Maternal and Child Health Overview

Maternal and Child Health

• Maternal and child health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children.
• It's a key element of Primary Health Care.
• Subareas include maternal health, child health, family planning, school health, children with disabilities, adolescence, and health care for children in special settings like day care.

Lecture Objectives

• Introduce students to the main concept of maternal and child health services and elaborates on the specific objectives of MCH services.
• Explain the main phases of maternity care.
• Familiarize students with the antenatal care visit schedule.
• Outline the WHO definition and areas of safe motherhood.

Specific Objectives of MCH

• Reduce maternal, perinatal, infant, and childhood mortality and morbidity.
• Promote reproductive health.
• Promote physical and psychological development of children and adolescents within families.
• The ultimate objective of MCH services is life-long health.

Phases of Maternity Care

• Premarital care phase.
• Prenatal (antenatal) care phase.
• Intranatal care phase.
• Postnatal care phase.

Premarital Care Phase

• Care given to girls and boys before marriage, essential for adolescent health.
• Includes promotive services like education about nutrition, STDs, and contraception.
• Also includes preventive services like immunizations (e.g., tetanus toxoid for females).

Premarital Care Phase (Specific Services)

• History of past medical history, especially hereditary diseases (thalassemia, hemophilia, sickle cell anemia).
• Medical examination (e.g., nutritional status of the female, chest examination if cough persists more than 3 weeks).
• Investigations (blood group, Rh factor, VDRL, HIV, MCV, MCH).
• Counseling on family planning and sex education.

Antenatal Care (ANC) Phase

• Care for women during pregnancy.
• Aims for a healthy mother and baby at the end of pregnancy.
• Ideally, begins soon after conception and continues throughout pregnancy.

Objectives of ANC

• Promote, protect, and maintain the mother's health during pregnancy.
• Detect high-risk cases and provide special attention.
• Detect complications and prevent them.
• Reduce anxiety and fear associated with delivery.
• Reduce maternal and infant morbidity and mortality.
• Teach mothers about child care, nutrition, personal hygiene, and environmental sanitation.
• Sensitize the mother about family planning.
• Attend to the under-fives accompanying the mother.

Antenatal Visit Schedule

• First 28 weeks of gestation: every 4 weeks.
• 28th–36th weeks of gestation: every 2 weeks.
• 36th week to term: every week.

Preventive Services for Mothers (Prenatal)

• First visit, regardless of when it occurs, includes health history, physical examination, and laboratory investigations.
• Laboratory investigations include complete urine analysis, stool examination, complete blood count (including Hb estimation), serological examination, blood grouping and Rh determination, chest X-ray (if needed), and Pap test (if facilities exist).
• Subsequent visits include physical examination (e.g., weight gain, blood pressure), laboratory tests (urine examination, Hb estimation), iron and folic acid supplementation and medication (as needed), immunizations (e.g., tetanus), and group or individual instruction on nutrition, family planning, self-care, delivery, and parenthood.
• Home visiting by a female health worker.
• Referral services (where necessary).

Risk Approach

• Identify “high-risk” cases as early as possible.
• Provide skilled care to high-risk cases.
• Provide appropriate care for all mothers.
• High-risk cases include elderly primi (30 years and over), short-statured primi (140 cm and below), malpresentations (breech, transverse lie), antepartum hemorrhage, threatened abortion, pre-eclampsia and eclampsia, anaemia, twins, previous stillbirth, intrauterine death, and manual removal of placenta.
• Other high-risk cases include elderly grand multiparas, prolonged pregnancy (14 days after expected date of delivery), history of previous caesarean or instrumental delivery, and pregnancy associated with general diseases (diabetes, tuberculosis, cardiovascular diseases).

Intranatal Care Phase

• Childbirth is a normal physiological process, but complications can arise.
• Septicemia from unskilled and septic manipulations, tetanus neonatorum from unsterilized instruments.
• Intranatal care is indispensable, even for normal deliveries.

Aims of Good Intranatal Care

• Thorough asepsis.
• Delivery with minimum injury to the infant and mother.
• Readiness to deal with complications like prolonged labor, APH, convulsions, malpresentations, and cord prolapse.
• Care for the baby at delivery – resuscitation, care of the cord, care of the eyes.

Postnatal Care Phase

• Care of the mother and newborn after delivery.
• Two main areas:
  • Care of the mother, primarily the responsibility of the obstetrician.
  • Care of the newborn, combined responsibility of obstetrician and pediatrician. This combined responsibility is also known as perinatology.

Care of the Mother (Postnatal Objectives)

• Prevent complications of the postpartum period.
• Provide care for the rapid restoration of the mother to optimum health.
• Check the adequacy of breastfeeding.
• Provide family planning services.
• Provide basic health education to mothers and families.

Postpartum Period Complications

• Puerperal sepsis.
• Thrombophlebitis.
• Secondary hemorrhage.
• Others (UTI, mastitis).

Neonatal Care

• Early neonatal care (the first week of life) is crucial.
• Aims to assist the newborn in adapting to the alien environment, including establishing and maintaining cardiorespiratory functions, maintaining body temperature, and avoiding infection.
• Establishing satisfactory feeding regimens.
• Early detection and treatment of congenital and acquired disorders, especially infections.

GOBI-FFF

• Selective PHC approach, techniques known as GOBI-FFF.
• Focuses on severe population health problems in developing countries where diseases are responsible for high infant and child mortality.
• Components include growth monitoring, oral rehydration therapy, breast feeding, immunization, family planning, female education, and food supplementation.

Safe Motherhood

• Four strategic interventions recommended by WHO: family planning, antenatal care, clean/safe delivery, and essential obstetric care.
• Implementation should be based on equity for women.

Family Planning

• Individuals and couples have information and services to plan timing, number, and spacing of pregnancies.

Antenatal Care

• Prevent complications where possible and ensure early detection and appropriate treatment.

Clean/Safe Delivery

• Ensure all birth attendants have knowledge and necessary skills and equipment for clean and safe deliveries.
• Provide postpartum care to mother and baby.

Essential Obstetric Care

• Make essential care available to high-risk pregnancies.
• Deal with complications appropriately and refer in a timely manner.

Incorrect Objective of Maternal and Child Health Care

• To provide employment for poor parents.