDING:A. Neonatal examinations:The neonatal examination is categories into two parts:First examination:- the first examination is made soon after the delivery room. This
examination is to ascertain that the baby has not suffered injuries during the birth
process and to detect malformation especially those requiring urgent treatment and to
assess maturity.
Second examination:- the second examination should be made preferably by a
paediatrician within 24 hours after birth. This examination should form the first stage
of a continual process of health care surveillance. It is a detailed systematic
examination from head to foot, conducted in good light.
B. Measuring the baby:Measurement of the birth weight, length (height) and head circumference are the
simplest and one of the reliable means by which the health and maturity of a baby is
evaluated.
C. Identification of at risk infants:-

The number of infants (and children 1-5 years of age) in a community or attending a
child health clinic, may be so large that it may not be possible to give sufficient
time and attention to all of them. It is therefore necessary to identify particularly
those at risk and give them special intensive care, because it is these at risk
babies that contribute so largely to perinatal, neonatal and infant mortality. The
basic criteria for identifying these babies include:
Birth weight less than 2.5 kg
Twins
Birth order 5 and above
Artificial feeding
Weight below 70% of the expected weight
D. Late neonatal care:The remaining three weeks of the neonatal period carry the common and serious
hazards of infection and failure of satisfactory nutrition. Diarrhea and pneumonia
take a heavy toll of life in infants exposed to an unsatisfactory environment.
BIBLOGRAPHY:(1).Basvanthappa B.T., Community health nursing, Jaypee Publication, 6th edition, Year
2012 ,Page no.584-605.
(2) Gulani K.K., Community health nursing, Kumar Publication, 3rd edition, Year 2012
Page no.591-593.
(3) www.pubmed.com Park K., Text book of preventive and social medicine, Bhanot
publication,
18th edition, Year 2011 Page no.674-699.

(4)www.ncbiiec.com

ASSIGNMENT ON
MATERNAL AND
CHILD HEALTH
SUBMITTED TO:MRS. TAJNISHA BANO
READER
S.NC., MEERUT
SUBMITTED BY:MS. ANNU PANCHAL
M.Sc.(N) FIRST YEAR
SUBHARTI NURSING
COLLEGE, MEERUT.