SOCIAL OBSTETRICS Defined as the study of the interplay of social and environmental factors and human reproduction going back to preconceptional or premarital period The social and environmental factors which influence human reproduction are

Age at marriage Child bearing Family size fertility pattern Level of education Child spacing Economic status Customs and beliefs Role of women in society

The social obstetrics relation with delivery of comprehensive maternity and child health care. Reproductive & child health care improves the health status of women and children in India .

REPRODUCTIVE CHILD HEALTH CARE AIM of RCH : Prevention of Malnutrition Infection Unregulated fertility Obstetrics complications like anemia, pre-eclampsia, IUGR, PPH.

Objective : Reduction of maternal & perinatal mortality and morbidity Promotion of health for mother child Adolescent in form of emergency maternal obstetrics neonatal care. (EMONC) RCH care interventions : Safe mother hood Adolscent and reproductive health Reproductive tract infections and STDs Gender Issue Others – safe abortion ,child care health and immunization

Safe Mother hood : Antenatal care Intranatal care Post natal care Antenatal care : it is a systematic examination and advice of a women during pregnancy .

AIMS : Prevent the risk cases Prevent and treat at the earliest any complication ensure confined medical surveillance and prophylaxis Educate the mother about pregnancy and labour by mother craft classes Discuss with couple about time, mode of delivery, care at new born Motivate the couple for family planning

Object : Ensure a normal pregnancy with delivery of healthy baby from a healthy mother The Antenatal care contains Early registration of pregnancy A minimum of 4 antenatal visits 1st at 16 weeks 2nd at 24weeks 3rd at 32 weeks 4th visit at 36 weeks

Risk approach to identify high risk cases and refer to equipped center Routine immunization with tetanus toxoid Iron folic acid therapy daily for 100 days after 1st trimester. Intranatal care : Institutional deliveries in 80 % cases 100 % deliveries by skilled persons Three( cleans hand perineal area, umbilical area, ) must be maintained

Postnatal care Support to restore the health of mother care of the new born Breast feeding – early and exclusive Family planning services.

Adolescents and reproductive health In half Adolescents are either sexually active or married Problems to over come are Early Mother hood Under nutrition and anemia psychological Consequencess of unprotected Sex RTI due to unsafe abortion Un cleaned delivery

Levels of RCH care : In India RCH services are available at three levels to reach the target “Health for All”. 1. Primary care (level 1 ) : Care to low risk mother and neonates 2. Secondary care (level 2) : Emergency maternal obstetrics, neonatal care (EMONC) 3. Tertiary care (level 3) : specialized care for high risk mother and neonate (5%)

Other objectives in social obstetrics Meternal mortality Perintal morality Maternal Mortality : Defind as death of a women while pregnant are with 42 days of the termination of pregnancy irrespective of duration and the site of pregnancy from any cause related to pregnancy. Meternal mortality in India is 407 per 10,000 live births. In that direct meternal death causes are 75% Causes : Hemorrhage ( 25%) PPH, APH, abortion. : Infection (20%) PROM, prolonged labour : Hypertension (15%) : un safe abortion (10%) : obstructed labour (8%), anemia (20%) : Other causes (5%)

Steps to reduce the meternal mortality : Health sector actions : Basic antenatal, intranatal, and postnatal care A skilled attendant present at every birth (Em OC) emergency obstetric care at the 1st referral unit (FRU) Prevention of unwanted pregnancy and unsafe abortion and family planning services Meternal mortality conferences for cause of death B. Community society and family actions C. Health planners actions Safe motherhood actions at local level Strengthen referral system Return management protocols for obstetric emergencies Periodic audit of exsting health care delivery system

Legislative and policy actions Educate about the age sex and risk of unprotected sex to adolescent Safe abortion services Social inequalities and discrimination Pernatal Mortality : Defined as death of fetuses weighing thousand grams or more at birth (28 weeks gestation) who die before are during delivery are with in the first seven days of delivery. In India it is 60/1000. Causes : Infection, birth asphyxia and truma, preterm birth, congenital malformations.

Prevention : Pre-pregnancy health care and counselling Genetic counselling Regular antenatal care Detection and correction of anemia, PIH... Screening of high risk patients careful monitoring in labour Skilled birth attendant Provision of referral neonatal services Health care education of mother about care of newborn Educate the family planning services Autopsy studies of all perinatal deaths. Continued study of perinatal mortality problems.

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