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> Maternal and child health survey conducted

DOH program related to: annually
1 Maternal, Newborn > Family Planning every five years
2 Child Health > Population and housing every 10 years
3 and Nutrition (MNCHN)
Four key Strategies of MNCHN
The current Maternal and Child health and 1. Ensuring access and utilization of an MNCH
Nutrition Situation core package of services and interventions
The Philippines is tasked to reduce the directed to
maternal mortality ratio (MMR) by three > Pre-pregnancy
quarters by 2015 to achieve its millennium > Pregnancy
development goal > Childbirth
> Postpartum
MMR 112/100,000 live births in 2010 > Newborn
MMR 80/ 100,000 live births by 2015 > And childhood period
MMR 114/ 100,000 live births by 2017 > And the community
2. Establishment of a service delivery network
Leading Causes of Maternal Death at all levels of care to provide the package of
1. Complication related to pregnancy occurring services and interventions
in the course of Labor, delivery and puerperium 3. organized use of instruments for health
2. Hypertension complicating pregnancy, system development to bring all localities to
childbirth and puerperium create and sustain their service delivery
3. Post partum hemorrhage networks
4. Pregnancy with abortive outcome 4. Rapid build up of institutional capacities of
DOH and PhilHealth, being the lead national
The main cause of neonatal deaths within agencies that provide support to local planning
the first week of life and development through appropriate
1. Asphyxia standards, capacity build up of implementers
2. Prematurity and financing mechanism
3. Severe infection
4. Congenital anomalies MNCHN strategy aims to achieve the
5. Newborn tetanus following intermediate result
1. Every pregnancy is wanted, planned and
Risk factors identified which increase the supported
maternal and neonatal death 2. Every pregnancy is adequately manage
1. Having mistimed, unplanned, unwanted and throughout its course
unsupported pregnancy 3. Every delivery is facility based and manage
2. Not secure adequate care during the by skilled birth attendant or professionals
pregnancy 4. Every mother and new born pair secures
3. Delivering without skilled birth attendant, proper post partum and newborn care
nurse or Physician
4. Not having post partum and post natal care MNCHN core package of services
1. Pre pregnancy package
2. Prenatal package
3. Childbirth package
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4. Postpartum package 1. Prenatal visits
5. Newborn (first week of life) care package
6. Child care package Prenatal Visits Period of Pregnancy
1st Visit During the first
Pre-Pregnancy package trimester or before
1. Nutrition the fourth month (1-
> Nutritional counseling 84 days)
> Promotion on the use of iodized salt 2nd visit During the second
> Provision of micro nutrient supplements trimester
- Iron and folate- 60mg 1 table daily for 3 to 6 (85-168 days)
months 3rd visit During the third
- Vitamin A 5,000 IU every week trimester
- Daily multivitamin supplements (169 days)
4th visit After the eight
2. promotion of healthy life style month of pregnancy
> No smoking till delivery
> Healthy diet
> Regular exercise 2. Micronutrient supplementation
> Moderate alcohol intake Iron and folate – (60mg/400ug) once a day for
3. Advice on Family planning and provision of 6 months or 180 tablets
Family planning services
Vitamin A supplementation – given 10,000 IU
4. Prevention and management of lifestyle 2X a week on the 4th month of pregnancy and
related diseases like diabetes, and not before the 4th month to avoid congenital
cardiovascular disease disorders
5. Prevention and management of infection
6. Counseling on STI, HIV/AIDS 3. Schedule of Tetanus Toxoid Immunization
7. Adolescent health services
8. Provision of oral health services Vaccine Minimum % Period of
dose age protected protection
Prenatal package interval to mother
1. Pre Natal visit TT 1 As early as 80%
2. Micronutrient supplementation possible
3. Tetanus toxoid immunization or
4. Promotion of exclusive breastfeeding anytime
5. Counseling on healthy life style during
6. Early detection and management of pregnancy
complications of pregnancy TT2 4 weeks 80% 3 years
7. Prevention and management of other after TT1
condition TT3 6 months 95% 5 years
8. Birth planning and promotion of facilty after TT2
based delivery TT4 1 year 99% 10 years
later after
TT3
TT5 1 year 1 year Lifetime
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later after later after >RH could only be fully achieved if
TT4 TT4 reproductive rights are recognized and enjoyed
Breastfeeding until 6months by every one regardless of race and creed
4. Promotion of exclusive breastfeeding,
newborn screening and infant immunization VISION: Reproductive health practice as a way
5. Counseling on healthy life style of life for every man and woman throughout
6. Early detection and management of life where:
complications of pregnancy > Every pregnancy should be intended
7. Prevention and management of other > Every birth should be healthy
conditions where indicated > Every sex act should be free of coercion and
8. Birth planning and promotion of facility infection
based delivery AIM: to achieve the desired fa

Home Based Mother’s Record (HBMR) Components of reproductive health

antenatal card 1. Maternal and Child Health and Nutrition
> Guide in the identification of risk factors, 2. Family Planning
danger signs and as a basis for instituting 3. Adolescent sexual and reproductive Health
appropriate measures/intervention 4. Men’s reproductive health
5. Prevention of reproductive tract cancer and
Post Partum Package other gynecological problems counseling
Usually 8 hours 6. Prevention of abortion and management of
1. Post partum visits within 72 hours and on its complications
the 7th day post partum check for condition 7. Education and counseling for human
such as bleeding or infections sexuality
2. Micro nutrient supplementation 8. Infertility management
> Iron and folate 60mg once a day for 3 months 9. Violence against women
or 90 tablets 10. Prevention and control of STI’s
> Vitamin 200,000 within 4 weeks after
delivery Reproductive Health strategies
3. Counseling on nutrition, child care, family - Increase and improve the use of more
planning and other available services effective or modern contraceptive method
- Provision of care management and
> Points to remember rehabilitation for RH
1. AMTSL – Active management of the third - RH care provision should focus on adolescent,
stage of labor men, unmarried and other displaced people
2. BEmONC- basic Emergency Obstetric and with RH problems
Newborn Care
3. CEmONC – Comprehensive Emergency Factors determinants of Reproductive Health
obstetric and newborn care 1. Socio-economic condition
4. EINC- Essential intrapartum and newborn a. Education
care (Unang yakap) b. Employment
c. Poverty
Reproductive Health d. Nutrition
>Is the state of well being in all matters relating e. Living condition/Environment
to sexuality and the reproductive system
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f. Family environment 4. Being too ill or unhealthy/too sick or having
an existing disease or disorder like iron
2. Status of women – women destined to deficiency anemia
raised children (2-3 child)
3. Social and gender issues – husbands provide Four pillars of the PFPP
guidance to wives (Guiding principles of the FP)
4. Biological, cultural and psychosocial factors- 1. Responsible parenthood
a. lack of knowledge of reproductive organ 2. Respect for life
and their function 3. Birth Spacing
b. Belief that the children are the source of 4. Informed choice
economic support, companion, so more
children the better Essential content of the Nurse-patient
interaction
> Points to remember 1. Effectiveness
Reproductive Health bill 2. Advantage and disadvantage
RA 10354 – known as responsible parenthood 3. Possible side effects, complications and signs
and reproductive health act of 2012 that require an immediate visit to health
RA 9710 the Magna Carta of Women facility
4. How to used the chosen method
PFPP 5. Prevention of STIs; and
> Started in the 1970’s as a family planning 6. When to return to health facility
service delivery component to achieved fertility
reduction Benefits of Family planning
To mothers;
Goals of Family planning 1. Enable her to regain her health after delivery
> Improve service quality in health facilities 2. Gives enough time and opportunity to love
> To increase demand and access to modern and provide attention to her husband and
contraceptive methods in both public and children
private sectors. 3. Gives more time for her family and own
personal advancement
Importance of Family Planning 4. When suffering from illness, gives enough
- Physical, psychological and emotional health time for treatment and recovery
of the mother
- Newborn attention Benefits to children;
1. Healthy mothers produce healthy children
FP is a means to prevent high risk pregnancies 2. Will get all the attention, security, love and
brought about by the following conditions care they deserve

1. Being too young or too old (less than 18 Benefits to fathers

years old, over 34 years old) 1. Lightens the burden and responsibility in
2. Having too many pregnancies (4 or more supporting his family
pregnancies) 2. Enables him to give his children their basic
3. Having closely spaced pregnancies (less than needs
36 months ) 3. Give him time for his family and own
personal advancement
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4. When suffering from illness, gives enough 5. Withdrawal method
time for treatment and recovery
Artificial Family Planning methods
Natural family planning 1. Combined oral contraceptives (COCs)
> Refers to methods for planning or avoiding 2. Depot medroxyprogesterone acetate (Depo
pregnancies by observation of the natural signs provera)
and symptoms of the fertile and infertile phase 3. Intra uterine device (IUD)
of the menstrual cycle 4. Barrier methods
1. Lactational amenorrhea method (LAM) 5. Permanent methods (BTL, Vasectomy)
2. Fertility awareness based (FAB)
Combined oral contraceptives
LAM – is a base on the menstrual effect of 99.7 % effective
breastfeeding on the mothers fertility after > Simply called pills
childbirth > Preparation contains hormones similar to
> Breastfeeding suppresses the secretion of women’s natural hormones- estrogen, and
gonadotropin and eventually, the development progestogen
of the ovarian follicle > Taken daily to prevent contraception
> The end effect is low estrogen level in blood > Prevent contraception mainly by suppressing
and transient infertility ovulation
> Also cause changes in the endometrium and
LAM is 98-99.5 % effective if the following thicken cervical mucus making sperm
criteria is met transport inside the uterus difficult
1. The mother’s menstrual period has not
returned Advantages of using COCs
2. Full (100%) or nearly full (85%) feeding of the 1. Convenient and easy to use
baby with breast milk, day and night 2. Makes menstrual cycle more regular and
3. The baby is less than 6 months predictable
3. Reduces symptoms of gynecologic conditions
such as dysmenorrhea and endometriosis
4. Reduces the risk of ovarian and endometrial
cancer
5. Reversible rapid return of fertility
6. Does not interfere with intercourse
7. Safe as proven through extensive studies

Disadvantage of using COCs

1. Effectiveness is lowered with incorrect use
Natural method of FP and intake of some drugs such as rifampicin
1. The calendar method -20% failure rate and most anticonvulsants
2. Single indicator method 2. Can suppress lactation
> Cervical mucus /ovulation test
> Basal body temperature method
> Two or more indicators method
3. The standard days method
4. LAM
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3. Requires regular resupply

Advantages of using IUD

1. Local action
2. Has no effect on amount or quality or breast
2. Depot medroxyprogesterone 99% effective milk
> Brand name depo provera 3. Low cost
> Progestin only preparation 4. Does not interfere with sexual intercourse
> Injected intramascularly every 3 months 5. One time application
6. Immediate return to fertility upon removal
Advantages of using depot 7. Can be inserted immediately after childbirth
1. Does not interfere with intercourse or after abortion and can be removed by a
2. Since it does not contain estrogen, it can be trained provider
used while breastfeeding a baby 6 months or 8. Long lasting- the cooper bearing IUD lasts for
older 10 years or more
3. May help against endometrial cancer, pelvic
inflammatory disease (PID) and iron deficiency Disadvantages of IUD
anemia 1. Has common side effects such as pan and
cramping, longer and heavier menstrual
Disadvantages of using Depot bleeding and menstrual irregularities
1. Delayed return to fertility for about 1-4 2. Device maybe expelled, possibly without the
months after use woman knowing it
2. Irregular vaginal bleeding is common 3. Requires a pelvic exam before insertion and
3. Gradual weight gain requires a trained health service provider to
4. Do not protect against STIs insert removed the IUD
4. Does not protect against STIs and may
3. Intrauterine Device (IUD) increase the incidence of PID
> Usually small plastic or metal device inserted 5. Although rare, possible uterine perforation,
inside woman’s uterus to prevent pregnancy which usually occurs at the time of insertion (1
- IUD hormone releasing in 1,000 cases)
- Copper-bearing IUD 6. Requires self checking of IUD strings from
> Inserted during menstrual bleeding time to time which some women may not want
> 99% effective to do
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4. Barrier Methods
> Use of device that mechanically or chemically
prevent fertilization
- Male condom
- Diaphragms
- Cervical caps
- Spermicides
- Female condom (not available in the
Philippines)

Newborn Screening (NBS)

5. Permanent Method NBS- is a simple procedure to find out if the
> Vasectomy for male newborn has a congenital metabolic disorder
> Bilateral Tubal ligation for female that may lead to mental retardation, death if
> Almost 100% effective untreated
Vasectomy- is a surgical procedure where the Recognition of NBS
vas deference is tied and cut or blocked RA 9288 know as New Born Screening act of
through the small opening on the scrotal skin 2004
>The health practitioner who delivers, assist in
the delivery of the newborn in the Philippines
has the obligation to inform the parents or
legal guardian of the availability nature and
benefits of the NBS

Schedule and Method of Screening

> 48 hours to the 72nd hours of life
> May also be done after 24 hours from birth
Bilateral tubal ligation (BTL) > Not later than 3 days from complete
delivery of the newborn
> The baby must be screened again after 2
weeks – accurate results
> NBS fee- 750- 550
> DOH – 50 pesos for collection of blood
sample
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> Results is 7-14 working days to 3 weeks

NBS results
> Negative means normal the baby is not
suffering from any of the disorder that being
screened
> Positive – nurse coordinator will immediately
inform the coordinator of the institution where
the sample was collected to recall the paints
for confirmatory testing

1. Disorders tested for NBS in the Philippines

and their long term effects (6)

Disorders Long term effect

Congenital Severe mental
hypothyroidism retardation
Congenital adrenal Death
hyperplasia
Galactosemia Death or cataract
Phenylketonuria Severe mental
retardation
G6PD deficiency Severe anemia
kernicterus
Maple syrup urine Death
disease

INFANT and YOUNG CHILDREN

> 2002 started the global strategy for infant
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and young children feeding (IYCF) jointly issued 9.Advise mother to relax- tension prevents let
by WHO and UNICEF down of milk
> The commitment of the Philippine DOH has
shown in various administrative order

IYCF the Philippine situation

1. Executive order No. 51 – Know as Milk Code,
prohibits advertising promotion , or other
marketing materials that shall imply or create a
belief that bottle feeding is equivalent to
breastfeeding
2. Executive order No. 382- provided for the
observance of the national food Fortification
Day every November 7 Associated problems with breastfeeding
3. RA 7600- rooming in and breastfeeding act 1. Engorgement
4. RA 8172 Know as ASIN Act for Salt Iodization 2. Sore nipple
Nationwide 3. Mastitis
5. RA 8976- Philippine Food Fortification Act 4. Nutrition
5. Advise mother on family planning methods
Recommended infant and young child feeding and responsible spacing of children
practices
1. Early initiation of breast feeding Advantages of Breastfeeding
2. Exclusive breast feeding for the first 6 B- Best For Babies
months R- Ready always
3. Extended breastfeeding up to 2 years and E- Economical
beyond A- Antibodies
4. Appropriate complementary feeding with S- Sterile and pure
the use of locally available and culturally T- Temperature always stable
available
5. Micro nutrient supplementation F- fresh milk never goes off
6. Universal salt iodization E- emotionally bonding
7. Food fortification E- Easy once established
D- digested easily within 2-3 hours
Breastfeeding I- Immediately available
Considerations: N- nutritionally optional
1. Latch baby’s mouth is able to fasten on to G- Gastro enteric greatly reduce
the mothers nipple
2. Audible swallowing by infant
3. Type of nipple of mother
4. Comfort of mother
5. Help given to nursing mother Expanded Program of Immunization
6. Feeding- 5 mins each breast, increase (EPI)
sucking time by 1 min/day until 10mins
7. Total 20 mins feeding time EPI- Establish in 1976 to ensure that the infant
8. Feed as per demand basis and children and mothers have access to
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routinely recommended infant childhood
vaccines.

Six vaccine preventable diseases

1. TB
2. Poliomyelitis
3. Diphtheria
4. Tetanus
5. Pertussis
6. Measles

Goals of EPI
> To achieved over all EPI goal of reducing the
morbidity and mortality among children
against the most common vaccine-preventable
diseases
> RA 10152 known as mandatory infants and
children Health immunization act of 2011
> RA 7846 provided for compulsory
immunization against hepatitis B for infant and
children below 8 years old

Specific goals of the program

1. To immunized all infants/children against the
most common vaccine preventable disease
2. To sustain the polio free status of the Immunization guidelines
Philippines 1. BCG vaccine shall be given to all school
3. To eliminate measles infection entrance regardless of the presence or absence
4. To eliminate maternal and neonatal tetanus of BCG scar
5. To control diphtheria, pertussis , hepatitis B 2. Fever, local soreness are rash are common
and German measles side effects
6. To prevent extra pulmonary TB among 3. FIC- complete vaccine
children 4. Contraindications
a. BCG vaccine if child has clinical AIDS
b. DPT2 and DPT3 if child had convulsion or
shock within 3 days of the previous dose unless
c. All serious condition that needs
hospitalization
5. The following are not considered as
contraindication
a. moderate fever up to 38℃
Schedule of Childhood immunization b. Permanent scar formation 2-12 weeks after

Maintaining the potency of EPI vaccine

1. Maintaining the cold chain
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a. Ensuring the potency of vaccine 2. Follow the recommended schedule, and
b. Cold chain management is the called chain following the proper cold chain
officer 3. Observe aseptic technique on immunization
4. Proper disposal of used syringe to prevent
health hazard
5. Health teaching with the importance of
vaccination

> Points to remember

⮚ Fully Immunized children (FIC)-complete
the basic vaccination before reaching
one year of age
⮚ Completely immunized children- refer to
children who completed their
immunization schedule at the age of 12-
23 months
⮚ Child protected at birth (CPAB) –term
Other considerations to maintain potency used to described a child whose mother
1. Observe the first expiry first out policy has received 2 doses of TT, 3 doses of TT
(FEFO) anytime prior to pregnancy
2. Comply with recommended duration of
storage and transport should not exceed one
month
3. Take note if the vaccine container has a
vaccine vial monitor (VVM)

Discarding unused Biological

1. Unopened or exposed vaccines maybe put
back in the refrigerator or freezer 2X only
discard after 3rd time
2. BCG discard after 4 hours
3. HBV, DPT, OPV, AMV, TT discard after 8
hours

Nursing Management
1. Clean the skin with Cotton ball moistened
with boiled water and sterile water and not
with alcohol
2. Let the skin dry before injecting vaccine
3. Fever is normal advice mother to give
antipyretic drops

Role of a nurse
1. Actively master list of infants eligible for
vaccination in the community