Maternal Health

Program
ABULENCIA, Nicole Chrislene
B. BANAGEN, Philip B.
BANTAC, Ely Grace
COMAFAY, Yazel Shane
Maternal Health Program
Antenatal registration
Tetanus toxoid immunization
Micronutrient supplementation
Treatment of diseases and others
Clean and safe delivery
The Philippine Situation
Maternal mortality ratio: number of women who die
during pregnancy and childbirth, per 100,000 live
births.
MMR is considerably high at 162/100,000 LB (2006)
MDG target reduction: 75% (121/100,000 LB) * 2017
years (change of 2.42 %)
MMR 2016: 124/100,000 LB
Current situation
current level of maternal mortality in the Philippines
is mostly attributed to the predominance of home
births (61%)* and the relatively high proportion
(37%) of these births assisted by traditional birth
attendants (TBAs) or “hilots”

*per the 2003 National Demographic and Health*

Current situation
88% of women who had a live birth saw a health
professional for antenatal care.
Yet, a significant number eventually ended up giving
birth at home, attended by a TBA.
women are generally aware of the importance of
skilled care by a health professional during pregnancy.
However, when it comes to childbirth, a significant
number are either unwilling to seek the same level of
care or are unable to overcome obstacles to accessing
such care
Gaps noted
1) emergency obstetrics and newborn care services
are available only in secondary and tertiary level
health facilities such as big district hospitals,
provincial hospitals and medical centers, facilities
that are not geographically accessible to majority of
women,
Gaps noted
2. Past policy on maternal care accommodated TBA
training and home deliveries assisted by TBAs
3. Failure to link TBAs to the formal health system
4. Failure of the health system to address women’s
issues that result to their deciding to give birth at
home rather than in hospitals or health centers
5. Poor access to family planning commodities
Maternal Mortality
Reduction: What Works
joint statement by WHO, UNFPA, UNICEF and the
World Bank in 1999, calling on countries to: “Ensure
that all women and newborns have skilled care
during pregnancy, childbirth and the immediate
postnatal period.”
What works
Such care is to be provided by a skilled birth
attendant: an accredited health professional who
has been educated and trained in the skills
needed to manage the critical stages in
pregnancy and childbirth as well as in the
identification, management and referral of
complications: Midwife, Nurse, or Doctor.
strategy encouraging home
deliveries has distinct
disadvantages:
home conditions can be very basic and could
limit the ability of the skilled attendant to deal
with emergencies, especially since the attendant
has only the family to rely on to assist rather than
other providers such as doctors or nurses in
health centers or hospital
Disadvantage of home
deliveries
home-based deliveries are inefficient in terms of
not only the skilled attendant’s time but also that
of the supervisor (who is most likely the already
overburdened rural health physician).
Conclusion made
“The best intrapartum-care strategy is likely
to be one in which women routinely choose
to deliver in a health centre, with midwives as
the main providers, but with other attendants
working with them in a team” (Campbell et al.
2006)
Goals and expected outcomes
80% of pregnant women with at least 4
antenatal visits by 2010; 100% by 2015
(baseline, 2003 NDHS: 70%).

80% facility-based deliveries by 2012;

90% by 2015 (baseline, 2003 NDHS:
39%).
Most desired outcome

no woman dies giving birth

The MNCHN Core Service
Package
For the women, this consist of services that span
the period before pregnancy to post childbirth
services that include essential newborn care during
the first week of life.
To assure the safety of mothers and newborns, the
following standards of care must be delivered in all
facilities within the MNCHN service delivery
Network.
Components of Maternal
(and Newborn) care
A. BASIC EMERGENCY OBSTETRIC AND
NEWBORN CARE (BEmONC)

B. COMPREHESIVE EMERGENCY OBSTETRIC

AND NEWBORN CARE (CEmONC)
Pre-pregnancy package of services
a. Micronutrient supplementation consisting of
important minerals and vitamins such as zinc,
iodine, calcium, vitamin A capsules and iron
tablets

b. Tetanus toxoid immunization following the

recommended schedule
Pre-pregnancy package
c. Family Planning
IEC and FP counseling: modern methods and
fertility awareness and observing the
principles of informed choice, birth spacing,
responsible parenthood and respect for life.
Contraceptive provision as appropriate
Pre-pregnancy package
d. Provision of oral health services
e. Counseling on STI/HIV/AIDS, nutrition, personal
hygiene, and the consequences of abortion
f. STI screening using syndromic approach
g. Adolescent and youth health services including
peer and professional counselling and RH
education
Pre-pregnancy package
i. Promotion of healthy lifestyle:smoking
cessation, healthy diet, regular exercise and
moderate alcohol intake.
j. Management of lifestyle-related diseases like
diabetes, cardiovascular disease (CVD), etc.
k. Prevention and Management of other diseases
including tuberculosis, malaria (e.g. provision of
insecticide treated bed nets for malaria-infested
areas)
 Complete Pre-Natal Package
A. Provision of essential antenatal care services
 Monitoring of height and weight
 Taking the blood pressure
 Screening and blood testing including Complete
Blood Count, blood Typing, urinalysis, VDRL or
RPR, HbSAg, blood sugar screening, pregnancy
test, cervical cancer screening using acetic acid
wash and papanicolau smear.
 Micronutrient supplementation (iron, folate and
Vitamin A supplementation)
 Malaria prophylaxis where appropriate
 Deworming
 Birth planning
 Complete Pre-Natal Package
B. Promotion of exclusive breastfeeding, newborn
screening, BCG and Hepatitis B birth dose
immunization.
C. Counselling on :
use of modern FP methods especially lactation
amenorrhea (LAM), with focus on health caring
and health seeking behaviors.
contraception including surgical procedures
where appropriate: bilateral tubal ligation (BTL),
no-scalpel vasectomy (NSV) and management of
complications resulting from contraception
 Complete Pre-Natal Package

D. Laboratory screening and medical

management of STI-HIV cases and their
complications.
E. Counseling on Healthy Lifestyle with focus on
smoking cessation, healthy diet and nutrition,
regular exercise, STI control HIV prevention
and oral health.
F. Prevention and management of early bleeding
in pregnancy
 Complete Pre-Natal Package

G. Administration of antenatal loading dose of

steroids for threatened premature delivery.
H. Early detection and management of signs of
complications of pregnancy
 Complete Pre-Natal Package
I. Measurement of fundic height against the age
of gestation, fetal heart beat and fetal
movement count to assess the adequacy of
fetal growth and wellbeing.
J. Prevention and management of other
conditions as indicated:
• Hypertension • Anemia
• Diabetes • Tuberculosis
• Malaria • Schistosomiasis
• STI/HIV/AIDS
Provision of other support services
Antenatal registration through active tracking by the
WHTs
o Birth Planning
o Home visits and follow up
o Safe blood supply
o Transportation and communication support
services
Antenatal Registration:

What is it?
The antenatal register chronicles each visit made during the
antenatal period.

What is its function?

It assists staff to monitor pregnancy risk and to log the delivery of
routine preventive services; including deworming, intermittent
preventive treatment for malaria (IPT), tetanus toxoid vaccination,
RPR screening for syphilis and insecticide treated net (ITN)
distribution.
Recommended antenatal visits:
At least four antenatal visits are recommended
ideally with the first visit in the first trimester of
pregnancy. The schedule may vary between
countries and monitoring requirements should be
adapted to the policy of the DOH.
Data collected during antenatal registration:
 basic identifying information
 obstetric history
 unique identifying code (or antenatal
number)
Risk Factors
The date and the presence of antenatal risk factors
should be logged at the first and all subsequent
visits. The baseline hemoglobin should also be
recorded at the first visit and, if indicated, at each
repeat visit.
recommended schedule 
of prenatal visits:
Weeks 4 to 28: 1 prenatal visit a month.

Weeks 28 to 36: 1 prenatal visit every 2

weeks.

Weeks 36 to 40: 1 prenatal visit every week.

 Micronutrient supplementation

consisting of important minerals and vitamins

such as zinc, iodine, calcium, vitamin A capsules
and iron tablets
o Iron folate 60 mg tablets 1 tablet daily for 3-6
months.
o Vitamin A at least 5000 IU every week (a daily
multivitamin supplement maybe taken as
option when the required vitamin A is not
available).
o Promotion of use of iodized salt.
Tetanus Toxoid Immunization

Tetanus vaccine, also known
as tetanus toxoid (TT) is an
inactive vaccine used to
prevent tetanus.
Tetanus toxoid vaccination is recommended for all
pregnant women & child bearing age women,
depending on previous tetanus vaccination
exposure, to prevent neonatal tetanus.

2 doses of tetanus toxoid vaccination must be

received by a woman 1 month before delivery.
3 booster dose shots
“Fully immunized mother” (FIM)
Deltoid – site of administration
Intramuscular (IM) – route of administration
 PREGNANCY
COMPLICATION
S
PREGNANCY
COMPLICATIONS
Complications of pregnancy are health problems
that occur during pregnancy. They can involve the
mother’s health, the baby’s health, or both. Some
women have health problems that arise during
pregnancy, and other women have health
problems before they become pregnant that could
lead to complications. It is very important for
women to receive health care before and during
pregnancy to decrease the risk of pregnancy
complications.
 DURING
PREGNANCY
Pregnancy symptoms and complications can range from
mild and annoying discomforts to severe, sometimes life-
threatening, illnesses. Problems during pregnancy may
include physical and mental conditions that affect the
health of the mother or the baby. These problems can be
caused by or can be made worse by being pregnant.
Always contact your prenatal care provider if you
have any concerns during your pregnancy.
 What health problems can
develop during pregnancy?
HYPERTENSION (HIGH BLOOD
PRESSURE)
One of the most common complications during pregnancy. Chronic
poorly-controlled high blood pressure before and during pregnancy
puts a pregnant woman and her baby at risk for problems. It is
associated with an increased risk for maternal complications such
as preeclampsia, placental abruption (when the placenta separates
from the wall of the uterus), and gestational diabetes. These women
also face a higher risk for poor birth outcomes such as 
preterm delivery, having an infant small for his/her gestational age,
and infant death.
 WHAT TO DO TO REDUCE
THE RISK OF
COMPLICATIONS?
Keep your prenatal appointments. Visit your health care provider regularly
throughout your pregnancy.
Take your blood pressure medication as prescribed. Your health care
provider will prescribe the safest medication at the most appropriate dose.
Stay active. Follow your health care provider's recommendations for physical
activity.
Eat a healthy diet. Ask to speak with a nutritionist if you need additional
help.
Know what's off-limits. Avoid smoking, alcohol and illicit drugs. Talk to
your health care provider before taking over-the-counter medications.
Taking good care of yourself is the best way to take care of your baby.
What health problems can
develop during pregnancy?
IRON DEFICIENCY ANEMIA
Anemia is having lower than the normal number of
healthy red blood cells. Women with pregnancy
related anemia may feel tired and weak.
This can be helped by taking iron and folic acid
supplements.
Your health care provider will check your iron
levels throughout pregnancy.
What health problems can
develop during pregnancy?
GESTATIONAL DIABETES
Gestational diabetes occurs when blood
sugar levels are found to be too high during
pregnancy. 
Treatment includes controlling blood sugar
levels through a healthy diet and exercise,
and through medication if blood sugar
values remain high.
 What health problems can
develop during pregnancy?
MENTAL HEALTH CONDITIONS
Some women experience depression during or after pregnancy.
Symptoms of depression are a low or sad mood, loss of interest
in fun activities, changes in appetite, sleep, and energy. Problems
thinking, concentrating, and making decisions, feelings of
worthlessness, shame, or guilt, and thoughts that life is not worth
living.
There are natural ways to treat depression during pregnancy such
as exercise, get adequate of sleep, diet and nutrition, and herbal
remedies (vitamin supplements).
What health problems can
develop during pregnancy?
FETAL PROBLEMS
Possible problems in the fetus include
decreased movement after 28 weeks of
pregnancy and being measured as smaller
than normal. These pregnancies often
require closer follow-up including more
testing such as ultrasound exams, non-stress
testing and biophysical profiles as well as
possible early delivery.
What health problems can
develop during pregnancy?
Hyperemesis Gravidarum
Many women have some nausea or vomiting, or
“morning sickness,” particularly during the first
3 months of pregnancy. However, hyperemesis
gravidarum occurs when there is severe,
persistent nausea and vomiting during pregnancy
—more extreme than “morning sickness.” This
can lead to weight loss and dehydration and may
require intensive treatment.
 Hospital treatment may
include all of the following:
Intravenous fluids (IV) – to restore hydration, electrolytes,
vitamins, and nutrients.
Tube feeding:
◦ Nasogastric – restores nutrients through a tube passing
through the nose and into the stomach.
◦ Percutaneous endoscopic gastrostomy – restores nutrients
through a tube passing through the abdomen and into the
stomach; requires a surgical procedure.
Medications – metoclopramide, antihistamines, and antireflux
medications
 CLEAN
AND SAFE
DELIVERY
1. Do Check Upon Admission for Emergency Signs

 Ask the birth companion to call for help if:

- The woman is bearing down with contractions.
- There is vaginal bleeding.
- She is suddenly in much more pain.
- She loses consciousness or has fits.
- There is any other concern.
2. Make the woman comfortable

 Establish rapport with the client by taking to her to make

her comfortable.
 Explain all procedures, seek permission, and discuss
findings with the woman.
 Keep her informed about the progress of labour.
 Praise her, encourage and reassure her that things are going
well.
3.Assess woman in
labor
 History of this labour:
- When did contractions begin?
- How frequent are contractions? How strong?
- Have your waters broken? If yes, when? Were they clear or
green?
- Have you had any bleeding? If yes, when? How much?
- Is the baby moving?
Check record, or if no record:
- Ask when the delivery is expected.
- Determine if preterm (less than 8 months pregnant).
If prior pregnancies:
- Number of prior pregnancies/deliveries.
- Any prior caesarean section, forceps, or vacuum, or other
complication such as postpartum
4. Determine the Stage of Labor
 the labor can be determine when woman response to contraction is
observed.
 explain to the pregnant that you will give her a vaginal examination
and ask for her consent.
♦ Look at vulva for:
- bulging perineum
- any visible fetal parts
- vaginal bleeding
- leaking amniotic fluid; if yes, is it meconium stained, foul-
smelling?
- warts, keloid tissue or scars that may interfere with delivery.
♦ Perform vaginal examination:
- DO NOT shave the perineal area.
*Prepare:
- clean gloves
- swabs, pads.
- Wash hands with soap before and after each examination.
- Wash vulva and perineal areas.
- put on gloves.
- Position the woman with legs flexed and apart.
5. Give supportive care through out the labor

 Encourage the woman to walk around freely

during the first stage of labor.
 Encourage the woman to bathe or shower or
wash herself and genitals at the onset of labor.
 Encourage the woman to empty her bladder
frequently. Remind her every 2 hours.
 Encourage her to use the breathing technique
breathe out more slowly, making a sighing
noise, and to relax with each breath
 Encourage companion to:
- massage the woman's back if she finds
this helpful.
- hold the woman's hand and sponge her
face between contractions.
6. Monitor and Manage Labor
●Different stages of labor to watch out for any danger
signs.

Stages of Labor What to do Not to do

 First Stage of Labor
(Early Labor and Active)
- longest part of labor - Go for a walk Don't allow the
and can last up to 20 hours. - Take a shower or patient to push yet
- cervix starts to open bath - Do not to vaginal
(dilate). - Listen to relaxing examination if it is
- dilates from 0 to 3 music 3cm wait until it
centimeters - Try breathing or reaches 4cm
- Mild contractions: relaxation techniques
start 5 to 20 minutes apart taught in childbirth
and last 60 to 90 seconds class
- divided into 2 phase: - Change positions
> latent phase
> active phase
 Second -never leave the -
Stage of patient alone
Labor when she has
(Birth of been transferred
to the delivery
Baby) room
- cervix is -encourage the
fully dilated at client to rest
10 centimeters between
- stage may contractions and
last two hours to push with
or longer. constractipn
- Position he
clients leg
lithotomy
position
- monitor the
patients blood
pressure and
fetal heart rate
every 5 minutes
 Third Stage of - deliver the - Tell to the
Labor placenta patient not to
(Delivery of - Check the massage the
Placenta) placenta for abdomen to
- begins after the completeness. deliver the
baby is born and - Check the placenta.
ends chord for 3
- called vessels and 2
“afterbirth” small arteries
- last from a and one larger
few minutes to vein
20 minutes - complications
- feel during delivery
contraction but or postpartum
it will be less
painful

* if there is any
small tear or
episiotomy it will
we stitched during
the labor.