counseling cards - wordpress.com › ... · 2015-08-23 · for a pregnant woman and her baby...

Caring for the Newborn at Home:A training course for community health workers

Counseling Cards

First PregnAnCy Visit Card 1: Promote antenatal Care

Caring for the Newborn at Home:A training course for community health workers

Counseling Cards

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greet the family. explain that you are visiting to talk about care during pregnancy.

Ask the pregnant woman: Do you have other children? (if yes) Did you attend antenatal clinic in previous pregnancies? in this pregnancy? Listen carefully and adapt your advice to the woman’s situation.

explain that the pictures are about a woman named Abena. Ask the family what they see in the pictures and listen to their answers. tell the story of Abena:

• Abena went for the first antenatal check up as soon as she knew she was pregnant. she knew that this was important to make sure she was healthy, to get the first injection to protect against tetanus, and iron and folic acid tablets to prevent anaemia or ‘weak blood’.

• Because Abena lives in an area where malaria is common, she received medicines to prevent malaria, and was advised to sleep under an insecticide treated bednet (itn).

• the health worker advised Abena to get tested for HiV, so that if she had HiV she could receive appropriate care and reduce the risk of passing HiV to the baby. she agreed to take the test.

• Abena went for antenatal check ups four times during her pregnancy.

Discuss with the family if the pregnant woman plans to go for four antenatal care visits. if yes, praise them, if no ask why not and try to solve any problems they may have.

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First PregnAnCy Visit Card 2: PrePare for birth in a health faCility

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if the woman has other children, ask her where she gave birth. if not, ask where other women in the family have given birth. Listen carefully and adapt your advice to the woman’s situation.

explain that the pictures show how Abena and her family prepared for birth in a health facility. Askthe family what they see in the pictures and listen to their answers. tell the story; Abena & her family:

• Chose that she would give birth in a health facility because they know that complications, like pro- longed labour and heavy bleeding, can happen to any woman and it is safer to be where these problems can be taken care of immediately

• identified transport to get to the health facility when labour starts, either during the day or night

• saved money for transport and other expenses for birth at health facility

• Collected supplies (dry and clean cloth for drying and wrapping baby, hat, socks and clothes for keeping the baby warm)

• Planned who will care for other children at home

• Went to health facility early in labour

Discuss how the family feels about health facility birth. Ask if they would plan for birth in a facility and prepare the same way as Abena. if yes, praise them, if no ask why not and try solve any problems they may have.

First PregnAnCy Visit Card 2: PrePare for birth in a health faCility

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First PregnAnCy Visit Card 3: PrePare for at home(iF FAmiLy tHinks FACiLity BirtH is not PossiBLe or is not sure)

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explain that these pictures show how sarah and her family prepared for a home birth, because they felt that facility birth was not possible.

Ask the family what they see in the pictures and listen to their answers. tell the story; sarah and her family:

• identified a midwife to assist at birth. they also identified an additional person (her mother-in-law) to help the birth attendant care for the baby immediately after birth

• made soap and clean water available for the birth attendant and her helper to wash hands

• made sure they had a new blade to cut the cord and clean ties to tie the cord

• gathered clean clothes to dry and wrap the baby and a hat, socks and clothes to keep the baby warm

• knew that if labour lasts longer than 12 hours, there is heavy bleeding or the placenta is not delivered, the mother should be taken to the health facility immediately to save her life

• saved money for use in case of emergency for the mother or baby

• identified transport to get to the health facility in case of emergency

Discuss how the family feels about sarah’s preparations and ask if they plan to prepare in the same way. if yes, praise them. if no, ask why not and try and solve problems. encourage them to consider the possibility of choosing facility birth.

First PregnAnCy Visit Card 3: PrePare for at home(iF FAmiLy tHinks FACiLity BirtH is not PossiBLe or is not sure)

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First PregnAnCy Visit Card 4: home Care for the PreGnant Woman

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First PregnAnCy Visit Card 4: home Care for the PreGnant Woman

Ask the family what care they think women need during pregnancy. Listen carefully and adapt your advice to the woman’s situation.

explain that these pictures show how Abena cared for herself during pregnancy. Ask the family what they see in the pictures and tell the story; Abena:

• Ate more than usual during pregnancy to help the baby grow. this means an extra portion of rice, bread, or lentils, and when possible an egg, fish or meat, and fruit and vegetables

• took iron-folic acid tablets and followed other advice given at the antenatal clinic

• Avoided heavy work and rested more, to help her and the baby stay healthy

• slept under a treated bednet every night to prevent her getting malaria. she knew that malaria can be dangerous for a pregnant woman and her baby

Discuss how the family feels about what Abena did and ask if the pregnant woman can do the same. if yes, praise. if no, ask why not what would make it possible for her to do these things.

giVe out tHe motHer AnD BABy CArD• Fill in the card and explain what the card shows. make appointment for the next visit.• show the pregnancy danger signs. it is possible these were explained at AnC.• explain that the family should contact you immediately when the baby is born so you can come for a home visit.• thank the family for their time and congratulate them for doing the best for mother and baby

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seConD PregnAnCy Visit Card 1: home Care for the PreGnant Woman

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seConD PregnAnCy Visit Card 1: home Care for the PreGnant Woman

greet the family and explain that today you would like to discuss preparations for birth and care of the newborn after birth.

Ask if the pregnant woman has attended antenatal clinic, and how many times. Ask the family how the preparations for birth are going. Ask if the woman has been able to eat and rest more, sleep under an itn and take iron folic acid tablets

Listen to their answers carefully. if the woman is following the advice, praise her and the family. if not, discuss the problems and adapt your advice according to their situation. if necessary, review the pictures and remind the family how Abena cared for herself during pregnancy; Abena:

• Went for 4 antenatal care visits

• Prepared for birth in a health facility — saved money, arranged transport and collected supplies

• Ate more than usual during pregnancy to help the baby grow. this means an extra portion of rice, bread, or lentils, and when possible an egg, fish or meat, and fruit and vegetables

• took iron and folic acid tablets and followed other advice given at the antenatal clinic

• Avoided heavy work and rested more, to make sure she and her baby stay healthy

• slept under a treated bed net every night to stop her getting malaria

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seConD PregnAnCy Visit Card 2: immediate neWborn Care

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seConD PregnAnCy Visit Card 2: immediate neWborn Care

explain that everyone needs to know the care that babies need right after birth, whether the birth is in the health facility or at home.

Ask the family what care they think a baby should receive right after birth. Listen carefully and adapt your advice to the family’s situation. Ask the family what they see in the pictures and listen to their answers. tell the story of the care that Abena’s baby received immediately after birth:

• the birth attendant dried the baby with a cloth immediately after birth, placed the baby skin to skin on Abena’s tummy, and covered the baby with a dry cloth to keep her warm

• the birth attendant waited until cord stopped pulsating (about 3 minutes) and then tied and cut the cord, using clean cord ties and a new, clean blade

• Abena’s mother-in-law helped her to put the baby to the breast within a few minutes of birth, to help the milk come in and to reduce Abena’s bleeding. she knew that the first breast milk is like a vaccine as it protects the baby from disease

• to make sure the baby stayed warm, the family delayed bathing until the next day

Discuss how the family feels about how Abena’s baby was cared for and ask if they will be able to do the same. if yes, praise. if no, ask why not and try and solve any problems they have.

thank the family for their time and congratulate them for doing the best for mother and baby.

remind them to contact you as soon as the birth takes place.

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First PostnAtAL Visit Card 1: aSSeSS feedinG, danGer SiGnS and WeiGht

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First PostnAtAL Visit Card 1: aSSeSS feedinG, danGer SiGnS and WeiGht

greet the mother and family and ask how the mother and baby are doing. Wash your hands before you proceed with the assessment.

Ask the mother if she has put the baby to the breast. if yes, praise her and the family. if no, encourage her to put the baby to the breast now.

observe the mother breastfeed. Help the mother to correct positioning and attachment, if necessary.

Ask the family if you can check the baby now. Assess baby for these danger signs:• not able to feed since birth, or stopped feeding well• Convulsed or fitted since birth• Fast breathing: 60 breaths or more in one minute (two counts)• Chest indrawing• High temperature: 37.5ºC or more• Very low temperature: 35.4ºC or less• only moves when stimulated, or does not move even on stimulation• signs of local infection: umbilicus red or draining pus, skin boils and eyes draining pus.

Weigh the baby, record the weight on the mother and baby card and explain it to the family.

Proceed further depending on what you have found on assessment. if the baby has:• no DAnger signs AnD WeigHt in green Zone: counsel on normal care (CArD 2)• no DAnger signs AnD WeigHt in yeLLoW Zone: counsel on care for small babies (CArD 3)• Any DAnger sign or WeigHt in reD Zone: refer to hospital using reFerrAL sLiP.

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First PostnAtAL Visit Card 2: Care of the normal baby

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First PostnAtAL Visit Card 2: Care of the normal baby

Ask the mother and family what they see in these pictures. Listen to their answers and tell the story about how Abena takes care of her normal baby; Abena:

• gives only breast milk to the baby, because she knows that:- breast milk is the best food for the baby- breast milk protects against infections- the more the baby suckles at the breast, the more milk is made

• Feeds the baby frequently during the day and night, whenever the baby wants

• Wraps the baby well and keeps him close to her to keep him warm.

• Bathes the baby with warm water and dries and wraps him immediately after bathing so that the baby does not get cold.

Discuss with the family the importance of giving only breast milk to the baby. Praise them if they intend to do this. if not, try to solve any problems they have in adopting this behaviour

Discuss the importance of keeping the baby well wrapped, and bathe only with warm water. Praisethem if they intend to do this. if not, try to solve any problems they have

show the family pictures of signs of illness on the motHer AnD BABy CArD. explain that if any of these problems arise it is important to take the baby to the health facility immediately.

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First PostnAtAL Visit Card 3: Care of the Small baby

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First PostnAtAL Visit Card 3: Care of the Small baby

Ask the mother and family what they see in these pictures. Listen to their answers. explain that small babies need extra care for feeding and keeping warm and clean:

Feed the small baby breast milk frequently:

• if the baby is able to breastfeed, the mother should breastfeed every 2-3 hours during the day and night. if necessary, help the mother to improve positioning and attachment

• if the baby is not able to breastfeed well, help the mother to express breast milk and give it every2-3 hours with a cup or paladai. reFer to hospital if the baby is unable feed

keep the small baby warm:

• explain that the best way to keep a small baby warm is skin-to-skin contact. if the mother agrees, help her place the baby skin-to-skin with her:

- the baby should only be wearing a napkin, hat and socks- Place the baby between the mother’s breasts with the legs along the ribs and the head turned- secure the baby with a cloth tied around the mother and baby

• if mother does not agree to give skin-to skin-care, advise her to wrap the baby well and keep close to her at all times

• Advise to delay bathing for a few days, instead clean the baby by quickly wiping and drying

Advise the family to wash hands frequently, particularly after going to the toilet and after coming home from outside


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First PostnAtAL Visit Card 4: Care of the mother

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First PostnAtAL Visit Card 4: Care of the mother

Ask the mother how she is feeling. if she has heavy bleeding or fever, reFer urgently to hospital. explain that these pictures tell a story of how Abena was cared for after the birth of her baby. Ask the mother and family what they see in the pictures and tell the story; Abena

• Went to the postnatal care clinic at a facility soon after delivery

• Drank more fluids and ate more to ensure she had enough energy to produce breast milk. she continued to take iron tablets to strengthen her blood

• Went for family planning counseling and adopted a method to space births. she knew that spacing births by at least 2-3 years helps lower the risk of illness and death for mothers and babies.

• slept with the baby under a treated mosquito net every night because she lived in a malaria af- fected area

Ask the family how they can help ensure that the mother receives this care. Listen to their answers and problem solve as needed

thank the family for their cooperation and let them know that you will return for the next visit in 2days

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First PostnAtAL Visit FoLLoW uP Card 5: folloW UP ViSit for referred or Small babieS

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First PostnAtAL Visit FoLLoW uP Card 5: folloW UP ViSit for referred or Small babieS

FoLLoW-uP For BABies reFerreD to HeALtH FACiLity

Ask whether the baby was taken to the health facility. if the baby was not taken, assess for danger signs (First Postnatal visit Card 1— Assessment of the baby). refer again if needed.

if the baby was taken to hospital, ask what happened. Look at the referral slip.

if the birth weight was in reD or yeLLoW zone, counsel on care of the small baby using CArD 3.

thank the family and make an appointment for the next visit.

FoLLoW-uP For smALL BABies

Assess for danger signs: First Postnatal visit Card 1 — Assessment of the baby

Check whether the family has been able to follow the advice on breastfeeding, skin-to-skin care, bathing and hand washing. Problem solve as needed


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seConD PostnAtAL Visit Card 1: aSSeSS the baby for danGer SiGnS

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seConD PostnAtAL Visit Card 1: aSSeSS the baby for danGer SiGnS

greet the mother and family and ask how the mother and baby are doing. Problem solve if the family has any concerns.

Wash your hands before you proceed with the assessment.

Ask the family if you can check the baby now. Assess for danger signs, tell them what you find:• not able to feed since birth, or stopped feeding well

• Convulsed or fitted since birth

• Fast breathing: 60 breaths or more in one minute (two counts)

• Chest indrawing

• High temperature: 37.5ºC or more

• Very low temperature: 35.4ºC or less

• only moves when stimulated, or does not move even on stimulation

• yellow soles

• signs of local infection: umbilicus red or draining pus, skin boils and eyes draining pus.

if the baby has one or more DAnger signs, refer to hospital using reFerrAL sLiP. explain that you will come back later today/tomorrow to find out what happened.

if the baby does not have any DAnger signs, proceed to Card 2 if birth weight was in green zone or to Card 3 if the birth weight was in yellow or red zone

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seConD PostnAtAL Visit Card 2: Care of the normal baby

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seConD PostnAtAL Visit Card 2: Care of the normal baby

Ask the mother and family how breastfeeding is going. Ask if the baby is getting only breast milk.Praise them if they have. if not, try to solve any problem they have in adopting this behaviour.

observe a breastfeed. if needed, help the mother to correct the position and improve attachment. Ask the family if they have been able to keep the baby well wrapped and close to the mother, and bathe the baby with warm water and dry and wrap him/her immediately. Praise them if they have. if not, try to solve any problem they have in adopting this behaviour.


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seConD PostnAtAL Visit Card 3: Care of the Small baby

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seConD PostnAtAL Visit Card 3: Care of the Small baby

Ask the mother and family how feeding is going. Ask if the baby is getting only breast milk every 2-3hours during day and night. Problem solve if necessary.

observe a breastfeed (is the baby is being breastfed). if necessary, help the mother correct the position and improve attachment.

if the baby is fed expressed breast milk, observe a cup/paladai feed, and help the mother improve her technique if necessary.

Ask and observe if the mother has been able to keep the small baby in skin-to-skin contact. Praise her if she has, solve any problem she may have.

Ask if the family delayed bathing, and are instead quickly wiping and drying the baby. Praise them if they have, problem solve if necessary.

Ask if the family is washing hands frequently, particularly after going to the toilet and coming home from outside. Praise them if they have, problem solve if necessary.


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seConD PostnAtAL Visit Card 4: Care of the mother

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seConD PostnAtAL Visit Card 4: Care of the mother

Ask the mother how she is feeling. if she has heavy bleeding or fever, reFer urgently to hospital.

Ask the mother and family to look at the pictures. Ask if the mother has:

• Attended postnatal care clinic at a facility?

• Been drinking and eating more, and taking iron and folic acid tablets to build up her blood?

• thought about going for family planning counselling to adopt â birth spacing method?

• Been sleeping with the baby under a treated mosquito net every night?

Listen to their answers and problem solve as needed

thank the family for their cooperation and let them know that you will return for the next visit in 4days

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seConD PostnAtAL Visit FoLLoW uP Card 5: folloW UP ViSit for referred babieS

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seConD PostnAtAL Visit FoLLoW uP Card 5: folloW UP ViSit for referred babieS

Ask whether the baby was taken to the health facility.

if the baby was not taken, assess for danger signs (First Postnatal visit Card 1— Assessment of the baby). refer again if needed and solve any problems the family in complying with referral.


if the baby does not have a danger sign now, and the birth weight was in red or yellow zone, counsel on care of the small baby (using Card 3)


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tHirD PostnAtAL Visit Card 1: aSSeSS the baby for danGer SiGnS

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tHirD PostnAtAL Visit Card 1: aSSeSS the baby for danGer SiGnS

greet the mother and family and ask how the mother and baby are doing. Problem solve if the family has any concerns

Wash your hands before you proceed with the assessment.

Ask the family if you can check the baby now. Assess for danger signs, tell them what you find:• not able to feed since birth, or stopped feeding well

• Convulsed or fitted since birth

• Fast breathing: two counts of 60 breaths or more in one minute

• Chest indrawing

• High temperature: 37.5ºC or more

• Very low temperature: 35.4ºC or less

• only moves when stimulated, or does not move even on stimulation

• yellow soles

• signs of local infection: umbilicus red or draining pus, skin boils and eyes draining pus.

if the baby has one or more DAnger signs, refer to hospital using reFerrAL sLiP. explain that you will come back later today/tomorrow to find out what happened.

if the baby does not have any DAnger signs, proceed to Card 2 if birth weight was in green zone or Card 3 if the birth weight was in yellow or red zone

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tHirD PostnAtAL Visit Card 2: Care of the normal baby

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tHirD PostnAtAL Visit Card 2: Care of the normal baby

Ask the mother and family how breastfeeding is going. Ask if the baby is getting only breast milk. if not, try to solve any problem they have in adopting this behaviour.

observe a breastfeed. if needed, help the mother to correct the position and improve attachment. Ask the family if they have been able to keep the baby well wrapped and close to the mother, and bathe the baby with warm water and dry and wrap him/her immediately. Praise them if they have. if not, try to solve any problem they have in adopting this behaviour.


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tHirD PostnAtAL Visit Card 3: Care of the Small baby

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tHirD PostnAtAL Visit Card 3: Care of the Small baby

Ask the mother and family how feeding is going. Ask if the baby is getting only breast milk every 2-3hours during day and night. Praise them or problem solve, as necessary. observe a breastfeed (if baby is breastfeeding). if necessary, help the mother correct the position and improve attachment.

if baby is fed expressed breast milk, observe a cup/paladai feed, and help the mother improve her technique if necessary.

Ask and observe if mother has been able to keep the small baby in skin-to-skin contact. Praiseher if she has, solve any problem she may have.

Ask if the family delayed bathing, and are instead quickly wiping and drying the baby. Praise them if they have, problem solve if necessary.

Ask if the family is washing hands frequently, particularly after going to the toilet and coming home from outside. Praise them if they have, problem solve if necessary.


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tHirD PostnAtAL Visit Card 4: Care of the mother

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tHirD PostnAtAL Visit Card 4: Care of the mother

Ask the mother how she is feeling. if she has heavy bleeding or fever, reFer urgently to hospital.

Ask the mother and family to look at the pictures. Ask if the mother has:

• Attended postnatal care clinic at a facility?

• Been drinking and eating more, and taking iron and folic acid tablets to strengthen her blood?

• thought about going for family planning counselling to adopt a birth spacing method?

• Been sleeping with the baby under a treated mosquito net every night?

Listen to their answers and problem solve as needed

Counsel on continued care of the baby beyond the first week:

• the mother should continue to exclusively breastfeed until the baby is 6 months old

• Continue to sleep under a treated mosquito net every night

• take the baby for immunization when he/she is 6 weeks old

thank the family for their cooperation.

- if this is not a small baby, explain that this is your last home visit, but the mother and family can contact you if they have any concerns.

- if this is a small baby, explain that you will return in a week.

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tHirD PostnAtAL Visit FoLLoW uP Card 5: folloW UP ViSit for referred babieS

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tHirD PostnAtAL Visit FoLLoW uP Card 5: folloW UP ViSit for referred babieS

FoLLoW-uP For BABies reFerreD to HeALtH FACiLity

Ask whether the baby was taken to the health facility. if the baby was not taken, assess for danger signs (First Postnatal visit Card 1— Assessment of the baby). refer again and problem solve, if needed.


- if this is not a small baby, explain that this is your last home visit, but the mother and family can contact you if they have any concerns.

- if this is a small baby, explain that you will return in a week.

thank the family for their cooperation.

FoLLoW-uP For smALL BABies

Assess for danger signs: First Postnatal visit Card 1 — Assessment of the baby

Check whether the family has been able to follow the advice on breastfeeding, skin-to-skin care, bathing and hand washing. Problem solve as needed

explain that this is your last home visit, but the mother and family can contact you if they have any concerns. thank the family and make an appointment for the next visit.

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counseling cards - wordpress.com › ... · 2015-08-23 · for a pregnant woman and her baby...

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