Health Education of ANC and PNC Mothers

PART A: Health Education During Antenatal Care (ANC)

1. Diet and Nutrition

• A full pregnancy consumes approximately 60,000 kcal over and above normal metabolic requirements; lactation demands an additional 550 kcal/day
• Target weight gain during pregnancy: 9-11 kg total; approximately 2 kg/month after the first trimester
• Low weight gain (< 2 kg/month) may indicate inadequate dietary intake and risks low birth weight (LBW) / intrauterine growth retardation (IUGR)
• Key nutrients to emphasize:
  • Iron and folic acid supplementation (tablet daily from early pregnancy, continued 100 days postpartum)
  • Calcium (especially in second and third trimester)
  • Protein-rich foods - pulses, eggs, milk, meat
  • Iodized salt to prevent goitre and cretinism
  • Vitamin A - green leafy vegetables, yellow fruits, liver
• Mothers should be counselled to eat at least one extra meal per day and avoid food taboos that restrict nutritious food during pregnancy

2. Personal Hygiene

• Daily bathing, keeping body clean, clean clothing
• Oral hygiene: brush teeth twice daily; dental caries and gum disease are common in pregnancy due to hormonal changes and increased acidity
• Perineal hygiene: keep the genital area clean; wipe front to back; change undergarments daily
• Breast care: keep nipples clean; inspect for flat or inverted nipples early so they can be corrected before delivery; wear a well-fitting supportive brassiere
• Rest and sleep: at least 8 hours sleep at night; 1-2 hours rest in the afternoon during the third trimester; avoid heavy physical labour especially in the last trimester

3. Bowel and Bladder Care

• Constipation is very common in pregnancy due to reduced gut motility; advise high-fibre diet, adequate fluids (8-10 glasses/day), mild exercise
• Do NOT take laxatives without medical advice
• Promptly report burning micturition or frequency as urinary tract infections (UTI) must be treated immediately - untreated UTI can cause premature labour

4. Exercise, Work, and Rest

• Moderate exercise is beneficial - walking is ideal; avoid strenuous work, lifting heavy loads, climbing ladders
• Continue normal activities as long as comfortable
• Avoid prolonged standing which can worsen varicose veins and ankle oedema
• Sexual intercourse should be avoided in the first 3 months (risk of abortion) and the last 6 weeks of pregnancy

5. Clothing

• Loose, comfortable, light clothing
• Avoid tight waistbands or clothes that restrict circulation
• Well-fitting flat-heeled shoes to prevent falls and backache
• Well-supporting brassiere

6. Antenatal Visits - Minimum Schedule

7. Immunization

• Tetanus Toxoid (TT): 2 doses - TT1 as early as possible, TT2 four weeks after TT1 (at least 4 weeks before delivery); gives protection against neonatal tetanus
• In a previously immunized woman, a single booster (TT booster) is sufficient

8. Danger Signs in Pregnancy (MUST report immediately)

1. Severe headache, blurred vision, spots before eyes (pre-eclampsia/eclampsia)
2. Swelling of face, hands, feet (oedema - sign of PIH)
3. Vaginal bleeding at any time
4. Reduced or absent foetal movements
5. High fever with chills (malaria, UTI, sepsis)
6. Severe abdominal pain
7. Difficulty breathing
8. Fits/convulsions
9. Leaking of fluid (premature rupture of membranes)
10. Severe vomiting - unable to keep food or water down

9. Birth Preparedness and Complication Readiness

• Decide on place of delivery early (institutional delivery strongly preferred)
• Identify a skilled birth attendant
• Arrange for transportation in case of emergency
• Keep emergency funds ready
• Identify blood donors of compatible blood group
• Prepare delivery kit for home birth if unavoidable: clean blade, clean thread for cord, clean cloth

10. Drugs to Avoid and Safe Medications

• Avoid all self-medication - many drugs are teratogenic in the first trimester
• Avoid: alcohol, tobacco, excessive caffeine
• Only take medicines prescribed by a doctor
• Iron + folic acid tablets: take on a full stomach if they cause nausea

11. Minor Discomforts of Pregnancy

12. High-Risk Identification

• Age < 18 or > 35 years
• Grand multiparity (4+ deliveries)
• Short stature (< 145 cm) - risk of contracted pelvis
• Severe anaemia (Hb < 7 g/dL)
• Previous caesarean, stillbirth, or neonatal death
• Multiple pregnancy
• Associated medical conditions: diabetes, hypertension, TB, HIV

PART B: Health Education During Postnatal Care (PNC)

1. Breastfeeding

• Initiate breastfeeding within 30 minutes to 1 hour of birth
• Feed the baby colostrum (first yellowish milk) - it is rich in antibodies (IgA), proteins, and vitamins; do NOT discard it
• Exclusive breastfeeding for 6 months - no water, no other milk, no other food
• After 6 months: complementary feeding begins while continuing breastfeeding up to 2 years or beyond
• Indian mothers, even with poor nutritional status, can secrete 400-730 ml/day
• Benefits of breastfeeding:
  • Provides complete nutrition in first 6 months
  • Confers immunity (IgA, lactoferrin, lysozyme)
  • Promotes mother-baby bonding
  • Reduces risk of postpartum haemorrhage (oxytocin release)
  • Lactational amenorrhoea provides natural contraception (though unreliable)
• Technique: ensure proper latch, feed on demand (8-12 times/day), allow baby to fully drain one breast before offering the other
• Contraindications to breastfeeding: maternal HIV (in resource-rich settings), active untreated TB, galactosaemia in the infant, certain chemotherapy drugs

2. Postnatal Nutrition and Rest

• Mother needs an extra 550 kcal/day during lactation
• Increase intake of protein, iron, calcium, and fluids
• Continue iron and folic acid tablets for at least 100 days after delivery to replenish stores
• Vitamin A supplementation (200,000 IU) given once within 6 weeks postpartum in areas of deficiency
• Adequate rest is essential; disturbed sleep due to the newborn increases exhaustion - family support should be arranged
• Avoid heavy physical work for at least 6 weeks

3. Perineal and Personal Hygiene

• Keep the perineum clean and dry; wash after each use of the toilet using a clean jug of water and wipe front to back
• Change perineal pads frequently
• Report any signs of wound infection: redness, swelling, discharge with foul odour, fever
• Sitz baths (warm water immersion of perineum) reduce discomfort from episiotomy or tears
• Breast hygiene: keep nipples clean; cracked nipples are the main entry point for mastitis
  • Apply breast milk to cracked nipples and let dry in air
  • For engorgement: warm compresses before feeds, cold compresses after

4. Danger Signs in the Postpartum Period (Report Immediately)

1. Excessive vaginal bleeding (postpartum haemorrhage - soaking >1 pad/hour)
2. Foul-smelling lochia (puerperal sepsis)
3. High fever (> 38°C) - puerperal sepsis
4. Severe lower abdominal pain
5. Swollen, red, painful breast with fever (mastitis)
6. Pain, swelling, redness in legs (deep vein thrombosis)
7. Fits or severe headache, blurred vision (eclampsia can occur postpartum)
8. Chest pain or difficulty breathing (pulmonary embolism)
9. Inability to pass urine (urinary retention)
10. Signs of depression, inability to care for baby (postpartum depression)

5. Newborn Care

• Kangaroo Mother Care (KMC): skin-to-skin contact for LBW and preterm babies - keeps the baby warm, promotes bonding and breastfeeding
• Cord care: keep cord stump clean and dry; apply chlorhexidine (7.1% gel) in the first week; do not apply anything unclean (turmeric, ash) to the cord
• Eye care: wipe eyes with clean cloth; report discharge
• Warmth: keep room warm, dress baby adequately; newborns lose heat rapidly
• Immunization of the newborn:
  • BCG - at birth
  • OPV 0 (birth dose)
  • Hepatitis B (birth dose within 24 hours)
• Danger signs in the newborn to report immediately:
  • Difficulty breathing / fast breathing / chest in-drawing
  • Poor feeding / not sucking
  • Convulsions
  • High fever or hypothermia (very cold to touch)
  • Jaundice appearing in first 24 hours or spreading to palms and soles
  • Umbilical redness or discharge

6. Family Planning

• Discuss family planning at every PNC contact
• Postpartum sterilization can be performed within 48 hours of delivery (recommended if family is complete)
• IUCD (CuT) can be inserted within 48 hours of delivery (post-partum IUCD)
• If not opting for permanent methods, use barrier methods (condoms) until menstruation resumes
• Lactational amenorrhoea method (LAM) is effective for up to 6 months only if exclusive breastfeeding is maintained and menstruation has not resumed
• Advise at least 2-3 years spacing between pregnancies for maternal and child health

7. Emotional and Mental Health

• Postpartum blues (mild, transient) are common in the first week - offer reassurance and family support
• Postpartum depression (persisting sadness, inability to cope, poor bonding) requires referral
• Encourage family involvement and social support
• Ensure the mother is not isolated

8. Postnatal Visits Schedule

Summary: Key Messages for Both ANC and PNC Mothers