Institutional Deliveries in
Primary Health Centre
By Dr. E.Aravind
Medical Officer,PHC, Veeraghattam
Why Institutional delivery• Availability of skilled staff to conduct delivery • Availability of drugs and equipment • Avoiding and prompt treatment of complications• Sterile conditions – less sepsis• Immediate identification and referral of
complicated cases• Neonatal care• To decrease maternal and infant mortality
Why Institutional delivery in a PHC• PHCs located near by to their living place
• PHCs are well equipped to conduct normal delivery
• No financial constrain• Promoting normal delivery• Promoting early breast feeding• Sound referral system• Cash incentive in the form of JSY
IEC Activity by MPHA and ASHA
• Information to public that PHC is equipped to conduct normal delivery and it is open 24 hrs
• Educating community about good habits, personal hygiene, diet …etc
• Importance of institutional delivery and advantages of delivery in Primary Health Centre
• Communicating with public by various means like group discussions, inter personal talking, posters and media
Awareness
Creating awareness in community about various schemes relating to delivery of child
• JSY• JSSK• 108• 104
Antenatal check-ups
• Registration and record keeping• At least two antenatal checkups by
MPHA(F) and two by Medical officer • Minor investigations like Hb%• Immunization• Identification of high risk mothers and
their referral to PHC or higher centers• Supplying IFA tablets• Importance of institutional delivery
particularly in Public Institutions
VHND’s• Co ordination with departments like ICDS, IKP,
tribal welfare etc….• Importance of anemia• Providing nutrition for antenatal and postnatal
mothers• Educating mothers about risk factors and how
to avoid them • Educating antenatal mothers about
disadvantages of cesarean section and to be accepted as last resort only
• Utilizing services of 108 and 104 • Antenatal check-ups by medical officer if
any medical camps conducted in a village• Home visit by MPHA(F) 1 week before EDD
and motivate the mother for Institutional Delivery in nearest PHC
Institution
• Primary Health Centre should be open round the clock with Staff Nurses in all shifts trained in SBA, NSSK …etc
• Availability of medical officer any time to attend difficult labour
• This message is should be communicated to public by our field staff and ASHA
Antenatal check-ups
• At least 2 antenatal check-up by medical officer of Primary Health Centre
• Specific day in a week• Monday in our Primary Health Centre• Identification of high-risk & management
Investigations Blood tests
• Hemoglobin• Blood group and
typing• Random blood sugar• HIV• HbsAg• VDRL
Urine tests
• Pregnancy test• Albumin and sugar• Microscopy
Drugs
• Inj Epidosin• Inj Oxytocin• Tab Misoprostol• Inj Methergin• Inj Carboprost• Inj MgSO4• Inj Lignocaine
Equipment
• Doppler fetoscope• Oxygen• Separate delivery
tray with instruments
• Outlet forceps• Resuscitation kit for
new born• Radiant warmer• Baby weighing
machine
Intra natal care
• 24-hour delivery• Promotion of institutional deliveries; • Conducting of normal deliveries• Assisted vaginal deliveries including forceps / vacuum delivery
whenever required• Manual removal of placenta• Referral for cases• Management of Pregnancy Induced hypertension • Pre-referral management (Obstetric first-aid) • There should be sufficient number of staff nurses
Post natal Care
• Care of mother after delivery.• Its components are:
– Postpartum examination– Medical care– Follow up– Health education– Family planning services– Child spacing– Nutrition – Psychological and social support
New born and Child Care
• Early initiation of Breast Feeding• Facilities and care for neonatal resuscitation • Management of neonatal hypothermia / jaundice • Emergency care of sick children -Integrated Management of
Neonatal and Childhood Illness (IMNCI) • Care of routine childhood illness • Essential Newborn Care • Promotion of exclusive breast-feeding for 6 months.• Full Immunization of all infants and children against vaccine
preventable diseases. • Vitamin A prophylaxis to the children • Prevention and control of childhood diseases, infections, etc.
Referral
• A prompt and sound referral system should be there for mothers with complications to nearest first referral unit where cesarean section facilities are available
• Providing PHC with Ambulance
Utilizing HDS funds
• Purchase of drugs chemicals and equipment
• Purchase of kits and chemicals for lab• Providing amenities and security to
patients and staff
IEC activity
• LCD TV• Charts• Drawings • Pamphlets
Amenities and Security
• Power back up with generator and inverter• Meals for patient and one attendant under
JSSK• Drinking water – RO filter• Hot and Cold water – Water dispenser• Closing all breeches in compound wall• Providing lighting in and around Primary
Health Centre
• Medical officer communicating with expectant mother by means of letters and phone calls
• Prompt payment of JSY to beneficiaries
• Continuous educating staff about process of labour and newer innovative methods
• Trainings for field level workers about importance of institutional delivery especially in PHC
Barriers for deliveries in PHC
• Increased no. of cesarean sections• Commercialization of medicine• Touts by private practioners• Lack of adequate staff in PHCs
JSSK• Free and Cashless Delivery• Free C-Section• Free treatment of sick-new-born up to 30 days• Exemption from User Charges• Free Drugs and Consumables• Free Diagnostics• Free Diet during stay in the health institutions – 3 days in case of normal
delivery and 7 days in case of caesarean section• Free Provision of Blood• Free Transport from Home to Health Institutions• Free Transport between facilities in case of referral as also Drop Back from
Institutions to home after 48hrs stay.• Free Entitlements for Sick newborns till 30 days after birth similarly include
Free treatment, Free drugs and consumables, Free diagnostics, Free provision of blood, Exemption from user charges, Free Transport from Home to Health Institutions, Free Transport between facilities in case of referral and Free drop Back from Institutions to home.
Utilizing technology • Using telemedicine
concepts would be very useful
Life begins with waking up and loving yours mother's face