Guide to maintain maternal health

India has developed modern techniques in medical field after independence and became a world leader in medical science.India offers best health services and has team of qualified medical practitioners in the world. Still, quality health care remains unreachable for many undeveloped Indian provinces.

In the area of maternal child health, there are many programs initiated in India such as Family Welfare Programme of India since the time of the First and Second Five-Year Plans (1951-56 and 1956-61). Government of India took major initiatives to strengthen maternal health services. As part of the Minimum Needs Programme introduced during the Fifth Five-Year Plan (1974-79), maternal health, and nutrition services were combined with family planning services. Maternal health is associated with women during pregnancy, childbirth, and the postpartum period. It includes the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to decrease maternal illness and death rate.

Management of maternal health services:

At the national scale, there are two major divisions within the Ministry of Health and Family Welfare: the Department of Family Welfare (DFW) and the Department of Health (DH). MCH, reproductive health, rural health, primary healthcare, and family planning come under the DFW while medical colleges, national institutes, and disease-control programmes come under the DH. The Maternal Health Division within the DFW take care of all technical and administrative features of maternal health activities all over India.

Functions of Maternal Health Division, Department of Family Welfare, India:

1. Provision of technical guidance to the Minister and the Secretary of Health and Family Welfare who are non-technical officials.
2. Designing new evidence-based maternal health programmes.
3. Setting technical standards and developing strategies.
4. Reviewing research and developing new evidence-based strategies
5. Reviewing training content and tailoring it to emerging needs
6. Monitoring programme, implementation, and performance, including quality and evaluation of results.
7. Providing information to address questions in the parliament
8. Providing technical information on policy, legal and other issues.
9. Commissioning special studies and reviewing data.
10. Dealing with professional organizations, non-governmental organizations, consumer groups.
11. Interacting with donors, international agencies, and development partners.
12. Planning and executing national information, education, and communication.
13. Preparing budgets and funding programmes.

In order to enhance the availability of and access to quality maternal health care, especially people who live in rural areas, the poor, women, and children, the government has launched the National Rural Health Mission for the 2005-2012 period. Major goals of the National Rural Health Mission is to offer access to better-quality health care at the household level through female Accredited Social Health Activists (ASHA), who act as an interface between the community and the public health system.

The ASHA acts as a bond between the ANM and the village, and this health services is responsible to the Panchayat. It assists promote recommendations for universal immunization, escort services for RCH, construction of household toilets, and other health care delivery programmes (Ministry of Health and Family Welfare, 2006). Major objective of NFHS-3, like NFHS-1 and NFHS-2, is to offer information on the use of safe motherhood services delivered by the public and private sectors.

Antenatal care (ANC) is described as pregnancy-related health care, which is typicallyoffered by a doctor, an ANM, or another health expert. Preferably, antenatal care should observe a pregnancy for signs of difficulties, detect and treat pre-existing and concurrent problems of pregnancy, and giveguidance and counselling on preventive care, diet during pregnancy, delivery care, postnatal care, and related problems.

In Indian scenario, the Reproductive and Child Health Programme is intended to offer at least three antenatal check-ups which should include a weight and blood pressure check, abdominal examination, immunization against tetanus, iron and folic acid prophylaxis, as well as anaemia management (Ministry of Health and Family Welfare, 2005).

Function of NFHS-3 is to collect information from women on women problems which they experience during their pregnancies and whether they saw anyone for antenatal care for their pregnancy. Women who received antenatal care were enquired about the care provider, the timing of the first antenatal care visit, the total number of visits, the procedures conducted as part of their antenatal care, and the advice given to them. Furthermore, the survey enquires women whether they received tetanus toxoid injections and iron and folic acid tablets or syrup during the pregnancy.

At global scale, most of maternal deaths are dueto obstetric complications; mainly haemorrhage, sepsis,unsafe abortion, pre-eclampsia and eclampsia, and prolongedor obstructed labour. Complications of unsafeabortions are responsible more maternal deathsglobally.

Health studies have indicated that these maternal death are preventable.An estimated 74 per cent of maternal deaths couldbe prevented if all women had access to the mediationsto treat pregnancy and birth complications,in particular emergency obstetric care. Global health reports signified that a majority of maternal deaths occur in Asia and Africa.

Inmany developing countries where percentage of maternal mortality rates are high,there is a need to increase provision of appropriate quality services. In India, levels of maternal mortality differ greatly across the regions, due to variation in primary access to emergency obstetrical care, prenatal care, anemia rates among women, education levels of women, and other factors. Poverty, gender and other disparities,a lack of information, weak health systems, a lack ofpolitical commitment, and cultural barriers are otherhindrances that must be overcome if women are toaccess technical services and information that canoften prevent maternal mortality and illness.

Pregnancy is a medical condition in which care must be done at prenatal (before birth) and postnatal (after birth) by healthcare professionals. It involves treatments and trainings to guarantee a healthy pre-pregnancy, pregnancy, and birthing process for the mother and for her child.

Prenatal Care: Expecting mothers must take precautions during prenatal period. Prenatal care helps decrease risks during pregnancy and increase the chance of a safe and healthy delivery for the mother and child. It is recommended that expecting mothers must regularly visits to theirhealth clinicso that doctors can monitor pregnancy and recognize any problems or complications before they become serious. Prenatal care perfectly starts at least three months before women begin trying to conceive.

There some useful healthy habits to follow during this period which are mentioned as under:

1. Quit smoking and drinking alcohol
2. Take folic acid supplements (400 to 800 micrograms)
3. Always in touch with treating doctor about medical conditions and any dietary supplements and over-the-counter or prescription drugs that pregnant woman take
4. Avoiding all contact with toxic substances and chemicals at home or work that could be harmful.

Care during Pregnancy: Pregnancy is considered as high-risk expecting mothersand it may require more frequent visits and special care. Women may also need to see a doctor who works with high-risk pregnancies.

The reports of The World Health Organization (WHO) indicated that many women die from pregnancy- and birth-related causes. A woman in a developing country is 97 times more chances of losing their life during pregnancy as compared to a woman in a developed country.

Health care during pregnancy is a complicated program that involve medical visits, prenatal testing, nutrition, exercise, screening for infections and certain genetic diseases where appropriate, getting any maternal illnesses under control, and taking any other special considerations. Initial step during pregnancy is to receive good health care. To do this, pregnant women has to choose best health care provider.These days, most women in the developed world can select an obstetrician, family doctor, or midwife to see them through pregnancy, childbirth and the first few weeks after birth.

During pregnancy, women must take good nutrition and develop healthy eating practices to ensure a healthy pregnancy. Pregnant woman need to maintain a healthy diet with food choices from the four major food groups: milk and milk products, meat and meat alternatives, fruits and vegetables, and grain products. A vitamin, known as folic acid is also important to protect against the development of birth defects called neural tube defects.

Pregnant women are advised to do regular moderate exercise which is very helpful during pregnancy. Women who do not exercise are at higher risk of excessive weight gain, gestational diabetes, pregnancy-induced hypertension, varicose veins, and low back pain in pregnancy.

It is very important to share all information with doctor and ifpregnant women or her partner have a family history of certain diseases, they should both undergo screening to determine if they carry the traits for those diseases. Carrier screening is done for couples with a family history of cystic fibrosis, congenital hearing loss or who are high-risk for genetically determined diseases such as sickle cell anaemia or thalassemia.

Medical studies indicate that some infections put the unborn baby at risk during pregnancy. All pregnant women should consider screening for HIV, because if the diagnosis is done at early stage, transmission to the unborn baby can be reduced. High-risk women should consider screening for syphilis and hepatitis B, and there is a vaccine for hepatitis B that can be given during pregnancy if needed.

Screening can also be done to determine if women have had fifth disease (parvovirus) before, in which case they would be immune. If pregnant women have not had rubella or chickenpox, stay away from people who are infected with these diseases, as they can seriously impact on unborn baby. While there are vaccines available for rubella and chickenpox, they can only be given before or after, not during, pregnancy.

During pregnancy, it is advised to reduce exposure to any potentially harmful substances, called teratogens. These substances can cause problems in the development of unborn baby, generally in the first couple of months of pregnancy.

Potential teratogens include certain drugs, hazardous substances at work, pesticides, paint thinners, smoking, alcohol, cocaine, marijuana, and heroin. Furthermore, some chronic diseases in the mother can create complication during pregnancy and pose a threat to the unborn baby and/or the mother. It is important to get these conditions under control, preferably before becoming pregnant. In some cases, a change in treatment may be needed, because some medications are injurious to the fetus.

Some Considerations for the woman over age 35:

In present scenario, many women are working in corporate sector and postpone to have children until after age 35. But at the age of 35, pregnancy poses a higher risk to both mother and baby. If women are over age 35, they may want to consult a geneticist to go over any risks to unborn baby. Today, these risks are quite small, but they do increase somewhat with age.

Major risks at this stage are mentioned below:

1. Infertility: The risk of infertility increases with age, and reaches about 20% in couples who are over age 35.
2. Maternal conditions: Some common ailment in women over 35include high blood pressure, diabetes, and cardiovascular disease.
3. Pregnancy complications: For women over 35, there is greater risk of miscarriage, preterm labour, and postpartum hemorrhage.
4. Down syndrome and other chromosomal abnormalities: The risk of giving birth to a baby with Down syndrome is greater for a 35-year-old. Prenatal screening must be done assess the risk of these abnormalities in a given pregnancy. If the risk is significant, certain tests such as ultrasound, amniocentesis, and chorionic villus sampling are available.

Postnatal Care:

It has been observed that women take care during pregnancy and become careless after baby birth. Medical reports signify that postnatal care is also important. The postnatal period lasts six to eight weeks, beginning just after the baby is born. During this period, the mothersundergo many physical and emotional changes while learning to care for her newborn. Postnatal care involves getting proper rest, nutrition, and vaginal care.

Similarto prenatal care, the postpartum health care also occurs during the 6 weeks after childbirth. It is very important to new mother’s health. Unlike the tracking of prenatal visits, however, few national data exist on postpartum health-care utilization or postpartum health problems encountered by new mothers. As health specialists who practice in array of health-care settings, nurses are in a crucial position to contribute to health-care policies and practices that may improve care for postpartum women.

In postnatal period, mothers may experience severe pain in back. They also have headaches. In addition to fatigue, tiredness, and pain, other physical conditions of lower prevalence have a significant impact on mother’s physical and social health.

Such conditions include:

• Haemorrhoids
• Constipation
• Urinary incontinence
• Disturbed sleep
• Sleeping disorders
• Lack of sexual desire
• Painful intercourse.

These health problems have major impact on mother’s health as well as affect children's health. Poor maternal physical health was associated with children's reduced general physical health, frequent tantrums, and difficulty in playing with other children. If mother is not well, she may find difficult to manage her new born baby.

In India, the National Health Policy (1982) aimed at reducing the maternal mortality. To enhance maternal health, there is need to establish policies regarding postpartum maternal health, re-evaluating and reforming the program of routine postpartum health care, encouraging family support, offering support groups, designing long-term educational programs, and conducting research focused on postpartum maternal health.

The government’s strategy should include harmonising the roles of the public and private sectors to make best use of resources and to extend care to women whom government programs do not reach. The challenge for the government is to support direct and improve privately provided services through appropriate regulatory arrangements and by boosting an expansion of their scope to include promotion and prevention.

It can be said that maternal health care has traditionally been visualized in different stages such as antenatal care, care during labor and delivery, and postpartum care.It is a global concern and all nations must offer good medical care for women during this period and to reduce the unsatisfactorily high maternal death rates especially in developing countries.

Maternal health concept is a matter of debate among health professionals recently. After birth, the child’s health care, vaccinations, growth monitoring, and nutrition, has also been viewed separately from the mother’s postpartum care, and has often received far more attention in global health programs.

Good maternal health is vital for the welfare of the whole family, especially children who are dependent on their mothers to provide food and care. Deterrence of the death of a mother is most significant intervention for the health of a child.

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