OBJECTIVES

At the end of the this presentation learner will be able:

• Discuss the objectives of MCH Services and get the introduction to the concept of Reproductive Health.
• Discuss the physiological changes during Pregnancy.
• Identify minor aliments during pregnancy and discuss their management.
• Discuss the causes of maternal mortality in Pakistan.
• Identify high-risk mothers and discuss the need of referral.
• Describe the guide lines for antenatal assessment, care and teaching.
• Explain the preparation of mothers for home delivery .
• Discuss home delivery process and its management
• Discuss the postnatal complications.
• Describe guidelines for postpartum assessment care and teaching
• Care of new born baby at home and emphasize on breast feeding

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Safe Motherhood

Rukhsana.M.Haroon
Lecturer
ION&M, DUHS

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OBJECTIVES OF MCH CENTERS

The MCH Program aims to achieve the following objectives:

• Increase utilization of quality family planning, maternal, neonatal, and child health services
• Improve nutrition and water sanitation and hygiene practices and promote healthy growth and
development of children.
• To reduce maternal childhood mortality and mobidity and also identify health problem of mother
and children.

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REPRODUCTIVE HEALTH

• Reproductive Health includes family planning, health services, health education, prevention and
treatment of sexually transmitted infections.
• Freedom to make decisions regarding a healthy sex life.
• Access to appropriate reproductive health services for both men and women.
• Safe, effective, affordable access to family planning methods.
• Access to appropriate reproductive health services.

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PHYSIOLOGICAL CHANGES DURING PREGNANCY

• During pregnancy, a woman’s body changes in many ways due to the effect of hormones. These
changes can sometimes be uncomfortable, but most of the time they are normal and enable her to
nourish and protect the fetus.

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CONT:

Changes in estrogen and progesterone

• A woman will produce estrogen and progestrone during pregnancy.
• Estrogen helps utreus grow and promote blood flow within the uterus and the plancenta.
• Progesterone helps maintain uterine linning throughout the pregnancy.

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CONT:

CHANGES IN BODY WEIGHT

• Some degree of weight gain is expected during pregnancy. The enlarging uterus, growing
fetus, placenta, amniotic fluid, normal increase in body fat, and increase in water retention all
contribute weight gain during pregnancy.
• There can be a slight loss of weight during early pregnancy if the woman experiences much
nausea and vomiting (often called ‘morning sickness’).

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CONT:

• The expected increase in weight of a healthy woman in an average pregnancy, where there is a
single baby, is as follows:
• About 2.0 kg in total in the first 20 weeks
• Then approximately 0.5 kg per week until full term at 40 weeks
• A total of 9 -12 kg during the pregnancy.

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CONT:

Cardiovascular changes
• The heart adapts to the increased cardiac demand that occurs during pregnancy in many ways.
Cardiac output increases throughout early pregnancy, and peaks in the third trimester, usually to
30-50% above baseline.
• Uterine enlargement beyond 20 weeks' size can compress the inferior vena cava, which can
markedly decrease the return of blood into the heart. As a result, healthy pregnancy patients in a
supine position or prolonged standing can experience symptoms of hypotension.

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CONT:

GU CHANGES
• A pregnant woman may experience an increase in the size of ureter due to the increase blood
volume and vasculature.
• Progesterone causes vasodilatation and increased blood flow to the kidneys, and as a
result glomerular filtration rate (GFR) commonly increases by 50%, returning to normal around 20
weeks postpartum. The increased GFR leads to increased urinary output, which the woman may
experience as increased urinary frequency.

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CONT:

GI Changes
• Energy intake needs to increase by 1200kJ/day
• Smooth muscle tone and motility decreased due to progesterone
• Constipation
• Increased transit time for food
• Acid reflux to the above and physical pressure
• Nausea and vomiting in 1st trimester are due to rising levels of ovarian steroids

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CONT:

Skin Changes
• Pigmentation: due to increased melanocyte stimulating hormone
• Linea Nigra
• Chloasma Gravidarum

• Striae Gravidarum
• Stretch of the abdominal wall
• Rupture of the subcutaneous elastic fibers
• Pink lines in flanks

• Become white after labor

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MINOR ALIMENTS DURING PREGNANCY &
THEIR MANGMENT
• During pregnancy, hormones including estrogen, progesterone and prolactin rise rapidly. It turns
the womb into a suitable environment for the baby’s growth. And at the same time, it could cause
discomfort to the mother. Most of these changes are normal.
• Most of the minor ailments in pregnancy will spontaneously subside after delivery. Therefore you
do not need to worry too much.
• Herbs and medicines should be avoided especially during early pregnancy because they can enter
the fetal circulation through placenta.

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NAUSEA & VOMITING

• Nausea is very common in the early weeks of pregnancy. Adjusting your dietary habits may help to
ease the discomfort.
• Some pregnancy complications and medical diseases like multiple pregnancy, molar pregnancy and
thyrotoxicosis can lead to severe vomiting.
MANAGEMENT:
• If possible, eat some dry food like bread, biscuit, low-fat food, carbohydrate-rich food (e.g. rice,
noodle, mashed potatoes) and try some sour drink (e.g. lemonade, plum juice). Avoid eating deep-
fried or greasy food, garlic and other spices and avoid drinking coffee.
• Eat small amounts of food often rather than several large meals, say every 2-3 hours. Don’t stop
eating. Drink plenty of fluids in between meals to avoid stomach fullness.

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HEART-BURN

• This is very common during pregnancy. The relaxation effect of progesterone on the esophageal
sphincter results in reflux of acidic fluid to the esophagus, causing irritation and heartburns.
MANAGEMENT:
• Eat small, low-fat meals frequently. Chew the food well and eat slowly.
• Avoid spicy food.
• Avoid lying down, bending and stooping after eating. Elevate the head of the bed. Wear loose-
fitting clothing.
• Do not take any antacids without consulting a doctor.

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CONSTIPATION

• This affects 10-40% of pregnant women. Progesterone lowers intestinal muscle tone and
movement of colon. There is also additive effect of increase in reabsorption of water from bowel
mucosa.
MANAGEMENT:
• Drink at least 8-12 cups of fluid everyday in the form of water, milk, juice or soup. Warm or hot
fluid is particularly helpful.
• Increase fiber intake by eating more whole grain breads and cereals, vegetables, fruits and legumes
such as beans, split peas and lentils.
• Maintain an active lifestyle with regular exercise such as walking and swimming.

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FREQUENT URINATION

• This is the result of increase in blood flow to kidneys by 50% during pregnancy and the relaxation
effect of progesterone on smooth muscle of the urinary tract.
MANAGEMENT:
• You should never restrict fluid intake because this might increase the chance of urinary tract
infection.
• In case you have a urinary tract infection, you should take a course of antibiotics according to the
doctor’s instructions.

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BACKACHE

• Pregnancy strains your back and posture. To avoid or reduce backache, avoid lifting heavy
weights, wearing high-heeled shoes or standing for too long.
MANAGEMENT:
• Support your back with a cushion. Kneeling on all fours and rocking from side to side.
• Sleep on your side with a pillow between your legs.
• Sit with your back straight and well-supported.
• Use hot or cold pack on the sore part of your back.

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MATERNAL MMR
MORTALITY ID CAUSES
17%

When a woman dies from anything PPH

36%
having to do with pregnancy, it is
called maternal mortality or maternal ABORTION
16%
death. Maternal death can happen
while a woman is pregnant, during
labor and delivery, or in the 42 days
SEPSIS
after childbirth or the termination of 16% ECLAMPSIA
15%
pregnancy.

PPH ECLAMPSIA SEPSIS ABORTION ID CAUSES

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CAUSES OF MATERNAL MORTALITY

DIRECT CAUSES
Postpartum Hemorrhage
• Postpartum hemorrhage (PPH) is excessive bleeding and loss of blood after childbirth. PPH is
often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours
following childbirth. A skilled health care provider can stop the bleeding. But, if a healthcare
provider with the proper knowledge and skills is not available, a mother can die from losing too
much blood. PPH is responsible for approximately 36 percent of all maternal deaths.

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CONT:

Eclampsia
• Eclampsia is the onset of seizures in a woman with pre-eclampsia. With good medical care,
doctors can treat and monitor pre-eclampsia. But, without care, it can become dangerous and lead
to death. Eclampsia responsible for 15 percent of pregnancy-related deaths.

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CONT:

Infection
• Women can get an infection from unsafe abortion, an unsanitary delivery, or a very long labor. A
lack of understanding and information on personal hygiene and how to care for the body after
childbirth can also put a mom at risk for infection. About 16 percent of maternal deaths are the
result of an infection

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CONT:

Termination of Pregnancy
• An unsafe abortion is a leading cause of death among women who have an unintended pregnancy.
It is estimated that 26% of all pregnancies that occur in the world are terminated by induced
abortions. Termination of pregnancy accounts for 16 percent of the maternal deaths.

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INDIRECT CAUSES

• An indirect cause of death in pregnant women is from a condition that is not directly related to the
pregnancy but develops or gets worse during pregnancy. Pregnancy can affect health problems
such as HIV and heart disease. Conditions such as diabetes and anemia can develop or get worse.
These issues account for approximately 17 percent of maternal deaths

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HIGH RISK MOTHER’s

HIGH RISK PREGNANCY

• High risk Pregnancy is defined as one in which the mother or the fetus has a significantly
increased chance of death or disability. Is one in which the life of the health of the mother or infant
is jeopardized by a disorder coincidental with or unique to the pregnancy.

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IDENTIFICATION OF HRP’s

• A high risk pregnancy can be identified only if the woman has access to prenatal care.
• Poverty limiting access to the health care system and lack of ability of society and government
to provide medical coverage to those unable to pay for these services are powerful factors that
prevent access to prenatal care. 
• Once the women has access to prenatal care, the second limiting factor preventing the
identification of those at risk is the quality of the prenatal care itself because, in many cases the
services provided are of marginal quality and high risk patients are not identified.

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CONT:

• High risk pregnancies are a small segment of the obstetrical population that produces the majority
of the maternal and infant mortality and morbidity. 
• This denomination includes women with chronic hypertension ,pregestational diabetes, anemia,
chronic lung disease, Rh alloimmunization, cardiac and renal disease, women at a risk
for congenital abnormalities in the offspring and other conditions, that place the pregnancy.

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NEED OF REFERRALS

• As emphasized by the (WHO 1994), this back-up function of referral is of particular importance in
pregnancy and childbirth as a range of potentially life threatening complications require
management and skills that are only available at higher levels of care.
• The following levels of care gave been identified:
1. Family/Community
2. Health Centre
3. District Hospitals

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WHO Guide line

• A minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care.

• Counselling about healthy eating and keeping physically active during pregnancy.

• Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) folic acid for
pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.

• Tetanus toxoid vaccination is recommended for all pregnant women, depending on previous tetanus vaccination exposure,
to prevent neonatal mortality from tetanus.

• One ultrasound scan before 24 weeks’ gestation (early ultrasound) is recommended for pregnant women to estimate
gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term
pregnancy, and improve a woman’s pregnancy experience.

• Health-care providers should ask all pregnant women about their use of alcohol and other substances (past and present) as
early as possible in the pregnancy and at every antenatal visit.

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NEW Born care

•
By Article Discussion

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REFRENCES:

• Santora, E. (2020). The Impact of the Safe Motherhood Initiative from 1987 to 2000. Embryo Project Encyclopedia.

• Batra, S., & Anand, S. (2020). PROMOTING SAFE MOTHERHOOD: A NARRATIVE BASED ANALYSIS OF
POSITIVELY DEVIANT BEHAVIOURS. The Indian Journal of, 30(1), 1.

• Govender, D., Naidoo, S., & Taylor, M. (2019). Knowledge, attitudes and peer influences related to pregnancy, sexual and
reproductive health among adolescents using maternal health services in Ugu, KwaZulu-Natal, South Africa. BMC public
health, 19(1), 928.

• Jaffery, S. (2002). Maternal Mortality in Pakistan. JPMA - Journal of Pakistan Medical Association, 10. Retrieved from
http://jpma.org.pk/PdfDownload/2474

• UNICEF. (2015). Maternal and Newborn Health Disparities in Pakistan. Country Profile Pakistan, 08. Retrieved from
https://data.unicef.org/wp-content/uploads/country_profiles/Pakistan/country%20profile_PAK.pdf

• Kaweeta Kumari, S. M. (2016). Hazards of Unsafe Abortions in the Past and Present. A Continuing Dilemma and a
Preventable cause, 15, 09. Retrieved from https://www.lumhs.edu.pk/jlumhs/Vol15No01/pdfs/6.pdf

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