Essential Care for Mothers and Newborns:
Pregnancy and Postpartum
Lesson Plan
Essential Care for Mothers and Newborns: Pregnancy
and Postpartum
Contents
Lesson 1: Antenatal Care and Danger Signs during Pregnancy ......................... 5
Lesson 2: Preparing For Delivery and Birth .................................................. 14
Lesson 3: Importance of Postpartum Care ................................................... 23
Lesson 4: Newborn Care Practices .............................................................. 33
Lessons 1-4 Pre and Posttest ..................................................................... 43
Lessons 1-4 Pre and Posttest ANSWERS...................................................... 45
Lessons, stories, and activities in the Essential Care for Mothers and Newborns:
Pregnancy and Postpartum Lesson Plan complement the information provided in
the Essential Care for Mothers and Newborns: Pregnancy and Postpartum Leader
Mother Flipchart.
Understanding the Lesson Plan
Each lesson begins with objectives. These are the
behavior, knowledge and belief objectives that are
covered in the lesson. Make sure that each of these
objectives is reinforced during the lesson. There are
four types of objectives. Each is described below.
Behavior objectives: Most objectives are behavioral objectives written as
action statements. These are the practices that we expect the caregivers to
follow based on the key messages in the flipchart.
Belief objectives: We know that beliefs and attitudes affect our practices.
Many times it is a person’s inaccurate belief or worldview that hinders them from
making healthy behavior change.
Behavioral determinant objectives: Behavioral determinants are reasons
why people practice (or don’t practice) a particular behavior. There are eight
possible behavioral determinants as identified in the Barrier Analysis1 surveys
done in each region. The surveys identify the most important determinants for
each behavior. By reinforcing the determinants that have helped the doers
(caregivers in the community already practicing the new behavior) we are able
to encourage the non-doers (caregivers who have not yet tried or been able to
maintain the new practices). We also help non-doers (caregivers who are not
practicing new behaviors) to overcome obstacles that have prevented them from
trying or maintaining the practice in the past.
1
See http://barrieranalysis.fhi.net for more information.
Under the objectives, all of the materials needed for the lesson are listed. The
facilitator should make sure to bring all of these materials to the lesson. See
below for more information.
Each exercise (section of the lesson plan) is identified by a small picture.
Pictures are used to remind non-literate Leader Mothers of the order of the
activities. For example when it’s time to lead the game the lesson plan shows a
picture of people laughing as if they are enjoying a game (see below). The
pictures in the lesson plan cue Leader Mothers of the next activity. Review the
descriptions below for more information.
The first activity in each lesson is a game or song.
Games and songs help the participants to laugh, relax
and prepare for the lesson. Some games review key
messages that the participants have already learned.
Game
Following the game, all facilitators will take
attendance. The promoter follows up with any
difficulties that the Leader Mothers had teaching the
previous lessons.
Attendance and
Troubleshooting
The Activity Leader meets with the facilitator ten minutes before each lesson
to discuss the needed materials for the next lesson’s activity. The Activity
Leader is responsible to talk with the others (Leader Mothers or neighbors)
during the “Attendance and Troubleshooting” to organize the materials needed
for the next meeting, asking them to volunteer to bring the items. The
facilitator will lead the activity, but the Activity Leader will support her by
organizing the volunteers and aiding the facilitator as needed during the activity.
Next the facilitator reads the story printed on the flipchart, using the images to
share the story. The story in each lesson is followed by discussion questions.
Discussion questions are used to discuss the problems
faced by the two main characters in the module (Amina
Nlwere and Maria Ngomo). Use the story and
discussion questions to find out the current practices of
the women in the group.
Ask about Current
Practices
2
After turning to a new flipchart page ask, “What do you
think these pictures mean?” After the participants
respond, explain the captions and key messages written
on the back of the flipchart.
Share the Meaning
of Each Picture
The lesson plan also contains additional information for the trainer. The
additional information does not need to be discussed during the lesson unless it
relates to questions asked by the participants.
Next is an activity. Activities are “hands-on” exercises
to help the participants understand and apply what
they have learned. Most of these activities require
specific materials and preparations which are organized
by the Activity Leader.
Activity
Discuss Barriers
The facilitator asks if there are any obstacles that
prevent the caregivers from trying the new
practices. The facilitator and other group members
give more information or a different perspective to
help caregivers understand how to overcome these
obstacles.
Next is Practice and Coaching. This section is required for the training of
Leader Mothers only. We want to make sure that they understand the material
and can present it to others. In this activity, the promoter observes and coach
Leader Mothers as they practice teaching in pairs.
Finally, the facilitator requests a commitment from each
of the women in the group. It is up to each woman to
make a choice. They should not be forced to make a
commitment if they are not ready.
Request
Commitments
3
All lessons follow the pattern described above. Lessons can be adapted as
needed to fit the needs of your group. Lessons should not exceed two hours in
length although some lessons may take longer than others. The suggested time
for each section is listed below.
Section name
Game or Song
Attendance and Troubleshooting
Story
Ask about Current Practices
Share the Meaning of Picture 2
Share the Meaning of Picture 3
Share the Meaning of Picture 4
Activity
Discuss Barriers
Practice and Coaching
Request Commitments
Time needed for this section
5 - 10 minutes
5 - 15 minutes
5 minutes
10 minutes
10 minutes
10 minutes
10 minutes
15-30 minutes
15 minutes
5 - 20 minutes
10 minutes
2 – 2 ½ hours
Acknowledgements
Many thanks to the illustrators including Ir Léonidas Nisabwe (Burundi), and
Octávio Consalves (Mozambique). Games used in the lessons are available
through the HIV/AIDS Alliance. See below for full details and resources used in
the development of this module.
Suggested Citation: Hanold, Mitzi J. (2011) Essential Care for Mothers and
Newborns: Pregnancy and Postpartum. Washington DC. Food for the Hungry
(FH), made possible through support provided by the Office of Food for Peace,
Bureau of Democracy, Conflict, and Humanitarian Assistances, and the U.S.
Agency for International Development under the terms AID-FFP-A-00008-0008600. The opinions expressed herein are those of the authors and do not
necessarily reflect the view of the U.S. Agency for International Development
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Resources used in the development of this module include the following:
Beck, Diana, et al. Care of the Newborn: Reference Manual. DC: Save
the Children, 2004.
Burns, A. August, et al. Where Women Have No Doctor. Berkley:
Hesperian Foundation, 1997. Available:
http://www.hesperian.org/index.php
100 ways to energize groups: games to use in workshops, meetings and
the community. Available at www.aidsalliance.org. International
HIV/AIDS Alliance, 2002.
4
Lesson 1: Antenatal Care and Danger Signs
during Pregnancy
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Pregnant women will visit the health center at least four times during
pregnancy.
o Health workers will counsel mothers regarding conditions that may
cause a difficult delivery.
o
Health workers will offer supplements, vitamins and vaccinations to
keep the mother healthy during and after delivery.
o
Health workers will check for illness and offer deworming and malaria
medications to women after the fourth month of pregnancy.
Caregivers will deliver their next child at the health center or regional
hospital.
Caregivers will be able to list at least four advantages of birthing at a hospital
or clinic.
o Women who birth at the health center are more likely to survive
childbirth, recovery quickly and have a healthy child.
o
Experienced personnel with medical experience to help with life
threatening complications.
o
Sterile and clean environment for birthing.
o
Ability to give vaccinations to infants at birth.
Caregivers will go immediately to the health clinic if they see any of the
pregnancy danger signs:
o Vaginal bleeding
o
Severe headaches
o
Severe stomach aches
o
Persistent vomiting
Materials:
1. Attendance Register
2. Leader Mother Flipchart
Summary:
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Game: People to People
Attendance and Troubleshooting
Share the story and ask about current practices
5
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Show pictures and share key message on flipchart pages 6-11: Antenatal
Care during Pregnancy, Advantages of Delivery at the Health Facility and
Danger signs during Pregnancy.
Activity: Delivery at the Health Center
Discuss Barriers
Practice and Coaching in pairs
Request Commitments
1. Game: People to People – 10 minutes
1. Ask each woman to find another woman and stand next to her.
2. Explain that the leader will call out actions and each pair must touch these
two body parts together.
3. For example, if the leader says, “Back to back” each pair must stand with
their backs touching. If the leader says, “Hip to Hip” each pair must stand
with their hips touching. If the leader says, “Knees to Knees, each pair must
stand with their knees touching. However, if the leader says, “People to
People,” everyone must find a new woman to stand with.
4. Give many commands using different body parts.
5. Continue giving new commands using different body parts until the women
are laughing and having fun.
Now that we are energized, let’s begin our lesson.
2. Attendance and Troubleshooting – 15 minutes
1. Fill out the attendance sheets for each Leader Mother and neighbor group
(beneficiary group).
2. Complete the vital events mentioned by each Leader Mother (new births, new
pregnancies, and mother and child deaths).
3. Ask the Leader Mothers if they had any problems teaching the last lesson.
4. Help solve the problems mentioned by the Leader Mothers.
5. Thank the Leaders for their hard work. Encourage them to continue.
6
6. Ask the Activity Leader2 to discuss the needed items for next week’s activity
and solicit volunteers.
When the Leader Mother is teaching the neighbor group, she will use this time to
take attendance.
Visiting the Health Center (Picture 1.1) – 10 minutes
3. Story

Read the story on page 4 of the flipchart.
Maria Ngomo sees Amina Nlwere walking along the path. “Where are you
going?” Maria Ngomo asks. “I am going to the health center. The health
worker will examine me to make sure the child is growing well.” Amina Nlwere
says. Maria Ngomo says, “Growing well? I thought that only sick people went to
the health center.”
4. Ask about Current Practices

Read the questions on page 4 of the flipchart.
?
?
?
Where is Amina Nlwere going? Why?
Why would she go to the health center if she is not sick?
How often did you visit the health center during your last
pregnancy?

Ask the first question to review the story.
o Amina Nlwere is going to the health center. She is not sick, but is
going so the health worker can monitor her health and the health of
the growing child in her belly.

Ask the second question to discuss the beliefs and practices of the women
regarding visiting the health center.
o We hope the women respond in this way: Often people in the
community go to the health center when they are ill. However,
pregnant women and small children should go regularly to the health
clinic for vaccinations, vitamins and supplements to help them stay
healthy.

Ask the last question to find out how often women visited the clinic during
their last pregnancy.
2
The Activity Leader should arrive ten minutes prior to each care group meeting to get the
description of the activity and the list of needed items from the promoter.
7
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o
At the moment that a woman knows (or believes) she is pregnant, she
should visit the health center for her first visit.
o
Pregnant women should visit the health center at least once every two
months (at least four times before birth).
Encourage discussion. Don’t correct “wrong answers.” Let everyone
give an opinion. This page is for discussion, not for teaching.
After the participants answer the last question, move to the next flipchart
page by saying, “Let compare your ideas with the messages on the following
pages.”
Antenatal Care during Pregnancy (Picture 1.2) – 10 minutes
5. Share the Meaning of Each Picture
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Ask the caregivers to describe what they see in the pictures on page 7.
Share the meaning of each picture on flipchart pages 6 and 7.
Use the captions on the flipchart to remind you which images represent each
point.
Visit the health center at least four times during pregnancy.
o
o
o
Visit the health center at the first sign of pregnancy.
Visit the health center at least once every two months.
The health worker will tell you when to return.
Health workers give vaccinations and supplements and monitor the
growth of the mother and child.
o
o
o
o
Take iron supplements each day to prevent anemia during
pregnancy.
Take malaria and deworming medication after the fourth month of
pregnancy to prevent anemia.
The health worker measures the mother’s belly to see if the child is
gaining enough weight and growing well.
The health worker examines the mother for malaria, anemia and
other illnesses that can harm the mother and child.
8
o
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Health worker will give advice to help the mother and child grow
well.
Do you think spending your time visiting the health center is a wise use of
your time? Why or why not?
Advantages of Delivery at the Health Center (Picture 1.3) – 10
minutes
6. Share the Meaning of Each Picture
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?
Ask the caregivers to describe what they see in the pictures on page 9.
Share the meaning of each picture on flipchart pages 8 and 9.
Use the captions on the flipchart to remind you which images represent each
point.
What do you think these pictures mean?
Women who deliver at the health center are more likely to survive
childbirth, recover quickly and have a healthy baby.
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The health center is a clean place for delivery.
Clean beds and equipment prevent infection.
Health workers have medicine and equipment to overcome problems
during delivery.
Health workers are able to give special care to weak or sick infants.
Newborns born at the health center receive vaccinations at birth to
prevent illness.
 Vaccinations prevent severe childhood illness.
?
What are some other reasons why delivering at the health center is better
than delivering at home?
9
Additional Information for the Trainer
Tetanus in Adults

Mothers are at risk of tetanus from unclean deliveries or poor hygiene during
the postnatal period.
 A woman who has been vaccinated with five properly spaced doses is
protected for life. Infants born to this mother are protected for the first few
weeks of life and then should receive the appropriate infant and child
vaccinations which include tetanus.
 An expectant mother whose tetanus immunization status is uncertain or
whose last immunization was more than 10 years ago should be immunized
against tetanus.
Tetanus Vaccination
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Infants are at risk of tetanus if the umbilical cord is cut with an unsterilized
instrument or if the stump is not allowed to dry and heal in the first week of
life.
Signs of tetanus in newborns appear 3 to 10 days after birth. The child
begins to cry continuously and is unable to suck.
Danger Signs during Pregnancy (Picture 1.4) – 10 minutes
7. Share the Meaning of Each Picture
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Ask the caregivers to describe what they see in the pictures on page 11.
Share the meaning of each picture on flipchart pages 10 and 11.
Use the captions on the flipchart to remind you which images represent each
point.
10
?
What do you think these pictures mean?
If you have severe bleeding or headaches go immediately to the health
center.
If you have stomach pains or vomiting that does not stop, go
immediately to the health center.

These are danger signs for you and your infant!

Don’t wait.

Go immediately to the health center for treatment.
8. Activity: Delivery at the Health Center – 15
minutes
1. Ask the mothers to compare birth at home to birth at the health center.
2. Draw two columns on the ground. Above one column, draw an outline of a
house. Above the second column, draw an outline of a clinic (or cross for
health center).
3. Use rocks, leaves or other items to represent the advantages of each option.
4. Some advantages for birthing at the health center might include:
a. There are specialists to help me if I have trouble.
b. It is a clean environment for birthing.
c. They can give the infant care immediately after birth if there is a
problem.
d. They can easily give the needed vaccinations at birth (BCG and Polio).
e. More women (and their infants) die during home births than births at
the health center.
5. Compare the advantages of birth at home versus birth at the health center.
?
?
Which of these choices is best for the infant?
Which of these choices is best for the mother?
6. Reinforce that birth at the health center is the safest place for both infant and
mother. If there are problems, the health workers can work quickly and help
11
the mother and infant recover. At home, if there are problems, the mother
and infant are at higher risk of infection and death.
7. Discuss their concerns. Reinforce the advantages of birthing at the health
center. Encourage those who are not yet committed to birth at the health
center to reconsider and discuss the idea with their family.
9. Discuss Barriers – 15 minutes
?
What do you think about these ideas? Is there anything that might prevent
you from trying these new health practices?
Ask mothers to talk to a woman sitting next to them. They will share barriers
and concerns they have about the new teaching. Together they will try to find
solutions to these barriers. After five minutes, ask the women to share what
they have discussed with the large group.
Help find solutions to their concerns. If a woman offers a good solution to
another woman’s concern, praise her and encourage others to consider this
solution.
10. Practice and Coaching ─ 20 minutes
1. Ask each Leader Mother to share the teachings she has learned with the
person sitting next to her. (All Leader Mothers will work in pairs). Each
Leader Mother teaches in the same way that she was taught.
2. In each pair, one woman will teach the first two pages of the lesson to her
partner. After she is finished, the other Leader Mother will teach the last two
pages of the lesson.
3. Watch, correct, and help Leader Mothers who are having trouble.
4. When everyone is finished, answer questions that the mothers have about
the lesson.
When the Leader Mother is teaching the neighbor group, she will ask each
woman to discuss the things she has learned with the woman sitting next to her.
12
They will repeat the key messages that they have heard. They will do this in
pairs. This will help them to verbally repeat the messages and clarify
understandings.
11. Request Commitments ─ 10 minutes
?
Are you willing to make a commitment to the teachings you have heard
today? What is your commitment?
Ask each mother to say aloud a new commitment that she will make today.
Each mother can choose the commitment that is most important to her.
For example:
 I commit to delivering my next child at the health center or hospital.
 I commit to visiting the health center at least four times during pregnancy.
 I commit to going immediately to the health center if I see a danger sign.
?
What was your commitment at the last lesson? Have you kept that
commitment?
?
How – what did you do?
o
Did anyone (husband, grandmother or children) interfere or tell you
not to follow your commitments? Tell the story of what happened?
o
What factors (people, events or chores) in your life made it difficult to
keep your commitments?
o
How were you able to overcome these problems?
13
Lesson 2: Preparing For Delivery and Birth
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
Pregnant women will go immediately to the health center if they see one of
the danger signs:
o When contractions are strong and come regularly (every 20 minutes).
o
Water comes from the vagina as if a bag of water has broken inside.
o
Bloody and sticky mucus comes from the vagina.
Caregivers will be able to describe what they should do during delivery.
o Women will take long deep breaths once the health worker tells her
she is ready, and begin pushing.
o
When the child’s head begins to birth, the woman will take short quick
breaths with short pushes to help the child come slowly.
o
After the birth of the child, the umbilical cord will be tied after it turns
white. The cord will be tied in two places and cut with a new razor.
o
As soon as the newborn is dried, he will be placed skin to skin on the
mother’s chest.
o
Mother will begin breastfeeding immediately to help the placenta to
birth.
Materials:
1. Attendance Register
2. Leader Mother Flipchart
Summary:
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Game: Musical Mats
Attendance and Troubleshooting
Share the story and ask about current practices
Show pictures and share key message on flipchart pages 14-19: Signs that
Girth is Near, Delivery at the Health Center and Final Stages of Delivery.
Activity: Making a Birth Plan
Discuss barriers
Practice and Coaching in pairs
Request commitments
14
1. Game: Musical Mats - 10 minutes
1. Ask the women to stand in a circle with something to sit on (a chair or a mat
behind them). The facilitator stands to the side.
2. Now remove one of the mats so that one person does not have a place to sit.
3. Tell the women that you are going to sing a song. The women will walk
around the circle clapping and dancing as you sing. When you stop singing,
they must find the closest mat and sit down. The woman who doesn’t find a
seat must leave the circle.
4. The facilitator should turn his back (so he can’t see the women) and begin
singing. Stop suddenly in the middle of the song. The woman without a mat
leaves the game.
5. Remove one more mat. Then begin the song again with the remaining
women.
6. Continue until there is only one mat and one woman left.
Now that we are energized, let’s begin our lesson.
2. Attendance and Troubleshooting – 15 minutes
1. Fill out the attendance sheets for each Leader Mother and neighbor group
(beneficiary group).
2. Complete the vital events mentioned by each Leader Mother (new births, new
pregnancies, and mother and child deaths).
3. Ask the Leader Mothers if they had any problems teaching the last lesson.
4. Help solve the problems mentioned by the Leader Mothers.
5. Thank the Leaders for their hard work. Encourage them to continue.
6. Ask the Activity Leader3 to discuss the needed items for next week’s activity
and solicit volunteers.
3
The Activity Leader should arrive ten minutes prior to each care group meeting to get the
description of the activity and the list of needed items from the promoter.
15
When the Leader Mother is teaching the neighbor group, she will use this time to
take attendance.
Breaking Waters (Picture 2.1) – 10 minutes
3. Story

Read the story on page 12 of the flipchart.
Maria Ngomo plans decided to have her birth at the health center. She makes a
delivery plan and prepares her supplies. She sets aside a small amount of food
and water for after delivery, and some clean clothing. She also talks with her
neighbors about her plans. She is on her way to the market when a gush of
water comes out of her. What is this? Is this a sign of labor?
4. Ask about Current Practices

Read the questions on page 12 of the flipchart.
?
?
?
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Should she go to the health center or wait for another sign?
What are the signs that you should leave for the health
center for delivery?
Ask the first two questions to discover the women’s beliefs about labor.
o The water is a sign that the bag which holds the child has broken. The
woman must deliver within one day from this time. If she waits too
long, she and her child will develop infection and risk death.
o

What happened to Maria Ngomo? What does it mean?
She should leave immediately so she arrives at the health center on
the same day.
Ask the last question to find out what signs of labor are already known by the
women.
Encourage discussion. Don’t correct “wrong answers.” Let everyone
give an opinion. This page is for discussion, not for teaching.
After the participants answer the last question, move to the next flipchart
page by saying, “Let compare your ideas with the messages on the following
pages.”
16
Sings that Birth is Near (Picture 2.2) – 10 minutes
5. Share the Meaning of Each Picture
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?
Ask the caregivers to describe what they see in the pictures on page 15.
Share the meaning of each picture on flipchart pages 14 and 15.
Use the captions on the flipchart to remind you which images represent each
point.
What do you think these pictures mean?
When pains in the belly are frequent and strong, go to the health center
for delivery.
o
o
o
Pains will start slowly.
Pains will increase in number, strength, and length as time passes.
These pains begin to open the bag that holds the infant.
When clear water or a lump of mucus comes from the vagina, go to the
health center for delivery.
o
o
The infant is inside a bag of liquid in the mother’s belly.
When the bag breaks, liquid comes out of the body.
o
o
o
The bag which holds the infant is sealed with this mucus.
When the bag opens, a lump of mucus comes out.
There may also be some blood.
o
These are signs that birth is near.
Go immediately to the health center.
o
17
Delivery at the Health Center (Picture 2.3) – 10 minutes
6. Share the Meaning of Each Picture
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?
Ask the caregivers to describe what they see in the pictures on page 17.
Share the meaning of each picture on flipchart pages 16 and 17.
Use the captions on the flipchart to remind you which images represent each
point.
What do you think these pictures mean?
When the cervix is fully opened, take long deep breaths and push.
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The cervix is the narrow end of the bag which holds the infant.
It may take from sun up to sun down for the neck of the bag to fully
open.
Wait until the health worker tells you to begin pushing.
If the mother begins pushing too early, it may cause tearing,
increase the time of labor and tire the mother too early.
Never push on the outside of the woman’s body to make the infant
come out.
When the top of the head appears, take quick, slow breaths.
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Slow quick breaths stop the mother from pushing too hard.
This helps the head come slowly.
If the mother pushes hard and fast, she may tear.
After birth, dry the infant’s head and body with a clean, dry cloth.
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
Wipe the mucus from the nose and mouth.
Dry the head and hair.
Additional Information for the trainer
Contractions
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It may take 10 to 20 hours for contractions to open the cervix (mouth of the
bag which holds the infant) during the first pregnancy. For a second or third
birth, it may only take 7 to 10 hours.
The cervix is considered open when it dilates 10 centimeters. Once the
cervix opens, the woman should start pushing.
18
Final Stages of Delivery (Picture 2.4) – 10 minutes
7. Share the Meaning of Each Picture
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?
Ask the caregivers to describe what they see in the pictures on page 19.
Share the meaning of each picture on flipchart pages 18 and 19.
Use the captions on the flipchart to remind you which images represent each
point.
What do you think these pictures mean?
To give the infant strong blood, wait until the cord stops beating before
cutting it with a clean razor.
 The cord will stop beating and turn white.
 Tie it two finger-widths away from the infant.
 Add another tie two finger-widths away.
 Cut the cord with a clean razor in between the two ties.
Begin breastfeeding immediately to help slow the mother’s bleeding
and expel the placenta.
 Place the naked infant onto the mother’s naked chest.
 Cover them with a warm blanket.
 The mother’s body will warm and calm the infant.
 Breastfeeding helps the mothers’ body to recover from delivery.
 Breastfeeding will help the cord to detach from inside the body.
 Never pull on the umbilical cord.
Additional Information for the Trainer
Delayed Clamping

Delayed clamping (after the cord turns white) of the umbilical cord lessens
the risk of anemia in newborns.
Placenta
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As the placenta separates from the womb, the cord will slowly come out of
the vagina. This is a sign that the placenta has separated and the woman
can begin pushing to help the placenta exit.
If the placenta does not come out after the birth, and there is no bleeding,
wait up to one hour for the placenta to come.
19
8. Activity: Making a Birth Plan – 15 minutes
?
Which of you have had a child at the health center? Please tell us about your
experience.
?
What are the things that a mother should bring with her to have a child at
the health center?
Add any of the following things that were not mentioned:
 Clean clothing for the mother and newborn.
 A blanket
 Food and water for the mother to eat and drink during and after delivery
 Money for transportation to and from the health center
?
What other things does a woman need to prepare before she leaves her
home for the health center?
Add any of the following things that were not mentioned:
 Someone to watch her other children and feed the family
 Someone to come with her and help during the birth
 Someone to stay with her for one week after the birth
8. Ask each pregnant mother, “Do you have the supplies that you need for
delivery? Do you know who will go with you to the health center?”
9. Discuss any questions they have about the birthing plan. Encourage those
who have not already made a plan to start today.
10.Remind them that it is important to discuss this plan with everyone in the
family and begin preparing for birth.
9. Discuss Barriers – 15 minutes
20
?
What do you think about these ideas? Is there anything that might prevent
you from trying these new health practices?
Ask mothers to talk to a woman sitting next to them. They will share barriers
and concerns they have about the new teaching. Together they will try to find
solutions to these barriers. After five minutes, ask the women to share what
they have discussed with the large group.
Help find solutions to their concerns. If a woman offers a good solution to
another woman’s concern, praise her and encourage others to consider this
solution.
10. Practice and Coaching ─ 20 minutes
1. Ask each Leader Mother to share the teachings she has learned with the
person sitting next to her. (All Leader Mothers will work in pairs). Each
Leader Mother teaches in the same way that she was taught.
2. In each pair, one woman will teach the first two pages of the lesson to her
partner. After she is finished, the other Leader Mother will teach the last two
pages of the lesson.
3. Watch, correct, and help Leader Mothers who are having trouble.
4. When everyone is finished, answer questions that the mothers have about
the lesson.
When the Leader Mother is teaching the neighbor group, she will ask each
woman to discuss the things she has learned with the woman sitting next to her.
They will repeat the key messages that they have heard. They will do this in
pairs. This will help them to verbally repeat the messages and clarify
understandings.
11. Request Commitments ─ 10 minutes
21
?
Are you willing to make a commitment to the teachings you have heard
today? What is your commitment?
Ask each mother to say aloud a new commitment that she will make today.
Each mother can choose the commitment that is most important to her.
For example:
 I commit to going to the health clinic when I see the signs that birth is near.
 I will gather food and water to take with me to the health center.
 I will ask the nurse to let me breastfeed immediately after the child is born.
?
What was your commitment at the last lesson? Have you kept that
commitment?
?
How – what did you do?
o
Did anyone (husband, grandmother or children) interfere or tell you
not to follow your commitments? Tell the story of what happened?
o
What factors (people, events or chores) in your life made it difficult to
keep your commitments?
o
How were you able to overcome these problems?
22
Lesson 3: Importance of Postpartum Care

Women who have delivered a child in the last six weeks will:
o Rest more often than normal to help the body recover from the blood
loss and strain on the body from delivery.
o
Eat two additional snacks each day to regain strength after delivery.
o
Drink more liquids than normal to help the body recover and
encourage production of breast milk.

Women who have delivered a child will go to the health center for vitamin A
in the first six weeks after giving birth.
o Vitamin A helps improves the health status of the mothers and supplies
Vitamin A to the infant through breast milk for improved survival.

Women who have delivered a child in the last two weeks will go to the health
center if one of more of the following danger signs are seen:
o High fever and pain in the belly are all signs of infection.

o
Severe bleeding or bleeding that continues for more than two weeks
o
Leaking urine or stool is caused by long labor.
Caregivers will discuss methods to help mothers rest and share her work in
the weeks after delivery.
Materials:
1.
2.
3.
4.
Attendance Register
Leader Mother Flipchart
A woman’s health card
Container of iron pills
Summary:








Game: I’ve Never
Attendance and Troubleshooting
Share the story and ask about current practices: Maria Ngomo Goes Back to
Work
Show pictures and share key message on flipchart pages 23-27: Maternal
Care after Delivery, Services after Delivery at the Health center, and Danger
Signs after Delivery.
Activity: Care After Delivery
Discuss barriers
Practice and Coaching in pairs
Request commitments
23
1. Game: I’ve Never – 10 minutes
1. Place enough mats for each woman in a circle to sit.
2. Choose one volunteer. The volunteer stands in the middle. Her mat is
removed from the circle.
3. The volunteer names one thing that she has never experience. She should
think of something that others in the group have experienced. For example:
“I do not have a male child, or “I have never been to the capital city.”
4. All of the women who HAVE a male child (or have been to the capital) must
stand up and move to a new mat. At the same time, the volunteer tries to sit
on one of the open mats. One person will be left without a mat to sit on.
That person now stands in the middle and names one thing that she has
experienced.
5. The object of the game is to stay in your seat. If you must move, move
quickly into an open seat so that you will not have to stand in the middle.
6. Continue to play until everyone has a chance to stand in the middle.
Now that we are energized, let’s begin our lesson.
2. Attendance and Troubleshooting – 15 minutes
1. Fill out the attendance sheets for each Leader Mother and neighbor group
(beneficiary group).
2. Complete the vital events mentioned by each Leader Mother (new births, new
pregnancies, and mother and child deaths).
3. Ask the Leader Mothers if they had any problems teaching the last lesson.
4. Help solve the problems mentioned by the Leader Mothers.
5. Thank the Leaders for their hard work. Encourage them to continue.
6. Ask the Activity Leader4 to discuss the needed items for next week’s activity
and solicit volunteers.
7. Ask the group to select a new Activity Leader who will be responsible to
coordinate the supplies and preparations for the activities in the next module.
4
The Activity Leader should arrive ten minutes prior to each care group meeting to get the
description of the activity and the list of needed items from the promoter.
24
She will make sure that each volunteer brings one or more of the needed
items for the lesson’s activities. She will come to each of the six meetings
ten minutes early so the promoter can give her the list of needed items and
explain the activity for the next lesson. The Activity Leader will then ask for
volunteers who are willing to bring the needed items during the “Attendance
and Troubleshooting” section. She will also assist the promoter during the
day’s activity. Choose a new Activity Leader when she completes six lessons.
When the Leader Mother is teaching the neighbor group, she will use this time to
take attendance and select a new Activity Leader.
Maria Ngomo Goes Back to Work (Picture 3.1) – 10 minutes
3. Story


Read the story on page 20 of the flipchart.
The story encourages discussion about the importance of resting after
delivery.
Two days after delivery, Maria Ngomo begins her work again. In the morning,
she sweeps her compound and goes to the market. In the afternoon, she begins
preparing food, but she is not able to finish. She lies down and quickly falls
asleep. Her son sees that her bleeding is heavy and runs for help.
4. Ask about Current Practices

Read the questions on page 20 of the flipchart.
?
?
?
Why is Maria Ngomo bleeding?
How long should a woman rest after delivery?
How many days did you rest after delivery?

Ask the first questions to review the story.
o We hope the participants will say: Maria Ngomo has not healed from
her delivery. She is working too hard. It increases her bleeding.

Ask the second question to find out the beliefs of how long women should
rest (or is able to rest) after delivery.
o It is best for a woman to rest often and work less than normal for up
to six weeks. If a mother is bleeding she must rest until her body is
healed.
25



Ask the last question to find out how many days the women in the group
rested.
Encourage discussion. Don’t correct “wrong answers.” Let everyone
give an opinion. This page is for discussion, not for teaching.
After the participants answer the last question, move to the next flipchart
page by saying, “Let compare your ideas with the messages on the following
pages.”
Maternal Care After Delivery (Picture 3.2) – 10 minutes
5. Share the Meaning of Each Picture



?
Ask the caregivers to describe what they see in the pictures on page 23.
Share the meaning of each picture on flipchart pages 22 and 23.
Use the captions on the flipchart to remind you which images represent each
point.
What do you think these pictures mean?
For six weeks after delivery rest often; work less than normal.



Ask someone to stay with you after delivery for one week or more.
Work less until your body has healed.
Women who do not rest bleed more.
Eat two additional snacks each day to gain strength after delivery.




?
Eats beans, lentils, green leafy vegetables and organ meats for
strong blood.
These foods have iron for strong blood.
Organ meats, red meat and beans bring healthy muscles and
bones.
Drink more water than normal to bring breast milk.
Is it difficult to rest after delivery?
26
?
?
Who can help the mother complete her work after delivery?
What advice would you give to a new mother about resting after delivery?
Additional Information for the Trainer
Maternal Mortality Rate


In developing countries, over half (60%) of maternal deaths occur in the
weeks after delivery. Of those who die after birth, most (45%) of them are
within 24 hours after delivery. Another 23% of the deaths are on days 2-7
after delivery.5
The two largest reasons for maternal death are bleeding and infections.
Appropriate care in the first hours and days after delivery can prevent the
majority of these deaths.
Services after Delivery at the Health Center (Picture 3.3) – 10
minutes
6. Share the Meaning of Each Picture





?
Ask the caregivers to describe what they see in the pictures on page 25.
Share the meaning of each picture on flipchart pages 24 and 25.
Use the captions on the flipchart to remind you which images represent each
point.
Show the container of iron pills to the mothers. Explain where they can
purchase (or receive) iron pills.
After reviewing the flipchart, point out the place on the health card where
tetanus vaccinations are marked.
What do you think these pictures mean?
Continue taking iron pills each day for three months after giving birth.
o
o
o
Take iron pills with food.
Iron helps to make the mother’s blood strong.
Iron gives energy and strength to the mother.
5
Li, XF, Fortney, JA, Kotelchuck, M, and Glover, LH. 1996. The postpartum period: The key to maternal
mortality. International Journal of Gynecology and Obstetrics 54(1): 1-10.
27
Receive Vitamin A in the first six weeks after giving birth.
o
o
o
The mother receives a drop of Vitamin A during her visit.
Vitamin A helps to restore the mother’s health.
Vitamin A in the mother’s breast milk helps the infant to resist
sickness.
?
How many of you are taking iron pills now?
?
How many of you have already received vitamin A?
?
Why are these services important?
Additional Information
Iron Pills

Iron pills (also referred to as ferrous sulfate) should be available to pregnant
and lactating women at health centers.
 Women should take iron pills daily, with food after their first prenatal visit
until four months after delivery.
Vitamin A and Mortality

It is estimated that 140-250 million children under five years of age have
vitamin A deficiency. These children suffer an increased risk of death,
blindness and illness (especially measles and diarrhea).
Danger Signs after Delivery (Picture 3.4) – 10 minutes
7. Share the Meaning of Each Picture



Ask the caregivers to describe what they see in the pictures on page 27.
Share the meaning of each picture on flipchart pages 26 and 27.
Use the captions on the flipchart to remind you which images represent each
point.
28
?
What do you think these pictures mean?
Quickly return to the health center if you have fever, sharp belly pain.


Fever and belly pain maybe be signs of infection inside the belly.
Many women die from untreated infections after delivery.
Quickly return to the health center if you have heavy bleeding or urine
and feces leaking from the body.



Bleeding that does not stop after two weeks is a danger sign.
If you see one of these signs, do not wait.
Go immediately to the health center.
?
How does a woman know if her bleeding is heavy? What is the normal
amount of bleeding after delivery?
?
Why is it important to go immediately to the clinic?
Additional Information for the Trainer
Fistula

Leaking urine or feces is a sign that a tear has formed between the vagina
and rectum or the woman has a hole in the bladder or bowel. This is
caused when labor goes too long and the skin dies between the vagina and
anus.
 In most cases, surgery can repair these damages and help the woman to live
a normal life including the birth of more children.
Additional Danger Signs



Headaches, nausea, vomiting and feeling faint are signs of eclampsia
(toxemia).
Calf pain, redness or swelling of calves; shortness of breast or chest pain
may be signs of a blood clot.
In general, women should go to the health center if they do not feel “right” or
notice any unusual signs.
8. Activity: Care After Delivery – 15 minutes
1. Explain: In Mozambique many women die during pregnancy or just after
delivery.
29
2. Out of every 37 women will die because of problems during pregnancy,
delivery or recovery.6 (That means one of out every three care groups (3 x
12 women in each group = 36 women) or one out of every three neighbor
groups is at risk of death from problems from pregnancy!)
3. Actions that we take to stay health can save lives. It can save your life and
mine.
?
What time is the most dangerous for mothers?
During delivery? Or after delivery?
Is it during pregnancy?
4. The majority of mothers die in the first seven days after delivery. This is the
most important time for mothers to rest and recover.
?
How many days is a mother usually given to rest after delivery? Is this
enough?
?
?
Is there someone watching if she shows a danger sign?
What are things that families can do to help women to recover after birth?
Some possible responses:





Husbands can save a small amount of money (including transportation and
money for medication) in case the mother shows danger signs.
The community can organize a vehicle for emergency trips to the hospital or
clinic.
Husbands and older children can help with household work so the mother can
rest and breastfeed the newborn.
Those who help women after delivery must know the danger signs. They can
watch mothers and help to get them to the health center if there are
problems.
Old women in the community can volunteer to do field work for women who
have recently given birth.
Ask each mother,
?
How can women help husbands and others in the community understand the
importance of caring for the mother after delivery?
?
How can you help other mothers who have just delivered?
Encourage the women to think of one thing they can do to raise awareness or
help other women in the community after delivery.
6
Estimates of Maternal Mortality 2008 (WHO/UNICEF/UNFPA/The World Bank). Available:
http://www.childinfo.org/maternal_mortality_countrydata.php
30
9. Discuss Barriers – 15 minutes
?
What do you think about these ideas? Is there anything that might prevent
you from trying these new health practices?
Ask mothers to talk to a woman sitting next to them. They will share barriers
and concerns they have about the new teaching. Together they will try to find
solutions to these barriers. After five minutes, ask the women to share what
they have discussed with the large group.
Help find solutions to their concerns. If a woman offers a good solution to
another woman’s concern, praise her and encourage others to consider this
solution.
10. Practice and Coaching ─ 20 minutes
1. Ask each Leader Mother to share the teachings she has learned with the
person sitting next to her. (All Leader Mothers will work in pairs). Each
Leader Mother teaches in the same way that she was taught.
2. In each pair, one woman will teach the first two pages of the lesson to her
partner. After she is finished, the other Leader Mother will teach the last two
pages of the lesson.
3. Watch, correct, and help Leader Mothers who are having trouble.
4. When everyone is finished, answer questions that the mothers have about
the lesson.
When the Leader Mother is teaching the neighbor group, she will ask each
woman to discuss the things she has learned with the woman sitting next to her.
They will repeat the key messages that they have heard. They will do this in
pairs. This will help them to verbally repeat the messages and clarify
understandings.
31
11. Request Commitments ─ 10 minutes
?
Are you willing to make a commitment to the teachings you have heard
today? What is your commitment?
Ask each mother to say aloud a new commitment that she will make today.
Each mother can choose the commitment that is most important to her.
For example:



I will work less often in the six weeks after birth.
I will visit the health center for Vitamin A tablets after giving birth.
I will continue taking iron pills for three months after giving birth.
?
What was your commitment at the last lesson? Have you kept that
commitment?
?
How – what did you do?
o
Did anyone (husband, grandmother or children) interfere or tell you
not to follow your commitments? Tell the story of what happened?
o
What factors (people, events or chores) in your life made it difficult to
keep your commitments?
o
How were you able to overcome these problems?
32
Lesson 4: Newborn Care Practices


Caregivers will wait until the second day of life to clean the newborn with a
wet cloth.
Once the umbilical cord falls off and heals, they will wash the infant in a basin
every two or three days.
o Caregivers will keep the cord clean and dry to prevent infection.
o




Caregivers will not place herbs or tobacco on cord which may increase
infection.
Caregivers will wash their hands with soap and water before breastfeeding
and after cleaning child feces.
Mothers will breastfeed the infant whenever the infant shows signs of hunger
including sticking the tongue in and out; turning the head side to side or
sucking on hands or fingers.
Caregivers will take the newborn immediately to the health center if any of
the following newborn danger signs are seen:
o Fever
o Difficulty breathing
o Difficulty feeding or refusing to eat
o Irritated cord with pus or blood
Pregnant and breastfeeding women will believe that by breastfeeding and
taking care of their infant they will be using their time and resources wisely.
Materials:
1. Attendance Register
2. Leader Mother Flipchart
Summary:









Game: Rainstorm
Attendance and Troubleshooting
Share the story: Washing the Newborn
Ask about current practices
Share the meaning of each picture on flipchart pages 30-35: Washing the
Newborn, Newborn Care and Newborn Danger Signs.
Activity: Preventing Newborn Death
Discuss Barriers
Practice and Coaching in pairs
Request Commitments
33
1. Game: Rainstorm ─ 10 minutes
1. Ask the women to sit quietly in a circle with their eyes closed.
2. Their job is to listen to the sounds that are made by the woman sitting on
their right. They should repeat the sound that they hear from the woman
sitting on their right.
3. The facilitator begins by rubbing her palms together to create the sound of
rain.
4. The woman to her right makes this sound, and then the next woman until
everyone in the circle is rubbing their palms together.
5. Once everyone is rubbing palms, the facilitator makes the rain sound louder
by snapping her fingers.
6. The woman on her right repeats this sounds until one by one everyone is
snapping their fingers.
7. Then the facilitator claps both hands together and the group joins in one by
one.
8. Then the facilitator slaps her thighs and the group joins in one by one.
9. Then the facilitator stomps her feet, the rain becomes a hurricane.
10.To indicate the storm is stopping, the facilitator reverses the order, thigh
slapping, then clapping, finger snapping, palm rubbing, and ending in silence.
Now that we are energized, let’s begin today’s lesson.
2. Attendance and Troubleshooting ─ 15
minutes
1. Fill out the attendance sheets for each Leader Mother and neighbor group
(beneficiary group).
2. Complete the vital events mentioned by each Leader Mother (new births, new
pregnancies, and mother and child deaths).
3. Ask the Leader Mothers if they had any problems teaching the last lesson.
4. Help solve the problems mentioned by the Leader Mothers.
5. Thank the Leaders for their hard work. Encourage them to continue.
6. Ask the Activity Leader7 to discuss the needed items for next week’s activity
and solicit volunteers.
7
The Activity Leader should arrive ten minutes prior to each care group meeting to get the
description of the activity and the list of needed items from the promoter.
34
When the Leader Mother is teaching the neighbor group, she will use this time to
take attendance.
Story: Washing Ancha (Picture 4.1) ─ 15 minutes
3. Story:
 Read the story on page 28 of the flipchart.
Amina Nlwere gave birth to a girl a few days ago. She was named Ancha. After
she returned from the clinic she rested at her mother’s house. She kept her
child close to her body to keep her warm. Amina Nlwere’s mother says, “Let me
bathe her in this basin.” “Not yet,” says Amina Nlwere. We must wait until her
umbilical cord heals. If she sits in dirty water, it will bring sickness and
infection.”
4. Ask about Current Practices
 Read the questions on page 28 of the flipchart.


How did Amina Nlwere care for her infant after birth?
?
How and when did you bathe your infant after birth?
Why did Amina Nlwere ask her mother to wait? Is this good
advice?
Ask the first question to review the story.
o She kept the infant warm by keeping her close to her body.
Ask the second question to review the reasons Amina Nlwere did not want
her to be washed in a basin.
o She was worried that washing her in a basin would cause infection to
the umbilical cord.
o

?
?
This is good advice as the water carries bacteria that can bring
sickness to the umbilical cord.
Ask the last question to discuss bathing practices of the women in your
group.
o We hope the women respond in this way: dry the infant after birth,
not using water which will make the infant too cold.
o On the second day of life they use a wet towel to clean the infant
and continue each day until the umbilical cord falls off. At that time
they are able to wash the infant in a basin every two or three days.
35


Encourage discussion. Don’t correct “wrong answers.” Let everyone
give an opinion. This page is for discussion, not for teaching.
After the participants answer the last question, move to the next flipchart
page by saying, “Let compare your ideas with the messages on the following
pages.”
Washing the Newborn (Picture 4.2) - 10 minutes
5. Share the Meaning of Each Picture



Ask the caregivers to describe what they see in the pictures on page 31.
Share the meaning of each picture on flipchart pages 30 and 31.
Use the captions on the flipchart to remind you which images represent each
point.
?
What do you think these pictures mean?
Wait until the second day to wash the infant with a wet cloth.





On the first day, dry the newborn with a dry cloth.
On the second day, clean the newborn with a wet cloth.
Dipping the infant in water will make the child too cold.
Wipe the infant’s head, neck and around the eyes.
Wipe inside the folds of skin on the neck and legs.
Wait until the cord falls off before washing the infant in a basin.
 Keep the umbilical cord dry. Do not wrap it with cloth.
 Do not put tobacco or plants on the cord.
 After the cord falls off, wash the infant in a basin every two days.
 If the cord has not fallen off, the water in the basin can cause
infection.
?
How do these practices show that we are using the things God has given
us wisely?

If we take actions to prevent sickness and death, we are using our
time and energy well.
36
Additional Information for the Trainer
Infant Heat Loss

Newborns are not able to maintain their body temperature as well as adults.
They lose body heat quickly if they are wet, uncovered, or exposed to wind.
 Twenty five percent of an infant’s heat loss comes from the head.
 Cover the infant’s head with a hat or cloth to keep them warm for the first
three weeks of life. This prevents the risk of death from the infant’s body
becoming too cold (hypothermia).
Infant Mortality

Of all children who die under the age of five, 40% of them die within the first
28 days of life. Most of these deaths occur during the first 24 hours of life.
There are three main causes of newborn death: infections, asphyxia (the
infant does not receive enough oxygen before, during, or just after birth),
and preterm births.8
Newborn Care (Picture 4.3) - 10 minutes
6. Share the Meaning of Each Picture



Ask the caregivers to describe what they see in the pictures on page 33.
Share the meaning of each picture on flipchart pages 32 and 33.
Use the captions on the flipchart to remind you which images represent each
point.
?
What do you think these pictures mean?
Breastfeed
o
o
o
whenever the infant shows signs of hunger.
The infant moves his tongue in and out
The infant sucks on his fingers or thumb.
The infant turns his head from side to side.
Sleep with the infant under a mosquito net each night.
o Treated nets protect the infant from malaria.
8
2009 WHO/UNICEF Joint Statement, “Home Visits for the Newborn Child: A Strategy to Improve
Survival.”
37
o
Malaria is very dangerous for infants.
Wash hands after cleaning the infant’s feces and before breastfeeding.
o Keep infants healthy by keeping your hands clean.
o Wash your hands with soap and water after cleaning infant feces.
o Wash your hands with soap and water before breastfeeding.
?
Why isn’t crying listed as a sign of hunger?
o Children cry for many reasons.
o Hunger is only one of the reasons.
o Children will always show signs of hunger, before crying from
hunger.
Additional Information for the Trainer:
Newborns and Hand washing

A study showed that newborns where birth attendants and mothers washed
hands before handling them had a 41% lower illness rate compared to
newborns where mother and birth attendant did not wash hands.9
Hand Washing


The most important times to wash hands are before preparing food or eating
and after using the latrine or cleaning child feces.
Hand washing with soap is the most cost-effective way to prevent death and
disease from diarrhea. Hand washing before eating, preparing food and after
using the toilet can reduce diarrhea in children by 50%.10 If soap is not
available use ash.
Newborn Danger Signs (Picture 4.4) ─ 10 minutes
7. Share the Meaning of Each Picture



Ask the caregivers to describe what they see in the picture on page 35.
Share the meaning of each picture on flipchart pages 34 and 35.
Use the captions on the flipchart to remind you which images represent each
point.
9
Rhee V. et al. 2008. “Maternal and birth Attendant Hand Washing and Neonatal Mortality in Southern Nepal.”
Archives of Pediatrics & Adolescent Medicine. Vol 162 (No. 7), pp 603-608. July 2008
10
Curtis, V., and S. Cairncross. 2003. “Effect of Washing Hands with Soap on Diarrhea Risk in the
Community: A Systematic Review.” Lancet Infectious Diseases 3: 275–81.
38
?
What do you think these pictures mean?
Go immediately to the health center if the newborn has fever, refuses to
breastfeed or has difficulty feeding.
Go immediately to the health center if the newborn has difficulty
breathing, or a red swollen cord.
 Do not wait.
 These are signs that the infant’s life is in danger,
?
What other danger signs should a mother look for?
o
o
If you infant is not acting the way he normally does, go to the
health center.
If the infant has fits or convulsions.
8. Activity: Preventing Newborn Death - 20
minutes
5. The first 28 days of an infant’s life is the time when he is most vulnerable to
germs, sickness, and death. Most of these newborn deaths happen on the
first day of life. Let’s look at the reasons that newborns die.
6. Ask 10 women to stand up. These 10 women represent 10 newborns that die
in the first month of life.
a. Ask three of the 10 women to stand together. These three women
represent newborns that die because they were born too small or too
early.
b. Ask two of the remaining 7 women to stand together. These two
women represent newborns that die because the delivery was very
hard and the infants were not able to breathe well during or after
delivery.
c. Ask two of the remaining 5 women to stand together. These women
present newborns that die because of infections (germs that have
gotten inside their bodies).
d. The last three women represent newborns that die from many other
causes.
?
Are you surprised by the reasons that infants die? Why or why not?
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7. Spend the next five minutes encouraging the women to discuss practices to
prevent the three main causes of newborn death.
Add any of the following practices that were not mentioned.

To prevent infants born too small or too early.
a.
b.
c.
d.
e.
f.

Eat well during pregnancy
Visit the antenatal clinic to monitor the size of the infant.
Take iron pills every day during pregnancy.
Sleep under a mosquito net (to prevent weak blood).
Add a sprinkle of iodized salt to family foods.
Eat a variety of foods – one from each food group.
To prevent infants not being able to breathe.
g. Visit the health center four times before birth so they can monitor the
growth and position of the infant. If the infant is turned, labor may be
too long causing him to suffer.
h. Deliver at a health center so health workers can use medicine and
equipment to hurry the delivery.

To prevent newborn infections.
i. Wash your hands before handling a newborn and after cleaning up
feces.
j. Keep the umbilical cord clean and dry.
k. Deliver at the health center where health workers can treat infections.
9. Discuss Barriers ─ 15 minutes
?
What do you think about these ideas? Is there anything that might prevent
you from trying these new health practices?
Ask mothers to talk to a woman sitting next to them. They will share barriers
and concerns they have about the new teaching. Together they will try to find
solutions to these barriers. After five minutes, ask the women to share what
they have discussed with the large group.
Help find solutions to their concerns. If a woman offers a good solution to
another woman’s concern, praise her and encourage others to consider this
solution.
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10. Practice and Coaching ─ 20 minutes
1. Ask each Leader Mother to share the teachings she has learned with the
person sitting next to her. (All Leader Mothers will work in pairs). Each
Leader Mother teaches in the same way that she was taught.
2. In each pair, one woman will teach the first two pages of the lesson to her
partner. After she is finished, the other Leader Mother will teach the last two
pages of the lesson.
3. Watch, correct, and help Leader Mothers who are having trouble.
4. When everyone is finished, answer questions that the mothers have about
the lesson.
When the Leader Mother is teaching the neighbor group, she will ask each
woman to discuss the things she has learned with the woman sitting next to her.
They will repeat the key messages that they have heard. They will do this in
pairs. This will help them to verbally repeat the messages and clarify
understandings.
11. Request Commitments ─ 10 minutes
?
Are you willing to make a commitment to the teachings you have heard
today? What is your commitment?
Ask each mother to say aloud a new commitment that she will make today.
Each mother can choose the commitment that is most important to her.
For example:




I commit to washing my hands after using the latrine or cleaning up child
feces.
I commit to washing my hands with soap before breastfeeding.
I commit to breastfeeding whenever my child shows signs of hunger.
I commit to waiting until the umbilical cord falls off to wash my child is a
basin of water.
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?
What was your commitment at the last lesson? Have you kept that
commitment?
?
How – what did you do?
o
Did anyone (husband, grandmother or children) interfere or tell you
not to follow your commitments? Tell the story of what happened?
o
What factors (people, events or chores) in your life made it difficult to
keep your commitments?
o
How were you able to overcome these problems?
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Lessons 1-4 Pre and Posttest
Two questions from each lesson are listed below. Before and after teaching the
materials to staff and trainers, give the posttest to evaluate their
comprehension. For those who score 75% or less (must have at least 9 correct
answers), give them more training to help them understand the information.
Trainers should not teach others until they are able to score 75% or better.
1. How many times should a pregnant mother visit the health center for
antenatal care?
a.
b.
c.
d.
She should visit the health center only when she feels sick.
She should visit the health center every month.
She should visit the health center at least four times before delivery.
She should go the health center for antenatal care one day before
delivery.
2. Name two advantages of having a child at the health facility.
_________________________________________________________
_________________________________________________________
3. Name two signs of labor (the birth of the child is near). These signs
tell the mother she should leave quickly for the health center.
_________________________________________________________
_________________________________________________________
4. All of the following practices are recommended for woman after
delivery, except one. Choose the practice that is NOT recommended.
a.
b.
c.
d.
Take iron tablets each day for four months after delivery.
Within six weeks, go for a vitamin A tablet.
Rest more often than normal.
Eat less food than normal.
5. Name two danger signs after delivery. If a mother has these signs,
she needs to be taken immediately to the health center.
_________________________________________________________
_________________________________________________________
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6. When should the umbilical cord be cut?
a. As soon as the infant is delivered.
b. After the cord stops pulsing and turns white.
c. Before the infant begins breastfeeding
d. After the placenta (infant’s feeding bag) is delivered.
7. On what day can you use a wet cloth to wash a newborn?
a. On the first day
b. On the second day
c. On the third day when the white milk comes
d. On the 10th day when the umbilical cord falls off.
8. Name two signs that a newborn gives to show that he is hungry.
_____________________________________________
_______________________________________________
________________________________________
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Lessons 1-4 Pre and Posttest ANSWERS
1. How many times should a pregnant mother visit the health center for
antenatal care?
C. She should visit the health center at least four times before delivery.
2. Name two advantages of having a child at the health facility.
Any two of the following are correct:






Women who deliver at the health center are more likely to survive childbirth
and recover quickly.
The health center is a clean place for delivery
The health center has equipment to help with problems during delivery
The health center has medication to help with problems during delivery
Health workers have experience solving problems during delivery
Health workers are able to give vaccinations to newborns.
3. Name two signs of labor (the birth of the child is near). These signs
tell the mother she should leave quickly for the health center.
Any two of the following are correct:



Water released from the vagina
Contractions that are strong, regular and close together.
Mucus comes from the vagina
4. When should the umbilical cord be cut?
B. After the cord stops pulsing and turns white.
5. All of the following practices are recommended for woman after
delivery, except one. Choose the practice that is NOT recommended.
D. Eat less food than normal.
6. Name two danger signs after delivery. If a mother has these signs,
she needs to be taken immediately to the health center.
Any two of the following are correct:




High fever
Sharp pains in the belly
Heavy bleeding or bleeding that continues for more than two weeks
Urine or feces that leaks from the body
7. On what day can you use a wet cloth to wash a newborn?
B.
On the second day
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8. Name two signs that a newborn gives to show that he is hungry.
Any two of the following are correct:




He
He
He
He
moves his tongue in and out and makes sucking noises.
sucks on his fingers.
opens his mouth and turns his head from side to side.
cries.
46