MATERNAL, NEWBORN, and

CHILD HEALTH and NUTRITION

PROGRAM
Part 1

By:
ROWENA MISSION TURTAL, MAN, RN
 INTRODUCTION
• This unit deals with DOH protocols on
maternal, newborn, and child care.
• According to the DOH, significant
developments have been noted over the
decades. Maternal and children mortality
rates have been declining, however, they
are still high.
“ During childbirth, one foot of the mother is
already in the grave”.
a death of a woman due to the
complications of childbirth is not a normal
thing.
 pregnancy is not an illness which women
should be dying from
 Why are mothers dying?
• There are risk factors and three phases of
delay that contribute to maternal deaths
based on the “3 Delays Model”.
 Risk Factors to Maternal (and
Newborn) Deaths
• Mistimed, unplanned, unwanted, and
unsupported pregnancy
• Inadequate care during pregnancy
• Birth unattended by skilled health care
providers (nurse, midwife, doctors)
• Poor access to emergency obstetric and
neonatal care
• Inadequate postpartum and postnatal care
 Why did Leah die?
Instruction: This is a CI group activity!
1.Read and understand the “Three Delays”
Model” to maternal deaths.
2.Read the story of Leah in the succeeding slides.
3. Identify all the specific events that
contributed to the death of Leah.
4.Classify the events based on the “3 Delays
Model”.
5.Submit your output to me for grading.
 The Story of Leah
Leah is a 26 year old pregnant woman,
living in the hinterland of Mabini with her
husband and their 5-year old child. As her
labor contractions started, her husband
fetched the TBA who kept watch on her
while she was on labor. Later that day the
TBA told the husband of Leah that she
had to leave for a while and promised she
will be back soon. She said that it will still
take a while for Leah to deliver. When the
TBA left, the husband noticed that Leah
was bleeding quite heavily, but thought that
its something that normally happens during
giving birth. Morning came, but still the TBA
did not comeback. Concerned already, he
sought for the lone midwife who lived 10
kilometers away. However, upon reaching
the place of the midwife he learned that the
she is out attending to another delivery.
Since Leah was already feverish and
bleeding heavily, the husband and the rest of
the family decided to take her to the hospital
situated 100 kilometers
away. It took them a while to look for a
transportation as the transportation charge is
high because of the distance and the sky high
cost of the gasoline. Eventually, the barangay
captain helped them shoulder the amount.
Upon reaching the provincial hospital, Leah
was already highly feverish and delirious. A
Cesarean section could not be done right
away because there was no vacant operating
theater and no doctor available. After
sometime, the operation was done
and it was discovered that the baby's left arm was
detached and missing. The baby was already
dead and decomposing which resulted to an
awfully foul smell throughout the hospital. It was
also the cause of the sepsis of Leah that lead to
a very high fever. On the second day after the
operation, Leah's condition worsened.
Apparently, the antibiotic did not help. On the
third day, Leah died, leaving behind her grieving
son, husband, and the rest of the family.
Note: It was discovered that the TBA
pulled the arm of the baby to hasten
the delivery process, resulting to the
avulsion of the part. ( Note: The baby
was on a transverse lie.) After
realizing that she did something
horrible, she got scared, the reason
why she left Leah, taking the arm of
the baby with her. After the incident,
the TBA could not be found again in
their place.
 Maternal, Newborn, and
Child Health, and Nutrition
(MNCHN)
Key Strategies
Four Key Strategies of MNCHN
1. Ensuring universal
access to and utilization
of MNCHN core
package of services
and interventions
directed to mothers and
women of reproductive
age, newborn, children,
and the community.
• Ensures that every:
-pregnancy is wanted, planned, and
supported
-pregnancy is well managed (beginning to
end)
-delivery is facility-based & managed by
skilled health professionals
-mother, newborn receive proper
postpartum
and child care
2. Establishment of a service delivery
network at all levels of care to provide the
services.
• 3 Levels of care in the MNCHN
service delivery network:
a. Community level service providers or
the community health team (CHT)
-include OPD clinics, RHU, BHS
as well their as their professional
and non- professional health
staff, BHW, and
traditional birth attendants
- performs 2 basic functions:
navigation and basic service
delivery (Refer to Famorca, 2013
p.210 or
Nies, 2020 p. 266-67)
b. A BEmONC-capable facility/provider
*can perform the following:
- parenteral administration (PA) of
oxytocin in the 3rd stage of labor
-PA of loading dose of
anticonvulsants
-PA of initial dose of antibiotics
-Performance of assisted
deliveries ( breech delivery)
-removal of retained products of
conception
-manual removal of retained placenta
 -newborn resuscitation
-treatment of neonatal sepsis
-oxygen support
-blood transfusion if with qualified
personnel
Note: Can be based in an RHU/CHO, lying-in
clinic, or birthing home
c. A CEmONC-capable facility/provider
*can perform functions of BEmONC plus:
-CS delivery
-blood banking and transfusion
-other highly specialized interventions
-mngt of low birthweight or preterm NBs
-other specialized NB services
 Cont…Key strategies
3. Organized use of instruments (resources)
for health systems development for
sustained service delivery. Eg. Adequate and proper
scheduling of personnel and timely replenishment of supplies

4. Rapid build-up of institutionalized

capacities of DOH and PhilHeath to
provide support to LGUs to enhance
capacity build-up and financing
mechanisms.
Note: All the four key strategies aim to
minimize if not eradicate the risk factors and
the “three delays” contributing to maternal,
newborn, and children deaths.
 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!