1. Primary Health Care Nursing (NUR 473)
MATERNAL AND INFANT HEALTH CARE IN PRIMARY HEALTH CARE SETTING
Lecture 9

2. Objectives of maternal –infant and child health care program:
Objectives of maternal –infant and child health care program:
Ensure that every expected and nursing mother maintains good health, has a normal delivery, bears healthy children and learns the art of child care
Conduct activities for the health promotion of children from birth to 6 years of age

3. Services offered by primary health center to mothers and infant:
Pre-marital care and counseling
Maternity care
Infant and preschool child care
Family planning
Health education
Social care

4. Importance of pre-marital care:
PRE-MARTIAL CARE
Importance of pre-marital care:
Early detection of health problems, better chance to treatment
Providing guidance, preparation for marriage , family education , training in the art of children rearing and family planning
Prevention of health problems for the couple and their future children

5. The goal of the premarital care is to:
Promote the health of the future parents
Prevent health hazards and to have healthy future generations.
Give education about health care before marriage
Implement medical consultation for those who are not of a legal age to marry, or who have severe genetic diseases, psychiatric diseases and certain infectious diseases
Perform physical exams, including radiological exams, screening for diseases of the renal, reproductive, and metabolic systems, and screening for sexually transmitted diseases.

6. Components of Premarital Care
Premarital Counseling
Premarital examination
Premarital immunization
Genetic counseling
Premarital education

7. Premarital Counseling
Is a communication process in which the counselor (nurse) tries to provide a couple with complete and accurate information about the responsibilities of marriage
Topics in counseling includes sexuality, sexual health and sexual problems, the family planning concept, the befits of different methods of family planning
The benefits of premarital counseling:
It can reduce the risk of divorce by up to thirty percent
It can lead to a significantly happier marriage
It can help reduce the stress of planning a wedding

8. Premarital Counseling
The role of the nurse premarital counseling
Prepare a proper atmosphere for counseling
Ensures privacy of the client
Assess the health needs of the couple
Take a complete history of the couple
Helps them to understand several topics including family planning, conception, etc.
Help the future couple to make decisions about their future lives and their marriage

9. B. Premarital Examination
History taking should include:
Personal history; as name, age, occupation, education & address, religion
Menstrual history
Medical history
2. Physical examination:
Complete physical examination including: heart and chest examination, pelvic measurement to detect contracted of deformed pelvis
3. Laboratory examination:
Complete blood counts , hematocrit , hemoglobin and platelet counts .
Antibody test to detect Human Immunodeficiency Virus (HIV).
Urine analysis for sugar and albumin to exclude D.M or kidney diseases.
Analysis of the man's seminal fluid to determine its speed , morphology , volume and number of sperms for early detection and intervention in case of infertility.
Chest x-ray to exclude pulmonary T.B

10. C. Premarital Immunization
Such as:
MMR
Tetanus
Hepatitis
D. Genetic Counseling
Genetic counseling is the process of:
Evaluating family history and medical records
Ordering genetic tests
Evaluating the results of this investigation
Helping parents understand and reach decisions about what to do next

11. E. Premarital education
Premarital education used to guide and prepare couples for marriage
The following areas of health education should emphasize on:
Parent’s health
Nutrition
Safe environment
Role of father
Role of mother
Child rearing
Sex education
Family planning

12. Antenatal Care in Primary Health Care Centers
Antenatal care is the care giving to pregnant women in primary health centers to maintain their mental and physical fitness
Objectives of antenatal care:
To maintain the mother and her fetus health
To prepare the mother for labor and subsequent care of her child
To early detect and appropriate treatment of high risk conditions
To reduce of maternal and infant mortality, stillbirths and prematurely
Increase the number of breast fed babies

13. Antenatal Care in Primary Health Care Centers
Schedule of antenatal visits:
The total visits during pregnancy are 12 to 15 visits in normal as follows:
One visit every month until the 6th months of pregnancy
One visit every two weeks during 7th and 8th months of pregnancy
One visit every week during the 9th month of pregnancy

14. Antenatal Care in Primary Health Care Centers
Anti natal care during initial visit:
A. History taken including
Social history: family members
Family history: any genetic diseases, hypertension DM, TB, heart disease
Medical history: past illness HD, DM, TB, venereal diseases
Menstrual history: LMP, EDD, Menarche, any disorders or irregularities
Obstetric history : gravidity , parity , and complications for mother of baby

15. Antenatal Care in Primary Health Care Centers
B. General physical examination concentrated on
Extremities are examined for varicose veins and edema
Blood pressure: should be 120/80 or less and not above 140/90
Body weight and height: weight should be recorded in the first visit
Obstetric examination: For breast and abdomen (fundal height, fetal lie, presentation and fetal heart sound should be assessed accurately)

16. Antenatal Care in Primary Health Care Centers
C. Laboratory investigation :
Urine analysis for glucoses and albumin
Blood group is determined because of the risk of hemorrhage
Hemoglobin: if HB is below 12.9g: iron , folic acid and vitamins B&C are prescribed .
Screening for AID’s and Hepatitis C

17. 3. Post Partum Care
The first six weeks after birth – is critical to the health and survival of a mother and her newborn.
Schedule of home visits for post partum care by nurse or midwife or community health nurse:
1st day of post partum,
3rd day of postpartum,
7th day of post partum,
40th day of post partum

18. 3. Post Partum Care Objectives of post partum care:
To help women to resume physical and mental health
Detect and arrange proper management and follow up obstetric injuries, heath problems, and pregnancy associated complication, as well as treat reproductive tract infection
Examine the newborn for early detection of congenital malformation, handicapping condition and jaundice.
Provide health education and guidance for the mother regarding hygiene, nutrition, child-care, breast feeding, immunization, birth spacing and family planning methods.