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Table 1. Maternal Mortality Rates and Infant Mortality Rates (200-2003) Postpartum (PP) w/at least 1 PP visit 7,210 6,885
Maternal Infant Under-5 PP mothers given complete iron dosage 1,055 852
Year Mortality Rate Mortality Rate Mortality Rate
(%) (%) (%) PP women initiated breastfeeding 7,286 6,933
2000 0.67 40.09 6.77
Lactating mothers given Vitamin A 5,787 6,265
2001 0.76 53.48 7.86
2002 0.72 39.01 5.32 Women 15-49 given oil capsules -0- 177
2003 0.87 33.90 4.04
OBJECTIVE OF THE MATERNAL CARE
PROGRAM
Maternal Mortality Rate in the OF MANILA HEALTH DEPARTMENT
• mainly focuses on the safe motherhood and child
Philippines from year 2000-2003 survival
1 • It aims to improve the over-all reproductive health
0.8 status of women in order to uplift their status and
general welfare
0.6 • Thus, ensuring the health and welfare of their
Percent
Under-5 Mortality
40
Rate (%)
30
109.89 per 1000 live births in 1995 to 87.88 in
Infant Mortality
Rate (%) 2003
20
10
SERVICES
0
Yr 2000 Yr 2001 Yr 2002 Yr 2003
• covers pregnancy, childbirth and postnatal
periods
• several activities are planned to answer to the
needs of both mother and child
• Services include:
o adequate prenatal, natal, postnatal care
o food and micronutrient supplementation
o dental care
o TT immunization
MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC
PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU
RACHE ESTHER JOEL GLENN TONI
FCM III
Prenatal and Postnatal Care
Page 2 of 5
o family planning services and • not at risk and may qualify for
o health counseling. home delivery.
Motivate the mother
• refer her to the nearest health
facility for tetanus toxoid
MATERNAL CARE immunization
• More than 76% of deliveries in the Philippines are
home deliveries.
• This culminated the formulation and During Delivery
implementation of an official protocol from the Observe aseptic technique to ensure
Department of Health. hygienic and safe delivery.
• Ask the pregnant woman to
bathe and put on clean clothes
PROTOCOL FOR HOME DELIVERY
• Wash the woman’s perineum
• Objectives:
using soap and water, and if
o To have a clear guideline on home deliveries. available, use antiseptic after
o To decongest hospitals and make use of limited washing
maternity hospital beds for referrals only. • birth attendant must wash and
o To increase coverage by reaching out into the scrub her/his hands thoroughly
homes of mothers. with soap and clean water, if
antiseptic is available, ask an
PERSONS ALLOWED TO CONDUCT HOME assistant to pour into the hands
DELIVERY and then air dry the hands
1. Licensed doctors • Use sterile gloves if available
2. Licensed nurse-midwives • Use clean and sterile/boiled
3. Licensed nurses trained in deliveries instruments and cord clamps
4. Licensed midwives and string
5. Trained traditional birth attendants • Use clean towel and clothes (if
possible, newly ironed for the
PREGNANT WOMEN WHO ARE QUALIFIED TO baby)
HAVE HOME DELIVERY After Delivery
1. Full term Cord must be cut cleanly
2. Second to fourth pregnancies Mother must be closely monitored , first
3. Cephalic presentation 2 hours
4. Healthy mothers Refer immediately any complication that
5. No history of complications like hemorrhage develops
6. No history of difficult delivery and prolonged Motivate mother, help her initiate
labor breastfeeding right after delivery
7. No previous caesarian section Weigh the baby and record weight
8. Imminent deliveries
Issue a Growth Monitoring Card (MC) for
9. No premature rupture of the membrane
the baby right after delivery
10. Adequate pelvis
Register the baby within 30 days
Post-partum Visit
THE DELIVERY KIT
Perform a minimum of 3 postnatal visits
should contain the following:
(24 hours, 1 week, and 6weeks after
1. sterilized scissors (if not available, new and
delivery).
sterilized razor blade)
Postnatal care for the mother: vital signs,
2. Two pairs clamps
check for bleeding and any abnormal
3. Sterile cord strings
signs and symptoms
4. Antiseptic (may use 70 % alcohol)
5. Soap nutritional advice
6. Clean towel or pieces of cloth Breastfeeding advice
7. Flashlight family planning
8. Sphygmomanometer and stethoscope Immunization of the child
The DOH has been training hilots intensively Help mothers initiate breast-feeding within half
since 1974, to make hilot practice safe and make hour of birth
them competent as primary health care worker Show mothers how to breastfeed, and how to
maintain lactation even if they should be
Republic Act No. 2644 allowed hilots trained separated from their infants
under the DOH to practice, was amended by the
Give newborn infants no food or drink other than
Midwifery Act of 1992 - required only registered
breast milk, unless medically indicated
midwives to attend to deliveries
Practice rooming-in. Allow mothers and infants to
to strengthen maternal and child care in the remain together 24 hours a day
country and to meet the unserved needs of Encourage breast feeding on demand
pregnant women trained hilots should be Give no artificial teats or pacifiers (also called
allowed to continue attending to normal home dummies or soothers) to breast feeding infants
deliveries until the ratio of midwife to population Foster the establishment of breast-feeding
reaches the ideal of 1:3,000 support groups and refer mothers to them on
discharge from the hospital or clinic
GUIDELINES OF TRAINED HILOT PRACTICES
FAMILY PLANNING ALLOWS THE MOTHER TO:
1. Hilot practice is not encouraged on localities Provide love and attention to her husband and
where there are adequate professional health children
workers to attend to birth/home deliveries. Enable her to regain her health after the last
2. Only hilots in active practice shall be trained; no delivery (it usually takes 2-3 years to fully
new hilots are to be trained recover health following delivery)
3. shall be provided with hilot kits and these kits Recover and be treated for illnesses such as
shall be withdrawn and their practice will not be tuberculosis, heart disease, anemia, infection,
allowed if found violating their rules of etc.
practice/guidelines. Work and practice her profession and help her
4. must attend to deliveries within their area limits. husband earn a living
5. Hilot practice is not encouraged on localities Pursue higher education; n order to further her
planned career
where there are adequate professional health
workers to attend to birth/home deliveries. Participate in religious, social and civic activities
in the community
6. Only hilots in active practice shall be trained; no
new hilots are to be trained
FAMILY PLANNING
7. shall be provided with hilot kits and these kits The earliest record of family planning and birth
shall be withdrawn and their practice will not be control practice in the Philippines was in the
allowed if found violating their rules of early 12th century
practice/guidelines. it has evolved into a modern and more
8. must attend to deliveries within their area limits. sustaining methods.
On Human Rights Day in December 1967,
NURSES’ AND MIDWIVES’ RESPONSIBILITY TO President Marcos signed the “Declaration on
PRACTICING HILOTS Population”
1. Selection of untrained hilots for training. Prolect Officer of Maternal and Child Health
2. Training of qualified practicing hilots in the (POMCH) in the DOH and the Executive Order
locality. 171
3. Enforcing monthly follow-up meetings. ultimate goal of family planning is to improve the
4. Inspection of kits and re-supplying its content. quality of life through birth spacing, birth
limitation and helping infertile couples to have
5. Involving trained hilots in health activities.
children.
6. Developing trained hilots for other functions like also prevents:
motivation for family planning and nutrition Pregnancy in very young and older
information with emphasis on breastfeeding. mothers, since pregnancy in these
groups is associated with high risks
COUNSELING ON CHILD-BEARING AND Pregnancy in high risk women with
REARING concurrent serious disease or other
Ten Steps to Successful Breastfeeding: medical problems
Have a written breast-feeding policy that is Unwanted pregnancy, and consequently,
routinely communicated to all health care staff prevent illegal induced abortion
Train all health care staff in skills necessary to Gives the parents and the rest of the family more
implement this policy time to love and care for their children
Inform all pregnant women about the benefits Increases the likelihood of healthier children
and management of breast-feeding because the mother’s health is safeguarded
FCM III
Prenatal and Postnatal Care
Page 4 of 5
Provides mother security because fewer children Oral Dental exam - mothers are advised to use
in the family have better opportunities for iodized salt in their food or to take iodine capsules to
adequate food, clothing and good education. prevent goiter
Laboratory Exam – urinalysis, RPR, CBC and UTZ
STRATEGIES when indicated
Maternal Care Referral when applicable, either to a hospital or a
Provision of standardized quality Maternal physician/RHU
Care services
Prenatal Care POSTPARTUM CARE
ØHome Based Mother’s Record Normal postpartum period = 1 ½ months (6 weeks)
(NBMR) should be used after delivery
Micronutrient Supplementation
this is a record card given to 1. Iron tablets – mothers are recommended to take
mothers where their 1 tab per day for 3 weeks or 2 months after
physician can record their delivery
health status at each visit 2. Vitamin A – a dose of 20,000 IU is also
monitor the presence of any of the 4 recommended to be take together with iron
danger signs of pregnancy: any type supplements
of vaginal bleeding; puffiness of face Postpartum check-up
and hands; headache, dizziness, The mothers are required to have the
blurred vision; and being pale or following schedule of check-up
anemic. postpartum:
new complete prenatal visit: 1. Home visit
1 visit – 1st 3 trimesters a mother is given home visit by
1 visit – 2nd 3 trimesters health workers 1 week after
3 visit – 3rd trimester delivery
1 visit/week – on the last month of 2. Clinic visit
pregnancy mothers are recommended to
have clinic visits 4-6 weeks after
STANDARD PRENATAL PE delivery
Take note of vital signs (weight, blood pressure, For each visit, several conditions are being
temperature, presence of pallor) monitored in both the mother and the newborn,
Abdominal examination to detect any postpartum complication or birth
1. 1. check fundic height defects especially for those delivered at home.
2. 2. palpate fetal parts for presentation For the mothers, the following are
3. 3. auscultate for fetal heart sounds (normal for considered:
5th month is 120-160/min Bleeding
Breast examination Infections
Neck examination for goiter vital signs
breastfeeding practices
BASIC PRENATAL SERVICES postpartum counseling (birth
Tetanus Toxoid2 Immunization spacing, cord care, hygiene,
WHO recommended schedule nutrition)
TT1 at first contact or as early as possible in For the newborn, the following are
pregnancy considered:
TT2 at least 4 weeks after TT1 Sucking reflex
TT3 at least 6 months after TT2 Breastfeeding practices &
TT4 at least 1 year after TT3 or during problems
subsequent pregnancy Umbilical stump for bleeding &
TT5 at least 1 year after TT4 or during infection
subsequent pregnancy Pathologic jaundice
Pallor
MICRONUTRIENT SUPPLEMENTATION
1. Iron tablets DELIVERY
given at 4th-9th month of pregnancy Domicillary Obstetrical Services
dose: 60mg, 1 tab OD + Folic acid Lying-in-Clinics deliveries
2. Low dose vitamin A normal pregnancies are delivered in LICs,
given at 4th to 9th month however, referrals are also given when
dose: 10,000 IU, 1 tab 2/wk necessary