1 - Overview of Maternal and Newborn Care

Click to edit Master title style
• Click to edit Master text styles

– Second level
• Third level
– Fourth level
» Fifth level
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– Second level
• Third level
– Fourth level
» Fifth level
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Click to edit Master
Learning title style
Objectives
• At
Click
theto edit
end Master
of the textthe
module, styles
participants must be
– Second
able levelthe:
to discuss
• Third level
• Current situation of maternal and newborn health
– Fourth level
• “Three delays”
» Fifth level
• Millennium Development Goals
• The MNCHN Strategy
• Interventions to reduce maternal & newborn
mortality
• Enabling laws and administrative orders
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– Second level
• Third level
– Fourth level
» Fifth level
Screen shot by Mark Leon Goldberg, May 16, 2012, UN Dispatch

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Click toHealth:
Maternal edit Master title
Scope of thestyle
Problem
• Maternal mortality is unacceptably high.
• 800 women die from pregnancy or its complications
– Second level
worldwide = 1 woman dying every 2 minutes
• Third level
• 50 % decrease
– Fourth level from 1990 statistics of 540,000
maternal deaths
» Fifth level to 287, 000 in 2010
• Most are preventable and in low-resource settings

• 99% of maternal deaths occur in developing countries
• Women developing countries have 15X risk of dying
from pregnancy and related complications.
(WHO Health Statistics, 2012)
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Most maternal deaths occur during labor,
delivery and the immediate post-partum period
– Second level
• Third level
– Fourth level Percent of maternal deaths in developing
countries
» Fifth level
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. Li et al., International Joumal of Gynecology & Obstetrics 54 (1996): 1-10

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Click toHealth:
Neonatal edit Master title
Scope of thestyle
Problem
• • Click
Everytoyear
edit Master text styles
4 M neonatal deaths
––Second levelwho die in the first month, 2/3 die
Of those
• Third
in thelevel
first week
– Fourth level
– 8 neonatal deaths every minute
» Fifth level
– 4 million stillbirths
• Philippines is one of 42 countries that
account for 90% of global under-five deaths
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Click toHealth:
Neonatal edit Master title
Scope of thestyle
Problem
• Click to edit Master text styles Prematurity 27%
– Second level Asphyxia 26%

• Third level
– Fourth level Infection
» Fifth level (Sepsis+Pneumonia)
10%
Congenital Anomalies
9%
Neonatal Tetanus 2%
Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)

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Reasons for High Maternal and
Neonatal Mortality
• –Young
Second age
levelat marriage & first pregnancy
• Third level
• Domestic violence and gender inequality
– Fourth level
• Poor maternal
» Fifth levelhealth
• Poor hygiene during and after delivery

• Lack of/poor newborn care
• The three delays
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The Three Delays
Delay in deciding to seek medical care
 – Failure
Second to recognize danger signs
level
 Lack of level
• Third money
– Fourth level
 Unplanned/unwanted pregnancy
» Fifth level
 Lack of companion in going to health facility
 No person to take care of children/home
 Fear of being ill treated in
health facility
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The Three Delays
Click toinedit
Delay Masterand
identifying title style
reaching
appropriate facility
 – Distance
Second levelfrom a woman’s home to health
facility/provider
• Third level
 Lack– of/poor
Fourth levelcondition of roads
Fifth level
 Lack of»emergency transportation
 Lack of awareness of existing services
 Lack of community support
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6/13/2012 11
The Three Delays
Click
Delayto
in edit Master
receiving title style
appropriate and
adequate care at health facility
 – Second
Lack oflevel
health care providers
• Third level
 Shortage of supplies
– Fourth level
 Lack of» equipment
Fifth level
 Lack of competence
of health providers
 Weak referral system
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6/13/2012 12
– Second level
• Third level
– Fourth level
» Fifth level
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Click 4:
MDG to edit Master
Reduce title
Child style
Mortality
Target:
– SecondReduce
level Child Mortality by 2/3
between 1990 and 2015
• Third level
– Fourth level
Indicators: » Fifth level
Reduce Under 5-mortality rate

• From 80.0 to 26.7 (per 1,000 LB)
Reduce Infant mortality rate
• From 57.0 to 19.0 (per 1,000 LB)
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Click5:
MDG toImprove
edit Master title style
Maternal Health
– Second: level
Target Reduce maternal mortality
• Third level
by 75% by 2015
– Fourth level
» Fifth level
Reduce Maternal Mortality Ratio

• From 209 to 52/100,000 LB
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– Second level
• Third level
– Fourth level
» Fifth level
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– Second level
• Third level
– Fourth level
» Fifth level
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– Second level
• Third level
– Fourth level
» Fifth level
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Howtowill
Click editweMaster
make ittitle
happen?
style
(Current tools to avert maternal death and disability)
• –ASecond
skilled levelhealth care professional
attends every childbirth
• Third level
– Fourth level
• Every woman» Fifth level 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
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Click to edit
Skilled Master
Health Caretitle style
Worker
• “The
Clicksingle most
to edit important
Master textway to reduce maternal
styles
deaths is to ensure that a skilled attendant is present at
– Second
every birth.”level
(Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of Maternal Mortality, 1999)
• Third level
– Fourth
• A SKILLED level
ATTENDANT is an accredited health
» Fifth(a
professional level
midwife, nurse or doctor) who has
been educated and trained to proficiency in the skills
needed to manage normal pregnancies, childbirth
and the immediate postnatal period, and in the
identification, management and referral of
complications in women and newborns.
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MNCHN Service Delivery Network
End-Referral facility (Provincial hospitals etc):
BEMONC services + BT, CS and Advanced NB
• Click to edit Master text styles Resuscitation; Operates 24 hrs, with OB/surgeon,
CEmONC pedia, nurse, MW, med tech
– Second level
End-referral
• ThirdBEmONC
level Normal vaginal delivery, imminent breech
– Fourth level delivery, emergency drugs (antibiotics, MgSO4,
FACILITY oxytocin, dexamethasone), ENC, Basic NB
» Fifth
District level &
Hospitals
Rural Health Units with SBA’s,
resuscitation, FP services
Private Lying In Clinics
Pregnancy tracking, birth
planning, home visits & follow-up,
nutrition package incldg
Community Level breastfeeding support; IEC on
Service Provider: facility delivery & family planning;
Community Health Teams communication activities targeted
to mothers and their families
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Emergency Obstetric and Newborn Care
(EmONC)
• • Click
Elements
to editofMaster
obstetric
textand
styles
newborn care
–needed
Second for
levelthe management of normal and
complicated
• Third level pregnancy, delivery, postpartum
periods– Fourth
andlevel
the newborn
» Fifth level
– Early detection and treatment of problem
pregnancies to prevent progression to an
emergency.
– Management of emergency complications*
Definition
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Basic Emergency Obstetric and
Newborn Care (BEmONC)
•• Click to edit
Parenteral (IV Master text styles of emergency drugs
or IM) administration
––Second
Oxytocin
level
– Anticonvulsants
• Third level
– Fourth level
– Antibiotics
» Fifth level
– Dexamethasone
• Manual Removal of Placenta
• Removal of Retained Products of conception
• Assisted Vaginal Delivery (imminent breech delivery)
• Essential Newborn Care
• Basic Newborn Resuscitation
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Comprehensive Emergency Obstetric
and Newborn Care (CEmONC)
All
– Second level BEmONC Services
• Third level
– Fourth level
PLUS
» Fifth level
• Surgery (Cesarean section, Hysterectomy)
• Blood Transfusion
• Advanced Newborn Resuscitation
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The
Click to Midwifery
edit MasterAct ofstyle
title 1992
Practice of Midwifery defined
• 1.Click to edit Master text styles
care of women during pregnancy, labor and
– Second level management of normal deliveries
puerperium;
• Thirdeducation
2. health level of the patient, family and
– Fourth level
community;
» Fifth level
3. primary health care in the community, including
nutrition and family planning
4. carrying out the written order of physician with
regard to antenatal, intranatal and postnatal of the
normal pregnant mother,
5. giving immunization
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Click to edit
Skills Master
required title style
by R.A.7392
• Internal examination during labor
– Second level
• Repair
• Thirdoflevel
obstetric perineal lacerations
– Fourth level
• Intravenous fluid insertion

» Fifth level
• Oxytocics after delivery of placenta

• Vitamin K for newborn
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Click to edit Master
Administrative Ordertitle style
2010-0014
• Known as the General Guidelines for the “Administration
of Lifesaving Drugs and Medicines By Midwives to
–Rapidly
Second level Maternal and Neonatal Morbidity and
Reduce
• Third level
Mortality”
– Fourth level
– “… midwives are hereby allowed to administer lifesaving
» Fifth
drugs such as level
magnesium sulfate, oxytocin, steroids and
oral antibiotics, provided they are appropriately trained
and certified proficient to perform the necessary care and
services to prevent maternal and newborn deaths.”
– It is clear that these interventions are meant to be
provided under emergency conditions when no physician
is available
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Click to edit
Principles Master titleConduct
of Professional style
•• Click to edit Master
In providing text styles
professional services, a certain
–level of competence
Second level is necessary.
• Third level
• Professionals shall undertake only those
– Fourth level
services »that they can reasonably deliver with
Fifth level
professional competence.
• Keep up with new knowledge and techniques
in their field, continually improve their skills
and upgrade their level of competence, and
take part in a lifelong continuing education
program.
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Click to edit
Key Master title style
Messages
• Most maternal and neonatal deaths occur during the
–critical
Second level covering labor, delivery and the
period
• Third level
immediate postpartum period.
– Fourth level
• The 4 major direct
causes of maternal mortality are:
» Fifth level
(1) hemorrhage
(2) hypertension
(3) obstructed labor
(4) complications from abortion
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Click to edit
Messages
• The 3 delays act as barriers to accessing health care
–
onSecond level may result to death.
time. Delay
• Third level
• The interventions
– Fourth level that can save maternal and
newborn »lives:
Fifth level
(1) a skilled health professional attending every
childbirth
(2) access of every mother and newborn to EmONC
(3) family planning services to help a woman space
her pregnancies
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Click to edit
Messages
• • Click
The to edit Master
practice text styles
of midwifery is governed by the
–Midwifery
Second level Act of 1992 (R.A.7392) and
• Third level
modified by Administrative Order 2010-0014
– Fourth level
General Guidelines
» Fifth level
“Administration of
Lifesaving Drugs and Medicines By Midwives
to Rapidly Reduce Maternal and Neonatal
Morbidity and Mortality”
• The midwife performs specific signal functions
or services as a member of a BEmONC team
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– Second level
• Third level
– Fourth level
» Fifth level
Giving birth should be about

giving life, not giving up a life.
7/28/2018 32

1 - Overview of Maternal and Newborn Care

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Click to edit Master title style

• Click to edit Master text styles

Screen shot by Mark Leon Goldberg, May 16, 2012, UN Dispatch

• Most are preventable and in low-resource settings

Day of maternal death after delivery

Source: X. F. Li et al., International Joumal of Gynecology & Obstetrics 54 (1996): 1-10

– Second level Asphyxia 26%

Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)

• Poor hygiene during and after delivery

Reduce Under 5-mortality rate

Reduce Maternal Mortality Ratio

• Intravenous fluid insertion

• Oxytocics after delivery of placenta

Giving birth should be about

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