PRACTICE TEACHING ON-

BIRTH PREPAREDNESS
&
COMPLICATION READINESS

Submitted to- Submitted by-

MADAM APARNA ARI TANIA DAS
SENIOR FACULTY ROLL NO.- 11
GOVT.CON NRSMCH M.Sc. NURSING 1ST
YEAR
GOVT.CON
NRSMCH
 Introduction-
 Every pregnancy is a joyful moment for all mothers who dream of a safe pregnancy and
a healthy baby. However, every pregnant woman faces the risk of sudden, unpredictable
complications that could end in death or injury to herself or to her infant. So, birth
preparedness & complication readiness (BPACR) is much needed in this phase.

 Definition of Birth Preparedness & Complication Readiness -

Birth preparedness and complication readiness (BPACR) is a strategy that encourages
pregnant women, their families and communities to effectively plan for births and deal
with emergencies, if they occur.
It is a key component of globally accepted safe motherhood programs.

 National Protocol for Birth Preparedness & Complication Readiness-

 Encouraging all pregnant women to have institutional/trained service providers
for delivery.
 Introducing the concept of a birth plan on a second visit and reinforcing follow
up visits.
 Confirming the place of delivery and the provider with the pregnant woman and
family.
 Providing information on how to recognize onset of labor and when to seek
assistance including danger signs in the pregnancy and labor.
 For institutional delivery-
 Advice the pregnant woman and her husband/family about when to go
hospital and take along the necessary things.
 Arrange to have a second person of the woman’s own choice to be
present.
 Help her to identify her support people to take care her children and her
household.
 Arrange transportation to go to the health facility for the birth.
 Identification of compatible blood donor in case of emergency.
 Funds for birth related and emergency expences.
 Advice to follow 6C’s-
 Clean birth site/surface- prevents delivery directly to the floor.
 Clean hands- prevents the birth attendant from transmitting germs to
mother and baby.
 Clean cord ties- prevents bleeding from umbilical cord from mother
and baby.
 Clean gauze – wipes away birth canal secretions from the baby’s eyes,
which decreases the probability of future eye infections.
 Cleaned umbilical cord cut- prevents infection by washing and drying
the stumps.
  Clean perineum.

 Rationale of Birth Preparedness & Complication Readiness -

There are some rationale of BPACR. Those are following-
 To ensure all arrangements for clean and safe delivery.
 Availability of skilled birth attendant when the time comes.
 Timely identification of possible risks and complication that cannot be predicted.
 Getting ready as for how to respond any emergency.
 Minimizing the life threats to mother and baby.
 To provide timely care needed to preserve health and survival of both.
 Birth preparedness-
 Definition :
It is not written document but is an ongoing discussion with the women and her
family to ensure that she and baby will receive appropriate care promptly at the
time of birth and if complication arise before or after the birth.
Birth preparedness plan is usually given to the women during 1st antenatal visit.
 Components of Birth Preparedness:
The components of birth preparedness are following-
 Decision making in an emergency.
 Skilled attendant at birth.
 Supplies needed for clean delivery.
 Identification of support people.
 Establish a financing plan for delivery.
 Blood donor.
 Transportation.
 Activities of Birth Preparedness:
Details of the activities to be carried out while planning and preparing for birth
are listed below-
 Early registration of the pregnant woman:
 During first antenatal visit, Maternal and Child Protection Card
(MCP Card) and the antenatal register should be filled up.
 Inform the mother of the dates of her subsequent antenatal visits
and emphasis the importance of making all these visits in time.
 Identification of a skilled provider:
Help all pregnant women to reach a decision regarding the health care
provider they want for conducting their delivery.

 Recognizing the signs of labor:

 Should be advised the mother to go to the health facility or inform the
ASHA to contact the skilled birth attendant if the woman has any one of
the following signs which indicate the start of labor-
 A bloody, sticky discharge from the vagina (show).
 Painful uterine contractions increasing in duration, frequency and
intensity with the passage of time.
 Identification & arrangement for referral transport:
Delay in reaching a health care is one of the major ‘delays’ responsible for
maternal abnormality. It is, therefore, necessary to ensure the following-
 If the woman decided to deliver at a health facility, ensure that a
vehicle is available to transport her to the facility whenever
required.
 The contact number of the ambulance or the vehicle provided by
the state, private or any other provider, should be available with
the ANM/ASHA, and should be communicated to the pregnant
woman and her family members.
 If vehicle is not available in the village, help of the panchayat,
village health committee, Mahila Mandals, youth groups or any
other such groups can be taken to decide on how to obtain a
vehicle in case of an emergency.
 Locate the nearest PHC/FRU:
The woman and her family members should be aware of the nearest health
facilities: the PHC, where 24-hour emergency obstetric care services are
available and the FRU, where facilities of blood transfusion and surgery are
available.
 Identification of support people:
These people are needed to help the woman look after her children and/or
household, arrange for transportation, and/or accompany her to the health
facility. Seek help from either the close relatives of the woman or community-
based health functionaries, such as AWW/ASHA.
 Finances:
The woman and her family should be assisted in calculating an estimate of
expenses of the delivery and related aspect (such as transport). They should also
be advised to keep an emergency fund, or have a source for emergency funding
in case of complications. Keep in mind, the various schemes that are available for
assisting woman with transportation facilities or providing funds for maternal
health (such as the JSY) and whatever other schemes may have been launched in
your state. Help the woman and her family access these schemes and collect the
allocated funds to pay for the delivery.
 Birth preparedness for Institutional delivery:
 All pregnant women must be encouraged to opt for an institutional delivery.
Should be explained to the woman why delivery at a health facility is
recommended and emphasis the following:
 Complication can develop at any time during pregnancy, during delivery
or in the postnatal period. These complications are not always
predictable. If they are not handled by professionals at the health facility,
they can cost the mother and/or the newborn their life.
 Since a health facility has staff, equipment, supplies and drugs, it can
provide the best care. It also has a referral system should the need for
referral arise.
 Complication Readiness-
 Definition: Complication readiness is the ability of the mother and her family
members to recognize danger signs during pregnancy, labor and after
delivery/abortion.

 The pregnant woman and her family/caretakers should be informed about the
potential danger signs during pregnancy, delivery and in the postpartum period.
 She must be told that if she has any of the following signs during pregnancy or
delivery or in the postpartum/post-abortion period, she should immediately visit
a PHC/FRU without waiting, be it day or night. Also, counsel her to inform ANM
and the ASHA.
 In case, ANM detect a complication during examination or the woman arrives at
the health center with complications, ANM must refer her to the FRU/24hour
PHC. Also, see to it that she carries a filled in referral slip with her.
 Danger signs during pregnancy & labor & after delivery/abortion:
The danger signs in pregnancy and referral system are discussed below-

 Visit FRU  Visit PHC

 Malpresentation  High fever with or without abdominal
 Multiple pregnancy pain, too weak to get out of bed
 Any bleeding P/V during pregnancy and  Fast or difficult breathing
after delivery (a pad is soaked in less  Hemoglobin 7-11gm% even after
than 5 mins) consuming IFA tablets for 30 days
 Severe headache with blurred of vision  Excessive vomiting, unable to take
 Hemoglobin <7gm% anything orally
 Convulsions or loss of consciousness  Breathlessness at rest
 Decreased or absent fetal movement  Reduced urinary output with high BP
 Active labor lasting longer than 12  High BP (>= 140/90mmHg) with or
hours in a primipara and more than 8 without proteins in the urine
hours in a multipara
 Continuous severe abdominal pain
 Premature rupture of membranes
(PROM) before 37weeks
 High BP >=140/90mmHg with proteins
in the urine, and severe headache with
blurred vision or epigastric pain
 Temperature more than 38 degree
centigrade
 Foul smelling discharge before or after
delivery/abortion
 Ruptured membranes for more than
18hours
 FHR >160/min or <120/min
 Perineal tear (2nd ,3rd & 4th degree)

 Conclusion-
Birth preparedness and complication readiness is the process of planning for normal
birth and anticipating the actions needed in case of an emergency.
In many societies in the world, cultural beliefs, and lack of awareness inhibit preparation
in advance for delivery and expected baby. The majority of pregnant women and their
families do not know how to recognize the danger signs of complications. When
complication occur, the unprepared family wastes a great deal of time in recognizing the
problem, getting organized, getting money, finding transport and reaching the
appropriate referral facility.
Birth preparedness is a strategy to promote the timely use of skilled maternal and
neonatal care especially during childbirth.

 BIBLIOGRAPHY-
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Ltd;New Delhi;2015.
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3. Jacob Annamma.A comprehensive textbook of Midwifery & Gynecological Nursing.5 th edition.
Jaypee Brothers Medical Publishers (P) Ltd;New Delhi;2018.
4. Cunningham,Leveno,Dashe,Hoffman,Spong,Casey.Williams Obstetrics.26 th edition.McGraw-Hill
Education Publishers;2021.
5. Bhaskar Nima.Midwifery & Obstetrical Nursing.3 rd edition.EMMES medical publishers;India.