1. Antenatal Care: Counseling SBA - Presentation 3 (c i) Maternal Health Division Ministry of Health & Family Welfare Government of India

2. Antenatal Care: Counseling2 Session objectives To demonstrate how to counsel a pregnant woman – for birth preparedness – against sex selective abortion – on complication readiness – on diet, rest, breastfeeding, sex during pregnancy, domestic violence and contraception – Benefits under JSY

3. Antenatal Care: Counseling3 Pre-requisites for counseling Ensure privacy Maintain confidentiality Treat the woman with respect

4. Antenatal Care: Counseling4 Birth preparedness Registration Identification of place of birth and a skilled birth attendant Encourage institutional delivery Locate nearest functional FRU/ 24x7 PHC for referral Identify and arrange for transport Identify support people Identification of blood donors if required

5. Antenatal Care: Counseling5 Preparedness for home delivery Explain that home delivery may be risky and potentially life threatening If she still insists on home delivery Help identify SBA for delivery Arrange disposable delivery kit (DDK) Explain and counsel to maintain 6 cleans Clean surface Clean cord cut Clean cord tieClean umbilical stump Clean handsClean perineum Encourage every woman for an institutional delivery

6. Antenatal Care: Counseling6 Items required for home delivery Antenatal case record Clean towels/ cloth for drying and wrapping the baby Clean clothes washed and sun dried for the mother and the baby Sanitary pads/clean cloth for the mother Food and water for the mother and support person

7. Antenatal Care: Counseling7 Against sex selective abortion Child sex ratio in India is 914 females per 1000 males (Census 2011) Male preference in the society leads to gender discrimination at birth PCPNDT Act was enforced in 1994 in India – To prohibit sex selection, before or after conception – To regulate pre-natal diagnostic techniques for the purposes of detecting genetic abnormalities – To prevent its misuse for sex determination leading to female foeticide

8. Antenatal Care: Counseling8 Complication readiness Recognizing signs of labor Awareness and recognition of danger signs during pregnancy, delivery and postpartum period Identification of nearest functional FRU / PHC Identification of transportation facilities

9. Antenatal Care: Counseling9 Recognizing signs of labor A bloody sticky vaginal discharge (show) Painful abdominal contractions every 20 min or less Advise the woman to go to a health facility or contact a SBA if she has any of the above signs

10. Antenatal Care: Counseling10 What is the importance of dietary counseling? Requires extra calories for Maintenance of her health Growing fetus Lactation How much more calories are required? Needs about – 300 extra kcal / day during pregnancy – 500 extra kcal / day during lactation

11. Antenatal Care: Counseling11 Counseling: Diet What food items should the diet include? Foods rich in proteins, iron, vitamins, calcium micronutrients and fiber Should include items like cereals, milk and milk products, green leafy vegetables, pulses, eggs, meat, fish, nuts, fruits, jaggery etc Tea or coffee within 1 hr of meal should be avoided and foods rich in proteins and vitamin C (lemon juice, amla, orange juice etc) should be taken for better absorption of iron

12. Antenatal Care: Counseling12 Counseling: Diet Which category of pregnant women need additional nutrition? Underweight women (<45 Kg) Women with increased physical activity Pregnant adolescents Pregnancy during lactation Pregnancy with in 2 years of previous delivery Multiple pregnancy

13. Antenatal Care: Counseling13 Counseling: Diet Advise diet keeping in mind – Socioeconomic status – Food habits – Seasonally available food – Taste of the pregnant woman Advise against any food taboo Encourage woman with hypertension to have normal diet

14. Antenatal Care: Counseling14 Counseling: Rest Pregnant woman should be advised to sleep for 8 hrs at night and 2 hrs in day refrain from doing heavy work take rest in left lateral position to increase blood supply to baby Encourage her family members to help her in routine household chores

15. Antenatal Care: Counseling15 Counseling Advise her To refrain from alcohol, tobacco, smoking or addictive drugs like opium during pregnancy and after delivery Not to take any medication unless prescribed by a qualified health practitioner

16. Antenatal Care: Counseling16 Counseling: Sex during pregnancy Sex is safe in uncomplicated pregnancy Should be avoided if – Risk of abortion – Risk of preterm labor – H/O APH or PROM Sexual desire of the woman may decline during pregnancy Husband should ensure the comfort of the woman Advise use of condoms while having sex

17. Antenatal Care: Counseling17 Counseling: Domestic violence In India 39.7% of ever married women have suffered from either physical and or sexual violence ( NFHS 3 ) Domestic abuse and violence against pregnant women has immediate and long term adverse effects on the mother and the fetus Blunt trauma to the abdomen can cause placental separation, uterine rupture, miscarriage / stillbirth, preterm labor and PROM

18. Antenatal Care: Counseling18 Counseling: Breast feeding Ideal time to counsel the pregnant woman regarding the benefits of breast feeding Emphasize the following: Initiation of breast feeding within 1 hr of birth No prelacteal feeds Demand feeding Importance of rooming in (Keeping mother and baby together) Exclusive breast feeding for 6 months

19. Antenatal Care: Counseling19 Counseling: Contraception Pregnancy is the best time to counsel the couple for contraception Explain that if the woman is not exclusively breastfeeding she can become pregnant as early as six weeks after delivery Advise abstinence for 6 weeks postpartum or longer if perineal wounds have not healed Advise the couple to delay next pregnancy by 3-5 yrs

20. Antenatal Care: Counseling20 Counseling: Contraception Available contraceptive methods Lactational amenorrhea method (LAM) Barrier method: Condoms Intrauterine contraceptive device (IUCD) Contraceptive pill (COCs) Depot medroxy progestrone acetate (DMPA) Emergency contraceptive pill (ECP) Female/ Male sterilization (FS, MS)

21. Antenatal Care: Counseling21 900200700HPS 1200200100020006001400LPS TotalPackage to ASHA Assistance package to mother TotalPackage to ASHA Assistance package to mother Urban areaRural area Category of state Gives cash incentives for pregnant women to seek an institutional birth. To reduce IMR and MMR by promoting Institutional delivery Launched in 2005 in rural area, in 2006 BPL women in urban area and SC/ST women irrespective of BPL card are also included Cash incentives as following Benefits under JSY 600 200 800 700 600 1300 600 200 800 HPS (tribal area)

22. Antenatal Care: Counseling22 Thank you