Role of Nurse in Perinatal and Neonatal Care (Indian Context)
Nurses play a vital role in ensuring the health and well-being of both mother and child during the perinatal period (which includes the time shortly before, during, and after childbirth) and the neonatal period (first 28 days of a newborn’s life). In India, where maternal and infant mortality are still public health concerns, the nurse’s role becomes even more critical. Their responsibilities span preventive, promotive, and curative aspects of care, across rural and urban health settings. Below is a detailed explanation of their role:
1. Antenatal (Before Birth) Role
a. Health Education and Counseling
- Nurses educate expectant mothers on nutrition, hygiene, rest, and danger signs in pregnancy such as bleeding or high blood pressure.
- They provide counseling on family planning, breastfeeding, and importance of institutional delivery.
- Special focus is given to adolescent pregnant women, anemic mothers, and those with high-risk pregnancies.
b. Monitoring and Early Detection
- Nurses regularly monitor weight, blood pressure, fetal heart rate, and fundal height.
- They ensure regular antenatal checkups, iron and folic acid supplementation, TT immunization, and early detection of complications like pre-eclampsia or gestational diabetes.
c. Emotional and Psychological Support
- Pregnancy can be emotionally stressful. Nurses provide empathy, support, and reassurance to alleviate maternal anxiety and build trust.
- Special attention is given to first-time mothers or those with previous traumatic birth experiences.
2. Intranatal (During Birth) Role
a. Assisting in Safe Delivery
- Nurses in labor rooms assist doctors or conduct deliveries independently, especially in primary health centres (PHCs) or rural settings.
- They ensure aseptic techniques, proper documentation, and active management of the third stage of labour to prevent postpartum hemorrhage.
b. Monitoring the Labour Process
- Nurses monitor labour progression using a partograph, which helps identify delayed labour.
- They observe vital signs of the mother, uterine contractions, and fetal well-being.
c. Emergency Management
- In case of complications like obstructed labour, cord prolapse, or fetal distress, the nurse initiates emergency protocols, provides first aid, and arranges for referral to higher centres.
3. Postnatal (After Birth) Role
a. Maternal Care
- Postnatal nurses monitor lochia, uterine involution, and signs of infection or postpartum depression.
- They educate mothers on personal hygiene, postnatal exercises, and proper nutrition.
- Nurses also promote Kangaroo Mother Care (KMC) for low birth weight infants and help mothers initiate exclusive breastfeeding within the first hour of birth.
b. Newborn Care
- Nurses assess the APGAR score immediately after birth.
- They ensure thermal protection, administer Vitamin K injection, and monitor for early signs of jaundice, respiratory distress, or sepsis.
- Nurses also ensure timely immunization (BCG, OPV, and Hepatitis B).
4. Neonatal Intensive Care (NICU) Role
In cases where the newborn requires special attention (e.g., preterm, low birth weight, infections), nurses work in NICUs with the following roles:
a. Monitoring and Observation
- Continuous monitoring of vital signs (temperature, pulse, respiration, oxygen saturation).
- Monitoring fluid balance, urine output, and feeding patterns.
b. Administration of Medication and Oxygen
- Nurses administer intravenous fluids, antibiotics, and assist in oxygen therapy or CPAP in preterm infants.
c. Infection Control
- Strict hygiene and handwashing protocols are followed.
- They ensure sterile handling of equipment to prevent nosocomial infections.
d. Parental Involvement
- Educate and counsel parents on baby care techniques.
- Allow and promote mother’s presence in NICU, fostering bonding and emotional stability.
5. Role in Community and Home-Based Care
Especially in Indian rural settings, ANMs (Auxiliary Nurse Midwives) and ASHA workers collaborate in:
a. Home Visits
- Nurses conduct postnatal home visits to check mother and baby health.
- They encourage follow-up immunizations and ensure that both mother and infant are doing well.
b. Health Promotion
- Conduct group sessions on breastfeeding, immunization schedules, family planning, and danger signs in neonates like fever, poor feeding, or abnormal cry.
c. Referral Services
- Identify and refer high-risk neonates or mothers to District Hospitals or SNCUs (Special Newborn Care Units).
6. Documentation and Record Keeping
- Maintaining accurate and complete records is critical for continuity of care.
- Records include antenatal history, delivery details, APGAR score, immunization, birth weight, etc.
- Nurses also contribute data to government health programs such as Janani Suraksha Yojana (JSY) and Rashtriya Bal Swasthya Karyakram (RBSK).
7. Support in Government Health Programs
Nurses play a critical role in implementing national programs:
- Janani Shishu Suraksha Karyakram (JSSK): Ensuring free and cashless delivery and treatment of neonates.
- Mission Indradhanush: Full immunization coverage.
- LaQshya: Labour room quality improvement initiative.
Conclusion
In summary, nurses are the backbone of perinatal and neonatal care in India. Their holistic role—from prenatal education to intrapartum monitoring and neonatal intensive care—is vital for reducing maternal and infant mortality, especially in underserved areas. Empowering nurses through training, adequate staffing, and infrastructure can dramatically improve India’s maternal and child health indicators.