Facilitator's Guide For Training Yashoda-Mamta

Facilitator’s Guide
for training
Yashoda/Mamta
National Institute of Health and Family Welfare
Trained Nurses Association of India (TNAI)
National Neonatology Forum
Norway India Partnership Initiative (NIPI)
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National Child Health Resource Center,
1 st Floor, National Documentation Center,
National Institute of Health and Family Welfare,
Baba Gang Nath Marg,
Munirka, New Delhi – 110067, India
E. mail:
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Foreword
The Norway India Partnership Initiative (NIPI) is a unique support embedded

within NRHM processes. The programmes provide strategic, flexible, catalytic,
and innovative support to the NIPI focus states of Orissa, Madhya Pradesh,
Rajasthan, Bihar and Uttar Pradesh to improve the child health and related
maternal health service delivery.
As part of the enabling strategy that can maximize the success of Janani
Suraksha Yojana (JSY) under NRHM, NIPI has identified an innovative method
to improve the quality of care for the newborn and the mother at the facility.
“Yashoda/Mamta”, non-medical, voluntary support worker, has been placed at

hospitals with high delivery load. Her role is to create a congenial environment for
the mother and the newborn in the facility and to counsel the mother about good
newborn care practices at home.
However, Yashoda/Mamta will be able to effectively execute their responsibilities

once they undergo good quality, standardized training. This Guide is meant for
trainers to take Yahsoda/Mamta through orientation training with ease, in a
participatory, interactive environment. The book also contains information for
trainers after each chapter in the form of ‘notes for the trainer’.
I hope that this guide will be useful for the trainers. It can also be used by the
Yashoda/Mamta mentors for reference while they hand-hold Yashoda/Mamta
during her work.
Director, NIPI
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Preface
I am happy to bring out this publication through the National Child Health
Resource Center (NCHRC). The center was established at National Institute of
Health and Family Welfare (NIHFW), New Delhi in the year 2008 with the support
of Norway India Partnership Initiative (NIPI).
Norway-India Partnership Initiative (NIPI) is a commitment of Government of
India and Government of Norway to collaborate towards achieving the MDG 4
(Reduce by two-third the mortality rate among children under five years). NIPI is
being implemented as an integral part of the National Rural Health Mission
(NRHM), providing an up-front, strategic, innovative and flexible support to
accelerate the efforts of the mission in four NIPI focus states namely Madhya
Pradesh, Rajasthan, Bihar and Orissa.
The National Child Health Resource Center (NCHRC) aims to strengthen the
focus on child health and mainstreaming the agenda in public health through
collating, developing, analyzing and disseminating relevant information and
creating a platform for discussion and discourse at national and state level. The
Center is functioning with the support of Technical Advisory Group (TAG), which
is a group of professionals from premier institutions/ agencies working on child
health issues and overall leadership of NIHFW.
“Facilitator’s Guide for Training Yashoda/ Mamta” is intended for the use of
trainers involved in the training of Yashoda who is a non-medical, volunteer
worker placed at District Hospitals and community health centers to create
congenial environment for the mother and newborn baby and help them to
understand basic newborn care after leaving the facility. This document is a
comprehensive guide that provides interactive guidelines for use by the trainers
and can be used as a reference book by the facilitator and ‘Yashoda’. The book
provides detailed guidelines which may be modified to suit local needs. Each
session in this document presents the topic, describes the session objectives and
the learner’s objectives; time, materials, method, steps and the trainer’s notes.
Lastly, we gratefully acknowledge the input, critique and suggestions provided by
‘Trained Nurses Association of India’ (TNAI) and ‘NIPI Secretariat’ in developing
this publication.
Prof. Deoki Nandan

Director, NIHFW
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Contents
Introduction to Yashoda/Mamta Training…………………………………1
Introduction to Yashoda/Mamta Facilitator’s Guide………………………3
Goal of the training…………………………………………………………5
Settings and Logistics for Training…………………………………………..6
Sessions & Sessions Plan:

Day 1
1. Introductory Session………………………………………………….7
2. Review the Purpose of the Training…………………………………..8
3. Status of Maternal and Infant Health and Role of Yashoda ………….13
4. Housekeeping of maternity, post natal ward and labor room……….18
5. Care of the mother before, during and after delivery…………………22
6. Preparations for welcoming the baby…………………………………27
7. Early Initiation of Breast Feeding…………………………………….31
8. Proper positioning while Breast Feeding …………………………….35
9. Exclusive Breast Feeding for six months and Complementary feeding..38
10. Breast Feeding – some common problems…………………………..42
Day 2
11. Keeping the newborn warm………………………………………..45
12. Bathing the newborn………………………………………………48
13. Care of the low birth weight baby…………………………………51
14. Danger signs in newborns…………………………………………55
15. Danger signs in mother……………………………………………59
16. Clean practices to Prevent Infections………………………………63
Day 3
17. Diet of a lactating mother………………………………………………48
18. Immunization……………………………………………………………72
19. Family Planning methods……………………………………………...76
20. People available in the community to help mother………………….81
21. Birth Registration & Record Keeping…………………………………85
22. Principles of Counselling/Interpersonal Communication…………..93
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Introduction to Yashoda/Mamta
Rationale:
The sudden influx of beneficiaries in public health institutions due to JSY has
added to the challenge to provide quality maternal and neonate health care.
However, it provides a window of opportunities to improve the RCH services at
the facilities. Surveys on JSY show that many of the women stay in the institution
for less than 24 hours after delivery, regardless of a normal delivery or a difficult
delivery. UNFPA’s and GTZ’s evaluation of JSY in 2007 raised several issues
about its benefits and processes for the women. These include: the duration of
stay at the facility, the quality of services, the facilities available at the hospital,
the safety of mother & child, and the availability of counseling on follow up visit,
breastfeeding, immunization, family planning, newborn care and diarrhoea
management, etc.
The first 24-48 hours after delivery offer a golden opportunity for integrating
neonatal care with postpartum care. Many of the conditions responsible for the
mother and/or neonate’s death are recognizable in the first 48-72 hours after
delivery. This includes: hemorrhage, sepsis, eclampsia (responsible for more
than half of the maternal deaths), birth asphyxia, sepsis, hypothermia, and low
birth weight/ pre-maturity (responsible for more than 2/3 rd of neonatal deaths).
Therefore the government of India norms require that mothers stay in the hospital
with the newborn for 24-48 hours after delivery.
Can a person from the existing facility be found?
To make the pregnant women feel welcome at the facility, to make her feel
comfortable after delivery, to initiate exclusive and immediate breast feeding, to
counsel the mother on basic newborn care, and to motivate the mother to stay at
the facility for a longer duration? The hospitals, with increasing volumes of
deliveries per day, have not been able to use this opportunity fully due to a
shortage of nurses and a poorly managed logistics system. ‘Yashoda’, a
dedicated non-clinical support worker, apart from helping motivate mothers to
stay for a longer duration, would also assist the nurses with initial care for the
mother and the newborn soon after the delivery.
Why Yashoda/Mamta, and why not ASHA?
It has been observed that in almost 30-40 % of cases, ASHAs do not accompany
the pregnant women to the hospital. Even those who accompany do have other
responsibilities under NRHM and cannot be away from the community for over
24 hours. If we assume that ASHAs accompany pregnant women to a District
hospital where 20-30 deliveries take place a day, in the course of two days, there
will be 40-60 ASHAs at the hospital. There is no arrangement for their stay, food,
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or security. These additional people in an already stretched infrastructure can
create chaos.
The NIPI focus states have engaged ‘Yashoda’ (in all states except Bihar
where the same worker is called ’Mamta’) at the facility level for facilitating the
initial care that the newborn and the mother require during their stay at the
facility, there by addressing the above gaps to some extent.
• Yashoda is not a regular employee of the health system at present. This

innovation aims at introduction of a volunteer support worker paid a
performance linked incentive, who acts as a catalyst and supports the
nursing staff.
• She is not a substitute for the nursing staff or paramedical staff available
at the facility. However, with appropriate support and capacity building, it
is expected that competent Yashodas/Mamta could be used in future as
‘Newborn Nursing-Aide’ to work in the Sick Newborn Care Units coming
up in the District Hospitals and Stabilization Units in the Block hospitals.
Responsibilities of Yashoda/Mamta
• Make a congenial environment
• Support to nurse in the labour room
• Maintaining cleanliness
• Assist the nurse in post delivery care
• Counsel the mothers and family on basic care of mother and newborn
• Information on immunization
• Inform about mother care after leaving hospital
• Assist mother in understanding the contraceptive options
• Provide information on locally available support
• Maintenance of daily record register
(The responsibilities are explained in more detail in the document ‘Role of

Yashoda/Mamta’)
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Introduction to Yashoda/Mamta Training
Training process:
The training will be done in three phases -
Phase I – Induction training

The induction training will be conducted over 3 days in hospital premises. It s
expected that this 3 day module will set a sound theoretical backing for the
practical skills development of Yashoda. It is also expected that this module
will bring in enhancement of knowledge and an attitude towards good health
practices among Yashoda. It will bring in clarity and ability to focus on key
issues related to child health
Phase II – Hands - on training
The month following the induction training will be the period of hands - on
training wherein the focus will be on enhancement of skills. During this
training, the Yashoda will learn though demonstration and practice while at
work
Phase III - Refresher trainings
Series of two day refresher training sessions will be conducted every 3 months
Training of trainers:
A one day workshop will be held for the trainers on the day prior to the scheduled
induction training of Yashoda/Mamta. During the workshop, the trainers will be
familiarized with the training course. They will be familiarized with the Yashoda
training kit and how to use the flip chart and handouts. They will also go through
this guide book.
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Profile of trainers:
The trainers can be ANM, teacher from ANM training school, Nurse, Doctor,
experienced Yashoda or any other medical, paramedical or experienced health
worker.
Profile of trainee:
The trainee ‘Yashoda’ (a foster mother in Indian mythology) is a dedicated non-
clinical support worker, who can help in all the care for the mother and new born.
She is a support worker who is paid a performance linked incentive, acts as a
companion of the mother, supports the nursing staff and acts as a link between
both.
The trainee is a local woman in the age group of 25-50 years. She is at least 8 th
pass and may or may not have any working experience. She may or may not
have any health experience. She is a voluntary worker who gets a performance
based incentive and is not a paid employee.
The trainee will work only in the hospital setting for new born and maternal care.
Her main role is providing friendly support, comfort and counseling to mother and
her family and giving dedicated attention to the newborn. She is required to
assist the family in registering the mother as a JSY beneficiary and for registering
the birth of the baby.
She does not have any technical know how to provide any medical or nursing
care to the beneficiaries and is not expected to provide medical or nursing care.
Yashoda will be given appropriate logistics and administrative support, mentoring

and supportive supervision by the Child Health Supervisor (CHS) and Deputy
Child Health Supervisor (DCHS) along with the nursing staff located at the
hospital to fulfil the above tasks.
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Introduction to Yashoda/Mamta Facilitator’s Guide
This book is intended for the use of trainers involved in the training of Yashoda.
This is a comprehensive guide that provides interactive guidelines for use by the
trainers & also provides the trainers with back ground technical information that is
to be imparted to the trainees. This book can be used as a reference book by the
facilitator and Yashoda.
The book provides detailed guidelines but these guidelines are not rigid.
Guidelines may be modified to suit local needs. District, village data needs to be
used during the sessions to make the training more suitable for local needs.
The module is distributed into 22 sessions. Each session mentions the topic,
describes the session objectives and the learner’s objectives, time, materials,
method, steps and the trainer’s notes.
The guide takes the trainees through a journey in the hospital from the time a
mother-to-be enters the hospital, till the time she leaves with her new born.
Through this journey, the trainee needs to understand very clearly her role and
responsibilities and how to perform them.
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Remember some Adult learning principles
The trainees are adult women and the method of learning among adults differs
greatly from children. While teaching adults, the following principles of adult
learning have to be kept in mind:
1. Focus on “real world” problems.
2. Emphasize how the learning can be applied.
3. Relate the materials to the learners’ past experiences.
4. Allow debate and challenge of ideas.
5. Listen to and respect the opinions of learners.
6. Encourage learners to be resources to you and to each other.
7. Treat learners like adults.
8. Give learners “control
9. Provide a safe atmosphere (a cheerful, relaxed person learns more
easily than one who is fearful, embarrassed, or angry)
10. Make a comfortable environment (a person who is hungry, tired, cold,
ill, or otherwise physically uncomfortable cannot learn with maximum
effectiveness)
11. This training must not be just a lecturing exercise but rather should be
highly interactive and practical hands on training.
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Training Goal
To provide good quality standardized training to Yashoda/Mamta for
better care and support to newborns and new mothers as an
intervention for Child care and a contribution to achieve MDG 4
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Setting and logistics for training
Institutional arrangements for the Induction training:

The setting of the induction training is the district hospital. A classroom in the
hospital premises that can accommodate about 20 trainees and 3 facilitators will
be used. The maternity ward, post natal ward and labor room of the hospital will
be utilized as training and demonstration rooms for the trainees.
Time schedule: The training will be held from 9 AM to 5 PM or till the defined
agenda for the day is completed on all three days
Checklist of supplies for each trainee

1) YASHODA TRAINING KIT - Flip chart for Yashoda, handouts for Yashoda,
note pad, pencil, pen, and eraser 2) Facilitator’s guide,
Checklist of supplies for the trainer

Facilitator’s guide, Flip chart for Yashoda, handouts for Yashoda, Note pad,
pencil, pen, eraser, felt pens in two colors, chalk, white board, duster, wipe,
Access to and LCD (preferred) or an OHP & a CD player.
Other material required for the training

As per session requirements
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Session 1:
Title: Introductory session
Session objectives: To introduce the trainers and trainees to each other
Learners Objectives: After this session, the trainees will be able to:
• Be familiar with the names and professional backgrounds of each other
• Be familiar with the names and professional background of the trainers
Time: 15 minutes
Materials: Blackboard, Chalk, Chart Paper, Pens
Setting: Classroom
Method: Discussion
Steps:
1. Ask the trainees to sit in rows facing you. The trainers should be in front of
the group, facing the trainees. Each trainer should introduce
himself/herself and should give a brief background of his/her experience in
new born and maternal care.
2. Ask the trainees to introduce themselves to the trainers and to each other
and give a brief description of their work experience (if they have any).
3. After the last trainee finishes the introduction, thank the trainees and move
on to the next session.
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Session 2:
Title: Reviewing the purpose of this training
Session objectives:
• Familiarize the trainees with the purpose & objectives of this training
• Familiarize the trainees with the objectives of this training and seek their
feedback about the objectives
• Amend the objectives based on their feedback (if required)
• Familiarize the trainees with the methods used in this training
• Orient the trainees towards a participatory method of training
Learner’s Objectives:
After this session, the trainees should be able to:
1. Define the objectives of this training
2. Be satisfied that objectives suggested by them have been incorporated in
the training objectives
3. Be clear about the flow & methods that will be used during this training
4. Engage fully with the trainer and other participants without any hesitation
5. Understand the role of the facilitator
6. Use the flip chart and handout as reference material
Time: 15 minutes
Setting: Classroom
Materials: Black board or chart with objectives of the training program written
therein, trainee’s kit (folder containing Flip chart for Yashoda, Handouts for
Yashoda, a note pad, pencil, pen, eraser)
Method: Discussion
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Special preparation: Chart paper or black board with purpose and objectives of
the training written clearly.
Steps:
1. Inform the participants about the purpose of this training
2. Use the chart (or black board) that enumerates the objectives of the
training to describe each objective.
3. Ask them if they have any other expectation that will not being fulfilled
through this training. If yes, record the comments with the trainees’ name.
If you feel that the comment is valid, amend any previously noted objective
or add the objective and thank the participant.
4. Explain the flow of the training and the methods that will be used
5. Explain that the training is expected to be fully participatory.
6. Now hand over the trainee’s kit to each participant. Explain to them that
this the flip chart and handouts are their main reference material and
should be consulted after each session.
7. Explain the use of the flip chart and handouts and the link between the two
8. They can use the note pad to write down any notes that they want.
9. Describe your role as facilitator.
Trainer’s Notes
Q. What is the purpose of this training?
A. The purpose of this training is to create a cadre of dedicated hospital based
workers for maternal and newborn care and support.
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Q. What are the objectives of this training?
A. After this training the trainee should be able to:
1. Use the information regarding status of child health in the state and the reasons for
high infant and maternal mortality rate to understand the importance of her role.
2. Be comfortable with the hospital setting – labour room, maternity ward, post natal
ward, nursery (if required), records section, registration room, immunization room, birth
registration room, water supply and other facilities in the hospital.
3. Enumerate her responsibilities as ‘house keeper’ in the labour room and wards that will
be used by the mother and new born.
4. Demonstrate the activities required to provide care to the mother before, during and
after delivery
5. Demonstrate the preparations needed for the birth of a newborn
6. Demonstrate how to keep the newborn warm
7. Demonstrate how to initiate early breast feeding
8. Counsel the mother what is exclusive breast feeding and how to continue it in sickness
and health
9. Counsel the mother what is complementary feeding and what are the food the baby
should be given
10. Identify common problems with breast feeding and provide support and advice to the
mother regarding these
11. Identify danger signs in mother and newborn and know when and who to refer to
12. Develop good counseling skills
13. Be familiar with the process of registering birth
14. Demonstrate how to maintain her records
15. Counsel the mother and family about the health facilities available in the community
16. Counsel the mother about the appropriate family planning method for her and refer her
to the right place to get it.
17. Use the communication tools provided – flip chart, background information sheets
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Q. How the training will flow and what will be the methods used?
A. The training will be mostly hospital based, practical learning and not
theoretical. However, the trainees must be clear about the basic theoretical
concepts behind all the activities they are expected to carry out. The training is
designed to be a journey through the activities Yashoda has to carry out as a
mother enters the hospital and leaves with her newborn.
The training course is simple and task oriented. There will be
background theory sessions to enhance knowledge followed by hospital ward
sessions for skill building/upgradation. Theory sessions will not be lectures,
these will be fully participatory during which the trainees will discuss a given
issue and the trainer will only guide the discussion and sum up the key
messages. There will be several interesting tasks/exercises to keep all
participants involved. Additional tasks may be designed by trainer if the need
is felt.
Q. What is meant by participatory training?
A. It is vital for the trainees to understand that they must fully participate in the
process of the training. This can be done by raising questions, narrating their
experiences, presenting their practical problems for discussion with others,
story telling etc. Explain to trainees that their questions will be greatly
appreciated. They must avail this opportunity to remove all doubts they may
have regarding child health issues and must familiarize themselves with the
role they will have to perform as Yashoda.
Q. What is the purpose of the flip chart & handouts?
A. The flip chart is provided to Yashoda as a tool for communicating good
health practices to the mothers and the family. It is also to be used as her core
reference material. The flip chart has two parts. The front of the page has
pictures. These pictures display key messages to be communicated to the
mother and family by Yashoda. The back of the page is for her reference. The
handouts provide more details about each issue covered through the flip chart.
These are provided to the Yashoda to upgrade her knowledge so that she is
better informed and can refer to these whenever she needs.
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Q. Who is a training facilitator?
A. Training facilitators are usually subject experts & provide training using the
principles of adult education: establish existing knowledge, build on it and
keep it relevant. The role is different from the formal trainer who will take a
more leading role and take the group through an agenda designed to transmit
a body of knowledge.
The basic skills of a facilitator are about following good meeting
practices: timekeeping, following an agreed-upon agenda, and keeping a clear
record. The higher-order skills involve watching the group and its individuals in
light of group dynamics. In addition, facilitators also need a variety of listening
skills including ability to paraphrase; stack a conversation; draw people out;
balance participation; and make space for more reticent group members. It is
critical to the facilitator's role to have the knowledge and skill to be able to
intervene in a way that adds to the group's creativity rather than taking away
from it.
A successful facilitator embodies respect for others and a watchful
awareness of the differences in the attitude and reactions of different persons.
In the event that a consensus cannot be reached then the facilitator would
assist the group in understanding the differences that divide it. Remember that
your role is that of a facilitator and not a lecturer. It is expected that the
participants will talk most of the time and the trainer will be there only to guide
the discussion if required.
Key messages
Ø The training is designed as a journey of Yashoda with the mother
and newborn as the mother’s friend and support
Ø During this training, most of the time will be spent in the hospital.
Ø The trainer will be a facilitator and not a lecturer
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Session 3
Title: Status of maternal and infant health in the state and district & role of
Yashoda
Session objectives:
The trainees should be able to use the information being provided to
understand the rationale for contracting them. They should also be introduced
to the activities they will perform in the ward as dedicated support and care
workers for mother and newborn.
Learners Objectives:
1. Use the information provided on maternal & infant health to explain the
rationale for contracting Yashoda into the system
2. Enumerate the common reasons for maternal
3. Enumerate the common reasons for newborn mortality
4. Enumerate her responsibilities in the hospital
Time: 45 minutes
Training Materials: Facilitator’s guide, Yashoda training kit, black board & chalk
or white board & felt pens in two colors, duster, wipe, access to and LCD
(preferred) or an OHP
Setting: Classroom
Method: Discussion
Steps:
1. Ask a trainee why she chose to become a Yashoda
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2. It is likely that she will talk about maternal and child health.
3. If not, ask another trainee the same question till the topic of maternal &
child health is introduced.
4. Write the proportion of pregnant women & children below 1 year in their
state and district on the board.
5. Write the infant mortality rate and maternal mortality rate in the state on
the board.
6. Ask the participants, what could be the common reasons for high maternal
& infant deaths in their state and district.
7. Note the given reasons on the board.
8. If any reason is missed out, add it.
9. Recap the written reasons.
10. Inform them that most deaths occur in the first 7 days of life and mention
the common reasons of the same
11. State the common reasons for maternal deaths especially in the first 6
weeks after birth.
12. Stress that proper care in the hospital immediately after birth will help
prevent many maternal and newborn problems.
13. Enumerate the various other responsibilities of Yashoda
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Trainer’s notes:
Q. Who is Yashoda and what is the rationale behind introduction of
Yashoda?
A. The birth of a baby is a glorious event in the life of the baby and the
parents. However, pregnancy and the process of birth is a very difficult
process for both the mother and the baby. They need special care before,
during and after the event of birth.
The first 24-48 hours after delivery offer a golden opportunity for
proving care, support and counseling to the mother and her family. Many of
the conditions responsible for the mother and/or neonate’s death are
recognizable in the first 48-72 hours after delivery. This includes: hemorrhage,
sepsis, eclampsia (responsible for more than half of the maternal deaths), birth
asphyxia, sepsis, hypothermia, and low birth weight/ pre-maturity (responsible
for more than 2/3rd of neonatal deaths). Therefore the governments of India
norms require that mothers stay in the hospital with the newborn for 24-48
hours after delivery.
However, we know that in the hospital, all hospital staff is very busy.
The ASHA may get the mother to the hospital, but she may not be able to stay
there with the mother. So, Yashodas have been provided to busy hospitals so
that the new mother feels safe & comfortable & danger signs in newborn and
mother are brought to the notice of the doctor early and treated.
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‘Yashoda’ is a dedicated non-clinical support worker, who can help in all the
care for the mother and new born. She is a support worker who is paid a
performance linked incentive, acts as a companion of the mother, supports the
nursing staff and acts as a link between both.
Yashoda is not a regular employee of the health system at present. She is not
a substitute for the nursing staff or paramedical staff available at the facility.
Q. What is the Status of Child Health in the state & district?
A. ….These indicators are to be added at local level
Q. What are the reasons for infant deaths in the first 7 days of life (early
neonatal deaths)?
A. Birth asphyxia, sepsis, hypothermia, and low birth weight/ pre-maturity
Q. What are the reasons for maternal deaths in the first 6 weeks after
delivery (maternal mortality)?
A. Hemorrhage, underlying anemia, sepsis, obstructed labor, toxemia
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Q. What are the responsibilities of Yashoda?
A. Yashodas have a host of responsibilities:
• Be a friend to the mother & support to the family
• Help register the mother as a JSY beneficiary
• House keeping of the labour room and the maternity and post natal
wards
• Maintain records of the mother and newborn
• Facilitate safety, security, dignity and privacy of the mother
• Provide basic care to the newborn by teaching the mother and family
how to keep the newborn warm, providing breast feeding support to
mother, ensuring immunization at birth
• Identification of danger signs in mother and newborn
• Counsel the mother on early initiation of breast feeding, advantages of
exclusive breast feeding, complementary feeding, mother’s diet,
infection control, immunization, family planning choice etc.
• Ensure that the birth is registered
Key messages
Ø The maternal and child health status in the state is poor
Ø Most of the deaths among infants occur in the first 28 days of life
and maternal deaths in the first 6 weeks after delivery & yet there is
no one to look after the mother and child in the hospital
Ø Yashoda will fill this gap
Ø Yashoda has several responsibilities and all these responsibilities
are geared towards making the mother and newborns stay in the
hospital comfortable
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Session 4:
Title: House keeping of the maternity & post natal wards and labor room
Session objectives:
It is expected that after this session the Yashoda will be well informed about her
responsibilities as housekeeper of the wards and labour room and will be able to
perform these duties.
Learner’s objectives:
1. Perform her supervisory duties to ensure that the support staff in the ward
does their work well – Aayah, ward boy, nurse etc.
2. Perform the activities she will undertake to make the labour room,
maternity and post natal wards comfortable for the mother and newborn.
3. Access the supplies available to her for housekeeping
Time: 1 hour and 10 mins
Materials: Facilitator’s guide, Yashoda training kit, Black board & Chalk or white
board & felt pens in two colours, duster, wipe, access to LCD (preferred) or an
OHP
Setting: Classroom followed by visit to maternity ward, labour room & supplies
section
Training Methods: Discussion followed by demonstration
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Steps:
Class room discussion: (Time: 10 minutes)
1. Inform trainees about the objectives of this session. Explain to them that in
the next few minutes you will be enumerating the chores that must be
done to keep the hospital clean and free of germs.
2. Ask the participant one by one to mention one activity she undertakes to
keep her own house clean. Note it on the black board.
3. Explain that the way these tasks need to be done at home, similarly, these
need to be done at the hospital.
4. Enumerate the activities that the trainee will need to perform
Divide the trainees into 3 groups. Each group must have its designated
trainer. One group will then proceed to the maternity ward, one group to the
labour room and one group to the supplies section. The groups will be rotated
so that each group has a chance to spend 10 minutes in the labour room & 10
minutes in the supplies section.
Demonstration in Ward: (40mins)

5. In the ward, the trainer will introduce the trainees to the personnel who are
responsible for housekeeping in the ward.
6. Explain in brief the roles of all the staff.
7. The trainer will demonstrate one by one all the activities that help in
keeping the ward clean and comfortable
8. Demonstrate how to make the bed
9. Let each trainee practice bed making
10. Show trainees how to mix disinfectant in water in the right proportion
Demonstration in Labour room: (10 mins)

11. Introduce the trainees to the ward staff and explain their roles
12. Familiarize the trainees with the equipment
13. Demonstrate the activities Yashoda needs to perform
26
Visit to supplies section: (10 mins)
14. Demonstrate the supplies available for housekeeping of the ward
15. Inform the trainees about the procedure for accessing supplies
16. Demonstrate how to fill the stock register
Special Preparations for this session -

The trainer should familiarize himself/herself with the staff of the wards and labor
room beforehand and understand their job charts. Request them to be available
in the ward at the time of this session.
Trainer must know how to make the bed. Trainer must also know how to mix
disinfectant In the right proportion
Also familiarize yourself with the time schedule of sweeping, mopping of the ward
and the place where the supplies are kept.
Make a list of the supplies for your reference.
Study the process of accessing the supplies.
27
Trainer’s notes:
Q. What are the activities Yashoda has to perform for housekeeping in the ward?
• Each Yashoda should take a round of the wards, labor room and toilets attached to
the wards at the time of shift change to satisfy herself about the cleanliness
• The floor should be mopped by the ‘safai karmchari/Aayah’ with water that contains
a disinfectant mixed in the right proportion.
• The disinfectant should always be available in the ward and trainees should be
shown the store room from where they can access this.
• In case food, water, body fluids or any other material is thrown on the floor, it must
be cleaned at once to prevent flies from swarming in the ward. Yashoda is to
ensure that the Aayah promptly sweeps and mops any spills.
• Other fittings in the ward like door handles, light switches, bedside counters & the
bottom of all incubators, cots and cribs should be cleaned by the Aayah.
• If Aayah is not doing her job, Yashoda should bring this to the notice of the nurse.
• It is important that Yashoda ensures that the bed allotted to a new admission has a
clean sheet and is made well. She must help the nurse in doing this and should be
able to do this by herself.
• In case of soiling of the mother’s bedsheet, the sheet should be changed at once
• Yashoda should ensure that all the electrical fittings in the ward are working. The
store for electrical fittings should be visited.
• The procedure for accessing electrical fittings like bulbs, tube lights etc from
hospital supplies should be explained.
• The trainees need to be informed about the water supply of the hospital. Yashoda
should inform nurse in case there is shortage of water in the ward or toilet.
Q. What activities should Yashoda perform in the labour room?
A. Yashoda has to ensure the cleanliness of the delivery table
The bed sheets covering the beds in the waiting room should be clean and fresh
Any spills in the room should be promptly cleaned
Q. What are the supplies available in the hospital for housekeeping?
A. Broom, mop, disinfectant, bed sheets, makintosh etc (the trainer needs to add his/her
observations from the hospital)
28
Session 5
Tile: Care of the mother before, during & after delivery
Session objectives:
• To explain to the Yashoda about the needs of a mother before, during and
after delivery and her responsibilities during this period.
• Yashoda should be able to demonstrate how to register a woman as a JSY
beneficiary
After this session, the trainee should be able to:
1. Understand the special needs of women before, during and after delivery
2. Understand her role as supporter and friend of mother and guide for the
family
3. Enumerate her responsibilities towards the mother during the time the mother
is in the hospital
4. Enumerate how she can assist the nurse in her duties towards the care of the
mother
5. Demonstrate how to register a woman as a JSY beneficiary
Time: 1 and a half hour
Setting: Maternity ward followed by JSY registration room followed by classroom
Materials: Facilitator’s guide, Flip chart for Yashoda, handouts for Yashoda, Note
pad, pencil, pen, eraser, felt pens in two colors, chalk, white board, duster, wipe,
access to and LCD (preferred) or an OHP & a CD player
Method: Demonstration followed by task followed by role play
29
Steps:
Demonstration in ward: (Time 30 minutes)
Divide the group into 3. A trainer should accompany each group.
1. Take the trainees to the maternity ward.
2. Demonstrate how to greet a pregnant woman and her family
3. Demonstrate the questions that need to be asked to ASHA and the mother to
gather information about the pregnancy
4. Demonstrate how to record the gathered information about the pregnancy
5. Demonstrate how to provide encouragement to the mother
6. Demonstrate how to massage the mothers back to relieve the pain
7. Demonstrate the activities in which Yashoda can assist the nurse for the care
of the mother
Demonstration in JSY registration room: (Time 15 minutes)
8. Take the group to the room where women are registered as JSY beneficiaries
and demonstrate the entire process of registration
Tasks: (Time 15 minutes)

Each group can be divided into smaller groups.
• Get the smaller group (2 or 3) of trainees from your group to register a
mother as JSY, another 2 - 3 trainees to collect and record the pregnancy
related information of a mother.
• The tasks can be exchanged after the two groups are done
• On completion of the task, discuss the tasks
30
Role Play in classroom: (Time 30 minutes)
1. Take the groups back to the classroom
2. Now, the groups will be allotted the following 3 scenarios to prepare:
a. Any one participant of Group I can make a role play of her past
experience in the ward
b. Yashoda welcoming a mother as she enters the hospital and
making her comfortable
c. Yashoda welcoming the family of a mother and advising them about
the preparations required for the arrival of the newborn
The participants can be given 10 minutes to prepare the role plays and 5
minutes each to perform.
3. Discuss the role play and recap the session – Time – 5 minutes
Trainer’s notes:
The Yashoda is the arm of the health system that provides the hitherto missing
support to women and children in a hospital setting. Explain to the Yashoda that - the
hospital is like her second home. A pregnant woman coming to the hospital and her
family are guests. Providing a warm welcome by greeting the mother is essential for
the mother to feel safe when she comes to the hospital for delivery. Providing a
conducive environment will encourage the mother to stay in the hospital for longer
duration (at least 2-3 days). This will help to ensure that the complications are
detected and treated early. As a supportive care provider, Yashoda needs to ensure
the following when the mother gets admitted in the hospital for delivery.
I. Welcome the mother
• Orient her to the maternity ward; be cordial with her family members.
II. Gather basic information
• Gather basic information from ASHA who has accompanied the mother about
completion of ANC checkup, any problem the mother had during pregnancy and
inform the nursing staff for necessary action.
• If there is no ASHA accompanying the mother, enquire from the mother about
gestational age, movement of the fetus, pain, duration of pain and its frequency,
any discharge from the vagina. Record this information.
• Ask the mother if the membrane is ruptured or not. If it is ruptured observe the
colour of the fluid (the normal colour of the amniotic fluid is colour less)
31
III. Provide psychological support and physical comfort
• Provide comfort, emotional support, reassurance, encouragement and
praise
• Give back massage to the mother if it gives comfort to her
• Ensure and respect the privacy of the mother during examinations and
discussions
• Ensure cleanliness of the birthing area
• Encourage mother to wash her genitals at the onset of labour
• Never leave the mother alone
• Find out from the nurse whether the mother can have light food. This will
help the mother from the effect of labour such as physiological exhaustion,
which can lead to distress in the baby. If mother is not at risk of requiring
an operation, she can be allowed to have light, easily digested, low fat
food during labour and should be given warm drinks
• Encourage mother to walk around. This helps ease the pain and shorten
the labour
• Encourage mother to urinate frequently
IV. Be a link between the hospital staff, the mother and her family.
• Help the mother to register as a JSY beneficiary
V. Assist the nurse
• Assist the nurse in providing comfortable bed to the mother
• Assist the nurse to avoid over crowding in the ward.
• Assist the nurse for pelvic and vaginal examination of the mother.
• Be available in the labour room if any help is required from you.
• Assist the nurse to keep the labour room clean, well ventilated, adequately
lit and warm for receiving the baby.
32
VI. Identify signs of discomfort in the mother
Observe the mother for any of these signs. If these are present, inform the
nurse immediately:
• If the colour of the liquor (amniotic fluid) is reddish/greenish/dark yellow
• If there is difficulty in breathing,
• vaginal bleeding, convulsions or unconsciousness
VII. Prepare for the delivery and the birth
• Assist the nurse to keep the delivery tray and baby tray ready.
• Keep a warm bed ready to receive the baby.
VIII. Post natal care
The post-natal period begins after delivery and includes the first six weeks after
delivery. During this time, the mother is in a delicate state. She has lost a lot of
blood and other nutrients during the delivery process. She is also breastfeeding
her baby and needs good nourishment to produce sufficient milk. Proper attention
has to be paid to the mother’s health. There are many good opportunities during
post-natal period for you to teach new mothers how to take care of themselves
and their babies so that the health of both is maintained.
Help the mother during her post natal period in the hospital
§ Help the mother to change sanitary pad frequently (Every two hours).
Ensure that the mother has enough sanitary napkins
§ Clean the mother and the area beneath her
§ Help the mother to eat and drink
§ Help her to clean the breast and feed then baby
§ Help the mother to keep the baby very close to her all the time
§ Encourage the mother to pass urine
Key messages
Ø Yashoda must be a friend & support for the mother and make the
mother physically comfortable by providing her clean surroundings
and back massage
Ø Yashoda must provide a psychologically comfortable environment
for the mother by speaking to her gently and encouraging her
33
Session 6:
Title: Preparations for welcoming the baby
Session objectives:
To impress upon the trainees the importance of making preparations for the
birth of a baby & familiarizing her about the kind of preparations needed
After the session, the trainee should be able to:
1. Communicate to a mother the importance of preparing for the arrival of a
new baby
2. Enumerate the articles required for the preparation
3. Enumerate the practices that are harmful for the mother and newborn
Time: 30 minutes
Setting: Classroom
Materials: A table, 2 trays, some examples of clothes needed for a newborn

baby, a rupee note, bottle of honey, kajal, black board & chalk, Yashoda training
kit, black board & Chalk or White board & felt pens
Training method: Discussion and Task
Steps:
Discuss: (Time 10 minutes)
1. Ask the participants if they think it is important to make preparations for
the birth of a baby.
2. Those who agree that it is important to make preparations for the birth can
raise their hands.
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3. Those who raise their hands should tell the group one by one why they
think it is important.
4. Facilitate the discussion and summarize
Task: (Time 10 mins)

Place a table in front of the trainees and place the following articles on it -
2 trays, some examples of clothes needed for a newborn baby, a rupee note,
bottle of honey, bottle of Kajal.
1. Introduce the purpose of this task
2. Ask one trainee to come forward and separate out materials from the
tray into two groups - Tray 1 - containing materials needed for the
newborn, Tray - 2 containing materials not needed by the newborn
3. This exercise should be repeated by at least 4 participants
4. Draw a table on the board with the names of the 4 participants and the
list of articles they selected
Trainer’s notes:
The purpose of this task is to enlist the articles needed for the newborn and
those not needed
Discuss the task: (20 mins)

1. Ask how many participants agree or disagree about each article. Ask them
to raise their hands and count the number.
2. Ask if there are any other articles they would bring for the preparations.
(This will give you an idea about the common beliefs in the community)
3. Note on the board if the group has added any article to the list of
preparations required.
4. Now, stress on the importance of getting each of the desirable items
5. Explain why the undesirable items written on the board should not be used
35
Special preparations: You can draw a table on the board beforehand with the
name of each participant and the list of articles. E.g:
Name of Clothes for Money Honey Kajal
trainee newborn
For each trainee, tick the articles she selects
Trainers notes:
It is very important to make preparations for the arrival of a new born.
Q. Why is it important to make preparations for the birth of a baby?
A.The baby is very fragile immediately after birth. The baby is vulnerable to
cold and both mother and baby are vulnerable to infections. Some articles are
required to save them from cold and infections. Preparations also have to be
made for emergencies.
Q. What are the articles required for the newborn?
A. Clothes including socks and cap during winter, old sari or dhoti that has
been washed and dried & money.
Q. Why is it important to keep clothes ready for the newborn?
A. The new born is very susceptible to cold (hypothermia). It is important that
the newborn is immediately covered well in accordance with the weather. In
cold weather, socks and cap are required since the baby loses maximum heat
from the feet and head. Old sari/dhoti can be washed, and kept dry to keep the
baby warm and use as nappies.
Q. Why should honey, Kajal not be applied?
A. The newborn is very susceptible to infections. Giving honey or applying
kajal can cause infections in the newborn.
Q. Why is money required?
A. Money is required for any emergency need of the newborn or the mother.
36
Key messages:
Ø It is very important to make preparations for the birth of a baby
Ø Keep articles like – money & clothes ready
Ø Do not use Kajal in the eyes of the newborn and do not give honey
or any such product to the newborn.
37
Session 7
Title: Early Initiation of breast feeding
Session objective:
To ensure that the Yashoda is well aware about the importance of early initiation
of exclusive breast feeding of the newborn
After this session the trainees should be able to:
1. Internalize the benefits of early initiation of breast feeding
2. Be clear about the benefits of giving Colostrum
3. Be clear about the harmful effects of giving pre lacteal feeds to the
newborn
Time: 1 hour
Materials: Facilitator’s guide, Flip chart for Yashoda, handouts for Yashoda,
Note pad, pencil, pen, eraser, felt pens in two colors, chalk, white board, duster,
wipe, access to and LCD (preferred) or an OHP & a CD player
Setting: Classroom
Methods: Group discussion
Steps:
Group discussion: (Time: 30 minutes)
Divide the trainees into 3 groups of 8-9 each. One trainer should be present with
each group who will act as a facilitator.
1. Give the following 3 topics to the groups
a. When should breast feeding be initiated?
38
b. Should Colostrum be given to the newborn?
c. Which other food/drinks should be given to the newborn in the first
few days of life?
2. In each group let the group member chose their team leader and inform
the trainer
3. Ask the groups to discuss these questions among themselves and
formulate answers
4. Ask them to give the written answers on a chart paper with at least 3
points in favor of their answer
Discussion: (Time: 30 minutes)

1. Once the task is completed, ask the team leaders to read out the answers
to the first question given by the groups one by one.
2. Note the answers on the board with the reasons given in favors of the
answer
3. Now ask the team leaders for answers to the second and third questions
and note the answers on the board
4. Let the participants open on the flip chart the page dealing with initiation of
breast feeding
5. Hold up a flip chart in front of the class and show on the flipchart the page
that deals with initiation of breast feeding
6. Explain why breast feeding should be initiated within an hour of the baby’s
birth.
7. Explain the advantages of giving Colostrum
8. Explain how pre lacteal foods can harm the newborn
9. Now discuss the participant’s answers noted on the board and tick them
as right or wrong. Give explanation for each as you go along the list.
10. At the end, ask the trainees if there are any other practices associated
with feeding the newborn that have not been covered.
11. If yes, address the issues raised
39
Trainer’s notes:
Q. When should breast feeding be initiated and why?
- Breastfeeding should be initiated within an hour after birth.
- Early breast feeding helps in expulsion of the placenta and reduces bleeding of
the mother.
- Helps the milk to flow and makes more milk
- Helps in mother and baby bonding
- Keeps baby warm and safe from infections
Q. What are the benefits of feeding colostrum to the newborn?
A. Colostrum is very rich in all nutrients required by the baby. It s easily digestible by
the newborn & contains large number of antibodies that help the newborn in fighting
off infections.
Q. What are the harmful effects of giving prelacteal feeds?
A. In many families, there is a practice of giving honey, water and other such
prelacteal feeds. These external food stuffs transmit infections to the newborn.
Secondly, if the newborn doesn’t suckle enough, the quantity of mother’s milk reduces
and the baby will be malnourished.
There is no benefit whatsoever of giving these other fodds/drinks
40
Key messages
Ø Breast feeding must be initiated within 1 hour of birth
Ø Colostrum contains all the nutrients a newborn needs and must be
given to the newborn
Ø Prelacteal feeds like honey, water can harm the baby
41
Session 8
Title: Proper positioning while breast feeding
Session objectives:
To build the capacity of the Yashoda to help a mother attain the proper position
for breast feeding
After this session, the trainee will be able to:
1. Help a mother attain a suitable position for breast feeding
2. Demonstrate other appropriate positions for breast feeding
3. Communicate to mother the precautions to be taken while breast feeding
the newborn
Time: 30 minutes
Materials: Facilitator’s guide, Yashoda training kit
Setting: Post natal ward
Method: Video & Demonstration
Steps:
Show the Video on Breast feeding (good attachment & position), in the local
language
Divide the trainees into 3 groups. Each group will be led by a trainer. The teams
should be taken to the Post natal ward and will be allotted different beds where
there is a mother and newborn.
42
1. The trainer will take the group to a mother and newborn and demonstrate
how to initiate breast feeding
2. Demonstrate both - the techniques of initiating breast feeding on a mother
who has had a normal delivery and for a mother who has had a caesarian
section
3. Other positions for initiating breast feeding that can be adopted by the
mother should also be demonstrated.
4. Demonstrate to the trainees the precautions needed while breast feeding
the newborn
Trainers notes:
Q. Which positions can be adopted while breast feeding the baby?
A. Different positions of breast feeding –
1. mother supporting the head, body and buttocks of the baby on her arm
2. mother reclining at an angle and breast feeding
3. mother lying down with baby close by
Things to be kept in mind while breast feeding the newborn –
Q. What are the precautions needed while breast feeding the baby?
A. Breast feeding is better when:
o The mother is comfortable.
o The baby is cuddled to mother with his/her head held up and with support for the
head, body and buttocks.
- The baby should have the whole of the areola in his/her mouth and not just the nipple.
Baby’s mouth should be wide open and should cover most part of the areole.
- The baby’s chin should be close to the breast
- Complete one breast before offering the other breast.
- Improper positioning while breast feeding could result in nipple biting or injury
- Baby’s face should not be covered; Mother should be able to see the baby and interact
with the baby.
- Mothers under gone surgery can feed lying down or in a semi inclined position till they
recover.
- In the case of twin babies both can be fed simultaneously or one after another.
- Do burping by keeping the baby upright and rubbing or patting the back gently. 43
Key messages
Ø Improper position of breast feeding is a common reason for failure to
breast feed or injury to nipple
Ø To attain the proper position, the baby should be close to the mother
with her mouth facing the mother’s breast and entire body supported
on the mother’s arm
Ø The entire areola should be in the mother’s mouth and not just the
nipple
Ø Other positions that are comfortable for the mother can also be
adopted
44
Session 9:
Title: Exclusive breast feeding for six months and complementary feeding
Session objectives:
It is important that during this session the trainees understand what is exclusive
breast feeding for six months, are convinced about its importance and that breast
feeding should be continued during illness. They should also be able to counsel
the mother about how to start complementary foods and what to give as
complementary food.
After this session the trainees should be able to:

1. Communicate to mother what is meant by exclusive Breast feeding
2. Enumerate the benefits of exclusive breast feeding
3. Communicate to mother the importance of breast feeding during her or the
baby’s illness
4. Communicate to mother when to start complementary food and how to start it
Time: 40 minutes
Materials: Facilitator’s guide, Yashoda training kit, pin board & pins, or white
board & sticking tape, cut out pictures of a Calf, Cow, Camel, baby Camel,
Goat, baby Goat, human baby, woman.
Setting: Classroom
Method: Task followed by Discussion
45
Task: (Time: 10 minutes)
1. Place the cut out animal pictures on a table.
2. Ask one participant to match the pictures of mother and baby.
3. As she matches, let her paste the picture of mother and baby together
on the pin board/white board/ wall
Discuss: (Time: 30 minutes)

1. Ask the participant if there is any difference of opinion with the matching
that has been placed on the board
2. Now explain to participants that the way a cow’s baby or goat’s baby
needs its mothers milk, similarly a human baby needs its mother’s milk
(ensure that each participant understands what you are saying).
3. Encourage the participants to express any difference of opinion (if they
feel that the baby should be given some other food stuff besides mother’s
milk?)
4. If there is any other point of view, note it on the board.
5. Once all opinions are collected, read the list and cross out one by one all
other food/drink mentioned (if any)
6. Explain why other food stuffs are not needed by the human baby.
7. Explain the advantages of exclusive breast feeding as mentioned below
8. Ask a participant if mother should feed the baby if the baby is unwell. Let
her answer in yes or no.
9. Ask how many agree with the answer. Those that agree can raise their
hands.
10. Count the number of hands and inform them if they are right or wrong.
11. Explain why it is required that the mother should breast feed the baby
even when the baby is sick
12. Explain what is complementary feeding and what food can be given when
starting complementary feeds for the baby.
46
Trainers notes:
This session is very crucial. It is imperative that the participants give voice to
all their concerns about exclusive breast feeding and clear all doubts. Breast
feeding is one of the most important interventions for preventing morbidity and
mortality among children.
Q. What is meant by exclusive breast feeding?
A. Exclusive breast feeding means giving the baby only the mother’s milk. No
other food/drink is required by the baby while it is being exclusively breast fed.
Baby does not even require water during this time.
Q. What are the advantages of exclusive breast feeding?
A. There are several advantages -
- Mother’s milk provides all the nutrients required by the baby.
- It is safe. There is no outside source of infection.
- It contains antibodies that help the baby fight off infections.
- It is also easily digestible by the baby.
- It is easily available.
- It is of no cost to the family.
- Breast feeding provides warmth to the baby and prevents baby getting
cold.
- Bodily contact between the mother and baby promotes better emotional
bonding between mother and baby.
47
Q. For how long should exclusive breast feeding be continued?
A. Exclusive breast feeding should be continued for 6 months.
Q. Why should other fluids like baby formula, water, rice water etc not be used?
A. Substances other than the mother’s milk do not contain all the nutrients required by the
baby. If other fluids are given, they will decrease the appetitive of the baby for mother’s milk
even though they are not providing the essential nutrients. Additionally outside food stuffs
are potential carriers of diarrhea. Most often, if baby is being given other liquids, these are
given through a bottle. Bottle is very risky for the baby since a large number of germs may
develop in bottles that are not cleaned adequately. Cleaning a bottle properly is a
cumbersome and tedious task that most mothers are not able to perform.
Q. What is complementary feeding?
A. Feeding the baby food other than breast milk at the age of 6 months is called
complementary feeding. Babies should be fed soft, light, well cooked food. You can give
home made soft food prepared with locally available food. (dal, dahlia, rice). Start with liquid
consistency and gradually increase the thickness. Start with 2 times a day and gradually
increase it to 4 times. Breast feeding can continue along with other feeds for at least 2
years. To monitor growth, check the weight of the baby regularly.
Q. Should the mother feed the baby when the baby is sick?
A. Yes, the mother should feed the baby when the baby is sick. It has two major
advantages:
- During sickness the baby needs more fluids which are provided through breast milk
- Breast milk has antibodies that help the baby fight off infections
Key messages
Ø The human baby needs only the mother’s milk till 6 months of life
Ø Breast milk contains all the nutrients necessary for the baby, helps
fight infections and helps in good emotional development of baby
Ø Mother should continue to feed the baby even if she is sick
Ø Baby needs mother’s milk more when he/she is sick
48
Session 10:
Title: Breast feeding- some possible problems.
Session objectives:
The trainees should be well versed with some common problems that mothers
may encounter during breast feeding and should be able to provide some easy
solutions.
After this session the trainee should be able to:
1. Enumerate common problems that a mother may have during breast
feeding
2. Identify these common breast feeding problems
3. Support the mother to solve these problems
Time: 45 minutes
Divide the trainees into three groups. Each group should be accompanied by a
trainer. Allot one bed to each group on which a mother and newborn are located
Steps:
1. Ask 5 trainees one by one if she has ever encountered a mother who
could not breast feed her child
2. If yes, what was the problem?
3. Note the problems mentioned
49
4. Ask what did the mother do then & what was the solution provided for
these problems?
5. Now, open the flip chart for Yashoda and pointing to the pictures of
inverted/flat nipple, and fullness of breast; ask if they can identify what the
problem is.
6. Using the pictures in the flip chart for reference, explain the simple
solutions given
7. Demonstrate on a mother how to express breast milk by hand.
8. Ask a trainee to practice on the mother.
Trainer’s notes:
Most breast related problems are easy to manage with simple actions. It is
often seen that mothers stop or are never able to initiate breast feeding
although they have a problem that is easily rectifiable.
Q. What are the common problems with breast feeding?
• Inverted or flat nipples
• Fullness and pain in breast
• Cracks and pain in nipples
Reasons and actions required:
• Inverted or flat nipple can be improved with continued suckling of the
breast by the baby.
• Fullness of breast occurs when the baby is not breast fed early or
regularly. Baby is unable to suckle on engorged breast. Hot
fomentation, light massage and expression of some milk by hand
before putting the baby to breast will help.
• Cracked nipples occur due to improper attachment leading to vigorous
sucking by the baby. This can be remedied by application of some
expressed breast milk on the nipple after each feed and correcting the
attachment by proper positioning.
• Slight pain in the breast can be relieved with medicine. If the problems
persist, a doctor or nurse should be consulted.
• Do not use soap to clean the breast/nipple since it can cause cracked
nipples; wash with plain water during the time of bathing.
50
Key messages
Ø Inverted/flat nipples will improve with continuous sucking by the
baby
Ø Fullness of breast can be corrected by hot fomentation light hand
massage and expressing some breast milk
Ø Cracked nipples can be relieved by application of some breast milk
on the nipple after feeding the baby and by correcting the attachment
Ø Drying agents like soap should not be used on the nipples
51
Session 11
Title: Keeping the newborn warm
Session objectives:
This session is designed to impress upon the trainees the importance of keeping
the newborn warm and to teach them how to do it.
1. Communicate to the mother why it is necessary to keep the newborn
warm
2. Enumerate the clothes needed to keep the newborn warm
3. Demonstrate how to wrap the newborn
4. Demonstrate how to clean the newborn after he/she urinates, defecates
5. Demonstrate how to change the newborn’s nappy
6. Demonstrate how to keep the newborn close to the mother
Time: 1 hour
Materials: Facilitator’s guide, Yashoda training kit, 3 doll babies, baby

towels/blankets to wrap baby, 3 pairs of socks, 3 caps for baby
Method: Demonstration and practice
Steps:
52
Divide the trainees into 3 groups – each of 8-9 trainees. Each group should be
accompanied by a trainer. These three groups must now be taken to the post
natal ward.
1. Here the trainer should explain the importance of keeping the newborn
warm
2. Enlist all the methods by which the baby can be kept warm
3. Enumerate the clothes that are needed to keep the newborn warm and
demonstrate the use of the clothes on the doll
4. Demonstrate on the baby doll how to wrap a baby
5. Let each trainee practice on the doll the technique of wrapping the baby
6. Demonstrate on the doll how to clean the baby after it urinates and
defecates
7. Demonstrate on the doll how to change the nappy
8. Let each participant practice how to clean the baby and change the nappy
9. Now demonstrate on a live baby how to wrap the baby
10. Demonstrate on the live baby how to clean and change the baby
11. Each Yashoda should practice wrapping a live baby at least once
12. Trainer will demonstrate how to keep baby very close to the mother
Summing up
13. Ask each participant one measure to keep the baby warm
14. Trainer will now sum up all the measures that should be taken to keep the
baby warm
53
Trainers notes:
Q. Is it necessary to keep the baby warm and why?
A. The newborn is very vulnerable to hypothermia (cold) for the first few
months after birth. It is very essential to keep the newborn warm and dry to
prevent her/him from cold.
Q. What are the measures to keep the newborn warm?
• Newborn should be kept in skin to skin contact as far as possible
• Breast feeding the newborn
• Wrap the newborn with a blanket/sheet; ensure to cover the head as
well
• During winters, covering baby with extra layers, socks and caps
• Clean, dry & change the baby after he/she urinates or defecates
• Keep the room warm
• Avoid giving bath on the first day
Q. Why should the baby be kept close to the mother?
• The body warmth of the mother helps the baby keep warm
• Keeping the baby close stimulates better milk output in the mother
• Being close to the mother encourages the baby to feed better
• It is also easier for the mother to breastfeed the baby on demand
Key messages
Ø The newborn is very vulnerable to cold and must be kept warm at all
times
Ø Keep the newborn clean, dry & well covered and always very close to
the mother
Ø Avoid giving bath on the first day
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Session 12
Title: Bathing the new born baby
Session objectives:
Yashoda should be aware about when and how often to bathe the newborn & the
precautions to be taken while bathing the newborn
After the session, the trainees should be able to:
1. Inform the mother when to bathe the newborn
2. Demonstrate how to bathe a new born
3. Enumerate the precautions to be taken while bathing a newborn
Time: 1 hour
Method: Demonstration
Steps:
Divide the trainees into 3 groups each led by a trainer.
1. Take trainees to the ward
2. Explain when the newborn should be bathed and why
3. Demonstrate how to bathe a newborn
4. Demonstrate how the cord stump is kept clean and dry
55
Trainer’s notes:
Q. When should the newborn be bathed?
A. Newborn babies with normal weight (2.5 KGs) require bath only after the
first day of birth. Small and low birth weight newborns can bathe after the cord
falls off or preferably till baby gains weight to 2000 gms. Till then, daily
cleaning with wet cloth soaked in lukewarm water is adequate.
Q. What are the precautions to take while bathing the newborn?
A. Bathe gently and do not rub the baby vigorously. If you do so you may
remove the white film/ vernix caseosa on the body of the newborn which gives
protection to the baby. Support the head of the baby at all times. Keep the
room warm and use luke warm water. Assess the temperature by touching the
water to the exterior aspect of your elbow. Do not use any soap or powder.
Bathe quickly and dry the baby quickly. Do not apply any thing on the cord
stump and allow that to dry naturally. Cover the baby well and keep her/him
close to the mother for breast feeding. Do not apply any powder or perfume on
the baby.
Key messages
Ø Do not bathe the newborn on the first day after birth

Ø Do not use and soap, powder or any other perfumed agent on the
baby’s body
Ø Keep the cord stump dry and clean
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Trainer’s notes
Q. Is it necessary for the mother to eat more after delivery?
A. Yes. It is important for a new mother to eat well. This enables her to replenish the
nutrients she has lost during delivery. If mother is breast feeding the baby, it is even
more important for her to eat well. The requirement of the mother increases when
she is producing milk for the baby. This is for her to produce better quality and
quantity of milk.
Q. What should the mother eat?
A. Mother can stay healthy by eating whatever food available locally. She requires
two balanced big meals and two small meals in a day to meet her nutritional
requirement. During breast feeding mother has to take more fluids.
Q. What food should the mother avoid?
A. No food items need to be avoided by the mother. There is no specific ‘hot food/
cold food that mother should or should not eat.
Q. What are the food customs that may harm the mother?
A. In some households, various food materials are restricted for the mother in the
false belief that the food material is ‘hot’ or ‘cold’. This limits the variety of food the
mother can partake. This may lead to nutritional deficiencies in the long run.
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Session No. 13
Title: Care of the low birth weight baby
Session objectives:
The trainee should be able to identify a low birth weight newborn by its weight
and take basic care of the low birth weight newborn
After this session, the learner should be able to:
1. Identify a low birth weight baby by its weight
2. take the weight of a newborn using a standard weighing scale available in
the hospital
3. Enumerate special needs of the Low birth weight baby
4. Demonstrate Kangaroo Mother Care position
5. Demonstrate how to express breast milk
Time: 1 hour
Setting: Post natal Ward
Materials: : Facilitator’s guide, Flip chart for Yashoda, handouts for Yashoda,
wipe, access to and LCD (preferred) or an OHP & a CD player.
Steps:
Form 3 groups. Each group should be led by a trainer. The groups will assimilate
in the post natal ward.
1. Using the flip chart, show the picture of a low birth weight baby
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2. Explain what is meant by low birth weight
3. Mention the characteristics of a low birth weight baby – poor feeding &
increased susceptibility to cold
4. Explain the special needs of such a baby – feeding, keeping warm.
5. Demonstrate KMC on a mother of a newborn
6. Demonstrate KMC on the father of a newborn.
7. Explain the advantages of KMC
8. Demonstrate on a mother how breast milk can be expressed by hand to
feed a weak low birth weight newborn
9. Demonstrate how to take the weight of the baby using the standard
weighing scale available in the hospital
Picture of a standard weighing scale for babies
59
Trainer’s notes:
What is meant by a low birth weight baby?
Babies weighing less than 2500 gms are known as small babies or low birth
weight babies. Further, babies weighing less than 2000 gms require special
and extra care. Pre term babies are also usually low birth weight & and are
born before time.
What are the special needs of low birth weight babies?
Low birth weight babies are at higher risk of hypothermia (cold), more prone to
infections; poor growth, and ill health. They are at higher risk of jaundice
(turning yellow). Due to their weakness, often they do not suck the breast well.
In the long run, low birth weight babies have more chance of becoming weak/
malnourished.
What is Kangaroo Mother Care (KMC)?
Small babies – low birth weight babies, pre mature babies are prone to cold
and illness very fast. They require this special skin to skin contact known as
‘Kangaroo mother care’. Kangaroo mother care means placing the baby on the
mother’s chest, between the breasts and well covered. There should be skin to
skin contact between the mother and baby. There are several benefits to this
method. This method is simple, cost effective and easy to follow. It keeps the
baby warm through skin to skin contact between adult and baby. Along with
this frequent breast feeding can help the baby to fight illness and grow
healthy. Mothers can practice this while sitting, lying down and as long as
possible. Other family members can also do this and support mother when
possible.
What can be done if a low birth weight baby is unable to suckle?
§ Express breast milk every 2-3 hours and feed baby with ‘palada’ or cup
& spoon
§ Put the baby to the breast to let him lick the nipple and perhaps suckle
a little
§ Once the baby can suckle, he should be put on the breast frequently to
stimulate milk production
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Key messages
Ø A low birth weight baby has special needs – is more vulnerable to

cold and may not be able to suckle
Ø Keep the low birth weight baby warm and well covered with
Kangaroo mother care
Ø If the baby is too weak to suckle properly, feed the baby expressed
breast milk from a katori and palada
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Session 14
Title: Danger signs in new born
Session objectives:
Yashoda should be able to identify a newborn that has danger signs and should
be able to refer such a baby to the appropriate authorities
After this session, trainee should be able to:
1. Distinguish between normal and abnormal appearance and activities of a
newborn
2. Identify danger signs in the newborn
3. Be aware of the authorities she should refer the sick newborn to
Time: 1 hour
Materials: Facilitator’s guide, Yashoda training kit, access to LCD (preferred) or

an OHP
Method: Demonstration followed by slide show
Steps:
Demonstrate in ward: (Time: 30 minutes)
1. Divide trainees into 3 groups. Each group is to be accompanied by a
trainer.
2. The trainers will demonstrate on a live, healthy newborn:
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• General condition & movements
• Normal cry
• Normal suckling/feeding
• Normal breathing – count the breaths per minute
• Normal colour of lips and skin
• Normal stools of a baby
3. Let the trainees touch the baby’s abdomen & feet to feel the normal
temperature of the newborn
Slide show in classroom: (Time: 30 minutes)
4. Take the trainees into the classroom.
5. Go through the slide show and explain the danger signs in newborns
6. Explain to the trainees that they must be aggressive and vigilant while
identifying danger signs. If there is any doubt, it is better to refer than to
wait since symptoms in newborns progress very fast and the condition can
worsen
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Trainer’s Notes:
Q. What are the characteristics of a normal newborn?
A. The normal newborn has a pink face & feet. He/she is usually in the state of
quiet alertness (eyes open, looking around). The limb movements are smooth
and spontaneous and not unusually jerky. He/she has a vigorous, lusty cry.
The normal Respiratory Rate is 40-60 breaths / minute. The respiratory rate
should be counted by observing the rise and fall of the newborn’s
chest/stomach for a full minute.
What are the danger signs among newborns?
These are the following:
§ Lethargy, not feeding or feeding less
§ Cold to touch
§ Rapid breathing (>60 per minute), grunt, gasping, apnea
§ Abnormal movements, vacant stare
§ Abdominal distension, vomiting
§ Bleeding
§ Jaundice
In the hospital, if Yashoda identifies any of the above signs, she should inform
the nurse immediately. If the mother observes such signs in her newborn at
home, she should immediately inform the ASHA /ANM or AWW for
confirmation of sickness and guidance. During this time, ensure that the baby
is well wrapped, kept warm during transport and continue feeding.
How to assess Hypothermia

• If abdomen is warm & feet are warm & pink, body temperature is normal
• If abdomen is warm & feet are cold, it is cold stress. Cover the baby with
extra clothing
• If both abdomen and feet are cold, it is Hypothermia & the baby requires
urgent attention
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Key messages
Ø Newborns are prone to rapid progression of illness

Ø Yashoda must be very vigilant and aggressive while looking for
danger signs in newborns
Ø Yashoda must note the general condition of the newborn,
temperature, respiratory rate, colour of skin or any other
abnormalities
65
Session No. 15
Title: Danger signs in mother
Session objectives:
The trainee should be able to identify signs of danger in the mother
1. Be well informed about the normal physiological changes after delivery
2. Identify and treat some common minor problems mothers face after
delivery
3. Identify danger signs after delivery
Time: 1 hour
Steps:
Divide the participants into 3 groups. A trainer should accompany each group.
1. Take the groups to the post natal ward.
2. Demonstrate the normal physiological changes in a woman after delivery -
Uterine contraction , Normal uterine discharge (bleeding)
3. Explain the common problems a woman might face and the easy
remedies for these.
66
4. Using the pictures given in the flip chart for Yashoda, explain the danger
signs and symptoms
5. Once you have explained, let the participants repeat each danger sign or
symptoms till you are satisfied that they have understood and learnt each
sign and symptom
67
Trainer’s notes:
What are the normal physiological changes in a woman after delivery?
Normally after delivery the uterus (womb) undergoes contraction and becomes smaller and
smaller in size. Sometimes, there may be some after pain (discomfort pain in the abdomen
during breast feeding). The normal uterine discharge (bleeding) for 3-4 weeks for normal
delivery is called Lochia. Usually all women continue to bleed /discharge at least for six
weeks after delivery. The colour of Lochia changes over the weeks from red –yellow-white.
Some women may experience mood changes during the first week.
What are the common problems a woman might face after delivery and how to treat
these?
§ Retention of Urine: Hot/Cold water application on the supra public region, sound of
running water may help to initiate urination. Ask the patient to pass urine in squatting
position. If no relief inform to the staff
§ Pain: at the site of the cut which may be due to stitches in the skin. Inform to the staff
§ Swelling of breasts: Hot water fomentation and light massage from periphery towards
nipple help in removing engorgement with free flow milk,
What are the serious signs and symptoms during post natal period?
General condition
§ Mother feels dizzy
§ Looks pale
§ Increase in body temperature
§ Fast or difficult breathing
§ Fits
§ Visual disturbances
Pains
§ Severe pain and tenderness in the abdomen
§ Severe pain in the private part or genital area
§ Severe headache
§ Swollen, red or tender breasts or sore nipple
§ Severe leg pain and tenderness over calf of muscles (pain in the calf muscles)
Mental state
§ Keeping quite or not talking to anyone
§ Not taking care of the baby or refuse to feed the baby, 68
Bleeding and Discharge from vagina
§ Excessive bleeding from the vagina
§ Passage of fist size clots
§ Foul smelling discharge from vagina
Key messages
Ø The Yashoda must be vigilant and aggressive while checking for
danger signs in the mother
Ø Refer if the mother has poor general condition – lethargic, is pale,
has rapid or slow breathing than normal, has fits, has visual
disturbance, has low or high temperature
Ø Refer if the mother has any severe pains
Ø Refer if the mother has severe mood swings and is non responsive
towards the baby
Ø Refer if mother has severe bleeding or foul smelling discharge from
vagina
69
Session No. 16
Title: Clean practices to prevent infection
Session objectives:
To ensure that the Yashoda is well versed with clean practices in ward, to be
practiced by herself, the mother and baby
1. Enumerate infection control practices to be undertaken by Yahsoda in the
ward
2. Enumerate the infection control practices to be taken by themselves
3. Demonstrate how to wash hands properly
4. Enumerate infection control practices to be undertaken by the mother in
hospital and at home
5. Enumerate infection control practices for the baby in hospital and at home
Time: 1 hour
Steps:
1. Explain the role of Yashoda in maintaining infection control in the ward
70
2. Explain what actions Yashoda can take for their personal hygiene and for
preventing infection to others
3. Demonstrate how to wash hands properly
4. Let each trainee wash her hands as demonstrated
5. Explain infection control measures that a mother should take at hospital
and at her home for herself and the baby
How to wash hands properly
71
Trainer’s notes:
Q. Why should we make an effort to prevention infection?
A. Small babies are very vulnerable to infections since they are new in this
world and have not yet learnt to fight against the disease causing germs.
Neonatal infection is one of the major causes of neonatal death in our country.
It is possible to prevent infection in the newborn by following some simple
procedures.
Q. What measures can be taken by Yashoda in the ward for infection
control?
• Avoid over crowding in the ward.
• Keep the bed and ward clean calm and free from dust.
• The floor of the ward should be cleaned with water and disinfectant
when required (at least once in each shift)
• Ensure that the files, X ray films etc. are not kept on the baby cot.
• Ensure that mother washes hands after washing bottom of the baby &
after she herself goes to toilet
Q. What personal hygiene measures can Yashoda take to prevent spread
of infection?
• Wash hands before handling the baby.
• Have a bath daily
• Always keep trimmed nails and clean and combed hair
72
What infection control measures should a mother take at home and in
the ward for herself and for the baby?
• Persons with infections should not be allowed to come into direct
contact with baby.
• Number of persons handling the baby should be limited.
• Six hours after birth (or) after the baby’s temperature is stable, clean
the baby’s skin with cotton clothes soaked in warm water to remove
blood or other body fluids and then dry the baby. Delay bathing until at
least the second day of life.
• The buttocks and perineal area of the baby should be cleaned each
time the baby’s napkin is changed or as often as required, using cotton
soaked in warm, soapy water and then the area to be dried.
• Ensure that the mother knows correct positioning and attachment for
breast feeding to prevent mastitis and nipple damage.
• Use only clean clothes for baby. Do not use unwashed new clothes
• Keep the umbilical cord of baby clean and dry.
• Instruct family not to apply anything on the cord stump.
• Tell family not to apply anything to the eyes and skin of the baby.
• Advice mother and others who handle baby have short trimmed nails.
• Advise mother to clean her hands and breasts before and after breast
feeding the baby.
• Advise mother and others who handle baby to wash their hands with
soap and water after defecation.
• Advice mother to wash her hands thoroughly before cooking for family
and for the baby
• Counsel mother to exclusively breast feed baby.
• Advise mother and family members to keep the home and surrounding
area clean and free from insects such as mosquito.
• Instruct her to take the baby at 6 weeks to the nearest health centre for
immunization.
• Tell her not to use pacifier.
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Key messages
Ø Simple measures can prevent spread of infection to the baby

Ø Avoid overcrowding around the baby & let very few people handle
the baby
Ø Wash hands with soap and water before feeding the baby after
washing the baby’s urine or feces, before cooking
Ø Do not apply anything on the cord stamp, always keep the cord
stump clean and dry
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Session 17
Title: Diet of a lactating mother
Session objectives:
To familiarize the trainee about the diet requirements of a breast feeding mother
& to understand the local customs regarding the food practices of breast feeding
mothers
1. Communicate to mother why it is important for a mother to eat well after
delivery
2. Communicate to mother which food items she should consume
3. Explain to family which dietary restrictions can harm the mother
4. Communicate to mother the number of times she should eat in a day
5. Communicate the mother the number of feeds the baby needs in a day
Time: 1 hour
Setting: Classroom
Method: Group Task followed by role play
75
Steps:
Group Task 1: (Time: 15 minutes)

Divide the trainees into 3 groups. Each group should have a trainer.
1. The trainer will nominate a group leader for the group.
2. Pose the following two questions to all the three groups:
a. Is it necessary for the mother to eat more during the time that
she is breast feeding the baby?
b. What are the food stuffs that she should eat?
c. What are the foodstuffs that she should avoid?
3. Instruct the groups to answer the three questions as explained below
Instructions for group leaders:

• The groups should reach a consensus about the answer to question a.
in the form of a ‘Yes’ or ‘No’ with reasons in support of the answer.
• To answer the question 2, the groups will make small chits of a piece of
blank paper. Each trainee will pick up an empty chit and note down a
food item that the mother should eat in GREEN and a food item the
mother should not eat in RED. These chits will be folded and given to
the team leader.
• The three group leaders will get together and open the chits. Based on
the answers of the three groups, they will prepare a consolidated chart
containing two lists in table format with foods that the mother can eat
and food that the mother cannot eat. If a food item is repeated, in one
list, it needs to be mentioned only once. But if a food item is mentioned
as both food to be eaten and avoided, it should be noted in both lists.
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Discuss: (Time: 15 minutes)
1. Ask the group leaders to read aloud the answer to question 1.
2. Explain to the participants why a new mother should eat more and how
many meals she should eat in a day
3. Now display the chart with answer to questions 2 and 3, prepared by the
group leaders on the board
4. Go through each food item written
5. Discuss which food items should be consumed by the mother and which
food items should not
6. Ask the trainees about local dietary customs for new mothers
7. Discuss what local dietary customs may harm the mother in the long run
77
Role play (30 minutes)
Instructions for Role play
1. Ask the three groups to prepare a role play with the following three
scenarios:
a. Yashoda advising a new mother in the hospital about what foods
she should eat and what she should avoid while the mother-in-
law insists on following harmful customs
b. Yashoda advising a new mother about the importance of
exclusive breast feeding
c. Yashoda advising a mother about how to breast feed her baby
2. Let the three groups perform the role plays
3. Discuss
4. Praise the groups for putting in the effort
Trainers notes:
Q. Which are the foods that mother needs to consume or avoid?
• Mother should have a variety of food rich in calories, proteins, vitamins
and roughage e.g. Cereals in the form of like Rice, Chapati, Pulses,
Green leafy vegetable and fruits & dry fruits (if available).
• Mother should avoid spicy, oily food.
Key messages
Ø The process of pregnancy and delivery drains on the mother’s

nutritional status and therefore she needs a good, nutritious diet
with a variety of food stuffs
Ø She needs to take two large meals and two small meals in a day
Ø No food items need to be avoided by the mother
78
Session No: 18
Title: Immunization
Session objectives: To familiarize Yashoda with the immunization schedule and

the impress upon her the importance of giving vaccines
1. Enumerate the vaccines that should be given at birth
2. Enumerate the vaccines that should be given in the first year of life
3. Be familiar with the vaccine schedule in the first year of the infant’s life
Time: 1 hour
Setting: Classroom followed by visit to immunization room
wipe, access to and LCD (preferred) or an OHP & a CD player, Vials of
vaccines – DPT, Hepatitis B, BCG, Measles and OPV
Steps: 1 hour
Classroom demonstration (Time 20 minutes)
1. Ask the trainees if they are aware of the vaccines to be given to the baby
under 1 year
2. Ask a participant whether her own children are immunized? If yes, is she
aware of which vaccines have been given?
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3. Ask another participant if she know which diseases can be prevented
through vaccination
4. Note her answer on the board
5. Now pick up the vaccine vials one by one and display to the class.
Mention which diseases the vaccine protects against
6. Also mention the route of administration and time schedule of the vaccine
Demonstration in Vaccination room (40 minutes)

7. Divide the trainees into three groups and take them to the vaccination
room.
8. Here demonstrate each of the vaccines
9. Demonstrate the route of administration and site of vaccination
10. Demonstrate the vaccines that need to be given as zero dose
11. Ask the participant to repeat what they learnt
12. Demonstrate how to read and fill an immunization card
13. At the end, inform the participants about the points that must be told to
mothers and family of the newborn in relation to immunization
80
Trainer’s notes
Which vaccines are given to children below 1 year of age?
DPT, BCG, Hep B, Measles, OPV
Which diseases do these vaccines protect against?
Name of Vaccine Disease prevented
DPT Diphtheria, Pertussis, Tetanus
BCG severe forms of childhood TB
Measles Measles
OPV Polio
Hep B Hepatitis (Jaundice)
Which vaccines should be given at birth?

Following vaccines are to be given at birth – OPV, Hep B and BCG. Yashoda should
ensure that the newborn gets these before discharge.
What is the importance of the prescribed vaccination schedule?
Timely vaccination of the child can build their immunity and prevent diseases.
Vaccines are given at specific intervals and age of life. The baby needs to be given all the
prescribed vaccinations in the first year of life. The vaccines should be given at the time
prescribed in the schedule. However, if a child has missed a dose, the ANM/nurse/doctor
can decide how the schedule can be modified to benefit the child.
What is the vaccination schedule?
BCG Polio DPT Measles Vitamin A
At At birth ----- ----- -----
birth
6 weeks 6 weeks 9 months. 6 months
10 weeks 10 weeks 12 months
14 weeks 14 weeks. 18 months.
What is the route of administration of the vaccines?
Most vaccines are injections. Only polio vaccine is oral drops.
Where are vaccines available in the village?
Vaccination days are held at the village where an ANM visits and immunizes all the
children of the village. Ask ASHA/ANM/AWW for information on immunization days
81
What information should the Yashoda give to the mother and family about
immunization?
• Counsel the mother to immunize her baby with polio drops, BCG Vaccine,
Hepatitis B, DPT and measles vaccines.
• Communicate clearly that these vaccines must be given at the right age and
right dose. The full course must be completed for giving protection to the
child against diseases.
• Advise her to take the baby to the nearest health centre for routine
immunization. Ask her to keep the immunization card safely.
• Explain the immunization schedule to the mother and advise her when and
how many doses of each vaccine is to be given to the child.
• Make it clear to her that the full course of vaccination must be completed at
the right age to protect the child from diseases.
Key messages
Ø Ensure that the newborn has received zero dose immunization –
vaccines BCG, OPV and Hep B
Ø Counsel the mother about the other vaccines that must be given to
the child along with the schedule
Ø Impress upon her the importance of getting the child immunized fully
and on time
82
Session No. 19
Title: Family Planning methods
Session objectives:
The trainees should be well versed with the birth control options available in the
government health facilities so that they are able to guide the mother properly
1. Understand the risks of frequent pregnancies
2. Enumerate the birth control options available in government health facilities
3. Suggest an appropriate option for a woman after delivery
Time: 45 minutes
Materials:
Setting: Classroom
Method: Demonstration followed by role play
Steps:
Demonstration (Time: 20 minutes)
1. Ask the participants if they think it is important to space and control births.
Ask the participants to reply in Yes or No.
2. Ask what will happen if a woman has too many children
3. Ask the participants what will happen if a woman has children at a young
age
4. Discuss the answers
5. Ask the participants to mention some birth spacing options. Note these on
the board.
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6. Use the flip chart to show the pictures of the different birth spacing/control
options
7. Now enumerate them
8. Ask participants to repeat what they saw in the flip chart
9. Explain the advantages of the different methods
10. Explain how the methods can be used in different circumstances
11. Recap
12. Ask if abortion should be used as an alternative for birth control.
13. Explain why it should not be used.
Role Play (Time 25 minutes):

1. Divide the participants into three groups. Each group will have a
trainer.
2. Give the following three scenarios to the groups:
a. Yashoda counseling a 30 years old woman who has had
three children and is in the hospital to deliver a fourth one
b. Yashoda counseling a newly married girl who is in hospital to
have her first child
c. Yashoda counseling 25 years old woman who is due for her
second child
3. Let the three groups prepare the role plays in 10 minutes and
perform these in
4. 5 minutes each.
5. Discuss
6. Thank the participants and compliment them
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Trainer’s notes
Q. What is the harm in having frequent pregnancies?
A. Harm to the mother – anaemia, general weakness due to rapid loss of
nutrients
Harm to baby – Mother is unable to give adequate attention, family is
unable to provide well due to demands on family resources
Q. Which are the family planning methods available for new mothers?
• CuT (Copper T)
• Oral Contraceptive pills
• Condom
• Female Tubectomy
• Male vasectomy
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Q. What are the advantages of each and under which circumstances can
these be used?
A. CuT is the most suitable method for spacing birth especially in women who
are breast feeding. It is an easily insertable device that can be removed if
more children are desired. It can be done on an OPD basis and can be done
over 10 minutes. E.g – A woman who has one child and is breast feeding the
child.
Oral contraceptive pills are pills that need to be consumed every day.
These are very suitable for birth spacing among newly married women who do
not desire to have children soon. These can also be taken by new mothers
who are not breast feeding. But, these are not to be consumed if the child is
being breast fed. E.g. A newly married woman who wants to delay first child
birth.
Condom is a temporary method of contraception. It is a device that is
used during coitus. It can be easily put and removed by the man using it. It has
the additional advantage of protecting a couple from HIV and STD/RTI.
However, it has a high rate of failure.
Tubectomy and Vasectomy are permanent methods of sterilization.
They are irreversible. So, these methods are useful for couples who have
completed their family. E.g. a couple who has had two children already
Q. Why can’t abortion not be used as an alternative to birth control?
A. Repeated abortions are harmful to the health of women. They cause
weakness, blood loss & Anemia.
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Key messages
Ø Having more children is a drain on the resources of the family
Ø Having more children also harms the health of the mother
Ø Family planning measures like CUT, Condoms,
Vasectomy/Tubectomy can be used to control birth
Ø These measures are easily available free of cost in the government
health facilities and are not time consuming
87
Session 20
Title: People available in the community to help the mother and baby
Session Objectives:
The Yashoda should be well informed about the people the mother can seek help
from regarding her and her newborn’s health after she goes back home.
After this session the trainee should be able to enumerate:
1. Who are the persons who can assist a mother regarding her and her
child’s health when she goes back home from the hospital.
2. What are the roles of these persons in the care of the child and mother
Time: 30 minutes
Setting: Classroom
Materials: Facilitator’s guide, Yashoda training kit, Black board & Chalk or White
board and pens in two colors
Method: Discussion & Task
Steps:
1. Explain that taking care of the newborn and mother is the responsibility of
every citizen since the child is the future of the society and the mother is
the creator of the child. However, some staff is provided by the
government for dedicated help and support to the family to take care of
the mother and baby at home.
88
Task
1. Draw a circle on the board. Write newborn and mother in the centre of
the circle. Draw three other circles around it.
2. Ask the participants if they can fill the circles with the names of people
who can take care of the mother and newborn in the community.
3. Let them fill the names. Correct them if there are any mistakes.
4. Ask the participants to note in the circles, the services that each worker
provides. Correct them if wrong and add any that have been missed
out.
5. Similarly, ask the trainee to draw another circle on the board with
mother and baby in hospital.
6. Ask them to draw three other circles around the central circle.
7. Ask the trainee to write in the surrounding circles the people who take
care of the mother and baby in the hospital.
8. Inform where these services are available & inform that services are
free of cost.
9. Ask the trainees to repeat
ANM
Treats common
ailments
Trainer’s notes – the Immunizes, refers
diagrams can be drawn as
such
New born & mother

at Home
AWW ASHA
Does growth New born care
monitoring, Counsels mother
organizes camps on health, refers
Health workers responsible for newborn & mother care at home
89
Trainer’s notes:
Community: The ANM/HW (Female) is available on the specified days when
she is scheduled to visit her area. Ask the AWW of your area for the schedule
of the ANM. During these visits, the ANM does the following:
• Examine pregnant and nursing mothers
• Conduct home deliveries.
• Immunize mothers and children below one year
• Distribute iron and folic acid tablets to pregnant and nursing women
• Distribute Vitamin A to children 1 to 5 years of age
• Treat mothers and children for minor ailments and refer them to PHC is
necessary
• Give health teaching about the care of mother and child
At the Sub Centre: Daily clinic is attended by a ANM/Health Worker (F). The
Services provided for mothers and children are as follows:
• Prenatal and postnatal care
• Child health care
• Immunization
• Distribution of iron and folic acid and vitamin A
• Treatment of minor ailments
• Health teaching
The weekly MCH Clinic is attended by the Medical Officer, PHC and/or LHV.
90
At the PHC: The following services are available at PHC:
• Daily general clinic attended by the one of the Medical Officer.
• Weekly out patient MCH clinics attended by one of the Medical Officers.
• In patient care
• Referral to the District Hospital
Key messages
Ø The doctor, nurse and Yashoda are responsible for care of the
newborn in the hospital
Ø The ANM, AWW & Helper and the ASHA are directly responsible for
care of newborn in the community
Ø Child health services like immunization, growth monitoring & care
for common ailments are available free of cost in government
facilities like subcenter, Anganwadi, PHC
91
Session 21
Title: Registration of birth & Record keeping
Session objectives:
Trainees must know how & where to register birth and what is its importance.
Trainees must be clear how to fill their records.
1. After this session, the trainee should be able to:
2. Communicate to mother the importance of registering the birth of her baby
3. Communicate to the mother how and where the birth can be registered
and how the certificate can be obtained
4. Fill completely and accurately the record Yashoda is supposed to keep
5. Know the importance of handing over the record to the next Yashoda who
takes over her duty
Time: 1 hour
Setting: Classroom
Materials: Facilitator’s guide, Yashoda training kit, Black board and Chalk, 6 two
sets of the three sheets – one sheet with one part of exercise on it.
Method: Discussion and Task
Steps:
1. Ask the trainees if they have heard of birth registration.
2. Ask if they think registering a birth is important and why
3. Ask if they know whom to inform if there is a birth in hospital or at home
4. Explain why birth registration is important.
92
5. Explain who is to be informed in the hospital and in the community
Trainer’s notes:
Q. Is it important to get birth registered?
A. Registration of birth is very important for every child. It is the child’s right.
Q. Is birth registration useful?
A. The birth of a baby should be registered within 21 days of the birth. But it
can be registered later also if there is a delay due to any reason. A birth
certificate can only be acquired if the birth is registered. The birth certificate is
required for: Admission in school, getting a ration card, insurance, and
pension. It is essential for getting a marriage or a driver’s license. It may be
required to open a bank account, to apply for and secure formal employment
and to inherit property. A birth certificate may also be needed obtain family
allowances. A birth certificate proves identity and age. You can vote if you
have your birth certificate.
Q. How is a birth registered in a hospital?

A. In case of a hospital birth, the medical officer is in-charge of informing
higher authorities. The birth certificate can be obtained from the hospital in a
few days after birth.
Q. How is a birth registered in the community?
A. In case of a home birth, the head of household, ASHA, AWW or ANM
(whoever knows about the birth informs the village Panchayat secretary. He in
turn informs the Tahsildar of the Taluka. The Tahsildar issues the birth
certificate free of cost to the family.
93
Yashoda Daily Reporting Format
Name of the District Name of the
Name of the Hospital Name of the
Vaccinatio
Any problem
Any problem
Any problem
Date & Time
of discharge
Remarks by
Date & time
Date & time
with Mother
sex of baby
Duration of
Initiation of
Supervisor
Admission
of delivery
Yashodas
with Baby
Signature
Signature
Weight of
yashoda
Address
Name &
at birth
Parity
Sl no
baby
BCG
OPV
BPL
stay
age
BF
of
Record keeping by Yashoda
Steps:
1. Display the record sheet
2. Explain the importance of filling the record completely and accurately
3. Explain step by step the process of filling the sheet
4. Make chits with numbers written from 1 to 6.
5. There should only be three chits of each number. Ask each participant to
pick up one chit each from a box.
6. Let them open the chit and see the number written in it.
7. All persons with the same number will collect together.
8. This will form 6 groups of 3-4 Inform each group that they are a team
working in 8 hour shifts by rotation.
94
Task - fill the register (20 minutes)
Present the following case scenario in three parts (use three separate sheets):
Part I (sheet I)
A pregnant woman, Kamla, age 27 and her family arrived in the hospital on 10/10/08
at 10 in the morning. Kamla’s mother-in-law is very irritable and stubborn. Kamla is
due to deliver her second child. She was admitted at 10.30 in the morning in the ward
on bed number 1. She had labour pains and a nurse and Yashoda care for her.
Part II (Sheet II)
You have just reached the hospital for your duty at 6 pm and bed number 1 is
assigned to you. Kamla, age 27 is admitted on this bed. Kamla’s mother-in-law is very
irritable and stubborn. The Yashoda taking care of Kamla has left in a hurry but has
handed you her register. Kamla delivers a healthy baby boy by normal vaginal delivery
at 7 in the evening on 10/10/08. You & a nurse have to care for them.
Part III (Sheet III)
You have just reached the hospital at 6 in the morning and are assigned bed number
1. Kamla, 27 years of age delivered the previous night. Kamla is accompanied by her
husband and mother-in-law. Her mother-in-law is very irritable and stubborn. Kamla
will be discharged at 12 in the afternoon. You and a nurse have to care for them.
9. In each small group, give one sheet to one trainee

10. Request the trainee not to look at each others sheet but fill the information
in the register and pass on the register as they would do in the hospital
11. Check the entries & discuss
95
Trainer’s Notes
How to fill this register:
Name of the district – Mention the name of your district here
Name of the hospital – Mention the name of your hospital here
Sl. No. – The number assigned to the entry as the mothers arrive
Name & Address – Full name and address of the mother (in case there is no house
number, mention the nearby landmark so that a field worker can easily find the
house)
96
Age – Age of the mother in completed years. This is important to assess if the mother is
old enough to have a safe pregnancy (above 18 years). Aged mothers are also at some
risk (>35 years of age).
Parity – Number of living children the mother has. This is important to give sound and
practical family planning advice to the mother.
BPL – Write ‘Yes’ or ‘No’. ‘Yes’ indicates that the mother and her family are below the
poverty line. ‘No’ indicates that they are above the poverty line.
Date and Time of admission – mention the date of admission in day/month/year

format. Also enter the time as – ‘morning’, ‘afternoon’ or ‘evening’. If the mother is
admitted at 12.05 midnight, the date must be mentioned as the morning of the next day.
For example: 14/10/08, 12.05, morning.
Date and time of delivery – This is the time at which delivery takes place. It must be
entered in the same format – day/month/year. Also enter the time as – ‘morning’,
‘afternoon’ or ‘evening’. If the mother is admitted at 12.05 midnight, the date must be
mentioned as the morning of the next day. For example: 14/10/08, 12.05, morning.
Sex of the baby – Entered as ‘boy’ or ‘girl’. If there is any genital anomaly and the
doctor says that the sex cannot be determined, this must be mentioned.
Weight of the baby – The weight of the baby at birth as taken by the nurse or by
yourself must be mentioned here in kgs with two decimal points. E.g 3.25 Kgs
Any problem at birth – Mention if the delivery was vaginal or caesarian. If it was
vaginal, was it normal or there was use of forceps or any other procedure to deliver the
baby. e.g. – Vaginal, normal or vaginal, forceps. This information should be gathered
from the nurse.
Initiation of breastfeeding – If breast feeding was initiated, write ‘Yes’. If not, write ‘no’.
If your entry is a ‘yes’ mention the time after birth when breast feeding was initiated. E.g.
Yes, 1 hour after birth.
Vaccination – Tick the box if the doses of BCG and OPV are given. If not, put a cross
in the appropriate box.
97
Date and time of discharge - This is the time at which the mother and baby are
discharged from the hospital. It must be entered in the same format – day/month/year.
Also enter the time as – ‘morning’, ‘afternoon’ or ‘evening’. If the mother is admitted at
12.05 midnight, the date must be mentioned as the morning of the next day. For
example: 14/10/08, 12.05, morning.
Duration of stay – Mention how long the mother stays in the hospital in hours. E.g if
mother is admitted on 13/10/08 at 1, afternoon and leaves on 15/10/08 at 10, morning,
her duration of stay is – 43 hours.
Any problem with baby - Mention if the newborn has any problem at birth E.g low birth
weight baby, jaundice at birth, discharge from eyes or any such danger signs you have
learnt above or congenital anomaly mentioned by the doctor/nurse. This information is
to be gathered from the nurse.
Any problem with mother – Mention if there is any problem with the mother. E.g
mother is suffering from TB, heart disease, bled too much etc.
Remarks by Yashoda – This column can be used by you to mention anything special
that you notice.
Signature of Yashoda – There are three columns in this section. Column 1 is to be

signed by the Yashoda who is present at the time of admission. Column 2 is to be
signed by Yashoda present at the time of delivery. Column 3 is to be signed by
Yashoda present at the time of discharge.
Signature of supervisor – The child health supervisor of your hospital will sign this
after checking your entries.
After filling the relevant columns in this register, Yashoda must remember to hand it to
the next Yashoda on duty so that there is a continuum of care.
Key messages
Ø Registering the birth is the right of every child
98
Ø The birth registration certificate will help the individual get
admission in school, get a ration card, be able to vote, get a
certificate of marriage & have a legal standing for any legal issues
Ø Birth registration should be ensured by Yashoda in hospital
Ø In the community, the secretary of the village should be informed
about the birth by the head of the household so that he can start the
process of registration
Ø Filling the register accurately and completely is very important for
providing continuous care to the mother and baby
Ø It is a record of the Yashoda’s work
Ø It is also a record that can be used by appropriate authorities to
compile and analyze maternal and newborn data from the hospital
99
Session 22
Title: Principles of Counseling/Interpersonal communication
Session objectives:
Counselling is one of the main roles of Yashoda. The trainees must learn how
to counsel, how to ensure that their advice is relevant and practical & that it
does not antagonize the mother or her family. Trainees must also get an idea
of the hurdles they will face during the counseling
Learner’s objectives
1. Counsel the mother about her own and her newborn’s health
2. Counsel the family
3. Overcome the hurdles she may have while counseling
Time: 1 hour
Setting: Classroom
Materials: Facilitator’s guide, Yashoda training kit, Black board & chalk or
white board and felt pens, two sets of the case scenarios given below.
Method: Role Play & Discussion
Steps:
Divide the trainees into three groups.
100
Role Play - (20 minutes)
Assign the following case scenario to the groups – I part to each group
(use three separate sheets. Do not allow the groups to interact with each
other. Let an active & energetic trainee to assume the role of Kamla’s mother-
in-law and ask her to be stubborn. Let another trainee assume the role of
Kamla. Another trainee can assume the role of Kamla’s husband. In this way,
the family continues to be the same while the nurse and Yashoda change)
Group I (sheet I)
A pregnant woman, Kamla, age 27 and her family arrived in the hospital on
10/10/08 at 10 in the morning. Kamla’s mother-in-law is very irritable and
stubborn. Kamla is due to deliver her second child. She was admitted at 10.30
in the morning in the ward on bed number 1. She had labour pains and a
nurse and Yashoda care for her.
Group II (Sheet II)
You have just reached the hospital for your duty at 6 pm and bed number 1 is
assigned to you. Kamla, age 27 is admitted on this bed. Kamla’s mother-in-law
is very irritable and stubborn. The Yashoda taking care of Kamla has left in a
hurry but has handed you her register. Kamla delivers a healthy baby boy by
normal vaginal delivery at 7 in the evening on 10/10/08. You & a nurse have to
care for them.
Group III (Sheet III)
You have just reached the hospital at 6 in the morning and are assigned bed
number 1. Kamla, 27 years of age delivered the previous night. Kamla is
accompanied by her husband and mother-in-law. Her mother-in-law is very
irritable and stubborn. Kamla will be discharged at 12 in the afternoon. You
and a nurse have to care for them.
101
Discuss each principle of counseling in the context of their
performance –
a. Did the group attempt to build a rapport with the mother and her
family?
b. Did the group make an effort to ask relevant questions and listen
patiently to the answers
c. Did the group give sound and practical advise relevant to the
mother and family’s context?
3. After you discuss the principles of counseling with the trainees, you can
ask a group to again perform role play ‘b’ applying the principles that they
have learnt.
102
Trainer’s Notes:
The following preface can be used to explain to Yashoda why we are trying
to teach her how to interact better with others.
We constantly interact with each other in everyday life. If we are better
informed than the other person, we try to impart our knowledge to them. It
is easy to impart information. But, being informed does not mean that we
will change our attitude or behavior based on that information. In fact, it is
very difficult to change another person’s attitude and behavior however
harmful or wrong it may.
Each one of us has our own idea about how to take care of our health
and our family’s health. All of these ideas may not be incorrect. As a health
counselor, our role is to; be well informed about how to take best care of
ourselves and the community, have a positive attitude and follow in our
own life the healthy behavior that we preach. Only after this, we can think
of trying to instill healthy behavior and best practices among others.
Changing other people’s attitude and behavior cannot be done in a day
and is a long and uphill journey. However, some of the following principles
may help you while you are counseling the mother and family.
103
Q. How can we build a rapport with the mother and her family?
A. Build a rapport by greeting, introducing yourself and explaining why you
are in the hospital
Gather information to understand the problem, understand the family’s
circumstances and to develop a care plan.
• This can be done by questioning and listening.
• Speak clearly, use local language, avoid medical words
• Be patient
• Listen to the mother and family
• Ask questions but be careful not to hurt the sentiments of the
mother and family
• Have positive body language and don't make any gestures which
may not be liked by them
• Do not be judgmental
Q. What is Empathy?
A. Showing empathy is the ability to put yourself in someone else’s
place and feel how they feel in a situation.
Listening is important.
Most of us are very fond of our own voice and we love to talk.
Especially, if we feel that are more knowledgeable than the other, it is
easy to get carried away while advising. However, we must always
remember that all of us have our own beliefs and circumstance and
may not like to be advised. Often there may be situations where our
receiver may listen but may not be able to follow the given advice since
it is impractical in their circumstances. So, it is very important to
understand the receiver’s circumstances so that we may be able to give
sound, practical advice.
104
Q. But, how can we be better listeners?
• Pay attention to the person, showing interest, and hearing what
is being said.
• Be attentive
• Concentrate on the client (eye contact, lean toward them, nod
your head).
• Don’t interrupt.
• Express your feelings and queries once she/he stops
• Don’t jump to conclusions or diagnosis without hearing what the
person has to say.
• Avoid - not making eye contact, interrupting, jumping to
conclusions, not asking for more information, tapping feet,
shuffling papers, looking outside or making bad gestures,
finishing sentences for the speaker
• Praise the mother if she has done something good (given good
care, came immediately if danger sign appeared, etc.). This
helps raise her self confidence.
• Confirm what you have understood from their expressions
• You may repeat what they have said and felt.
• Acknowledge feelings
105
Q. How can we Counsel better?
• Try to explore parent’s understanding of illness or situation to
see what they already know
• You can supplement what they already know instead of talking to
them as if they didn’t know anything.
• It can also identify any beliefs/ practices that may be harmful.
• Correct, misconception of facts:
• Try to convince to avoid or modify the incorrect belief/practices
• Be careful and sensitive when you correct misconceptions- do
not make the person feel stupid.
• Explain the situation clearly in simple language
• Explain the care plan (as understood from the doctor/ nurse)
• What the mother (or father) needs to do?
• Ask the mother to repeat what she has understood in her own
words.
• Encourage to follow the care plan (treatment)
• Summarize and repeat key information
• Follow up as indicated (as informed by the doctor/ nurse)
Key messages
Ø To be a good counselor, rapport building by greeting the mother and
her family and being polite and respectful to them is most important
Ø Ask questions and listen to their answers showing interest, and
hearing what is being said
Ø Understand the mother’s circumstances
Ø Explain the care plan to the mother and family
Ø Counsel giving practical, feasible points that do not offend and are
acceptable by the mother and her family
106

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Facilitator’s Guide

National Institute of Health and Family Welfare

Trained Nurses Association of India (TNAI)

National Neonatology Forum

Norway India Partnership Initiative (NIPI)

The Norway India Partnership Initiative (NIPI) is a unique support embedded

“Yashoda/Mamta”, non-medical, voluntary support worker, has been placed at

However, Yashoda/Mamta will be able to effectively execute their responsibilities

Prof. Deoki Nandan

Introduction to Yashoda/Mamta Training…………………………………1

Introduction to Yashoda/Mamta Facilitator’s Guide………………………3

Goal of the training…………………………………………………………5

Settings and Logistics for Training…………………………………………..6

Sessions & Sessions Plan:

Can a person from the existing facility be found?

Why Yashoda/Mamta, and why not ASHA?

• Yashoda is not a regular employee of the health system at present. This

(The responsibilities are explained in more detail in the document ‘Role of

The training will be done in three phases -

Phase I – Induction training

Yashoda will be given appropriate logistics and administrative support, mentoring

Institutional arrangements for the Induction training:

Checklist of supplies for each trainee

Checklist of supplies for the trainer

Other material required for the training

Title: Introductory session

Session objectives: To introduce the trainers and trainees to each other

Materials: Blackboard, Chalk, Chart Paper, Pens

Title: Reviewing the purpose of this training

Time: 1 hour and 10 mins

Training Methods: Discussion followed by demonstration

Demonstration in Ward: (40mins)

Demonstration in Labour room: (10 mins)

Special Preparations for this session -

Time: 1 and a half hour

Setting: Maternity ward followed by JSY registration room followed by classroom

Method: Demonstration followed by task followed by role play

Tasks: (Time 15 minutes)

Title: Preparations for welcoming the baby

Materials: A table, 2 trays, some examples of clothes needed for a newborn

Training method: Discussion and Task

Task: (Time 10 mins)

Discuss the task: (20 mins)

For each trainee, tick the articles she selects

Ø It is very important to make preparations for the birth of a baby

Ø Keep articles like – money & clothes ready

Title: Early Initiation of breast feeding

Methods: Group discussion

Discussion: (Time: 30 minutes)

Title: Proper positioning while breast feeding

Materials: Facilitator’s guide, Yashoda training kit

Setting: Post natal ward

Method: Video & Demonstration

After this session the trainees should be able to:

Method: Task followed by Discussion

Discuss: (Time: 30 minutes)

Title: Breast feeding- some possible problems.

Materials: Facilitator’s guide, Yashoda training kit

Setting: Post natal ward

Title: Keeping the newborn warm

Materials: Facilitator’s guide, Yashoda training kit, 3 doll babies, baby

Setting: Post natal ward