The objectives of the maternal and neonatal health counseling were to do the following:
• Highlight the vulnerability of the neonatal period.
• Inform participant and her family of the schedule recommended by the government of Bangladesh for prenatal care and strongly encourage participants to seek appropriate prenatal care, including tetanus toxoid vaccination. Tetanus toxoid is provided free of cost as part of antenatal care at all government of Bangladesh health facilities.
• Discuss birth plans and encourage participants to develop a birth plan, including location of the birth, materials, persons needed, and an emergency plan.
• Introduce and discuss the use of a clean delivery kit for hygienic delivery to reduce infections. This will include instructions on cutting the umbilical cord. Provide a clean delivery kit to the participant, which will include a clean blade, a clean string for tying the cord, and a clean mat for the mother to lie on, among other items.
• Encourage close family members to motivate or demand hand washing with soap by birth attendants before and during labor and delivery.
• Discuss maternal danger signs with participant and her family and encourage care seeking when recognized.
• Discuss neonatal danger signs with participant and her family and encourage care seeking when recognized.
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• Discuss neonatal hypothermia prevention with participant and her family and work with the family to build acceptance of the message.
◦ Specifically, recommend immediate drying of the newborn and placement on the mother’s belly or chest and then covering.
◦ Delay bathing until day 2 of life.
• Discuss the benefit of immediate and exclusive breastfeeding with participant and her family and work with the family to build acceptance of the message.
• Provide chlorhexidine and gauze for umbilical cord cleansing, and explain chlorhexidine cord care to the participant and work with her and her family.
Materials: Each participant was given a clean delivery kit and a culturally appropriate pictorial card depicting each of the danger signs for the mother pre-, during, and post-labor, and for the neonate.
