Policy Development
1. Administrative Order 2008-0029 entitled: “Implementing Health Reforms for the Rapid
Reduction of Maternal and Neonatal Mortality
2. Administrative Order 2009-0025 known as Adopting New Policies and Protocol on
Essential Newborn Care
Policy Objective: Reduce maternal and neonatal mortality rates faster from 2007 to 2015
in order to meet MDG targets
MNCHN Intermediate Goals
1. Every pregnancy is wanted, planned and supported;
2. Every pregnancy is adequately managed throughout its
course;
3. Every delivery is facility-based and managed by
skilled birth attendants/skilled health professionals; and
4. Every mother and newborn pair secures proper
post-partum and newborn care with smooth transitions to the women’s health care
package for the mother and child survival package for the newborn.
MNCHN Service Delivery Network
1. Third Tier: CEmONC Capable Health Facilities
2. Second Tier: BEmONC Capable Health Facilities
3. First Tier: Community Level Service Providers
Essential Intrapartum and Newborn Care
1. Hospital Reform Agenda
2. Network of Centers of Excellence
3. Curriculum Changes
4. Social Marketing Campaign
Millenium Development Goal
Goal 1: Eradicate Extreme Poverty and Hunger
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV and AIDS, malaria and other
diseases
Goal 7: Ensure environmental sustainability
Goal 8: Develop a global partnership for development
5 Direct Obstetric
Complications
1. Hemorrhage (41%)
2. Unsafe Abortion (12%)
3. Hypertension (22%)
4. Other (15%)
5. Infection (10%)
FOCUSED ANTENATAL CARE
1. At least 4 routine antenatal visits
2. Recognition and management of complicated pregnancies
3. Screening for diseases that may complicate
pregnancies
4. Giving preventive measures
5. Birth preparedness counselling
6. Complication Readiness planning
Schedule for Visit: 1st trimester, 26th wk, 32th wk and 38th week.
Screening for Diseases: HPN, Anemia, Syphillis, Diabetes Mellitus, HIV and UTI
Preventive Measures
a. Iron and
folate supplementation
b. Tetanus Immunization
In Selected Populations
a. Intermittent pressumptive treatment for malaria
b. Iodine supplementation in severely iodine deficient
area.
Recognition and Management of Complicated Pregnancies
Administer antenatal steroids to all patients who:
a. Pesent with preterm labor: 24-34 weeks AOG
b. Patients with any of the following prior to term:
·
antepartal hemorrhage
·
hypertension
·
prelabor rupture of membrane
Bexamethasone 12mg IM q 24hr X 2 dose
|
Dexamethasone 6mg IM q 12hr X 4 dose
|
The Birth Plan
1. The woman’s condition during pregnancy
2. Preferences for her place of delivery and choice of birth attendant
3. Available resources for her childbirth and newborn baby
4. Preparations needed should an emergency situation
arise during pregnancy, childbirth and postpartum.
Emergency Plan
1. Advise on danger signs
2. Where to go?
3. How to go?
4. Who will go with you to health center?
5. How much will it cost? Who will pay? How will you
pay?
6. Start saving for these possible costs now.
7. Who will care for your home and other children when
you are away?
REFOCUSED ANTENATAL CARE
1. Health Education
2. Nutrition
3. Self-care
4. Signs of Labor
5. Danger Signals of Pregnancy
6. Breastfeeding
7. Newborn Screening
8. Family Planning
Stages of Labor
1st Stage: regular uterine contractions/start of active labor
until full cervical dilatation.
2nd Stage: full cervical dilatation until baby is delivered.
3rd Stage: after baby is delivered until placental delivery
4th Stage: the hour immediately after delivery
Intrapartum Care During the First Stage of Labor
Before
|
Present
|
Routine enema
|
per request
|
Perineal shaving
|
|
Routine IVF
|
Allow woman to eat & drink during labor
|
Keep woman in supine position
|
Mobility and position of choice
|
Routine analgesia and anesthesia
|
continous maternal support during labor
|
Early amniotomy to hasten labor
|
only when indicated
|
Oxytocin augmentation
|
as needed
|
Maternal Support During Labor
1. Respect for privacy
2. Communication
3. Allow food and drink during labor
4. No routine IVF
5. Mobility
6. Non Suppine Position
7. Pain-relief
8. Companion of choice
Relief of Pain and Discomfort During Labor
1. Communication - explain, inform, respect, praise, encouragem, reassure
2. Mobility - move freely, choice of position
3. Urination - encourage every two hours
4. Breathing Technique
5. Birth Companion
Fetal Distress: meconium staining, decreased heart rate, fetal trashing.
Partograph - used in monitoring labor
Linear Arrangement of Instruments
a. Gloves (3pairs)
b. Towel and Bonnet
c. Cord Clump
d. Peans
e. Scissors
f. Kindney Basin
Care During Second Stage of Labor
Before
|
Present
|
Routine catheterization to empty bladder
|
Void spontaneously
|
Lithotomy Position
|
Assist into a comfortable position
|
Fundal pressure
|
Dont do this
|
Urge to push
|
Allow to push as she wish w/ contractions
|
Massage perineum
|
Perineal support and controlled ddelivery of the
head
|
Routine episiotomy
|
Fundal Push Effects
1. Maternal: perineal tears, ruptured uterus, hypotension, RDS, abdominal bruising, fractured ribs, ruptured liver.
2. Fetal: brachial
plexus, injuries, fractured humerous and clavicle, hypoxemia, asphyxia,
increased ICP, cord compresions.
Cardinal Movements
1. Descent
2. Flexion
3. Internal Rotation
4. Extension
5. External Rotation
6. Expulsion
Alternatives: patience, avoidance of arbitrary frames.
Approaches in the Management of the 3rd Stage of Labor
Physiologic (Expectant)
|
Active (AMSTL)
|
|
Uterotonic
|
not given until placenta is delivered
|
Given within 1 minute of baby’s birth
|
Signs of placental separation
|
WAIT
|
DONT WAIT
|
Delivery of the placenta
|
by gravity with maternal effort
|
Controlled Cord Traction (CCT) with counteractions
on uterus
(BRANDT-ANDREWS Maneuver)
|
Uterine Massage
|
after placenta is delivered
|
Calkin’s Sign - change in uterus shape
Benefits of AMSTL (Active Management of the Third Stage of Labor)
a. decrease blood loss of 1L or more
b. decrease in blood transfusion
c. decrease in the use of additional uterotonics
