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SECTION 1: ANTENATAL CARE


HOME VISITS

Indications for Home Visits

Home visits should be made in the following instances:

  • Routinely to all antenatal mothers at least once during pregnancy
  • As necessary in ‘high risk’ cases
  • In cases where there is a need to assess suitability of the home conditions, including general cleanliness, sanitization, water and food supply and storage, etc
  • In any case where the client fails to keep clinic appointments.



SELECTION OF PLACE OF CONFINEMENT

Home Delivery will be considered in the following circumstances:

  • Normal pregnancy – not classified as high risk
  • 2nd to 5th pregnancy
  • Normal past obstetrical history
  • Normal progress of present pregnancy
  • Suitable home conditions
  • Midwife available for home confinement
  • Client’s wish, provided that other criteria are satisfied, will be booked by the District Health Visitor for home delivery.


Delivery at Maternity Units/District Health Facilities/Hospitals will be considered in the following circumstances:

  • Normal pregnancy- not classified as "high risk"
  • 2nd to 5th pregnancy
  • Normal past obstetric history
  • Normal progress of present pregnancy
  • Client’s wish
  • Unsuitable home conditions


Delivery at Maternity/General/County Hospital will be selected in the following circumstances:

  • All ‘high risk’ pregnancies
  • Client’s desire




ONSET OF LABOUR

Evidence of any of the following may indicate onset of labour and should alert client to seek professional advice:

  • Regular painful contractions – 1:15 or more frequently (this may be preceded by a ‘show’ of mucus and blood and associated with back pain)
  • Loss of liquor – rupture of membranes
  • Vaginal bleeding




PREPARATIONS FOR CONFINEMENT

Preparation for confinement includes the securing of items for the mother and baby. A list of these items is presented in the Appendix.

For domiciliary cases:

  • Give instructions for the preparation of the room for delivery e.g. boiling of water, arrangement of furniture.
  • Advise mother to notify midwife at onset of labor.




HEALTH INFORMATION FOR PREGNANT WOMEN

Counselling

  • Patient must be given individual counseling at every prenatal visit, on the deviations from norms which may occur, so that they can seek early care if there are problems.
  • At the first visit, clients should be made familiar with the clinic procedures.
  • Sessions on breastfeeding should be carried out including the uniqueness of breast milk and the benefits of exclusive breastfeeding


General Education

  • Reason for attendance and importance of clinic visits
  • Body changes that take place during pregnancy
  • Maintenance of good physical and mental health.
  • Information on antenatal and postnatal home visits.
  • Information on sex during pregnancy.


Diet in Pregnancy and Lactation

  • Need for foods rich in iron and vitamin C
  • Need for a balanced diet comprising a variety of foods from the six food groups
  • Need to increase energy intake
  • Vegetarian mothers to be advised accordingly, especially regarding Vitamin B12 deficiency
  • Clients should be given literature on the role of nutrition to ensure proper development of the foetus
  • Consequences of poor diet include increased risk of anemia, maternal complications and death in the mother; as well as increased risk of foetal, neonatal and infant death, intra uterine growth retardation, and birth defects


Hygiene and General Advice

  • General care with emphasis on teeth, breast care
  • Advice on clothing e.g. supportive brassiere • Advice on wearing comfortable shoes
  • Emphasis on cleanliness of the environment
  • Importance of physical activity - both pre and postnatal.


Preparation for Delivery

  • Requirements for delivery
  • Signs and symptoms of labour
  • When to go to hospital etc.


Breastfeeding

  • How breastfeeding works
  • Preparation for breastfeeding and breast care includes building confidence and giving support
  • Emphasise benefits
  • Duration of breastfeeding (encourage exclusive on demand breastfeeding for 6 months and continued to 2 years and beyond)
  • Informed choice on breastfeeding for the HIV positive mother (see section on HIV/ AIDS)
  • Any situations in which breastfeeding may be difficult to achieve or may be contraindicated
  • Positioning the baby to the breast
  • Expressing breast milk, its proper storage and its safe preparation


Care of Baby

  • Advice on cleaning and bathing of baby
  • Clothing for baby
  • Sleeping position and arrangements
  • Skin care including the diaper area.
  • Immunizations for baby


Registration of Births

  • Advise on local laws for registration of births


Attendance at Child Health Clinic

  • All mothers and their infants should visit the clinic within two weeks after delivery or earlier if they have any problems.


Family Planning and Contraceptive Care

  • Discuss reasons / benefits and commonly used methods
  • Advise where services are available


Post-Natal Care and Follow-up

  • Reasons for post-natal care
  • Need for post-natal physical activity
  • Times when and where services are available
  • Pap Smear
  • Emphasize the maintenance of breastfeeding and advise on weaning, complementary feeding and initiation of immunization.


Caribbean Public Health Agency © 2014