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NCM 33 Lecture health supervision and efficient medical attention, and is taught the elements
Instructor: Barbara Lyn Galvez of healthy living (Reyala, 2000).
Transcribed by: Claire J. Tenaja
Philosophy of MCN
Framework for Maternal and Child Nursing
Is community-centered Protects the rights of all family members do a daily
Newborn - 0-28 days body scan
Infant - after 28 days
● Some books say they are both the same Is research-centered Use of existing knowledge in a new and creative
way so as to generate new concepts,
Childbirth is 50/50 methodologies, and understandings
● Mother dies child lives or vise versa
Is based on nursing Places importance on promotion of health
theory
Health of the Mother and Child:
● Involves the whole family, not just the mother or child
Is based on the belief Personal, cultural, and religious, attitudes and
● Doctor will first give the information, not the nurse (e.g. bleeding of the that pregnancies or beliefs influence the meaning of pregnancy for
mother) childhood illness are individuals and make each experience unique
stressful because they
What is the most critical year of a child’s life? 1st year are crises
→ immunizations are common (hepa B, BCG, polio, oral polio)
→ immunizations help protect babies from diseases Is a challenging for for Maternal-child nursing is family centered. The
the nurse and is a major father of the child is as important as the mother
factor in promoting high
When are the most vital moments of a pregnancy? 1st Trimester/First 3 months level wellness in
Framework for maternal and child health nursing families
- Provides guidance and direction to implementation of programs and research-centered
interventions in maternal/reproductive, newborn and child health
- A structure that facilitates implementation of child and maternal health Pregnancy, labor and
delivery and the
puerperium are part of
Obstetrics - Care of woman during childbirth; derived from Greek work “obstare” (to
the continuum of the
keep watch) total life cycle. Is based
on nursing theory.
Pediatrics - derived from Greek word, “pais” (child)

Postpartum - up to 6 weeks before involution

Focus on MCN (Maternal and Child Nursing) - Care of childbearing and
Involution - before uterus returns back to normal
childbearing families

Strategic Thrusts (2005-2010)

What is the difference between obstetrics and pediatrics?
Basic emergency obstetric care
● Launch and implement the Basic Emergency Obstetric Care strategy in
Primary goal of MCH - promotion and maintenance of optimum health of the mother
coordination with the DOH.
and newborn
● It entails the establishments of facilities that provide emergency obstetric
care for every 125,000 population and which are located strategically.
Goals of MCH (Maternal and Child Health)
Prenatal and postnatal care
1. To ensure that every expectant and nursing mother maintains good health,
● Improves the quality of prenatal and postnatal care
learns the art of child care, has normal delivery and bears healthy child
Women’s Health Risks and Reduction
2. That every child, wherever possible lives and grows up in a family unit with
love and security, in healthy surroundings, receives adequate nourishment,
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● Reduce women’s exposure to health risks through the institutionalization of b. Provision of warmth
responsible parenthood & provision of appropriate health care package to all c. Referral
women of reproductive age especially those who are less than 18 years old d. Blood transfusion: due to massive blood loss of mother
Health Advocation
● 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 newborn

Maternal Neonatal and Child Health and Nutrition Strategy (MNCHN)

- It applies specific policies and actions for local health systems 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 (BEMONC)

- Refers to lifesaving services for emergency maternal and newborn
condition/complications being provided by a health facility of professional
- Services include the following:
7 Signal Obstetric Functions
1. Parenteral antibiotics BeMONC shall operate within 24hours with 7 signal obstetric function. Shall have
- Injectable antibiotics due to complications relating to of access to communication and transportation facilities
infection to the mother Lying in Clinics → same service, lesser expenses
- If infection untreated, it would lead to sepsis
- Sepsis: generalized infection → can reach up to the brain Staff composition
2. Parenteral uterotonics ● Medical doctor
- Uterotonics: products that induce contractions ● Registered nurse
3. Parenteral anticonvulsants ● Registered midwife
- Given by injection to stop convulsive seizures to mothers
in labor Comprehensive Emergency Obstetrics and Newborn Care (CEMONC)
4. Manual removal of the placenta - Refers to lifesaving services for emergency maternal and newborn
- Retaining the placenta will cause infection to the mother condition/complications as in BeMONC plus the provision of surgical delivery
5. Removal of retained products of conception and blood bank services and other specialized obstetric interventions
6. Assisted vaginal delivery - BeMONC + surgical delivery + blood bank services
- Nurses assist doctors and midwives in delivering babies ● blood bank → blood donations for whenever the mother is bleeding
- 3 [student] nurses in delivery ● Vaginal birth → 500 mL of blood
● handle nurse → gets the baby ● Cesarian Birth → 1000mL of blood or more
● assisting nurse → cutting placenta
● initial care nurse → takes care of baby like Essential Health Services Available in the Health Care Facilities
resuscitation A. Antenatal Registration/Prenatal Care
7. Resuscitation of the newborn Objective: to reach all pregnant women, to give sufficient care to ensure a
healthy pregnancy and the birth of a full term healthy baby
- Available in all health facilities
Performance of Assisted Vaginal Deliveries - Not limited only for pregnant mothers:
- Removal of retained placental product it also includes neonatal interventions Normal Healthy instructions and counseling advice for
which include at the minimum: prompt prenatal care examination
a. Newborn resuscitation
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○ Dose: 60mg/400ug tablet
Mild complications: ● Thorough evaluation
○ Schedule: daily
● Will determine the frequency of follow-up
● Folic acid supplementation (very important)
of these cases by the rural health unit, city
○ prevents neurological conditions to the newborn
health clinic or puericulture center
○ If mothers don’t take this, there are cases where babies are born
without a skull (anencephaly) → will lead to death due to fragility
Potentially serious Referred to the most skilled source of medical and
complications hospital care (like NOPH)
Clean and Safe Delivery
Check for emergency signs (7 Danger signs of pregnancy)
- All RHUs and BHS should have a master list of pregnant women in their 1. Unconsciousness - May lead into seizures
respective catchment center 2. Vaginal bleeding - Not normal
- The Home Based Mother’s Record (HBMR) shall be used when rendering 3. Severe abdominal bleeding
prenatal care as a guide in the identification of risk factors, danger signs and - Might be ectopic pregnancy → embryo is not grown in the uterus,
to be able to do appropriate measures fallopian tube (not a nourishing environment, might burst)
- There should be at least 3 prenatal visits following the prescribed timing: 4. Looks very ill - A pregnant woman is not sick
3 Prenatal visits 5. Severe headache with visual disturbance - Not normal in pregnancy
6. Severe breathing difficulty - Gasping for breath is not normal
First Prenatal Visit Early in pregnancy as possible, during the first
(1-3 months) trimester 7. Severe vomiting - Vomiting is not normal in 2nd to 3rd trimester

Second Prenatal Second trimester B. Make woman comfortable

Visit (4-6 months) C. Assess the woman in labor
● LMP: Last Menstrual Period
Third and Third and subsequent visits during the third ● Number of pregnancy
Subsequent Visits trimester. More frequent visits should be done for ● Start of labor pains
(6-9months and those at risk or with complications. ● Age/height
beyond)
● 7 Danger signs of pregnancy
4th* - postpartum (uncommon though, usually until 3rd ra)
Idk ngano walay D
Tetanus Toxoid Immunization E. Decide if the woman can safely deliver
● Important for pregnant women and child bearing age women to protect them F. Give supportive care throughout labor - be with the woman at always
from the deadly disease TETANUS G. Monitor and manage labor - monitor signs and check for emergencies
○ 2 doses of tt vaccination received 1 month before delivery to H. Monitor closely after delivery - monitor signs and check for emergencies
protect baby from neonatal tetanus, and; I. Continue care for at least two hours postpartum - monitor signs and check for
○ 3 booster dose shots to complete the five doses following the emergencies
recommended schedule provides full protection J. Inform, counsel, and teach woman - teach how to hold, care, burp the baby; cord
*The mother is then called as a “fully immunized mother” (FIM) care
*Total of 5 doses
Micronutrient Supplementation Home Delivery
Is necessary to prevent anemia, vitamin A deficiency and other nutritional disorders - Is normal for pregnancies attended by licensed health personnel
● Vitamin A - Is discouraged if woman is able to go to the hospital
○ Dose: 10,000 iu - Trained hilots may be allowed to attend home deliveries only in the following
○ Given a week starting on the 4th month of pregnancy (do not give it circumstances
before the 4th month of pregnancy because it might cause a. Areas where there are no health personnel and maternal care
congenital problems in the baby) b. When, at the time of delivery, such personnel is not available
● Iron

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c. Actively practicing but untrained birth attendants, (hilots) should be ○ By doing NBS, metabolic disorders may be detected even before
identified, trained and supervised by a personnel of interest clinical signs and symptoms are present
BHS/RHU trained on Maternal Care ● This treatment can be given early to prevent consequences of untreated
The following are qualified for home delivery: conditions
● Full term - retained in the uterus for the normal period of gestation before
birth a full-term newborn Timing
● Less than 5 pregnancies ● Ideally done within 48-72hrs of life
● Cephalic position - head first ● May also be done after 24hrs of birth
● Without exiting diseases - like high blood, asthma, allergies - Blood is taken from heel of baby, then placed on a paper (or a
● No history of complications place to put the blood), and then screened by the laboratory
- Treatment can be done immediately
Home delivery kit
● 2 pairs of [sterile] clamps *Watch videos on newborn screening*
● Pair of scissors
● Antiseptice (may use 70% Povidone/Iodine) Government programs that provide a safe and healthy baby-mother
● Soap and hand brush relationship
● Clean towel/piece of cloth The rooming-in and Breastfeeding Act of 1992
● Flashlight - To encourage, protect, and support the practice of breastfeeding
● Sphygmomanometer, stethoscope - Creates an environment where basic physical, emotional, and psychological
● Clean hands, clean surface, and clean cord must be strictly followed to need of mothers and infants are fulfilled through the practice of rooming in
prevent infection and breastfeeding
● Provide a safe and healthy mother and baby relationship
Guide for Home Delivery ● For early attachment/ binding with the mother
For registered patients ● Colostrum: necessary nutrients the baby needs (in mother's milk)
- Time when regular pains started ● Before wheeling out from OR, start breastfeeding immediately
- Whether bag of water ruptured or not
- Presence or absence of vaginal discharge and bleeding, etc., Milk Code of 198 Safe and Adequate Nutrition for Infants
- Whether mother moved her bowels and has urinated - Aims to contribute the provision of safe and adequate nutrition of infants by
- Fetal movement felt by the mother or not unusual symptoms such as the protection and promotion of breastfeeding; and by ensuring the proper
bleeding, headache, spots before eyes use of breastmilk substitutes and supplements when these are necessary
*sports in the eyes are danger signs (indicator of high blood - Call of intensification of the dissemination of information on breastfeeding
pressure, arterial spasm) and proper nutrition, and the regulation of advertising, marketing and
distribution of breastmilk substitutes and other related products, including
For unregistered patients bottles and teats
- Get same information as for those registered patient ● Commercial milk is DISCOURAGED
- Get medical and obstetric history ● Mothers should breastfeed their babies
● Exclusive breastfeeding for babies
Newborn Screening (NBS)
- Is a public health program aimed at the early identification of infants who are Family planning counseling
affected by certain genetic/metabolic/infectious conditions - Support a woman and her partner in choosing the method of family planning
- Early identification and intervention can lead to significant reduction of that best suits them and to support them in solving any problems that may
morbidity, mortality, and associated disabilities in affected infant arise with the selected method
-
Significance of Newborn Screening Quiz - 25 August 2021, 7:30 am
● Most babies with metabolic disorders look “normal” at birth Class at 9am
TENAJA 2021 | NCM 33 Lecture