Self motherhood

Motherhood in its simplest meaning can be defined as a state of being a mother. Safe motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy child birth.

The safe motherhood initiative is world wide effort that aims to reduced the number of death and illness associated with pregnancy and child birth. Safe motherhood can be achieved by providing high quality maternal health serviced ti all women during pregnancy,child birth and the post mar tum period. Service to help make motherhood safer include:care by skilled health personnel before, during and after childbirth and emergency care for life. Threatening obstetric complication. Good maternal health is the well being of the mother before during and after the baby's birth.

Preventing and managing those problems require a well functioning health system that provides accessible, high quality care from the household to the hospital level. In addition, a large of social, economic and cultural factors also contribute to women;s poor health before during and after pregnancy.Millions of women do not have access to good quality health services during pregnancy and child birth especially women who are poor uneducated or who live in rural areas. In case of Nepal, the situation of maternal health status is more critical Nepal demographic and health survey shows that one in two percent women receive untenable car, with 28 percent receiving care from a doctor or nurse, midwife or auxiliary health workers, 3 percent receive care from a maternal and child health worker and, 6 percent receive care from village health worker. Most Nepalese women who receive antenatal get if at a relatively late safe in their pregnancy and do not make the minimum recommended number of antenatal visit only one in seven women (14 percent) makes four more visits during their in tire pregnancy, while 16 percent of women report that their first visit occurred to less then four month of pregnancy. Forty five percent of women receive two or more doses of tetanus taxied injections during their most recent pregnancy.

The Prime Massages Related to Safe Motherhood

The following Prime massages related to safe motherhood are the most useful for safe motherhood.

1. The risk of child birth can be drastically reduced by going to the nearest health worker for regular check-ups during pregnancy because a health worker will help the women to Have a safe birth and a healthy baby.
2. A trained person should assist at every birth because a trained birth attendant will know how to keep the birth clean and reduce the risk of infection.
3. To reduce the dangers of pregnancy and child birth ,all families should know the warning signs . It is important of pregnant woman, their husbands ,and other family members , to know the signs which indicate that extra care , and regular visits to a health workers are needed.

• Warning signs before pregnancy and during pregnancy are listed as follows:
  
  (a)Warning signs before pregnancy begins:
  
• An interval of less than two years since the last birth.
• woman less than 18 or more than 35 years.
• Woman has four or more previous premature birth .
• woman has had a previous premature miscarriage abortion or still birth.
• Woman weight less than 38kg before pregnancy .
• Woman measures less than 145 cm in height .
• Woman had a previous convulsion.
• Woman had a goiter, HIV AIDS, sexually turnsmitted disease or other medical problems such as heart disease, lungs diseases etc.

(b) Warning sings developing during pregnancy:

• failing to gain weight at least 6kg should be gained in pregnancy.
• Unusual swelling of legs, arms or face
• Woman has had previous convulsion
• Woman has goiter and or other medical problems pf heart lungs etc.
• paleness of inside eyelids ( should be red or pink)

(c) Five sings which mean get help immediately:

• Bleeding from the vagina during pregnancy
• severe headache (sign of high blood pressure
• Severe vomiting
• High fever
• Blurring of vision

(4) Unless she is already overweight a woman needs more food during pregnancy. All pregnant woman need more rest.


(5) Spacing pregnancies at least two year apart and avoiding pregnancies below the age of 18 and above the age of 35 years drastically reduces the dangers of child bearing.


(6) Girls who are healthy and well fed during their own childhood and teenage years have fewer problems in pregnancy and childbirth.


(7) Smoking among pregnant woman increases risks of pregnancy and endangers the health of the infant.

Scope of Safe Motherhood

Safe motherhood includes a large number of subject matters. So the scope of safe motherhood is very wide. Generally, the scope of safe motherhood can be classified under the following five broad heading.

1. Antenatal care: Antenatal care means care during pregnancy.
2. Delivery care:
3. Postnatal care: Postnatal care means care after delivery.
4. Neonatal care: Neonatal care means care of infant under one month of age.
5. Reproductive right of woman and social justices.

Maternal and Child Health Care

Maternal and child health care(MCH) refers to the promotive, preventive curative and rehabilitative health care for mother and children. The ultimate objective of maternal and child health care programme is life long health. The major objectives of maternal and child health care are as followings.

(i) Reduction of maternal, perinatal, infant and childhood mortality and morbidity.

(ii) Promotion of reproductive health.

(iii) Promotion of the physical and psychological development of the child and adolescence within the family.


The maternal and child health care programme includes the following component:

(a)Antenatal Care(ANC)

(b)Intranatal Care(INC)

(c)postnatal Care(PNC)

(d)Care of children under age 5 year.

(a) Antenatal care(ANC): Antenatal care is the care of the woman during pregnancy. It is universally accepted that only healthy mother can give birth to a healthy child. the pregnant mother needs special health care and that can be gives in the following ways.

-pregnant female should have proper check up their health where ever it is possible such as health post, health centre,hospital etc.Minimum four times check up is needed as following:

• first check up before 10th weeks .
• Second check up 20-24 weeks.
• third check up 28-32 weeks.
• Fourth checks up 36-37 weeks
  

- Pregnant female should take nutritious food which helps to make the health of both mother and foetus in a good condition. Pregnant female should can some 300kcal extra energy and lactating woman should can sume 550kcal extra energy every day.

-Pregnant female should do light physical exercise and also should take rest but should not carry heavy load because in many result abortion. She should take rest of at least 2 hours in a day time and 8hours in night times.


-Pregnant female should be immunized against Titanus, TT vaccine is to be taken at 16-20 weeks and at 20-24 weeks (with a gap of 1 month).

-She should not take drugs without prescription and she should not take X-ray.

-Pregnant female should not travel long distance.


(b) Intranatal care(INC): Intranatal is the care during delivery or child birth. The ways of caring the woman at the time of delivery are as following.

• Transport the casually to the nearest hospital.
• Advice the casualty to take bath and public hair should be cleanly shaved.
• Glucose water or plain water should be given frequently.
• Facilitate the casualty in a dorsal position.
• After delivery, facilitate for clear expulsion of mucus umbical cord and placenta .
• Advice and ask casually for urination.
• Home delivery should be done by Trained Birth Attendant(TBAs) and "3 cleans " should be born in mind i.e. clean hand, clean cutting instrument and clean sheet. Now days SUTKERY SAMAGRI has become popular which contains blade, plastic, rubber coin, soap and threads.
• Torn up part (i.e., perineum) should be stitched.
  
  
  (c) Postnatal care (PNC): Post natal care is the care of the mother and the child until 6 weeks after delivery. the woman has physically more weakness due to hard labour which may create various health problems. For this reason, proper health care postnatal mother is necessary and for that the following ways should be adopted.
  
  
• Mother should be advised to take bath with warm water.
• Mother should be kept in a warm and clean room where sunlight may easily come.
• Sexual intercourse should be avoided up to 42 days from the time of delivery.
• Soon after the delivery, the health check up must be frequent.
• Balanced diet should be given to the mother.
• The instrument used to cut the umbical cord should be sterilized by boiling.
• Breast feeding should be started immediately after the birth of child.
• The nose of the infants should be cleaned.
• Proper warm and clean clothes should be used for the neonates.
• Health examination9n of infants should be done from time to time.
  
  
  (d) Care of Infants and Children Ages Under 5 years: proper health care of children aged under 5 years is required and for this, the following ways be adopted.
  
  
• Breast milk provides adequate nutrition for infants till the age of 5-6 months.
• Introduction of additional food essential after reaches 5-6 months of age.
• Breast milk should ideally be continued till a child is 24 months of age.
• Infections diseases like measles, whooping cough, tetanus, diphtheria, Polio etc. are associated with under age five years. Therefore, children should be immunized by BCG, DPT,Polio, Measles and TT within the period of 12 months from the time of birth.

Safe Motherhood programme in Nepal

Safe motherhood programme is one of the important programmes carried out under ministry of health towards reducing maternal and neonatal mortality.

Objectives, Targets and Programme of Safe Motherhood in Nepal

Objectives

The main objectives of safe motherhood programme in Nepal is to reduce neonatal mortality rate,to reduced maternal complication and to reduce neonatal mortality rate. The other objectives of safe motherhood programme in Nepal are as follows.

1. Strengthen and extension of maternal health care services.
2. To increase the quality of antenatal, delivery and postnatal services by providing training opportunities to all level of workers.
3. Strengthen the basic delivery services in district hospital by providing necessary instruments and qualified and efficient health workers.
4. To provide at least one kit box (a box in which all the necessary medicine and instruments) to each and every health post, sub health post and all the ANM and MCCH workers who are engaged in health institutions for the emergency treatment and management of complication during the period of antenatal, delivery and postnatal.
5. To establish effective and workable mailing system from village to district level.
6. Strengthen the community based safe motherhood services through public participation by condition information and educational programme.
7. To increase public awareness and participation about different subject related to safe motherhood services.
8. Especial emphasis is given for the appropriate improvement of minimum legal age at marriage and liberalization abortion law.
9. Promotion of basic education for children and adult education and income generating skill programmes for woman.
10. Identification and conduction of research and education activities for the improvement of mother's health.
11. Increase the mailing and the service providing facilities for maternal complication and emergency service.
    
    
    Targets
    
    The following targets related to safe motherhood have been set for the second long term health plan(1997-2017).
    
    
12. To reduced the total fertility rate 3.05 per woman.
    To reduced the maternal mortality rate to 250 per hundred thousand live births.
13. To increase the contraceptive per valence rate 65 percent.
14. To increase the percentage of pregnant woman attending a minimum four antenatal visits to 80 percent. To reduced the percentage of iron deficiency anaemia among pregnant woman 15 percent.
15. Ti increase the percentage of woman of childbearing age(15-49) who receive tetanus taxoid(TT2) to 90 percent.
16. To income the percentage of delivery attended by trained personnel to 60 percent.
17. To increase The supply of unmet need of necessary delivery services at the rate of 2 percent by the year 2006 in those districts where the programme has been launched and this rate also increase along with extension of the programme.
18. To decrease the percentage of newborns weighting less then 2500 grams to 12 percent.
    
    

Programmes

The followings four types of strategies have been formulated to conduct the safe motherhood programme in Nepal.

1. Strengthen the maternal and child health care services include the following strategies. (a)Strengthen the primary health services related to safe motherhood. (b) Expansion the district hospital as a centre for the basic delivery services. (c) Effective mobilization of local NGO's.
   
2. Involvement of different agencies\ organizations in safe motherhood programme.
   
3. Increase the status of woman through education, law and income generating activities.
   
4. Promotion of research activities related to safe motherhood.

Menstrual cycle

Menstruation is the flow of blood and other dead cells from the uterus through vagina once a month in the female. Menstruation occurs in female every month throughout the child bearing period starting from age of menarche to menopause .

The menstrual cycle consists of change in ovary and uterus. The menstruation last about 4 to 5 days during the period, the surface epithelium is striped off the lining of the uterus and bleeding occur es. The average length of this cycle is about 28 days. However, it ranges from 26 to 35 days because this period is varies according to diet, environment, climate, malnutrition etc.

There are, generally, there phases menstrual cycle.

(i) Proliferative phase

(ii) Secretory phase

(iii) Menstrual phase

1. Proliferative Phase

This phase last about 14 days, starting from the first day of menstruation of the day of ovulation. Generally ovulation occurs 14th day of menstruation. So this phase involves 14 days.

During the period, the interior pituitary gland release Follicle Stimulating Hormone(FSH). FSH stimulates the development of follicles in the ovary. The cells follicles secretes oestrogen hormone which stimulates the uterine epithelium to proliferate.

When the oestrogen in the blood reaches a certain concentration, it also acts on the pituitary glands to shut down FSH production and the pituitary glands now release Luteinizing Hormone(LH) to the circulation. In combination with residual, FSH it results in ovulation.


2. Secretary Phase

This phase prepares the endometrium for pregnancy and implantation. During this phase, LH stimulates lining cells of the ovarian follicle to produce progesterone. The progesterone influences the endometrium to secrete watery mucus which helps to thickness the . This phase lasts about 10 days.


3.The Menstrual Preparation Phase

If pregnancy does not relation, it is followed by menstruation and so, it is also called premensmtruation phase.

During this phase, due to high level of oestrogen and progesterone in the blood, they restrain the activity of the pituitary glands. Production of ovulation hormones then drops. As a result, the surface epithelium break down the lining of the uterus and discharge of blood along with some mucus through the vaginal orifice. This is called menstruation.

Sex Determination

Determination of individuals sex depends on the kind of sperm that unites with the ovum. Two kinds of spermatozoa are produced in equal numbers. The first contains twenty two matched chromosomes plus one x chromosome. The second contains twenty two matched chromosome plus one y chromosome. The x and y chromosomes are sex determining chromosomes. The mature ovum always contains and x chromosomes. If it is fertilized by y bearing spermatozoa, The offspring will be a buy. If it is fertilized an x bearing spermatozoa, the offspring will be a girl.

Number of offsprings

Most of humans are born singletons, multiple birth also occur in some cases. Wen a ripe ovum is fertilized by one spermatozoa, the result will be a singleton, unless the fertilized ovum (zygote) splits into or more distinct parts during the early stage cell cleavage. When this happens, the result will be identical twins, triplets, or other multiple births. If to or more Ava are released simultaneously and are fertilized by different spermatozoa, the result will be nonidentical twins, triplets or other multiple birth. Meredith has reported that 1 out of 80 births is twins 1 out of 9000 is triplets and one out of every 570000 quadruplets. There are more frequent multiple birth among blacks and fewer among Chinese, Japanese and other Mongoloid, race group than there are always whites.

Fertilization

During sexual intercourse, spermatozoa are deposited at the month of the uterus. Through strong harmonic attraction, they are down into fallopian tube through uterus. These sperms actively swim with the help to their tail and pass through the cervix into uterus progressing of the rate of approximately 1.5mm per minute. F 21 rom the uterus, they climb up to reach the oviducts.

As a result of ovulation, the ovum as released in the abdominal cavity. the cilia of fallopian tube produce a current by which ovum enters a oviduct funnel. It travels down the Fallopian tube. If there happens to be a spermatozoa in the oviduct, fertilized ovum units with a sperm. The fusion of sperm uncleus with age uncleus is called fertilization and zygote is formed.

A single ejaculation by the human male is about 2-6 ml and contains about four hundred million sperms. Out of the million of sperms released in the vaging, very few are able to climb up to the upper parts of oviducts, the rest die on the way and are absorbed.

Conception takes place when the sperms from the male meets and units with the egg of the female. Gradually, the egg fertilized by the sperm from a foetus which is the tiny beginning of the baby, and it continuous to grow 9 months.

Breaset feeding

Breaset feedingBreast feeding is a process of breast fed to her child. Babies should started to breast fed as soon as possible within 30 minutes after birth starting to breast fed immediately after birth stimulates the production of breast milk. If possible breast feeding should Begin not later then one hour after the delivery of the baby.

In some areas, mothers are advised not to feed their babies on the yellowish breast milk called(colostrum) which is produced in the first few days after The birth. This ad viced is wrong. Colostrum is good for babies and helps to protect them against common infections. The baby does not need any other foods or drinks while waiting for the norther's mil to "come in".

Mother can still breastfeed even when she had undergone caesarion operation, even when she menstruating, or even when she has common cold or flu, or have small breast. Women may fell a little discomfort at the smart of breast feeding. But if the woman is emotionally and psychologically fitted, this will encourage them let down reflex that controls milk flow. Silk babies can and should continue to be breastfeed. The breast food for any baby is their own mother's milk.

From birth, the baby should be breastfed when ever he or she wants to, usually indicated by crying. Demand feeding is best for baby and best for mother and frequent sucking at the breast is necessary to stimulate the production of more breast milk. From the moment of birth up yo the age of sex months, breast milk is all the food and drinks a baby needs. Supplementary foods and drinks are necessary when a baby reaches the age of six months until the age of nine or ten months, the baby should be breastfed first be for other foods. Breastfeeding should continue well into the second year of life and fore longer if possible.


Advantage of breastfeeding

There are several advantage of breastfeeding for baby and mother. Some important advantages of breastfeeding are as follows.

1. Babies fed on breast milk have fewer illness and less malnutrition then babies who are fed on other food.
   
2. Breast milk along is the best possible food and drink for the baby in the first six months of life. It is the breast food a child will ever have all substitutes.
   
3. Even in hot, dry climates, breast milk contains sufficient water for a long baby's needs. Additional water or sugar drinks are not needed to quench the baby's thirst.
   
4. Frequent breastfeeding, both day and night, helps to delay the return of menstruation and so help to post pone the next pregnancy.
   
5. The thick yellowish breast milk which is produced in the first few days after the birth helps to protect them against common infections.
   
6. Frequent sucking helps to stop the breast from becoming swollen and painful.
   
7. Breast milk in an important source of energy and protein and helps to protect against disease during the child's second year of life.
   
8. A child who is needs breast milk. It provides nutritious easily digestible food when the child loses appetite for other foods.
   
9. A mother feels a kind of satisfaction during breastfeeding.
   
10. Breastfeeding makes emotional relationship between mother and children.
    
11. Breastfeeding reduce the probabilities of becoming breast cancer.
    
12. It contains every thing a baby needs for health and growth.
    
13. Always clean and free from germs.
    
14. Always available, fresh at a right temperature.
    
15. Easy to feed, no preparation is required.
    
16. Breastfeeding helps to create a close relationship between mother and baby.
    

Does bottle feeding appropriate for a baby

Bottle feeding process is wrong. Bottle feeding can lead to serious illness and death. Bottle feeding can cause illness such as diarrhoea unless the water is boiled and the bottle and nipples are sterilized in boiling water before each feeding. A bottle fed baby is 25 times more likely to due of diarrhoea that baby fed exclusively on breast milk for the first 6 months. The best food for a baby who, for whatever reason, cannot be breastfed is milk squeezed from the mother's breast, it should be given in a cup that has been sterilized in boiling water. Mother can use sterilized spoon to feed milk for the baby. A bottle is difficult to clean and keep free from germs. If the bottle is not cleaned and boiled properly, it can cause serious infections in the baby.


The prime message related to Breastfeeding:

1. Breast milk alone is the best possible food and drink for a baby in the first six months of life.
   
2. Babies should start to be breastfed as soon as possible within 30 minutes after birth. Sucking will help stimulate milk production. Virtually, every mother can breastfed her baby.
   
3. Frequent sucking is needed to produce enough breast milk for the baby's needs.
   
4. Bottle feeding can lead to serious illness and death.
   
5. Breastfeeding should continue well into the second year a chid's and for4 longer, if possible, if mother's health permits.

MEANING OF ADOLESCENCE

The term adolescence comes from the Latin words Adolescence meaning "to grow" or "to grow to maturity". As it used today, the term adolescence has a broader meaning. It includes mental, emotional and social maturity as well as physical maturity.
The term "Adolescence, youth and young people" are used differently in various societies. Thus categories are associated where they are recognized at all with different roles, responsibilities and ages that depend on the local context.

adolescences has been defined by the world health organization as the period of life spanning the ages between 10-19 years and youth as between 15-24 years. Young people are those between 10-24 years of ages. (WHO,1997). Adolescence is the second decade of life and it is a period of rapid development. Moreover, it is a time when growth is accelerated, major physical changes take place and differences between boys and girls are accentuated.

Adolescence is a transitional period from 10-19 years of ages during the period of rapid changes occurs in the baby. This period can be classified into two groups.

(a)Early adolescence
Early adolescence is the period of life spanning the ages between 10_14 years.

(b)late adolescence
Late adolescence is the period of life spanning the ages between 15-19 years.


During the past decade, young people and their health needs have been the subject of greater attention worldwide. Specially, the issues of adolescent's reproductive health global attention after the international conference population and development(ICPD,1994}, since adolescence is a time of mental and phychological adjustment and it a situation of being no longer then a child, but not get an adult either.

Change During Adolescence

Change that take place during the period of adolescence can be ategorized female during three different categories
Physical change

1.Mental change

2.psychological change

1. Physical change

There are different kind of physical change can be observed in both make and female during adolescent. So physical change during adolescence can be separately described.

A. Physical change during adolescence in female:

Breast Budding

This starts between age of 8 and 13 and complete between ages of 13 and 18

Pulic Hair

Pubic hair begins to grow between the ages of 11and 12 on an average.

Axillary hair

Axillary hair appears on an average some 2 years after the beginning of public hair growth.

Menarche starts

Generally the age range for menarche may very from 9-18 years. this usually begins 2 years after the starts of breast development.

Completion of the growth of uterus and vagina

The musculature well of the uterus becomes larger and elaborate. The vagina becomes larger and its lining grows thicker.

Growth of Bony Pelvis

This change primarily involves the widening of the pelvic inlet and broadening the much more noticeable hips.

Voice change melodious voice

B.physical changes during adolescence in male

Growth of testes and scrotum

Growth of testes and scrotum usually begins between the ages of 10 and 14 years and is completed between the ages of 14 to 18 years. During the period, seminiferious tubules increases in size and the cells in the lining of the tubules pass through a succession of stages.

Growth of public hair

This occurs between the ages of 10 and 15. Public hair becomes darker, coarser and more curly hair as it spreads over the scrotum and higher up the abdomen.

Wet Dream/ nocturnal emission

This usually occurs about a year after testicular growth. The average age for first ejaculation is 14.6 years of age.

Growth of penis

The start of penis growth spurt occurs normally between the ages of 10.5 years and completion of this growth spurt range from 12.5 to 16 .5 years.

Voice Change

This occurs relatively late in adolescence and of ten a gradual process.

Facial hair

Facial hair begins to grow at about the time auxiliary hair appears

Auxiliary hair

These generally appears a couple of years the growth of public hair.

2.Psychological Changes

Psychological changes during adolescence period are like more or less same in both male and female. These are listed as followings.

• Development of sense of identity
• Drawing apart from older members of the family
• developing more intense relationship with peers, particularly with those of the opposite sex.
• Moving from group of the same sex to mixed group.
• Sexual pairing may take place.
• Because they mixture earlier, girls may experience romantic interest before boys, this sometimes leads to sexual activity.

3.Mental Changes

Mental changes during adolescence period are less or more same in both male and female. These are listed as followings.

• Adolescence is a time for exploration and discovery
• Young people begin to think seriously and plan for their future during this phase.
• To achieve emotional maturity, adolescents must learn to get a perspective on situations which otherwise would bad to emotional reactions.

They can do this by discussing their problems with others.

Issues and Problems of Adolescence

1. The major physical hazard of adolescence, suicide is becoming increasingly frequent and serious, through other physical hazards, such as awkwardness, a sex-inappropriate baby build and homeliness are to common to be overlooked.
2. The major psychological hazards of adolescence center around failure to make transition to maturity, which is the most important development task of adolescence.this future is often due to obstacles over which adolescents have little or on control.
3. Shift in mood
4. Lack of control emotion
5. Feeling of inferiority and superiority
6. Feeling of anxiety and guilty
7. Feeling of double standard
8. Sexual fantasy
9. Sexual harassment, Sexual abuse, Sexual exploitation
10. Negative Sexual attitudes.

Management of Issues and Problems of Adolescents

1. Role of parent, family, relatives and community
2. Role of School and college

• Including sex education in curriculum
• Extra curricular activities
• Counseling

3. Role of beer group/youth group

4. Own role