Community Education in

Obstetric
Dr. Ns. Ratna Hidayati, M.Kep., Sp.Mat.

Maternity Ners

Introduction
MMR in Indonesia is the highest in the
ASEAN countries, which is 359 per
100,000 live births (BKKBN-2013)
Malaysia Singapore Thailand
41
6
40

Filiphina
170

MMR is still high despite the fact that

almost all (97%) of women accept prenatal
care and birth by health professionals in
hospitals

Indonesian Government Solutions ?

The government policy :
Safe motherhood (4 pillars: family planning, ANC,
Clean & Safe Delivery, Obstetric Essential Care)
Affection for giving-birth mother
Early Breastfeeding
Expanding Maternal and Newborn Survival (EMAS)

Mothers Welfare and Safety

Why MMR is still high ???

Let's learn !! How Success of developing

countries reducing the MMR
Sri Lanka & Thailand (MMR 30 and 40/100.000
of live births), intervention strategy :
Family Planning Program
Prevent / minimize the chances of women with
complications of pregnancy / childbirth Prevent
/ minimize the death

Improving utilization and quality of care

which emphasis on giving free life-saving care
Expanding access to more effective maternity
care by midwives and doctors
The World Bank, 2003

Differences In The Pattern Of Decline In

MMR
Swedia : adherence to use aseptic technique
Japan : professionalization of deliveries at
home
Malaysia: growing the socio-economic
system, supporting the efforts of Safe
Motherhood management policies and using
the health care facility as well
North Europe : well coordination among ANCdelivery-postpartum

Why are they success ?

1. Improving the role of professional
personnel
2. Giving accurate and continuous
information
3. Improving the professional skill to
make them professional

Learning from the failure of developed

countries reducing the MMR!
In the past century United States has
"Profession Arrogance " bringing bad
effect on the acceleration of declined
MMR

ANALYSIS ISSUE
1. MMR : 6 hours - 7 days of post-parturition = 59%
2. Preeclampsia is the first cause
3. Low birth weight and asphyxia are the highest cause
IMR
Referral has been done in the early planning and timely
*

The quality of the integrated ANC ?

* The nutrition monitoring of pregnant women ?
* The readiness of the referral hospital ?
* The quality of human resources ?
The facilities and infrastructure of the referral hospital ?

THE CAUSE OF MATERNAL MORTALITY

(Pregnancy, Childbirth and Postpartum)
The direct
causes of
death
Indirect
Causes
(3 late)
Risk Factors
(4 T)

Other
indirect
causes

Nutritional status; deficiency Fe (causes bleeding, LBW): 40%

Chronic Energy Deficiency (Left arm circle < 23.5 cm)

THE CONCEPT of
SOLUTION :
Good ANC and delivery will reduce MMR (5090%) and IMR (30-40%)
Improvement of social, cultural, economic, and
educational, help to overcome the causes of
MMR 64%.
Improvement of clinical treatment can reduce
36% of MMR.
Community awareness of the dangerous signs
in pregnancy can minimize obstetric emergency

Alternative Solutions ??

Family Centered Maternity

Care
Prepare for delivery directly & when
they are in emergencies conditions,
using facilities and health personnel
11

IMPROVING PARTICIPATION of
FAMILY and COMMUNITY

Begin from planning, implementation and

monitoring / assessment for pregnancy
Participation is directed to :
knowledge and awareness dangerous

signs
family & community preparation to face
the labor and the danger that may occur
provision and utilization of MCH services
guarding quality of care

Setting The Framework

Approach childbirth education as a scientific
discipline major to community

Giving childbirth education to parents to help

them preparing an optimal birthing experience
and learning skills that will enhance there
wellfare (Nichols, 2000).
13

Maternal Health Care System

Helping families take appropriate
decisions through health information
and counseling:
to provide basic antenatal and delivery
services to all women
to ensure referral and adequate obstetric
care to high-risk mothers and obstetric
emergencies.

The Quality of Education & A Better

Living
Educated women:
Are more likely to delay marriage
Giving more antenatal care
Ensure that their children are immunized
Aware to give good nutrition
Giving birth spacing

So

All pregnant women

need Access to*
Emergency Obstetric Care
(EmOC)
* Not the same as
Institutional Delivery [ID]

Family and Community Focused when

ANC :
1.Having a delivery plan
2.Prepare for complications
The ability of early detection
Decision maker (guardiance) must be ready
Ready funds - communication - transport - a blood
donor

3.Fathers Participation in Prenatal Class

To engage men as primary nurturers of their babies

To normalize and validate mens commitment to
fathering

Public Education & Home Visit

Role of Family Medicine to Mothers and

Children
Family medicine are very influenced by the role
of society such as figure or influenced people, the
elders, and traditional birth attendance

We must cooperate with them, give them

education and training about mothers and babies
care

Maternal and fetal

complications
Prevention of mother to
child transmission of HIV
M/M or referral of
obstetrics & neonatal
complications

Birth Asphyxia
Resuscitation
Post resuscitation care
Referral if necessary

SPECIAL CARE
Low birth weight
Special warmth , KMC
Hygiene, Cord care
Assisted feeding, if
necessary

Infection, malformation,
and other problems
Antibiotics
Supportive care
ART if in need
Referral if necessary

20

Family Expert About

Continuum of Care
T

of
s
ay
d
0
0
0
1
t
s
fir
life
e
h

Lansi
a

The
quality
degener
ation

reproductive
health for teens
Counseling:
Nutrition
HIV/AIDS,
NAPZA dll

UKS/firs
t aid kid
Nutrition

Monitoring
growth and
Complete development
Nutrition
basic

Pregnancy
Exclusive
immunization
Counseling Classes
breastfeeding the scaling
Family
Fe & asam folat Postnatal family
Vit A
planning
Nutrition
planning
service
pregnant women
TT

The key to success as an effective

counselor in the community:
Being able to create a comfortable and safe
atmosphere for clients
Cultivating mutual trust client-counselor
Being able to recognize the dangerous sign
Able to deliver objective, complete and clear
information
Willing to listen to the problem actively and
effectively and ask politely
Being able to recognize what the client's want
and aware understand about background

23

Photo credit: Sheena Currie

CONCLUTION
A womans ability to have a
SAFE and healthy pregnancy
and childbirth be the
responsibility of family
How the family is able to ensure
the safety mother and child,
becomes the responsibility
health worker through education
to the community
Topic: what is the cause of
morbidity / mortality of mothers
and children, how to prevent
and handling

References
Buffington ST, Sibley L, Beck D, Armbruster D. Home-based
life saving skills manual. Silver Springs, MD: American
College of Nurse-Midwives, 2004.
Sibley L, Buffington ST. Building community partnerships for
safer motherhood: Home-based life saving skills. At-a-glance.
Washington (DC): NGO Networks for Health, 2003, January.
Sibley L, Buffington ST, Haileyesus D. The American College
of Nurse-Midwives home-based lifesaving skills program: A
review of the Ethiopian Field Test. J Midwifery & Womens
Health, 2004;49:320-328.

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