Maternal Health Program

MATERNAL HEALTH PROGRAM

Tasked:
to reduce MMR by three
quarters by 2015 to
achieve ( millennium
Development Goal) MDG
 Maternal Mortality Rate (2003)
CAUSE
Other Complications related to pregnancy
occurring in the course of labor, delivery and
puerperium
1. Hypertension complicating pregnancy,
childbirth and puerperium (25%)
2. Postpartum hemorrhage (20.3%)
3. Pregnancy with abortive outcome (9%)
4. Hemorrhage related to pregnancy
 Strategic thrusts for 2005-2010
1. Launch and implement Basic Emergency and
Obstetric Care (BEMOC) strategy in coordination with
DOH
 Entails establishment of facilities that provide emergency
obstetric care for every 125,000 population and which are
located strategically
2. Improve quality of prenatal and postnatal care
 Pregnant women should have at least four (4) prenatal visit
3. Reduce women’s exposure to health risks
 Institutionalization of responsible parenthood
4. Stakeholders must advocate for health
 Resource generation and allocation for health services
 Essential Health Service Packages
A. Antenatal Registration
B. Tetanus Toxoid Immunization
C. Micronutrient Supplementation
D. Treatment of Diseases and Other
Conditions
E. Clean and Safe delivery
F. Recommended Schedule for Post Partum
Care Visits
G. Importance of BF
 A. Antenatal Registration
Prenatal Period of pregnancy
visits
1st visit As early in pregnancy as possible
before four months or during the
first trimester
2nd visit During the 2nd trimester
3rd visit During the 3rd trimester
Every two After 8th month of pregnancy till
weeks delivery
 B.Tetanus Toxoid Immunization
Vaccine Minimum Age Percent Duration
Interval Protected of
Protection

As early as  
TT1 possible 80%
during
pregnancy
 At  Infants born to the
least 4 mother will be
TT2 weeks
later 80 protected
% from neonatal
tetanus. Gives 3
years protection for
the mother from
tetanus.
 At least Infants born to
TT3 6 the mother will
months 90
later % be protected
from neonatal
tetanus.
Gives 5 years
protection for
the mother.
TT4 At least 1 99%  Gives 10
year later protection
for the
mother
TT5 At least 1 year 99% Gives lifetime
later protection for
the mother.
All infants
born to that
mother
will be
protected.

Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
 C. Micronutrient
Vitamins Dose Supplementation
Schedule Remarks

Vitamin A 10,000 IU Do not give

2x a week
starting on Vitamin A before
4th month of
the 4th
pregnancy. It
month of might cause
pregnancy congenital
problems in the
baby

ron 60mg/400 ug Daily

tablet
 D. Treatment of Diseases and
Other Conditions
Types:
1. Difficulty of breathing/
obstruction of airway
2. Unconsciousness
3. Post partum bleeding
4. Intestinal parasite infection
5. malaria
 1. Difficulty of breathing/
obstruction of airway
What to do?
 Clear the airway
 Place in her best position
 Refer woman to hospital with
EmOC capabilities.
Do not give anything PO
 2. Unconsciousness
What to do?
 Keep on her back arms at the side.
 Tilt head backwards (unless trauma is suspected)
 Lift chin to open airway
 Clear secretions from throat.
 Give IVF to prevent or correct shock.
 Monitor BP and SOB every 15’
 Monitor fluid given. If DOB and puffiness develops, stop the
infusion.
 Monitor UO
Do not give:
 ORS for both unconscious or with convulsions
 IVF if not trained to do so.
 3. Post partum bleeding
What to do?:
 Massage uterine and expel clots.
 If bleeding persist:
▪ Place cupped palmed on uterine fundus and feel for state of
contraction
▪ Massage fundus in a circular motion
▪ Apply bimanual uterine compression if mem treatment done
and postpartum bleeding still persist.
▪ Give ergometrine 0.2mg IM and another dose after 15’
Do not give:
 Mem to woman with eclampsia, pre-eclampsia or
HPN
 4. Intestinal parasite infection

What to do?
 Give mebendazole 500mg tab. Single
dose anytime from 4-9mos. Of pregnancy
if none was given in the past 6 mos.
Do not give:
 Mebendazole in the 1st 1-3mos. Of
pregnancy
▪ This might cause congenital problem in
the baby
 5. Malaria
What to do?
 Give sulfadoxin-pyrimethamine to
woman from malaria endemic areas
who are in 1st or 2nd pregnancy
 500mg-25mg tab., 3 tabs. At the
beginning of 2nd to 3rd tri semesters
not less than one month interval.
 E. Clean and Safe delivery
Presence of skilled birth attendant
Purpose
 to ensure hygiene during labor and
delivery.
 Provide non-traumatic delivery
 recognize complications
 Referred those complicated deliveries
to high level of care
Please refer accordingly
Steps to follow during
labor, childbirth and
immediate postpartum
 1. Do a quick check upon admission
for emergency signs:
Unconscious/convulsion
Vaginal bleeding
Severe abdominal pain
Looks very ill
Severe headache with visual
disturbance
Severe breathing difficulty
Fever
Sever vomiting
2. Make the woman comfortable

Establish rapport
with the client by
greeting and
interviewing to make
her comfortable
3. Assess the woman in labor
- to determine the status during labor
 LMP
 Number of pregnancy
 Start of labor pains
 Age/height
 Danger signs of pregnancy

Taking the history through interview

will help determine the client’s
condition during delivery of baby
 4. Determine the stage of labor
Uterine contractions
Bulging vulva
Leaking amniotic fluid
Vaginal bleeding
IE
 5. Decide if the woman can safely
deliver
By assessing the condition
of the client
and not finding any
indication that could harm
the delivery of the baby
 6. Give supportive care throughout
labor.
Purpose:
 To deliver clean, safe and free from fatigue
1. Encourage to take a bath at the onset of labor
2. Encourage to drink but not eat as this may interfere
surgery in case needed
3. Encourage to empty bladder and bowels to facilitate
delivery of the baby. Remind to empty the bladder every 2
hours.
4. Encourage to do breathing technique to help energy in
pushing out the vagina. Panting can be done by breathing
with open mouth with 2 short breaths followed by long
breaths. This prevent pushing at the end of the 1st stage
7. Monitor and manage the different stage of labor
-watch out for any danger signs
1. First stage: not in active labor
 Cervix: 3cms
 Contraction: weak
 Frequency: < 2 to 10’
What to do?
 Check Q 1hr. for emergency signs, frequency and duration of contractions and
FHT.
 Check Q 4hrs. For fever, pulse, BP and cervical dilatation.
 Record time of ROM and color of amniotic fluid
 Assess progress of labor
▪ Refer STAT to hospital with complete facilities for the ff condition:
▪ If after 8hrs, contractions are stronger and more frequent but not progress in cervical dilatation, with or
without membranes ruptured
 It is false labor if after 8hrs there is no increase in contractions, membranes are
not ruptured and no progress in cervical dilatation.
Not to do:
 IE more frequently than Q 4hrs.
First stage: active labor
 4cms cervical dilatation
What to do?
 Check Q30’ for emergency signs
 Check Q4hrs. For fever, pulse, BP and cervical
dilatation
 Record time of ROM and color of amniotic fluid
 Record finding in partographs/patient record.
Not to do:
 Do not allow woman to push unless delivery is
imminent. It will just exhaust the woman
 Do not give medication to speed of labor. It may cause
trauma to mother and the baby
Second stage:
 Cervix: 10 cms. or bulging thin perineum and
head visible
What to do:
 Check Q 5’ for perineum thinning and bulging,
visible descend of the had during contraction,
emergency signs, FHR and mood and behavior
 Continue recording in the partograph.
Not to do:
 Do not apply fundal pressure to help deliver
the baby
Third stage:
 Between birth of the baby and
delivery of the placenta
What to do:
 Deliver the placenta
 Check the completeness of placenta
and membranes
Not to do:
 Do not squeeze or massage the
abdomen to deliver the placenta
8. Monitor closely within 1hr. After delivery and give
supportive care.
9. Continue care after 1hr. Postpartum. Keep watch
closely for at least 2hrs.
10. Educate and counsel on FP and provide FP method
if available and decision was made by a woman.
11. Informs, teach and counsel the woman on
important MCH messages:
 Birth registration
 Importance of BF
 Newborn Screening for babies delivered in RHU or at
home within 48hrs up to 2 weeks after birth.
 Scheduled when to return for consultation for
postpartum visit
 F. Recommended Schedule for Post
Partum Care Visits

1st visit 1st week post partum

preferably 3-5 days
2nd visit 6 weeks post partum
G. Importance of BF
 BREASTFEEDING
Breast milk is best for babies up to 2 years old.
Exclusive breastfeeding is recommended for the
first six months of life. At about six months,
give carefully selected nutritious foods as
supplements.
Breastfeeding provides physical and
psychological benefits for children and mothers
as well as economic benefits for families and
societies.
 BENEFITS :
For infants
a. Provides a nutritional complete food for
the young infant.
b.Strengthens the infant’s immune system,
preventing many infections.
c. Safely rehydrates and provides essential
nutrients to a sick child, especially to those
suffering from diarrheal diseases.
d.Reduces the infant’s exposure to infection.
 BREASTFEEDING/ LACTATION
MANAGEMENT EDUCATION TRAINING
Breastfeeding practices has been proved
to be very beneficial to both mother
and baby thus the creation of the
following laws support the full
implementation of this program:
A. Executive Order 51
B. Republic Act 7600
C. The Rooming-In and
Breastfeeding Act of 1992
A. EO 51 THE MILK CODE –
protection and promotion of
breastfeeding to ensure the safe
and adequate nutrition of infants
through regulation of marketing of
infant foods and related products.
(e.g. breast milk substitutes, infant
formulas, feeding bottles, teats
etc. )
B. RA 7600 THE ROOMING –IN and
BREASTFEEDING ACT of 1992
=An act providing incentives to
government and private health
institutions promoting and
practicing rooming-in and breast-
feeding.
=Provision for human milk bank.
=Information, education and re-
education drive
=Sanction and Regulation
BABY
 Provides Antibodies
 Contains Lactoferin (binds with Iron)
 Leukocytes
 Contains Bifidus factor-promotes growth of
the Lactobacillus-inhibits the growth of
pathogenic bacilli
  For the Mother
e. Reduces a woman’s risk of excessive blood loss
after birth
f. Provides a natural method of delaying
pregnancies.
g. Reduces the risk of ovarian and breast cancers
and osteoporosis.
 For the Family and Community
h. Conserves funds that otherwise would be spent
on breast milk substitute, supplies and fuel to
prepare them.
i. Saves medical costs to families and
governments by preventing illnesses and by
providing immediate postpartum contraception.
 POSITIONS IN BF THE BABY:
 1.     Cradle Hold = head and neck are supported

 2.     Football Hold

 3.     Side Lying Position

BEST FOR BABIES

REDUCE INCIDENCE OF ALLERGENS
ECONOMICAL
ANTIBODIES PRESENT
STOOL INOFFENSIVE (GOLDEN YELLOW)
EMPERATURE ALWAYS IDEAL
FRESH MILK NEVER GOES OFF
  EMOTIONALLY BONDING
EASY ONCE ESTABLISHED
DIGESTED EASILY
IMMEDIATELY AVAILABLE
NUTRITIONALLY OPTIMAL
GASTROENTERITIS GREATLY REDUCED