Maternal Care Program Study Notes

Overview of Maternal Care Program

  • Focus on the Maternal, Newborn and Child Health and Nutrition (MNCHN) Strategy

  • Objectives include ensuring that every pregnancy is wanted, planned, supported, and managed.

  • Importance of skilled birth attendants for facility-based deliveries.

  • Health packages for women and survival packages for newborns

  • Implementing a risk approach where all pregnant women are considered at risk for complications.

MNCHN Service Delivery Network

  • Community Level Service Providers/Health Teams

    • Informing families about health risks, needs assessments, and health plans.

    • Facilitating access to health services and providing family planning counseling.

    • Tracking pregnancy.

  • Facilities Required for Different Levels of Care:

    1. Basic Emergency Obstetrics and Newborn Care (BemONC)-capable facilities

    • Services Provided:

      • Parenteral medications: oxytocin, anticonvulsants, antibiotics

      • Assisted deliveries

      • Removal of retained products of conception

      • Manual removal of placenta

    • Must be capable of:

      • Blood transfusion services

      • Providing intra-uterine devices (IUD) and voluntary surgical contraception (VSD)

      • Operating a Rural Health Unit (RHU) or Barangay Health Station (BHS)

    1. Comprehensive Emergency Obstetrics and Newborn Care (CEMONC)-capable facilities

    • Includes all functions in BemONC, plus:

      • Caesarean delivery

      • Blood transfusion

      • Management of low birth weight or preterm newborns

      • Emergency neonatal care, which includes:

        • Newborn resuscitation

        • Treatment of sepsis

        • Oxygen support

        • Administration of steroids for premature delivery

    • Must be a tertiary level hospital.

Schedule of Maternal Visits

  • Prenatal Visits:

    • 1st trimester: ASAP

    • 2nd trimester: 72 hours, then 7 days for a home visit

    • 3rd trimester: Every 2 weeks starting from the 8th month

  • Postnatal Visits:

    • Clinic visit 1 week after delivery

    • Home visit at 3-5 months post-delivery.

Activities and Care Services

  • Regular and Quality Maternal Care Services

    • Prenatal Care Activities (P.H.I.S.I.C.A.L):

    1. Physical examination

    2. History taking

    3. Immunization: Tetanus Toxoid

  • Immunization Schedule (Tetanus Toxoid):

    Dose

    Administration

    % Protected

    Duration of Protection (Years)

    TT1

    ASAP during pregnancy

    TT2

    After 4 weeks

    80%

    3

    TT3

    After 6 months

    95%

    5

    TT4

    After 1 year

    99%

    10

    TTS

    After 1 year

    99%

    lifetime

  • Safe Delivery Care:

    • Follow the "3 Cleans": Clean Hands, Clean Surface, Clean Cord

    • Supplementation with Iron, folate, Vitamin A

  • Iron and Vitamin A Supplementation for Pregnant Women:

    • Iron: 1 tablet OD (once daily) for 6 months

    • Vitamin A: 10,000 IU twice a week starting from the 4th month AOG (Age of Gestation) until delivery

    • Postpartum Women receive 200,000 IU of Vitamin A within 1 month after delivery.

  • Counselling on prenatal care involves educating mothers through a Pink card, which serves as a Home-Based Mother's Record.

Laboratory Exams

  • Urinalysis

    • Benedict’s Test for sugar in urine:

    • 3-5 ml Benedict's solution + 6-8 drops urine, heat for 3 minutes:

      • Red (Brick) = (++++)

      • Orange = (+++)

      • Yellow = (++)

      • Green = trace (+)

      • Blue = (-) sugar

  • Heat and Acetic Acid Test for albumin determination in urine:

    • 3-5 ml urine + 6-8 drops Acetic Acid, heat for 3 minutes:

    • Clear = negative

    • Cloudy precipitate = positive (albumin)

Nursing Care Post Delivery

  • Assessment of Mother (BUBBLE-HE):

    • Breasts, Uterus/Fundus, Bladder, Bowel movement, Lochia, Episiotomy, Homan's sign, Emotional response.

  • Assessment of Newborn (S.A.P.U.):

    • Sucking reflex, Airway, Pneumonia, Umbilical stump (monitor for tetanus risk).

Registration Requirements

  • Registration at the Civil Registrar (PD 651) is required within 30 days after birth.

Essential Intrapartum and Newborn Care (EINC)

  • Also known as Unang Yakap, this consists of necessary components for safe and quality care during childbirth:

    • Continuous maternal support and companion of choice during labor and delivery

    • Freedom of movement during labor

    • Use of partograph for monitoring

    • Nondrug pain relief options before labor anesthesia

    • Position of choice during labor and delivery.