1 - Overview of Maternal and Newborn Care - 08022014 - PHA RHMPP and NDPs

1
Overview of Maternal and Newborn Car
Click to edit Master title style

RHMPP Quarterly
• Click to edit Master text styles
– Second level
Conference
• Third level
– Fourth level
» Fifth level
September 24, 2015
Naga Regent Hotel
Naga City
11/23/21 1
EmONC MODULE FOR MIDWIVES
1

NDP Quarterly
– Second level
Conference
• Third level
– Fourth level
» Fifth level
September 28, 2015
Naga Regent Hotel
Naga City
11/23/21 2
1

OVERVIEW OF
– Second level
• Third level
MATERNAL AND
– Fourth level
» Fifth level
NEWBORN CARE
11/23/21 3
1
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
– Fourthsituation
level of maternal and newborn health
• “Three» Fifth
delays”
level
• Millennium Development Goals

• The MNCHN Strategy
• Interventions to reduce maternal & newborn
mortality
• Enabling laws and administrative orders
11/23/21 4
1

– Second level
• Third level
– Fourth level
» Fifth level
Screen shot by Mark Leon Goldberg, May 16, 2012, UN Dispatch

11/23/21 5
1
Click toHealth:
Maternal edit Master title
Scope of thestyle
Problem
• Maternal mortality is unacceptably high.
–• Second
800 women
level die from pregnancy or its complications
•worldwide
Third level = 1 woman dying every 2 minutes
– Fourth level
• 50 % decrease from 1990 statistics of 540,000
» Fifth level
maternal deaths 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

11/23/21 6
from pregnancy
EmONC MODULE FOR MIDWIVES and related complications.
1
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

11/23/21 7
1
Click toHealth:
Neonatal edit Master title
Scope of thestyle
Problem
• • Click
Everyto year
edit Master text styles
4 M neonatal deaths
––Second
Of thoselevelwho die in the first month, 2/3 die
• Third level
in the 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
11/23/21 8
1
Click toHealth:
Neonatal edit Master title
Scope of thestyle
Problem
• Click to edit Master text styles Prematurity 27%
– Second level Asphyxia 26%
• Third level Infection

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

11/23/21 9
1
Reasons for High Maternal and Neonatal

Mortality
• –Young
Second age at marriage & first pregnancy
level
• 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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1
The Three Delays

Delay in deciding to seek medical care
 – Failure to recognize danger signs
Second level
 Lack of level
• Third money
 Unplanned/unwanted
– Fourth level 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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1
The Three Delays

Click toinedit
Delay Master
identifying title
and style
reaching
appropriate facility
 – Distance
Second levelfrom a woman’s home to health
facility/provider
• Third level
 Lack– of/poor
Fourth levelcondition of roads
 Lack of»emergency
Fifth level
transportation
 Lack of awareness of existing services
 Lack of community support
11/23/21 12
6/13/2012
1
The Three Delays

Click
Delay to edit appropriate
in receiving Master title andstyle
adequate
care at health facility
 – Second
Lack oflevel
health care providers
• Third level
 Shortage
– Fourth of supplies
level
 Lack of» equipment
Fifth level
 Lack of competence
of health providers
 Weak referral system
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6/13/2012
1

– Second level
• Third level
– Fourth level
» Fifth level
11/23/21 14
1
Click 4:
MDG to edit Master
Reduce title
Child style
Mortality
Target:
– SecondReduce
level Child Mortality by 2/3
• between
Third level 1990 and 2015
– 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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1
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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1
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
11/23/21 17
1
Click to edit
Skilled Master
Health Caretitle style
Worker
• “The single
Click mostMaster
to edit important waystyles
text to reduce maternal deaths
is to ensure
– Second level that a skilled attendant is present at every
birth.” (Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of Maternal Mortality, 1999)
• Third level
– Fourth level
• A SKILLED»ATTENDANT is an accredited health
Fifth level
professional (a 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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1
MNCHN Service Delivery Network

Click to editEnd-Referral
Master
End-referral
title style
facility (Provincial hospitals etc):
BEMONC services + BT, CS and Advanced NB
CEmONC
• Click to edit MasterResuscitation;

text Operates 24 hrs, with OB/surgeon,
styles
pedia, nurse, MW, med tech
– Second level
• Third level
Private Lying In Clinics
Normal vaginal delivery, imminent breech
delivery, emergency drugs (antibiotics, MgSO4,
Rural Health Units with SBA’s,
– Fourth level
District Hospitals &
» Fifth level
FACILITY oxytocin, dexamethasone), ENC, Basic NB
BEmONC resuscitation, FP services
Pregnancy tracking, birth

planning, home visits & follow-up,
nutrition package incldg
Community Health Teams
Service Provider: breastfeeding support; IEC on
Community Level facility delivery & family planning;
communication activities targeted
to mothers and their families
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1
Emergency Obstetric and Newborn Care

(EmONC)
• • Click
Elements
to editofMaster
obstetrictextand
styles
newborn care
–needed
Second for
levelthe management of normal and
• Third level pregnancy, delivery, postpartum
complicated
– Fourth level
periods »and the
Fifth level
newborn
– Early detection and treatment of problem
pregnancies to prevent progression to an
emergency.
– Management of emergency complications*
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1
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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1
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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1
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 » Fifth
4 major direct
causes of maternal mortality are:
level
(1) hemorrhage
(2) hypertension
(3) obstructed labor
(4) complications from abortion
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1
Click to edit
Key Master title style
Messages
• –
The 3 delays
Second act as barriers to accessing health care
level
on •time.
ThirdDelay
level may result to death.
– Fourth level
• The interventions that can save maternal and
» Fifth level
newborn lives:
(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
11/23/21 24
1

– Second level
• Third level
– Fourth level
» Fifth level
Giving birth should be

about giving life, not giving
11/23/21 25

1 - Overview of Maternal and Newborn Care - 08022014 - PHA RHMPP and NDPs

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1

Overview of Maternal and Newborn Car

Click to edit Master title style

Click to edit Master title style

Click to edit Master title style

Click to edit Master

• Millennium Development Goals

Click to edit Master title style

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

• Most are preventable and in low-resource settings

• 99% of maternal deaths occur in developing countries

• Women developing countries have 15X risk of dying

Most maternal deaths occur during labor,

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%

• Third level Infection

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

Reasons for High Maternal and Neonatal

• Poor hygiene during and after delivery

The Three Delays

The Three Delays

The Three Delays

Click to edit Master title style

Reduce Under 5-mortality rate

Reduce Maternal Mortality Ratio

Obstetric and Newborn Care (EmONC)

MNCHN Service Delivery Network

• Click to edit MasterResuscitation;

Pregnancy tracking, birth

Emergency Obstetric and Newborn Care

Basic Emergency Obstetric and

Comprehensive Emergency Obstetric

Click to edit Master title style

Giving birth should be

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