MATERNAL, NEWBORN, AND
CHILD HEALTH AND NUTRITION
PALAWAN D. BATUA, JR., RN,
MAN
MNCHN CORE PACKAGE OF SERVICE
PREPREGNANCY PACKAGE
Nutrition
Promotion of healthy lifestyle
Advice on FP
Prevention and management of lifestyle-related disease
Prevention and management of infection
Counseling on STI/HIV/AIDS, nutrition, personal hygiene, and
consequences of abortion
Adolescent health services
Provision of oral health services
MNCHN CORE PACKAGE OF SERVICE
PRENATAL PACKAGE
Prenatal visits:
Number of Prenatal Visit When in course of pregnancy
First Visit 1st Trimester
Second Visit 2nd Trimester
Third Visit On the 8th months of pregnancy
Fourth Visit On the 9th months of pregnancy
Prenatal Assessment: Weight, V/S FH, FHT, Fetal Movement
Micronutrient Supplementation
• Iron and Folate (60mg/400ug) once a day for 6 months or 180 tabs
• Vitamin A 10,000 IU twice a week from fourth month of pregnancy
• Elemental Iodine 200 mg given once during the pregnancy
MNCHN CORE PACKAGE OF SERVICE
PRENATAL PACKAGE
Tetanus Toxoid Immunization:
TT Dose Interval Percent Duration of Protection
Protecti
on
TT1 As early as possible
during first pregnancy
TT2 At least 4 weeks later 80 3years protection to the mother
TT3 At least 6 months later 95 5years protection to the mother
TT4 At least 1 year later 99 10years protection to the
mother
TT5 At least 1 year later 99 Lifetime protection to the
mother
MNCHN CORE PACKAGE OF SERVICE
PRENATAL PACKAGE
Promotion of exclusive Breastfeeding, NBS and infant immunization
Counseling on healthy lifestyle
Early detection and management of complication of pregnancy
Prevention and management of other condition where indicated:
HPN, anemia, diabetes, TB, Malaria, schistosomiasis, and
STI/HIV/AIDS.
Birth planning and promotion of facility-based delivery
MNCHN CORE PACKAGE OF SERVICE
Home-Based Mother’s Record (HBMR) - is used when rendering
care to the pregnant mother. A simplified record of the history of present
and past pregnancies, when applicable, and the findings and measures of
TBA, BHW, or health professionals.
Provides a means of promoting continuity of care
Promotes early recognition of women who are at risk of developing
illness/complication
Encourage self-care
support initiation of appropriate care
Serves as a useful records of care and health information and source of
health statistics
Guides the health workers in providing for the health educational needs
MNCHN CORE PACKAGE OF SERVICE
Childbirth Package
Skilled Birth Attendant / Skilled Health Professional-Assisted
Delivery
Facility Based Delivery (including the use of partograph)
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MNCHN CORE PACKAGE OF SERVICE
Childbirth Package
Essential Intrapartum and Newborn Care (EINC) also known as
UNANG YAKAP
Maternal Support
Freedom of Movement
Monitoring progress using the partograph
Nondrug pain relief before offering labor anesthesia
Position of choice during labor and delivery
Spontaneous pushing in a semi-upright position
Hand hygiene
Nonroutine episiotomy
MNCHN CORE PACKAGE OF SERVICE
Postpartum Package
Postpartum Visit: 24hrs and within 7 days
Micronutrient Supplementation:
Iron and Folate (60mg/400ug) once a day for 3 months or 90 tabs
Vitamin A 200,000 IU within 4 weeks after delivery
Counseling on nutrition, child care, family planning, and other
available services
MNCHN CORE PACKAGE OF SERVICE
Newborn (First Week of Life) Package
Intervention within the first 90 minutes:
Immediate and thoroughly drying
Skin-to-skin contact between mother and newborn (initiation of
breastfeeding)
Cord clamping 1-3minutes after birth
Nonseparation of baby from the mother
Essential newborn care after 90 minutes :
Vitamin K prophylaxis
Hepatitis B and BCG Vaccination
Examination of the baby for birth injuries, malformation, or defects
Additional care for a small baby (weight: <2,500g)
MNCHN CORE PACKAGE OF SERVICE
Newborn (First Week of Life) Package
Care prior to discharge after the first 90 minutes:
Support unrestricted, per demand breastfeeding, day and night
Ensure warmth of the baby (Kangaroo Mother Care: Preterm
Infants)
Washing and bathing
Look for danger signs
Look for signs of jaundice and local infection
Perform Essential Newborn Screening and Hearing Test
Provide instructions on discharge
MNCHN CORE PACKAGE OF SERVICE
Child Care Package
Immunization
Nutrition
Exclusive breastfeeding up to 6months
Sustained breastfeeding up to 24 months with complimentary
feeding
Integrated Management of Childhood Illness (IMCI)
Injury prevention
Oral Health
Insecticide-treated nets for mothers and children in malaria-
endemic areas
MNCHN CORE PACKAGE OF SERVICE
MNCHN Service Delivery Network (3-Levels of
Care)
1. Community Level Service Providers or Community Health Team
a. Navigation Function
b. Basic Service Delivery Function
2. BEmONC-Capable Facility – six signal of obstetric function
a. Parenteral administration of oxytocin in the third stage of labor
b. Parenteral administration of loading dose of anticonvulsants
c. Parenteral administration of initial dose of antibiotics
d. Performance of assisted deliveries (imminent breech delivery)
e. Removal of retained products of conception
MNCHN CORE PACKAGE OF SERVICE
MNCHN Service Delivery Network (3-Levels
of Care)
2. BEmONC-Capable Facility – Emergency Newborn
Intervention
a. Newborn resuscitation
b. Treatment of neonatal sepsis/infection
c. Oxygen 1 BEmONC Facility: 125,000
support
population
MNCHN CORE PACKAGE OF SERVICE
MNCHN Service Delivery Network (3-Levels
of Care)
3. CEmONC-Capable Facility
BEmONC Functions
Provide Caesarian Delivery Service
Blood banking and transfusion services
1 CEmONC
Other specialized Facility:
obstetric 500,000
intervention
population
MNCHN CORE PACKAGE OF SERVICE
Reproductive Health Program
Reproductive Health (RH) - a state of complete physical,
mental, and social well-being, not merely the absence of disease or
infirmity, in all matters relating to the reproductive system and to its
functions and processes.
Magna Carta of Women of 2009 (RA 9710) – “state shall, at all times,
provide for a comprehensive, culture-sensitive, and gender-responsive health
service and programs covering all stages of women’s cycle and which address
the major causes of women’s mortality and morbidity.”
Responsible Parenthood and Reproductive Health Act of 2012 (RA
10354) – state recognizes and guarantees the human rights to sustainable
human development, health, education and information, and the right to choose
and make decisions and in accordance with one’s religious convictions, ethics,
cultural beliefs, and demand of responsible parenthood.
MNCHN CORE PACKAGE OF SERVICE
Reproductive Health Program
10 Elements of Reproductive Health Care
1. Family Planning
2. Maternal and Child Health and Nutrition
3. Prevention and control of reproductive tract infection, STIs, and
HIV/AIDS
4. Adolescent Reproductive Health
5. Prevention and Management of Abortions and Its Complication
6. Prevention and Management of Breast and Reproductive Tract Cancers
and Other Gynecological Conditions
7. Education and Counseling on Sexuality and Sexual Health
8. Men’s Reproductive Health and Involvement
9. Prevention and Management of Violence Against Women and Child
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
The National Family Planning Policy through
AO 50-A – assert that family planning as a health intervention shall
made available to all men and women of reproductive age (15-49 years
old). FP is a means to prevent high-risk pregnancies brought about the
following:
Being too young (<18 years old) or too old (over 34 years old)
Having had too many (4 or more) pregnancies
Having closely spaced (too close) pregnancies (less than 36 months)
Being too ill or unhealthy/too sick or having an existing disease or disorder
like iron deficiency anemia
AO 132 s. 2004 – created the DOH Natural Family Planning (NFP)
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Four Pillars of the PFPP
A.Responsible Parenthood.
B.Respect for Life.
C.Birth Spacing.
D.Informed Choice
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Counseling- a client-centered,
face-to-face, interactive communication process between the
health service provider and the client that helps the latter to make
a free and informed choices regarding one’s fertility intention or
plan.
Family Planning Counselor:
1. Knowledgeable
2. Positive Attitude Towards Work
3. Sensitive, Understanding, and Helpful
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Counselor interaction content regarding
the chosen method:
1. Effectiveness
2. Advantages and Disadvantages
3. Possible side effects, complications, and signs that require
immediate visit to the health facility
4. How to use the chosen method
5. Prevention of STIs
6. When to return to the health facility
CLIENT ASSESMENT – aims to gather pertinent information about client’s health
status
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Benefits of Family Planning:
A. Benefits to Mothers
1. Regain her health after delivery
2. Give enough time and opportunity to love and provide attention to her husband and
children
3. Gives more time for her family and own personal advancement
4. When suffering from illness, gives enough time for treatment and recovery
B. Benefits to Children
1. Healthy mother produce healthy children
2. Will get all the attention, security, love and care they deserve
C. Benefits to Fathers
1. Lightens the burden and responsibility in supporting his family
2. Enables him to give his children their basic needs
3. Gives him time for his family and own personal advancement
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Natural Family Planning Method – refers to methods for
planning or avoiding pregnancies by observation of the natural signs and
symptoms of the fertile and infertile phase of the menstrual cycle.
1. Modern NFP Methods:
I. Lactation Amenorrhea Method (LAM)
II. Fertility Awareness-Based Methods (FAB)
2. Traditional NFP Methods:
1. Withdrawal Method
2. Calendar/Rhythm Method
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Natural Family Planning Method
Advantages:
I. Effective when used correctly
II. No physical side effect
III. Inexpensive
IV. No follow-up medical appointments
V. Couple develop better understanding about their sexual physiology
and reproductive functions
VI. Shared responsibilities
VII. Foster better communication between spouse
VIII.Couple may utilize the signs and symptoms of the women’s fertility to
either avoid or achieve pregnancy based on the couple‘s decision
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Natural Family Planning Method
1. Modern NFP Methods:
I. Lactation Amenorrhea Method (LAM) – natural breastfeeding on the
mother’s fertility, that is, delay in the return of fertility after childbirth.
Breastfeeding suppresses the secretion of gonadotropin-releasing
hormone by the hypothalamus leads to low estrogen level in blood and
transient infertility. Effectivity: 98-99.5%
Criteria:
a. Absence of menstrual periods
b. Fully (100%) or nearly full (85%) feeding of the baby with breast milk,
day and night
c. The baby is less than 6 months old
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Natural Family Planning Method
1. Modern NFP Methods:
II. Fertility Awareness-Based Methods (FAB) – are based on scientific
analysis of the fertile time in the woman’s menstrual
cycle.
FAB Methods:
1. Billings’ Ovulation Method (BOM) also known
as CERVICAL MUCUS METHOD –
fertility management based on the cervical mucus, the body’s
natural sign of fertility. Develop by Drs. John and Evelyn
Billings.
Menstruatio
Basic Changing Peak ofEffectivity: 95-97%
Postovulatory
Infertile Pattern of Infertile Phase
n fertility
Pattern Infertility
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Natural Family Planning Method
1. Modern NFP Methods:
II. Fertility Awareness-Based Methods (FAB)
FAB Methods:
3. Symptothermal Method– all the signs of fertility
are taken note of. Other signs:
a.) Mittelschmerz – one-sided, lower abdominal
pain that occurs at around the time of ovulation
b.) Spinnbarkeit – the capacity of cervical
mucus to stretch a distance before breaking
c. ) Breast Tenderness
d.) Increased Libido
e.) Mood Changes
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Natural Family Planning Method
1. Modern NFP Methods:
II. Fertility Awareness-Based Methods (FAB)
FAB Methods:
4. Standard Days Methods (SDM)
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Natural Family Planning Method
1. Modern NFP Methods:
II. Fertility Awareness-Based Methods (FAB)
FAB Methods:
5. Two-Day Method - is a simple, fertility
awareness technique that uses
cervical secretions as an indicator of fertility.
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning
Methods:
A. Artificial Family Planning
Method –
1. Combined Oral Contraceptives
(COC) – simply called pills, are
preparation that contain hormones
similar to the woman’s natural
hormones – estrogen and
progesterone – taken daily to
*Progestine Pill Only (POP)
prevent conception. Effectivity:
99.7% with perfect use, 92% with
typical use.
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method –
1. Combined Oral Contraceptives (COC)
Advantages:
1.) Convenient and easy to use
2.) Reduce symptoms of gynecologic conditions
3.) Reduces risk of Ovarian and Endometrial cancer
4.) Reversible, Rapid Return of Fertility
5.) Safe
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method –
1. Combined Oral Contraceptives (COC)
Disadvantages:
1.) Effectiveness is lowered with incorrect use and intake of some drugs
2.) Can suppress lactation
3.) Requires regular resupply
4.) Offers no protection against STIs, including HIV
5.) Side effect: nausea, dizziness or breast tenderness but not generally harmful
6.) My pose health risk for some women: increased risk of cardiovascular disease
– specifically blood clots, heart attacks and strokes.
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method –
2.) Depot-Medroxyprogesterone Acetate (DMPA)– progestin-
only preparation injected intramuscularly every 3
months. Effectivity: 97% - 99%
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method
2. )Depot-Medroxyprogesterone Acetate (DMPA)
Advantages:
1.) Doesn’t interfere with intercourse
2.) Can be use of Breast Feeding Mom
3.) May help protect against Endometrial cancer, pelvic inflammatory disease
(PID), and Iron-deficiency anemia
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method
2. )Depot-Medroxyprogesterone Acetate (DMPA)
Disadvantages:
1.) Delayed return of fertility for about 1-4 months after use
2.) Irregular vaginal bleeding
3.) Gradual weight gain
4.) Offers no protection against STIs, including HIV
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning
Method
3.) Intrauterine Device (IUD) – is
usually a small plastic or metal device
inserted inside a woman’s uterus to
prevent pregnancy. Effectivity: 99%
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method
3. ) Intrauterine Device (IUD)
Advantages:
1.) Local action
2.) has no effect on amount or quality of breast milk
3.) Low cost
4.) does not interfere with Sexual Intercourse
5.) One-time application
6.) Immediate return to fertility upon removal
7.) Can be inserted immediately after childbirth or after abortion
8.) Long-lasting: 10 years or more
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method
3. ) Intrauterine Device (IUD)
Disadvantages:
1.) Has common side effects: pain and cramping, longer and heavier menstrual
bleeding and menstrual irregularities
2.) Device maybe expelled, possibly without the woman knowing it
3.) Requires a pelvic exam before insertion and requires trained health service
provider to insert/remove the IUD
4.) Although rare (1 in 1,000 cases), possible uterine perforation
5.) Requires self-checking of IUD strings from time-to-time
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method
4.) Barriers Method – involves the use of devices that mechanically
or chemically prevent fertilization. Effectivity: 70%-85%
Barriers Device:
a.) Male Condoms
b.) Diaphragms
c.) Cervical Caps
d.) Spermicides
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method
5.) Permanent Methods
a.) Vasectomy – a surgical procedure where the vas
deferens is tied and cut or blocked
through small opening on the scrotal skin.
Possible Complication:
- scrotal hematoma
- wound infection
- epididymitis
- sperm granuloma
MNCHN CORE PACKAGE OF SERVICE
Philippine Family Planning Program
Family Planning Methods:
A. Artificial Family Planning Method
5.) Permanent Methods
b.) Bilateral Tubal Ligation (BTL) – involves cutting
or blocking the two fallopian tubes.
Possible Complication:
- wound infection
- bleeding at the incision site
- injury to internal organs
- anesthesia risk
- rarely, ectopic pregnancy
MNCHN CORE PACKAGE OF SERVICE
Essential Newborn Screening
Newborn Screening – is a simple procedure to find out if a
baby has a congenital metabolic disorder that may lead to mental retardation
or even death if left untreated.
Disorders Long-Term Effects
Congenital Hypothyroidism Severe Mental Retardation
Congenital Adrenal Hyperplasia Death
Galactosemia Death or Cataracts
Phynelketonuria Severe Mental Retardation
G6PD Severe Anemia, Kernicterus
Maple Syrup Urine Disease Death
MNCHN CORE PACKAGE OF SERVICE
Essential Newborn Screening
RA 9288 or Newborn Screening Act of 2004
– this law states that, prior to delivery, any health practitioner who delivers, or
assists in the delivery, of a newborn in the Philippines has the obligation to
inform the parents or legal guardian of the newborn of the availability, nature,
and benefits of NBS.
Ideally done on the 48th to the 72nd hours of life, NBS may be also be done
after 24hours from birth.
MNCHN CORE PACKAGE OF SERVICE
Essential Newborn Screening
Disorders Definition
Congenital Hypothyroidism A condition in which the baby is born with the inability to
produce enough thyroid hormone
Congenital Adrenal Hyperplasia A group of inherited disorders characterized by the inability of
the adrenal gland to secrete cortisol or aldosterone, or both
Galactosemia An inherited disorder in which the body is unable to metabolize
galactose and the person is unable to tolerate any form of milk
– human or animal
Phenylketonuria An inherited condition in which a baby is born without the
ability to properly breakdown an amino acid called
phenylalanine.
G6PD A hereditary condition in which red blood cells breakdown when
the body is exposed to certain drugs, foods, severe stress, or
severe infection
Maple Syrup Urine Disease A genetic defect in which a person is unable to break down the
amino acid leucine, isoleucine, and valine: urine of affected
persons smells like maple syrup
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Newborn Hearing Screening
Universal Newborn Hearing Screening and
Intervention Act of 2009 (RA 9709) – for early
detection of congenital hearing loss among newborn and referral for early
intervention services to infants with hearing loss.
