COLLEGE OF NURSING

Silliman University
Dumaguete City

Resource Unit on Maternal and Child Health

 COLLEGE OF NURSING
SILLIMAN UNIVERSITY
Dumaguete City, Philippines

Vision:
A leading Christian institution committed to total human development for societal and environmental well-being.

Mission:
 Infuse into the academic learning the Christian faith anchored on the gospel of Jesus Christ; provide an environment where
Christian fellowship and relationship can be nurtured and promoted.
 Provide opportunities for growth and excellence in every dimension of the University life in order to strengthened
character, competence and faith.
 Instill in all members of the University, community an enlightened social consciousness and a deep sense of justice and
compassion.
 Promote unity among peoples and contribute to national development.
PLACEMENT: Level IV 1st Semester SY 2010-2011, NCM 104 COPAR Rotation
TIME ALLOTMENT: 1 hour and 15 minutes
TOPIC DESCRIPTION: This topic deals with the Maternal and Child Health Program. It includes a brief outlook of the current health status of maternal women and the goal of the program. The discussion will
primarily focus on the different health services available to protect and promote the health of maternal women.
CENTRAL OBJECTIVE: At the end of the discussion, the learners shall acquire comprehensive knowledge, develop beginning skills, and manifest positive attitude on how to render quality and compassionate
care to mothers and her unborn child.

T-L
OBJECTIVES CONTENT TA EVALUATION
ACTIVITIES
Prayer
Given varied teaching- I. Introduction 5 Power Point
learning activities within The Story of Nena mins. Presentation
the 1 hour and 15 minute Nena is a 23-year old mother from Samar who gave birth to her first baby at home with the assistance of a traditional
discussion, the learners birth attendant (TBA). The TBA instructed her to put sanitary napkins as she may still bleed. She thought that heavy Socialized
will be able to: bleeding was normal especially for first time mothers like her. However, a day had passed and she was still bleeding Discussion
profusely. Her husband went to see the only midwife in their community but she was attending to another delivery
then. He wanted to bring her to the provincial hospital but they had no means of transportation at that time. Finally
he was able to bring her to the hospital but it was already too late. She died of heavy bleeding.

“Nasa hukay ang isang paa ng isang inang manganganak.” This is a common Filipino saying about pregnancy. Sadly, in some
communities when mothers die due to childbirth, it is seen more of a fate rather than a health and human rights issue which needs
to be addressed. It is a fact that there are risks in pregnancy. However, there are ways to minimize these risks. A woman’s death
due to childbirth and its complications should not be seen as a ‘normal’ thing. Pregnancy is not an illness or a condition which a
woman should be dying from.

Nena is just one out of the 10 Filipino mothers who die every day from complications related to pregnancy and childbirth.
Tragically, 14 percent of all deaths among Filipino women 15-49 years old are due to maternal deaths. (Social Watch Philippines
2005 Report). Major causes of maternal death are post-partum hemorrhage, eclampsia, obstructed labor, and complications from
abortions. Indirect causes of maternal deaths are anemia, malaria, diabetes, and sepsis. (Pilliteri, 2007)

But if the TBA and if Nena and her husband knew about the danger signals after birth and if there had been emergency obstetric
care for Nena, she would not have been part of the statistics.

II. Understanding the Implications of the Three Delays on Maternal Death 10 Socialized
a. Briefly explain the Most mothers in the communities who died giving birth experienced what experts have classified as the three delays. These are: mins. Discussion
implications brought 1. Delay in deciding to seek medical care,
about by the three The following are the common reasons cited by mothers, midwives, nurses, doctors, TBAs and community members for
delays on maternal delay in deciding to seek care.
death in their own  Failure to recognize danger signs
words.  Absence of skilled attendants
 Lack of money to pay for medical expenses and cost of transportation
 Pregnancy is unplanned or unexpected
 Poor quality of obstetrical care
 Fear of being ill-treated in the health facility
 Reluctance from the mother or the family due to cultural constraints
 The woman or family member present at childbirth lacks power to make a decision
 Lack of encouragement from relatives and community members to seek care
 No available person to take care of the children, the home and livestock
 Lack of companion in going to the health facility

The delay in deciding to seek care usually stems from failure to recognize the danger signs by both midwife and mother. On
the average, almost 50% of the pregnant women all over the country are not informed of any pregnancy complications.
Mothers will be saved from further harm if they know the danger signs in pregnancy and midwives are knowledgeable in
managing them.

2. Delay in reaching appropriate care,

The second delay may be attributed to:
 Distance from a woman’s home to a facility or provider
 Lack of roads or poor condition of roads
 Lack of emergency transportation whether by land or water
 Lack of awareness of existing services
 Lack of a referral system
 Lack of communication with referral facility
 Lack of moral, financial and logistical support from neighbors, the barangay captain and barangay officials or the mayor.

This delay relates to the issue of access to care. It is inexcusable that mothers are dying because of the delay in reaching
care. Sadly, in remote areas, this is usually the case. However, if mothers know that there are skilled midwives in the
community who can attend to their delivery, they need not go to hospitals unless complications arise. In cases that they
have to be brought to the hospital, ensuring the rapid transport of the mother to the nearest medical facility by the
relatives, neighbors or barangay officials is crucial in saving her life.

3. Delay in receiving care at health facilities

The delay in receiving care is generally caused by problems in the referral facility. These may be:
 Lack of healthcare personnel
 Unprofessional attitudes of health care providers
  Shortages of supplies (i.e emergency medicines or blood)
 Lack of basic equipment e.g. for caesarean section, blood transfusion
 Poor skills of health care providers
 Health is not prioritized by the barangay and municipal officials
 Lack of budget from the LGU

More often district and provincial hospitals are poorly equipped with the right personnel, supplies and logistics due to LGU
neglect. If the health of the people will be the priority of the local government and if communities actively participate in
health programs, mothers will be secured of better health care through the services and facilities available.

b. Enumerate the all the 5 Too’s to avoid pregnancy

given five ‘Too’s to  Too young
avoid pregnancy’.  Too old
 Too close
 Too many
 Too sickly

III. Maternal and Child Health Program

20 Lecture
mins. discussion
A.Overview
Every woman has the right to health—to have a healthy pregnancy and safe delivery, the right to quality maternal health
care and the right to make decisions about their own health. Unfortunately, this remains an ideal and not a reality.
Unavailability of services and proper information, existence of laws that are discriminatory against women, and inequalities
at home and in the community are just some of the factors which prohibits them from realizing these reproductive health
rights.

To ensure that women all over the world will enjoy this right, governments are obliged to enact policies that will improve
maternal and child health (MCH). These policies should be beneficial not only to the rich but most especially to the
marginalized women in the communities. Through the Primary Health Care approach, problems on MCH in the communities
will be addressed by providing promotive, preventive, curative and rehabilitative services. People will also be able to
participate individually and collectively in the planning, implementation and evaluation of their health care. (Tan, 2006)

The Millennium Development Goals (MDGs), which have been agreed upon by 189 countries including the Philippines to fight
against poverty, target the reduction of maternal deaths by 75% and mortality rate among children under five by two thirds
by year 2015. Achieving the goals of reducing maternal and child mortality and morbidity will only be realistic through the
political will of the government, both national and local, commitment of the health workers and concerted action of the
people. Only then can we be ensured of communities with healthy mothers and children. (Reyala, 2000).
c. Explain briefly the goal
 of Maternal and Child B. Goal of the program
Health Program in The overall goal of the program is to improve the survival, health and well being of mother and unborn through a package of
their own words. services for the pre pregnancy, prenatal, natal and post natal stages. (Cuevas, 2007)

d. Be familiar with the C. The strategic thrusts of the program for 2005-2010
four strategic thrusts  Launch and implement the Basic Emergency Obstetric Care or BEmOC strategy in coordination with the DOH.
for Maternal Health
Program. Emergency obstetric care (EmOC) is a strategy that can be used to combat the three delays. Generally, all obstetric
complications can be treated especially if danger signs are recognized earlier and prompt treatment is given. Some
countries have low maternal mortality ratio because EmOC is available.

At present, very few RHUs are capable of giving Basic Emergency Obstetric care (BEmOC) health facilities .The BEmOC
strategy entails the establishment of facilities that provide emergency obstetric care for every 125,000 population and
which are located strategically. The strategy calls for families and communities to plan for childbirth and the upgrading
of technical capabilities of local health providers. (Cuevas, 2007) It is essential that midwives, nurses and doctors are
equipped with the basic skills needed so that they can contribute in reducing if not eliminating maternal and infant
mortality and morbidity in their communities.

 Improve the quality of prenatal and postnatal care. Pregnant women should have at least four prenatal visits with time
for adequate evaluation and management of diseases and conditions that may put the pregnancy at risk. Post-partum
care should extend to more women after childbirth, after a miscarriage or after an unsafe abortion.

 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 ages especially those who are less than 18 years old and
over 35 years of age, women with low educational and financial resources, women with unmanaged chronic illness and
women who had just given birth in the last 18 months.

 LGUs, 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. (Cuevas, 2007)
e. Enumerate 5 out of all
the given essential D.Essential Health Service Packages Available in the Health Care Facilities.
health service According to Cuevas (2007), these are the packages of services that every woman has to receive before and after pregnancy
packages available in and or delivery of a baby.
the health care
facilities and briefly 1. Antenatal Registration
discuss each in their Pregnancy poses a risk to the life of every woman. Pregnant women may suffer complications and die. Every woman
own words. 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 visits that a woman has to
 receive during pregnancy are as follows:

Prenatal Visits Period of Pregnancy

1st Visit As early in pregnancy as possible before four months or during the first trimester.
Inform of proper nutrition, preventing anemia and malaria, discomforts of pregnancy,
emergency signs of pregnancy, follow-up visits and when and where to go during
emergencies, newborn screening, education and counseling on FP.
2nd Visit During the 2nd trimester. Inform of self care during pregnancy, advantages of health
facility delivery, preparation for obstetric events.
3rd Visit During the 3rd trimester. Inform of breastfeeding, FP, clean and safe delivery by a skilled
professional, newborn screening, education and counseling on FP.
Every 2 weeks After 8th month of pregnancy till delivery.

2. Tetanus Toxoid Immunization

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 women and child bearing age women.
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 one month before delivery to protect baby from neonatal tetanus. And the
3 booster dose shots to complete the five doses following the recommended schedule provides full protection for
both mother and child. The mother then is called as A “Fully Immunized Mother” (FIM).

TT 1- Given upon first contact of the woman 14-45 years old.

TT 2- Given 1 month after TT 1 was given. Gives protection to the mother for a period of 3 years. Infants born to mother
will be protected from neonatal tetanus.
TT 3- Given during 6th month after TT2 was given. Gives protection to the mother for a period of 5 years. Infants born
to mother will be protected from neonatal tetanus.
TT 4- Given 1 year after TT3 was given. TT 4 is given even if the mother is pregnant for another child or not. 10 years of
protection for the mother. Infants born to mother will be protected from neonatal tetanus.
TT 5- Given 1 year after TT 4 was given. Lifetime protection for the mother. Infants born to mother will be protected
from neonatal tetanus.

3. Micronutrient Supplementation
Micronutrient supplementation is vital for pregnant women. These are necessary to prevent anemia, vitamin A
deficiency and other nutritional disorders. They are:

Vitamins Dose Schedule of Giving Remarks

Vitamin A 10,000 IU Twice a week starting Do not give Vitamin A supplementation
on the 4th month of before the 4th month of pregnancy. It might
 pregnancy cause congenital problem on the baby
Iron 60mg/400 ug tablet Daily

4. Treatment of Diseases and Other Conditions

There are other conditions that might occur among pregnant women. These conditions may endanger her health and
complication could occur. Follow first aid treatment:

 Difficulty of breathing/obstruction of airway

a. Clear airway
b. Place in her best position for breathing
c. Refer woman to hospital with EmOC capabilities

 Unconscious
a. Keep on her back arms at the side
b. Tilt head backwards (unless trauma is suspected)
c. Lift chin to open airway
d. Clear secretions from throat

 Shock
a. Give IVF to prevent or correct shock
b. Monitor blood pressure, pulse and shortness of breath every 15 minutes
c. Monitor fluid given. If difficulty of breathing and puffiness develops, stops infusion.
d. Monitor urine output
e. If IV access is not possible, give oral rehydration solution (ORS). Do not give ORS to a woman who is unconscious
or has convulsions. ORS may go to her lungs.

 Postpartum bleeding
a. Massage uterus and expel clots
b. If bleeding persists:
-place cupped palm on uterine fundus and feel for state of contraction
-massage fundus in a circular motion til uterus is well contracted
-when well contracted, place fingers behind fundus and puch down in one swift motion to expel clots
-apply bimanual uterine compression if ergometrine treatment done and postpartum bleeding still persists
-give ergometrine 0.2 mg IM and another dose after 15 minutes. Do not give ergometrine if woman has eclampsia,
pre-eclampsia or hypertension

 Intestinal parasite infection

a. Give Mebendazole 500 mg tablet single dose anytime from 4-9 months of pregnancy if none was given in the past
 6 months. Do not give mebendazole in the first 1-3 months of pregnancy. This might cause congenital problems in
baby.

 Malaria
a. Give sulfadoxin-pyrimethamine to women from malaria endemic areas who are in 1st or 2nd pregnancy, 500mg -25
mg tab, 3 tabs at the beginning of 2nd to 3rd trimesters not less than one month interval

5. 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.

Home delivery is another important nursing interventions. Republic Act No. 9173 states that nursing care of
individuals, families and communities in any health care setting and includes but not limited to nursing care during
conception, labor, delivery. It’s also the duty of the nurse to perform internal examination during labor in the absence
of antenatal bleeding and delivery.

The DOH came out with a Protocol for Home Deliveries through DOH Department Circular No. 187-As. This circular
allows licensed nurse-midwives and nurses trained in delivery to conduct home deliveries. Licensed physicians,
midwives and trained birth attendants or hilots (allowed only in areas where there are no licensed physicians, nurses,
midwives or no available health professional at the time of delivery) are also listed as other legitimate birth
attendants.

Qualifications for home delivery includes: full term pregnancy, 2nd to 4th delivery, cephalic presentation, pelvic
adequacy, no premature rupture of membranes, imminent delivery, no history of prolonged labor, hemorrhage,
ceasarean section. (Maglaya, 2004)

6. Support Breast Feeding

Most mothers do not know the importance of breastfeeding. A support care groups like nurses have a critical role to
motivate them to practice breastfeeding. The nurse helps the woman to make a decision on breastfeeding. (Cooper,
2003).The Philippines, being supportive of the 1981 International Code of Marketing of Breastmilk Substitute by the
World Health Organization (WHO) is pursuing strong advocacy work in the promotion of breastfeeding. We
recommend breast milk as the best form of infant feeding for the first six months. During the early prenatal visits, the
following are recommended:

a. Identify personal and demographic information that can affect breastfeeding decision (example: work,
socioeconomic status, prior exposure to breastfeeding, intend to breastfeed, access to support system for
breastfeeding)

f. Comprehensively E.
discuss the
interventions provided
for mothers during
different phases, citing
3 examples, 75% level
of competency
b. Assess breast and nipples for conditions that can promote or hinder breastfeeding. Nipple/breast problems were
cited by 13.6% of women as reason for not initiating breastfeeding.
c. Provide information on how to manage breastfeeding problems.
d. Facilitate feeding (ideally within the first 2 hours); rooming in; unrestricted breastfeeding 8-12 times/24 hours.
PAGPAPASUSO:
Pinakamasustansyang gatas sa kalibutan
Allergy sa panit, hubak mapugngan
Gastos sa pamilya makunhoran
Puno sa paghigugma
Anak nga sunod-sunod malikayan
Panginahanglan sa bata matubag
Alima sa inahan dili matupngan
Sa oras sa iyang pagkalibang walay sagabal
Ug sa natural nga miniralis ug bitamina walay makalabaw
Sakto sa inahanong pag-amuma ug pagmahal
Oras-oras ang gatas sa inahan mahatag
7. 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 year interval will help
completely recover the health of a mother from previous pregnancy and childbirth. The risk of complications increases
after the second birth.
Interventions Provided for the Mother during Different Stages
1. During Prenatal Care 20 Socialized
61.3% of mothers in rural areas and 38.2% in urban areas go to midwives and nurses for prenatal care. (Tan, 2006) mins. Discussion
Through prenatal care, disease which may lead to complications can be detected and managed early. Women are also
informed and educated on danger and emergency signs and symptoms. She and her family are also being prepared
for childbirth and at the same time receive recommendations where to seek treatment if complications arise.
(Maglaya, 2004)
a. Do a quick check for emergency signs to assess the condition of the woman and ensure that their immediate
needs are taken care of promptly. Emergency signs include unconsciousness, convulsing, vaginal bleeding, severe
abdominal pain, looks very ill, severe headache with visual disturbance, severe breathing difficulty, fever, and
severe vomiting.
b. Make the woman comfortable
c. Assess the pregnant woman.

ASK,CHECK, RECORD LOOK, LISTEN, FEEL INDICATIONS PLACE of DELIVERY

ALL VISITS  Feel for trimester  Prior delivery by REFERRAL LEVEL
 Check duration of pregnancy. of pregnancy caesarean  Explain why
 Where do you plan to deliver?  Age less than 18 delivery needs to
 Any vaginal bleeding since last visit? years be at referral level
 Is the baby moving? (after 4  Transverse lie or  Develop the birth
months) other obvious plan with
 Check record for previous malpresentation emergency
complications and treatments within one month preparedness
received during this pregnancy. expected delivery measures
 Do you have any concerns?  Obvious multiple
 Has she been given education and pregnancy
counseling on family planning?  Tubal ligation or
FIRST VISIT  Look for caesarean IUD insertion
 How many months pregnant are scar desired
you? immediately after
 When was your last period? delivery
 When do you expect to deliver?  Desired for
 How old are you? spacing method:
 Have you had a baby before? If yes: pills, etc
 Check record for prior pregnancies  Documented third
or ask about degree tear
 Number of prior pregnancies/  History of current
deliveries vaginal bleeding or
 Prior caesarean section, forceps or other
vacuum complications
 Prior third degree tear during this
pregnancy
 Heavy bleeding during or after
delivery  Last baby born
dead or died
 Convulsions
during the first day
 Stillbirth or death in the first day
 More than 6
 Any illness during this pregnancy
previous births
 Do you smoke, drink alcohol, or use
 Prior delivery with
any drugs?
  Has she been given education and heavy bleeding,
counseling on family planning? convulsions, by
forceps
THIRD TRIMESTER  Feel for obvious  None of the above  Explain why
 Has she been given education and multiple delivery needs to
counseling on family planning? If pregnancy be by a health
yes, does she want tubal ligation or  Feel for transverse professional
IUD? lie preferably in a
 Listen to fetal health facility
heartbeat  Develop the birth
plan with
emergency
preparedness
measures

d. Get baseline laboratory information of the woman on the first or following the first visit.

e. Check for gestational diabetes.

f. Check for pallor or anemia.

g. Check for hypertension/pre-eclampsia.

h. Check for fever, burning sensation on urination and abnormal vaginal discharge.

i. Immunize against tetanus.

j. Treat for intestinal parasites.

k. Prevent anemia and neural tube defects with iron and folate supplementation.

l. Give preventive intermittent treatment for falcifarum malaria.

m. Give Vitamin A.

n. Provide health information, advice and counsel on danger signs and three delays.
Emergency signs include unconsciousness, convulsing, vaginal bleeding, severe abdominal pain, looks very ill,
 severe headache with visual disturbance, severe breathing difficulty, fever, and severe vomiting.

o. Encourage the woman to come back for return visits.

2. During Labor, Childbirth and Immediate Postpartum

In preventing maternal and newborn mortality, good quality health care is important during the critical period of labor
and delivery. The presence of a skilled birth attendant, may it be a midwife, nurse, or doctor does not only ensure
hygiene during labor and delivery but may also provide safe and nontraumatic care, recognize complications, and also
manage them effectively or refer competently the woman to a higher level of care.

a. Do a quick check upon admission for emergency signs.

A quick check is necessary to ensure that problems or conditions that require immediate attention are taken care of
promptly. This will avoid worsening of condition and/or prevention of death. Assess for unconsciousness,
convulsion, vaginal bleeding, severe abdominal pain, looks very ill, severe headache with visual disturbance, severe
breathing difficulty, fever and severe vomiting. Immediate referral must be done to the nearest facility with
capability of handling the needed services.

b. Make the woman comfortable.

Establish rapport with the client by greeting and interviewing to make her comfortable.

c. Assess the woman in labor.

Assessing the client is a reference guide for a health worker to determine its status during labor stage. This can be
done by taking the history of the ff:
 Last menstrual period (LMP)
 Number of pregnancy
 Start of labor pains and her response
 Age/height
 Danger signs of pregnancy

d. Determine the stage of labor.

Labor can be determined when woman’s response to contraction is observed pushing down and vulva is bulging,
with leaking amniotic fluid, and vaginal bleeding. A vaginal examination can be performed to determine the degree
of contraction.

e. Decide if the woman can safely deliver.

By assessing the condition of the client and not finding any indication that could harm the delivery of a baby, a
trained health worker can decide a safe delivery of a mother.
f. Give supportive care throughout labor.
There are many things that a woman needs to do during labor. This will help her deliver clean, safe and free from
fatigue. These are:
 Encourage to take a bath at the onset of labor.
 Encourage to drink but not to eat as this may interfere with surgery in case needed.
 Encourage to empty bladder and bowels to facilitate delivery of the baby. Remind to empty bladder every 2
hours.
 Encourage to breathing technique to help energy in pushing the baby out the vagina. Panting can be done by
breathing with open mouth with 2 short breaths followed by long breath. This prevent pushing at the end of the
first stage

g. Monitor and manage labor.

There are different stages of labor to watch out any danger signs.

Stages of labor What to do Not to do

First Stage: not yet in  Check every hour for emergency signs, frequency and Do not do vaginal
active labor, cervix is duration of contractions, fetal heart rate, etc. examination more
dilated 0-3cm and  Check every 4 hours for fever, pulse, BP and cervical frequently than every 4
contractions are weak, dilatation hours
less than 2 to 10 minutes  Record time of rupture of membranes and color of
amniotic fluid
 Assess progress of labor
-Refer woman immediately to hospital facility with
comprehensive emergency obstetrical care
capabilities if after 8 hours, contractions are stronger
and more frequent but no progress in cervical
dilatation, with or without membranes ruptured
-It is false labor if after 8 hours there is no increase in
contractions, membranes are not ruptured and no
progress in cervical dilatation

First Stage: in active  Check every 30 minutes for emergency signs  Do not allow woman to
labor, cervix is dilated 4  Check every 4 hours for fever, pulse, BP and cervical push unless delivery is
cm or more dilatation imminent. It will just
 Record time of rupture of membranes and color of exhaust the woman.
amniotic fluid  Do not give medications
 Record findings in partograph/patient record to speed up labor. It
 may endanger and
cause trauma to mother
and the baby.
Second stage: cervix  Check every 5 minutes for perineum thinning and  Do not apply fundal
dilated 10 cm or bulging bulging, visible descend of the head during pressure to help deliver
thin perineum and head contraction, emergency signs, fetal heart rate and the baby.
visible mood and behavior.
 Continue recording in the partograph.

Third stage: between  Deliver the placenta  Do not squeeze or

birth of the baby and  Check completeness ofplacenta and membranes massage the abdomen
delivery of the placenta. to deliver the placenta

h. Monitor closely within one hour after delivery and give supportive care.

i. Continue care after one hour postpartum. Keep watch closely for at least 2 hours.

j. Educate and counsel on FP and provide FP method if available and decision was made by a woman.

k. Inform, teach and counsel the woman on important MCH messages:

 Birth registration Active oral
participation
 Importance of BF
by answering
 Newborn Screening for babies delivered in RHU or at home within 48 hours up to 2 weeks after birth
questions.
 Schedule when to return for consultation for post partum visits
Students who
Recommended schedule of post partum care visits:
will answer the
1st Visit 1st week post partum preferably 3-5 days
nd
questions will
2 Visit 6 weeks postpartum
be determined
randomly.
3. During Postpartum
Reporter will
a. Do a quick check for emergency signs.
randomly pick
Assess for unconsciousness, convulsion, vaginal bleeding, severe abdominal pain, looks very ill, severe headache
a name from a
with visual disturbance, severe breathing difficulty, fever and severe vomiting.
container. The
student who
b. Make the woman comfortable.
will be picked
will be asked to
c. Assess the postpartum woman for current condition (BUBBLEHE).
answer the
question.
 d. Check for pallor or anemia. FINAL
EVALUATION:
e. Treat for intestinal parasites. Cabbage
Give Mebendazole 500mg tablet if none was given during pregnancy. Game. A ball
made of pieces
f. Prevent anemia with iron and folate supplementation. of paper
Give iron/folate supplementation daily til scheduled return visit. Continue til 3 months postpartum. containing the
questions will
g. Give Vitamin A if none was given postpartum. be passed
Give Vitamin A 200,000 IU, once within 6 weeks after delivery. around while
the music is
h. Counsel on family planning. playing. When
the music
i. Provide health information, advice and counseling such as that of proper hygiene, nutrition, caring for newborn and stops, the
others. learner who is
holding the ball
j. Encourage the woman to come back with her baby for return visits. will detach a
Recommended schedule of post partum care visits: piece of paper
1st Visit 1st week post partum preferably 3-5 days containing the
2nd Visit 6 weeks postpartum question from
the ball and
IV. Evaluation 10 will be asked to
mins. answer it.

V. Open Forum 10
mins.

References:
Cooper, C. (2003). Johnson’s mother and baby. Great Britain: Dorling Kindersley.
Cuevas, F.P. (2007) Public health nursing in the Philippines(10th ed.) National league of Philippine government nurses Inc.: Philippines.
Gordon, Y. (2002). Birth and beyond. London: Vermilion Random House.
Kozier, et al.(2004).Fundamentals of Nursing.7th ed. Singapore: Pearson Education, Inc.
Maglaya, A. (2004). Nursing Practice in the Community. (4th ed). Marikina City: Argonauta Corp.
Pilliteri, A. (2007). Maternal and Child Health Nursing: Care of the childrearing family (5th ed). Philadelphia, USA: Lippincott
Reyala, P. et.al(2000). Community health nursing services in the philippines. 9th ed. Philippines
Tan, J. et. al.(2006). Community-Managed Maternal& Newborn Care: A Guide for Primary Health Care Professionals. Manila
Maternal and Child Health Programs from RHU Valencia Orientation