Lesson 4 Maternal and Newborn Health Promotion 

According to WHO Health Promotion is : ” the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.” 

Health promotion does not merely correspond to preventing disease but it stands for a daily effort towards enhancing and strengthening physical, social and mental well-being. 

In 2015, the United Nations set the Sustainable Development Goals (SDGs). These goals are a universal call towards creating a global sustainable development agenda by 2030. There are 17 development goals, where number 3 is about health and number 3.1 refers to decreasing global maternal mortality rate to less than 70 per 100000 live births by 2030.

  • Health before pregnancy
  • Antenatal care (care during pregnancy)
  • Carein childbirth
  • Postpartum care (careof the mother and the newborn after labour)

The health and the lifestyle choices of parents can directly or indirectly affect fertility alongside with maternal and newborn health. If you aspire to have children, you should be screened for health problems that could possibly interfere with the pregnancy. Additionally, it is well-known that unhealthy diet and habits like sedentary lifestyle and alcohol misuse can have a negative impact on pregnancy and postnatal outcomes. Therefore, adopting a healthier lifestyle can enhance the course of the pregnancy. 

Antenatal care is a form of preventive health care, in which at least four visits are required in order for women to be acquainted with healthy behaviours during pregnancy, learn about the risks and warning signs and be supported on a social and emotional level. It must be noted that it enhances survival and health of newborns by decreasing stillbirths and neonatal mortality. In addition, it creates the first contact between mother and healthcare, that is fundamental for the course of the pregnancy. 

According to WHO guidelines, this process should include identification and management of obstetric complications like pre-eclampsia, immunisation against tetanus, preventive treatment for malaria and testing and medication of infections like HIV, syphilis and other sexually transmitted infections (STIs). Additionally, antenatal care can help mothers familiarise with healthy pregnancy practices, safe childbirth and postnatal behaviours like early postnatal care and breastfeeding and planning of future pregnancies.  

  • Identification and surveillance of the pregnant woman and her expected child
  • Recognition and management of pregnancy-related complications, particularly pre-eclampsia
  • Recognition and treatment of underlying concurrent illness 
  • Screening for conditions and diseases such as anaemia, STls (particularly syphilis), HIV infection, mental health problems, and/or symptoms of stress or domestic violence
  • Preventive measures, including tetanus toxoid immunisation, de-worming, iron and folic acid, intermittent preventive treatment of malaria in pregnancy (IPTp), insecticide treated bednets (ITN)
  • Advice and support to the woman and her family for developing healthy home behaviours and a birth and emergency preparedness plan
  • Increase awareness of maternal and newborn health needs and self care during pregnancy and the postnatal period, including the need for social support during and after pregnancy
  • Promote healthy behaviours in the home, including healthy lifestyles and diet, safety and injury prevention, and support and care in the home, such as advice and adherence support for preventive interventions like iron supplementation, condom use, and use of ITN
  • Support care seeking behaviour, including recognition of danger signs for the woman and the newborn as well as transport and funding plans in case of emergencies
  • Help the pregnant woman and her partner prepare emotionally and physically for birth and care of their baby, particularly preparing for early and exclusive breastfeeding and essential newborn care and considering the role of a supportive companion at birth
  • Promote postnatal family planning/birth spacing

What to expect during your antenatal visit

  • Source: https://www.pexels.com
    Take care of yourself
  • Eat healthy food
  • Try not to stress
  • Stay active
  • Find time to relax 
  • Find a pediatrician 
  • Get vaccinated 
  • Get the future caregivers of your baby vaccinated

During labour and delivery it is very important that mothers effectively cooperate with the healthcare assistants, in avoiding and treating any possible complications and optimising postnatal outcomes. Care should include skilled care at birth, thorough obstetric care and management of preterm birth. It is a fact that:

  • 1.3 millions intrapartum stillbirths occur per year
  • 3 millions of newborns and women could be saved every year with high quality care before and after the time of birth 

The first days and weeks after childbirth are of great importance for the mother and for the newborn, as during this period there is a great risk for maternal and newborn death. Therefore, alertness for maternal  newborn complication is mandatory.

  • Provision of information and psychological support tomothersby healthcare professionals
  • Transition from midwife to health visitor care
  • Transfer to community care
  • First midwife visit within 36 hoursaftertransfer of care 
  • First health visitor visit within 7 to 14 days after transfer of care (if no antenatal care, the visit should be arranged sooner)

During the visits, the woman’s physical and psychological health, and well-being are assessed by healthcare professionals and appropriate interventions are made if necessary. Additionally, women are given the opportunity to talk about their birth experiences and are informed about support services and birth reflection services if needed. 

As for the newborn’s health, at each contact, the healthcare professional assess the newborn’s general well-being, feeding and development. They also provide parents with information about the everyday tasks and processes they have to follow in order to maintain the baby’s health like feeding, skin care, safe sleeping, vaccinations and early signs and symptoms of disease. 

It should be noted that all four stages (Health before pregnancy, antenatal care, care in childbirth and postpartum care) are related to one another and all together create a continuum of health that will follow throughout newborn, infant, child, adolescent and adult life. Therefore, being present at each one of them is of great importance! 

Source: https://pixabay.com 

Breastfeeding is very beneficial for baby’s health and exclusive breastfeeding is recommended for the first six months of life. Afterwards, feeding can continue with both breastfeeding and complementary foods until the baby reaches approximately 12 months. 

However, according to WHO, two out of three newborns are not exclusively breastfed during the first 6 months.

Also, 3 in 5 newborns are not breastfed in the first hour of life !

Breastfeeding has an abundance of benefits for the child and for the mother. First and foremost, it is the ideal food and source of nutrients and energy for the baby, thereby promoting the baby’s growth and development. In addition, it contains antibodies that keep the baby safe, protecting it from illnesses. 

Moreover, breastfeeding has been associated with long-term protection from several diseases for the baby and the mother. (see next page)

  • Asthma.
  • Obesity.
  • Type 1 diabetes.
  • Severe lower respiratory disease.
  • Acute otitis media (ear infections).
  • Sudden infant death syndrome (SIDS).
  • Gastrointestinal infections (diarrhea/vomiting).
  • Necrotizing enterocolitis (NEC)

  • Breast cancer.
  • Ovarian cancer.
  • Type 2 diabetes.
  • High blood pressure.

Source: https://pixabay.com 

Source:  https://www.pexels.com 

Kangaroo Care is a method of holding your baby closely to your chest that has benefits for both you and your newborn child. More specifically it refers to skin-to-skin contact between parent (mother or father) and the baby, where the baby is an upright position and is pressed against parent’s chest for a few hours. For extra warmth you can wrap you and your baby in a cloth. The goal is to relax together with your baby and stay calm for a few hours. 

Kangaroo care is encouraged for preterm babies for several hours during the day. However, full term babies can also experience the benefits of it alongside with mere skin-to-skin contact which is highly recommended for all babies! 

Cleveland Clinic highlights the benefits of Kangaroo Care as the following: 

  • Stabilising your baby’s heart rate. 
  • Improving your baby’s breathing pattern and making the breathing more regular. 
  • Improving oxygen saturation levels (this is a sign of how well oxygen is being delivered to all of the infant’s organs and tissues). 
  • Gaining in sleep time. 
  • Experiencing more rapid weight gain. 
  • Decreasing crying. 
  • Having more successful breastfeeding episodes. 
  • Having an earlier hospital discharge.
  • Improving bonding with your baby and the feeling of closeness. 
  • Increasing your breast milk supply. 
  • Increasing your confidence in the ability to care for your new baby. 
  • Increasing your confidence that your baby is well cared for. 
  • Increasing your sense of control.

How to kangaroo care with your baby  

Take care of your mental health for you and your baby 

Many women during the prenatal period experience feelings of anxiety or depression. If you have these feelings, you should never be ashamed of them but on the contrary, you should share them with people you trust in order to make you feel better.

  • Share your feelings and worries with your family, friends or doctor
  • Eat healthy
  • Stay active to a level you are comfortable with
  • Be present at all your antenatal visits, where your doctor can update you on the course of your pregnancy
  • Make a birth plan
  • Try to attend an antenatal class, where you can meet and share with other pregnant people
  • Try breathing techniques to reduce stress 

If you want to learn more information, you can refer to Module 6: Gender specific health.

Find out if you are struggling with perinatal mental health issues 

As it was discussed, refugee/migrant women have to confront many barriers and obstacles in order to access maternal health. Thereby, newborn health is also affected as the lack of antenatal and postnatal care indirectly increases newborn mortality rates. 

Certain interventions are necessary in order to enhance health status of parents, accessibility and quality of healthcare and public policies. 

  • Health status of parents : Migrant/refugee parents should be informed in plain and understandable language abouthealth careand screening opportunities.
  • Accessibility of care: All women should be informed about their rightsin accessing maternal care and care should be affordable and accessible for everyone. 
  • Quality of care: The use of interpreters and cultural mediators and the appropriate risk assessment can enhance the quality of care.
  • Public policies: Support services should provideequity in health ,full health coverage and healthcounselling without discrimination.

Low SES is considered a risk factor that is correlated with increased maternal and newborn mortality. 

Reducing inequity in healthcare will be materialised by implementing interventions addressed to low SES women towards promoting preventing health services like immunisation, treatment of prevalent diseases and nutrition knowledge. 

Furthermore, local communities could provide door to door healthcare services in order to overcome economic or transfer barriers and provide information about health and well-being. In addition, direct financial support to those in need could improve healthcare access.