Maternal and Child Health (MCH) care

Introduction to Maternal and Child Health (MCH) Care

Maternal health refers to  the health of the mother. Similarly, child health is related to the health of the child. A child is a young baby below five years. Children are directly or indirectly affected by the health of the mother. Newly born infants depend upon the breast milk from their mother. Therefore, the health of children is closely connected with the health of the mother. In this context, child health and maternal health are studied together. Maternal and child health care (MCH) is defined  as the process of promoting health of pregnant, neonate and breastfeeding mother as well as children below five years. The level of MCH care in developing countries is low in comparison to that of the developed countries. There must be necessary laws and their effective implementation to promote the status of MCH care in developing countries like Nepal. It is important for promoting the aggregate health of the nation.

Importance of Maternal and Child Health (MCH) care

• It helps in healthy pregnancy and safe delivery.
• MCHC provides trained birth attendants (TBA) at the time of delivery. It saves the lives of both the mother and infant.
• It includes the appropriate care of the pregnant mother, including their balanced diet, immunizations, sanitation, and necessary precautions regarding pregnancy and delivery. Thus, it protects the mother during these complicated periods.
• It protects the reproductive rights of women.
• It helps to make family members aware about providing proper care to the mother in their family.
• Children can live a healthy life duet o implementation of MCH care. It gives focus to immunizations, balanced diet and healthy lifestyle of the children. 

Care of Pregnant Woman, Neonatal and Postnatal Mother and Newborn Child

a) Care of pregnant women

As we discussed earlier, pregnancy is a complicated period, which requires conscious  care with a balanced diet reproductive knowledge, love and sympathy. The conscious care provided to a pregnant woman is described below:

i. Nutritious food

Nutritious food contains all types of nutrients in appropriate proportion. Nutritious includes vitamins, proteins, minerals, carbohydrates, fats, etc. Nutritious taken by the mother is the only source of nutritious for the fetus. It is utilized for the proper growth and development of the fetus. A pregnant mother must take cereals, meat, fish, milk, egg, green vegetables, fruits in proper amounts. She should not take alcohol, tobacco, drugs, junk and adulterated foods as well as other harmful food items. Haphazard intake of medicines by oneself or instructions of quacks should be restricted strictly by a pregnant woman.

ii. Health check-up

There are various ups and downs during the period of pregnancy. A pregnant women needs more health care and check-up because of the complex biological processes within her body. Regular health check-up helps the mother to diagnose health problems earlier and to save the lives of the fetus and herself. The health check-ups of a pregnant mother must be according to the followings:

• Once a month up to the seventh month of pregnancy
• Twice a month in the eighth month of pregnancy
• Once a week after the eighth month of pregnancy

The above-mentioned information is not sufficient for mothers in abnormal cases. If there is any unexpected and abnormal symptom during pregnancy, she should consult the doctor immediately.

iii. Cleanliness

Cleanliness is one of the important preventive measures to stay safe from infections and infestation by disease germs and parasites. A clean body and surroundings prohibit diseases. Pregnant body becomes dirty faster than in normal conditions. There is production of dandruff on the face and discharge of fluids from the vaginal openings. Therefore, efforts at cleanliness should be increased in pregnant women. Cleanliness includes clean body, clean surroundings, a clean home, clean food items, and clean dresses.

iv. Physical exercise and rest

A pregnant woman neither needs total rest nor excessive physical exercises. There must be normal and light physical exercises on a daily basis. Morning walk, light jogging and simple yoga exercises are beneficial for a pregnant woman.

Heavy exercise contracts the abdominal muscles and may cause harm to the uterus and fetus. The pregnant woman should not carry heavy loads. She should take proper rest and a sound sleep to refrain from mental tensions and sleeplessness. It is the duty of all the family members to create a peaceful and harmonious family environment for the pregnant woman. 

v. Vaccination / Immunization

The pregnant woman is vulnerable to tetanus. Therefore,  she must take two doses of immunization (TT-Tetanus Toxoid vaccination ) against tetanus between the seventh month of pregnancy and two weeks before childbirth. Time lag between two doses of TT  vaccination must be one month. This vaccination saves the mother and fetus against tetanus.

b)Care of the mother during childbirth and neonatal period

Pregnancy ends after the birth of the baby. The fetus becomes mature and ready for independent survival in the external environment after a certain period. The period is of about 280 days from the last menstrual flow of the mother. After maturity, the baby is expelled from the womb. This process is called labor. 

There are three stages of labor. The amniotic fluid which surrounds the baby inside the womb is expelled in the first phase. The baby gets birth by rhythmic contractions of the muscular wall of the uterus in the second phase. The third phase ends with the expulsion of the placenta. The following must be considered for caring the mother during childbirth and neonatal period.

• Immediately after the onset of symptoms of labor, the pregnant woman should be taken to a hospital or provided with a Trained Birth Attendant (TBA) .
• She should be cared with consolations, sympathy and psychological assistance.
• She should be provided with light fruit juice, milk, glucose solution or other nutritious fluids.
• Suggestion to urinate is useful for the mother to reduce pressure and pain in the lower abdomen. Urination decreases the fluid pressure in the lower abdominal site.

c) Care of neonatal /postnatal mother

It is the care given to the woman after delivery of the child. The period of about two months after childbirth is regarded as postnatal period. Childbirth  brings declination in various aspects in the body of the mother. Due to  childbirth, there is sore and pain around the vagina. The perineum membrane may be torn due to passage of the child through the vaginal canal. Anemia is a common problem in neonatal period due to excessive loss of blood. The following points should be considered for the care of the mother during this period:

1. Dietary intakes should be increased with nutritious food, including protein-rich and iron-rich foodstuffs.
2. Milk, fish, meat, eggs, cereals, green vegetables, fruits should be given more during this period.
3. It is better to clean her body with a clean towel soaked with lukewarm water.
4. After about one week, she can take normal body bath.
5. Breastfeeding must be started from the day of delivery. The breast area should be cleaned properly.

d) Infant health care

A newborn baby is called an infant. The baby has a normal weight of about three kilograms and normal height of about 50 centimeters. The weight of the infant reaches about three multiples of the weight at birth and the height reaches about 75 centimeters after one year. The 1,000 days between a woman's conception and her child's second birthday (270 days of pregnancy +365*2 days=1000 days) is termed 'Sunaula Hazar Din' or ' Golden 1000Days' in Nepal. The Government , with coordination of NGOs and INGOs, has launched various programs incorporating awareness, nutrition, cleanliness, immunization etc. for infants and children. It is believed that it is an unique period that shapes a healthier and more prosperous future of the child. Right nutrition and care during this :1,000 days window" can have a profound impact on a child's ability to grow, learn and rise long-term health, stability and prosperity. A newborn cannot express desires and problems. Therefore, we must understand the problems and desires properly. Infant health care can be given as follows:

1. The baby should be kept in an upside down position to discharge the mucous and water inside the nose and mouth.
2. The mucous, membranes and fluids that have accumulated inside the mouth and nose should be cleaned thoroughly.
3. The baby should be kept at a lower level from the body of the mother before trying the umbilical cord. It prevents the  back flow of blood of the infant towards the placenta.
4. The baby should be kept warm by wrapping with clean and soft clothes.
5. A blade or scissors used to cut the umbilical cord must be clean, sharp an sterilized.
6. The cord should be tied with a clean and sterile thread.
7. Breast milk contains a nutritious component called colostrum . It strengthens the immunity power of the infant. Therefore, it should be fed to the infant as soon as possible.
8. Frequent health check-ups should be done for monitoring and treatment of health problems.

e) Infant and child nutrition 

An infant is not capable of obtaining foodstuffs needed for survival with its own effort. It is the duty of the mother and family members to manage appropriate food for infants and children. Breastfeeding is the most appropriate food for infants up to five moths of age. Colostrum found in breast milk strengthens the immune power of the infant and provides the necessary nutrition. Artificial and marketed milks do not contain all the components needed for the growing infant and child. Therefore, breastfeeding should be encouraged instead of giving bottled milk purchased from the market. 

Benefits of breastfeeding 

1. Breast milk is naturally produced for infants. Therefore, it is the best food for them. 
2. It is ready-made, and it can be provided to the infant at any time. 
3. It contains all the nutrients in appropriate proportion. 
4. Breast-milk contains Colostrum, which adds immunity power to the infant. 
5. It is easy to digest. Diarrhea and other gastrointestinal problems are prevented by breast-milk. 
6. It builds a cordial relationship between the mother and the child. 
7. Regular breastfeeding prevents hardening of the breasts and breast cancer. 
8. Breastfeeding increases the production of progesterone hormone. This hormone prevents conception and helps in birth spacing
9. It saves extra expenses to purchase bottled and marketed milk. 

f) Immunization 

Immunization is the process of increasing the immunity power against germs by administering the related immunizing vaccination. If there is a vaccination against any disease, the chances of the onset of the disease are less. Immunization helps the body to develop the capacity to fight and kill the causative germs.

The immunization schedule should be followed in a proper way for the development of effective immunity power. The following points should be considered in immunization: 

1. There must be three doses of immunization for DPT and polio at appropriate time intervals. 
2. The time schedule should be followed strictly. 
3. A child may fall sick after immunization. We should not worry about at because minor illnesses are common symptoms. 
4. There may be a minor wound after the administration of BCG vaccination. The wound heals itself after a few days. Massage on the wound becomes harmful. IT is better to cover the wound with a clean piece of cloth. 
5. Immunization can be administered even if there are minor illnesses. 
6. Basic immunizations are available free of cost at the local health centres. 

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