DOH Maternal Health Program

8/6/2019 DOH Maternal Health Program

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DOH Maternal Health Program

The Philippines is tasked to reduce the maternal mortality ratio (MMR) by three quarters by 2015 to achieve its millenniumdevelopment goal.

This means a MMR of 112/100,000 live births in 2010 and 80/100,000 live births by 2015.

Year Expected MMR

2010 112/100,000 live births

2015 80/100,000 live births

The maternal mortality ratio (MMR) has declined from an estimated 209 per 100,000 live births in 1987-93 (NDHS 1993) to172 in 1998. The Philippines found it hard to reduce morality. Similarly, perinatal mortality reduction has been minimal. It

went down by 11% in 10 years from 27.1 to 24 per thousand live births

Year Actual MMR

1987-1993 209/100,000 live births

1998 172/100,000 live births

The percentage of pregnant woman with at least four prenatal visits decreased from 77% in 1998 to 70.4 in 2003. In addition,pregnant women who received at least two doses of tetanus toxoid also decreased from 38% in 1998 to 37.3% in 2003. Only

about 76.8% of pregnant women received iron supplementation during pregnancy.

The Philippine Health Statistics revealed that maternal deaths are due to:

Complication Percentage of total maternal deaths

Hypertension 25%

Postpartum Hemorrhage 20.3%

Pregnancy with abortive outcomes 9%

However births attended by health professionals increased from 56% in 1998 to 59.8% in 2003. There was also a notableincrease to 51% in 2003 from 43% in 1998 in the percentage of women with at least one prenatal visit. Only 44.6% of

postpartum women received a dose of Vitamin A.

The underlying causes of maternal deaths are delays in taking critical actions:

delay in seeking care, delay in making referral and delay in providing of appropriate medical management.Other factors that contribute to maternal deaths includes

closely spaced births, frequent pregnancies, poor detection and management of high-risk pregnancies, poor access to health facilities brought about by geographic distance and cost of transportation, and as well as health care and health staff who lack competence in handling obstetrical emergencies.The overall goal of the program is to improve the survival, health and well being of mothers and unborn through a package ofservices all throughout the course of and before pregnancy.

The Strategic Thrust for 2005-2010

Basic Emergency Obstetric Care (BEMOC)

Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the DOH. The BEMOC

strategy entails the establishment of facilities that provide emergency obstetric care for every 125, 000 population and whichare located strategically. The strategy calls for families and communities to plan for childbirth and the upgrading of technical

capabilities of local health providers.


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Improve the quality of Prenatal and Postnatal Care

Pregnant women should have at least four prenatal visits with time for adequate evaluation and management of diseases and

conditions that may put the pregnancy at risk. Post-partum care should extend to more women after childbirth, after amiscarriage or after an unsafe abortion.

Reduce womens exposure to health risks

Through the institutionalization of responsible parenthood and provision of appropriate health care package to all women of

reproductive age especially those who are:

less than 18 years old and over 35 years of age, women with low educational and financial resources, women with unmanaged chronic illness and women who had just given birth in the last 18 months.

Appropriate Allocation of Resources

LGUs, NGOs and other stakeholders must advocate for health through resource generation and allocation for health services tobe provided and are in place in the health system.

To address the problem, packages of health services are provided to the clients. These essential health care packages areavailable and are in place in the health system.

Essential Health Service Package Available in the Health Care Facilities

These are the packages of services that every woman has to receive before and after pregnancy and or delivery of a baby.

Antenatal Registration

Pregnancy poses a risk to the life of every woman. Pregnant women may suffer complication and die. Every woman has to visit

the nearest facility for antenatal registration and to avail prenatal care services. This is the only way to guide her in pregnancycare to make her prepare for child birth. The standard prenatal visits that women have to receive during pregnancy are as

follows:

Prental Visits Period of Pregnancy

1stvisit As early in pregnancy as possible before four months or during the first trimester

2nd visit During the 2nd trimester

3rd visit During the 3rd trimester

Every 2 weeks After 8th month of pregnancy till delivery.

Tetanus Toxoid Immunization

Neonatal Tetanus is one of the public health concerns that we need to address among newborns. To protect them from deadly

disease, tetanus toxoid immunization is important for pregnant women and child bearing age women. Both mother and childare protected against tetanus and neonatal tetanus. A series of 2 doses of Tetanus Toxoid vaccination must be received by awoman one month before delivery to protect baby from neonatal tetanus. And the 3 booster dose shots to complete the five

doses following the recommended schedule provides full protection for both mother and child. The mother is then called as a

fully immunized mother (FIM).

Micronutrient Supplmentation

Micronutrient supplementation is vital for pregnant women. These are necessary to prevent anemia, vitamin A deficiency and

other nutritional disorders. They are:


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NutrientDose Schedule Remarks

VitaminA

10,000 IU Twice a week starting on the4th month of pregnancy

Do not give Vitamin A supplementation before the 4th month ofpregnancy. It might cause congenital problems in the baby.

Iron 60 mg/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 What to do Do not give

Difficulty ofbreathing/obstruction of

airway

Clear airway Place in her best position Refer woman to hospital with EmOC capabilities

Unconscious Keep on her back arms at the side Tilt head backward (unless trauma is suspected) Lift chin to open airway Clear secretions from throat Give IVF to prevent or correct shock Monitor VS every 15 minutes Monitor fluid given. If difficulty of breathing and puffiness

develops, stop infusion Monitor U.O. 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 soPost partum bleeding Massage uterus and expel clots

If bleeding persists: Place cupped palm on uterine fundus and feel for state

of contraction

Massage fundus in a circular motion Apply bimanual uterine compression if ergometrine

treatment done and postpartum bleeding still persists

Give ergometrine 0.2. IM and another dose after 15minutes.

Do not give ergometrine if woman has eclampsia, pre-eclampsia or hypertension.

Intestinal parasite infection Giver mebendazole 500mg tablet single dose anytime from 4-

9 months of pregnancy if none was given in the past 6 months

Do not give mebendazole in the first

1-3 months of pregnancy. Thismight cause congential problems in

baby.

Malaria Give sulfadoxin-pyrimethamine to women from malaria

endemic areas who are in 1stor 2nd pregnancy, 500mg-25 mgtab, 3tabs at the beginning of 2nd to 3rd trimesters not lessthan one month interval.

Clean and Safe Delivery

The presence of a skilled birth attendance will ensure hygiene during labor and delivery. It may also provide safe and non

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


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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 vomitingMake woman comfortable

Establish rapport with the client by greeting and interviewing to make her comfortable.

Assess the woman in labor

Assessing the client is a reference guide for a health worker to determine its status during labor stage. This can be done bytaking the history of the ff:

Last menstrual period (LMP) Number of pregnancy Start of labor pains Age/height Danger signs of pregnancyTaking the history through interview will help determine the clients condition during delivery of a baby.

Determine the stage of labor

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

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 delivery of a mother.

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 ever 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.

Monitor and manage labor

These re different stages of labor to watch out any danger signs

Stage What to do Not to do

First Stage

Not yet in ative labor, cervic

is dilated 0-3cm and

contractions are weak, less

Check every hour for emergency signs, frequencyand duration of contractions, fetal heart rate, etc.

Check every 4 hours for fever, pulse, BP andcervical dilatation

Record time of rupture of membranes and color ofamniotic fluid.

Do not do vaginal examination morefrequently than every 4 hours.


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than 2 to 10 minutes. Assess progress of labor Refer woman immediately to hospital facility

with comprehensive emergency obstetrical care

capabilities if after 8 hours, contractions arestronger and more frequent but no progress incervical dilatation, with or without membranes

ruptured.

First Stage

In active labor, cervic isdilated 4 cm or more

Check every 30 minutes for emergency signs Check every 4 hours for fever, pulse, BP and

cervical dilation Record time of rupture of membranes and color of

amniotic fluid Record findings in partograph/patient record. Do not allow woman to 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

Cervic dilated 10 cm orbulging thin perineum and

head visible

Check every 5 minutes for perineum thinning andbulging, visible descend of the head during

contraction, emergency signs, fetal heart rate and

mood and behavior.

Continued recording in the partograph. Do not apply fundal pressure to help delivery the

baby.

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 deliverthe placenta

Others

Monitor closely within one hour after delivery and give supportive care Continue care after one hour postpartum.Keep watch closely for at least 2 hours. Educate and counsel on FP and provide FP method if available and decision was made by a woman. Birth registration Importance of BF Newborn Screening for babies delivered in RHU or at home within 48 hours up to 2 weeks after birth Schedule when to return for consultation for post partum visitsInform, teach and counsel the woman on important MCH messages:

1stVisit 1stweek post partum preferable 3-5 days

2nd Visit 6 weeks post partum

Support to Breast Feeding

Most mothers do not know the importance of breastfeeding. A support care groups like nurses have critical role tomotivate them to practice breastfeeding.

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. Birth spacing of three to five years interval will help completely recover the health of a mother from

previous pregnancy and childbirth. The risk of complications increases after the second birth.

Conclusion

The DOH has be eager to decrease the maternal mortality rate of the country and this program is a good example to that effort. This was

adapted from the DOH book.

Documents

DOH Maternal Health Program