Maternal & Child Health Assistant Professor Dr. Batool Ali Ghalib Yassin Dept. of Community & Family Medicine College of Medicine – University of Baghdad
Objectives By the end of this lecture you will be able to: • Define Maternal & Child Health & Services • Value the impact of MCH on population health & development. • List the phases of maternal health services; Premarital, antenatal, natal and post natal care • Describe the important aspect of each phase. • Mentioned the detailed services provided to the pregnant women during ANC. • Understand the concept of risk approach • List the factors and causes leading to risky pregnancy
Definitions MCH: Is that aspect of health which is concerned with the special needs and problems of mothers and children and more precisely the needs and problems arising from the process of human reproduction, growth and development. MCH Services: Are the services concerned with the well fare of mothers, infants and pre-school children.
MCH services are needed in developing countries 20 -25 % of the population are children below 5 years of age 48 % of the population below 14 year of age Mothers represent 25 % of the population. Why are MCH Services Needed?
Regarding women Annually, > 200 million women become pregnant all over the world % of all 15 At least need pregnant women skilled obstetric care some time during pregnancy, delivery or puerperium For ½ million women, complications of pregnancy, child birth or the puerperium are fatal Facts
Facts • Maternal health and nutritional status. Poor • Management of labor is responsible for about 75% of 7.5 million annual perinatal deaths Inappropriate • Is one of the most neglected health problems in the world. • Interventions are available, but policies are inappropriate Reproductive Health
Regarding children Of the infants born alive, nearly 8.1 million die during the first year of their lives Of those (4 million) die during the first month of their lives Of those 2.8 million die during the first week of their lives Nearly 3 millions die in utero and are stillborn Facts
Objectives of MCH Services Reducing Both Morbidity & Mortality Among Mothers Among Infants Among Children Promotion of reproductive health Promotion of physical and psychological development Of Children& Adolescents within Families
Objectives are achieved Health promotion of children Prevention and control of health hazards to children Treatment of common childhood diseases Rehabilitation of handicapped children Ensuring a favourable outcome of pregnancy and puerperium and dealing with factors leading to unfavourable outcomes (risk factors) Ensuring secure relationships between parents themselves and parents and their children
METHODOLOGY FOR APPLICATION: High Risk Management Detection Equity in coverage Follow up
• Reproductive health policies to girls’ education, status of women and overall poverty reduction Linking • Unwanted Pregnancies Preventing Facilitating • Positive health practices e.g. early treatment of STDs., delayed marriages, birth spacing and education Promoting (ICPD 1994) Reproductive Health Policy: safe pregnancy, delivery and motherhood by preventing and managing pregnancy complications
COMPONENTS OF MCH SERVICES:- Promotive Preventive Curative
1. Adaptation to ecology and needs. 2. Real community participation. 3. Within economic constraints. 4. Integration within general health services. 5. “At – risk” in focus. 6. Education. 7. Trained staff. 8. Guided evaluation. 9. Acceptable within national development 10. Planning activities. 11. Re-assess priorities 12. Consider cost-effectiveness For Developing Appropriate MCH Services:
INFORMATION SYSTEMS AND MCH SERVICES:- Monitor events, report them, complete records. Useful data for building MCH information system include: 1 . Births. 2. Marriages. 3. Divorce. 4. Deaths. 5 . Mortality. 6 . Morbidity. 7 . Use of services. It is preferable to be categorized by Age and sex.
SPECIFIC DATA ON UTILIZATION OF HEALTH SERVICES INCLUDE: Prenatal Care Mechanisms for referral of ill mothers to high risk centers and rate of return and follow-up. Data on availability and use of non-medical prenatal services i.e. nutrition, education and other programs. Data on screening tests done.
Phases of Maternity Care A) Premarital Care: Is the health care given to girls and boys before they get married for physical and psychological preparation of couples to bear responsibility, and is an essential part of adolescent health care. it includes promotive health services such as: History (past medical history, hereditary diseases) Medical examination & investigations (blood group (ABO and Rh), CXR for excluding TB. Testing for Sexually Transmitted Infections (STIs) , for HIV/AIDS, Syphilis (VDRL, WR or Kahn test) Education regarding proper nutrition & Life style It also includes preventive services such as immunization Counselling on family planning (in some countries) 16
17 It is defined as the complete health supervision of the pregnant woman in order to maintain, protect and promote the health and well-being of the mother, the foetus and the newborn infant. Phases of Maternity Care B) Prenatal Care or Antenatal (ANC):
18 Six (6) Important Reasons to Attend the Antenatal Clinic 1. To build a trusting relationship between client and health care provider. 2. To achieve the best possible health status for mother and fetus. 3. To obtain baseline recording data. 4. To identify and manage high-risk pregnancies. 5. To provide basic health education in relevant topics. 6.To minimize maternal and fetal mortality and morbidity rates Phases of Maternity Care B) Prenatal Care or Antenatal (ANC):
19 Antenatal Care • In order to make antenatal care (ANC) services effective, they must be delivered adequately. • Adequacy should be in quantity & quality Schedule of ANC Visits First 28 weeks gestation Every 4 weeks 28th - 36th week Every 2 weeks 36th week to term Every week AND AT ANY TIME WHEN MEDICAL CARE IS NEEDED
20 This approach provides care for the community as well as for individuals through a flexible and more rational distribution of existing resources according to the level of risk, so that some care will be provided for all, but more skilled care is given to those at higher risk . High Risk Pregnancy : Is one in which the foetus and/or the mother has a significantly increased chance of morbidity or mortality. Pregnant women at such risk must be identified during ANC, according to the presence of certain risk factors The Risk Approach High-risk Pregnancy
Risk Factors for Evaluation Personal Factors Age; Less than 18 years old & more than 35 years old Socio economic factors Personal habits Consangui nity History of infertility Obstetric al History Primi aged > 30 years, Grand multipara > 5 No spacing Any previous obstetrical problem Past History History of any previous medical or surgical problems Family History History of DM, HT, Multiple pregnancy & anomalies Current pregnancy Any disease or problem facing the mother
22 C) Natal Care: This phase is characterized not only by its short duration (hours), but also by being a dangerous phase for both mother and infant. If not properly handled, it leads to morbidity or mortality of either or both of them. The mother might develop complications such as * Bleeding * May be exposed to surgical interventions, * Risk of infections * Risk of trauma. The infant may be exposed to * Asphyxia * Birth trauma * Hypothermia * Infections.
AIMS: • Asepsis • Minimum injury to mother and newborn. • Preparedness to deal with complications. (prolonged labor – ante partum hemorrhage convulsions malpr.) • Care of baby at delivery. C) Natal Care:
24 C) Natal Care: Good natal care will reduce the number of deaths and disabilities resulting from such conditions. Training of birth attendants (doctors and midwives) is very important for the reduction of these conditions. Only 50 % of Deliveries occur in Hospitals or Health institutes . On discharge, a CARD containing full birth information should be given to the mother to be used by the PHCC for completing child care.
D)Post-Natal Care: Aims: • Health restoration. • Check adequacy of breast feeding. • Provide basic health education. • (Evaluate effect of antenatal Care)?!
26 D) Postnatal Care : • This period starts one hour after delivery of the placenta and continues for six weeks. • During this period two medical examinations with the aim of detecting and curing minor ailments resulting from birth. • The first examination is carried out within two weeks after delivery. • The second between 4 and 6 weeks after delivery.
27 D) Postnatal Care : • We must check the size and position of the uterus, cervix and perineum, blood pressure. • The GUE and Hb testing should be repeated. • We must teach pelvic floor exercise and promote breast feeding. • Home visits should be paid to women who are discharged early by a home visitor or a public health nurse.
To summarize MCH & Services are important to maintain good health status The Phases of care in reproductive health are; * Premarital, * Antenatal, * Natal and * Post natal Every pregnant is at risk