LEARNING OBJECTIVE

At the end of the 2 hr session the mother will be able to: 1. Understand the importance of prenatal care 2. To understand what to expect during pregnancy 3. Enumerate the ways on how to stay healthy 4. Discuss why prenatal check up is needed 5. Enumerate the danger signs of pregnancy 6. State self care tips during pregnancy 7. State ways to ease the discomforts of pregnancy

TOPICS
Prenatal Care: y Introduction y When is pregnancy suspected y A healthy pregnant mother y Why is prenatal check up needed y Danger signs of pregnancy y Self care during pregnancy y Practical ways to ease the discomfort of pregnancy

TEACHING METHOD

INSTRUCTIONAL MEDIA

Discussion

y Pamphlets y Powerpoint presentation

Introduction
Prenatal care should begin the moment the mother suspects she may be pregnant and certainly as soon as pregnancy is confirmed. The primary reason for this is as obvious as it is important: the embryo starts developing immediately and within days after fertilization, it implants itself in the uterus. There, rapidly dividing cells soon protect and nourish it with a vascular organ known as the placenta and a sac filled with a watery, cushioning liquid known as amniotic fluid. Fundamental body systems are already forming, and by the third week a rather primitive heartbeat can be detected. By the second month human features are distinguishable, although it is not until the third month that the embryo is designated a fetus. At this time the baby s sex can be identified. During this period of rapid development the mother is aware she is pregnant part of it even before

many factors can adversely affect the formation of an

unborn child and the health of its mother, among them, drugs, poor nutrition, infections and other disorders. Thus, early prenatal care is essential. Once the pregnancy is confirmed, it is important to decide where you will have your baby and who will look after you. Regular monthly visits to your doctor will be essential until about your 32nd week of pregnancy, and rather more frequently after that.

PREGNANCY IS SUSPECTED WHEN: 1. The woman misses her menstrual period 2. In the morning, she feels like vomiting 3. She urinates more often 4. Her breasts get bigger 5. Her belly gets bigger 6. Her armpits, belly and the nipples become darker 7. The baby starts to move on the fifth month of pregnancy REMEMBER: y y y A pregnant woman should stay healthy during and after pregnancy A well fed mother will have a strong and healthy baby A poorly fed mother will have a pale and weak baby

A HEALTHY PREGNANT MOTHER: 1. Eats enough to gain weight regularly. Drinks 8 or more glasses of water a day Eats nutritious food A pregnant woman should have gained: 1 kilogram within the first 3 months of pregnancy 5 kilograms within the second 3 months of pregnancy 5 kilograms within the last 3 months of pregnancy 2. Takes a bath everyday. 3. Visits the Health Center for her regular monthly prenatal check ups. 4. Has received 2 shots of tetanus toxoid during her pregnancy. 5. Does not smoke nor drink alcohol. 6. Stays away from smoking persons. 7. Stays away from sick persons. 8. Rests more and does less work than usual. 9. Takes food rich in calcium everyday. PRENATAL CHECK UP IS NEEDED: 1. To check the health condition of both the mother and the baby. 2. To detect early problems that is likely to arise during pregnancy. 3. To check baby s growth and position in the womb. 4. To immunize the mother against tetanus.

Pregnant mothers with any of the following risk factors have a higher change of encountering problems during pregnancy and delivery: 1. She is less than 17 years old or more than 35 years old. 2. She has more than four children. 3. She had severe bleeding from the vagina during her previous pregnancy. 4. She does not have a good history in her previous pregnancies like: y y y y y Two or more abortions Difficult delivery 2 or more babies born before the expected delivery Given birth to twins Last baby was born dead or died soon after birth

5. She previously delivered by C section 6. Her last baby was born less than 2 years ago 7. She weighs less than 45 kg or more than 80 kg. 8. She is very pale and looks tired. 9. She has TB, diabetes, heart / or kidney disease. THE SIGNS OF A DANGEROUS PREGNANCY ARE: 1. The presence of any of the following: y y y y y y y y Blurring of vision Convulsion Severe vomiting Severe headache Swelling of face, hands and legs Sudden weight gain Stomach pain Marked increase in blood pressure

2. Severe anemia y Too pale or too weak to work

3. Vaginal bleeding or spotting 4. Signs of labor before the 9th month of pregnancy: y y y y Rupture of bag of water Frequent abdominal contraction Bloody discharge Increasing abdominal pain

5. Non movement of the baby in the womb

SELF CARE DURING PREGNANCY 1. Eat more nutritious food during pregnancy and lactation. 2. Avoid taking medicine unless prescribed by the doctor. 3. Space pregnancy at least 2 yrs apart. 4. DO NOT smoke and avoid second hand smoke. 5. DO NOT drink alcohol beverages and DO NOT expose yourself to harmful chemicals like pesticides and fertilizers. 6. Avoid strenuous activities and take a nap in the middle of the day. 7. The couple may have sexual relations during pregnancy unless there is a history of preterm labor or if it causes pain. PRACTICAL WAYS TO EASE THE DISCOMFORTS OF PREGNANCY y Morning sickness / nausea ad vomiting y Eat small, frequent meals Eat small serving of bread, biscuit or rice immediately after waking up Take small sips of water

Constipation Increase usual fluid intake from 6 to 8 glasses to 10 to 12 glasses / day Eat lots of vegetables, fruits and nuts Do regular exercise such as walking

Haemorrhoids Avoid long periods of sitting Avoid constipation Avoid straining during bowel movements Bath the perineum with warm water twice a day Replace the haemorrhoid with a finger after passing stool

Heartburn or indigestion Eat small, frequent meals Avoid spicy or greasy foods Avoid lying down right after eating

For leg cramps Keep legs propped up when sitting If leg cramps occur, straighten knee and bend foot towards the leg or stand up on the cramping leg Massage legs lightly

LEARNING OBJECTIVES

TOPICS

TEACHING METHOD

INSTRUCTIONAL MEDIA

At the end of the 2 mother will be able to:

hr session, the Post natal care: 1. Introduction 2. Care of the mother after delivery 3. How to take care of the newborn baby 4. How to care for the cord 5. Danger signs after delivery 6. Danger signs in the newborn 7. Why breast milk is the best 8. Breast feeding problems 9. How to manage breast feeding y y y Discussion Return demo of cord care Return demo of expressing breast milk

y y y

Flip charts Power point presentation Audio visual procedures

1. State the measures on how to care for herself after delivery 2. State how to take care of her new born baby 3. State the measures on how to prevent cord infection 4. Enumerate the danger signs after delivery 5. Enumerate the danger signs of her baby 6. State the importance of breast milk 7. Discuss on what to do if the nipples become sore 8. Discuss when immunization is given to her and her baby

problems 10. When immunization is received

INTRODUCTION After delivery, the mother can expect to have some symptoms, but they are usually mild and temporary. Complications are rare. Nonetheless, the doctor, hospital staff members, or health care plan usually sets up a home visit or close follow up program. The most common

complications are excessive bleeding, bladder, kidney, or breast infections; problems with breast feeding and depression. Postpartum haemorrhage may occur soon after delivery but may occur as late as 1 month afterward. Immediately after delivery, the woman s temperature often increases. A temperature of 1010F (38.30C) or higher during the first 12 hours after delivery could indicate an infection but usually does not. Nonetheless, in such cases, the woman should be evaluated by her doctor or midwife. A postpartum infection is usually diagnosed after 24 hours have passed since delivery and the woman has had a temperature of 100.40F (380C) or higher on two occasions at least 6 hours apart. Postpartum infections are rare, because doctors try to prevent or treat conditions that can lead to infections. A breast infection can occur after delivery, usually during the first 6 weeks and almost always in women who are breastfeeding. If the skin of on around the nipples becomes cracked, bacteria from the skin can enter the milk ducts and cause an infection. An infected breast usually appears red and swollen and feels warm and tender. The woman may have a fever. A fever that develops later than 10 days after delivery is often caused by a breast infection.

CARE OF THE MOTHER AFTER DELIVERY A mother who has just given birth should: 1. Take a bath daily. 2. Gently massage the breasts towards the nipples to prevent or lessen breast swelling and increase milk flow. 3. Get enough rest and do less heavy work. 4. Breast feed right after birth. 5. Clean the breast with warm water after breast feeding. 6. Eat healthy food to produce more breast milk. TO TAKE CARE OF THE NEWBORN BABY 1. Breastfeed the baby right after birth. 2. Give sponge bath daily. After the cord drops off, give baths daily. 3. Keep the baby warm enough. 4. Protect the baby from flies and mosquitoes. 5. Keep the baby in a clean place. 6. Keep the baby away from sick persons. 7. Bring the baby to the Health Center for Immunization against the 6 common childhood disease. CARE OF THE CORD 1. Wash hands with soap and water before and after cord care. 2. DO NOT apply dust, powder, herbs, medicine or anything to the stump. 3. Keep stump loosely covered with clean clothes. Do not bandage stump or abdomen. 4. Fold cloth / diaper below stump. 5. If stump is soiled, wash it with clean water and soap and pat dry with a clean cloth. 6. The cord stump will come off by itself. DO NOT pull. It can cause bleeding and will invite infection. 7. Avoid touching the stump unnecessarily. 8. See a health professional immediately if stump is red or draining pus or blood. A lot of changes occur in the mother s body during the first few weeks after giving birth. It is at this time that complications of delivery usually happen. WATCH FOR: 1. Unconscious / convulsing 2. Vaginal bleeding 3. Severe abdominal pain 4. Looks very ill

5. Severe headache with visual disturbance 6. Severe breathing difficulty 7. High fever 8. Severe vomiting 9. Breasts swollen, red or tender breasts or sore nipple 10. Urine dribbling or pain in urination 11. Pain in the perineum or draining pus 12. Foul smelling vaginal discharge DANGER SIGNS IN THE NEWBORN 1. Fast breathing (more than 60 bpm) 2. Slow breathing (less than 60 bpm) 3. Severe chest indrawing 4. Grunting 5. Convulsions 6. Floppy or stiff 7. Fever >38oC 8. Temperature <35oC or not rising after rewarming 9. Umbilicus draining pus or umbilical redness extending to skin 10. Bleeding from stump or cut 11. Pallor 12. Cyanosis of lips and mucus membranes 13. Apnea, not breathing BREAST FEEDING y y Mother s milk is the best food a baby can have in the first 6 months of life. Breastfeed as often as your baby wants, day and night. Breastfeeding per baby s demand ensures that he / she gets sufficient nutrients This is the best stimulus for continued milk production

WHY BREAST MILK IS BEST 1. It helps protect the baby against: Diarrhea Cough / colds Malnutrition Other common illness

2. There is no need to prepare breast milk 3. It is always available at no cost 4. It helps babies grow up with close bond to their mother

5. It is easy to digest 6. It is clean and has the right temperature REMEMBER y y Breastfeeding should start within 30 mins after birth Give colostrums to your baby y y y y It prepares your baby s stomach to digest milk It contains many protective substances against infection It does not cause tummy ache or diarrhea

When the baby is 6 moths old, start giving other food in addition to breastmilk Continue to breastfeed sick babies A sick mother can still breastfeed her baby Breastfeeding mothers should eat nutritious food to become stronger

SOME BREASTFEEDING PROBLEMS y Sore nipples y This is common in mothers who have short nipples This may develop when the baby bites on the nipple

Prevention In women with short or inverted nipples, squeeze the nipples several times a day

WHAT TO DO 1. Use both hands. Start at the base of the breast. 2. Then move your hands toward the nipple, squeezing the milk out of the nipple. 3. Place the breast milk in sterilized container. 4. Give it to baby using spoon or dropper. FOR WORKING MOTHERS This is how to store breast milk to be used for subsequent feedings: 1. Milk the breast by hand before going to work when the breast is full. 2. Place milk in a sterilized container. 3. Store in a cool place. 4. Give breast milk within 24 hours. IMMUNIZATION y y y Immunization protects the body against possible attack by germs. Vaccines work by building up the person s defences. Vaccines can prevent the 6 very dangerous diseases that can cause death Tuberculosis BCG vaccine

Polio OPV vaccine Measles anti measles vaccine Diphtheria DPT vaccine Pertussis DPT vaccine Tetanus DPT vaccine

Who needs to be immunized? All children under 1 yr old All pregnant women All women of childbearing age (14 44 yrs old) Other children, especially those less than 2 yrs old with incomplete immunization

When to immunize

1. Immunization schedule for infants / children y y y y y BCG birth or anytime after birth (injection) DPT 1 , 2 , and 3 months (injection) OPV 1 , 2 , and 3 months (polio drops) Measles 9 months (injection); a booster dose must be given at 12 months All immunizations should be completed before the child reaches 1 yr old

2. Immunization schedule of tetanus toxoid for pregnant women y y y y y First shot as soon as pregnancy is known Second shot 1 month after first shot but not on the last month of expected delivery Third shot 6 months after the second shot Fourth shot 1 year after the third shot Fifth shot 1 year after the fourth shot

LEARNING OBJECTIVES

TOPICS

TEACHING METHOD

INSTRUCTIONAL MEDIA

At the end of the 2 mother will be able to:

hr session, the Nutritional Anemias: 1. Introduction 2. What are the causes

y Discussion y Brain storming and y Question and answer portion y Puzzle games

y y

Flip chart Audio visual presentation

1. Understand the nature of anemia 2. Define anemia 3. Enumerate the different kinds of anemia 4. Discuss the effects of anemia to her pregnancy 5. Enumerate how anemia can be diagnosed through lab tests 6. Discuss how to prevent anemia 7. Enumerate the different kinds of foods rich in iron 8. Discuss how iron works in our body 9. Explain how to take complete iron during pregnancy 10. State the significance of iron and its effects

consequences of IDA 3. What is Folate deficiency anemia 4. How is IDA diagnosed 5. How anemia 6. What is iron, its functions and sources to control nutritional

INTRODUCTION Nutritional anaemia is the condition that results when the erythropoetic (red blood cell forming) tissue is unable to maintain a normal haemoglobin concentration because of an inadequate supply of one or more essential nutrients. There is a range of haemoglobin values among both healthy and anaemic populations and these overlap to some extent. Thus it is difficult to define precisely a haemoglobin cut off level below which an individual can be said to be anaemic. There are two types of nutritional anaemia: 1. Hypochromic microcytic anaemia caused by iron deficiency 2. Megalobastic anaemia due usually to folate or less than vit. B12 deficiency Nutritional anaemia is a problem to some extent in every country or area in the Region although most prevalent in the developing areas. Pregnant women and toddlers are the main groups affected. Iron deficiency is the most common cause but folate deficiency is also common among pregnant and lactating women. Infections, such as hookworm and malaria, are associated causes in many cases. Vit. B12 deficiency appears to be rare.

WHAT IS IRON DEFICIENCY ANAEMIA? 1. Iron deficiency anaemia is a condition in which there is not enough haemoglobin in the red blood cells because of lack of iron. There are many other cause of anaemia, but iron deficiency is the most important and most widespread. 2. There are four major causes of IDA: a. Low intake of iron rich foods especially the more absorbable iron from foods of animal origin. b. Blood loss. This may be due to any of the following: Hookworm infestation (most common cause of chronic blood loss) that causes bleeding in the large intestine which may go unnoticed Menstruation that is heavier and longer than usual Blood loss during child delivery

c. Poor absorption of iron. This may be due to any of the following: Dietary sources of iron are predominantly plants (the less absorbable iron) Lack of iron absorption enhancers in the diet Excessive intake of inhibitors of iron absorption

d. Increased demand during certain stages of life Iron is needed especially by babies, preschoolers, adolescents and pregnant and lactating women. Therefore those in these age groups and physiologic status are most prone to IDA. Infants, preschoolers and adolescents have extra demand for iron for growth Pregnant women need more iron to supply the growing foetus and the enlarging placenta as well as their own increased blood formation in preparation for delivery Lactating women need more iron because some iron goes to breast milk

CONSEQUENCES OF IDA a. Low birth weight babies Pregnant women who are anaemic often give birth to underweight babies. Low birth weight babies easily get sick and suffer from malnutrition as they grow older. b. Pregnant women and young children have low resistance to infection c. School children have poor scholastic performance d. Decreased physical work and community earning capacity FOLATE DEFICIENCY ANAEMIA Folate deficiency is due to low dietary intake (associated with artificial feeding, poverty, prolonged cooking) or increased requirements (as in premature infants and pregnancy and lactation). Pregnancy and lactation are probably the commonest causes of folate deficiency in the Region. Folates are widely distributed in meat, dairy products, vegetables, fruits and cereals but tend to be destroyed by cooking.

HOW IS IRON DEFICIENCY ANAEMIA DIAGNOSED 1. Biochemical or laboratory. Anaemia is best diagnosed by measuring the amount of haemoglobin in the blood. According to the WHO standards, the minimum amount of haemoglobin should be: AGE Group / Physiological Status Children 6 months to 6 yrs old Children 6 14 yrs old Adult males Adult females (not pregnant) Pregnant females Hb levels 11 gms / dl 12 gms / dl 13 gms / dl 12 gms / dl 11 gms / dl

2. Stain a film of peripheral blood In iron deficiency anaemia the red cells are hypochromic (pale) and microcytic (smaller than normal). In folate or vit. B12 deficiency anaemia the red cells are fewer and macrocytic (larger than normal). In severe cases there may be immature nucleated red cells known as megeloblasts. While cells may be reduced in number. 3. Perform where possible the ff. Tests to diagnose or confirm the cause of anemia. a. Iron deficiency. Abnormal levels of serum ferritin, serum iron, percentage transferring saturation and erythrocyte protoporphyrin will be present b. Folate or B12 deficiency. There will be low levels of these vit. In the serum or red cells c. Tests for other causes of anaemia such as hookworm, malaria, chronic infection, chronic malnutrition or internal bleeding 4. Clinical a. Clinical signs are only useful if anaemia is severe. It is possible that the haemoglobin levels are already low yet the patient may not show pallor y y y y Pale skin Pale conjunctiva Pale buccal mucosa Pale palm / nailbed

b. Symptoms. People suffering from anaemia may complain of: y y y y y y Weakness Easily getting tired Dizziness Lack of concentration Lack of appetite Lack of sleep

CONTROL OF NUTRITIONAL ANAEMIA There are two principal forms of direct intervention: 1. Supplementation is the only way to treat severely anaemic individuals especially pregnant women who where the aim must be to improve haemoglobin levels before delivery. For pregnant women in the latter part of pregnancy it is suggested that supplements supplying 100 120 mcg folic acid are taken twice daily. Ideally supplements should be taken

between meals to encourage maximum absorption. 2. Food fortification the fortification of food with iron holds the most promise for alleviating

the iron deficiency problem. However there are many technical problems to be overcome before this becomes practical, the principal one being the identification of an iron compound that does not affect the colour, taste or texture of the vehicle food and yet is well absorbed when consumed as a constituent of the regular diet. WHAT IS IRON ITS FUNCTIONS AND SOURCES 1. Iron is a mineral found in many of the foods we eat. A mineral is a substance needed by the body to function properly. 2. Functions of iron: a. Oxygen carrier Most of the iron in our body is used to make haemoglobin. Haemoglobin is that part if the RBC which carries oxygen to nourish the tissues. Haemoglobin also gives blood its red color b. Providing increased resistance to infection Iron is essential for the normal functioning of the immune mechanism of the body 3. Sources of foods rich in iron are: a. Best animal sources (Heme Iron) Liver Internal organ Meat (pork and chicken) Blood Fish and shellfish

b. Best plant sources (Non Heme Iron) Green leafy vegetables (alugbati, kangkong, saluyot, petsay, kamote tops, mustasa) Dried bean (abitsuelas, kadyos, munggo)

The iron from animal sources, or heme iron is more absorbable than iron from plant sources or non heme iron . The latter, however, are cheaper and if the family cannot afford the heme iron, however, can be

animal sources, a plant sources are better than none. The non

absorbed better by taking foods rich in vit. C which are Iron Absorption Enhancers .

4. Iron absorption enhancers When eaten with non heme iron or iron from plant sources, these foods increase the

amount of iron absorbed by the body. Example are: Vit. C rich fruits (guava, mango, pineapple, calamansi) and green leafy vegetables Liver, internal organs, meat, blood, fish and shellfish