Safe Motherhood and Newborn Health
This topic covers about Safe Motherhood and Newborn Health
Why it is important?
- Every pregnant woman hopes for a healthy baby and an uncomplicated pregnancy. However, every day, about 1,500 women and adolescent girls die from problems related to pregnancy and childbirth. Every year, some 10 million women and adolescent girls experience complications during pregnancy, many of which leave them and/or their children with infections and severe disabilities.
- Each year, about 3 million babies are stillborn, and 3.7 million babies (latest data available, 2004) die very soon after birth or within the first month. The poor health of the mother, including diseases that were not adequately treated before or during pregnancy, is often a factor contributing to newborn deaths or to babies born too early and/or with low birth weight, which can cause future complications.
- The risks of childbearing for the mother and her baby can be greatly reduced if: 1) a woman is healthy and well-nourished before becoming pregnant; 2) she has regular maternity care by a trained health worker at least four times during every pregnancy; 3) the birth is assisted by a skilled birth attendant, such as a doctor, nurse or midwife; 4) she and her baby have access to specialized care if there are complications; and 5) she and her baby are checked regularly during the 24 hours after childbirth, in the first week, and again six weeks after giving birth.
- Pregnant women and their partners who are HIV-positive or think they may be infected should consult a trained health worker for counselling on reducing the risk of infecting the baby during pregnancy, childbirth and breastfeeding, and caring for themselves and their baby.
- Governments have a responsibility to ensure that every woman has access to quality maternity care, including prenatal and post-natal services; a skilled birth attendant to assist at childbirth; special care and referral services in the event serious problems arise; and maternity protection in the workplace.
- Most governments have ratified the Convention on the Elimination of All Forms of Discrimination against Women. Some countries have ratified the international agreements on maternity protection, and most have enacted legislation on maternity protection. These international agreements in defence of women's rights include a legally binding commitment to provide pregnant women and mothers with health services and protection in the workplace.
- Many women, including adolescents, have difficulty accessing quality health care due to poverty, distance, lack of information, inadequate services or cultural practices. Governments and local authorities, with support from non-governmental and community-based organizations, have a responsibility to address these issues to ensure that women receive the quality health care they need and that they and their newborns have a right to receive.
What every family and community has a right to know?
- Girls who are educated and healthy and who have a nutritious diet throughout their childhood and teenage years are more likely to have healthy babies and go through pregnancy and childbirth safely if childbearing begins after they are 18 years old.
- The risks associated with childbearing for the mother and her baby can be greatly reduced if a woman is healthy and well-nourished before becoming pregnant. During pregnancy and while breastfeeding, all women need more nutritious meals, increased quantities of food, more rest than usual, iron-folic acid or multiple micronutrient supplements, even if they are consuming fortified foods, and iodized salt to ensure the proper mental development of their babies.
- Every pregnancy is special. All pregnant women need at least four prenatal care visits to help ensure a safe and healthy pregnancy. Pregnant women and their families need to be able to recognize the signs of labour and the warning signs of pregnancy complications. They need to have plans and resources for obtaining skilled care for the birth and immediate help if problems arise.
- Childbirth is the most critical period for the mother and her baby. Every pregnant woman must have a skilled birth attendant, such as a midwife, doctor or nurse, assisting her during childbirth, and she must also have timely access to specialized care if complications should occur.
- Post-natal care for the mother and child reduces the risk of complications and supports mothers and fathers or other caregivers to help their new baby get a healthy start in life. The mother and child should be checked regularly during the first 24 hours after childbirth, in the first week, and again six weeks after birth. If there are complications, more frequent checkups are necessary.
- A healthy mother, a safe birth, essential newborn care and attention, a loving family and a clean home environment contribute greatly to newborn health and survival.
- Smoking, alcohol, drugs, poisons and pollutants are particularly harmful to pregnant women, the developing fetus, babies and young children.
- Violence against women is a serious public health problem in most communities. When a woman is pregnant, violence is very dangerous to both the woman and her pregnancy. It increases the risk of miscarriage, premature labour and having a low-birth weight baby.
- In the workplace, pregnant women and mothers should be protected from discrimination and exposure to health risks and granted time to breastfeed or express breast milk. They should be entitled to maternity leave, employment protection, and medical benefits and, where applicable, cash support.
- Every woman has the right to quality health care, especially a pregnant woman or a new mother. Health workers should be technically competent and sensitive to cultural practices and should treat all women, including adolescent girls, with respect.
Key messages - Girls who are educated and healthy and who have a nutritious diet throughout their childhood and teenage years are more likely to have healthy babies and go through pregnancy and childbirth safely if childbearing begins after they are 18 years old.
Girls with more formal education are better equipped to fulfil their potential in life. They tend to know about health-care practices and are less likely to become pregnant at a very young age. They are more likely to marry later, have fewer and better-spaced pregnancies, and seek prenatal and post-natal care. It is estimated that two maternal deaths can be prevented for every additional year of school attendance per 1,000 women.
The healthy growth and development of a girl through adolescence helps to prepare her for healthy pregnancies during her childbearing years.
In addition to education and health care, girls need a nutritious diet during childhood and adolescence to reduce problems later in pregnancy and childbirth. A nutritious diet includes iodized salt and foods rich in essential minerals and vitamins such as beans and other pulses, grains, green leafy vegetables, and red, yellow and orange vegetables and fruits. Whenever possible, milk or other dairy products, eggs, fish, chicken and meat should be included in the diet.
Girls who stay in school are more likely to delay marriage and childbirth. Early pregnancy can have serious consequences for adolescents under 18 years old, particularly for those under 15 years old. Adolescent girls and their babies are at much higher risk of complications and death.
It is important to empower girls to avoid early pregnancy and inform both girls and boys about the risks of early pregnancy as well as sexually transmitted infections, including HIV. They both need to develop the skills to make healthy life choices that also support equality and respect in relationships.
Genital cutting of girls and women can cause severe vaginal and urinary infections that can result in sterility or death. It can also cause dangerous complications during childbirth.
Health workers and community outreach programmes can help raise awareness of harmful practices and the importance for adolescents to delay marriage and pregnancy for their health and well-being.
Families need to understand the high risks of early pregnancy. If an adolescent girl marries early and/or becomes pregnant, her family should provide her with support and ensure she obtains the health services she needs.
Key messages - The risks associated with childbearing for the mother and her baby can be greatly reduced if a woman is healthy and well nourished before becoming pregnant. During pregnancy and while breastfeeding, all women need more nutritious meals, increased quantities of food, more rest than usual, iron-folic acid or multiple micronutrient supplements, even if they are consuming fortified foods, and iodized salt to ensure the proper mental development of their babies.
Adolescent girls, women, pregnant women and new mothers need the best foods available: milk, fresh fruit and vegetables, meat, fish, eggs, grains, peas and beans. All of these foods are safe to eat during pregnancy and while breastfeeding.
Women will feel stronger and be healthier during pregnancy if they eat nutritious meals, consume greater quantities of nutritious food and get more rest than usual. Nutritious foods rich in iron, vitamin A and folic acid include meat, fish, eggs, green leafy vegetables, and orange or yellow fruits and vegetables.
After childbirth, women also need nutritious meals and a greater quantity of food and rest. Breastfeeding mothers need about 500 extra calories per day, the equivalent of an additional meal.
During prenatal visits, a trained health worker can provide the pregnant woman with iron-folic acid or multiple micronutrient supplements to prevent or treat anaemia. Malaria or hookworm infection can be treated if needed. The health worker can also screen the pregnant woman for night blindness and, as necessary, prescribe an adequate dosage of vitamin A to treat the woman and contribute to the healthy development of the fetus.
If the pregnant woman thinks she has anaemia, malaria or hookworms, she should consult a trained health worker.Salt consumed by families should be iodized. Iodine in a pregnant woman's and young child's diet is especially critical for the healthy development of the child's brain. Goitre, a swelling at the front of the neck, is a clear sign that the body is not getting enough iodine. A diet low in iodine is especially damaging during the early stages of pregnancy and in early childhood. Women who do not have enough iodine in their diet are more likely to have an infant who is mentally or physically disabled. Severe iodine deficiency can cause cretinism (stunted physical and mental growth), stillbirth, miscarriage and increased risk of infant mortality
Key messages - Every pregnancy is special. All pregnant women need at least four prenatal care visits to help ensure a safe and healthy pregnancy. Pregnant women and their families need to be able to recognize the signs of labour and the warning signs of pregnancy complications. They need to have plans and resources for obtaining skilled care for the birth and immediate help if problems arise.
When a young woman begins to be sexually active, she needs information about pregnancy and the risks of sexually transmitted infections (STIs), including HIV. She should be able to recognize the early signs of pregnancy. If she becomes pregnant, she should be supported to receive prenatal care early in the pregnancy from a trained health worker. She should learn about the normal phases of pregnancy and how to keep herself and her baby healthy during the pregnancy. She needs to know the warning signs of serious pregnancy complications.
A pregnant woman needs at least four prenatal visits with a trained health worker during every pregnancy. The first prenatal visit should take place as early as possible, ideally in the first three months (the first trimester) of pregnancy, and the other three visits can be scheduled to take place at predetermined times during the remainder of the pregnancy.
To help ensure a safe and healthy pregnancy, a trained health worker or skilled birth attendant should:
- Provide the pregnant woman with information on the changes occurring in her body
- Check for high blood pressure, which can be dangerous to both mother and child
- Check for anaemia and provide iron-folic acid supplements, ensure that the woman understands the importance of taking the supplements and explain the normal side effects, including constipation and nausea
- Screen for night blindness to determine if the woman needs to be treated with vitamin A and, if necessary, prescribe vitamin A to protect the mother and promote the healthy development of the fetus
- Review the mother's tetanus immunization status and give the dose(s) needed to protect her and her newborn baby
- Encourage all pregnant women to use only iodized salt in food preparation to help protect their children from mental and physical disabilities and to protect themselves from goiter
- Encourage all pregnant women to have more nutritious meals, increased quantities of food and more rest than usual
- Prescribe antimalarial tablets and recommend use of an insecticide-treated mosquito net where needed
- Prescribe deworming medication, as necessary, from the second trimester onward to help reduce low birth weight
- Prepare the mother and father for the experience of childbirth and caring for their newborn, give the mother advice on breastfeeding and caring for herself, and provide the father with guidance on how he can assist
- Advise the pregnant woman and her family on where the birth should take place and how to get help if complications arise before and during childbirth or immediately after delivery
- Provide referrals when needed to groups in the community that provide support and protect pregnant women living with violence
- Advise on how to avoid STIs, including HIV
- Check for infections during pregnancy, especially urinary tract infections and STIs, including HIV, and treat them with appropriate medications
- Provide voluntary and confidential HIV testing and counselling.
A pregnant woman who is HIV-positive should consult a trained health worker for counselling on how to reduce the risk of infecting her baby during pregnancy, childbirth and breastfeeding and how to care for herself and her baby. A pregnant woman who thinks she may be infected with HIV should be supported to get tested and receive counselling. The father-to-be should also be tested and counselled (refer to the HIV chapter for more information).
Every pregnant woman and her family need to know that pregnancy and childbearing can have risks. They should be able to recognize the warning signs.
It is generally recommended that women give birth in a facility and with a skilled birth attendant, since complications cannot be predicted. For some women, this is even more important because the possibility of complications increases if they:
- Are under 18 or over 35 years of age
- Gave birth less than two years ago
- Have had several previous pregnancies
- Have had a previous premature birth or a baby weighing less than 2 kilograms at birth
- Have had a previous difficult birth or Caesarean birth
- Have had a miscarriage or stillbirth
- Weigh less than 38 kilograms
- Are less than 1.5 metres tall
- Have been through infibulation or genital cutting
- Have HIV or other STIs.
A pregnant woman should be supported to recognize the signs of labour and know when it is time to seek a skilled birth attendant to assist with the birth.
The signs of labour include any one of the following:
- Painful contractions every 20 minutes or less
- The water breaks
- Bloody, sticky discharge.
Warning signs during pregnancy include:
- Anaemia (symptoms include paleness of the tongue and inside the eyelids, fatigue and shortness of breath)
- Unusual swelling of legs, arms or face
- Little or no movement of the fetus.
Signs that mean help is needed immediately include:
- Spotting or bleeding from the vagina
- Severe headaches, blurred vision
- Convulsions (fits)
- Severe abdominal pain
- Fever and weakness
- Fast or difficult breathing
- Labour pains for more than 12 hours.
During the prenatal visits, the pregnant woman and her family should be supported in preparing for the birth and possible complications by developing a plan that specifies:
- Where the woman will give birth and where she will go if complications arise
- Who will accompany her?
- How she will get there
- What supplies she needs to take for herself and her baby
- What costs are involved and how they will be covered
- Who will help take care of her family while she is away?
- Who can donate blood if it is needed?
Because conditions may change, the plan for the birth and possible complications should be updated during every prenatal care visit as the pregnancy progresses.
The plan for emergency care in case of complications should include the location of the nearest maternity clinic or hospital and the resources needed to quickly get the woman there at any time of the day or night.
All pregnant women should have access to a maternity clinic or hospital when they give birth. This is particularly important if the woman and her family are aware that the birth is likely to be difficult. In some cases, where distance and/or an expected risky birth are factors, it may be preferable to have the mother-to-be move closer to the clinic or hospital as her due date approaches so she is within quick reach of health services.
Health workers, families and communities need to give special attention to pregnant adolescents because they are at higher risk of pregnancy complications and in some cases they may lack the influence to make family decisions or ask for assistance..
Key messages Childbirth is the most critical period for the mother and her baby. Every pregnant woman must have a skilled birth attendant, such as a midwife, doctor or nurse, assisting her during childbirth, and she must also have timely access to specialized care if complications should occur.
Every pregnancy deserves attention because there is always a risk of something going wrong with the mother, baby or both. Many dangers, illnesses or even death can be avoided if the woman plans to give birth attended by a skilled birth attendant, such as a doctor, nurse or midwife, and makes at least four prenatal visits to a trained health worker during the pregnancy.
The likelihood of the mother or the baby becoming ill or dying is reduced when childbirth takes place in a properly equipped health facility with the assistance of a skilled birth attendant, who also checks regularly on the mother and baby in the 24 hours after delivery.
When the pregnant woman is ready to give birth, she should be encouraged to have a companion of her choice accompany her to provide her with continuous support during childbirth and after birth. In particular, the companion can support the woman in labour to eat and drink, use breathing techniques for different stages of childbirth, and arrange for pain and discomfort relief as needed and advised by the skilled birth attendant.
During and immediately following childbirth, the skilled birth attendant will:
- Assess and follow the progress of labour and pay attention to danger signs that indicate help is needed immediately
- Advise the woman and her family if specialized care is needed and if a transfer to a hospital or maternity centre is necessary
- Reduce the risk of infection by keeping hands, instruments and the delivery area clean, and by using gloves at appropriate times
- Encourage the woman to walk during the first stage of labour and support her choice of position for childbirth
- Assist the different stages of labour and the birth of the baby
- Cut the umbilical cord at the appropriate moment and care for it
- Care for the baby and keep her or him warm after birth
- Guide the mother to put her baby on her chest for immediate skin-to-skin contact and initiation of breastfeeding soon after birth
- Deliver the afterbirth (placenta) safely and care for the mother after the baby is born
- Examine and weigh the baby and put recommended drops in the baby's eyes to prevent blindness and infection
- Manage newborn health problems and refer or transfer the baby with the mother to an appropriate health provider or health facility, if necessary.
Key messages - Post-natal care for the mother and child reduces the risk of complications and supports mothers and fathers or other caregivers to help their new baby get a healthy start in life. The mother and child should be checked regularly during the first 24 hours after childbirth, in the first week, and again six weeks after birth. If there are complications, more frequent check-ups are necessary.
Post-natal care assisted by a skilled birth attendant is important to help ensure the survival and health of the mother and her newborn. During the first hours after childbirth and the first week and month of life, newborn babies are particularly vulnerable.
After childbirth the skilled birth attendant will:
- Check the mother's and baby's health regularly during the 24 hours after birth, during the first week, and again six weeks after birth
- Advise and support the mother on how to continue breastfeeding the baby
- Advise the new parents on how to prevent or delay another birth
- Advise the mother on nutrition, rest, hygiene, immunizations, sleeping under an insecticide-treated mosquito net in malarial areas, regular health check-ups and how to care for herself and her baby; advise the father to be supportive of these needs of the mother and child
- Explain potential danger signs for the mother and her baby
- Support the mother, father and family in preparing an emergency plan in the event complications arise
- Advise mothers and fathers on STIs, including HIV, and if they are infected with HIV, how to care for themselves and their child and how to practise breastfeeding in a way that reduces the risk of infecting the child
- Counsel the mother who is HIV-positive and her partner to help them make informed decisions on future pregnancies and contraceptive methods (refer to the HIV chapter for more information)
- Schedule the next follow-up visit for the mother and her baby.
For the mother and/or child with complications, the skilled birth attendant will:
- Explain to the mother any complications she or her baby had and the treatment received and how she should continue to care for herself and her baby at home
- Provide the mother with medications if necessary and instructions on how, when, and for how long to administer them
- Identify and administer missing immunizations to the mother, including tetanus toxoid
- Advise the mother and father or other caregivers on how to best care for their baby if born too soon or too small, or with other special needs
- Schedule frequent follow-up visits to assess the health of the mother and her baby.
The first days and weeks are especially risky for low-birth weight babies. The majority of newborn deaths occur in low-birth weight babies. Many of these babies could be saved with post-natal care provided by a skilled birth attendant who will:
- Identify and address the danger signs in a timely manner
- Provide extra support for breastfeeding, including expressing milk and cup feeding
- Ensure the baby is warm by helping the mother or other caregiver use skin-to-skin care, also known as the 'Kangaroo Mother Care' method
- Refer the baby for emergency care if the infant is unable to breastfeed or accept expressed milk.
Key messages - A healthy mother, a safe birth, essential newborn care and attention, a loving family and a clean home environment contribute greatly to newborn health and survival.
Newborns need to be carefully cared for around the clock, loved, kept clean and warm, and fed. Mothers and fathers or other primary caregivers who meet their basic needs contribute to building the foundation of the babies' future health, happiness, growth, learning and development.
A newborn thrives when she or he is:
- Kept close to and frequently held and cuddled by the mother, father or other primary caregiver
- exclusively breastfed from birth through the first six months on demand and at least eight times in a 24-hour period, contributing to bonding between the infant and the mother and giving the baby immunity against infections
- Loved and given affection, attention, encouragement and stimulation from her or his family members, helping the baby to grow and learn rapidly
- Kept warm, clean, comfortable and safe, and changed regularly and burped after feeding
- Cared for in a clean environment that helps to prevent infections
- Provided with quality health care, including regular check-ups with timely immunizations and weighing to monitor growth.
A skilled birth attendant will:
- Respond to new parents' questions on caring for their newborn that may relate to breastfeeding, formula feeding, immunizations, bathing the baby, interacting with the baby, language development, sleeping patterns and more
- Inform the new parents of danger signs in an infant that require immediate medical attention
- Help mothers and fathers develop their emergency plan in case complications should arise with their baby
- Provide the mother and father with a record of essential information about the baby at birth (weight, height, time of birth)
- Issue the baby's birth certificate for parents to report the birth to the civil registrar.
Babies born early or with low birthweight or babies with other special needs require special care, love and attention to ensure their survival and optimal growth and development.
A skilled birth attendant can play a critical role in instructing the mother and father on how to care for their baby with special needs.
Some babies may need extra care at a special care unit of a hospital until they are sufficiently developed or well enough to go home with the parents. If a baby is not yet able to breastfeed, the mother can express her milk and safely store it so it can be fed to the baby using a sterilized feeding tube, spoon or cup.
Caring for a newborn brings joy to the mother and father as well as anxiety and fatigue as they adjust to having full-time care of the new baby in their lives. Since newborns are generally dependent on their parents to provide for their every need, mothers and fathers need to take good care of themselves. Breastfeeding mothers especially need to eat more nutritious food, and all mothers should get more rest. A father can support the mother while she breastfeeds by caring for the household and other children or by caring for the newborn while she rests.
Key messages - Smoking, alcohol, drugs, poisons and pollutants are particularly harmful to pregnant women, the developing fetus, babies and young children.
If a pregnant woman smokes, her child is more likely to be born underweight. Her child is also more likely to have coughs, colds, croup, pneumonia or other breathing problems.
A pregnant woman can damage her own health and the health of the fetus by drinking alcohol or using narcotics. These substances can severely affect a child's physical and mental development. The mother-to-be should stop drinking alcohol and/or taking drugs as soon as she plans a pregnancy or suspects she is pregnant. If she has difficulty stopping, she should seek medical advice and support from a trained health worker, a health centre or a substance-abuse organization.
A pregnant woman should not take medicines during pregnancy unless they are absolutely necessary and prescribed by a trained health worker.
To ensure proper physical growth and mental development of the child, women of childbearing age, pregnant women, mothers and young children need to be protected from smoke from tobacco or cooking fires; from pesticides, herbicides and other poisons; and from pollutants such as lead found in water transported by lead pipes, in vehicle exhaust and in some paints.
Families and communities can especially help pregnant women, mothers and their children by supporting smoke-free environments so they do not inhale damaging secondary tobacco smoke.
Workplaces should protect women of childbearing age, pregnant women and mothers from exposure to harmful smoke, poisons and pollutants that can affect their health and that of their children.
Key messages - Violence against women is a serious public health problem in most communities. When a woman is pregnant, violence is very dangerous to both the woman and her pregnancy. It increases the risk of miscarriage, premature labour and having a low-birthweight baby.
Violence and abuse are unacceptable at any time. Women who are abused during pregnancy may suffer from early labour and could lose their babies as a result. Babies can be born with low birthweight, which can affect their health and survival.
Health workers, families and communities should be aware of these dangers, provide protection, and work to prevent and eliminate violence against women. Local authorities, with support from organizations and community leaders, have the responsibility to: 1) take action to prevent violence against women and challenge social norms that increase women's risk for violence and abuse; 2) enforce laws protecting women from violence and abuse; and 3) provide accessible protection and support services for abused women.
Key messages - In the workplace, pregnant women and mothers should be protected from discrimination and exposure to health risks and granted time to breastfeed or express breastmilk. They should be entitled to maternity leave, employment protection, medical benefits and, where applicable, cash support.
Worldwide, nearly 60 per cent of women of childbearing age were in the labour force as of 2006. Many women work in the informal economy, where their work is not recorded, regulated or protected by public authorities. Whether women work in the formal or informal economy, it is important that protective measures are put in place in communities, with support from the government and civil society, to safeguard the health and economic security of women, children and families.
Protective measures can include:
Maternity leave: A mother has the right to a period of rest when her child is born, means to support herself and her family, and a guarantee that she can return to work when her leave is finished.
Employment protection: This is a guarantee that pregnant women and new mothers will not be discriminated against and lose their job or job entitlements (pension, paid holiday leave, etc.) due to pregnancy, maternity leave or time off for childbirth
Cash (income) support and medical benefits: Working pregnant women and mothers and their newborns and families generally need cash support and medical care benefits. Cash support replaces a portion of lost income caused by the interruption of the women's work due to pregnancy, childbirth and newborn care. Medical benefits are needed by pregnant women, new mothers and newborns for prenatal, childbirth and post-natal services, and hospitalization when necessary.
Health protection: The pregnant or nursing woman should not be obliged to perform work that can affect her health or that of her child. Where there is a risk, changes in her work conditions should be made to reduce workplace health risks. The woman should return to her job when it is safe for her to do so, or she should be provided with an equivalent job with the same remuneration.
Breastfeeding: Mothers should have the right to breastfeed a child after returning to work, because breastfeeding has major benefits for the health of the mother and her child. Mothers should be entitled to take one or more breaks, or a reduction in work hours for breastfeeding, which should not be subtracted from her paid work time.
Key messages - Every woman has the right to quality health care, especially a pregnant woman or a new mother. Health workers should be technically competent and sensitive to cultural practices and should treat all women, including adolescent girls, with respect.
Many dangers of pregnancy and childbirth can be avoided if women have access to quality health care during pregnancy and childbirth and after childbirth.
All women have the right to the services of a skilled birth attendant, such as a doctor, nurse or midwife, and to emergency care if complications should arise.
Quality health care that offers information and counselling enables women and men to make informed decisions about their reproductive health. A woman in need of maternal care should be supported by her husband or partner and family to take good care of herself and her baby and to reach a health facility when needed, including for prenatal care, childbirth, post-natal care and emergency care.
Governments, with support from communities, should make sure that the cost of health services does not prevent women, including adolescent girls, from using them. Other barriers such as the cost of transport, long distances, difficult roads and cultural practices also need to be addressed to ensure access to health services.
Health-care providers should be supported through regular training to maintain and improve their technical and communication skills needed to provide quality health care. They should be trained to treat all women with respect, to be sensitive to cultural norms and practices, and to respect a person's right to confidentiality and privacy. They need to be sensitive and understanding of the particular needs of adolescents, and know how to support and counsel them in caring for themselves and their babies.