MOTHER AND

CHILD HEALTH
 Mother and child health (MCH)
Mother and child health (MCH) refer to a
package of comprehensive health care services
which are developed to meet promotive,
preventive, curative, rehabilitative needs of
pregnant women before, during and after
delivery and of infants and pre-school children
from birth to five years.
Objectives
• Reduce maternal mortality and morbidity.
• Reduce intranatal and neonatal mortality and
morbidity.
• Regulate fertility so as to have wanted and
healthy children when desired.
• Provide basic maternal and child health care to
all mother and children.
• Promote and protect health of mothers.
• Promote and protect physical growth and
psycho-social development of children.
Components of MCH Care
• Maternal Health
• Child Health
• Family planning
Maternal health care
• Maternal health care include care of women
during pregnancy, child birth and after child
birth. It also includes treatment of child-less
couples.
Maternal Risk Factors
• Maternal risk is defined as the probability of
dying or experiencing serious injury as a result of
pregnancy or child birth.
• Young primi i.e. below 19 years:-
• There is grave risk to both mother and the
child because the teenage mother:
• Is still growing and is not adequately equipped
to cope the pregnancy and labour & is not
psychologically prepared for the
responsibilities of marriage.
Maternal Risk Factors
• Elderly primi i.e. 30 years and over:-
• Having babies too late in life, leads to
increased risk of complications in pregnancy
and labour.
• Having too many babies:-
• When the mother bears more than tree
babies, she is at high risk of developing
problems due to repeated pregnancies and
labour. This is due to weakening of tissues,
depletion of nutrients and over all poor
physical health of the mother.
Maternal Risk Factors
• Having too close pregnancies:-
• When the interval between the two
pregnancies is less than three years, it can
create problems during the pregnancy. It is
because mother did not get enough time to
recover completely and fully from the stress
and strain of the previous pregnancy.
 Maternal Risk Factors
• Other conditions of mothers :-
• These include:
1) Mothers with short height i.e. less than 145 cm,
having a small and inadequate pelvis.
2) Mothers having less than 40kg of weight: usually
under weight mothers are malnourished and anemic
and have high risk of developing complications
pregnancy.
3) Mothers having more than 70kg of weight have
difficulty during child-birth.
4) Mothers having malnutrition and anemia. These
mothers are weak and find it difficult to tolerate the
stress and strain of pregnancy and child birth.
 Associated Medical Conditions
• These include;
• Heart disease, high blood pressure, kidney
disease, tuberculosis, diabetes, repeated
attacks of malaria, hepatic disorder etc.
Maternal Healthcare Component;
Maternal healthcare component include:-
• Antenatal care
• Natal care
• Postnatal care
• Family planning
ANTINATAL CARE
(Antenatal care is care during pregnancy.)
OBJECTIVES OF ANTINATAL CARE:-
• To promote, protect and maintain health of
mother during pregnancy.
• To ensure the birth of mature and healthy baby.
• To identify high risk mothers and give them
appropriate attention to prevent complication.
• To prepare the mother for confinement.
• To prepare the mother to care for her baby.
Essential antenatal care services
• Registration of pregnant women:- The mother
must be registered within 12 weeks of
pregnancy.

• Antenatal visit:- Ideally the mother should

attend the antenatal clinic once a month during
the first 7 months, twice a month during the
second month, and thereafter, once a week, if
everything is normal.
Essential antenatal care services
• Care during first contact:-
• Taking health history.
• Physical examination.
• General medical examination.
• Obstetrical examination.
• Laboratory examination
• Immunization against Tetanus:-
• 2doses of tetanus toxoid should be given.
Essential antenatal care services
• Iron and folic acid tablet:-Mother is given one
tablet of iron and folic acid twice a day for at
least 3 months to prevent anemia in mother & to
promote proper growth of fetus.
• Health education during pregnancy:- A pregnant
women should be educated regarding personal
hygiene.
• Diet during pregnancy:- A well balanced diet is
required during pregnancy for the proper growth
and development of fetus & for optimum health
of mother. -
Essential antenatal care services
• Smoking and drinking:- Mother should be
advised to avoid smoking and drinking alcohol. It
lead to low birth weight and retardation.
• Drugs:- The mother should be advised not to
take any medicine unless it is prescribed by the
Doctor.
• Radiation:- The mother should be advised to
avoid abdominal X-ray it predisposes child to the
risk of leukemia and other cancers
Essential antenatal care services
• Protection from infections and illnesses:- An
expected mother should be instructed to protect
herself from the risk of infection especially measles
& syphilis because these infection can cause
spontaneous abortion, malformation, mental
retardation, still birth etc.
• Sexual activities:-Avoid coitus during the first & last
trimester.1st trimester it increases the risk of
abortion & last trimester it predisposes to
infection.
• Travel:-Avoid travel during first and last trimester
Essential antenatal care services
• Reporting of untoward sign and symptoms:-the
mother should be instructed to report to health
personal if there is unusual pain, bleeding from
vagina, swelling in the feet, hand or face,
headache, blurred vision, dizziness, high fever
baby’s movement not being felt.
• Child care:-the mother should be educated on
various aspects of child care.
• Follow up visits:-Mother must be educated about
the need for regular visit and proper care during
pregnancy.
Essential Antenatal Care Services
• Family planning:- When the mother is pregnant
she is more receptive because she is
experiencing the impact and burden of child
birth. The mother should be educated and
motivated for small family norm and spacing of
children
Natal Care
• Natal care refers to care during confinement,
delivery/ birth of a child.
Objective:- The objectives of natal care:
• To prevent infection
• Prevent injury to both mother and baby
• To detect and deal with any complications e.g.
ante partum and post-partum hemorrhage,
prolonged labour, Malpresentation, prolapse cord
etc.
• To resuscitate the baby and to provide immediate
care to baby.
 Elements Of Natal Care
• Preparation of place and surroundings of confinement.
• Preparation of equipment and supplies required during delivery.
• Physical and psychological preparation of the mother.
• Examination of mother’s physical condition abdominal palpation,
monitoring fetal heart sound, observation of vital signs, labour pain and
uterine extraction etc.
• Conducting delivery, watchful about any problem and helping mother in
taking pains.
• Referral of mother immediately in case of any such problem.
• Giving immediate care to mother and baby after delivery.
• Giving instruction to the mother and family members.
• Maintaining record and reporting of birth to authority.
 Postnatal Care
• It refers to care which is rendered to both mother and the baby
after delivery.
Objectives:-
• To restore, promote and maintain health of mother and baby.
• To promote breast feeding.
• To prevent complications.
• To establish good nutrition's of the baby.
• To prevent infection and identify any health problem/disorder
in the baby.
• To support and strengthen the parents confidence and their
role within their family and cultural environment.
• To educate mother and family on various aspects of mother
and child care.
 Immediate Care Of New Born
• Clearing of airway:- Immediately after birth the baby
should cry and breathe. In order to promote
breathing the airway needs to be cleared of mucus
and any other secretions.
• Maintenance of baby temperature:-The new born
baby has the risk of hypothermia because of
immature heat regulating system. The risk of
hypothermia is greatly reduced if the new born baby
is immediately and carefully dried with towel or
clean cloth, wrapped in a clean cloth, kept close to
the mother for skin to skin contact and breast fed as
soon as possible preferably within an hour of birth.
 Immediate Care Of New Born
• Care of the eyes:- The care of eyes include, wiping of
each eye from inside to out side with boil cooled
swabs, one for each eye as the child is born before he
opens the eyes.
• Care of the umbilical:- the cord should be legated in
two places, 6cms and 9cms from the umbilicus and
cut in between with sterilized scissors/blade and tied
with sterilized cord tie to prevent tetanus. The cord
should be kept dry. Special instructions should be
given to the mother and family not apply anything
e.g. any oil, ash, or cow dung on the cord. Such
customs increase the danger of tetanus infection.
APGAR Scoring
• APGAR scoring is a device to monitor physical
condition of the baby. It is determined by immediate
observation of the heart rate, respiration, muscles
tone, reflex response and colour of the infant. The
observation is done at 1 minute and again at 5
minutes after birth.
• Care of the skin:- The care of the skin is very
important to protect the child from any infection
and keep the baby clean and warm. The vernix on
the baby’s body is protective in nature. Therefore if
culturally acceptable, the bathing soon after can be
postponed for 12-24 hours.
Immediate Care Of New Born
• Physical examination:- the physical examination
of the baby should be done by health worker
assisting mother in delivery soon after the birth
to identify any birth injury, malformations and
general health condition of the baby.

• Breast feeding:- The breast feeding should be

started as soon as possible preferably within an
hour of the birth.
Immediate Care Of Mother
After the baby is born and placenta is delivery, it is very
important that mother is made comfortable and watched
for any complication.
• The fundus is palpated, clots are expressed, and fundal
height is measured.
• The perineum is inspected for any laceration or tear,
perineal care is given, napkin fixed.
• Mother is made comfortable by removing the soiled
linen, thorough cleaning and by keeping her warm etc.
• Hot drink is given thereafter.
• The vital signs are recorded.
Immediate Care Of Mother
The following instructions are given to mother and
family:-
• Regarding mother:- To rest, to watch for bleeding,
to maintain perineal hygiene, to take normal diet,
to report incase there is any problem.
• Regarding baby:- To let the baby sleep and handle
as little as possible, watch for bleeding from cord,
to breast feed the child, not to give any thing else
even the water, not to apply anything on the cord,
to report, in case there is any problem.
Postnatal Visit And Care
• It is very important to give regular and frequent visit to
post-natal mother when the delivery is conducted in
home by health worker, under mentioned schedule:-
• 1st visit - within 24 hours (on the 2nd of delivery was
conducted by her )
• 2nd visit - 5th or 6th day
• 3rd visit - 10th day
• 4th visit - 2nd to 4th week
• 5th visit -6th to 8th week (the visit is done in the
clinic). During these visits, both mother and baby are
given care to meet their health needs.
Care Of Mother
• During each visit the following actions are
generally performed.
• General observation of the mother and the
surrounding to assess overall health status of
mother, cleanliness etc.
• Observation temperature, pulse and respiration.
• Examination of breast, involutions of uterus,
lochia, perineum for any kind of abnormality.
• Observation of any abnormality in the abdomen
likes painful and hard abdomen.
Care Of Mother
It should be seen that the mother:
• Takes adequate nutritious diet.
• Takes sufficient rest and sleep.
• Keeps herself clean and protects from infections
• Breast feeds her baby.
Care Of New Born
During each postnatal visit the following actions are
generally performed to take care of the newborn baby.
• General observations of the baby and how is he/she.
• Observation of temperature, heart rate and respiration.
• Observation of eyes for any kind of abnormality such as
watering of eyes or any discharge etc.
• Observation of skin for change in colour.
• Observation of cord stump .
• The weight is checked and recorded.
• Observation of any sign of abnormality of abdomen
such as distension, tenderness etc.
Care Of New Born
It should be seen that the baby is.
• Adequately clothed, kept clean.
• Breast fed on demand.
• Allowed to sleep and rest most of the time and
handled only when necessary.
• Not given bottle feeds.
Mother should be enquired about any problem
regarding baby.
 Child Health Care
• Child health care refer to care of children from
conception to birth till the age of five.
OBJECTIVE:-
• Every child receives adequate care and proper
nourishment.
• Every child is immunized and protected from diseases.
• To monitor growth and development.
• To identify ailments and treated without delay.
• To educate the mother and family members to give
proper care to their children.
 Feeding Of The Child
Adequate and proper feeding is very important.
• Breast feeding:-For the first few month(6 month)of
life, breast feeding is best food which is made
available by nature for healthy growth and
development.
• Supplementary food:-for the first six month, breast
feed alone is sufficient for normal growth and
development. Beyond six month baby require
additional food to meet body requirements.
therefore it is necessary to introduce various other
food items suitable for the age of the child. These are
called supplementary food.
MONITORING OF GROWTH AND
DEVELOPMENT
• It is very important to monitor growth and
development of children regularly.
• It indicates health and nutrition status of the
child .
• It helps in identification of any deviation from
normal.
• Ideally weight is measured and recorded once in
a month upto one year, once in two months up
to two years and once in three months upto five
years.
Immunization of children :-
• The child needs to be protected from six infectious and
vaccine preventable diseases. There diseases include
tuberculosis, tetanus, diphtheria, whooping cough, measles
and poliomyelitis. It is very important that health workers
must educate all the mothers about the importance of
immunization and must explain them about the immunization
schedule so that they will bring the child for immunization
according to schedule.
Safety and security of children
• Safety and security can be ensured by providing clean, safe
and comfortable physical environment.
• The water, milk, and food supply must be free from infectious
agents and/or toxins.
• Disease carrying insects must be controlled.
• Accidents hazards need to be removed or controlled in order
to prevent accidents such as falls, burns, poisoning, drowning,
aspiration of foreign objects, cuts and abrasions etc.
Early recognition and treatment of
ailments
• There are number of ailments which can occur in children
from one month to five years and cause morbidity and
mortality.
• The most common ailments includes diarrheal diseases, acute
respiratory infection, vaccine- preventable diseases,
nutritional deficiency problems.
• It is very important to recognize these ailments as early as
possible so that timely treatment and care can be taken at the
family and health center level.
The package of services
For the mothers
• TT immunization
• Prevention and treatment of anemia
• Antenatal care and early identification of maternal
complication
• Deliveries by trained personnel
• Promotion of institutional deliveries
• Management of obstetric emergencies
• Birth spacing
Essential newborn care
• Exclusive breast feeding and weaning
• Immunization
• Appropriate management of diarrhea
• Appropriate management of ARI
• Vitamin A prophylaxis
• Treatment of anemia
Prevention of pregnancy
• Safe abortion RTI/STD
• Prevention and treatment of reproductive track infection and
sexually transmitted disease
The MCH services
• The MCH services are rendered to both urban and rural area
RURAL AREA:-
• Village health post:-
• village health post is at the village level. It is manned by village
health guide and trained dai. Village health guide is trained in
primary health care for a period of 3 month to render simple
mother –child and family planning services. The dais are
trained for one month to provide safe hygienical services
during antenatal, natal and postnatal period. they can also
provide family planning services.
Sub centre level:-
Sub centre is manned by multipurpose health worker ( male &
female). The maternal and child health function carried out at
sub center level include:-
• Contacting eligible couples and motivating for small family
norms.
• Registration of all pregnant women.
• Providing essential antenatal & postnatal care.
• Immunization of mother and children.
• Nutrition & health education.
• Ensure safe delivery through trained birth attendant.
Primary health centre level:-
• MCH & Family planning services rendered from PHC are:-
• It rendered all those services which are rendered from sub
centre.
• Planning, organizing and implementing MCH prog. & services.
• Coordinating the work of all sub centres.
• Collecting & compiling performance reports of MCH activities
from sub-centres.
• Ensuring intersectoral coordination.
• Training and continuing education prog. Of maternal and child
health teams
Community Health Centers:-
• The centre is manned by four specialists and 21 health
personnel ( including 7 nurse Midwives) and other staff.
• It serves first referral unit & provide specialists services for
mother and children.
In urban areas the MCH services
• In urban areas the MCH services are available through:-
• District Family welfare units/centres.
• District and state level Hospital.
• Urban MCH centers, clinics, Maternity homes, Hospitals.
• Urban Family welfare centres. The nongovernment
organization for MCH are:-
• Nursing homes and Hospital.
• Voluntary organizations & Charitable Trust.
• Private practitioners of all systems.