2. MATERNAL AND
CHILD HEALTH

3. INTRODUCTION
Maternal and child health is
recognised as one of the significant
components of family welfare.
 Women in child bearing age and
growing infants and children under 15
years of age together from a large
section of our society.
 They are more dependent and
vulnerable members of the society they
are at high risk or mortality and morbidity.

4.  It is also being observed that the deaths of
mothers and children are the major
contributors to mortality in any community in
india.
 Health of mothers and children is very
important for acceptance and practice of
small family norms to stabilise population.
 Maternal and child health care services are
essential and specialised services because
mothers and children have special health
needs which are not catered to by general
health care services.

5.  Objectives :
 Identify maternal and child development
stages and realise the importance of care
during each stage.
 Defined and explain the concept of
maternal and child health.
 Analyse and discuss maternal morbidity
and mortality problems and their
prevention and control.
 Explain the concept of maternal health
care, describe maternal risk factors, state
the objectives and strategies of maternal
health care.

6.  Explain the concept of antenatal care, state
its objectives and discuss essential services to
be rendered to all antenatal mothers.
 Identified advantages and disadvantages of
home delivery and help family in making
decision for confinement.
 Explain the concept of postnatal care, state
its objectives and discuss the post natal acre
which need to be given to both mother and
child.
 Explain the concept and importance of child
health.
 Discuss the roles and function of community
health nurse in providing MCH services.

7. MATERNAL AND CHILD
DEVELOPMENT STAGES
PREPREG
NANT
STAGE
PREGENT
STAGE
LABOUR
AND
DELIVERY
STAGES
PUERPERI
UM
STAGE
INTER
CONCEP
TION

8. MATERNAL STAGE:
 PRE-PREGNANT STAGE :
 This refers to all non pregnant time during the
mother’s reproductive period.
 Pregnancy and child birth are natural process
but it is a time of stress for the mothers.
 If the mother already has physical and
emotion problems and or if her social
environment is not supportive then she is at
great risk to develop any kind of emotional
and physical problem.

9.  PREGNANT STAGE :
 This stage is also known as antenatal or
prenatal period.
 This period begins with the fertilization of
mature ovum by the fusion of
spermatozoa in the fallopian tube.
 Within three to four days time the zygote
reaches the uterus and gets implanted in
the uterine wall the fundus by 10-11 days
of time.

10.  LABOUR AND DELIVERY STAGE :
 This stage is also known as intranatal period.
 Full term normal delivery occurs after nine
months or 40 weeks.
 The normal delivery periods is about 24 hours.
 There is a need for effective and efficient
system of providing ambulance and
emergency service to handle any obstetric
emergency at home and in health centers.

11.  PUERPERIUM STAGE :
 This stage is also known as postnatal period.
 This stage after the birth of child the
expulsion of placenta.
 It lasts up to six weeks.
 During this period the mother tries to
overcome the stresses of pregnancy and
labour, readjusts physiologically and
psychologically, regains her optimum
health, takes care of her child etc.

12.  INTER CONCEPTION STAGE :
 This period starts after six weeks of
postnatal period.
 During this periods all opportunities
should be provided to the mothers by
the family and community to take
care of her own health and welfare
and that of her child.

13. CHILD DEVELOPMENTAL STAGE :
These refers to growth and
development periods from conception to
birth of a child and thereafter till five years.
 EARLY FETAL PERIOD :
 The first 20 weeks of pregnancy is growth
and development.
 In this period, during the first 7 to 9 days
fertilization of the ovum takes place with
the union of sperms in the fallopian tubes.
 The fetus from 14 days to 9 weeks is known
as embryo.

14.  LATE FETAL PERIOD :
 The second 20 weeks is the period of late
fetal development.
 The baby born between 28-37 weeks is
called as premature baby.
 The late fetal period and early neonatal
period are taken together as “PERI NATAL
PERIOD”
 The risk of deaths during the perinatal
period is high in comparison to any other
age except 60 plus.

15. late fetal deaths early neonatal
(28 weeks of + deaths (first 7
gestation and days in one
peri- more) year)
natal = __________________________________
mortality live birth in the same year
 In 1991,the perinatal mortality rate was 46 per
1000 live birth and in 2007,it was 37 per 1000
live and still births.

16.  The main causes for perinatal mortality
are :
 INTRA-UTERINE AND BIRTH ASPHYXIA
 LOW BIRTH WEIGHT
 BIRTH TRAUMA
 INTRA UTERINE
 NEONATAL INFECTION

17. DEFINITION:
According to WHO,
Maternal and child health service can
be defined as “ promoting , preventing
,therapeutic or rehabilitation facility or care
for the mother and child.”

18. Sab areas :
 The components of MCH include the
following:
 Maternal health
 Family planning
 Child health
 School health
 Handicapped children
 Care of the children in special setting such
as day care centre.

19. COMPONENTS :
1. Improvement of maternal health.
2. Improvement of child health.
3. Family planning.
4. School health maintenance.
5. Reduction of maternal, perinatal, infant
and childhood mortality.
6. Promotion of reproductive health.
7. Promotion of physical and psychological
development.

20. MATERNITY :
INTERCO
NCEPTIO
N
FERTILIZA
TION
ANTENAT
AL
INTRANAT
AL
POSTNAT
AL MATER-
NITY
CYCLE

21. • Maternity is the period of a women during
pregnancy and continues after child birth.
 Care of mother :
1. Antenatal care :
Fertilization onset of true labour pain.
 components of antenatal care :
I. Antenatal visit
II. Antenatal examination
III. Risk approach
IV. Prenatal advice
V. Specific health protection
VI. Mental preparation
VII. Family planning
VIII. Paediatric component

22.  IDEAL VISIT :
1 visit / month (1st – 7th month) = 7
2 visit / month (8th month) = 2
1 visit / week (9th month) = 4
_____________________________________________
TOTAL = 13

23.  MINIMUM VISIT :
1st - 12th week : 1
14th – 26th week : 1
28th – 36th week : 1
36th – delivery : 1
_____________________________
TOTAL = 4

24. HIGH RISK MOTHER:
1. Elderly primi
2. Mal presentation
3. Ante partum haemorrhage
4. Pre eclampsia and eclampsia
5. Anaemia
6. Twins
7. Hydraminos
8. Previous still birth, intrauterine death
9. Elderly grand multiparas
10. Prolong pregnancy

25. 11. Pregnancy associated with general disease
(kidney disease, diabetes, TB etc.)
12. Treatment for infertility
13. Three or more spontaneous consecutive
abortion.

26. IMMUNIZATION OF ANTENATAL
PERIOD
 A pregnant women must get 2 injection
of TETANUS TOXOID during the period
between 16 – 36 weeks, at 1 month
interval.
 If the women is immunised earlier within
3 years of the pregnancy, then 1
booster dose will be enough.

27. IRON AND FOLIC ACID AND VITAMIN A
AND D SUPPLEMENTATION :
 50 – 60 percentage of pregnant women are
anaemic due to iron and folic acid deficiency.
 One tablet containing 60 mg of elemental iron
and 500 mg of folic acid three times daily after
third month of pregnancy till 3 months after
child birth if the mother is found having
anaemia.
 Mother is given 1 tablet of iron and folic acid
twice a day for at least 1000 days to prevent
anaemia in mother and to promote proper
growth of fetus.

28. DIET DURING PREGNANCY :
 On an average, a normal healthy women
gains about 12 kg of weight gain is about
6.5 kg.
 A pregnant women required 2300 -2500
calories per day.
 DAILY NUTRITION REQUIREMENT OF
PREGNANT WOMEN :

29. NUTRIENTS REQUIREMENT EXTRA
CALORIES 2500 CAL 300 CAL
PROTEINS 60 GMS 10 GM
FATS 50 GMS NIL
CARBOHYDRATES 460 GMS 65 GM
FOLIC ACID 150 – 300 MG 50 – 200 MG
IRON 40 MG 20 MG

30.  INTRANATAL CARE :
 CONCEPTS :
o Natal care refers to care during
confinement/delivery/birth of a child.
o About 1 percent of deliveries tends to be
abnormal and another 4 percent tend to
be difficult.

31.  OBJECTIVES :
 To prevent infection.
 To prevent injury to both mother and
baby.
 To detect and deal with any
complications.
 To resuscitate the baby and to provide
immediate care to baby.

32.  PROCEDURES :
1. Clean hands of attendant.
2. Clean surface.
3. Clean equipment.
4. Skilled birth attendant.
5. Readiness to deal complication.
6. Specific care of new-born.

33. ADVANTAGES AND DISADVANTAGES OF
HOME DELIVERY :
 Advantages :
o The mother is in her natural environment,
feels secure. she is less worried about other
family members, especially her children.
o The risk of cross infection is very less in
comparison to hospital delivery.
o The mother and family is relieved of hospital
tension.

34.  Disadvantages :
o Lack of medical and nursing supervision.
o Delays in handling emergencies.
o Difficulties in transportation of mother
during emergency situations.

35.  POSTNATAL CARE :
 CONCEPTS AND OBJECTIVES :
 It refers to care which is rendered to both
mother and baby after delivery.
 It starts soon after birth of baby and
continues for 6 weeks.

36.  OBJECTIVES :
 To restore, promote and maintain health of
mother and baby.
 To promote breast feeding.
 To prevent complication.
 To establish good nutrition of the baby.
 To prevent infection and identify and health
problem in the baby.
 To motivate for planned and small family norms.
 To educate mother and family on various
aspects of mother and child care.

37.  Physical examination :
1. Postnatal examination
2. Anaemia
3. Nutrition
4. Postnatal exercise

38.  Psychological :
1. Fear of ignorance.
2. insecurity for baby.
3. Support of husband.
 Social :
1. Women can do is to have a baby.
2. Creating a family atmosphere.

39. IMMIDIATE CARE OF NEW BORN :
 To establish and maintain breathing of the
baby.
 To maintain body temperature.
 To prevent infections.
 To detect any congenital abnormality.
1. Clearing of airway.
2. Maintenance of body temperature.
3. Care of the eyes.
The care of the eyes include, wiping of
each eye from inside to out side with boiled
cooled swabs , one for each eye as the child is
born before he opens the eyes.

40. 4. Care of the umbilical cord :
 The mother and family members special
instruction not to apply anything e.g. any oil,
or cow dung on the cord.
 The cord dries, shrinks and falls off within 5-8
days by aseptic necrosis.
5. Apgar scoring :
 It is determined by immediate observation of
the heart rate, respiration, muscles tone, reflex
response and colour of the infant.
 The observation is done at 1 minute and
again at 5 minute after birth.

42. 6. Care of skin :
 Apply oil before giving bath to the baby.
 The baby is given by the trained birth
attendant/health workers or a nurse
depending upon the situation.
 The bath is given with soap and warm water to
remove the meconium and blood clots.
 In winter the repeat bath can be postponed
by 2-3 days.
7. Breast feeding :
 Breast feeding helps in mother child bonding
and in establishing feeding.
 The baby should be feed on demand.

43. 8. Under five clinic :
Care in
illness
Growth
monitor
ing
Family
plannin
g
Prevent
ive
care

44.  Postnatal visits and care :
 1st visit : within 24 hrs.
 2nd visit : 5th or 6th day.
 3rd visit : 10th day.
 4th visit : 2nd to 4th week.
 5th visit : 6th to 8th week.

45.  CHILD CARE :

46.  Child age period :
 Infant : up to 1 year
1. Neonatal period ( first 28 day life)
2. Post neonatal period (28th – 1 year)
 Preschool age : 1 – 4 year
 School age : 5 – 14 year

47.  Neonatal care and objectives :
1. Establishment and maintenance of
cardiorespiratory function.
2. Maintenance of body temperature.
3. Avoidance of infection.
4. Establishment of satisfactory feeding
regimen.
5. Early detection and treatment of
congenital and acquired disorders
especially infections.

48.  Key elements in child survival
programme :
 G : Growth monitoring
 O : Oral rehydration
 B : Breast feeding
 I : Immunization
 F : Female education
 F : Food supplementation
 F : Family planning

49. MAJOR
CHILD
HEALTH
PROBLRMS
ACCIDEN
TS AND
POISIONI
NG
INFECTIO
N AND
PARASITES
MALNUTRI
TION
LOW
BIRTH
WEIGHT
BABY
BEHAVIOR
AL
PROBLEM

50.  High risk babies :
1. Birth weight less than 2.5 kg.
2. Twins.
3. Birth order 5 or more.
4. Artificial feeding.
5. Weight below 70% of the expected weight.
6. Children with PEM, diarrhoea.
7. Working mother /single parents.
8. Failure of gaining weight during 3
successive months.

51.  Assessing the neonate ( Low birth weight
babies )
 LBW : Below 2500 grams.
 PRETERM : Mostly born before week 38
 Small for date neonates

52.  Growth of child :
 Growth of the child refers to increase in size
of the body which is measured in terms of
body weight, height, head, arm and chest
circumference.
 These measure are called
“ANTHROPOMETRIC” measurements.

53. MATERNAL AND CHILD
HEALTH PROGRAMME :

54.  Activity :
 Complete health check-up and care of the
child and mothers from conception to birth.
 Studying health problems of mothers and
children.
 Providing health education to parents for
taking care of children.
 Training to professional and assistant workers.

55.  Need for MCH programme :
1. Mother and child below the age of 15 years
make up the majority of population in almost
countries.
2. Mother and children constitute a ‘special risk’ or
vulnerable group in the case of illness deaths, in
the terms of pregnancy , child birth of mother
and growth and development in the case of
children.
3. By improving the health of mother and children
we can improve the health of the family and
community.
4. Ensuring child survival is a future investment for
the family and community.

56.  Indicator :
1. Maternal mortality rate below 1 (for every
1000 live births)
2. Infants mortality rate below 30 (for every
1000 live births)
3. Death rate of 1-4 year old age group
below 10
4. Size of family 2-3 membrane
5. Perinatal mortality rate 30-35
6. Weight of minimum 90% of total children
according to height / weight chart.

57.  Recent trends :
A. Integration of care :
 Earlier maternal and child health care services
were divided into antenatal, child care and
family planning.
B. Risk approach :
 This new thought was born from the lack of
resources and their availability.
C. Man power changes :
 According to new concept, maternal and
child health, service should be left to
traditional health workers rather than

58. specialist of field and child volunteers and
workers of NGOs.
D. Primary health care :
 It makes available information about
protection and protection and resources for
mother and child health care.
E. Reproductive and child health :
 As per the decision taken in world women
conference, maternal and child health
services have been included in
reproductive and child health services.

59.  Organization activities of MCH
services :
 Complete health check-up and care of the
child and mother from conception to birth.
 Styding the health problem of mothers and
child.
 Providing health education to parents for
taking care of children.
 Training to professionals and assistant
workers.

60.  Responsibility of community
health nurse in MCH services :
1. Direct care :
• Antenatal care
• Intranatal care
• Postnatal care
• Neonatal care
• Home visits
• Antenatal check up
• Anatomy, physiology and psychology of
pregnancy

61. • Diet during pregnancy
• Plans of delivery
• Neonatal care
• Family planning
2. Managerial function :
• Playing the role of liaison officer under
referral system, for sending the mother to
hospital for safe delivery.
• Taking part in community activities.
• Explaining the importance of reproductive
and child health in community.
• Organizing and managing maternal clinics.

62. • Coordinating between the doctor, family
and patients.
• Storing and maintaining the records of
maternal and child health services.
• Assisting the research work in the field of
maternal and child health services.
3. Educational functions :
• Provide health education to mother and
family either individually or in the group.
• Community health nurse has a multifaceted
role in maternal services.
• It is only through proper discharge maternal
and infant mortality can be reduced to
targeted rate.

63. SUMMARY

64. ANY QUESTION