FCM III

Prenatal and Postnatal Care

shar, viki, maqui
2nd Shifting/August 15, 2008

SITUATIONER Activity Evaluation of Maternal Care in the Philippines from 2002-2003

 Maternal and Child Health Activities 2003 2002
o basic health services offered by government Pregnant w/ 3 or more prenatal visits 6,716 6,655
 Prenatal and Postnatal Care
o focuses on one of the most stressful period in a Pregnant given TT2 plus 7,580 7,227
mother and child’s life. Pregnant given complete iron dosage 1,564 1,603

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

children and families

0.4
• The objective can be accomplished by reducing
0.2 maternal mortality by 50% and from 21/1000 live
0 births in year 2000 to 11/1000 live births in year
yr 2000 Yr 2001 Yr 2002 Yr 2003 2003
• Target: female population aged 15-44 considered
capable of bearing children.

Infant Mortality Rate and Under-5 RISK REDUCTION OBJECTIVES

Mortality Rate in the Philippines
• To reduce the Infant Mortality Rate (IMR) from
from 2000-2003
27.59 per 1000 live births in 1995 to 23.9 in 2003
70
• To reduce the Under-5 Mortality Rate from 32.67 in
60
1995 to 23.9 in 2003
50
• To reduce the Maternal Mortality Rate (MMR) from
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

GENERAL DUTIES AND RESPONSIBILITIES OF THE HILOT

THE PERSON PERFORMING THE HOME  A hilot or traditional birth attendant (TBA) is a
DLIVERY person who assists mothers during childbirth
 During Pregnancy  Most mothers prefer hilots to attend to them
 Perform risk assessment because of the hilot sense of caring, personal
• pregnant woman is at risk & approach and response to cultural and spiritual
require hospital delivery needs.

 The DOH has been training hilots intensively
since 1974, to make hilot practice safe and make
them competent as primary health care worker
 Republic Act No. 2644 allowed hilots trained
under the DOH to practice, was amended by the
Midwifery Act of 1992 - required only registered
midwives to attend to deliveries
 to strengthen maternal and child care in the
country and to meet the unserved needs of
pregnant women trained hilots should be
allowed to continue attending to normal home
deliveries until the ratio of midwife to population
reaches the ideal of 1:3,000
GUIDELINES OF TRAINED HILOT PRACTICES
FAMILY PLANNING ALLOWS THE MOTHER TO:
1. Hilot practice is not encouraged on localities
where there are adequate professional health
workers to attend to birth/home deliveries.
2. Only hilots in active practice shall be trained; no
new hilots are to be trained
3. shall be provided with hilot kits and these kits
shall be withdrawn and their practice will not be
allowed if found violating their rules of
practice/guidelines.
4. must attend to deliveries within their area limits.
5. Hilot practice is not encouraged on localities
where there are adequate professional health
workers to attend to birth/home deliveries.
6. Only hilots in active practice shall be trained; no
new hilots are to be trained
7. shall be provided with hilot kits and these kits
shall be withdrawn and their practice will not be
allowed if found violating their rules of
practice/guidelines.
8. must attend to deliveries within their area limits.
NURSES’ AND MIDWIVES’ RESPONSIBILITY TO
PRACTICING HILOTS
1. Selection of untrained hilots for training.
2. Training of qualified practicing hilots in the
locality.
3. Enforcing monthly follow-up meetings.
4. Inspection of kits and re-supplying its content.
5. Involving trained hilots in health activities.
6. Developing trained hilots for other functions like
motivation for family planning and nutrition
information with emphasis on breastfeeding.
COUNSELING ON CHILD-BEARING AND
REARING
Ten Steps to Successful Breastfeeding:
 Have a written breast-feeding policy that is
routinely communicated to all health care staff
 Train all health care staff in skills necessary to
implement this policy
 Inform all pregnant women about the benefits
and management of breast-feeding
FCM III
Prenatal and Postnatal Care
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 Help mothers initiate breast-feeding within half
hour of birth
 Show mothers how to breastfeed, and how to
maintain lactation even if they should be
separated from their infants
 Give newborn infants no food or drink other than
breast milk, unless medically indicated
 Practice rooming-in. Allow mothers and infants to
remain together 24 hours a day
 Encourage breast feeding on demand
 Give no artificial teats or pacifiers (also called
dummies or soothers) to breast feeding infants
 Foster the establishment of breast-feeding
support groups and refer mothers to them on
discharge from the hospital or clinic
 Provide love and attention to her husband and
children
 Enable her to regain her health after the last
delivery (it usually takes 2-3 years to fully
recover health following delivery)
 Recover and be treated for illnesses such as
tuberculosis, heart disease, anemia, infection,
etc.
 Work and practice her profession and help her
husband earn a living
 Pursue higher education; n order to further her
planned career
 Participate in religious, social and civic activities
in the community
FAMILY PLANNING
 The earliest record of family planning and birth
control practice in the Philippines was in the
early 12th century
 it has evolved into a modern and more
sustaining methods.
 On Human Rights Day in December 1967,
President Marcos signed the “Declaration on
Population”
 Prolect Officer of Maternal and Child Health
(POMCH) in the DOH and the Executive Order
171
 ultimate goal of family planning is to improve the
quality of life through birth spacing, birth
limitation and helping infertile couples to have
children.
 also prevents:
 Pregnancy in very young and older
mothers, since pregnancy in these
groups is associated with high risks
 Pregnancy in high risk women with
concurrent serious disease or other
medical problems
 Unwanted pregnancy, and consequently,
prevent illegal induced abortion
 Gives the parents and the rest of the family more
time to love and care for their children
 Increases the likelihood of healthier children
because the mother’s health is safeguarded
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Prenatal and Postnatal Care
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 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

FOCUS ON HIGH RISK GROUPS/AREAS

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Prenatal and Postnatal Care
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 Risk factors in pregnancy (Field Health Service o Inadequate support of the

Information System): relatives/neighbors
 AGE: less than 18 years or greater than
35 years 2. Lack of trained TBA in some areas
 HEIGHT: less than 4’11” tall B. Agent
 PARITY: 4 or more babies 1. Attendant at birth not trained
 ONE OR MORE OF THE FOLOWING 2. The practice of calling anybody not trained to
CONDITIONS: assist birth delivery
C. Health Services
 Previous ceasarian section
- Inadequate quality care
 Consecutive miscarriages
1. heavy work load
 Still birth baby 2. accessibility
 ONE OR MORE OF THE FF CONDITIONS: 3. unsystematic service delivery
 Tuberculosis 4. inadequate logistics
 Heart Disease II. Needs to be done
 Diabetes Melllitus A. Community
 Asthma 1. Emphasis on responsible parenthood
 Goiter 2. Community education
 DANGER SIGNS OF DELIVERY: 3. Recommend existing TBA for training
 Vaginal bleeding (especially those practicing in far flung
 Headache areas)
 Dizziness
B. Agent
 Blurring of vision 1. Implement/ enforce existing policies
 Puffiness of face and hands
 Pallor
2. Assess/ enhance trained TBA on their
capabilities
 BP: 140/190 and above
C.Health Services
a. Mobilize existing BHWs/Hilots
EVALUATION b. Shift health workers from accessible
 Infant Mortality Rate had decreased from year areas to concentrate on inaccessible
2000 to 2003 areas
 the target rate for 2003, which was 23.9% was III. Recommendations:
not achieved and was 0.10% higher than was A. Community
expected 1. Encourage husband to accompany wife
 a decrease in the Under-5 Mortality Rate from during prenatal check-up (MCRA)
2000-2003 2. Health education activities (parents'
future parents' class)
Activities Year 2003 (%)
3. Masterlisting of single j married ( 15-49
years old) women
Pregnant w/ 3 or more prenatal visits 0.015 4. Continuation of FFL/FHCW training
B. Agent
Pregnant given TT2 plus 0.017 1. Continuation of hilot training
2. Only trained TBAs can attend birth
deliveries
Pregnant given complete iron dosage 3.54
3. Conduct refresher course
C. Health Services
Postpartum (PP) w/at least 1 PP visit 1.79 1. Assignment of specific areas of
responsibilities
2. Systematic time management
PP mothers given complete iron dosage 2.622
3. Request for additional budget from LGU
and other sources
PP women initiated breastfeeding 1.811 4. Allocate funds for awards and incentives

Lactating mothers given Vitamin A 1.44

INVESTIGATION OF MATERNAL DEATHS

I. Existing Reality
A. Community
1. Family
o Presence of marital problem
o Attitudinal problem of the patient to the
recommendation of the health provider