The Maternal Health Program is a set of actions and services administered by the Department of

Health to aid women before, during and after pregnancy. The Philippines is tasked to reduce the
maternal mortality ratio (MMR) by three quarters by 2015 to achieve its millennium development
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) to 172 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 notable increase 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 Maternal Health Programis to improve the survival, health and well being of
mothers and unborn through a package of services 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
which are located strategically. 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. 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
a miscarriage 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 to be 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 are available 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 pregnancy care 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 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.
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).
Micronutrient Supplementation. Micronutrient supplementation is vital for pregnant women. These
are necessary to prevent anema, vitamin A deficieny and other nutritional disorders. They are:
Nutrient Dose Schedule Remarks Vitamin A 10,000 IU Twice a week starting on the 4th month of
pregnancy Do not give Vitamin A supplementation before the 4th month of pregnancy. 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 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 Post 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 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 Do not give mebendazole in the
first 1-3 months of pregnancy. This might cause congential problems in baby. 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.
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 post partum 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 These re
different stages of labor to watch out any danger signs Stage What to do Not to do First StageNot
yet in ative labor, cervic is dilated 0-3cm and contractions are weak, less than 2 to 10 minutes.
Check every hour for emergency signs, frequency and duration of contractions, 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. Do not do vaginal examination more frequently than every 4 hours. First
StageIn active labor, cervic 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 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 StageCervic 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 StageBetween 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 post partum visits Inform,
teach and counsel the woman on important MCH messages: 1st Visit 1st week 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 to
motivate 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 Maternal Health Program has
be eager to decrease the maternal mortality rate of the country and this program is a good example
to that effort.
Read more at Nurseslabs.com DOH Maternal Health Program http://nurseslabs.com/dohmaternal-health-program/