Module 3

Pregnant Woman
MODULE 3: PREGNANCY

Session 1: The gift of pregnancy

Activity 1: Healthy signs vs. danger signs of
pregnancy

Session 2: Care during pregnancy

Activity 1: Health services for pregnant women
Activity 2: The Mother and Child Book
Activity 3: Filling up the birth plan
Activity 4: Knowing the roles of a husband/partner
during pregnancy
 Module 3
Session 1: The Gift of
Pregnancy
Module 3 Session 5
 Module 3 Session 5

At the end of the session, participants will be able to:

 Define a healthy pregnancy;

 Enumerate the danger signs of pregnancy; and

 Fill up a birth plan

 Module 3 Session 5

METHODS
Group discussion

MATERIALS
Chalkboard/whiteboard or flip charts, chalk or marking
pens

TIME
1 ½ hours
Module 3 Session 5
 Module 3 Session 5

Activity 1:
Healthy signs vs. danger signs of
pregnancy
 Module 3 Session 5

PROCEDURE

STEP 1: Divide the participants into two groups, and ask

them to fall in line.

STEP 2: Draw a table with two columns on the

whiteboard/whiteboard or flipchart. Write the heading
“healthy signs” and “danger signs” on the first and second
column, respectively.
 Module 3 Session 5

PROCEDURE

STEP 1: Divide the participants into two groups, and ask

them to fall in line.

STEP 2: Draw a table with two columns on the

whiteboard/whiteboard or flipchart. Write the heading
“healthy signs” and “danger signs” on the first and second
column, respectively.
Healthy signs of Danger signs of
pregnancy pregnancy
 Module 3 Session 5

PROCEDURE

STEP 3: The first group shall write the healthy signs of

pregnancy while the second group shall write the danger
signs. Allow five minutes for the groups to write their
answers.

STEP 4: After five minutes, review the lists made by the

participants using the table below which summarizes the
correct answers for the activity. Afterwards have a
discussion using the key points.
 Module 3 Session 5

KEY POINTS FOR DISCUSSION

HEALTHY SIGNS OF PREGNANCY

1. Normal increase in weight

• According to trimester of pregnancy
• Total increase in body weight should be 20% of pre-
pregnancy BMI
 Module 3 Session 5

KEY POINTS FOR DISCUSSION

HEALTHY SIGNS OF PREGNANCY

1. Normal increase in weight

First trimester:1-2 kg (regardless of pre-pregnancy

BMI)
Second to third trimester:
Pre-pregnancy BMI Normal weight
increase
<18.5 500 g/week
= 18.5-24.9 400 g/week
≥ 25 300 g/week
 Module 3 Session 5

KEY POINTS FOR DISCUSSION

HEALTHY SIGNS OF PREGNANCY

2. Absence of illness

3. Absence of paleness

4. Physically active

5. Normal urination

6. Absence of body pain

 Module 3 Session 5

KEY
KEY POINTS
POINTS FORFOR DISCUSSION
DISCUSSION:

DANGER SIGNS OF PREGNANCY

• Swelling of legs, hands, and/or face
• Severe headache, dizziness
• Fever and chills
• Severe abdominal pain
• Watery vaginal discharge or bleeding
• Painful urination
• Fast or difficult breathing
 Module 3 Session 5

KEY
KEY POINTS
POINTS FORFOR DISCUSSION
DISCUSSION:

DANGER SIGNS OF PREGNANCY

• If any of the danger signs of pregnancy is observed,
advise the pregnant woman to have seek medical
attention immediately for proper monitoring and
evaluation.
 Module 3 Session 5

PROCEDURE

STEP 5: Process the activity by asking the following

questions to the participants:

• What happened in the activity?

• What have you learned from the activity?

• What should you do if you observe danger signs

during pregnancy?
 Module 3 Session 5

TAKE HOME MESSAGES

• The early sign of pregnancy is absence of menstruation.

Once missed, go to the nearest health center for
confirmation of pregnancy. If confirmed, comply with
prenatal schedule/advice.

• Every pregnancy is risky, therefore a pregnant woman

should be cared for by a health worker and give birth in
a health facility.
 Module 3 Session 5

TAKE HOME MESSAGES

• The three most common causes of death among

pregnant women are: hemorrhage, hypertension, and
infections.

• Complications can set in anytime. Seek help

immediately from a health worker when the danger
signs of pregnancy are observed.
 Module 3
Session 2: Care during
pregnancy
Module 3 Session 6
 Module 3 Session 6

At the end of the session, participants will be able to:

 Enumerate the different health services for pregnant

women available in the health facility;

 Understand the importance of the Mother and Child

Book;

 Learn how to fill out the birth plan; and

 Understand the role of partners/husbands during

pregnancy
 Module 3 Session 6

METHODS
Game, group discussion, lecture demonstration

MATERIALS
Mother and Child book, copies of birth plan (Annex I),
prepared visuals/game props, papers, pens

TIME
1 ½ hours
Module 3 Session 6
 Module 3 Session 6

Activity 1:
Health services for pregnant
women
Module 3 Session 6
 Module 3 Session 6

PROCEDURE

STEP 1: Request the participants

to form a circle and tell them
that they will be playing a game.

STEP 2: Give the mechanics of

the game.
 Module 3 Session 6

“Pass the Paper Cabbage” MECHANICS

• Give the paper cabbage to one of the participants and

ask them to pass it to the next person while the music is
playing.

• When the music stops, the person holding the paper

cabbage will peel off one sheet and answer the question
written. Other participants are encouraged to add
answers to the question.

• After all possible answers are given, the paper cabbage is

again passed around and this is repeated after all sheets
of paper are opened.
 Module 3 Session 6

PROCEDURE

STEP 3: Play the music and start the game. Ensure that
everyone is given a chance to share and provide their
inputs. Once all questions have been answered, ask the
participants to settle down.

STEP 4: Synthesize the activity by reviewing participants'

answers using the following list.
 Module 3 Session 6

Topic Answers
Health • Tetanus-diphtheria immunization
services • Iron-folic acid supplementation
available for • Weight and height measurement,
a pregnant assessment of body mass index (BMI)
woman in the • Abdominal checkup
health facility • Counselling on lactation amenorrhea
method (LAM), breastfeeding, nutrition,
healthy lifestyle, exercise, responsible
parenthood and birth spacing
 Module 3 Session 6

Topic Answers
Danger signs a • Swelling of legs, hands, and/or face
pregnant • Severe headache, dizziness
woman might • Fast or difficult breathing
encounter that • Fever and chills
will need • Severe abdominal pain
immediate care • Watery vaginal discharge or bleeding
in the health • Painful urination
facility
 Module 3 Session 6

Topic Answers
Vaccine given to • Tetanus-diphtheria immunization -
a pregnant helps in preventing tetanus and
woman diphtheria for both the mother and
her baby.
• Five doses are needed for lifetime
protection of the woman and her
future babies against tetanus
 Module 3 Session 6

Topic Answers
Important • Iron with folic acid to prevent anemia
micronutrients and folic acid deficiency.
a pregnant
woman should
take
 Module 3 Session 6

Topic Answers
Number of visits • At least four (4) visits.
to the health • Once every trimester during the
center a first and second trimesters;
pregnant • Two visits during the third
woman must trimester.
do
 Module 3 Session 6

Topic Answers
Record that a • The Mother and Child Book is a
pregnant record that should be brought at
woman needs every consultation visit. It is usually
for each given at the first prenatal checkup.
antenatal visit
 Module 3 Session 6

Topic Answers
Place where a • A pregnant woman should give birth
woman should in a health facility, and assisted at
give birth in delivery by trained health
professionals (doctor, nurse,
midwife)
 Module 3 Session 6

Topic Answers
Screening or • Pregnancy test
laboratory tests • STI/HIV testing
a pregnant • Routine lab tests such as: Complete
woman must Blood Count (CBC) and blood typing,
undergo urinalysis, fecalysis, hepatitis B
surface antigen test
 Module 3 Session 6

Activity 2:
The Mother and Child book
 Module 3 Session 6

PROCEDURE

STEP 1: Give each participant one Mother and Child Book.

STEP 2: Discuss the purpose and importance of the Mother

and Child Book and enumerate the essential information
that should be recorded there.
 Module 3 Session 6

KEY POINTS FOR

DISCUSSION

Mother and Child Book

An important record of events
and health services given to
the pregnant woman and her
baby. It is important that the
pregnant woman brings this
in every antenatal visit.

It consists of two parts:

pregnant mother record
and child record.
 Module 3 Session 6

KEY POINTS FOR DISCUSSION

MOTHER AND CHILD BOOK

Pregnant mother record details

• health services, results of examination or tests done

• preparations for pregnancy and delivery and personal

care of the mother.

• the birth plan which is an important record containing

information regarding her pregnancy and delivery.
 Module 3 Session 6

KEY POINTS FOR DISCUSSION

MOTHER AND CHILD BOOK

Child record includes

• information from the child’s birth up to 5 years of age.

• events, results of examination

• child health services

• developmental milestones checklist

• growth monitoring record

 Module 3 Session 6

Activity 3:
Filling out the birth plan
 Module 3 Session 6

PROCEDURE

STEP 1: Tell the participants to look for the birth plan in the
Mother and Child Book. Refer to Annex J for sample birth
plan.

STEP 2: Instruct the pregnant participants to fill-out the

important information they will actually do for their current
pregnancy. The non-pregnant participants will help in filling
out the birth plan.
 Module 3 Session 6

PROCEDURE

STEP 3 : Allow some time for the participants to fill out the
form and guide them on how to answer the questions.

Encourage them to ask questions and to clarify concerns

 Module 3 Session 6

KEY POINTS FOR DISCUSSION

BIRTH PLAN
• A document that details a pregnant woman’s
preferences for her child’s birth.

• Contains important information such as:

- Desired place of delivery
- Name and location of the nearest birthing center
- Name of birth attendant
 Module 3 Session 6

KEY POINTS FOR DISCUSSION

• Contains important information such as:

- Name and location of the nearest referral hospital
- Funds for birth-related and emergency expenses
- Desired birth companion
- Things to prepare for the newborn
- Things to bring on delivery date
 Module 3 Session 6

KEY POINTS FOR DISCUSSION

• Contains important information such as:

- Available support from community workers (e.g.
BHWs or persons authorized to look after the
house while the woman is giving birth
- Transport details from home to health facility,
including contact person and contact details
- Transport details from birthing center to referral
facility in case of obstetric emergency, including
contact person and contact details
 Module 3 Session 6

Activity 3:
Knowing the roles of a
husband/partner during
pregnancy
 Module 3 Session 6

PROCEDURE

STEP 1: Group the participants into three groups. Ask each

group to answer in one big sheet of paper “What could be
the role of the husband/partner when their wife is
pregnant?” Allow five minutes for the group to give their
responses.

STEP 2: Ask a representative of the group to present their

answers to the big group.
 Module 3 Session 6

KEY POINTS FOR DISCUSSION

ROLES OF A HUSBAND/PARTNER DURING PREGNANCY

• Spend more time with your wife and communicate with
her more often.
• Know her preferences. Certain foods or smell may cause
her to vomit.
• Try to share in the housework.
• Talk about sex during pregnancy and seek professional
advice.
• Accompany your wife during her antenatal check-ups.
• Accomplish the birth plan with your wife.
 Module 3 Session 6

KEY POINTS FOR DISCUSSION

ROLES OF A HUSBAND/PARTNER DURING PREGNANCY

• Give her some gentle back massage
• Be patient and considerate. Avoid any conflicts,
confrontations and hurting her physically.
• Share planning to acquire needed materials of the baby
• Take a walk with her as a form of exercise
• Avoid alcohol and smoking.
 Module 3 Session 6

PROCEDURE

STEP 3: Process the activity by asking the participants the

following questions:

• What happened in the activity? What did you feel?

• What was easy? What was difficult?

• What have you learned from the activity?

STEP 4: Close the session by giving the take home messages

 Module 3 Session 6

TAKE HOME MESSAGES

Health services for the pregnant woman

• Pregnant mothers should go to the health facility at

least four (4) times during her pregnancy:
• at least one (1) visit each during the first and second
trimester; and
• at least two visits at two weeks interval during the
third trimester.
• Those with difficult pregnancy will be advised to have
more antenatal visits for proper monitoring and
evaluation.
 Module 3 Session 6

TAKE HOME MESSAGES

Health services for the pregnant woman

• Get tetanus-diphtheria toxoid immunization

o Five (5) doses are needed for lifetime protection
against tetanus.
o The schedule for tetanus-diphtheria toxoid
immunization can be found in the Mother and Child
Book.
 Module 3 Session 6

TAKE HOME MESSAGES

Health services for the pregnant woman

• Take iron with folic acid supplement daily for 180

days to prevent anemia and neural tube defects (NTDs)
in infants

• Women should undergo important screening tests as

part of antenatal care protocol
• Urinalysis, fecalysis, blood tests, STI/HIV screening,
Syphilis testing, and TB screening
 Module 3 Session 6

TAKE HOME MESSAGES

What should a pregnant woman do?

• Avoid crowded places to prevent infection and diseases.

• Practice good personal hygiene and observe cleanliness

of immediate surroundings.

• Exercise in moderate intensity and avoid strenuous

workload.

• Avoid smoking, alcohol, and drugs

 Module 3 Session 6

TAKE HOME MESSAGES

What should a pregnant woman do?

• Avoid taking medications without prescription
especially during the first three months of pregnancy.
Some medications may be harmful to the fetus.

• Seek immediate help from a health worker if ill

 Module 3 Session 6

TAKE HOME MESSAGES

What should a pregnant woman do?

• Be informed about breastfeeding, lactation
amenorrhea method (LAM) and other methods of birth
spacing.

• Have a copy of the Mother and Child Book and ensure

that it is filled out properly and completely, especially
the birth plan.
 Module 3
Session 3: Eating right for the
pregnant woman
OBJECTIVES
At the end of the session, participants will be able to:

 Understand the importance of good nutrition during

pregnancy;

 Determine what foods to eat during pregnancy; and

 Prepare sample menus appropriate for a pregnant

woman using the Pinggang Pinoy.
METHODS
Group discussion, lecture demonstration

MATERIALS
Pinggang Pinoy brochures for pregnant woman, paper
plates, pictures of different food items, papers, pencils,
scissors, masking tape

TIME
1 ½ hours
 Activity 1:
Nutrition during pregnancy
PROCEDURE

STEP 1: Introduce the

session by discussing the
importance of good
nutrition.
KEY POINTS FOR DISCUSSION

• The nutritional needs of a woman increases during

pregnancy. It is important for the woman to eat
healthy for herself and for her growing baby.

• Good nutrition during pregnancy will help the baby

develop well inside the womb. This will also provide
the necessary strength and stamina during
pregnancy, labor, and delivery
KEY POINTS FOR DISCUSSION

• The recommended weight gain during pregnancy is

dependent on her nutritional status.

• Poor maternal nutrition may result to the baby having

complications such as low birth weight, anemia, birth
defects, and brain damage. It may also possibly lead
to the death of both the baby and the mother.
PROCEDURE

STEP 2: Ask the participants about their food cravings

(foods they preferred) and food taboos (foods they
avoided) during pregnancy. Discuss and decide whether
the choice of food or the practice is good or bad.

Sample responses:
Food cravings Food taboos

Sour food items (green Eggplant (child will

mangoes, sampalok) have violet skin)
PROCEDURE

STEP 3: Group the participants by three's. Give each group

a Pinggang Pinoy brochure for pregnant women. Explain to
the participants what the Pinggang Pinoy represents. Refer
to Annex K.
 KEY POINTS FOR DISCUSSION

PINGGANG PINOY FOR

PREGNANT AND
LACTATING WOMEN

• Easy-to-understand

• Uses a familiar food

plate model to convey
right food group
proportions
KEY POINTS FOR DISCUSSION

Fish and
alternatives Fruit
17% 17%

Rice and
alternatives
33% Vegetables
33%
KEY POINTS FOR DISCUSSION
PROCEDURE

STEP 4: After the discussion, distribute paper plates to the

groups and ask them to fill up the plate with an adequate
menu for a pregnant woman using cutout pictures or
drawings. Invite other persons to act as judges during the
presentation. If possible, give rewards to the winners
PROCEDURE

STEP 5: Process the activity by asking the following

questions to the participants:

• What new things have you learned from the session?

• How will you apply the learnings you gained?

• Close the session by sharing the take home

messages.
 TAKE HOME MESSAGES

• Pregnant women need extra food each day because

they are also providing the energy and nutrition for
their growing baby. A pregnant woman should eat one
extra small meal or snack each day.

• Eat a variety of foods rich in carbohydrates, proteins,

vitamins and minerals, including milk, fresh fruits and
vegetables, meat, fish, eggs (well- cooked), grains, nuts
and beans.
 TAKE HOME MESSAGES

Go (energy-giving foods):

Whole grains like brown

rice, corn, wheat bread and
oatmeal; root crops like
kamote, gabi, kamoteng-
kahoy, and ube
 TAKE HOME MESSAGES

Grow (body-building foods):

Fish, shellfish, lean meat,

poultry, eggs, milk and dried
beans or nuts.
 TAKE HOME MESSAGES

Glow (body-regulating
foods):

Vegetables like
malunggay, kalabasa,
sitaw, ampalaya; fruits
like banana, mango,
dalanghita, and papaya.
 TAKE HOME MESSAGES

• Take daily iron supplements with folic acid to prevent

anemia and neural tube defects.

• Use iodized salt to prevent iodine deficiency.

• Drink 8-10 glasses of water everyday and avoid taking

tea, coffee and sugar sweetened beverages
 Module 3
Session 4: How the baby grows
and develops inside the womb
OBJECTIVES
At the end of the session, participants will be able to:

 Understand the importance of maternal health on

baby’s growth and development;

 Understand how a baby develops inside the womb;

 Determine appropriate psychosocial stimulation at

different stages of baby’s development; and

 Identify harmful acts that can pose detrimental effect

to the baby
METHODS
Lecture-discussion, group discussion, games

MATERIALS
Chalkboard/whiteboard or flip chart, chalk or marking pen,
metacards, masking tape, materials in Annex L

TIME
1 ½ hours
 Activity 1:
Psychosocial stimulation for the
baby inside the womb
PROCEDURE

STEP 1: Show pictures of the fetal development process

and put them on a space where all the pictures can be
placed side-by-side.
PROCEDURE

STEP 2: Divide the class into three and assign the following
to each group:

Group 1 – first trimester, 0-3 months (0-12 weeks)

Group 2 – second trimester, 4-6 months (13-34 weeks)
Group 3 – third trimester, 7-9 months (beyond 25 weeks)

Ask the groups to identify the appropriate description of

the fetal development process and psychosocial
stimulation methods for the trimester assigned to them
using the cards prepared. Let them place the cards below
the corresponding pictures.
PROCEDURE

Emphasize that there are psychosocial stimulation methods which

are applicable to more than one month of pregnancy
PROCEDURE

STEP 3: Review participants' answers and discuss each

stage of development and what methods mothers can do
to provide appropriate psychosocial stimulation at each
stage.
 KEY POINTS FOR DISCUSSION

Every human being starts developing well before birth,

begins at the moment of conception
• Psychosocial stimulation is helpful to promote full mental
development of a child

• The mother should relax and keep her stress level at a

minimal to promote fetal brain development
 KEY POINTS FOR DISCUSSION

STAGES OF FETAL DEVELOPMENT INSIDE THE MOTHER’S WOMB

Age Development Psychosocial stimulation

0-4 weeks • Brain begins to develop,
(1 month) simple spinal cord and marks
where the face will be.
• Fetus measures about 2mm in
length.
• Follow guide on how to
prepare for pregnancy,
particularly avoid getting
sick or any medications or
drugs that may affect the
baby’s growth .
 KEY POINTS FOR DISCUSSION

STAGES OF FETAL DEVELOPMENT INSIDE THE MOTHER’S WOMB

Age Development Psychosocial stimulation

4-8 weeks • Heart begins to beat around • Avoid stress
(2 months) six weeks, and all other organs • Listen to sweet and
start to develop soothing music, particularly
• Facial bones form, eyes and classical music or some low
eye color develop, fingers and piano sounds.
toes appear
 STAGES OF FETAL DEVELOPMENT INSIDE THE MOTHER’S WOMB

Age Development Psychosocial stimulation

8-12 • Major organs are now formed. • Take time to relax and have
weeks • Head is large compared to the some fresh air
(3 months) rest of the body • At this time, the baby inside
• Defined chin, nose and eyelids the womb is sensitive to
• Floats in the amniotic fluid. touch.
• Kicking gently • Let you and your husband
8-12 • Legs are longer than the arms touch your abdomen
weeks • Lungs are developing and caringly.
(4 months) heartbeat can be heard by • Have some massage time.
ultrasound
• Has facial expressions,
eyebrows and eyelashes grow
• Can turn head and open
mouth
• Hair on the head coarsens and
develop color
 STAGES OF FETAL DEVELOPMENT INSIDE THE MOTHER’S WOMB

Age Development Psychosocial stimulation

16-20 • Can suck thumb and respond • Both parents should talk to
weeks to sound of voices the fetus frequently.
(5 months) • Taste buds develop and can • Baby loves to hear mother’s
• differentiate between sweet voice
and bitter flavors
• Develops fingerprints
• Body is covered with fine hairs
called “lanugo”
• Baby inside the womb hears a
lot, from internal sounds of
mother’s heartbeat and
intestinal movements, to
external noises such as voices,
music, slamming doors, etc.
 STAGES OF FETAL DEVELOPMENT INSIDE THE MOTHER’S WOMB

Age Development Psychosocial stimulation

20-24 • Body is still thin, but now in • Avoid stress, tension, and
weeks proportion with the head emotional feelings.
(6 months) • Bone centers are hardening Hormones associated with
• Genitals are developed, mother’s emotions can
nostrils are opened, and cross the placenta and
makes breathing motion affect the baby.
• Sleep patterns have developed • Have story time with baby.
24-28 • Fats builds up under the skin,
This will help stimulate the
weeks head, hair grows, eyelids open
baby to recognize speech
(7 months) and brain is more active
and pitch of voice.
• Can hear a lot including
• Sing nursery rhymes
internal and external noises.
• Respond to baby’s kick by
pressing back gently.
 STAGES OF FETAL DEVELOPMENT INSIDE THE MOTHER’S WOMB

Age Development Psychosocial stimulation

28-32 • Perfectly formed • Start practicing birthing
weeks • Can see light through the techniques
(8 months) mother’s abdominal wall, eyes
blink
• Moves around less as baby
gains weight
• Lungs are not fully mature yet
• Has a good chance of survival
36 weeks • if born breathing, sucking
Practice
(9 months) and swallowing
• Fine downy hair on the body is
gone
• Intestines filled with
meconium which will pass out
in the first two days after birth
PROCEDURE

STEP 4: Process the activity by asking the following

questions to the participants.

• What new things have you learned?

• How will you apply the learnings you gained?

 TAKE HOME MESSAGES

• A pregnant woman can promote the mental

development of her child by using psychosocial
stimulation techniques such as frequently talking and
singing to the baby, listening to music or by touching
her abdomen

• Staying relaxed and keeping stress levels to a minimal

level can also help in the mental development of a baby
inside the womb.