Clinical/ Antenatal/Post Natal Health Care for mothers within Reproductive Health Age By Mrs Susana Larbi Wumbee Deputy Director Nursing Services Institutional Care Division GHS Headquarters

No Woman Should Die Giving Life

Outline of Presentation Introduction Pre-Pregnant Care Antenatal Care Intra Delivery Care Post Natal Care Normal Delivery Maternal Mortality Way forward Conclusion

Introduction Preparing the woman for child birth starts from infancy through the pubertal years to pregnancy and post natal care. Issues of Good diet , counseling on the choice of a partner to rule out genetic complications and education on pregnancy, delivery and post natal care all come into play. The need to access the assistance of the health care provider becomes crucial in this developmental/reproductive stage of life.

Clinical or Pre-pregnant state Child Hood The girl child must be given proper diet and taught how to keep up her posture to avoid any deformities especially the spine and pelvis bones that may cause obstructed labour in future Puberty Educate on personal cleanliness and the consequences of sexual immorality

Pre Pregnant stage (Cont) Preparation for Marriage: Counseling on diseases in the family such as sickle cell anemia, diabetes, schizophrenia etc, Preparation for pregnancy Visit to the doctor or midwife for assessment Treat every infection Take a nutritious diet Avoid smoking, alcohol and poor mental health

Antenatal care Pregnancy is typically a time of joy and anticipation, it can also be a time of concern and anxiety. Pregnant women should attend antenatal clinic at least four times or visits before delivery It is important for the assessment and monitoring of the mother and baby in terms of their health, growth of the baby, safe delivery and prevention of complications

Antenatal Care Assessment include: History taking General Examination –Physical, Obstetric Laboratory investigation Medications - TT, SP Schedule of visits Education on pregnancy and preparation for birth and motherhood

Intra Partum Care Signs of onset of labour Diet during labour Pain control during labour Examination and monitoring of labour Emotional support

Post Natal Care Initial and subsequent care of mother and baby Breast feeding Care of the Cord Immunizations Nutrition and prevention of infection Family Planning

Normal Delivery Important for the life of mother and baby Mother, family and friends are happy Involves the maintenance of the health of mother and baby Counseling for Family planning for birth spacing Assure uneventful subsequent deliveries In the long term -- Increase the productive labour force of the country

Maternal and Mortality “Women are not dying because of diseases that we cannot treat. they are dying because societies have yet to make the decision that their lives are worth saving.” Prof. Mahmoud Fathalla, 1997

What needs to be done is well known Prevention of pregnancy: Family Planning Prevention of complications: Skilled Care at Delivery Prevention of death by timely management of life-threatening complications: Emergency Obstetric Care Management of abortion and post abortion care

Family Planning A woman has the right to decide if and when she becomes pregnant 30% of maternal deaths could be prevented with family planning Full citation: Non-Use and Use of Ineffective Methods of Contraception,” in Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, ed. Majid Ezzati et al. (Geneva: World Health Organization, 2004): 1255-1320. Session 2 Source: Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, ed. Majid Ezzati et al. (Geneva: World Health Organization, 2004)

Skilled Care Ideally every woman should have a Skilled Birth Attendant (SBA) during the continuum of care SBA: midwifery skills or more, i.e. they attend normal deliveries, recognize complications and treat or refer For many years to come some countries will not have enough SBAs for all women

Emergency Obstetric Care Approximately 15% of pregnant women develop complications Most maternal deaths are caused by direct obstetric complications that can be treated Many direct obstetric complications cannot be predicted or prevented which is why it is important for faciltites to offer EmOC services Session 2

Other Maternal Mortality Reduction (MMR) Strategies Safe abortion and post-abortion care (PAC) PAC is treatment of all abortions and miscarriages + counseling and provision of contraception + referral for other reproductive health needs Abortion as a cause of maternal mortality is highly preventable Focused antenatal care Session 2

Wrap up Improving the health of women in the reproductive age for safe delivery and Reducing maternal mortality is possible What needs to be done to save lives is well-known Equity of coverage to quality maternity services is key Reducing maternal mortality is a collective responsibility

Responsibility for action involves diverse groups 4/13/2017 Responsibility for action involves diverse groups Media Individuals, households, community, Advocates, civil society, NGOs, parliamentarians Research institutions Health Workers Funders Government

Nothing is Impossible

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