INTRODUCTION TO MOTHER AND CHILD HEALTH NURSING
NCM 107
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.
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).
 Promotion and maintenance of
optimum health of the women
and newborn.
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
 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.
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.
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.
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
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financial resources, women with
unmanaged chronic illness and women
who had just given birth in the last 18
months.
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.
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.
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
 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
 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)
 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.
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.
Essential Health Services available
in the Health Care Facilities
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 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.
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
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.
 All RHUs and BHS should have a
masterlist of pregnant women in their
respective catchment center.
 The Homebased 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 at least 3 prenatal
visits following the prescribed timing:
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.
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.
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).
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
Clean and Safe Delivery
A. Check for Emergency signs
 Unconsciousness
 Vaginal bleeding
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  Severe abdominal bleeding
 Looks very ill
 Severe headache with visual
disturbance
 Severe breathing difficulty
 Fever
 Severe vomiting
B. Made woman comfortable
C. Assess the woman in labor
 LMP
 Number of pregnancy
 Start of labor pains
 Age/height
 Danger signs of pregnancy
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
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)
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.
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.
 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.
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
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cloth, flashlight,  Antepartum hemorrhage
sphygmomanometer, stethoscope.
 Hypertensive disorders of pregnancy
Clean hands, clean surface and clean and Eclampsia
cord must be strictly followed to
 Cephalo-pelvic disproportion
prevent infection.
 Placenta previa and abruption
Guide for home delivery:
placenta
 For registered patient: time
 Multifetal pregnancy
when regular pains started,
whether bag of water ruptured  Post term and preterm pregnancies
or not, presence of absence of
vaginal discharges, bleeding,  Previous uterine surgery such as
etc., whether mother moved her myomectomy.
bowels and has urinated, fetal APGAR Scoring
movement felt by the mother or
not, unusual symptoms such as  It provides a valuable index for
bleeding, headache, spots evaluation of the infant’s at
before eyes. birth. It is based on five signs
 For unregistered patients: get ranked in order of importance
same information as for those as follows: Heart Rate,
registered patients and get Respiratory Effort, Muscle
medical and obstetric history. Tone, Reflex Irritability and
Color. In general, they made 1
Delivery in Healthy Facility minute of life and 5 minutes.
Each signs is evaluated
 At lying-in clinics, Birthing
according to the degree to
Homes or within the
which it is present and is given
BHSs/RHUs.
a score of 0, 1 and 2. The
 Normal pregnancies and with
scores of each sign is added
labor progressing normally must
together to give a total scores
be encourage to deliver in this
(10 is the maximum).
facility.
Newborn Screening
Delivery in Hospitals
 It is a public health program
 Risk pregnancies should be
aimed at the early identification
advised to deliver in the hospital
of infants who are affected by
are the following:
certain
 Pregnancy more the 4
genetic/metabolic/infectious
 Previous CS conditions. Early identification
 History of postpartum and intervention can lead to
hemorrhage significant reduction of
 History of medical illness such morbidity, mortality and
as heart disease, goiter, associated disabilities in
tuberculosis, diabetes, severe affected infant
anemia, hypertension, bronchial
asthma Significance:

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  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.
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.
 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.
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.
Congenital Hypothyroidism
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  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
from mental and growth
retardation.
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.
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.
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.
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.
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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.