antenatal care: counseling sba - presentation 3 (c i) maternal health division ministry of health...

Antenatal Care: Counseling

SBA - Presentation 3 (c i)

Maternal Health DivisionMinistry of Health & Family Welfare

Government of India

Antenatal Care: Counseling 2


Session objectives

To demonstrate how to counsel a pregnant woman – for birth preparedness

– against sex selective abortion

– on complication readiness

– on diet, rest, breastfeeding, sex during pregnancy, domestic violence and contraception

– Benefits under JSY



Pre-requisites for counseling

• Ensure privacy

• Maintain confidentiality

• Treat the woman with respect



Birth preparedness• Registration

• Identification of place of birth and a skilled birth attendant

• Encourage institutional delivery

• Locate nearest functional FRU/ 24x7 PHC for referral

• Identify and arrange for transport

• Identify support people

• Identification of blood donors if required



Preparedness for home delivery• Explain that home delivery may be risky and

potentially life threatening

If she still insists on home delivery• Help identify SBA for delivery• Arrange disposable delivery kit (DDK) • Explain and counsel to maintain 6 cleans

Clean surface Clean cord cutClean cord tie Clean umbilical stumpClean hands Clean perineum

Encourage every woman for an institutional delivery



Items required for home delivery• Antenatal case record• Clean towels/ cloth for drying and wrapping

the baby• Clean clothes washed and sun dried for the

mother and the baby• Sanitary pads/clean cloth for the mother• Food and water for the mother and support

person



Against sex selective abortion•Child sex ratio in India is 914 females per 1000 males (Census 2011)•Male preference in the society leads to gender discrimination at birth•PCPNDT Act was enforced in 1994 in India

– To prohibit sex selection, before or after conception

– To regulate pre-natal diagnostic techniques for the purposes of detecting genetic abnormalities

– To prevent its misuse for sex determination leading to female foeticide



Complication readiness• Recognizing signs of labor

• Awareness and recognition of danger signs during pregnancy, delivery and postpartum period

• Identification of nearest functional FRU / PHC

• Identification of transportation facilities



Recognizing signs of labor• A bloody sticky vaginal discharge (show)• Painful abdominal contractions every 20 min

or less

Advise the woman to go to a health facility or contact a SBA if she has any of the above signs


What is the importance of dietary counseling?

Requires extra calories for• Maintenance of her health • Growing fetus• Lactation

How much more calories are required?• Needs about

– 300 extra kcal / day during pregnancy– 500 extra kcal / day during lactation


Counseling: DietWhat food items should the diet include?

• Foods rich in proteins, iron, vitamins, calcium micronutrients and fiber

• Should include items like cereals, milk and milk products, green leafy vegetables, pulses, eggs, meat, fish, nuts, fruits, jaggery etc

• Tea or coffee within 1 hr of meal should be avoided and foods rich in proteins and vitamin C (lemon juice, amla, orange juice etc) should be taken for better absorption of iron


Counseling: Diet

Which category of pregnant women need

additional nutrition?• Underweight women (<45 Kg)• Women with increased physical activity • Pregnant adolescents• Pregnancy during lactation• Pregnancy with in 2 years of previous delivery• Multiple pregnancy


Counseling: Diet

• Advise diet keeping in mind– Socioeconomic status – Food habits– Seasonally available food– Taste of the pregnant woman

• Advise against any food taboo

• Encourage woman with hypertension to have normal diet


Counseling: Rest

Pregnant woman should be advised to

• sleep for 8 hrs at night and 2 hrs in day• refrain from doing heavy work • take rest in left lateral position to increase

blood supply to baby

Encourage her family members to help her in

routine household chores


Counseling

Advise her

• To refrain from alcohol, tobacco, smoking or addictive drugs like opium during pregnancy and after delivery

• Not to take any medication unless prescribed by a qualified health practitioner


Counseling: Sex during pregnancy

• Sex is safe in uncomplicated pregnancy

• Should be avoided if

– Risk of abortion

– Risk of preterm labor

– H/O APH or PROM

• Sexual desire of the woman may decline during pregnancy

• Husband should ensure the comfort of the woman

• Advise use of condoms while having sex


Counseling: Domestic violence

• In India 39.7% of ever married women have suffered from either physical and or sexual violence ( NFHS 3 )

• Domestic abuse and violence against pregnant women has immediate and long term adverse effects on the mother and the fetus

• Blunt trauma to the abdomen can cause placental separation, uterine rupture, miscarriage / stillbirth, preterm labor and PROM


Counseling: Breast feeding

Ideal time to counsel the pregnant woman regarding the benefits of breast feeding

Emphasize the following:• Initiation of breast feeding within 1 hr of birth • No prelacteal feeds• Demand feeding• Importance of rooming in (Keeping mother

and baby together)

• Exclusive breast feeding for 6 months


Counseling: Contraception

• Pregnancy is the best time to counsel the couple for contraception

• Explain that if the woman is not exclusively breastfeeding she can become pregnant as early as six weeks after delivery

• Advise abstinence for 6 weeks postpartum or longer if perineal wounds have not healed

• Advise the couple to delay next pregnancy by 3-5 yrs


Counseling: Contraception

Available contraceptive methods • Lactational amenorrhea method (LAM)• Barrier method: Condoms• Intrauterine contraceptive device (IUCD)• Contraceptive pill (COCs)• Depot medroxy progestrone acetate

(DMPA)• Emergency contraceptive pill (ECP)• Female/ Male sterilization (FS, MS)


900200700HPS

1200200100020006001400LPS

TotalPackage toASHA

Assistancepackage tomother

TotalPackage toASHA

Assistancepackage tomother

Urban areaRural areaCategoryof state

• Gives cash incentives for pregnant women to seek an institutional birth.

• To reduce IMR and MMR by promoting Institutional delivery• Launched in 2005 in rural area , in 2006 BPL women in urban area

and SC/ST women irrespective of BPL card are also included• Cash incentives as following

Benefits under JSY

600 200 800

700 600 1300 600 200 800HPS (tribal area)


Thank you

antenatal care: counseling sba - presentation 3 (c i) maternal health division ministry of health...

Documents

antenatal care

institutional delivery

lactation slide

jsy slide

respect slide

home delivery help

support person slide

female foeticide slide