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MDG COUNTDOWN

:
CAPACITY ENHANCEMENT
PROGRAM FOR MIDWIVES
ON MATERNAL AND
NEWBORN CARE

Presentation Overview
1. Maternal and Newborn deaths

in the Philippines
2. “Three delays”
3. Millennium Development Goals
4. Interventions to lessen

maternal & newborn mortality
(SBA, EmOC, FP)
5. Philippine Midwifery Law and
Midwifery Ethics

Too many mothers and newborns are dying every year… .

Li et al. International Joumal of Gynecology & Obstetrics 54 (1996): 1-10 . delivery and the immediate post-partum period Percent of maternal deaths in developing countries 0-1 day 2-7 days 8-14 days 15-21 days 22-30 days 31-42 days Day of maternal death after delivery Source: X. F..Most maternal deaths occur during labor.

1997 . Geneva.Leading Causes of Maternal Mortality USAID website (2006) adapted from “Maternal Health Around the World” World Health Organization.

Sobel Unang Yakap – Essential Newborn Care Presentation . most could have been prevented Source: CHERG estimates of under-five deaths. 2000-03 The Philippines is one of the 42 countries that account for 90% of global under-five mortality Source: H.82.000 Filipino children die annually.

Reasons for High Maternal and Newborn Mortality Rate • Young age at marriage & first pregnancy • Domestic violence and gender inequality • Poor maternal health • Poor hygiene during and after delivery .

2003 .Attendants and Place of Delivery Source: Philippine Health Statistics.

Three DELAYS 1.       Failure to recognize danger signs Lack of money Unplanned/unwanted pregnancy Lack of companion in going to health facility No person to take care of children/home. DELAY IN DECIDING TO SEEK MEDICAL CARE. Fear of being ill treated in health facility .

DELAY IN IDENTIFYING and REACHING THE APPROPRIATE FACILITY  Distance from a woman’s home to health facility/provider  Lack of/poor condition of roads  Lack of emergency transportation  Lack of awareness of existing services  Lack of community support .Three DELAYS 2.

Three DELAYS 3. DELAY IN RECEIVING APPROPRIATE and ADEQUATE CARE AT HEALTH  Lack of health care providers FACILITY  Shortage of supplies  Lack of equipments  Lack of competence of health providers  Weak referral system .

.

0 (per 1.MDG 4: Reduce Child Mortality Reduce Under 5-mortality rate from 80.7 (per 1.000 LB) Reduce Infant mortality rate from 57.0 to 19.000 LB) .0 to 26.

MDG 5: Improve Maternal Health To accomplish MDG 5: Reduce maternal mortality by 75% by 2015 (for the Philippines the target is to reduce MMR from 209 to 52 deaths per 100.000 live births). .

209 203 197 191 186 180 172 162 52 .

How will we make it happen? (Current tools to avert maternal death •and disability) A skilled health care professional attends every childbirth • Every woman has access to Emergency Obstetric and Newborn Care (EmONC) • Family planning services to help women space their pregnancies Source: Averting Maternal Death and Disability Program .

Skilled Care During Childbirth The single most important way to reduce maternal deaths is to ensure that a skilled attendant is present at every birth. 1999. Source: A Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of Maternal Mortality. .

and in the identification. nurse or doctor) who has been educated and trained to proficiency in the skills needed to manage normal pregnancies. Source: A Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of Maternal Mortality. management and referral of complications in women and newborns. *Manage was added in 2000 by the Inter-Agency Group for Safe Motherhood in recognition that some skilled attendants will also have competencies to manage complications. childbirth and the immediate postnatal period. . 1999.A SKILLED ATTENDANT is an accredited health professional (a midwife.

postpartum periods and the newborn. Management of emergency complications* BEmONC Definition CEmONC . Early detection and treatment of problem pregnancies to prevent progression to an emergency.EMERGENCY OBSTETRIC and NEWBORN CARE (EmONC) … the elements of obstetric & newborn care needed for the management of normal and complicated pregnancy. delivery.

EmONC Key Functions Parenteral (IV or IM) administration of Antibiotics Oxytocin Anticonvulsants Manual Removal of Placenta Removal of Retained Products of conception Assisted Vaginal Delivery Administration of corticosteroid for preterm labor Essential Newborn Care Surgery (Cesarean Section) Blood Transfusion .

Geneva. 1997 . Antibiotics Family Planning & Post Abortion Care Iron Suppl Malaria tx HIV Tx MgSO4 USAID website (2006) adapted from “Maternal Health Around the World” World Health Organization.Evidence Based interventions for Main Causes of Maternal AMTSL Mortality Partograph Oxytocin Clean delivery.

Functioning referral system .

The Midwifery Act of 1992 Practice of Midwifery defined 1. primary health care in the community. health education of the patient. care of women during pregnancy. including nutrition and family planning 4. carrying out the written order of physician with regard to antenatal. management of normal deliveries 2. intranatal and postnatal of the normal pregnant mother. labor and puerperium. giving immunization . 5. 3. family and community.

Internal examination during labor Skills R.7392 Repairrequired of obstetric by perineal lacerations Intravenous fluid insertion Oxytocics after delivery of placenta Vitamin K for newborn .A.

Source: Code of Good Governance for the Professions in the Philippines signed June 23. a Conduct certain level of competence is necessary. continually improve their skills and upgrade their level of competence. Keep up with new knowledge and techniques in their field. Professionals shall undertake only those services that they can reasonably deliver with professional competence.Principles of Professional In providing professional services. and take part in a lifelong continuing education program. 2003. .

The Way Forward 1. Invest in community education: • Eliminate delays 4. Know when & where to seek care if complications arise 3. Recognize signs & symptoms of obstetric complications 2. Create women friendly policies .

References 1. 7. 2. childbirth. 5. Freedman Lynn et al Linangan ng Kababaihan (Likhaan) Safe Motherhood poster Thank . Inc.Updated second edition: Pregnancy. 3. postpartum and newborn care: A guide for essential practice . National Demographic and Health Survey 2008 National Statistic Office (NSO) Philippines and ORC Macro Making Pregnancy Safer World Health Organization Geneva 2002 Averting Maternal Death and Disability Program materials Columbia University New York Managing Complications in Pregnancy and Childbirth World Health Organization Geneva 2003 Pregnancy. (CARE). The Millennium Project Background Paper Task Force on Child Health and Maternal Health March 2003. childbirth. 8. 4. 6. postpartum and newborn care 2003 World Health Organization Promoting Quality Maternal and Newborn Care: A Reference Manual for Program Managers. Copyright © 1998 Cooperative for Assistance and Relief Everywhere.