Chapter 8 – Continuation of

Maternal and Child care

LAWRENCE RYAN A. DAUG, RN, MPM
CHN 1 - INSTRUCTOR
Learning Objectives:

1. Describe the role of the public health nurse in implementing

government programs.

2. Initiate a program on how to increase utilization of services at the

community level
Antenatal care services (first 270 days)

Republic Act 11148, known as "Kalusugan at Nutrition ng Mag-

Nanay Act", focuses on scaling up the national and local nutrition

programs through a strengthened integrated strategy for maternal,

neonatal child health and nutrition in the first one thousand (1,000)

days of life.
1. Pregnancy Tracking and Enrollment to Antenatal Care (ANC)

Antenatal care (ANC) is defined as the care provided by skilled health

professionals to pregnant women and adolescent girls to ensure the

best health conditions for both mother and baby during pregnancy

(World Health Organization, 2016).

It helps to reduce maternal and perinatal morbidity and mortality both directly

through detection and treatment of pregnancy-related complications, and indirectly,

through the identification of women and girls at increased risk of developing

complications during labor and delivery. ANC ensures referral to an appropriate

level of care. Its components include risk identification, prevention and

management of pregnancy-related or concurrent diseases, and health education and

health promotion.
The tracking of pregnancies in the community by barangay health workers (BHWs)
is one of the factors that influence women to seek ANC consultation. BHWs provide
both navigation and basic service delivery functions, assist pregnant women in
developing birth plans, and help families facilitate access to critical health services.
“Bantay Buntis," a practice at the regional level by organized communities with
indigenous people, ensure pregnant women avail of professional assistance
throughout pregnancy, delivery and postpartum. This service extends to ensuring the
provision of basic health services to newborns up to their childhood.
Pregnancy Tracking Form
a. Health—History and potential risk factors such as:

 Age < 18 years old or >35 years’ old

 Height less than 145 cm (4'9")

 Multiparous women (having a fourth or more baby)

 One or more of the following: a previous cesarean section, 3 consecutive

miscarriages or stillborn baby, and/or postpartum hemorrhage

 One or more of the following medical conditions: tuberculosis, heart disease,

diabetes, bronchial asthma, or goiter If the mother has any of these factors, she
should be closely monitored by the midwife or referred to a physician and probably
need to deliver the baby in the hospital.
b. Caring for Pregnant Woman Healthy pregnancy means a healthy baby

 Prenatal Assessment. The physical examination includes GPTPAL, EDC, AOG, weight and

height, fundic height measurement, Leopold's Maneuver, fetal heart beat and fetal

movement. Likewise, laboratory examinations are conducted like complete blood count

with platelet, blood typing and Rh factor determination, urinalysis (Benedict's sugar and

acetic acid tests-albumin), screening tests for sexually-transmitted infection, blood sugar

screening (FBS, OGTT, HbA1c), pregnancy test, ultrasound, cervical cancer screening test

using acetic acid wash (VIAA) and Papanicolau (Paps) smear and Receive Tetanus Toxoid
 Watch out for any Danger Signs!

• Swelling of the legs, hands and/or face • Severe headache, dizziness, blurring of

vision • Vaginal bleeding • Pale skin • Vomiting • Convulsion • Difficulty in

breathing • Fever and chills • Too weak to get out of bed • Severe abdominal pain •

Foul-smelling vaginal discharge • Watery vaginal discharge • Painful urination •

Absence or decrease in baby’s movement inside the womb

c. Birth Preparation and Emergency Plans - Mother Baby Booklet and Birth Plan should
be used to indicate the mother's plan of care during labor and delivery, including her
preferences of birth attendant and available resources for childbirth and newborn care.
The basic contents of the birth plan:

 Place of delivery and method of transportation

 Person or personnel to assist her during delivery

 Expectations during labor and delivery

 Materials to prepare and estimated cost of delivery

 Possible blood donors and where the mother will be referred in case of emergency
2. Diphtheria Tetanus Toxoid Immunization

Diphtheria Tetanus (DI) toxoid immunization involves the intramuscular administration of

0.50 ml. diphtheria tetanus toxoid at the deltoid muscle. Two doses of the toxoid provide

protection to the baby against neonatal tetanus through natural passive immunity, while a

single dose offers protection only to the mother by artificial active immunity. A mother who

received the complete five (5) doses of diphtheria tetanus is called a fully immunized

mother.
3. Consumption of Iodized Salt - Iodine is essential for healthy brain development
in the fetus and young child. Iodine deficiency negatively affects the health of
women, as well as economic productivity and quality of life.
Most people need an additional source of iodine as it is found in relatively small
amounts in the diet. Iodization is the process of fortifying salt for human
consumption with iodine and is an effective strategy to increase iodine intake at the
population level.
4. Micronutrient and Macronutrient Supplementation
- Micro and macro-nutrient supplementation primarily focus on addressing nutrient
deficiencies namely: iron deficiency anemia. vitamin A deficiency, iodine deficient
disorder, and macronutrient deficiencies.
a. Iron Deficiency Anemia - A risk factor for neural tube defect such as spina

bifida and anencephaly. Iron deficiency ingestion anemia of is prevented through

the both supplemental iron and folic acid alongside vitamin C-rich food for better

absorption. However, mothers should be informed of the potential side effect which

includes teeth and stool discoloration. Aside from supplementation, natural sources

of iron and folate should be ingested such as red meat, liver, and green leafy

vegetables.
 For Pregnant women – 1tab/day for 6 months or 2 tabs/day if prenatal

consultation starts on the 2nd and 3rd trimester of pregnancy

 For Lactating women – 1 tab/day for 3 months or 90 days

 60 mg of elemental iron is 300 mg ferrous sulfate heptahydrate, 180 mg ferrous

fumarate or 500 mg of ferrous gluconate.

 Folic acid should be commenced as early as possible (ideally before conception)

to prevent neural tube defects.

b. Vitamin A Deficiency - This deficiency is mitigated through the ingestion of

supplemental Vitamin A at the start of the second trimester until post-partal period.

Vitamin A supplementation is not given during the first trimester since it is a

teratogen and may lead to fetal deformities or even fetal demise. The recommended

dose for vitamin A supplementation for women.

Vitamin A Supplementation

 Pregnant women – 10, 000 IU (1cap 2x/week (4 months until

delivery)

 Post-partum women – 200,000 IU 1 cap once after delivery (may be

given within 4 weeks)

d. Macronutrient Supplementation - Calcium supplementation is recommended
for the prevention of preeclampsia in pregnant women, particularly among those at
risk of developing hypertension. Preferably. it should be taken at mealtime from 20
weeks’ gestation until the end of pregnancy. Women are regarded as at risk of
developing gestational hypertension and preeclampsia if they have one or more of
the following risk factors: obesity, previous preeclampsia diabetes. chronic
hypertension, renal disease, autoimmune disease, nulliparity, advanced maternal
age, adolescent pregnancy, and conditions leading to hyper placentation and large
placentas such as in cases of twin pregnancy.
5. Early Identification and Management of Nutritionally at-Risk Pregnant Client -

 The nutritional status of the Philippines is monitored and targeted by the Nutrition Program
which is legally embedded in Presidential Decree No. 491, which declared July as the
Nutrition Month and created the National Nutrition Council

 The program is composed of nutritional assessment methods evaluating the anthropometric

measurements, biochemical and laboratory parameters, chemical indicators, dietary history,
and health history of the patient.

 Different anthropometric measurements are evaluated among patients, and these include
weight-for-age, height-for-age weight-for-age, body mass index, mid-upper arm
circumference, and skin-fold thickness.
6. Counselling on maternal nutrition. breastfeeding and rooming-in, appropriate infant
and young child feeding practices.

7. Assessment of risk for parasitism and provision of anti-helminthic medicines

8. Provision of oral health services including oral health assessment

9. Counselling on proper handwashing environmental sanitation and personal hygiene

10. Counselling on nutrition, smoking cessation, and adoption of healthy lifestyle

practices

11. Philippine Health Insurance Corporation (PhilHealth) enrollment and linkages to

facility and community-based health and nutrition workers and volunteers
12. Social welfare support to improve access to health and nutrition services, such
as, but not limited, to dietary supplementation, healthy food products and
commodities for nutritionally at risk pregnant women belonging to the poorest of
the poor families including those with disabilities

13. Maternity protection during pregnancy

14. Counselling and support to parents and caregivers on parent/caregiver-

infant/child interaction for responsive care and early stimulation for early childhood
development

15. Provision of counselling and psychosocial support to parents and caregivers

Intrapartal Services
The DOH advocates facility-based delivery to ensure safe labor, availability of
intrapartum interventions and to safeguard the welfare of women and newborns.
The establishment of a network of public and private healthcare providers of
emergency obstetric and newborn care is integral to safe intrapartum interventions.
The network is configured to include birthing centers capable of providing
BEmONC and a referral hospital that can provide CEmONC. Ideally, a BEmONC-
capable facility should be reached within 30 minutes from homes using the most
common mode of transportation, while a CEmONC should be reached within an
hour from each BEmONC-capabIe facility.
 These Antenatal Corticosteroids medications are given to all pregnant women
who are at risk for preterm delivery (labor within 24-34 weeks AOC,) or has any
of the following prior to term:

 Antenatal hemorrhage or bleeding

 Hypertension

 Preterm rupture of membranes

 Two corticosteroids are given: Betamethasone 12 mg Intramuscularly every 24

hours for 2 doses or Dexamethasone 6 mg (1.50 mL) Intramuscularly every 12
hours for 4 doses. It must be noted that even a single dose of these corticosteroids
is highly beneficial and must be readily available.
 These Antenatal Corticosteroids medications are given to all pregnant women
who are at risk for preterm delivery (labor within 24-34 weeks AOC,) or has any
of the following prior to term:

 Antenatal hemorrhage or bleeding

 Hypertension

 Preterm rupture of membranes

 Two corticosteroids are given: Betamethasone 12 mg Intramuscularly every 24

hours for 2 doses or Dexamethasone 6 mg (1.50 mL) Intramuscularly every 12
hours for 4 doses. It must be noted that even a single dose of these corticosteroids
is highly beneficial and must be readily available
Postpartal Services
1. Postpartum Visit
 1st visit- within 24 hours
 2nd visit- within one week after delivery

2. Micronutrient Supplementation Vitamin A-200,000 IU/cap I

capsule within 4 weeks after delivery
 Iron and folate- 60 mg/400 gg/tab 1 tablet for 3 months or 90 days

3. Birth Registration
 The nurse monitor the mother and child thru
BHW and during home and facility visits:

 Assistance to thefamily for mother and child care

 Immunization of the baby

 Nutrition of the mother and child

 Psychological support for the family
Breastfeeding

Preparation for breastfeeding begins during pregnancy as early as the first

prenatal checkup. Family should be provided with adequate, accurate and
timely information and opportunities for developing necessary skills for
good breastfeeding practice. Assessment of the mother's knowledge. skills
and attitude breastfeeding helps in responding to her educational needs and
development of the health education plan of the nurse.
Benefits of Breastfeeding
 Breastmilk contains antibodies that help combat disease. It is present in colostrum, the yellowish fluid
secreted by the mammary glands in the first few days after birth. It is rich in Immunoglobulin A (IgA) and
white blood cells to protect the baby against infection

 Breastmilk prevents diarrhea because of reduced risk for contamination as well as its antibody content. Its
lgA component protects the mucosal membrane in the baby’s gut against pathogens

 Breastmilk protects the child against chronic conditions such as allergies, asthma, obesity, diabetes and heart
disease
 Breastmilk promotes intellectual and motor development. Many studies proved
that breastfed children do better on cognitive and motor development.

The health benefits of breastfeeding to the mother include:

 Promotes the release of oxytocin that keeps the uterus contracted. Thus, it
prevents postpartum hemorrhage

 Helps in the return of pre-pregnancy weight

 Delays the return of fertility

 Lowers risk for premenopausal breast and ovarian cancer

 Promotes early uterine involution

According to the Department of
Health in summary the advantages
of breastfeeding are as:
B- est for baby
R- educe allergy
E-motional bonding
A-ntibody present—lgA
S-tool inoffensive
T-emperature always right
F-resh always
E- conomical
E- asy once established
D- igested easily
I-mmediately available
N-utritious
G- astroenteritis is avoided
 Breastfeeding Practices

 Exclusive breastfeeding- allows to receive ORS, drops, vitamins and medicine

 Predominant breastfeeding- water, fruit juice ORS, drops, vitamins, medicine
 Complementary breastfeeding- food and liquids with breastmilk at 6 months
 Bottle feeding- food or drink (including breastmilk) from a bottle
 Early initiation of breastfeeding—after birth within 90 minutes of life
Expanded newborn screening test

The Comprehensive Newborn Screening (NBS) Program was integrated as part of

the country’s public health delivery system with the enactment of Republic Act no.

9288 otherwise known as Newborn Screening Act of 2004.

To ensure early detection and management of several congenital metabolic

disorders, which if left untreated, may lead to mental retardation and/or death. Early

diagnosis and initiation of treatment, along with appropriate long- term care help

ensure normal growth and development of affected individuals. Health professionals

who delivers or assists in the delivery of babies has the obligation to inform the

parents or legal guardian of the availability and benefits of new born screening

(NBS).
Newborn Screening Test is a simple procedure ideally done as early as after twenty-

four hours (24) after initial breastfeeding but not later than three days from the time

of delivery. However, newborns who are in the intensive care unit may be tested

within 7 days of age. The number of disorders detected by this test increased from

six (6) to twenty-eight

Universal Newborn Hearing Screening
Program

Established a Universal Newborn Hearing Screening Program (UNHSP) to

institutionalize measures for the prevention and early diagnosis of congenital
hearing loss among newborns, the provision of referral follow-up, recall and early
intervention services to infants with hearing loss, and counseling and other support
services for families of newborns with hearing loss, to afford them all the
opportunities to be productive members of the community.
How to accomplish Partograph
Internal Examination or IE
Stages of Labor
Gravidity and Parity
GTPAL
EDD and AOG