Maternal, Newborn, and Child Health Nutrition

• The goal of maternal, newborn, and child health nutrition is to ensure every pregnancy is wanted, planned, and supported, deliveries are facility-based, managed by skilled professionals, and proper postpartum and newborn care is secured.

Core Packages of Services

• Pre-pregnancy package (15-45 years old) should include nutrition, health lifestyle promotion, family planning services, prevention/management of lifestyle related diseases/infections, STD/HIV/AIDS counseling, nutrition counseling, personal hygiene counseling, abortion consequence counseling, adolescent health services, and oral health services.

Prenatal Package

• Prenatal visits aim to detect possible problems/complications early.
• Visit frequency: monthly (1-7 months), every 2 weeks (8-9 months), weekly at 10 months (40 weeks), twice a week post-term (41-42 weeks).
• Micronutrient supplementation is also included.
• Vitamin A is teratogenic in the 1st trimester.
• During pregnancy: 10,000 IU of Vitamin A, twice a week, starting at 4 months
• For night blindness: 10,000 IU of Vitamin A, regardless of AOG.
• Tetanus Toxoid (TT) immunization: 0.5 ml dose, IM route, deltoid site. Always shake before administration, at least TT2 immunized.
• Prenatal package involves exclusive breastfeeding promotion, newborn screening (NBS), infant immunization, counseling on healthy lifestyles, early management of pregnancy complications and other conditions, and promotion of facility-based deliveries.
• Childbirth package entails professional assisted deliveries, facility-based deliveries, proper management of pregnancy/delivery/newborn complications, and access to BEmOC/CEmOC.

Partograph

• Partograph is the gold standard for monitoring labor progress.

Fetal Well-being (FAM)

• FHR normal range: 120-160 bpm.
• Amniotic fluid should be clear, intact, meconium, bloody, or absent (CIMBA).
• Moulding: 2 types (Caput succedaneum and Cephalhematoma).
• 0: can be felt easily
• +1: touching each other
• +2: slightly overlapping
• +3: severely overlapping

Progress of Labor (CFC)

• Cervical dilation (Max IE: 4).
• Fetal descent (OB stations of engagement): floating (-3, -2), engaged (-1, 0), +2.
• +3: Crowning
• Partograph also includes floating, engaged, and crowning.
• Contractions can be mild (1-19 secs/dot), moderate (20-40 secs/slant lines), or severe (41+ secs/shade).

Maternal Well-being (VUM)

• Includes vital signs, urine check (volume, protein, acetone), and meds (oxytocin) and IV fluids.
• Blood Pressure Assessment includes systolic (▲) and diastolic [✔].

Basic Emergency Obstetric and Newborn Care

• BEmOC: Administration of MOCA & Performance
• Team includes MHO, nurses, midwives, and medical technologists; minimum is a midwife under MHO.
• Available within 30 mins
• Ratio: 1:125,000.

Administration of MOCA in BEmOC

• Magnesium sulfate
• Oxytocin: 10 IU dose, IM route, deltoid site. Given as Part of Active Management of the Third Stage of Labor (Placental expulsion).
• Interventions include Oxytocin, counter-cord traction, and massage.
• Corticosteroids: 24 mg/24 hours. 2 Doses: 12 mg/12 hours (Betamethasone). 4 Doses: 6 mg/6 hours (Dexamethasone).
• Stimulate lung maturity → Surfactant (maintain inflation).
• X: RDS √
• Antibiotics for mother and newborn

Performance for Mother

• Includes Simanual retraction of the placenta, management for High risk newborn, Imminent birth, Retained placental fragments, and Normal spontaneous delivery.
• Mother: RHU can handle what is listed above

Performance for Newborn

• Includes: Newborn resuscitation, Oxygen supplementation, Treatment for neonatal sepsis

Comprehensive Emergency Obstetric and Newborn Care

• CEmONC: BEmOC + surgeon, asst. surgeon, and anesthesiologist. Available within 60 mins Ratio: 1:500,000. Two Divisions include Administration of MOCA & Performance

Administration of MOCA in CEmONC

• Includes the same as BEmOC

Performance in CEmONC

• Mother →BHIRN + CS and BT
• Newborn →NOT + LBW and Pre-term

Childbirth Package

• Home Deliveries are attended by trained birth attendants only if no licensed health personnel are available
• Includes full term, less than 5 pregnancies, cephalic presentation, no history/present complications, no history prolonged labor, without existing diseases, and imminent deliveries.

Comparison of Traditional and New Labor and Delivery Protocols

• Includes a table that shows the contrast between practices.

Core Package of Services Postpartum Package

• Postpartum visits occur on: 1st visit (24 hours postpartum), 2nd visit (3-5 days postpartum), and 3rd visit (6 weeks postpartum).
• Includes for Micronutrient supplementation, Iron and folate for 3 months/90 tablets and Vitamin A, 200,000 IV w/in 4 weeks after delivery, and counseling on nutrition, childcare, family planning and other available services

Core Packages of Services Newborn (first week of life)

• EINC (Essential Intrapartum & Newborn Care) should be practiced.
• First 30 seconds: immediate and thorough drying (prevents hypothermia)
• First 3 mins: properly timed cord clamping & cutting
• Umbilical cord care with disinfectant (Alcohol or Betadine) or NSS (Sterile water)
• Abdominal Binder.
• First 90 minutes needs to be Early initiation of Breastfeeding & non separation

Newborn Screening

• RA9288 Newborn Screening Act needs to be followed.
• Done at least 24 hours, no later than 3 days
• ICU newborn patients are exempted
• Goal: screen for congenital metabolic disorder (Specimen: Blood through heel prick (medial or lateral side)

Metabolic Disorders Screened

• Congenital hypothyroidism (intellectual disability)
• Congenital Adrenal Hyperplasia (genital problems)
• Galactosemia (x breastfeeding or ✓ soybased milk) If not regulated can lead to brain damage
• Phenylketonuria (intellectual disability): phenylalanine is neurotoxic (blonde hair, very fair complexion, blue eyes); lead to lifelong complications even death (requiring lifelong management)
• Glucose 6 phosphate Dehydrogenase (G6pd) is prone to hemolytic anemia
• Maple Syrup Urine Disease has urine that smells like maple syrup and also causes protein bal
• Newborn hearing screening is done by a physician, nurse, med tech, or trained midwife.
• RA 9709 - Universal Newborn Hearing Screening and Intervention Act of 2009

Core Packages of Services Childcare Package

• Includes Immunization, nutrition, micronutrient supplementation, IMCI (Integrated Management of Childhood Illness), Injury prevention, and Insecticide treatment nets (malaria prevention; M&C in endemic areas).
• Family Planning Program goal is to provide universal access to family planning information and services whenever and wherever these are needed

Four Pillars of Family Planning Program

• Responsible parenthood
• Respect for life
• Birth spacing
• Informed choice
• Target group is 15-45 years old

Methods of Contraception

• Includes: Permanent, Artificial, Natural, and Abstinence
• Permanent Methods of Contraception entail Female sterilization/Bilateral Tubal Ligation (BTL) (removal of fallopian tube and local anesthesia) and Male sterilization/vasectomy (removal of vas deferens which is voluntary and permanent and can cause pain. swelling. and redness for 2-3 days post operation)

Artificial Methods of Contraception

• Hormonal includes Progestin only pills (safe for breastfeeding mothers) and Combined oral contraceptives (estrogen and progesterone are contraindicated to breastfeeding mothers.
• If missed 1 pill: take it ASAP and take scheduled pills.
• if missed 2 or more pills: >7 hormonal pills: take it as sched or <7 hormonal pills: take as sched and placebo discard
• Artificial Methods of Contraception, injectables such as d Deponedroxyprogesterone aceto and non implant implants than can last for 5 or 3 years

Artificial Methods of Contraception, Barrier

• These include a Diaphragm (insert 2 hours before sex and Remove at least 6 hours after sex) which can cause urinary discomfort; Cervical cap; or IUD (5 years. yearly check up) or a Condom (protection against pregnancy, STI's, STD's).
• For Condom use: store in a cool dry place, use lubricated condoms (water/oil based) and handle carefully
• Dont unroll before use or do not use if: torn/damaged (brittle/uneven/more than 5 years)

Natural Methods of Contraception

• Lactation Amenorrhea Method (LAM) EBF.
• Mucus / Billings / Ovulation Method that uses Basal Body Temperature everyday / morning / wake up along with the Symto Thermal Method
• Other Methods: calendar method, coitus interruptus (withdrawal - not effective), two day method, or the standard days method (cycle beads
• Abstinence is also key