Maternal Health Services

Maternal Health
Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, ill-health and even death.

Maternal Death
According to the WHO maternal death is: the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Causes of maternal deaths

Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy. Other complications may exist before pregnancy but are worsened during pregnancy. The major complications that account for 80% of all maternal deaths are:
severe bleeding (mostly bleeding after childbirth) infections (usually after childbirth) high blood pressure during pregnancy (pre-eclampsia and eclampsia) unsafe abortion. obstructed labour

The remainder are caused by or associated with diseases such as malaria, and AIDS during pregnancy.

Maternal Health Services

Family Planning Antenatal Care Intrapartum Care Postnatal Care

Antenatal Care
During pregnancy, both the woman and child face various health risks. For this reason, it is important that all pregnancies should be monitored by skilled care providers.

Antenatal Care
Goal of the ANC package is to prepare for birth and parenthood as well as prevent, detect, and manage the three types of health problems during pregnancy:
Complications of pregnancy itself pre-existing conditions that worsen during pregnancy Effects of unhealthy lifestyles

Antenatal Care
ANC also provides women and their families with appropriate information for:
A healthy pregnancy Safe childbirth Postnatal recovery (care of the newborn, promotion of early, exclusive breastfeeding Assistance with deciding on future pregnancies

The essential elements of a focused approach to antenatal care The new WHO model of antenatal care separates pregnant women into two groups: those likely to need only routine antenatal care (some 75%), those with specific health conditions or risk factors that necessitate special care (25%). For the first group, a standard programme of four antenatal visits is recommended (with additional visits should conditions emerge which require special care). The WHO guidelines are also specific as regards the timing and content of antenatal care visits according to gestational age. The guidelines stipulate that only examinations and tests that serve an immediate purpose and that have been proven to be beneficial should be performed.11 These examinations include measurement of blood pressure, testing of urine for bacteriuria and proteinuria, and blood tests to detect syphilis and severe anaemia. Routine weight and height measurement at each visit is considered optional. But evidencebased programming on the optimal number, timing and content of antenatal visits is not yet routine in most settings. This is a topic to which we will return later in this paper.

Antenatal Care
The essential elements of a focused approach to antenatal care Identification and surveillance of the pregnant woman and child Recognition and management of pregnancyrelated complications, particularly pre-eclampsia Recognition and treatment of underlying or concurrent illness Screening for conditions and diseases such as anaemia, STIs and HIV infection

 The essential elements of a focused approach to antenatal care Preventive measures:

Tetanus toxoid immunisation Iron and folic acid Intermittent preventive treatment of malaria in pregnancy (IPTp), Insecticide treated bednets (ITN)

Advice and support to the woman and her family for developing healthy home behaviours:

 The essential elements of a focused approach to antenatal care o Support care seeking behaviour, including recognition of danger signs and transport and in case of emergencies o Help the pregnant woman and her partner prepare emotionally and physically o Promote postnatal family planning/birth spacing

Antenatal Care
The essential elements of a focused approach to antenatal care The new WHO model of antenatal care separates pregnant women into two groups: 1. Those likely to need only routine antenatal care (75%) first group, a standard programme of four antenatal visits is recommended 2. Those with specific health conditions or risk factors that necessitate special care (25%). The routine examinations include:
Measurement of blood pressure Testing of urine for bacteriuria and proteinuria, Blood tests to detect syphilis and severe anaemia. Routine weight and height measurement (optional).

Antenatal Care
First visit (8-12 weeks) Confirm pregnancy and EDD, Classify women for basic ANC (four visits) or more specialized care. Screen, treat and give preventive measures. Develop a birth and emergency plan. Advise and counsel.

Antenatal Care
Second visit (24-26 weeks) Assess maternal and fetal well-being. Exclude PIH and anaemia. Give preventive measures. Review and modify birth and emergency plan. Advise and counsel.

Antenatal Care
Third visit (32 weeks) Assess maternal and fetal well-being. Exclude PIH, anaemia, multiple pregnancies. Give preventive measures. Review and modify birth and emergency plan. Advise and counsel.

Antenatal Care
Fourth visit (36-38 weeks) Assess maternal and fetal well-being. Exclude PIH, anaemia, multiple pregnancy, malpresentation. Give preventive measures. Review and modify birth and emergency plan. Advise and counsel.

Antenatal Care
Indicators for antenatal care Proportion of pregnant women who have at least one antenatal clinic visit # Proportion of pregnant women who have at least four ANC visits Tetanus protection at birth*

Intrapartum Care
Care provided during child birth Basic essential obstetric care services at the health centre level should include at least the following: 1. Parenteral oxytocic drugs 2. Parenteral sedatives for eclampsia 3. Manual removal of placenta 4. Manual removal of retained products

Intrapartum Care
Comprehensive essential obstetric care services at the hospital level should include all the above plus 1. Surgery 2. Anaesthesia, and blood transfusion.

Postnatal Care
The postnatal period defined here as the first six weeks after birth It is critical to the health and survival of a mother and her newborn. The most vulnerable time for both is during the hours and days after birth. Lack of care in this time period may result in death or disability as well as missed opportunities to promote healthy behaviours, affecting women, newborns, and children

Postnatal Care
Essential routine PNC for all mothers Assess and check for bleeding, check temperature Support breastfeeding, checking the breasts to prevent mastitis Manage anaemia, promote nutrition and insecticide treated bednets, give vitamin A supplementation Complete tetanus toxoid immunisation, if required Provide counselling and a range of options for family planning Refer for complications such as bleeding, infections, or postnatal depression Counsel on danger signs and home care

Postnatal Care
Essential routine PNC for all newborns Assess for danger signs, measure and record weight, and check temperature and feeding Support optimal feeding practices, particularly exclusive breastfeeding Promote hygiene and good skin, eye, and cord care Promote clean, dry cord care Identify superficial skin infections Ensure warmth by delaying the babys first bath to after the first 24 hours, practising skin-to-skin care, and putting a hat on the baby Encourage and facilitate birth registration Refer for routine immunisations Counsel on danger signs and home care

Why do women not get the care they need?

Poor women in remote areas are the least likely to receive adequate health care. In high-income countries, virtually all women have at least four antenatal care visits, are attended by a skilled health worker during childbirth and receive postpartum care. In low-income countries, just over a third of all pregnant women have the recommended four antenatal care visits. Other factors that prevent women from receiving or seeking care during pregnancy and childbirth are: poverty distance lack of information inadequate services cultural practices.