CHN CH 4 – MATERNAL AND CHILD CARE INCLUDING
Yet, 10
BEMONC AND CEMONC
1. Millennium Development Goals 4 (Reduce Child
Mortality) and 5 (Improve Maternal Health)
2. Maternal, Neonatal and Child Health and Nutrition
(MNCHN) Service Delivery Network
 Basic Emergency Obstetrics and Newborn
Care (BEMONC)
 Comprehensive Emergency Obstetrics and
Newborn Care (CEMONC)
DEFINITION OF MATERNAL AND CHILD HEALTH
 Maternal and child health (MCH) – refers to the
health of mothers, infants, children, and adolescents.
o It also refers to a profession within public
health committed to promoting the health
status and future challenges of this
vulnerable population.
 Maternal and Child Health – refer to philo-mother
and child relationship to one another and
consideration of the entire family as well as the
culture and socio-economic environment as
framework of the patient.
o It involves the care of the woman and family
throughout pregnancy and childbirth and the
health promotion and illness care for the
children and families.
 Child health – is a state of physical, mental,
intellectual, social and emotional well-being and not
merely the absence of disease or infirmity.
 Maternal health – is defined as the sense of well-
being related to the antenatal, natal and post-natal
periods of the woman's life cycle.
 Maternal health – also includes the absence of
maternal morbidity, severe maternal morbidity, and
maternal mortality.
PHILOSOPHY OF MATERNAL HEALTH
 Pregnancy, labor, delivery and puerperium are part of
the continuum of the total life cycle; it is family-
centered.
 Maternal and child health is based on the philosophy
of mother and child relationship in consideration of
the entire family, culture, and socioeconomic
environment.
OVERALL AIM AND GOALS OF MATERNAL HEALTH
 To improve survival as well as promote and maintain
the optimal health of women and their fetuses and/or
newborn through a package of services throughout
the pre-pregnancy, prenatal, natal and postnatal
stages.
 The goal of an effective maternal health program is to
ensure that every expectant and nursing mother
maintains good health; learns the art of child care;
undergoes normal delivery; and bears healthy
children.
IMPETUS FOR MATERNAL HEALTH
 Maternal and infant deaths are preventable.
women die every day que to pregnancy-related
causes and 24 newborns per 1,000 live births die
daily (FPS, 2006).
Some causes of maternal deaths are:
1. Hypertension (25%)
2. Postpartum Hemorrhage (20.3%)
3. and pregnancy with abortive outcomes which are
neither preventable nor predictable (9%) (PHS,
2000).
CAUSES OF MATERNAL DEATHS AND LEGAL BASIS
FOR MATERNAL HEALTH
Underlying causes of these maternal deaths include the
following:
1. Delays in seeking care, making referral and providing
appropriate medical management or treatment;
2. Closely spaced births
3. Frequent pregnancies
4. Poor detection and management of high risk
pregnancies;
5. Poor access to health facilities due to geographic
distance and transportation cost; and
6. Lack of competence in managing obstetrical
emergencies by some members of the health care
staff / team.
LEGAL BASIS FOR MATERNAL HEALTH
 The 1987 Constitution of the Philippines –
provides that "the State shall promote the right to
health of the people and instill health consciousness
among them."
 Magna Carta for Women (RA 9710), enacted into
law in March 2010 which supersedes all laws, Acts
and guidelines which are prejudicial or detrimental to
the welfare of women and government is mandated
to fully, address the issues which are related to health
of women.
o It is comprehensive women's human rights
law that seeks to eliminate discrimination
against women by recognizing, protecting,
fulfilling and promoting the rights of Filipino
women, especially those in marginalized
sector.
STRATEGIC THRUSTS FOR 2005 – 2010
 Launch and implement the Basic Emergency
Obstetric Care strategy in coordination with the DOH.
It entails the establishments of facilities that provide
emergency obstetric care for every 125,000
population and which are located strategically.
 Improves the quality of prenatal care and postnatal
care.
 Reduce women's exposure to health risks through
the institutionalization of responsible parenthood and
provision of appropriate health care package to all
women of reproductive age especially those who are
less than 18 years old and over 35 years of age,
 women with low education and financial resources,
women with unmanaged chronic illness and women
who had just given birth in the last 18 months.
 LGUS and NGOs and other stakeholders must
advocate for health through resource generation and
allocation for health services to be provided for the
mother and the unborn.
 To improve women's healthcare, action is required in
the four broad structural areas of the health
system.
 This includes the improvement of health services for
women; the provision of health information for
Women; women empowerment (participation in
decision-making on health issues, in production and
reproduction and in community life); and training and
gender sensitizing of traditional and existing health
care providers.
MATERNAL NEONATAL AND CHILD HEALTH AND
NUTRITION STRATEGY (MNCHN)
 It applies specific policies and actions for local health
system to systematically address health risks that
lead to maternal and especially neonatal deaths
which comprise half of the reported infant mortalities.
BASIC EMERGENCY OBSTETRICS AND NEWBORN
CARE (BEMONC) SERVICES
 Is a capable private health facility or an appropriately
upgraded public health facility that is either a Rural
Health Unit (RHU) and/or its satellite Barangay
Health Station (BHS) or Hospital capable of
performing the following emergency obstetric
functions.
BASIC EMERGENCY OBSTETRICS AND NEWBORN
CARE (BEMONC) SERVICES
 It refers to lifesaving services for emergency maternal
and newborn conditions/complications being provided
by a health facility or professional to Include the
following services:
1. Parenteral administration of oxytocin,
2. Parenteral administration of initial dose of
antibiotics
3. Administration of dose of parenteral
anticonvulsants
4. Administration of maternal steroids for
preterm labor
5. Performance of assisted vaginal deliveries
6. Removal of retained placental products
7. Manual removal of retained placenta
 It can also be a single or stand alone facility or part of
a network of facilities In an inter-local health zone.
Accessibility within 1 hour from residence or referring
facility within the ILHZ (Inter-Local Health Zones)
 The BEMONC facility shall consist of the core district
hospital.
 For geographically isolated / disadvantaged areas,
densely populated areas and designated BEMONC
facilities are the following: RHU, BHS, Lying-in clinics
and Birthing homes.
 Shall operate within 24 hours with 6 signal obstetric
functions.
 Shall have access to communication and
transportation facilities to mobilize referrals
 Staff composition: (1) Medical Doctor, (1)
Registered Nurse, (1) Registered Midwife
COMPREHENSIVE EMERGENCY OBSTETRICS AND
NEWBORN CARE (CEMONC) SERVICES
 Refers to lifesaving services for emergency maternal
and newborn conditions/complications as in
BEMONC plus the provision of surgical delivery (c-
section), blood bank services and other specialized
obstetric interventions.
 This set of life-saving services defines a health facility
with regard to its capacity to treat obstetric and
newborn emergencies
 It is a tertiary level regional hospital or medical
center, provincial hospital or appropriately upgraded
district hospital
 The centre has Obstetricians, Pediatricians, Doctors,
Staff Nurses, lab technicians, and support staff on
duty and Anesthetists on call.
 It can serve as high volume providers for Intrauterine
Device (IUD) and voluntary surgical contraception
(VSC) services.
 Intensive inputs were provided, in terms of training
and physical infrastructure, to ensure quality care.
Services in the Labor Room
1. Emergency treatment protocols, equipment and
drugs are available in the labour room
2. Partographs are used
3. Bio medical waste management procedures followed
Services for Care of the Newborn
1. Emergency treatment protocols, equipment and
drugs are available in the newborn care services
2. Resuscitation of the newborn emergencies
3. Initiation of breastfeeding immediately after birth
DIFFERENCE BETWEEN BEMONC AND CEMONC
Basic EMONC
 Includes health facilities that performs all seven
signal functions.
1. Parenteral administration of oxytocin,
2. Parenteral administration of Initial dose of
antibiotics
3. Administration of dose of parenteral
anticonvulsants
4. Administration of maternal steroids for preterm
labor
5. Performance of assisted vaginal deliveries
6. Removal of retained placental products
7. Manual removal of retained placenta
Comprehensive EMONC
 Includes health facilities, usually hospitals that
performs all seven signal functions in Basic EmONC
as well as Cesarean section deliveries and blood
transfusions.
ESSENTIAL HEALTH SERVICES FOR PREGNANT  Iron Supplementation – given 60 mg iron and 400
WOMEN ug folic acid daily for 6 months (WHO).’
1. Antenatal Registration | Prenatal care EARLY DETECTION AND MANAGEMENT OF
2. Tetanus Toxoid Immunization COMPLICATION
3. Micronutrient Supplementation
4. Early Detection and Management of Complication Report for:
5. Clean and Safe Home Delivery 1. Vaginal bleeding
6. Support to Breastfeeding 2. Edema of the face and hands
7. Family Planning Counseling 3. Headache
4. Dizziness
5. Blurred vision
ANTENATAL REGISTRATION | PRENATAL CARE 6. Pallor
 Prenatal Care is used to screen out the woman at
Risk for closer prenatal supervision there should be Assess:
at least Four prenatal visits during pregnancy: 1. Fundal height
 Compute the AOG and EDD 2. Temperature
 Schedule for Prenatal Visits / Prenatal Visits Period of 3. Blood Pressure
Pregnancy 4. Weight
o 1st visit – should be made as early in 5. Signs if urinary infection
pregnancy as possible, during the first 6. Signs of eclampsia
trimester or before the fourth month
o 2nd visit – during 2nd trimester Normal – 120/80 mmHg
o 3rd visit – subsequent visits during 3rd Prehypertension – 120 – 139 systolic, 80 – 89 diastolic
Stage 1 hypertension – 140 – 159 systolic, 90 – 100
trimester
diastolic
o 4th visit – after the 8th month of pregnancy
Stage 2 hypertension – 160 and above systolic, 100 and
till delivery (weekly). above diastolic
 Home Based Mother's Record (HBMR) – shall be
used when rendering prenatal care as a guide in the
identification of risk factors, danger signs, and as a
CLEAN AND SAFE HOME DELIVERY
basis for instituting appropriate
 The three (3) cleans namely: Clean hands, Clean
measures/interventions.
surface and Clean cord should be strictly followed to
prevent infection.
 Safe Delivery – Attendant must be aware of early
TETANUS TOXOID IMMUNIZATION
signs of complication to be able to refer properly and
 Tetanus is caused by an anaerobic spore forming timely.
bacteria called clostridium tetani
 All pregnant woman shall be given Tetanus Toxoid Home Delivery Kit (Basic)
Immunization to prevent neonatal tetanus or tetanus 1. Flashlight
neonatorum among newborns. 2. A pair of scissors / razor blade
 A mother with 3 doses of DPT vaccine as a child is 3. Soap and handbrush
categorized as TT1 and TT2. Begin with TT3. 4. Two pairs of clamps / strings
 TT1 – as early as possible or anytime during 5. Clean towel / piece of cloth
pregnancy / 5th to 6th month of pregnancy 6. Antiseptic (70% alcohol / Povidone lodine)
o 80% protection 7. BP apparatus
 TT2 – 4 weeks after TT1
o 80% protection; 3 years
 TT3 – 6 months after TT2 SUPPORT TO BREASTFEEDING
o 90% protection; 5 years
 TT4 – 1 year later after TT3 The Benefits of Breastfeeding
o 99% protection; 10 years To Infants:
 TT5 – 1 year later after TT4 1. Provides nutritional complete food for the young
o 99% protection; lifetime protection infant.
2. Strengthens the infant's immune system, preventing
many infections.
MICRONUTRIENT SUPPLEMENTATION 3. Safely rehydrates and provides essential nutrients to
a sick child, especially to those suffering from
 It is necessary to prevent anemia, vitamin A
diarrheal diseases.
deficiency and other nutritional disorders.
4. Reduces the infant's exposure to infection.
 Vitamin A Supplementation – given 10,000 IU two
times a week starting on the 4th month of pregnancy
To Mother:
and not before the 4th month to avoid congenital
1. Reduces a woman's risk of excessive blood loss after
disorders.
birth.
2. Provides natural methods of delaying pregnancies.
 3. Reduces the risk of ovarian and breast cancers and
osteoporosis.

To Household and the Community:

1. Conserve funds that otherwise would be spent on
breast milk substitute, supplies and fuel to prepare
them.
2. Saves medical cost to families and government by
preventing illnesses and by providing immediate
postpartum and contraception.

FAMILY PLANNING COUNSELING

 Discuss in the first prenatal visitor the subsequent
visits.
 IUD, condom, progesterone only pill, natural family
planning, spermicides, and permanent method

Importance of Family Planning

 Family planning is important not only for the physical
health of the mother but also her psychological and
emotional health.
 The newborn is given adequate attention and caring
by the mother.
 It promotes the physical, emotional, social and
spiritual health of the entire family.

Goals of Family Planning

 The goals of family planning are to improve service
quality in health facilities and to increase demand and
access to modern contraceptive methods in both
public and private sectors.