BASIC EMERGENCY OBSTETRIC AND NEONATAL CARE (BEmONC)

I. RATIONALE OF THE PROGRAM

The Philippines has committed to the United Nations millennium declaration that translated into
a roadmap a set of goals that targets reduction of poverty, hunger and ill health. In the light of
this government commitment, the Department of Health is faced with a challenge: to champion
the cause of women and children towards achieving MDGs 4 (reduce child mortality), 5
(improve maternal health) and 6 (combat HIV/AIDS, malaria and other diseases). Pregnancy and
childbirth are among the leading causes of death, disease and disability in women of
reproductive age in developing countries. A commitment to the MDGs is, among others, a
commitment to work towards the reduction of maternal mortality ratio by three-quarters and
under-five mortality by two-thirds by 2015 at all cost.
Confronted with the challenge of MDG 5 and the multi-faceted challenges of high maternal
mortality ratio, increasing neonatal deaths particularly on the first week after birth, unmet need
for reproductive health services and weak maternal care delivery system, in addition to
identifying the technical interventions to address these problems, the DOH with support from the
World Bank decided to focus on making pregnancy and childbirth safer and sought to change
fundamental societal dynamics that influence decision making on matters related to pregnancy
and childbirth while it tries to bring quality emergency obstetrics and newborn care to facilities
nearest to homes. This moves ensures that those most in need of quality health care by competent
doctors, nurses and midwives have easy access to such care.
II. VISION
Every woman, child and their families utilize quality health services in a continuum of care.
III. MISSION
To lead, harmonize and converge all efforts in delivery of maternal, newborn, child health and
nutrition (MNCHN) package of services to ensure equitable, accessible, efficient health services
to communities through dynamic partnership and shared advocacy, responsibility and
accountability.
III. GOAL
Rapidly reduce maternal and neonatal mortality through local implementation of a MNCHN
strategy.
IV. OBJECTIVES
GENERAL:
Implementing the MNCHN Strategic Plan supports the attainment of DOHs Universal Health
Care strategy as it aims
To reduce maternal mortality ratio from 162/100,000 live births to 52/100,000 live births

and
To reduce neonatal mortality rate from 17/1,000 live births to 14/1,000 live birth
SPECIFIC:
Increase percentage of pregnant women having at least four antenatal care visits from 78%
to 80%
Increase facility-based delivery from 55% to 85%
Increase skilled birth attendance from 72% to 85%
Increase percentage of newborns initiated to breastfeeding within one hour of life from
53.5% to 90%
Increase percentage of exclusively breastfed infants for the first 6 months of life from 48%
to 70%

V. STRATEGIES
The strategy is based on the following guiding principles:
1. In line with the agenda for health sector reform, the province-wide or city-wide health
system is recognized as the unit for planning, organizing and implementing the
MNCHN strategy.
2.

Local stakeholders shall be engaged and public-private partnerships shall be

strengthened to support the goal of rapidly reducing maternal and neonatal mortality.

3. LGU capacity to deliver the integrated MNCHN services shall be assured and the
service delivery network shall be mobilized to provide the continuum of MNCHN
services.
4. Improvements in the delivery of various component services in the maternal and
neonatal service package shall be continuously pursued.
5.

The implementation of appropriate demand-side interventions shall be developed and

supported.

6.

A monitoring, evaluation and dissemination system for the MNCHN strategy shall be
established and operated at local and national health systems.

7. . National support to local planning and development for the MNCHN strategy shall
be provided.
VI. ESSENTIAL HEALTH SERVICE PACKAGES AVAILABLE IN HEALTH CARE
FACILITIES

To address the problem, packages of health services are provided to the clients. These essential
health care packages are available and are in place in the health system.
These are the packages of services that every woman has to receive before and after pregnancy
and or delivery of the baby.
A. 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 pregnancy care to make her prepare for child
birth. The standard prenatal visits that women have to receive during pregnancy are as follows:

Prenatal Visits

Period of Pregnancy

1st visit

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.

B. 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 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. 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).
C. Micronutrient Supplementation

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

Dose

Schedule

Remarks

Vitamin A

10,000 IU

Twice a week
Do not give Vitamin A supplementation before the 4th month
starting on the 4th
of pregnancy. It might cause congenital problems in the
month of pregnancy baby.

Iron

60 mg/400 Daily
ug tablet

D. 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 of breathing/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 so

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

Massage uterus and expel clots

If bleeding persists:

Place cupped palm on uterine fundus

Do not give ergometrine of

woman has eclampsia, pre
eclampsia or hypertension.

and feel for state of contraction

Massage fundus in a circular motion

Apply bimanual uterine compression if
ergometrine treatment done and
p[ostpartum bleeding still persists
Give ergometrine 0.2. IM and another
dose after 15 minutes.

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

Malaria

Give sulfadoxin-pyrimethamine to women from malaria

endemic areas who are in 1st or 2nd pregnancy, 500mg-25
mg tab, 3tabs at the beginning of 2nd to 3rd trimesters not
less than one month interval.

Do not give mebendazole in

the first 1-3 months of
pregnancy. This might cause
congential problems in baby.

E. 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. The necessary steps to follow during labor,
childbirth and immediate postpartum include the following:
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

Make 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 by taking the history of the ff:
Last menstrual period (LMP)
Number of pregnancy
Start of labor pains
Age/height
Danger signs of pregnancy
Taking 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 leaking amniotic 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

Stage
First Stage. Not yet in
active labor,

What to do

Not to do

Check every hour for emergency signs,

frequency and duration of
contractions, cervix is dilated 0-3cm
and contractions are weak, less than
2 to 10 minutes.fetal heart rate, etc.

Check every 4 hours for fever, pulse, BP

and cervical dilatation

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 dilatation, with
or without membranes
ruptured.
First Stage. In active
labor, cervix is dilated 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

Do not do vaginal examination

more frequently than every 4
hours.

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 10 cm or bulging
thin perineum and head
visible

Check every 5 minutes for perineum

thinning and bulging, 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

deliver the 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 postpartum partum visits
Inform, teach and counsel the woman on important MCH messages:
- Birth Registration
- Importance of Breast Feeding
- 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 visits

1st Visit

1st week post partum preferable first 24 48 hours

2nd Visit

6 weeks post partum

.
F. Support to Breast Feeding
Most mothers do not know the importance of breastfeeding. A support care groups like nurses
have critical role to motivate them to practice breastfeeding.
G. 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
VII. Related Readings
A. DOH CONFIDENT OF ATTAINING MDG DESPITE INCREASE IN MATERNAL
DEATHS
June 18, 2012
SUMMARY:
In the said article, Health Secretary Enrique T. Ona revealed that the Department of Health
(DOH) is doubling its efforts in reducing maternal deaths in the country as the 2011 Family
Health Survey presented that maternal mortality rates increased from 162 to 221 between 2006
and 2011.
He added that while this finding is alarming, he is not surprised that more mothers died as health
services, especially for the poor, have been neglected in the past decade. He explained that
maternal deaths are highly preventable through effective family planning services, antenatal care,
and access to health facilities capable of handling complications.
To reduce maternal deaths in the country, the DOH will distribute around P500M worth of
family planning commodities and supplies. It has also provided P868M for the deployment of
community health teams tasked with giving families health information and facilitating health
services. They also allocated some P6B in the upgrading of local government unit (LGU)-owned
clinics and hospitals. At least 5.3 million poor families have also been enrolled to Philhealth

(2011) using P12B in premium subsidies with improved out-patient and in-patient benefits.
The health chief explained that these challenges can be overcome by fasttracking the
implementation of Kalusugan Pangkalahatan (universal health care). This strategy is focused in
areas where the poor belonging to the National Household Targeting System for Poverty
Reduction (NHTS-PR) of the Department of Social Welfare and Development (DSWD) are most
concentrated. These priority areas receive additional support in terms of cash and in kind grants
while current levels of public health effort are sustained in the rest of the country.
B. NO HOME BIRTHING POLICY: HIGHER MATERNAL MORTALITY AND
NEONATAL DEATHS
March 4, 2013

SUMMARY:
The article is about the government implementation of No Home Birthing Policy as an answer
to the soaring number of maternal and neonatal deaths. It blames the rise in Maternal Mortality
Rates to home births unsupervised by skilled health professionals. The policy states that all
pregnant women should give birth only in facility-based centers attended by skilled health
personnel. In addition, DOH has encouraged doctors, nurses and midwives to put up lying-in
centers, facilities and hospitals which become part of their social delivery network.
On the contrary, A non-government organization said it opposes the "no home birthing policy"
of the Department of Health in a bid to curb the soaring number of maternal and infant deaths in
the country.
Grace Cuasay, a registered midwife and director of Health, Education, Training and Services
department of the Council for Health Development, said the policy will, on the contrary, only
increase maternal and neonatal mortality. She said the government should provide more doctors,
nurses and midwives in rural communities, until the World Health Organization-prescribed ratio
of 1:500 midwife to population is met and "hilots" or traditional birth attendants should also be
seen as a complement to public health workers in the rural setting and should be provided
trainings and tools for more effective and efficient provision of basic health service.