GRSG-G: MCN 1 Lec, Topic 1

Measuring Maternal and Child Health

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The Concept of Family

Basic Family Types
Family of Orientation. The family one is born into.
Family of Procreation. A family one establishes.
1. Dyad Family
2. Cohabitation Family
3. Nuclear Family
4. Polygamous Family
5. Extended Family
6. Single-Parent Family
7. Blended Family
8. Communal Family
9. Foster Family
10. Adoptive Family

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Pubertal development is when secondary sex characteristics

The sex of an begin, and the hypothalamus acts as a gonadostat.
individual is PUBERTAL HORMONES

determined by the ANDROGEN

ü Testosterone is responsible for muscular development, physical
joining of the ovum growth, and increase in sebaceous gland secretions.
ü Secreted by the adrenal cortex, the testes, and the ovaries.
and the sperm. ESTROGEN
ü Secreted by the ovarian follicles.
Gonad produces sex ü One substance with three compounds of estrone, estradiol, and
estriol.
cells. ü Causes physical changes in females

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 GRSG-G: MCN 1 Lec, Topic 1

Secondary Sex Characteristics

1. Girls
Growth spurt, pelvis, breast
development, pubic hair,
menstruation, axillary hair,
and vaginal secretions.
2. Boys
Weight, growth of testes,
hair growth, voice changes,
penile growth, height, and
spermatogenesis.

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SCROTUM
TESTES
Rugated, skin-covered, muscular pouch
suspended from the perineum. Seminiferous Tubules
The actual sperm-
forming factories.
Interstitial Cells (Leydig Cells)
Produce androgens
(testosterone).

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DUCT SYSTEM
1. EPIDIDYMIS
PENIS Provides temporary storage for
immature sperm and while
Glans Penis sperm travels epididymis, they
mature, gaining ability to swim.
Prepuce 2. DUCTUS DEFERENS
Propel live sperm during
With sexual excitement, ejaculation from epididymis to
blood flow to penis urinary bladder, and enclosed
increases and causes along with blood vessels and
nerves in a connective tissue
dilation of arteries which called spermatic cord.
then contracts the 3. URETHRA
ischiocavernous muscle Extends from base of urinary
bladder to penis which carries
resulting in erection. sperm and urine to exterior
body part.

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 GRSG-G: MCN 1 Lec, Topic 1

ACCESSORY STRUCTURES SEMEN

SEMINAL VESICLES
Found at the base of bladder Milky white, sticky mixture of sperm and
and joins ductus deferens which
then produce seminal fluid accessory structure secretions.
which nourish and activate
sperm passing
PROSTATE GLAND
Encircles upper part of urethra
and below urinary bladder which
secretes milky fluid that plays a
role in activating sperm.
BULBOURETHRAL GLANDS
Inferior to prostate gland and
produce thick, clear mucus
which cleanses urethra of acidic
urine and serves as lubricant
during sexual intercourse.

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SPERMATOGENESIS
Production of sperm
Follicle Stimulating Hormone (FSH) begins during
q Spermatogenesis puberty when
anterior pituitary
Luteinizing Hormone (LH) gland secretes follicle
q Testosterone production stimulating hormone
and continues
throughout life.

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TESTOSTERONE PRODUCTION EXTERNAL GENITALIA

Testosterone are produced
by interstitial cells and
responsible for secondary
sex characteristics which
begins during puberty, but
this time, stimulated by
luteinizing hormone
secretion of anterior
pituitary gland.

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INTERNAL GENITALIA
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FEMALE PELVIS
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Average menstrual flow is 4 to 6 days (2 to 9 days)
My last month’s menstruation began August 10
and ended August 14. How long was its
duration?
Average cycle is 28 days (23 to 35 days)
I regularly have my mens Q 28 days. If today is
September 2 and this is my first day of mens,
when will I have my next menstrual flow?
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GRSG-G: MCN 1 Lec, Topic 1
BREAST
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qPeriodic uterine bleeding of dark red
color and combination of blood, mucus,
and endometrial cells, in response to
cyclic hormonal changes.
qAmount is about 30 to 80 ml per period.
A process that allows for:
Conception – bring an ovum to maturity.
Implantation – renew uterine tissue.
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LMP (Last Menstrual Period)
Regarded as “Day 1” or the first day of the
last menstrual period.
1. Vina’s last menstruation began August 5 and ended
August 7. When is her LMP?
2. How long was its menstrual flow duration?
3. If her usual cycle is 30 days, when will she expect her
next menstruation?
4. Her sister’s last menses were July 14 and August 12
respectively. How long is her menstrual cycle?
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 GRSG-G: MCN 1 Lec, Topic 1

My cycle lasts for 32
days. When will I have
my next menstrual flow if
yesterday, August 7, was
my 5th and last day of
mens?
Menarche
qFirst menstruation period in girls.
qTypically between 12 to 13 years (12.4), but may start as
early as 9 or as late as 17.
qNurses must start health education during elementary
years.
Menopause
qCessation of menstrual cycle.
qPerimenopausal is when menopausal changes occur
between 40 to 55 years (51).
qPostmenopausal is the time of life following
menopause.

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Aileen’s menstrual cycles are 30 days in length.

Her last menstrual period started March 28 and
1. Hypothalamus ended April 3.
2. Pituitary Gland 1. What is her LMP?
3. Ovary 2. How long was her last menstrual duration?
3. When was her last ovulation?
4. Uterus
4. When will she expect her next menstrual
5. Cervix flow?
5. When is her next fertile period?

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COMMON MENSTRUAL DISORDERS

1. Mittelschmerz
2. Dysmenorrhea
3. Menorrhagia
4. Metrorrhagia
5. Amenorrhea
6. Endometriosis

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 GRSG-G: MCN 1 Lec, Topic 1

MALE FEMALE
Gonads Testes produce sperm Ovaries produce egg cells
The Sexual Response Cycle
cells and testosterone. and estrogen.
1. EXCITEMENT
Sex cell production Begins at puberty. Begins intrauterine life Physical and psychological
and all have been stimulation.
formed already.
2. PLATEAU
Sex cell maturity At puberty. At puberty.
Sustained feelings reached just
before an orgasm.
Function of FSH Spermatogenesis. Maturation of immature 3. ORGASM
egg cells. The shortest stage in the sexual
response cycle where the body
Function of LH Testosterone production Ovulation and thickening discharges accumulated sexual
for secondary sex of endometrium. tension.
characteristics.
4. RESOLUTION
End of sex cell production Continues throughout At menopause. Return to unaroused state.
life.

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SUSTAINABLE DEVELOPMENT GOALS

• Officially known as ”Transforming our world: The 2030
Agenda for Sustainable Development”.
• A set of 17 "Global Goals" with 169 targets between them.
• Spearheaded by the United Nations through a deliberative
process involving its 193 Member States.
• The Resolution is a broader intergovernmental agreement
that acts as the Post 2015 Development Agenda, successor
to the Millennium Development Goals.
4 KEY PRINCIPLES
1. Universal
2. Sustainability
3. Leave no one behind
4. Participation

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Essential Intrapartal and Newborn Care

(EINC)
INTRAPARTAL
To discuss evidenced-based interventions that
are recommended and not recommended
during antenatal, labor, and delivery period.
NEWBORN
To describe and carry out the evidenced-based
routine care of a newborn baby at the time of
birth and prevent complications.

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 GRSG-G: MCN 1 Lec, Topic 1

The Reproductive Health Law, popularly known as the RH STATED PURPOSE

Law (RA 10354), previously, the Rh Bill, aims to guarantee
universal access to methods and information on birth control
and maternal care.
1. House Bill No. 4244 or An Act Providing for a Comprehensive
Policy on Responsible Parenthood, Reproductive Health, and
Population and Development, and For Other Purposes
introduced by Albay 1st district Representative Edcel Lagman.
2. Senate Bill No. 2378 or An Act Providing For a National Policy
on Reproductive Health and Population and Development
introduced by Senator Miriam Defensor Santiago.
The main concerns of the law, according to the Explanatory
Note, is that:
1. Population of the Philippines makes it the 12th most populous nation
in the world today.
2. The Filipino women’s fertility rate is at the upper bracket of 206
countries.
3. The Filipinos are responsive to having smaller-sized families through
free choice of family planning methods.
4. Rapid population growth exacerbates poverty while poverty spawns
rapid population growth.
And so, it aims for improved quality of life through a
consistent and coherent national population policy.

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The proponents state that RH will mean:

1. Information and access to natural and modern family planning.
2. Maternal, infant and child health and nutrition. A reproductive life plan is a plan for when, how,
3. Promotion of breast feeding. and whether to have children.
4. Prevention of abortion and management of post-abortion
complications. Although many people who desire children do so
5. Adolescent and youth health. through childbirth, some adopt children,
6. Prevention and management of reproductive infections, HIV, AIDS,
and STD. become foster parents, or use other
7. Elimination of violence against women. arrangements to achieve their desires such as
8. Counseling on sexuality and sexual and reproductive health.
9. Treatment of breast and reproductive tract cancers. co-parenting or surrogacy, but other people
10. Male involvement and participation in RH. also decide not to have children at all.
11. Prevention and treatment of infertility.
12. RH education for the youth.

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1. TEMPORARY METHODS A. NATURAL - ABSTINENCE

A. Natural methods The practice of
B. Artificial methods refraining from
some or all aspects
2. PERMANENT METHODS of sexual activity
A. Tubal ligation for medical,
B. Vasectomy psychological,
legal, social or
religious reasons.

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 GRSG-G: MCN 1 Lec, Topic 1

A. NATURAL - ABSTINENCE B. NATURAL - STANDARD DAYS METHOD

Developed by Georgetown University's Institute for Reproductive Health, the
The practice of Standard Days Method has a simpler rule set and is more effective than the
refraining from rhythm method. A product, called CycleBeads, was developed alongside the
some or all aspects method to help the user keep track of estimated high and low fertility points
during her menstrual cycle. The Standard Days Method may only be used by
of sexual activity women whose cycles are always between 26 and 32 days in length. In this
for medical, system:
psychological, A. Days 1-7 of a woman's menstrual cycle are considered infertile.
legal, social or B. Days 8-19 are considered fertile; considered unsafe for unprotected intercourse.
religious reasons. C. From Day 20, infertility is considered to resume.
D. When used to avoid pregnancy, has a perfect-use failure rate of 5% per year.

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B. NATURAL - STANDARD DAYS METHOD C. NATURAL - CERVICAL MUCUS METHOD

Also called ovulation method, Billings
ovulation method, or Spinnbarkeit, the
cervical mucus method is based on
careful observation of mucus patterns
during the course of menstrual cycle.
1. Before ovulation it’s thick and does not
stretch when pulled between forefinger and
thumb.
2. Just before ovulation, secretion increases.
3. On the day of ovulation is peak day where it’s
copious, thin, watery, transparent, and
stretches at least 1 inch before strand breaks.

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D. NATURAL - BASAL BODY TEMPERATURE D. NATURAL - BASAL BODY TEMPERATURE

Basal body temperature is the temperature when one

is fully at rest. Ovulation may cause a slight increase in
basal body temperature due to hormone progesterone.
1. Just before ovulation, BBT falls 0.5 F.
2. At time of ovulation, BBT rises 1 F or 0.2 C due to rise in
progesterone.
Most fertile days are with the slight decrease followed
by increase in BBT until the next three days.

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 GRSG-G: MCN 1 Lec, Topic 1

E. NATURAL - COITUS INTERRUPTUS F. NATURAL - LACTATIONAL AMENORRHEA

Also known as the withdrawal or pull-out method, coitus interruptus is a
method of birth-control in which a man, during intercourse withdraws his
penis from a woman's vagina prior to ejaculation. The man then directs
his ejaculate or semen away from his partner's vagina in an effort to avoid
insemination.
This method of contraception, widely used for at least two millennia, is
still in use today. This method was used by an estimated thirty-eight
million couples worldwide in 1991. Coitus interruptus does not protect
against STDs or STIs and is viewed by medical professionals to be an
ineffective method of birth control.
FOR WOMEN TO MEET CRITERIA, LAM is 98% - 99.5%
EFFECTIVE DURING THE FIRST 6 MONTH POSTPARTUM:
1. Breastfeeding must be the infant’s only source of nutrition.
Feeding formula, pumping instead of nursing, and feeding solids
all reduce the effectiveness of LAM.
2. The infant must breastfeed at least every 4 hours during the day
and at least every 6 hours at night.
3. The infant must be less than 6 months old.
4. The mother’s menses has not returned.

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F. NATURAL - LACTATIONAL AMENORRHEA G. ARTIFICIAL - ORAL PILLS

Oral contraceptives are medications
taken by mouth for the purpose of
birth control. Two types of female
oral contraceptive pill are widely
available:
1. The combined oral contraceptive pill
contains estrogen and a
progesterone, and is taken once
per day.
2. The progesterone-only pill contains only
progesterone, and is also taken
once per day.

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H. ARTIFICIAL - DMPA I. ARTIFICIAL - INTRAUTERINE DEVICE

Depot medroxyprogesterone The IUD is a T-shaped object
placed in the uterus in order to
acetate (DMPA) is a prevent pregnancy.
progesterone and long acting
1. COPPER IUD negatively affecting the
reversible hormonal contraceptive mobility of sperm and preventing them from
joining with an egg, and additionally, the foreign
birth control drug that is injected body inside the uterus irritates the lining and wall
making it hard for an embryo to implant.
IM every 3 months. This drug
inhibits follicular development and 2. HORMONAL IUD do not increase
bleeding as copper-containing IUDs do, rather,
prevents ovulation as its primary they reduce menstrual bleeding or prevent
menstruation altogether, and can be used as a
mechanism of action. treatment for menorrhagia.

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I. ARTIFICIAL - INTRAUTERINE DEVICE
The IUD is a T-shaped object
placed in the uterus in order to
prevent pregnancy.
1. COPPER IUD negatively affecting the
mobility of sperm and preventing them from
joining with an egg, and additionally, the foreign
body inside the uterus irritates the lining and wall
making it hard for an embryo to implant.
2. HORMONAL IUD do not increase
bleeding as copper-containing IUDs do, rather,
they reduce menstrual bleeding or prevent
menstruation altogether, and can be used as a
treatment for menorrhagia.
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K. ARTIFICIAL - DIAPHRAGM, CERVICAL CAP
Protect against pregnancy by covering the
cervix and keeps sperm from entering
the uterus to meet the egg.
These devices must be prescribed and
fitted by a healthcare professional and
best if used with spermicides.
Both devices can be inserted up to 2 hours
before sex.
The diaphragm can be left in place for up to
24 hours, the cervical cap for up to 48
hours.
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L. ARTIFICIAL – CONTRACEPTIVE SPONGE
Combines barrier and spermicidal
methods to prevent conception and
works in two ways:
1. First, the sponge is inserted into
the vagina, so it can cover the
cervix and prevent any sperm
from entering the uterus.
2. Secondly, the sponge is produced
with spermicide already inside of
it, which is used to prevent the
sperm from moving.
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GRSG-G: MCN 1 Lec, Topic 1
J. ARTIFICIAL - SPERMICIDE
A contraceptive substance that
eradicates sperm, inserted
vaginally prior to intercourse to
prevent pregnancy. Spermicides,
if combined with contraceptive
barrier methods are believed to
result in lower pregnancy rates
than either method alone. It may
be unscented, clear, unflavored,
non-staining, and lubricative.
K. ARTIFICIAL - DIAPHRAGM, CERVICAL CAP
Protect against pregnancy by covering the
cervix and keeps sperm from entering
the uterus to meet the egg.
These devices must be prescribed and
fitted by a healthcare professional and
best if used with spermicides.
Both devices can be inserted up to 2 hours
before sex.
The diaphragm can be left in place for up to
24 hours, the cervical cap for up to 48
hours.
M. ARTIFICIAL – CONDOM
A barrier device most
commonly used during
sexual intercourse to
reduce the probability of
pregnancy and
spreading sexually
transmitted diseases
such as gonorrhea,
syphilis, and HIV.
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A. TUBAL LIGATION B. VASECTOMY

A surgical procedure for A surgical procedure for
sterilization in which a male sterilization and birth
woman's fallopian tubes are control. During the
clamped and blocked, or
procedure, the vas deferens
severed and sealed, either
method of which prevents of a man are severed, and
eggs from reaching the then tied or sealed in a
uterus for fertilization. Tubal manner such to prevent
ligation is considered a sperm from entering into the
permanent method of seminal stream.
sterilization, and birth control.
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FERTILIZATION PROBLEMS
INFERTILITY
Pregnancy has not occurred after about 1 year of
unprotected coitus.
1. Primary infertility
2. Secondary infertility
STERILITY
Inability to conceive because of a known condition.

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