CHN and DOH program

1. and
Child Health
Nursing
Prepared by:
Ruby Shelah P. Dunque

2. Introduction
 Maternal and Child Health refer to philo-mother and child
relationship to one another and consideration of the entire
family as well as the culture and socio-economic
environment as framework of the patient.
 It involves the care of the woman and family throughout
pregnancy and childbirth and the health promotion and illness
care for the children and families.

3. Goal of MCH
 To ensure that every expectant and nursing mother maintains
good health, learns the art of child care, has normal delivery
and bears healthy child.
 That every child, wherever possible lives and grows up in a
family unit with love and security, in healthy surroundings,
receives adequate nourishment, health supervision and
efficient medical attention, and is taught the elements of
healthy living (Reyala, 2000).

4. Promotion and maintenance of optimum health of
the women and newborn.

5. Philosophy of MCN
Is community-centered
Is research-centered
Is based on nursing theory
Protects the rights of all family members
Uses a high degree of independent functioning
Places importance on promotion of health

6. Is based on the belief that pregnancies or childhood
illness are stressful because they are crises.
Is a challenging role for the nurse and is a major
factor in promoting high level wellness in families.
Pregnancy, labor and delivery and the puerperium
are part of the continuum of the total life cycle.

7. Personal, cultural and religious attitudes and
beliefs influence the meaning of pregnancy for
individuals and make each experience unique.
Maternal-child nursing is family centered. The
father of the child is as important as the mother.

8. Strategic thrusts (2005-2010)
 Launch and implement the Basic Emergency Obstetric Care
strategy in coordination with the DOH. It entails the
establishments of facilities that provide emergency obstetric
care for every 125,000 population and which are located
strategically.
 Improves the quality of prenatal and postnatal care.

9.  Reduce women’s 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 education and financial resources,
women with unmanaged chronic illness and women
who had just given birth in the last 18 months.

10.  LGUs and NGOs and other stakeholders must advocate for
health through resource generation and allocation for health
services to be provided for the mother and the unborn.

11. Maternal Neonatal and Child Health and
Nutrition Strategy (MNCHN)
 It applies specific policies and actions for local health
systems to systematically address health risks that lead to
maternal and especially neonatal deaths which comprise
half of the reported infant mortalities.

12. BeMONC- Basic Emergency Obstetrics and
Newborn Care
It refers to lifesaving services for emergency maternal and
newborn conditions/complications being provided by a health
facility or professional to include the following services:
 Administration of parenteral oxytocic drugs.
 Administration of dose of parenteral anticonvulsants
 Administration of parenteral antibiotics
 Administration of maternal steroids for preterm labor

13.  Performance of assisted vaginal deliveries
 Removal of retained placental products
 Manual removal of retained placenta
It also includes neonatal interventions which include at the
minimum:
 Newborn resuscitation
 Provision of warmth
 Referral
 Blood transfusion

14. BeMONC facility shall consist of the core district
hospital.
For geographically isolated/disadvantaged areas/
densely populated areas, the designated BeMONC
facilities are the following: Rural Health Unit,
Barangay Health Station, Lying-in Clinics and
Birthing Homes.
Accessibility within 1 hour from residence or
referring facility within the ILHZ (Inter-local
Health Zones)

15. Shall operate within 24 hours with 6 signal
obstetric function.
Shall have access to communication and
transportation facilities to mobilize referrals.
Staff composition: (1) Medical Doctor, (1)
Registered Nurse, (1) Registered Midwife.

16. CeMONC- Comprehensive Emergency
Obstetrics and Newborn Care facility
- Refers to lifesaving services for emergency maternal
and newborn conditions/complications as in Basic
Emergency Obstetric and Newborn Care plus the
provision of surgical delivery and blood bank services
and other specialized obstetric interventions.

17. Essential Health Services available in the Health
Care Facilities
A. Antenatal Registration/ Prenatal Care
OBJECTIVE: to reach all pregnant women, to give sufficient care
to ensure a healthy pregnancy and the birth of a full term healthy
baby.

18. Normal Patients- following the initial evaluation
they will be given healthy instructions and
counseling. This will include advice for prompt
prenatal care examination.
Patients with mild complications- a thorough
evaluation of the needs of patients with mild
complications will determine the frequency of
follow-up of these cases by the rural health unit,
city health clinic or puericulture center

19. Patients with potentially serious
complications- these patients shall be referred
to the most skilled source of medical and
hospital care. As a first choice they will be
referred if at all possible for continuing care
or consultation. Second choice will be
followed carefully by the rural health unit,
city health clinic or puericulture center.

20.  All RHUs and BHS should have a masterlist of
pregnant women in their respective catchment center.
 The Home Based Mother’s Record (HBMR) shall be
used when rendering prenatal care as a guide in in the
identification of risk factors, danger signs and to be able
to do appropriate measures.
 There should be atleast 3 prenatal visits following the
prescribed timing:

21.  First prenatal visits should be made as early in
pregnancy as possible, during the first trimester.
 Second during the second trimester
 Third and subsequent visits during the third trimester.
 More frequent visits should be done for those at risk
or with complications.

22. Tetanus Toxoid Immunization
 Neonatal tetanus is one of the public health concerns, that is
why it is important for pregnant women and child bearing age
women to get a tetanus toxoid immunization in order to protect
them from this deadly disease.
 A series of 2 doses of TT vaccination must be received by
woman one month before delivery to protect baby from
neonatal tetanus.

23.  And the three booster dose shots to complete the five
doses following the recommended schedule provides
full protection. The mother is then called as a “Fully
Immunized Mother” (FIM).

24. Micronutrient Supplementation
 It is necessary to prevent anemia, vitamin A deficiency and other nutritional
disorders.
Vitamin A
 Dose: 10,000 IU
 Given a week starting on the 4th month of pregnancy.
 Do not give it before the 4th month of pregnancy because it might cause
congenital problems in the baby.
Iron
 Dose: 60mg/400 ug tablet
 Schedule: Daily

25. Clean and Safe Delivery
A. Check for Emergency signs
 Unconsciousness
 Vaginal bleeding
 Severe abdominal bleeding
 Looks very ill
 Severe headache with visual disturbance
 Severe breathing difficulty
 Fever
 Severe vomiting

26. B. Made woman comfortable
C. Assess the woman in labor
LMP
Number of pregnancy
Start of labor pains
Age/height
Danger signs of pregnancy

27. D. Determine the stage of labor
E. Decide of the woman can safely deliver
F. Give supportive care throughout labor
G. Monitor and manage labor
H. Monitor closely after delivery
I. Continue care for at least two hours postpartum

28. G. Inform, counsel and teach woman
Birth registration
Importance of breastfeeding
Newborn screening
Schedule of postpartum visits. (1st visit: 1st week
postpartum preferably 3-5 days and 2nd visit: 6
weeks postpartum)

29. Home Delivery
It is for normal pregnancies attended by licensed health personnel.
Trained hilots may be allowed to attend home deliveries only in
the following circumstances:
 Areas where there are no health personnel on maternal care.
 When, at the time of delivery, such personnel is not available.
Actively practicing but untrained birth attendants (hilots) should
be identified, trained and supervised by a personnel of the nearest
BHS/RHU trained on Maternal Care.

30. The following are qualified for home delivery:
 Full term
 Less than 5 pregnancies
 Cephalic position
 Without existing diseases such as diabetes, bronchial
asthma, heart disease, hypertension, goiter, tuberculosis,
severe anemia.
 No history of complications like hemorrhage during
previous deliveries.

31.  No history of difficult delivery and prolonged labor (more
than 24 hours for primi and more than 12 hours for
multigravida)
 No previous cesarean section
 Imminent deliveries (those who are about to deliver and can
no longer reach the nearest facility in time for delivery)
 No premature rupture of membranes
 Adequate pelvis
 Abdominal enlargement is appropriate for age of gestation.

32. Home delivery kit must atleast contain two pairs
of clamps, a pair of scissors, antiseptic (may use
70% Povidone/Iodine) soap and hand brush,
clean towel/piece of cloth, flashlight,
sphygmomanometer, stethoscope.
Clean hands, clean surface and clean cord must
be strictly followed to prevent infection.

33. Guide for home delivery:
 For registered patient: time when regular pains
started, whether bag of water ruptured or not, presence
of absence of vaginal discharges, bleeding, etc.,
whether mother moved her bowels and has urinated,
fetal movement felt by the mother or not, unusual
symptoms such as bleeding, headache, spots before
eyes.
 For unregistered patients: get same information as
for those registered patients and get medical and
obstetric history.

34. Delivery in Healthy Facility
At lying-in clinics, Birthing Homes or within the
BHSs/RHUs.
Normal pregnancies and with labor progressing
normally must be encourage to deliver in this
facility.

35. Delivery in Hospitals
Risk pregnancies should be advised to deliver in the hospital
are the following:
 Pregnancy more the 4
 Previous CS
 History of postpartum hemorrhage
 History of medical illness such as heart disease, goiter,
tuberculosis, diabetes, severe anemia, hypertension,
bronchial asthma
 Antepartum hemorrhage

36. Hypertensive disorders of pregnancy and
Eclampsia
Cephalo-pelvic disproportion
Placenta previa and abruption placenta
Multifetal pregnancy
Post term and preterm pregnancies
Previous uterine surgery such as myomectomy.

37. Apgar Scoring
It provides a valuable index for evaluation of the
infant’s at birth. It is based on five signs ranked in
order of importance as follows: Heart Rate,
Respiratory Effort, Muscle Tone, Reflex Irritability
and Color. In general, they made 1 minute of life and
5 minutes. Each signs is evaluated according to the
degree to which it is present and is given a score of 0,
1 and 2. The scores of each sign is added together to
give a total scores (10 is the maximum).

38. Newborn Screening
It is a public health program aimed at the early
identification of infants who are affected by certain
genetic/metabolic/infectious conditions. Early
identification and intervention can lead to significant
reduction of morbidity, mortality and associated
disabilities in affected infant

39. Significance:
 Most babies with metabolic disorders look “normal” at
birth. By doing NBS, metabolic disorders may be
detected even before clinical signs and symptoms are
present. And as a result of this, treatment can be given
early to prevent consequences of untreated conditions.
Timing:
 It is ideally done on the 48th-72nd hours of life. However,
it may also be done after 24 hours from birth.

40. Procedure:
 A few drops are taken from the baby’s heel, blotted on a special
absorbent filter card and then sent to the Newborn Screening
Center (NSC). The blood samples for Newborn Screening (NBS)
may be collected by any of the following: physician, nurse,
medical technologies or trained midwife. The procedure costs
P550. The DOH advisory Committee on Newborn Screening has
approved a maximum allowable fee of P50 for the collection of
the sample. Newborn Screening is now included in the Philhealth
Newborn Care Package. It is widely available in hospitals, Lying-
ins, Rural Health Unit, Health Centers, and some private clinics. If
babies are delivered at home, babies may be brought to the nearest
institution offering newborn screening.

41.  Results can be claimed from the health facility where
NBS was availed. Normal NBS results are available
by 7-14 working days from the time samples are
received at the NSC. Positive NBS results are relayed
to the parents immediately by the health facility. A
NEGATIVE SCREEN MEANS THAT THE NBS IS
NORMAL.
 A positive screen means that the newborn must be
brought back to his/her health practitioner for further
testing. Babies with positive results maybe referred at
once to a specialist for confirmatory testing and
further management.

42. Disorders detected in Newborn
Screening
Phenylketonuria
 it is the inability to metabolize the amino acid
phenylaline, which is a common component such a milk.
Excessive accumulation of phenylalanine in the blood
causes brain damage. The babies may look like “albino”
with musty odor of the skin, hair, sweat and urine. PKU is
treated with a special low-phenylalanine diet which the
amount of amino acid is carefully regulated.

43. Congenital Hypothyroidism
most common causes of mental retardation. Most
affected infants may look normal at birth, however,
they may have large fontanels and tongues, big
tummies and prolonged yellowish discoloration of the
skin and eyes. Infants are treated with thyroid
hormones and it continues throughout life. If the
disorder is not detected and hormone replacement is
not initiated within two weeks, the baby with CH may
suffer fro mental and growth retardation

44. Galactosemia
it is the absence of enzymes necessary for
conversion of the milk sugar galactose to glucose.
Affected infants present with difficulty in
feeding, vomiting and diarrhea, yellowish skin
and eyes, weakness, white eyes (cat’s eyes) and
bleeding after blood extraction. Accumulation of
excessive galactose in the body may cause liver
damage, brain damage and cataracts. Treatment
may include elimination of milk from the diet
and use of milk substitute.

45. Glucose 6 phosphate dehydrogenase deficiency
(G6PD deficiency)
the body lacks the enzyme called G6PD that may
cause hemolytic anemia, when the body exposed to
oxidative substances found in certain drugs, foods
and chemicals. Children become pale, with yellow
skin and eye, tea colored urine and fast breathing. It
may lead to heart failure.

46. Congenital Adrenal Hyperplasia
refers to a group of disorders with an enzyme
defect that prevents adequate adrenal corticosteroid
and aldosterone production an increases production
of androgens. It manifested by poor feeding,
vomiting and diarrhea and weak cry. It also causes
short stature, early puberty excessive hair growth
and infertility. Treatment of corticosteroids for the
rest of child’s life.

47. Support to Breastfeeding
Motivate ,mothers to practice breastfeeding
A. The Rooming-in and Breastfeeding Act of 1992
 To encourage, protect and support the practice of breastfeeding. It shall create an
environment where the basic physical, emotional and psychological needs of mothers
and infants are fulfilled.
B. Milk Code of 1986
 The aim of this code is to contribute to the provision of safe and adequate nutrition for
infants by the protection and promotion of breastfeeding and by ensuring the proper
use of breast milk substitutes and breastmilk supplements when these are necessary,
on the basis of adequate information and through appropriate marketing and
distribution.

48. Family Planning Counseling
 Proper counseling of couples on the importance of family
planning will help them inform on the right choices of
family planning methods, proper spacing of birth and
addressing the right number of children. Birth spacing of
three to five years interval will help completely develop
the health of a mother from previous pregnancy and
childbirth. The risk of complications increases after the
second birth.

49. THANK YOU FOR
LISTENING!!!