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

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