RND20604

COMMUNITY HEALTH NURSING

MATERNAL HEALTH
 Introduction
• Good maternal care is essential to ensure the optimal health of the mother
and child.
• The Ministry of Health Malaysia (2002) assert that an individual’s health from
conception and early life has impact on their quality of life later.
• The component of maternal care in community nursing encompasses pre-
pregnancy care, antenatal care, intra-partum care and postnatal care.

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 MATERNAL CARE

Pre- Intra-
Antenatal Postnatal
pregnancy partum
Care Care
Care Care

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 Learning Outcomes
At the end of this session, students should be able to:
 state the importance of maternal health;
 describe briefly about safe motherhood strategies;
 explain pre-pregnancy and antenatal care;
 state the objectives of antenatal care;
 explain the activities of an antenatal care clinic;
 discuss intra-partum care;
 define postnatal care;
 state the objectives of postnatal care;
 state the postnatal care activities in clinics.

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 Importance of Maternal Health
• Mother
and child exposed to risk of infectious diseases, for
example, mother infected with rubella, baby is at risk for rubella
syndrome.
• Maternal mortality rate is one of the key health indicators.
• Mother experience critical stage during conception, therefore
required clear strategies and specific health interventions in order
to reduce maternal morbidity and mortality.
• It
supports the world initiative for “Safe Motherhood”, or often
referred as the Pillars of Safe Motherhood.

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Safe Motherhood

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 Safe Motherhood
Why Safe Motherhood?
• Every minute of every day, somewhere in the
world and most often in a developing country, a
woman dies from complications related to
pregnancy or childbirth.
• Loss of a mother shatters a family and
threatens the well-being of surviving children.
• Evidence shows that infants whose mothers
die are more likely to die before reaching their
second birthday than infants whose mothers
survive.
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 MATERNAL CARE

Pre- Intra-
Antenatal Postnatal
pregnancy partum
Care Care
Care Care

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 Pre-pregnancy Care
• Reduce mortality and morbidity of mother
and infant during prenatal stage.
• Given to women 15 - 49 years old.
• Steps to prepare women for pregnancy:
‒ Determine that all couples plan their
parenthood
‒ Assess all women under reproductive age
‒ Plan and implement health promotion to
create safe motherhood by giving health
education and counselling.

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Antenatal Care

• Antenatal
care is given to pregnant mothers
from conception until labour.
• Mothershould seek antenatal care as soon
as possible after confirmation of pregnancy.
• Malaysia Ministry of Health recommends
that the first visit (booking) should take place
before 12 weeks of gestation.

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 Objectives of Antenatal Care
• To promote and maintain mother’s health physically and mentally
during pregnancy.
• To detect early any abnormality and treat promptly in order to
prevent complication.
• To ensure birth of a mature, alive and healthy infant.
• To educate mother and prepare her for the role of motherhood.
• To reduce maternal and prenatal mortality and morbidity rate.
• To promote breast feeding and prepare mother for lactation.
• Educate mothers on family planning programme and birth spacing.

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 Activities in the Antenatal Clinic
1. Registration 2. Interview (History taking) 3. Routine examination
EDD • Weight, height, B/P

4. Routine screening test

10. Follow-up care • Urine; glucose & albumin
• Visit clinic as required • Blood: Hb%, Rh factors, Grouping
• Home visit VDRL, BFMP (prn) and HIV

5. Routine physical examination:

9. Give health education General examination, head to toe and
abdominal examination

6. Refer medical officer and dentist for

8. Treatment routine examination
• Routine vitamin
• Supplementary milk
• Minor illness 7. Immunisation ATT
Flow chart of activities in the antenatal
clinic
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 History Taking
• Social history
• Medical history
• Surgical history
• Family history
• Menstrual history
• Past obstetric history
• Current pregnancy/present obstetric history
• Gynaecological history

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 Calculate Expected Date of Delivery (EDD)
• EDD is calculated by Naegele’s rule
based on the knowledge of a typical
pregnancy lasts on average of 280
days or 40 weeks, starting with the first
day of the last normal menstrual period
(LNMP).

• It is calculated by
‒ adding 9 months and 7 days from
the LNMP (for first 3 month), OR
‒ Subtract 3 months and add 7 days
form the LNMP (from April onwards -
December)
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 Calculate Expected Date of Delivery (EDD)
Exercise 1 Exercise 2
• LNMP: 2 December 2019 • LNMP: 25 March 2020

Subtract 3 months add 7 days Adding 9 months and 7 days

Subtract 3 months from Add 9 months to March 

December  September December
2+7=9 25 + 7 = 32 (December has 31
days, so need to add another
Therefore EDD is on month)
9 September 2020 Therefore EDD is on 1 January
2021
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 Anthropometry and Blood Pressure
• Height
‒ Refer if <145 cm, may have small pelvic

• Weight
‒ Assess fetus growth and to detect
edema
‒ Average 12 – 12.5 kg increase
‒ 1st 20 weeks: 0.5 kg/month
‒ 2nd 20 weeks: 0.5 kg/week
• Blood pressure
‒ To detect PIH, refer doctor if 140/90 mmHg

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 Routine Screening Test
• Screening on booking
‒ Rhesus factor (Rh) and blood group
‒ VDRL to detect sexually transmitted disease at early pregnancy
‒ TPHA (Triplenima Palidum Heam Agglutination Test) is performed when VDRL result is
positive to confirm syphilis
‒ HIV screening test will be taken with written consent after pretest counseling
‒ Hepatitis B to detect hepatitis B surface antigen
‒ Blood Film for Malaria Parasite (BFMP) will be tested for mothers from high-risk area for
malaria
‒ Thalassemia (for primigravida who has not done the screening before)
‒ Full blood count

• Routine Screening done on every antenatal visit

‒ Routine urine test for glucose and albumin
‒ Hemoglobin (Hb) monthly or 2 weekly if patient is anemia (Hb < 11 gm%)
‒ Routine ultrasound by 18 - 22 weeks to confirm the gestational age and to identify
abnormality, second scan will be done at 32 – 36 weeks gestation.
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 Physical Examination
 Hair–hygiene, nutritional status  Thyroid–enlarged  Upper extremities–pulse , BP, anaemia,
 Face–pigmentation thyroid hygiene, oedema, carpal tunnel
 Eye–sign of anaemia  Jugular vein–extended
 Dental health
 Tongue–coated, anaemia
 Pelvic–presentation and engagement

 Heart–murmur
 Lung–crept Auscultation, foetus heart sound
 Doppler device
 Breast–retracted nipple,  Pinard for baby’s heart
lump  Foetus movement–kick count

Abdomen–
 Inspection
 Fundal height
 Number of poles  Lower extremities–oedema, varicose vein
 Lie  Vaginal- discharge, bleeding, purities and dip urine for protein
 Uterine tenderness and sugar, varicose vein

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 Physical Examination

Chloasma Varicose vein Previous scar

Striae gravidarum Linea nigra

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 Abdominal Examination

Inspection Palpation Auscultation

• Size of uterus • Fundal palpation • Fetoscope (8-12/52) Fetal Kick count
• Shape • Lateral palpation • Doppler ultrasound To monitor fetal
• Fetal movement • Pelvic palpation (12/52) movement .
• Contour of the • Pinard scopes Normal count is 10
abdominal wall • Normal rate 110-160 within 12 hours
• Skin changes bpm
• Estimation of
gestational period

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 Abdominal Examination

Pinard Fetal Stethoscope Sonicaid (Electronic)

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 Abdominal Examination

Measurement of fundal height

Estimate gestational period

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 Health Education
Purposes Example:
• Develop confidence in mother • Importance of antenatal visit
• Promote self-care and speedy • Antenatal care
recovery • Breast care

• Prepare for labour process • Process of labour & delivery

• Antenatal & postnatal exercises
• Ensure successful and
efficient parenthood • Fetal kick chart
• Postnatal care
• Breast feeding
• ………….
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 Immunization
• Tetanus toxoid is given to mothers to protect baby from tetanus neonetarum.
• Primigravida requires two doses; multi-gravida require only booster dose.
• First dose is given after quickening felt by mother (between 16 - 24 weeks).
• Second dose is to be given 4 - 6 weeks after first dose.
• The booster dose is given at 20 weeks gestation.

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 Treatment
Routine vitamin supplement
• Hematinic Pill
‒ Ferrous fumerate 200 mg daily
‒ Folic acid 5 mg daily
‒ Vitamin C 5 mg daily
‒ Vitamin B Complex 1 tablet daily

• Tab. Obimin 1 daily P.O if Hb normal in the first trimester

• Tab.
Zincofer 1 daily or BD from the second trimester
onwards

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 Referral
Medical officer Dental care

• Routineexamination of • Routine examination

heart and lung • Treatment for dental
• High-risk mother carrier

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 Follow-Up Care
• Plan care based on the risk
approach/colour code
• Schedule for revisit
< 12 weeks - first visit (booking)
< 28 weeks - monthly
28–36 weeks - 2 weekly
36 weeks & above - weekly
• Home visit

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 MATERNAL CARE

Pre- Intra-
Antenatal Postnatal
pregnancy partum
Care Care
Care Care

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 Intra-Partum Care
• Care given to mothers during labour
• Low-risk mothers will deliver at alternative birth center (ABC) or
home delivery
• Checklist for criteria of low risk:
1. Gravida 2 to 5
2. No past obstetric problems
3. No past medical conditions
4. No health/obstetric problems in current pregnancy
5. Height > 145 cm
6. Maternal age > 18 and has family support
7. POA > 37 weeks or < 41 weeks
8. Estimated birth weight > 2 kg and < 3.5 kg

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 Postnatal Care
• Postnatal care is the health care given to mother and
baby following delivery until the end of postnatal period
(about 4 - 6 weeks after delivery).

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 Objectives of Postnatal Care
 To assist mother to maintain health status mentally and physically
 To identify abnormal condition during puerperium
 To assist mother in gaining successful parenthood
 To supervise mother on breast feeding and infant feeding

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 Schedule of Postnatal Care at Home
• Normal delivery case
• Day 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15 and 20
• Complicated case
• Depends on individual needs
• Visit clinic at 4 - 6 weeks after delivery

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 Postnatal Care Clinic Activities
8. Follow-up care
1. General examination 7. Refer medical officer
 Measure weight  Baby will follow up at the child health clinic
 Check blood pressure as scheduled  Postnatal complication
 Take vital signs  Mother is not required to revisit the clinic Example: Hb< 9 gm% without
unless she is referred for further treatment
symptoms, BP>140/90, glucosuria
2. Laboratory test
 Check hemoglobin level
 Urine: glucose and albumin
6. Health teaching and advise
 Breast feeding/infant feeding
3. Physical examination  immunisation
 Head to toe examination as in  Family planning
antenatal examination, the focus will
be on:
 Breast 4. Interview mother on the following topic:
 Fundal high 5. Treatment
 Vaginal discharge  Health status
 Examine the perineum:  Postnatal care Prescribe vitamin supplements if
mother’s Hb low.
– Genital  Infant feeding/breast feeding
– Wound  Coping mechanism of new parenthood  Give full cream milk when
– Uterus/cervix  Family planning necessary
– Adnexa  Give contraceptive pills or
 Surgical scar (LSCS) condom

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THANK YOU

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