Bemon - cemonc

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MEMBERS:

Lumaban, ayyilah
MALIXI, INA CARMELA
MILLER, GEOFF RUSSEL
MOLINA, AHNDJILAH
Ortega, frances kyle
Pineda, Alexandra
Pulido, Reign Marjorae
 CONTE
Objectives
XT
introduction

Legal Basis on BEmONC Certification

BEmONC Signal Functions
BASIC EMERGENCY OBSTETRIC AND NEWBORN
CARE (BEmONC)
COMPREHENSIVE EMERGENCY OBSTETRIC AND
PROVIDER FACILITIES
NEWBORN CARE (CEmONC) PROVIDER FACILITIES
Objectives:

• Explain the principles of preventing excess maternal and newborn

mortality and morbidity in crisis settings
• Discuss how basic emergency obstetric and newborn care
(BEmONC) supports the implementation of the MISP for Sexual
and Reproductive Health in an emergency
Introduction:
Global Situation: Maternal and Newborn Health (MNH)
Maternal deaths
• 293,000 per year*
• 99% in developing countries
• Maternal morbidity: 5.1– 10.2 million
Still birth: 3.3 million per year
Neonatal Deaths
• 2.1 million per year*
• 75% first week of life
*GBD 2013 Mortality and Causes of Death Collaborators, Lancet 2014
Situation in the Philippines as of
2020
 Maternal mortality ratio: 2,600 per year
 Causes: bleeding, sepsis, pre-eclampsia, eclampsia
 Neonatal mortality rate: 18.815 deaths per 1000 live births
 Causes: birth asphyxia (29%), prematurity (28%), sepsis (23%)
Maternal, Newborn, and Child Health and Nutrition
The MNCHN core service package consists of health services
that are both PREVENTIVE AND CURATIVE established to lower
the risk and respond to the direct causes of maternal and
neonatal deaths and consequently improve women’s and
children’s health. The interventions cater to the spectrum of
needs of women and children.
 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.

Basic Emergency Obstetrics and Newborn Care

(BEmONC)
• private health facility (lying – in) or an
• appropriately upgraded public health facility that is either a
 Rural Health Unit (RHU)
 satellite Barangay Health Station (BHS)
 Hospital capable of performing the following emergency
obstetric functions.
 Comprehensive Emergency Obstetrics and Newborn Care
(CEmONC)
• tertiary level regional hospital
• medical center
• provincial hospital
• appropriately upgraded district hospital.
• privately operated medical center.
 It is capable of performing emergency obstetric functions as in
BEmONC provider facilities, as well as provides surgical delivery
(caesarean section) and blood bank transfusion services, and other
highly specialized obstetric interventions. It is also able to provide
emergency neonatal care.
Legal Basis on BEmONC
Certification
1.AO No. 2008 – 0029: Health Reforms for the Rapid
Reduction of Maternal & Neonatal Mortality
2.AO No.2009 – 0025: Adopting New Policies &
Protocol on ENC
3.AO No. 2010 – 0014: Administration of Life Saving
Drugs & Medicines by Midwives to Rapidly Reduce
Maternal & Neonatal Morbidity & Mortality
“”” "Ensure that all women and
newborns have skilled care during
pregnancy, childbirth and the
immediate postnatal period."” - joint
statement by WHO, UNFPA, UNICEF and
the World Bank in 1999
BEmONC Signal Functions

1. Administer parenteral antibiotics

2. Administer uterotonic drugs
3. Administer parenteral anticonvulsants
4. Perform manual removal of the placenta
5. Remove retained products of conception
6. Perform assisted vaginal delivery
7. Perform basic neonatal resuscitation
➢ BemONC capable facility can be based in an
RHU,
BHs, lying-in clinic or birthing home can either be a stand-
alone facility or composed of a network of facilities and
skilled health professionals capable of delivering the 6 signal
functions such as:

● Doctors ●
● Nurses Midwives
● Medtech
Midwife can provide lifesaving interventions within
the intent of DOH, 2010 – 0014 = ratio, 1 N/midwife
with physician on call = BemONC facility per =
125,000 population
Comprehensive EmONC (CEmONC): All
seven BEmONC Signal Functions plus

8. Perform Caesarean delivery

9. Provide blood transfusion
➢ Can perform the six signal obstetric functions
as in BEmONC as well as:
● Capable of providing neonatal emergency
intervention for BemONC.
● Management of low birth weight or preterm
newborn and other specialized newborn care.
➢ In an area with a population of at least
500,000 WHO recommends 1 CEmONC-
capable facility
 Republic Act No. 10354
(The Responsible Parenthood and
Reproductive Health Act of 2012)
Promotes the:
-Advancement of BEmONC and CEmONC services for emergency
maternal and newborn conditions/complications

-Development of training curricula for medicine, nursing, and midwifery

-Improvement of of facilities necessary to meet BEmONC and CEmONC

standards; the training and deployment of skilled health providers; natural
and artificial family planning commodity requirements.
The MNCHN
Core Service
Package
 BASIC EMERGENCY COMPREHENSIVE
OBSTETRIC AND NEWBORN EMERGENCY OBSTETRIC AND
CARE (BEmONC) PROVIDER NEWBORN CARE (CEmONC)
FACILITIES PROVIDER FACILITIES
1. Pre-pregnancy package of services include 1. Pre-pregnancy care
the following provisions:

a. Micronutrient supplementation consisting of - Micronutrient supplementation consisting of

important minerals and vitamins such as zinc, important minerals and vitamins such as zinc,
iodine, calcium, vitamin A capsules and iron iodine, calcium, vitamin A capsules and iron
tablets Iron folate 60 mg tablets 1 tablet daily tablets Iron folate 60 mg tablets 1 tablet daily
b. Tetanus toxoid immunization following the for 3-6 months.
recommended schedule
c. Family Planning
d. Provision of oral health services
 COMPREHENSIVE
EMERGENCY
OBSTETRIC AND
BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE
NEWBORN CARE (BEmONC) PROVIDER (CEmONC) PROVIDER
FACILITIES FACILITIES
e. Counselling on STI/HIV/AIDS, nutrition, personal hygiene,
and the consequences of abortion
- Laboratory screening for
f. STI screening using syndromic approach
STIs
g. Adolescent and youth health services including peer and
professional counseling and RH education
h. Promotion of healthy lifestyle including advice relative to
smoking cessation, healthy diet, regular exercise and moderate
alcohol intake.
i. Management of lifestyle-related diseases like diabetes,
cardiovascular disease (CVD), etc.
j. Prevention and Management of other diseases including
tuberculosis, malaria (e.g. provision of insecticide treated bed
nets for malaria-infested areas), schistosomiasis, and anemia
 BASIC EMERGENCY
OBSTETRIC AND NEWBORN
CARE (BEmONC) PROVIDER
FACILITIES
2. Complete Prenatal Package
a. Provision of eight essential antenatal care
services
b. Promotion of exclusive breastfeeding,
newborn screening, BCG and Hepatitis B
birth dose immunization.
c. counseling on –
d. Laboratory screening and medical
management of STI-HIV cases and their
complications.
COMPREHENSIVE
EMERGENCY OBSTETRIC AND
NEWBORN CARE (CEmONC)
PROVIDER FACILITIES
2. Prenatal care package (The following
antenatal services provided at the BEmONC
provider facilities shall likewise be provided in a
CEmONC facility:)
- Counseling on Healthy Lifestyle with focus on
smoking cessation, healthy diet and nutrition,
regular exercise, STI control HIV prevention
and oral health.
 BASIC EMERGENCY
OBSTETRIC AND NEWBORN
CARE (BEmONC) PROVIDER
FACILITIES
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.
g. Administration of antenatal loading
dose of steroids for threatened
premature delivery.
COMPREHENSIVE EMERGENCY
OBSTETRIC AND NEWBORN CARE
(CEmONC) PROVIDER FACILITIES
- Counseling on Healthy Lifestyle with
focus on smoking cessation, healthy
diet and nutrition, regular exercise, STI
control HIV prevention and oral health.
- Prevention and Management of early
bleeding in pregnancy and its
complications.
 BASIC EMERGENCY
OBSTETRIC AND NEWBORN COMPREHENSIVE EMERGENCY
CARE (BEmONC) PROVIDER OBSTETRIC AND NEWBORN CARE
FACILITIES (CEmONC) PROVIDER FACILITIES
h. Early detection and management of - Early detection and management of
signs of complications of pregnancy. danger signs and complications of
pregnancy.
i. Measurement of fundic height against
the age of gestation, fetal heartbeat and
fetal movement count to assess the
adequacy of fetal growth and wellbeing.
j. Prevention and management of other
conditions as indicated:
 BASIC EMERGENCY
OBSTETRIC AND
NEWBORN CARE COMPREHENSIVE EMERGENCY
(BEmONC) PROVIDER OBSTETRIC AND NEWBORN CARE
FACILITIES (CEmONC) PROVIDER FACILITIES
k. Provision of other support Provision of other support services
services • Antenatal registration by active tracking by
• Antenatal registration through WHTs
active tracking by the WHTs • Assistance in birth planning
• Birth Planning • Safe blood supply
• Home visits and follow up • Transportation and communication support
• Safe blood supply services
• Transportation and communication
support services
 BASIC EMERGENCY COMPREHENSIVE
OBSTETRIC AND NEWBORN EMERGENCY OBSTETRIC AND
CARE (BEmONC) PROVIDER NEWBORN CARE (CEmONC)
FACILITIES PROVIDER FACILITIES
3. Complete Childbirth Package 3. Complete Childbirth Package
For the mother:
a. Monitoring vital signs and the progress of
labor using the partograph.

b. Identification of early signs and symptoms

and administration of appropriate management
of prolonged labor, hypertension, abnormal
presentation, bleeding.

c. Active management of the third stage of labor.

 BASIC EMERGENCY COMPREHENSIVE
OBSTETRIC AND NEWBORN EMERGENCY OBSTETRIC AND
CARE (BEmONC) PROVIDER NEWBORN CARE (CEmONC)
FACILITIES PROVIDER FACILITIES
d. Provision of immediate postpartum nursing d. Provision of immediate post-partum nursing
care (prior to discharge from the care (prior to discharge from the delivery room)
delivery room) • Perineal washing
• Perineal washing • Change hospital gown
• Changing of hospital gown • Check vital signs
• Checking vital signs • Rooming-in in the case of non-problematic
• Rooming-in cases.
• Return to ward if baby is preterm and needs
to be confined at the

Newborn Intensive Care Unit (NICU). Advice

should be given relative to breastfeeding
schedules at the NICU.
 BASIC EMERGENCY
OBSTETRIC AND NEWBORN COMPREHENSIVE EMERGENCY
CARE (BEmONC) PROVIDER OBSTETRIC AND NEWBORN CARE
FACILITIES (CEmONC) PROVIDER FACILITIES
For the newborn:
a. Drying to keep the baby warm

b. Provision of appropriate thermal care through

mother and newborn skin-to skin contact,
maintaining a delivery room temperature of 25-
28 degrees centigrade and wrapping the
newborn with clean, dry cloth.

c. Immediate latching on and initiation of

breastfeeding within first hour after
birth.
 BASIC EMERGENCY
OBSTETRIC AND NEWBORN COMPREHENSIVE EMERGENCY
CARE (BEmONC) PROVIDER OBSTETRIC AND NEWBORN CARE
FACILITIES (CEmONC) PROVIDER FACILITIES
d. Non-immediate cord clamping (1-3 minutes
or until cord pulsation stops) Should
complications occur, a BEmONC provider
facility must be able to administer
the following emergency care services:

• Parenteral administration of oxytocin in the

third stage of labor.
• Parenteral administration of loading doses of
anti-convulsant.
• Parenteral administration of initial dose of
antibiotics.
 BASIC EMERGENCY
OBSTETRIC AND NEWBORN COMPREHENSIVE EMERGENCY
CARE (BEmONC) PROVIDER OBSTETRIC AND NEWBORN CARE
FACILITIES (CEmONC) PROVIDER FACILITIES
• Assisted vaginal delivery during imminent
breech delivery.
• Manual removal of placenta. Comprehensive Emergency Obstetric and
• Removal of retained placental products. Newborn Care
• Administration of loading dose of steroids for a. Cesarean section
premature labor. b. Blood transfusion
• Administration of intravenous fluid, blood c. Management of newborn complications
volume expander and/or blood
transfusion.
• Newborn resuscitation.
• Treatment of neonatal sepsis as necessary.
• Oxygen support for newborns.
 BASIC EMERGENCY COMPREHENSIVE
OBSTETRIC AND NEWBORN EMERGENCY OBSTETRIC AND
CARE (BEmONC) PROVIDER NEWBORN CARE (CEmONC)
FACILITIES PROVIDER FACILITIES
4. Complete Post-Partum and Post-Natal 4. Postpartum/ postnatal care
Package
For the mother:
a. Postpartum check up including
identification of early signs and symptoms
of postpartum complications such as
hemorrhage, infection and hypertension.
b. Micronutrient supplementation,
including iron and folate
c. Counseling on
 BASIC EMERGENCY OBSTETRIC AND
NEWBORN CARE (BEmONC) PROVIDER COMPREHENSIVE EMERGENCY
OBSTETRIC AND NEWBORN CARE
FACILITIES (CEmONC) PROVIDER FACILITIES
d. Laboratory screening and medical management of STI-HIV
cases and their complications

e. Provision of FP services including contraception: bilateral

tubal ligation (BTL), no-scalpel vasectomy (NSV) and
management of complications resulting from contraception.

f. Prevention and management of other diseases as indicated

g. Counseling on postpartum/postnatal check-up, home care

and immunization
Immediate postnatal care package (required within 24 hours
after birth)
 BASIC EMERGENCY COMPREHENSIVE
OBSTETRIC AND NEWBORN EMERGENCY OBSTETRIC AND
CARE (BEmONC) PROVIDER NEWBORN CARE (CEmONC)
FACILITIES PROVIDER FACILITIES
For the baby: 4. Postpartum/ postnatal care

g. Counseling on postpartum/postnatal
check-up, home care and immunization
Immediate postnatal care package
(required within 24 hours after birth)
 BASIC EMERGENCY COMPREHENSIVE
OBSTETRIC AND NEWBORN EMERGENCY OBSTETRIC AND
CARE (BEmONC) PROVIDER NEWBORN CARE (CEmONC)
FACILITIES PROVIDER FACILITIES
5. Provision of other support services 5, Other services:
In addition, the CEmONC provider facilities
shall provide comprehensive emergency
• Birth registration postnatal care that include life support
management for:
• Safe blood 1. low birth weight newborns
• transportation and communication 2. premature newborns
3. sick newborns
• sepsis
• fetal alcohol syndrome
• asphyxia
• severe birth trauma
• severe jaundice
• others
insights
BEmONC refers to an (abbreviated) list of services that can
save the lives of women and newborns with obstetric and
neonatal complications. While, signal functions for
Comprehensive emergency obstetric and newborn care
(CEmONC) are the major interventions for averting maternal
and neonatal mortalities. Readiness of the facilities is
essential to provide all the basic and comprehensive signal
functions for CEmONC to ensure emergency services from the
designated facilities.
THE
END…