FAMILY HEALTH

Prepared by:
Doliente, Merry Rose del Prado, Nikki Rose

Objectives
Given a hypothetical client and Learners will be able to:
Discuss comprehensively the overview of Family Health and its different concepts and aims about the different health programs. Recognize the programs of maternal health and its important concerns about maternal health Distinguish the programs of Family Planning and its specific goals and its strategies. Differentiate comprehensively the advantages and disadvantages about the usage of the different family planning methods.

Recognize the different misconception about FP method.

Know what are vital roles of PHN in FP program.

FAMILY HEALTH
Health is a right of every human being. Healthy people are a prerequisite to national development.
The Family Health Office is tasked to operationalize health programs geared towards the health of the family. It is concerned with the health of the mother and the unborn, the newborn, infant, child, the adolescent and youth, the adult men and women and older persons. Specifically, it aims to: 1. Improve the survival, health and well being of mothers and the unborn through a package of services for the pre-pregnancy, prenatal, natal, and postnatal stages. 2. Reduce morbidity and mortality rates for children 0-9 years. 3. Reduce mortality from preventable causes among adolescents and young people.. 4. Reduce morbidity and mortality among Filipino adults and improve their quality of life. 5. Reduce morbidity and mortality of older persons and improve their quality of life. Public Health Nurses have significant roles in ensuring the health of the family. Every effort has to be made to provide packages of health services to the family for a better and quality life.

The Maternal Health Program

The 2000 Philippine Health Statistics revealed: 25% - hypertension 20.3%-postpartum hemorrhage 9% pregnancy with abortive outcomes which are neither preventable nor non-predictable. The underlying causes of maternal deaths are delays in taking critical actions: Delay in seeking care Delay in making referral Delay in providing of appropriate medical management. The overall goal of the program is Improve the survival Health and well being of mothers and unborn through a package of services for the pre pregnancy, pre-natal, natal, and post natal stages.

A. The strategic thrusts for 2005-2010:e strategic

thrusts for 2005-2010

Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the DOH. The strategy calls for families and communities to plan for childbirth and the upgrading of technical capabilities of local health providers. Improve the quality of prenatal and postnatal care.

Reduce womens exposure to health risks through the institutionalization of responsible parenthood and provision of appropriate health care.
LGUs, NGOs and other stakeholders must advocate for health through resource generation and allocation for health services to be provided for the mother and the unborn.

B. Essential Health Service Packages Available in the Health Care Facilities Antenatal Registration
Pregnancy poses a risk to the life of every woman. Every woman has to visit the nearest health facility for antenatal registration and to avail prenatal care services. The standard prenatal visits that a woman has to receive during pregnancy are as follows: Prenatal Visits 1st visit Period of Pregnancy As early in pregnancy as possible before four months or during the first trimester During the 2nd trimester During the 3rd trimester After 8th month of pregnancy till delivery

2nd visit 3rd visit Every 2 weeks

Tetanus Toxoid Immunization

Neonatal Tetanus is one of the public health concerns that we need to address among newborns. Both mother and child are protected against tetanus and neonatal tetanus. A series of 2 doses of Tetanus Toxoid vaccination must be received by a woman one month before delivery to protect baby from neonatal tetanus.

Micronutrient Supplementation
Micronutrient supplementation is vital for pregnant women. These are necessary to prevent anemia, vitamin A deficiency and other nutritional disorders. They are:

Vitamins Vitamin A

Dose 10,000 IU

Schedule of Giving Twice a week starting on the 4th month of pregnancy

Remarks Do not give vitamin A supplementation before the 4th month of pregnancy. It might cause congenital problems in the baby

Iron

60mg/400 ug tablet

Daily

Treatment of Diseases and other Conditions

There are other conditions that might occur among pregnant women. These conditions may endanger her health and complication could occur. Follow first aid treatment:

Conditions/Diseases
Difficulty of breathing/ Obstruction of airway

What to do
Clear airway Place in her best position Refer woman to hospital with EmOC capabilities Keep on her back arms at the side Tilt head backwards(unless trauma is suspected) Lift chin to open airway Clear secretions from throat Give IVF to prevent or correct shock Monitor blood pressure, pulse and shortness of breath every 15 minutes Monitor fluid given. If difficulty of breathing and puffiness develops, stop infusion. Monitor urine output Massage uterus and expel cots Bleeding persist: -place cupped palmed on uterine fundus and feel for state of contraction

Do not give

Unconscious

Do not give Oral Rehydration Solution to a woman who is unconscious or has convulsions Do not give IVF if you are not trained to do so

Post partum Bleeding

-Do not give ergomentrine if woman has eclampsia, preeclampsia or hypertension.

-Apply bimanual uterine compression if ergometrine treatment done and postpartum bleeding still persists -give ergometrine 0.2 mg IM and another dose after 15 minutes. Intestinal parasite infection Give mebendazole 500mg tablet single dose anytime from 4-9 months of pregnancy if none was given in the past 6 months . Give sulfadoxinpyrimethamine to women from malaria endemic areas who are in 1st or 2nd pregnancy, 500mg-25mg tab, 3 tabs at the beginning of 2nd trimesters not less than one month interval. Do not give mebendazole in the first 1-3 months of pregnancy. This might cause congenital problems in baby

Malaria

Clean and Safe Delivery

Provide safe and non traumatic care, recognize complications and also manage and refer the woman to a higher level of care when necessary. The necessary steps to follow during labor, childbirth immediate post partum include the following:

1. Do a quick check upon admission for emergency signs: Unconscious/Convulsion Vaginal bleeding Severe abdominal pain Looks very ill Severe headache with visual disturbance Severe breathing difficulty Fever Severe vomiting

2. Make the woman comfortable Establish rapport with the client by greeting and interviewing to make her comfortable. 3. Assess the woman in labor Assessing the client is a reference guide for a health worker determines its status during labor stage. This can be done by taking the history of the ff: Last menstrual period(LMP) Number of pregnancy Start of labor pains Age/height Danger signs of pregnancy

4. Determine the stage of labor

Labor can be determine when womans response to contraction is observed pushing down and vulva bulging, with leaking amniotic fluid, and vaginal bleeding. A vaginal examination can be performed to determine the degree of contraction.

5. Decide if the woman can safely deliver

By assessing the condition of the client and not finding any indication that could harm the delivery of a baby, a trained health worker can decide a safe deliver a mother.

6. Give supportive care throughout labor

There are many things that a woman needs to do during labor. This will help her deliver clean, safe and free from fatigue. These are: Encourage to take a bath at the onset of labor Encourage to drink but not to eat as this may interfere surgery in case needed Encourage to empty bladder and bowels to facilitate delivery of the baby. Remind to empty bladder every 2 hours. Encourage to do breathing technique to help energy in pushing baby out the vagina. Panting can be done by breathing with open mouth with 2 short breaths followed by long breath. This prevent pushing at the end of the first stage.

7. Monitor and manage labor There are different stages of labor to watch out any danger signs.
Stages of labor
First Stage: not yet in active labor, cervix is dilated 0-3 cm and contractions are weak, less than 2 to 10 minutes.

What to do

Not to do

Check every hour for Do not do vaginal emergency signs, examination more frequently frequency and duration of than every 4 hours. contraction, fetal heart rate, etc. Check every 4 hours for fever, pulse, BP and cervical dilation Record time of rupture of membranes and color of amniotic fluid Assess progress of labor -Refer woman immediately to hospital facility with comprehensive emergency obstetrical care capabilities if after 8 hours, contractions are stronger and more frequent but no progress in cervical dilation

First Stage: In active labor, cervix is dilated 4 cm more

Check every 30 minutes for emergency signs Check every 4 hours for fever, pulse, BP and cervical dilation Record time of rupture o membranes and color of amniotic fluid Record findings in partograph/patient record

Do not allow woman t push unless delivery is imminent. It will just exhaust the woman. Do not give medications to speed up labor. It may endanger and cause trauma to mother and the baby.

Second stage: cervix dilated Check every 5 minutes for Do not apply fundal 10 cm or bulging thin perineum thinning and pressure to help deliver the perineum and head visible. bulging, visible descend of baby. the head during contraction, emergency signs, fetal heart rate and mood and behavior Continue recording in the partograph. Third stage: between birth of the baby and delivery of the placenta Deliver the placenta Check the completeness of placenta and membranes. Do not squeeze or massage the abdomen to deliver the placenta

8. Monitor closely with one hour after delivery and give supportive care
9. Continue care after on postpartum. Keep watch closely for at least 2 hours. 10. Educate and counsel on FP and provide FP method if available and was made by a woman.

11. Inform, teach and counsel the woman on important MCH messages.

Birth registration Importance of BF Newborn Screening for babies delivered in RHU or at home within 48 hours up to 2 weeks after birth Scheduled when to returned for consultation for post partum visits

Recommended Schedule of Post Partum Care Visits:

1st Visits 2nd visit 1st week postpartum preferably 3-5 days 6 weeks postpartum

6 Support to Breast Feeding Most mothers do not know the importance of breast feeding. A support care groups like nurses have a critical role to motivate them to practice breastfeeding. 7. Family Planning Counseling. Proper counseling of couples on the importance of FP will help them inform on the right choice of FP methods, proper spacing of birth and addressing the right number of children.

The Family Planning Program

The goal of Family Planning is to provide universal access to family planning information and services wherever and whenever these are needed.
Family Planning aims to contribute to: Reduce infant deaths Neonatal deaths Under-five deaths Maternal deaths It has the following objectives: Addresses the need to help couples and individuals achieve their desired family size within the context of responsible parenthood and improve their reproductive health to attain sustainable development Ensure the quality FP services are available in DOH retained hospitals, LGU managed health facilities, NGOs, and private sector

There are different strategies adopted to achieve goal and objectives such as: Focus service delivery to the urban and rural poor Reestablish the FP outreach programs Strengthen FP provision in regions with high unmet needs Mainstream modern natural family planning Promote and implement CSR strategy

A. The Family Planning Methods

There are different types of family planning methods used to prevent pregnancy. These includes : Methods
Female Sterilization

Description/Uses
Bilateral tubal ligation that involves cutting or blocking the fallopian tubes

Advantages
Permanent method of contraception. Nothing to remember, no supplies needed, and no repeated clinic visits required Does not interfere with sex.

Disadvantages
Uncommon complication of surgery: infection or bleeding at the incision site, internal infection or bleeding, injury to internal organs, anesthesia risk uncommon with local anesthesia.

%of effectiveness
Perfect use: 99.5% Typical use: 99.5 %

Results in increased sexual enjoyment-no need to worry about pregnancy No effect on breastfeedingquantity and quality of milk not affected No known long terms side effects or health risks

In rare cases, when pregnancy occurs, it is more likely to be ectopic than in a woman who has not undergone the procedure Requires an operating set up Permanentreversal surgery is difficult, expensive ,and not available in most areas Do not protect against sexually transmitted infections including HIV/AIDS

Clients may have limitation in physical activities such as heavy work and lifting heavy objects immediately after surgery Male sterilization The vas deference (passage of sperm) is tied and cut or blocked through a small opening in the scrotal skin. Very effective 3 months after the procedure Permanent, safe, and easy to perform Can be performed in a clinic, office or at a primary care center No supplies or repeated clinic visits It may be uncomfortable due t slight pain and swelling 2-3 days after the procedure Reversibility is difficult and expensive Bleeding may result in hematoma in the scrotum Perfect use: 99.9%

Typical use: 99.8%

No apparent long term health risks An option for couples whose female partner could not undergo permanent contraception A man who had vasectomy will not lose his sexual ability and ejaculation Does not affect male hormonal function, erection, and ejaculation

Does not lessen but may actually increase the couples sexual drive and enjoyment The man can have better sex since he does not fear that his partner will get pregnant

Pill

Contains hormonesestrogen and progesterone taken daily to prevent contraception

Safe as proven through extensive studies Convenient and easy to use Makes menstrual cycle occur regularly and is predictable

Often not used correctly and consistently, lowering its effectiveness Has side effects such as nausea, dizziness, or breast tenderness,

Perfect use: 99.7%

Typical use: 92.0%

How it used: drugs are taken daily per orem

Reduces the risk of ovarian and endometrial cancer

Often not used correctly and consistently, lowering its effectiveness

Perfect use: 99.7% Typical use: 92.0%

Reversible , rapid return to fertility Has side effects such as nausea, Does not dizziness, or interfere with breast tenderness, sexual intercourse which are not generally harmful but which some women may find difficult to tolerate Can suppress lactation Requires regular resupply

Male condom

Thin sheath of latex rubber made to fit on a mens erect penis How it used: Condom is inserted into the erected penis preventing the sperm from getting in contact with the egg cell
Contain synthetic hormone, progestin which suppresses ovulation,

Safe and has no hormonal effect Protects against microorganisms causing STIs/HIV Easily accessible

May cause allergy for people who are sensitive to latex or lubricant Interrupts the sexual act.

Perfect use: 98% Typical use: 85%

Injectables

Reversible No need for daily intake Does not interfere with sexual intercourse

Perfect use: 99.7% Typical use: 97.0%

thickens cervical mucus, How it used: drug containing progestin is injected into the body to suppress ovulation making sperm difficult to pass through the uterine lining

Does not affect BF-quality and quantity of milk is affected

Lactating Amenorrhea Method or LAM

Temporary introductory postpartum method of postponing pregnancy

LAM is universally available to all postpartum breastfeeding women.

Considered as an introductory, short term FP method which is effective only for a maximum of 6 mos.

Perfect use: 99.5% Typical use: 98%

based on physiological infertility experience by breast feeding women.

How it used: Amenorrhea Fully or nearly fully breastfeeding her infant Infant is less than 6 months

Using LAM, protection from an unplanned pregnancy begins immediately postpartum No other FP commodities are required

Disadvantages to women who do not pass any of the three criteria to practice lactation amenorrhea

Mucus/Billings Abstaining from sexual /Ovulation

intercourse during fertile (wet) days prevents pregnancy

Can be used by woman of reproductive age as long as she is not suffering from an unusual disease or condition that results in extraordinary

Cannot be used by woman with the following conditions: Medical conditions that would make pregnancy especially dangerous

Perfect use: 97% Typical use: 80%

How it used: Recording of menstruation and dry days. Inspecting underwater regularly for presence of mucus Recording the most fertile observation/chara cteristics at the end of the day

vaginal discharge that makes observation difficult.

Basal Body Temperture

Very effective BBT method is identifying the fertile and infertile period of a womans cycle by daily taking and recording of the rise in the body

Requires to take BBT every day and time to record temperature. Couples may practice abstinence during fertile periods.

Perfect use: BBT 99% Typical use: BBT: 80%

temperature during and after ovulation. How it used: Thermometer is placed in axilla or under the tongue to get the temperature at least 3 hours of undisturbed rest during (upon waking up and before any activity) throughout the menstrual cycle.

Symptothermal method

STH method is identifying the fertile and infertile days of the menstrual cycle

Perfect use: STH 9% Typical use: 80%

Two Day Method

Is a simple fertility awareness based with the method of FP that involves Cervical secretions as an indicator of fertility Women checking the presence of secretions every day

Can be used by women with any cycle length No health related side effects associated Incurs very little or no cost Enhances selfdiscipline, mutual respect. Provides opportunities for enhancing the couples the sexual life Acceptable to couples regardless of culture, religion, socioeconomic status, and education

Needs the cooperation of the husband -Can become unreliable for women who have conditions that cause abnormal cervical secretions -Does not protect the client from HIV/AIDS

Two days Method: 96.5% Typical use: 86%

Standard Days Method

A new method of natural family planning in which all users with menstrual cycle between 26 and 32 days are counseled to abstain from sexual intercourse on days 8-19 to avoid pregnancy. The couples use color coded cycle beads to mark the fertile and infertile days of the menstrual

No health related side effects associated with use Increases self awareness and knowledge of human reproductive and can lead to a diagnosis of some gynecologic problems No need for counting or charting since the standard days method makes used of beads for tracking the cycle days

Cannot be used by women who usually have menstrual cycle between 26 and 32 days long.

Perfect use: Standard days: 95% Typical use: 88%

B. Misconception about Family Planning Methods

There are misconceptions to family planning methods.

Some Family Planning methods causes abortion.

This is not true. Abortion is the termination of pregnancy, while family planning prevents pregnancy through the use of contraceptives, and abstinence during fertile periods, blocking of tubes, all of which prevent the meeting of the egg and sperm. It prevents induced abortion by preventing unplanned pregnancies.

Using contraceptive will render couples of sterile. Using contraceptive methods will result to loss of sexual desire.
In general, use of contraceptives does not affect an individuals sexual desire. In fact, the used of contraceptives free the couples from the fear of unwanted pregnancies. This enhances the couples sexual relationship.

C. The Roles of Public Health Nurse On Family Planning Program

Nurses play a vital role in FP program. The following activities that a nurse can do are: Provide counseling among the clients will help increase FP acceptors and avoid defaulters

-to inform educate and convince mothers on the use of family planning methods - to inform and discuss the importance andbenefits/advantages/disadvantages of family planning -to inform its side effects, complications and what to do if problems develop

-to inform its effectiveness of FP methods

Provide packages of health services among reproductive age group in all health facilities -family planning -MCHN -Management of reproductive tract infections including STIs/HIV/AIDS -Violence against women -Management of breast and other Reproductive Cancers

Ensure the availability of FP supplies and logistics for the client

Reference: Cuevas, Frances Prescilla L; et al. Public Health Nursing in the Philippines. 10th edition, 2007

 Flee from sexual immortality. All other sins a man commits are outside his body but he who sins sexually sins against his body. Do you know that your body is the temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own, you were brought at a price. Therefore honor God with your body. - I Corinthians 6: 18-20

Thank you For Listening GOD BLESS!