Antenatal Care: Counseling

1. SBA - Presentation 3 (c i) Antenatal Care: Counseling Maternal Health Division Ministry of Health & Family Welfare Government of India

2. Antenatal Care: Counseling 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 Antenatal Care: Counseling

3. Antenatal Care: Counseling Pre-requisites for counseling • Ensure privacy • Maintain confidentiality • Treat the woman with respect Antenatal Care: Counseling

4. Antenatal Care: Counseling 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 Antenatal Care: Counseling

5. Antenatal Care: Counseling 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 cut Clean cord tie Clean umbilical stump Clean hands Clean perineum Encourage every woman for an institutional delivery Antenatal Care: Counseling

6. Antenatal Care: Counseling 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 Antenatal Care: Counseling

7. Antenatal Care: Counseling 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 Antenatal Care: Counseling

8. Antenatal Care: Counseling 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 Antenatal Care: Counseling

9. Antenatal Care: Counseling 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 Antenatal Care: Counseling

10. 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 Antenatal Care: Counseling

11. 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 Antenatal Care: Counseling

12. 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 Antenatal Care: Counseling

13. 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 Antenatal Care: Counseling

14. 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 Antenatal Care: Counseling

15. 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 Antenatal Care: Counseling

16. 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 Antenatal Care: Counseling

17. 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 Antenatal Care: Counseling

18. 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 Antenatal Care: Counseling

19. 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 Antenatal Care: Counseling

20. 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) Antenatal Care: Counseling

21. Benefits under JSY • 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 Category of state Rural area Urban area Assistance package to mother Package to ASHA Total Assistance package to mother Package to ASHA Total LPS 1400 600 2000 1000 200 1200 600 800 HPS 700 200 900 200 200 800 600 600 700 HPS (tribal area) 1300 Antenatal Care: Counseling

22. Thank you Antenatal Care: Counseling