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MATERNAL HEALTH PROGRAM Introduction 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 by 2015. 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 (NDHS,1998). The Philippines found it hard to reduce maternal mortality. Similarly, perinatal mortality reduction has been minimal. It went down by 11% in 10 yrs. from 27.1-24 per thousand live births 91993 and 2003 NDHS). Essential Health Service Package Available in the Health Care Facilities. These are the packages of the 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 woman may suffer complications and die. Every woman has to visit the nearest health 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 visit that a woman has to receive during pregnancy are as follows: Visits 1st visit 2nd visit 3rd visit Every two weeks Period of Pregnancy As early in pregnancy as possible During the second trimester During third trimester After 8th month of pregnancy until delivery

B. Tetanus Toxoid 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 woman and child bearing age woman. 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 1 month before delivery to protect baby from neonatal tetanus. And the 3 booster dose shots to complete the 5 doses following the recommended schedule provides full protection for both mother and child. The mother then is called as a fully immunized mother (FIM).

C. Micronutrient Supplementation Micronutrient supplementation is vital for pregnant woman. These are necessary to prevent anemia, vitamin A deficiency and other nutritional disorders. They are : Micronutrient Vitamin A Dose 10,000 IU Schedule 4th Remarks

2x a week starting on Do not give vitamin A the month of supplementation before the 4th month of pregnancy. It might cause congenital

pregnancy

problems in the baby. Iron 600 mg/400ug Daily

D. Treatment of disease and other condition There are other conditions that might occur among pregnant woman. These conditions may endanger her health and complication could occur. Follow first aid treatment: Condition/Disease Difficulty of breathing/airway obstruction What to do Clear airway Place position Refer woman to in her best Do not give

hospital with EmOC capabilities. Unconscious Keep on her back arms Do not give oral

at the side Tilt head backwards (unless suspected) Lift chin to open trauma is

rehydration solution to a woman who or is has

unconscious convulsions

Do not give IVF if you are not trained to do so

airway Clear secretions from throat Give IVF to prevent or correct shock Monitor BP, Pulse, and shortness of breath

every 15 mins. Monitor fluid given. If difficulty of breathing and develops, infusion. Postpartum bleeding Monitor urine output. Massage expel clots If bleeding persists: -please cupped palmed on uterine fundus and fill for state of uterus and Do not give puffiness stop

ergomentrine if women has eclamsia, preor

eclamsia hypertension.

contraction -massage fundus in a circular motion -apply bimanual

uterine compression if

ergometrine treatment done and post partum bleeding still persists -give ergometrine 0.2 mg IM and another dose after 15 mins. Intestinal parasitic infection Give 500mg mebendazole tablet single Do not in give the

mebendazole

dose anytime from 4-9 months of pregnancy if non was given in the past 6 months.

first 1-3 months of pregnancy. This might cause congenital

problems in baby.

Malaria

Give

sulfadoxinto

pyrimethamine

women from malaria endemic areas who are in 1st or 2nd pregnancy, 500mg-25mg tab, 3

tabs at the beginning of 2nd 3rd trimesters not less than 1month

interval.

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 woman to a higher level of care when necessary. The necessary steps to follow during labor, child birth and immediate postpartum include the following:

Do a quick check upon admission for emergency sign Make the woman comfortable Assess woman in labor Determine stage of labor Decide if woman can safely deliver Give supportive care throughout labor Monitor and manage labor Monitor within 1 hour after delivery Educate and counsel about family planning Inform, teach, counsel on: o Birth registration o Importance of breastfeeding o NBS o Schedule of postpartum visits Recommended Schedule of Postpartum Care Visits: 1st Visit 2nd Visit 1st week postpartum preferably 3-5 days 6 weeks postpartum

F. Support to Breastfeeding Most mothers do not know the importance of breastfeeding. A supportive care groups like nurses have a critical role to motivate 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 the mother from previous pregnancy and childbirth. The risk of complication increase after the second birth.