MATERNAL, NEWBORN, and

CHILD HEALTH and

NUTRITION PROGRAM
Part 2

By:
ROWENA MISSION TURTAL, MAN, RN
 MNCHN Program Core Package of
Services
a. Pre-pregnancy
b. Pre-natal
c. Childbirth
d. Postpartum
e. Newborn (first week of life) care
f. Child care
A. Pre-pregnancy service package
- Delivered to adolescents and adults
1.Nutrition-
-counselling
-use of iodized salt
-supplementation of iron and folate
and vitamin A (5000 IU every
week) or a multivitamin
2. Healthy lifestyle promotion
3. Family planning counselling
and services
4. Prevention and management
of NCDs like DM and HPN
5. Prevention and management
of infection- deworming, etc.
6. Counselling on STDs,
nutrition, hygiene, and
consequences of abortion
7. Oral health services
 B. Prenatal service package
1. Prenatal visits- Pregnant mothers should
have quality prenatal visits which
means having 4 or more visits
throughout the pregnancy.
 Prenatal Visits Period of Pregnancy

1st visit As early in pregnancy as possible before 4

months or during the 1st trimester

2nd visit During the 2nd trimester

3rd visit During the 3rd trimester

every 2 weeks After 8th month of pregnancy till delivery

 2. Prenatal Assessment includes:
-weight and BP monitoring
-fundal height
-fetal heart beat and movement
-diagnostic exams like CBC, blood
typing, urinalysis, blood sugar,
pregnancy test, cervical CA and STI
screening
3. Micro nutrient supplementation
-iron and folate (60 mg/40 µg) one
tablet a day for 3-6 months
- elemental iodine 200 mg once during
pregnancy
- promotion of iodized salt use
4. Tetanus toxoid immunization- 0.5 ml IM to
deltoid muscle
Tetanus Toxoid Immunization Schedule

• Both mother and

newborn are protected
against
tetanus/neonatal
tetanus
• Creates passive
immunity in the
newborn
Vaccine Schedule Percent Duration of protection
Dose Protected

TT1 As early as
possible
during
pregnancy

TT2 At least 4 80%  infants born to the

weeks later mother will be protected
from neonatal tetanus

TT3 At least 6 95%  infants born to the

months mother will be protected
later from neonatal tetanus
 gives 5 years protection
for the mother
Vaccine Schedule Percent Duration of protection
Dose Protected

TT4 At least one 99%  infants born to the mother will

year later be protected from neonatal
tetanus
 gives the mother 10 years
protection

TT5 At least one 99%  gives lifetime protection for

year later the mother
 all infants born to that mother
will be protected
Pre-natal service package, cont….

5. Promotion of exclusive breastfeeding

(BF), newborn screening (NSB),
and immunization
6. Counselling on healthy lifestyle and
disease prevention
7. Early detection and management of
complications of pregnancy and other
conditions like TB, malaria, etc…
8. Birth planning and promotion of facility-
based delivery
Note: Every pregnant woman should have a
facility-based record and a home-based
record to facilitate continuity of care, early
recognition of complications, and for more
efficient care.
C. Childbirth package
1. Facility-based childbirth attended
by a skilled health professional
2. Proper management of
pregnancy and delivery
complications and newborn
complications through
implementation of essential
intrapartum and newborn care
(EINC) practices
Essential practices include:
a. Assess to determine status and labor
stage. Done by taking the history of the
following:
 LMP (last menstrual period)
 number of pregnancy
 Start of labor pains
 Age / Height
Danger signs of pregnancy
b. continuous maternal support by
allowing a companion of choice
c. freedom of movement during labor
d. monitoring of progress of labor using a
partograph. A partograph ensures
recording of the labor progress and
significant conditions of mother and
fetus
e. Give a supportive care throughout labor
 encourage to take a bath at the onset of
labor
 encourage to drink but not to eat as this
may interfere 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 do breathing technique
f. Non-drug pain relief before offering
labor anesthesia
g. position of choice during labor and
delivery
h. spontaneous pushing in a semi-
upright position
i. hand hygiene
j. non-routine episiotomy
k. active management of third stage of
labor
It is important for a skilled
health professional to handle a
woman on labor and delivery
to:
 ensure hygiene
 provide safe and none
traumatic care
 recognize complications
 check for vaginal tears and bleeding
 Clean the woman and make her comfortable
 encourage her to drink high – energy foods
that are easily digested
 Check every 15 minutes for emergency signs
and uterine contraction
• manage referrals when necessary

Note: Please also read Intrapartal Services found in the

book of Nies, 2020, pp. 277-282.
3. Access to basic emergency obstetric and
newborn care (BEmONC) or comprehensive
emergency obstetric and newborn care
(CEmONC) services
 References
• Cuevas, F. (Ed.). (2007) Public Health Nursing in the
Philippine Setting. Philippines: League of Government
Nurses in the Philippines.

• Famorca, Z., Nies, MA, McEwen, M. (2017 or 2018).

Nursing Care of the Community. Singapore: Elsevier
Mosby.

• Nies, M., McEwen, M. Sumile, E. F. (Ed.). (2020).

Community and Public Health Nursing. 2nd ed. Singapore:
Elsevier.
THANK YOU!