https://doi.org/10.33698/NRF0212 Ravneet Kaur, Surinder Kapoor, Sushma K Saini
Abstract : Advance preparation for birth during pregnancy is a beneficial step to meet all important needs of women and neonate. Aim of study was to prepare pregnant women for safe delivery, postnatal and neonatal care. An operational study was carried out in low income colony Chandigarh. Tools included survey proforma, socio demographic proforma, interview schedule and scoring sheet to assess the preparation of pregnant women for safe delivery, postnatal and neonatal care, protocol on safe delivery, postnatal and neonatal care was prepared in form of Hindi booklet and flipbook. Total seventy-two pregnant women of third trimester were selected through total enumeration technique and all were interviewed to assess their preparation for four subsequent weeks. In pre interventional assessment all subjects were registered, investigated for all essential laboratory diagnostics, immunized with TT injection, maintaining their personal hygiene, identified the institute for delivery. After implementation of protocol and repeated motivation during follow up visits all subjects were prepared themselves for safe delivery and postnatal and neonatal care. Most difficult aspect of the study was to prepare the subjects to take iron and folic acid tablets regularly, preparing bag for delivery, performing antenatal exercises and plan to adopt family planning methods. It is concluded Regular education and supervision by health care professionals will help the pregnant women to prepare for safe delivery, postnatal and neonatal care.
Keywords
Preparation, Safe Delivery, Postnatal Care, Neonatal Care
Introduction
In present scenario Maternal and Infant mortality is 174/1 lakh and 40 /1000 respectively. These two are the substantial burden on the developing countries. 1,2
Correspondence at
Ravneet Kaur Dhillon
16 Kalimna Way
Truganina Victoria 3029 Australia
Reduction in mortality of women and infant is an area of concern for the government across the globe. About a quarter of these “maternal” deaths occur in India.3 Every minute the maternal deaths occur due to lack of awareness about complications, delays in receiving care, precautions to be taken during pregnancy etc. To avoid all these it is important to maintain maternal health.4
Maternal health refers to the health of women during pregnancy, childbirth, and the postpartum period. Care done during both pregnancy and postnatal period helps the women to have healthy living. To have safe delivery pregnant women should register herself in antenatal clinic, avail all available clinic services, doing exercises, monitoring fetal movement chart, prior arrangement of money and vehicle, prior selection of hospital for delivery, prepare bag for both mother and baby and many more.5-7 Postpartum care includes the maintenance of personal hygiene, care of episiotomy, taking healthy diet, doing postpartum exercises, knowledge about danger signs of postnatal period, and family planning methods etc. It is mandatory for every woman to have knowledge of every aspect of postnatal care, thus postpartum deaths and complications can be avoided.8,9 A healthy delivery starts with providing good neonatal care, for that a mother needs to have sufficient knowledge about essential care of neonates that includes immediate and exclusive breastfeeding, warming of the infant, prevention of infections, Immunization, hygienic care of the umbilical cord, and timely identification of danger signs with referral and treatment etc.
To prepare the pregnant women for safe delivery, postnatal and neonatal care, readiness for safe motherhood program is the most important all over the world. Being prepared for safe delivery and being ready in case of any emergency will reduce these life- threatening delays and save the lives of both involves not only the pregnant woman, but also her family and community because they help in adequately prepared women for delivery. The process of prior preparation begins, immediately when a health care professional comes in contact with pregnant women. They required doing the regular assessment of pregnant women’s health and helping them to meet their health needs. Moreover regular guidance and supervision of woman by health worker ensures that pregnant women will receive skilled birth attendance at the time of delivery.11 Thus by considering the role of health workers in Preparation for safe delivery, postnatal and neonatal care the need was felt to carry out the study so that pregnant women can be educated.
Aim
To prepare pregnant women for safe delivery, postnatal and neonatal care.
Method
An operational study was carried out in months of Sept to Nov 2011 in low income colony, UT, Chandigarh. By total enumeration sampling technique all the pregnant women of third trimester were identified through survey proforma and enrolled in study and sample constitute 72 pregnant women.
Study was approved by the ethical committee of PGIMER Chandigarh and written permission was taken from Medical Officer of civil dispensary of low income colony, Chandigarh. The tools used in the study included survey Proforma, socio- demographic proforma, semi-structured interview schedule included total 46 items to assess the preparation of pregnant women for safe delivery, postnatal and mother and baby.4 Birth preparation neonatal care, scoring sheet was developed that consisted total 65 score and for each item was scored from 0 to 2. Further the total score was divided into excellent, good, average and poor. Protocol was prepared in the form of Hindi booklet and flipbook. The tools and protocol of the study were developed after reviewing the literature and validated by experts in the field of nursing, obstetrics and gynecology and public health.
To check the feasibility of study a pilot study on 5 subjects was done and necessary changes were made in tools. Cohn’s kappa inter-rater reliability of the interview schedule was checked on five subjects by two raters. Interrater reliability co-efficient was 0.9 for tool that was reliable.
For data collection house to house visit of 3003 houses were done and 72 subjects in third trimester of pregnancy were identified through survey proforma. A Written consent was signed by each participant before taking part in study. Preparation of subjects for safe delivery, postnatal and neonatal care was assessed by using semi-structured interview schedule and the scores were given to them. Then, on same day the each subject was educated from flipbook and demonstrations on antenatal, postnatal exercises and baby bath and baby eye care (on baby dummy) were given. For their ready reference Hindi booklet was given to them. The whole procedure had taken 1 hour 15 minutes. In post interventional period weekly four follow up visits were done .During this period same interview schedule was applied and return demonstrations were taken from each subject .Every time they were scored based upon their preparation and reemphasized the points in which they find difficulty. Here it is to be noticed that few participants delivered in between the study subsequently their number had reduced in each follow up visit and by the end total 52 subjects were there in study. Afterwards the data was analyzed using descriptive and inferential statistics. The various statistical measures used such as frequencies, percentage, and parametric tests i.e. paired t test and repeated measures Avona.
Results
Socio-demographic profile of the subjects’ show that age of all subjects’ ranged from 20 to 35 years with the mean age ± SD of 25.28 ± 3.89. More than half 41 (57%) of the total subjects’ were in period of 32-36 weeks of gestation, and this period ranged from 27-40 weeks with mean ± SD of 32.54 ± 2.43 weeks. Out of total 72 subjects’, 19 (26.4%) subjects’ were educated up to Matric. Majority (95.4%) of the subjects’ were housewives and 60(83.3%) of subjects’ belonged to Hindu families. As per caste is concerned 31(43.1 %) subjects were from schedule caste. More than half 40 (55.6 %) of the subjects belonged to nuclear families. The range of per capita family income was from Rs. 444/- to Rs.10,000/- and the mean income ± SD was Rs. 1768.8 ± 1314.42. Obstetric data of subjects’ show that out of total 72 subjects’, 26 (36 %) and 24 (33.5 %) subjects’ were first and second Gravida respectively .Only one subject was fifth Gravida. Out of total 72 subjects’ 13(18.1%) subjects had experienced missed abortion and 7(8.3%) had still birth, 2(2.8%) had problem of preterm labour, 1(1.4 %) subject each had problem of premature rupture of membrane and intra- uterine death of fetus in their previous pregnancies. Medical and surgical history of subjects’ show that 11(15%) subjects’ had history of medical illness .one woman each had Cholecystectomy and laparoscopy.
During preinterventional assessment (Table 1) it was good to noticed that all 72 subjects’ were already registered in health care facilities and immunized with TT. Almost all subjects’ (97.2%) had undergone all essential laboratory investigations. More than half (57%) subjects’ were undergoing regular antenatal checkups .Only 5(6.9%) subjects’ had consumed the 100 iron and folic acid tablets and 53(74% ) subjects’ had consumed 30-60 iron and folic acid tablets. 66 (91.6%) subjects’ were taking the calcium supplement regularly and 56 (77.8%) subjects were taking balanced diet. During post interventional assessment at the end of study all subjects’ started regular antenatal checkups. 23% subjects’ had consumed 100 and 57.7% subjects’ had consumed 30-60 iron and folic acid tablets. All subjects had started taking the calcium supplements regularly and almost all (94.2%) subjects’ had started taking balanced diet .Two subjects’ who had pica, they had started taking treatment.
Table 1: Pre and post interventional assessment of subjects in receiving essential antenatal care during pregnancy
| Variable | Pre interventional Assessment N=72(%) | Post interventional Assessment | |||
| 1st follow up N=72(%) | 2nd follow up N=64*(%) | 3rd follow up N=63(%) | 4th follow up N=52(%) | ||
| Registered in health facility | 72 (100) | 72 (100) | 64 (100) | 63 (100) | 52 (100) |
| Regular Antenatal checkups | 41 (56.9) | 58 (80.6) | 60 (93.7) | 61 (96.8) | 50 (96.2) |
| Immunized with TT (2 doses) | 72 (100) | 72 (100) | 64 (100) | 63 (100) | 52 (100) |
| Laboratory investigations | |||||
| Half | 2 (2.8) | 2 (2.8) | 1 ( 1.5) | 1 (1.6) | — |
| All | 70 (97.2) | 70 (97.2) | 63 (98.5) | 62 (98.4) | 52 (100) |
| Diet and Supplementation | |||||
| Iron and Folic acid tablets | |||||
| <30 tablets | 8 (11.1) | 8 (11.1) | 5 (7.8) | 2 (3.1) | — |
| 30-60 tablets | 53 (73.6) | 48 (66.7) | 44 (68.7) | 44 (69.9) | 30 (57.7) |
| 60-90 tablets | 6 (8.3) | 5 (6.9) | 9 (14.1) | 6 (9.5) | 10 (19.2) |
| 90 & above | 5 (6.9) | 11(15.3) | 6 (9.4) | 11 (17.5) | 12 (23.1) |
| Supplements (calcium) | 66 (91.6) | 69 (95.8) | 64 (100) | 63 (100) | 52 (100) |
| Balanced diet | 56 (77.8) | 54 (77.8) | 58 (90.62) | 59 (93.65) | 49 (94.2) |
| Taking pica treatment | — | 2 (100) | 2 (100) | 2 (100) | — |
| (Tab. Zinc and Iron) | |||||
Maintenance of Daily Activities of subjects’ (Table 2) show that 55 (76.4%) subjects were taking 2 hours rest during day and 8 hours sleep at night. Majority (93%) subjects’ were not performing any antenatal exercises. Most of subjects’ were not maintaining fetal movement chart. In post interventional assessment Majority (92.3%) of subjects’ had started taking adequate rest and sleep. 67% subjects’ had started doing antenatal exercises regularly and 38.5% subjects’ started maintaining the fetal movement chart.
Table 2: Maintenance of Health and Daily Activities in Pre and Post interventional Assessment
| Variable | Pre interventional Assessment N=72(%) | Post interventional Assessment | |||
| 1st follow up N=72(%) | 2nd follow up N=64*(%) | 3rd follow up N=63(%) | 4th follow up N=52(%) | ||
| Personal hygiene maintained | 72 (100) | 72 (100) | 64 (100) | 63 (100) | 52 (100) |
| Precautions taken in daily chores | 71 (98.6) | 72 (100) | 64 (100) | 63 (100) | 52 (100) |
| Doing antenatal exercises | |||||
| – Not performing | 67 (93.1) | 31 (43.1) | 30 (46.9) | 18 (28.6) | 17 (32.7) |
| – Performing irregularly | 5 (6.9) | 36 (50.0) | 28 (43.8) | 37 (58.7) | 17 (32.7) |
| – Performing regularly | — | 5 (6.9) | 6 (9.3) | 8 (12.7) | 18 (34.6) |
| Maintaining Fetal movement chart | 2 (2.8) | 20 (27.8) | 17 (26.6) | 19 (30.1) | 20 (38.5) |
| Taking adequate Rest and | 55 (76.4) | 65 (90.3) | 59 (92.18) | 60 (95.2) | 48 (92.3) |
| Sleep (2 hr in day & 8 hr in night) | |||||
| Avoiding long travel | 59 (81.9) | 69 (95.8) | 64 (100) | 63 (100) | 52 (100) |
| Avoiding coitus | 65 (90.27) | 72 (100) | 64 (100) | 63 (100) | 52 (100) |
Preparation of subjects’ for safe delivery (Table 3) during pre-interventional assessment describes that more than 80% of subjects’ had arranged money for delivery and had identified institute for delivery. Only 10(13.9%) subjects’ were ready with their bag for delivery. In post interventional assessment all subjects had arranged money for delivery and had identified institute for delivery.
Table 3: Preparation for safe delivery during pre and post interventional assessment
| Variable | Pre interventional Assessment N=72(%) | Post interventional Assessment | |||
| 1st follow up N=72(%) | 2nd follow up N=64*(%) | 3rd follow up N=63(%) | 4th follow up N=52(%) | ||
| Selected the health institute for delivery | 70 (97.2) | 72 (100) | 64 (100) | 63 (100) | 52 (100) |
| Knows distance of health institute from home | 58 (80.5) | 66 (91.7) | 64 (100) | 63 (100) | 52 (100) |
| Selected family member to accompany during hospitalization | 70 (97.2) | 72 (100) | 64 (100) | 63 (100) | 52 (100) |
| Arranged Vehicle for arriving to hospital | 68 (94.4) | 70 (97.2) | 62(96.9) | 63 (100) | 52 (100) |
| Arranged of money for delivery | 58 (80.5) | 68 (94.4) | 64 (100) | 63 (100) | 52 (100) |
All subjects’ were ready with their bags (Table 4) but for 8 subjects’ extra 4 weekly follow up visits were done regularly because they had concept in mind that very early arrangement of bag will harm the baby.
Table 4: Preparation for bag (that to be carried during hospitalization) in pre and post interventional assessment
| Pre Interventional assessment N=72
(%) |
1st follow up visit N=72 (%) | 2nd follow up visit N=64 (%) | 3rd follow up visit N=63* (%) | 4th follow up visit N=52 (%) | 5th follow up visit N=52 (%) | 6th follow up visit N=52 (%) | 7th follow up visit N=52 (%) | 8th follow up visit N=52 (%) | |
| Bag for mother | |||||||||
| Tooth brush, paste and comb | 38(52.8) | 52(72.2) | 62(96.8) | 63(100) | 52(100) | ||||
| Towel | 40(55.6) | 52(72.2) | 61(95.3) | 63(100) | 52(100) | ||||
| Soap | 35(48.6) | 50(72.2) | 62(96.8) | 63(100) | 52(100) | ||||
| Two Suit set | 30(41.7) | 57(79.1) | 60(93.8) | 63(100) | 52(100) | ||||
| Undergarments and Bra | 28(38.9) | 30(41.7) | 55(85.9) | 63(100) | 52(100) | ||||
| Sanitary pads | 10(13.9) | 25(34.7) | 38(59.3) | 50(79.3) | 52(100) | ||||
| Plate, glass, spoon | — | 60(83.3) | 64(100) | 63(100) | 52(100) | ||||
| Lab reports | — | 54(75.0) | 64(100) | 63(100) | 52(100) | ||||
| Antenatal card | — | 50(72.2) | 64(100) | 63(100) | 52(100) | ||||
| Bag for baby | |||||||||
| Baby towel | 35(48.6) | 40(55.6) | 53(82.8) | 57(90.4) | 46(88.4) | 46(88.4) | 47(90.3) | 49(94.2) | 52(100) |
| Baby sheet/blanket | 29(40.3) | 37(51.3) | 49(76.6) | 59(93.7) | 44(84.6) | 44(84.6) | 46(88.6) | 48(92.3) | 52(100) |
| Under shirt | 17(23.6) | 27(37.5) | 36(56.2) | 60(95.2) | 45(86.5) | 46(88.4) | 47(90.3) | 50(96.1) | 52(100) |
| Two set of Suits | 30(41.7%) | 38(52.8) | 47(73.4) | 55(87.3) | 47(90.3) | 49(94.2) | 50(96.1) | 50(96.1) | 52(100) |
| Baby soap | 10(13.9%) | 23(31.9) | 34(53.1) | 50(79.3) | 45(86.5) | 47(90.3) | 48(92.3) | 48(92.3) | 52(100) |
interventional assessment depicts that 54(75%) and 46(64.9%) subjects’ had no knowledge about prelabour changes and signs of true labour changes respectively. Majority 66(93.7 %) of subjects’ had no knowledge about danger signs during pregnancy while at the end of study all subjects’ were fully equipped with knowledge of pre labour changes, true labour changes and danger signs.
Knowledge of subjects’ about Care during Postnatal period in pre-interventional assessment reveals that 51(70.8%) and 55(76.4 %) subjects had no knowledge about maintenance of personal hygiene and family planning methods respectively. only 15 (20.8%) subjects’ had partial knowledge about care of episiotomy. Almost all (more than 90%) subjects’ had no knowledge about diet, post natal exercises, danger signs, postpartum coitus. Whereas in post-interventional assessment during fourth follow up all subjects had gained full knowledge about maintenance of personal hygiene, method of doing episiotomy care and aspects related to diet during postnatal period. 73.1% and 84.6% subjects’ had gained full knowledge about all post natal exercises and danger signs of postpartum period. 84% and 71.2 % subjects’ had gained full knowledge about coitus and methods of family planning respectively. knowledge of subjects’ about aspects of breast feeding during pre interventional assessment reveals that their knowledge about importance of Colostrum (40%), exclusive breast feeding (8.9%), time to start initial breast feed (31.9%), frequency of breast feeding/day (19.4%), methods to relieve breast engorgement (78%) and correct position during breast feeding (47.2%).Where as in post interventional period by the end of study all subjects’ had gained full knowledge about all above mentioned aspects of breast feeding.
Knowledge of subjects’ about essential care of newborn during pre interventional assessment show that majority 56(88.6 %) and 59(91.9%) subjects’ had no knowledge about essential care of new born that includes skin care, prevention of hypothermia, eye care and umbilical care, and dangers signs in neonate respectively. No one had any knowledge about immunization schedule. While in post interventional assessment during fourth follow up 82.7 % subjects had gained full knowledge about aspects related to essential care of new born and 21.1 % subjects’ gained full knowledge about immunization schedule.
Score of subjects’ for preparation of safe delivery, postnatal and neonatal care (Table 5) show the gradual gain in score during every subsequent visit. During preinterventional assessment
Table 5: Scores of subjects in preparation for safe delivery, postnatal and neonatal care
| Categories of Score | Pre interventional Assessment N=72(%) | Post interventional Assessment | |||
| 1st follow up N=72(%) | 2nd follow up N=64*(%) | 3rd follow up N=63(%) | 4th follow up N=52(%) | ||
| Excellent (76-100% ) | 1 ( 1.4) | 1(1.4) | 30(46.9) | 52(82.6) | 52(100) |
| Good
(51-75%) |
11 (15.3) | 52 (72.3) | 34 (53.1) | 11 (17.4) | — |
| Average (26-50%) | 60 (83.3) | 19 (26.4) | — | — | — |
| Poor
(£ 25%) |
1 (1.4) | — | — | — | — |
| Mean percentage score ± SD | 38.3 ± 5.1 | 61.23 ± 5.9 | 76.77 ± 5.0 | 83.23 ± 4.2 | 90 ± 2.8 |
* Paired t value between preinterventional and fourth follow up visit is -44.4 with df 51 (p<0.001) ** Value of F in repeated measure for ANOVA between preinterventional and all the four follow up visits is 736.5 with df (observation, error = 2.868, 146.24), (p<0.001 majority (83.3%) of subjects’ had scored average (26-50%). During post interventional assessment at the end of the study all subjects’ had reached up to excellent score (76-100%). Mean percent score of subjects’ during Pre- interventional visit (38.3 ± 5.1) increased significantly upto end of study (90 ± 2.8) as per paired t test (p < 0.001) and repeated measure Anova. At every evaluatory follow up visit significant increase was observed as indicated by Greenhouse-Geisser correction (F (2.868, 146.24) = 736.5, P <0.001).
Discussion
Conception, pregnancy, labour, birth, breastfeeding and parenting are all important part of women’s life. They are a continuum in nature, and how women experience each part affects the rest of the process. Taking care of health during pregnancy is not only important for women but also for growing fetus also. Women need to know everything about pregnancy, its related aspects and be prepared for safe delivery, postnatal and neonatal care.
Evidence supports that the active participation of pregnant women and family in the birth preparation is of primary importance in women’s satisfaction with their birth experience. All this is easy with the little help and guidance from health care professionals; women can maintain their everyday tasks. Nurses and midwives have an important role in this Endeavour. Dissemination of health related information to pregnant women and their family has the great impact on outcomes of pregnancy. So the present study was undertaken with an objective to prepare pregnant women for safe delivery, postnatal and neonatal care. Pregnant women of third trimester were enrolled and their preparation for safe delivery, postnatal care and neonatal care was assessed before and after implementing the protocol.
All the current reproductive and child health programs of India has given the special focus to safe delivery ,to achieve this every pregnant women should get registered in first trimester of pregnancy, all essential laboratory investigation should be done, must have 3 antenatal checkups and immunized with 2 doses of TT. In present study it was encouraging to find out that during preinterventional period all pregnant women were registered and immunized with TT and most of them (97.1%) had completed their all important laboratory investigations.
Improper diet in pregnancy can lead to several nutritional deficiencies in mother as well as in growing fetus. To maintain the growth and development of fetus, women should take nutritious foods consisting all essential nutrients and supplements daily. In present study it was good to see after intervention almost all subjects’ had started taking healthy diet and supplements. As per RCH program pregnant women should take 100 iron and folic acid tablets but in preinterventional period it was found that most of women were avoided taking tablets while after researcher’s intervention they all had started regular consumption of iron and folic acid tablets. It is a fact that adequate rest and sleep is important for healthy mind and body. According to recommendations pregnant women should take 2 hours rest in day and 8 hours sleep at night. In beginning of the study it was found that 55 (76.4%) of women were taking adequate rest and sleep while by the end of research all women had also started taking adequate rest and sleep.
Antenatal as well as postnatal exercises helps the mother to make the perineal and abdominal muscles strong .But in study it was found that majority (more than 90%) of the subjects had no knowledge about exercises. By end of study 68% subjects’ had started doing antenatal exercises regularly and more than 70% subjects’ had gained full knowledge about all postnatal exercises. A research study conducted on knowledge and practices of pregnant women about antenatal exercises at Bangalore had shown similar results that 67% study population had inadequate knowledge and 74% had inadequate practice about antenatal exercises .12 The prior selection of approachable hospital for delivery, family member for accompanying the women during hospitalization, arrangement of money and beforehand preparation of bag for delivery are also important factors for safe delivery. In current study during preinterventional period most of subjects had identified hospital, arranged transportation and money for delivery and decided about person. But it was observed that only a few subjects’ had prepared their bags for delivery. After one month of study most of the women were not ready with articles required for baby because they thought that prior arrangement of articles for baby will harm his development thus extra efforts were taken by researcher to reemphasize them to prepared bag with all necessary articles. A study conducted in Maharajgunj had also shown similar results that 82% respondents had knowledge about preparation for delivery. 86% respondents have knowledge about the place (where the baby will be delivered). 80% respondents had knowledge about preparation of helper. 76% had knowledge about preparation of transportation and only 56% respondents were ready with their own and babies clothes.
Early Recognition of pre and true labour changes and danger signs in pregnancy and postnatal period can help pregnant women to receive the right treatment at right time it is possible if she is aware about signals that helped her to seek medical help. In present study it was noticed that in preinterventional assessment, more than 70% women had partial knowledge about both pre and true labour changes and majority of subjects (91 %) had no knowledge about any danger signs of antenatal and postnatal period. whereas by termination of study all the women had gained full knowledge about both labour changes and majority (more than 90%) of subjects were able to remember all important danger signs Similar results had been reported in a study conducted by Finger WR, 1997 which shows that, after educating the mothers about post natal care, their Knowledge on at least three postnatal danger signs had shown an increase of 16%.13 Postnatal period is as crucial as antenatal period. Women should be fully equipped with all aspects related to postnatal period. In present study it was found that in preinterventional assessment very few subjects had knowledge about these aspects but as the study proceeded by the end of follow ups they all prepared for all aspects. Most difficult part was to convince them to adopt family planning methods, but through regular guidance 71.2 % subjects had selected the suitable family planning method. A hospital-based cross-sectional survey conducted in 2006 also shows similar results that a total of 55.2% subjects were aware of contraceptive methods and Permanent methods were known to nearly 50% subjects but acceptance for these methods was 5% only.14 Pregnancy does not end with delivering the baby safely but it includes the proper caring and rearing of child in a better way so that comfort of the child can be ensured. Current scenario says that a mother should have full knowledge about breast feeding and essential care of newborn. In current study it was seen that very less number of subjects’ had knowledge about newborn care . By end of study through regular teaching and demonstrations on essential care of baby majority of women were fully prepared for doing essential care of baby and gained full knowledge about breast feeding. A study conducted on Knowledge of pregnant women on newborn health care also showed similar results that only a little over half of the pregnant women had any information on newborn health care. Very less number of women had knowledge regarding proper care of the umbilical stump and knew nothing about vaccination.
15. A similar study conducted in Nepal also reported that the prior preparation of pregnant women helps planning for birth in a safe way .It has positive impact on knowledge and immediate health outcomes for mother and baby Results of present study also shows that regular teaching, guidance and monitoring of pregnant women had improved their preparation for safe delivery, postnatal care and newborn care to great extent. 6 The present study hence concludes that Operationalization of birth preparation concept has proved effective as it had improved the preparation of pregnant women for safe delivery, postnatal and neonatal care. It had helped the women in receiving essential antenatal care services, started preparing them care needed in postnatal period, make them well sufficient to take of their newborn baby.
Thus it is recommended that regular monitoring, teaching, guiding and counseling should be done by all health care professionals to prepare the pregnant women for safe delivery, post natal and neonatal care. Thus whenever the nurses /doctors came in contact with pregnant women they should start preparing her for best outcomes of pregnancy and neonatal care moreover the educational material in form of booklets ,flipbook ,charts etc should be prepared and always kept ready for use in health care centers.
References
- Index Mundi. Indian maternal mortality rate. [updated on October 8, 2016 accessed on 1.17] a v a i l a b l e a t
http://www.indexmundi.com/india/maternal_mort ality_rate.htm
- NITI AYOG. Infant Mortality Rate (IMR) (per 1000 live births). [accessed on 11.1.17] available at http://niti.gov.in/content/infant-mortality-rate-imr- 1000-live-births
- Rosenfield A. Maternal mortality in developing countries. The journal of the American Medical Association. 1989;262(3):376-9. PMID: 2661871 (Accessed 13 Dec 2010) available at https://www.ncbi.nlm.nih.gov/pubmed/2661871
- Mutiso SM, Qureshi Z, Kinuthia Birth preparedness among antenatal. East African Medical Journal 2008;85(6):275-83. PMID:18817024 (Accessed 3 Dec 2010) available a t
https://www.ncbi.nlm.nih.gov/pubmed/18817024
- The state of worlds children: Maternal and child health 2009. (Accessed 15 Dec 2010) available at https://www.unicef.org/sowc09/
- Manandhar DS , Osrin D, Shestha BP, Mesko N, Morrison J, Tumbahangphe KM, et al. Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: Cluster – randomized controlled trial. Lancet. 2011;364(9438):970-9. PMID:15364188. DOI:10.1016/S0140- 6736(04)17021-9 (Accessed 5 Jan 2011) available at https://www.ncbi.nlm.nih.gov/pubmed/ 15364188
- Fortney J. Antenatal risk screening and scoring: A New International Journal of Gynecology and Obstetrics 1995; 50:538.
- Steven-Simon C, Beach R, Gregor MC. Does incomplete growth and development Predisposes teenagers to preterm delivery. A Journal of Preinatology. 2002 4:315-23. PMID:12032796 DOI:10.1038/sj.jp.7210694 (Accessed 27 Jan 2 0 1 1 ) a v a i l a b l e a t https://www.ncbi.nlm.nih.gov/pubmed/12032796
- Griffiths PL ,Stephenson Understanding users’ perspectives of barriers to maternal Health care use in Maharashtra, India. Journal of biosocial. 2001 May; 33(3):339-59. (Accessed 23 Jan 2011) https://www.cambridge.org/core/journals/journal- o f – b i o s o c i a l – s c i e n c e / a r t i c l e / d i v – classtitleunderstanding-users-perspectives-of- barriers-to-maternal-health-care-use-in- m a h a r a s h t r a – indiadiv/1D216EE9C35F03FCC50FADD9B2BA2E2 6
- Bhutta A, Hasan Community-Based Interventions for Improving Prenatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence. Journal of American Academy of Pediatrics. 2005;115:519-20.
- Starrs A. The safe motherhood action agenda: priorities for next decade .Journal of Family Care International 1997;45:94. (Accessed on 2 Feb 2 0 1 1 ) a v a i l a b l e a t http://www.popline.org/node/526231
- Sharma S. Knowledge, practice and attitude regarding selected antenatal exercises among pregnant Care International. 2007;45:94
- Finger WR. Better postpartum care save lives 1997;4:18-21.
- Chopra S, Dhaliwal L. Knowledge, attitude and practices of contraception in urban population of north Arch Gynecol Obstet. 2010;281:273-7. doi:10.1007/s00404-009-(Accessed on 26 March 2 0 1 2 ) a v a i l a b l e a t http://link.springer.com/article/10.1007/s00404- 009-1096-y
- Darmstadt G, Bhutta ZA, Cousens S, Adam T, Walker N, Bernis L. Evidence –based, cost-effective intervention for neonatal survival. Lancet 2005;95:1039-46. [Accessed 20 Nov 2011) A v a i l a b l e a t http://www.who.int/maternal_child_adolescent/do cuments/pdfs/lancet_neonatal_survival_paper2.p df