MCH: INITIAL NURSING

ASSESSMENT, NEED BASED

CARE AND CONTINUATION OF
CARE
 INTRODUCTION

• Mothers, newborns, and children are inseparably linked

in life and health care.

• In the past, maternal and child care policy and programs

tended to address the mother and child separately,
resulting in gaps in care.
 NEED OF ASSESSMENT FOR MCH

• Birth rate: helps to find base line data

• MMR: 2/3rd are preventable by hospital
interventions(anemia, APH, PPH, puerperal infections)
• Perinatal mortality rate
• Motivate for Institutional delivery
 Cont…

• Attendant at delivery at community level

• Management in case of Prematurity
• ANC: crux of MCH , complete regular checkup, minimum 3
visits, early registration
 NEED BASED CARE IN TERMS OF

Prenatal/Antenatal Care Services

Intranatal Care Services

Postnatal Care Services

Under Five Child Health Services

ANTENATAL ASSESSMENT
 PRENATAL/ ANTENATAL ASSESSMENT

General antenatal assessment:

• History taking
• Assess for early signs of
pregnancy: presumptive,
probable, positive
• Systemic examination
• Laboratory assessment: blood
group, Hep B and C, triple test,
complete blood count, GTT,
urinanalysis.
 Cont…

• Ultrasonography.
• Vaginal examinations :
– At first visit to investigate vaginal discharge and TVS for
intrauterine pregnancy confirmation.
– At subsequent antenatal visits to investigate threatened
abortion, confirm PPROM, presenting part, assess for
favourable cervix.
 PRENATAL/ ANTENATAL CARE

• General care
Immunization
• Nutrition and diet
• Personal hygeine
• Environmental hygeine
• Rest and sleep
• Clothing
• Medication
• Care of breasts
• Birth preparedness
Focused care

• In case of complicated pregnancy, specific care like anemia, Rh

negative pregnancy, PIH, GDM,HIV, etc.
AND ASSESSMENT
 INTRANATAL ASSESSMENT AND CARE FOR
MOTHER AND FETUS

 1st stage of labour

– Checking documents, last USG, complication.
– Written informed consent .
– Ensure privacy.
– Maintaining Partograph
– Electronic fetal monitoring
– Maintain asepsis(in PROM, ARM, SRM)
 cont…..

– Keep on checking vital signs.

– Accurate, factual documentation
– Vaginal examination to check status of membranes, any
abnormal bleeding , cervical dilatation and effacement,.
– Colour of liquor if membranes ruptured.
 Cont…..

– Setting of trolley for labour and preparedness for emergency

cesarean.
– Hydration of patient
– Continuous monitoring during oxytocin administration.
– Bladder emptying
– Physical and psychological support during labour.
 Cont…

 2nd stage of labour

• Check vital signs of mother
• Abdominal examination and fetal heart rate.
• Documentation.
• Duration is different in primiparous and multiparous.
 Cont…

• Ensure that bladder is empty.

• Assist in bearing down and give support to perineum and
light counter pressure on the fetal head. Take measures to
reduce risk of 3rd and 4th degree tear.
• Gentle traction for shoulders if not coming spontaneously.
• Do not use fundal pressure.
• Cord clamping is recommended not earlier than 1 minute
after birth.
POSTNATAL ASSESSMENT AND CARE

For mother For baby

 POSTNATAL ASSESSMENT OF THE MOTHER

• BUBBLE-LE
– Breast
– Uterus
– Bladder
– Bowels
– Lochia
– Episiotomy and perineum: REEDA assessment
– Lower extremities
– Emotions: postpartum blues, depression and psychosis
 POSTNATAL CARE

• Vaginal discharge
• Pain relief
• Incontinence
• Hemorrhoids and bowel movements.
• Breast tenderness
• Rest and sleep
• Nutrition
• Postnatal exercises
• Contraception
• Abstinence from coitus
 COMPLICATIONS OF POSTNATAL PERIOD

• Puerperal sepsis
• Thrombophlebitis
• Secondary hemorrhage
• Others:UTI, mastittis, etc.
 POSTNATAL ASSESSMENT OF NEWBORN
• Initial assessment of newborn:
– APGAR score- activity (muscle
tone), pulse(heart rate),
grimace(reflexes), appearance
(skin colour), respiration
(breathing)
– Sex, weight, gestational age.
– Physical examination and
systemic examination
– Posture and movements.
– First urine and meconeum
 POSTNATAL CARE OF NEWBORN
• Immediate care of the newborn
– Airway
– Breathing
– Temperature
• Wrapping the baby
• Cord care
• Eye care
• Vit K prophylaxis
• Foot printing, identification and
registration
• Kangaroo mother care
• Early breastfeeding
 Cont…
• Daily care:
– Breastfeeding
– Elimination
– Weight changes
– Bathing, hygiene, grooming
– Vital signs
– Rooming-in
– Note for any abnormalities
CONTINUATION OF MCH CARE

ICDS

CSSM

BFHI
 ICDS( INTEGRATED CHILD DEVELOPMENT
SERVICES )

• It include preschoolers
• Main objective of ICDS is to
– Reduce the maternal, the infant and the preschool
child morbidity and mortality by
• Immunizations
• Supplemental nutrition
• Treatment and referral
 CSSM(CHILD SURVIVAL AND SAFE
MOTHERHOOD PROGRAM )

• Children
– Essential newborn care
– Immunization
– Appropriate management of diarrhea
– Appropriate management for acute respiratory infections
– Vitamin “A” prophylaxis
 CSSM(CHILD SURVIVAL AND SAFE
MOTHERHOOD PROGRAM )

• Mother
– Immunization
– Prevention and treatment of anemia
– Antenatal care and early identification of maternal
complications
– Deliveries by trained personnel
– Promotional of institutional deliveries
– Management of obstetric emergencies
– Birth spacing
BABY FRIENDLY HOSPITAL INITIATIVE
THANK YOU