This is a story of PHC Veeraghattam in improving Normal Delivery of children

1. Institutional
Deliveries in
Primary Health
Centre
By
Dr. E.Aravind
Medical Officer,
PHC, Veeraghattam

2. 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

3. 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

4. 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

5. Awareness
Creating awareness in
community about various
schemes relating to
delivery of child
• JSY
• JSSK
• 108
• 104

6. 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

7. 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

8. • 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

9. 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

10. 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

11. Investigations
Blood tests
• Hemoglobin
• Blood group and typing
• Random blood sugar
• HIV
• HbsAg
• VDRL
Urine tests
• Pregnancy test
• Albumin and sugar
• Microscopy

12. Drugs
• Inj Epidosin
• Inj Oxytocin
• Tab Misoprostol
• Inj Methergin
• Inj Carboprost
• Inj MgSO4
• Inj Lignocaine

13. Equipment
• Doppler fetoscope
• Oxygen
• Separate delivery tray
with instruments
• Outlet forceps
• Resuscitation kit for
new born
• Radiant warmer
• Baby weighing machine

14. 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

15. 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

16. 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.

17. 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

18. Utilizing HDS funds
• Purchase of drugs chemicals and equipment
• Purchase of kits and chemicals for lab
• Providing amenities and security to patients and
staff

19. IEC activity
• LCD TV
• Charts
• Drawings
• Pamphlets

21. 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

23. • 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

24. Barriers for deliveries in PHC
• Increased no. of cesarean sections
• Commercialization of medicine
• Touts by private practioners
• Lack of adequate staff in PHCs

25. 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.

26. Utilizing technology
• Using telemedicine
concepts would be
very useful

28. Life begins with waking up and loving yours mother's face