RAJASTHAN VIDYAPEETH

HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL ,

DABOK, UDAIPUR, RAJASTHAN

4TH BHMS
BATCH- 21ST
SESSION – 2022- 23
 TOPIC NAME: Maternal & Child Health

NAME: Anjum Abbasi

GUIDED BY : Prof. Dr. Naveen Vishnoi

 Maternal & Child Health
• Definition: The term “ maternal & child
health” refers to the promotive, preventive,
curative & rehabilitative health care for
mother’s & children.
• Objectives of MCH:- (a) Reduction of
maternal, perinatal, infant & childhood
mortality & morbidity.
(b) Promotion of reproductive health.
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(c) Promotion of the physical & psychological
development of the child & adolescent within
the family.
(d) Promotion of the physical & psychological
development of the child & adolescent within
the family.
(e) Lifelong health.
 Components of MCH
• Maternal health.
• Family planning.
• Child health.
• School health.
• Handicapped children.
• Care of the children in special settings such as
day care centres.
 Importance of MCH care

• Mother & Children constitute a large group.

• They are “vulnerable” or special risk group.
• The risk is connected with child bearing women &
growth, development & survival of infants &
children.
• Most of the sickness & deaths among mother &
children is preventable.
• By improving the health of mother’s & children we
contribute to the health of the general population.
 Mother & Child- One unit
• Mother & child must be considered as one unit
because:-
1. During the antenatal period, the foetus is part of
the mother. The foetus obtains all the building
materials and oxygen from mother’s blood during
the development of about 280 days.
2. Child health is closely related to maternal health. A
healthy mother brings forth a healthy baby, there is
less chance of premature birth, stillbirth or
abortion.
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3. Certain diseases & conditions of the mother
during pregnancy eg : Syphilis, German measles,
drug intake are likely to have their effects on the
foetus.
4. After birth, the child is dependent on the
mother at least upto the age of 6-9months for
feeding.
5. The mother is also the first teacher of the child.
 MCH Problems
• Malnutrition
• Infection
• Uncontrolled Reproduction
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 Antenatal Care
It is defined as the care provided by skilled
health care professionals to pregnant women
and pregnant adolescent girls in order to ensure
the best health conditions for mother and baby
during pregnancy.
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 Objectives Of Antenatal Care
• To promote, protect and maintain the health of
the mother during pregnancy.
• To detect “ high risk” cases & give them special
attention.
• To foresee complications & prevent them.
• To remove anxiety & dread associated with
delivery
• To reduce maternal & infant mortality &
morbidity.
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• To teach the mother elements of child care,
nutrition, personal hygiene & environmental
sanitation.
• To sensitize the mother to the need for family
planning, including advice to cases seeking
medical termination of pregnancy.
• To attend to the under-fives accompanying the
mother.
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• Objectives of Antenatal care is achieved by
following health care services:-
1. Antenatal visits.
2. Prenatal advice.
3. Specific health protection.
4. Mental preparation.
5. Family planning.
6. Pediatric component.
 Antenatal visits
• Ideally the mother should attend the antenatal
clinic:- once in a month during the first 7 months.
- twice in a 8 month.
- once in a week till delivery.
• The entire period of pregnancy should cover 4
minimum visits.
• 1st visit- within 12 weeks ( for registration of
pregnancy and first antenatal checkup).
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• 2nd visit- between 14 & 26 weeks.
• 3rd visit– between 28 & 34 weeks.
• 4th visit- between 36 weeks & term.
 Antenatal check-up
• Registration of pregnant women.
• History taking – During the first visit a detailed history of
the woman needs to be taken to :
1. Confirm the pregnancy only in first visit.
2. Identification of any complications during any previous
pregnancy or bearing one.
3. Identify any current medical/surgical or obstetric
condition.
4. Record the date of 1st day of LMP & calculate the EDD –
9months+7 days.
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5. Record symptoms which indicate complications for
eg:-
• Fever
• Persisting vomiting
• Abnormal vaginal discharge or bleeding.
• Breathlessness at rest or on mild exertion.
• Palpitation
• Severe headache
• Blurring of vision etc.
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6. History of any current systemic illness such as:-
• Hypertension
• Diabetes
• Heart disease
• Tuberculosis
• Renal disease
• Epilepsy
• Asthma
• Jaundice
• Malaria
• Reproductive tract infection
• STD, HIV/ AIDS etc.
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7. Record family history of twins or congenital malformation,
thalassemia
8. History of drug allergies & habit forming drugs
• Physical Examination
- Pallor
- Pulse
- Respiratory rate
- Oedema
- Blood pressure
- Weight
- Breast examination
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• Abdominal examination
- Measurement of fundal height:-
*12 weeks- Uterine fundus just palable per
abdomen
*20 weeks- Fundus flat at the lower border of
umbelicus
* 36 weeks- Fundus felt at the level of
xiphisternum
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- Foetal heart sounds: FHS can be heard after 6th
month which varies between 120-140/min
- Foetal movements: Foetal movements can be felt
after 18-22nd week
- Foetal parts: Felt about 22nd week
- Multiple pregnancy
- Foetal lie & presentation
- Inspection of abdominal scar or any other relevant
abdominal findings
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• Assessment of gestation age: It’s based on the
LMP
• Laboratory investigations:
- At the sub- centres
Pregnancy detection test.
Haemoglobin examination.
Urine test for presence of albumin & sugar.
Rapid malaria test.
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- At the PHC/CHC/FRU
Blood group including Rh factor.
VDRL/RPR.
Rapid malaria test.
Blood sugar testing .
HbsAg for Hepatitis B infection.
 Essential components of every antenatal
check-up
• Take the patients history.
• Conduct a physical examination- measure the
weight, blood pressure & respiratory rate &
check for Pallor & Oedema.
• Conduct abdominal palpatio for Foetal growth,
Foetal lie & auscultation of FHS according to the
stage of pregnancy.
• Carry out lab investigations such as Hb
estimation & Urine tests for sugar & proteins.
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 Interventions & Counselling
• Iron & folic acid supplementation &
medication as needed .
• Immunization against tetanus.
• Group or individual instruction on nutrition,
family planning, self care, delivery &
parenthood.
• Home visiting by a female health
worker/trained dai.
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• Referral services, where necessary.
• Inform the woman about Janani Suraksha
Yojana & other incentives offered by the
government.
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 Risk Approach
• Elderly primi (30 years & over).
• Short statured primi ( 140 cm & below).
• Malpresentations viz breech, transverse lie
etc.
• Antepartum haemorrhage, threatened
abortion.
• Pre-eclampsia & eclampsia .
• Anaemia.
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• Twins, hydraminos.
• Previous still birth, intrauterine death, manual removal removal of
placenta.
• Elderly grandmultiparas.
• Prolonged pregnancy ( 14 days-after expected date of delivery).
• History of previous caesarean or instrumental delivery.
• Pregnancy associated with general diseases viz cardiovascular disease,
kidney disease, diabetes, tuberculosis, liver disease, malaria,
convulsions, asthma, HIV, RTI, STI etc.
• Treatment for infertility.
• Three or more spontaneous consecutive abortions.
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 Maintenance of Records
• A mother & child protection card should be duly
completed for every woman registered. It contains a
registeration number, identifying data, previous health
history & main health events etc. This card has been
developed jointly by the Ministry of Health & Family
Welfare ( MOHFW) & Ministry of Women & Child
Development ( MOCWD) to ensure uniformity in record
keeping. The information contained in the card should
also be recorded in the antenatal register as per the
Health Management Information System ( HMIS) format.
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 Prenatal Advice
• Iron & folic acid tablet- mother is given 1 tablet of iron
& folic acid twice a day for at least 100 days to prevent
anemia in mother & to promote proper growth of
foetus.
• Health education during pregnancy –
(a) Diet: A well balanced diet is required during
pregnancy for the proper growth & development of
foetus & for optimum health of mother.
(b) Personal Hygiene: A pregnant women should be
educated regarding to personal hygiene.
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(c) Smoking & Drinking : Mother should be
advised to avoid smoking & drinking alcohol. It
lead to low birth weight baby & retarded baby.
(d) Drugs : The mother should be advised not to
take any medicine unless it is prescribed by the
Doctor.
(e) Radiation: The mother should be advised to
avoid abdominal X-ray, it predisposes child to the
risk of leukaemia & other cancers.
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(f) Protection from infections & illness: An expected
mother should be instructed to protect herself from
the risk of infection especially measles & syphilis
because these infection can cause spontaneous
abortion, malformation, mental retardation, still birth
etc.
(g) Sexual activities: Avoid coitus during the first & last
trimester . 1st trimester increases the risk of abortion &
last trimester predisposes to infection.
(h) Travel: Avoid travel during the first & last trimester.
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(i) Reporting of untoward sign & symptoms: The mother
should be instructed to report to health personal if
there is unusual pain, bleeding from vagina, swelling
in the feet, hand or face, headache, blurred vision,
dizziness, high fever, baby’s movement not being felt.
(j) Child care: The mother should be educated various
aspects of child care.
(k) Follow up visits: Mother must be educated about the
need for regular visit & proper care during pregnancy.
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• Preparing for confinement: The preparation for safe
delivery is very important. It should be done well in
advance to avoid any type of difficulty or emergency which
might occur at the time of delivery.
• Psychological preparation of the mother: The expectant
mother, especially the Primary Para mother has fear &
anxiety about child birth, it’s outcome complications etc. It
is very important to discuss various aspects of pregnancy &
delivery. This helps in overcoming their fears & anxieties.
• Family planning: When the mother is pregnant she is more
receptive because she is experiencing the impact & burden
of child birth. The mother should be educated & motivated
 Natal care
• Natal care refers to care during confinement,
delivery, birth of a child.
• Objectives:- To prevent infection.
- To prevent injury to both mother & baby.
- To detect & deal with any complications, eg:
Antepartum & Post-partum haemorrhage, Prolonged
labour, Malpresentation, Prolapse cord etc.
- To resuscitate the baby & to provide immediate care
to baby.
 Care during Natal

• Preparation of place & surrounding of confinement.

• Preparation of equipment & supplies required during delivery.
• Physical & psychological preparation of the mother.
• Examination of mothers physical condition, abdominal palpation,
monitoring fetal heart sound, observation of vital signs, labour pain etc.
• Conducting delivery, watchful about any problem & helping mother in
taking pains.
• Referral of mother immediately in case of any such problem.
• Giving immediate care to mother & baby after delivery.
• Giving instruction to the mother & family members.
• Maintaining record & reporting of birth to authority.
 Post Natal Care
• It refer to care which is rendered to both mother & baby after delivery.
• Objectives – To restore, promote & maintain health of mother & baby.
- To promote breast feeding.
- To prevent complications.
- To establish good nutrition to the baby
- To prevent infection & identify any health problem/disorder in the
baby.
- To support & strengthen the parents confidence & their role within
their family & cultural environment.
- To motivate for planned & small family norms.
- To educate mother & family on various aspects of mother & child care .
 Immediate care of the New born
• Clearing of airway:- After birth the baby should cry &
breathe immediately. In order to promote breathing the
airway needs to be cleared from mucus or any other
secretions.
• Maintenance of baby temperature:- The New born baby
has the risk of hypothermia because of immature heat
regulating system. The risk of hypothermia is greatly
reduced if the New born baby is carefully & immediately
dried with towel or clean cloth, wrapped in a clean cloth,
kept close to the mother for skin & skin contact & breast
feed as soon as possible preferably within an hour of birth.
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• Care of the eyes:- The care of eyes include wiping of each
eye from inside to outside with boil cooled swabs, one for
each eye as the child is born before he opens the eyes.
• Care of the umbilical:- The cord should be legated in 2
places 6cms & 9cms from the umbilicus & cut in between
with sterilized scissors/blade & tied with sterilized cord tie
to prevent tetanus. The cord should be kept dry . Special
instructions are given to the mother & family not to apply
anything for eg- oil, ash, or cow dung on the cord because
this may lead to Septicemia or tetanus neonatrum.
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• Care of the skin:- The care of the skin is very
important to protect the child from any infection &
keep the baby clean & warm. First bath is given after
temperature stabilization, preferably after a week.
• APGAR Score:- The observation is done at 1 minute
& again at 5 minutes after birth. It requires
immediate & careful observation of the heart rate,
respiration rate, muscle tone, reflex response &
colour of the infant.
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• Breast feeding:- The breast feeding should be

started as soon as possible preferably within
an hour of the risk.
 Post Natal Visit & Care
• The health worker is expected to follow the
mentioned schedule:-
(a) 1st visit – within 24 hours .
(b) 2nd visit- 5th or 6th day.
(c) 3rd visit- 10th day.
(d) 4th visit- 2nd to 4th week.
(e) 5th visit- 6th to 8th week ( in clinic) .
During these visits, both mother & baby are given
care to meet their health needs.
 Child Health Care
• It refers to care of children from conception to birth
till the age of five.
• Objective: - Every child receives adequate care &
protected from diseases.
- Every child is immunized & protected from diseases.
- To monitor growth & development.
- To identify ailments & treated without delay.
- To educate the mother & family members to give
proper care of their children.
 Care of Child
• Personal care of children – Every child must get proper personal care to
protect the child from any kind of injury with maintenance of personal
hygiene, body temperature, rest & sleep, exercise, healthy habits etc.
• Feeding of the child- Adequate & proper feeding is very important
(a) Breast feeding: For the first 6 months breast feeding is best food which
is healthy for growth & development.
(b) Supplementary food: Beyond 6 months baby require additional food to
meet body requirements. These are called supplementary food.
(c) Monitoring of Growth & Development: It is very important to monitor
growth & development of children regularly. It helps in identification of any
deviation from normal health. Ideally weight is measured & recorded once
in a month upto 1 year, once in 2 months upto 2 years, & once in 3 months
upto 5 years.
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(d) Immunization of children: The child needs to be protected
from 6 infectious & vaccine preventable diseases. Disease
include are TB, tetanus, diphtheria, whooping cough, measles
& poliomyelitis. Health workers must educate all the mothers
about the importance of immunization & explain the
immunization schedule so that they will bring the child for
immunization according to schedule.
(e) Safety & Security of Children: Water, milk & food supply
must be free from infectious agents/ or toxins.
- Disease carrying insects must be controlled.
- Accidents hazards need to be removed or controlled in order
to prevent accidents such as falls, burns, poisoning,
drowning, aspiration of foreign objects, cuts & abrasions etc.
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(f) Early recognition & treatment of ailments: There
are no. Of ailments which can occur in children from
one month to five years cause morbidity & mortality.
- The most common ailments are diarrheal diseases,
acute respiratory infection, vaccine preventable
diseases, nutritional deficiency problems.
- Timely recognise these ailments & timely treatment
can take place.
 The package of services
• For mother:- TT immunization.
- Prevention & treatment of anemia.
- Antenatal care & early identification of maternal complication.
- Deliveries by trained personnal.
- Promotion of institutional deliveries.
- Management of obstetric emergencies.
- Birth spacing.
• For children:- Essential New born care.
- Exclusive breastfeeding & weaning .
- Immunization.
- Appropriate management of diarrhoea.
- Appropriate management of Acute respiratory infection.
- Vit. A prophylaxis.
- Treatment of anemia.
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• For eligible couples:- Prevention of pregnancy.
- Safe abortion.
- Prevention & treatment of reproductive tract
infection & sexually transmitted disease.