Southern Luzon State University

College of Allied Medicine

AY 2024-2025 | 1st Semester | FINAL
NCM04: Community Health Nursing 1:
Individual and Family as Clients

LECTURE NOTES

MATERNAL, NEWBORN, AND CHILD HEALTH AND NUTRITION STRATEGY

Overview

The health of the Filipino mothers and children determines the health of the next generation of
Filipinos. It is given that socio-economic development can happen only when people are able to
attain and maintain a certain level of health. Understandably to attain the first Millennium
Development Goal (MDG) to eradicate extreme poverty and hunger), maternal and under five
mortality rates have to be drastically reduced and diseases that take a heavy toll on human capital
like malaria and HIV/AIDS have to be controlled.

Access to adequate and good quality maternal, newborn, and child health, and nutrition services is
expected to impact on the national situation in general. Therefore, improving maternal and child
health condition is imperative is being given top priority by health planners in the country. Vigorous
efforts toward this direction are evidenced by statements from the DOH leadership urging health
workers to be committed to the attainment of MDG 4 and 5 (reduction of maternal and under five
mortality rates respectively) and various documents containing evidence-based directives on
MNCHN.

This module deals mostly with DOH policies and guidelines on maternal and child services. If quality
maternal and child health goals are to be made accessible to the target populations, LGU have to
exert all efforts towards compliance with these directives.

The nurse being in direct contact with health care clients, is at the forefront in the delivery of public
health services. In addition, the nurse has administrative/managerial functions. Therefore, public
health nurses are in the unique position of being in the unique position of being in the “middle” of
delivery of services to mothers, neonates, and young children. The health status of mothers,
particularly during pregnancy, the postpartum period and the period of lactation, is a major affecting
the health status of their children. Understandably, MNCHN services yield effects that carry a
tremendous impact on the well-being and ultimately, the development of the nation.

Learning Objectives

Upon completion of this module, the learners will be able to:

• Describe the current maternal and child health situation in the Philippines
• Explain the components of the core package of services in the Maternal, Newborn and Child
Health and Nutrition Strategy
• Recognize the role of the nurse in the delivery of the core package of services in the MNCHN
Strategy
 Southern Luzon State University
College of Allied Medicine
AY 2024-2025 | 1st Semester | FINAL
NCM04: Community Health Nursing 1:
Individual and Family as Clients

The Current Maternal and Child Health and Nutrition Situation

Leading Causes of Maternal Death

1. Complications related to pregnancy occurring in the course of labor, delivery and puerperium
2. Hypertension complicating pregnancy, childbirth and puerperium
3. Postpartum hemorrhage
4. Pregnancy with abortive outcomes

Leading Causes of Neonatal Deaths

1. Asphyxia
2. Prematurity
3. Severe infections
4. Congenital anomalies
5. Newborn tetanus

Risk Factors of Maternal and Neonatal Deaths

1. Having mistimed, unplanned, unwanted, and unsupported pregnancy
2. Not securing adequate care during the pregnancy
3. Delivering without skilled birth attendance, i.e., attendance by skilled midwives, nurses, or
physicians and not having access to emergency obstetric and neonatal care
4. Not having proper postpartum and postnatal care for the mother and the newborn

Leading Causes of Infant Deaths

1. Bacterial sepsis of newborn
2. Respiratory distress of newborn
3. Pneumonia
4. Disorders related to short gestation and low birth weight
5. Congenital malformations of the heart
6. Congenital pneumonia
7. Neonatal aspiration syndromes
8. Other congenital malformation
9. Intrauterine hypoxia and birth asphyxia
10. Diarrhea and gastroenteritis of presumed infectious origin

The MNCHN Core Package Services

The maternal and newborn care package is characterized by a paradigm shift from the risk approach
that focuses on identifying pregnant women at risk of complications to one that considers all
pregnant women at risk of such complications.

Four Key Strategies

1. Ensuring universal access to and utilization of an MNCHN core package of services and interventions
directed not only to individual women of reproductive age and newborns at different stages of the life
cycle
 Southern Luzon State University
College of Allied Medicine
AY 2024-2025 | 1st Semester | FINAL
NCM04: Community Health Nursing 1:
Individual and Family as Clients

2. Establishment of a service delivery network at all levels of care to provide the package of services
and interventions
3. Organized use of instruments of health systems development to bring all localities to create and
sustain their service delivery networks, which are crucial for the provision of health services to all
4. Rapid buildup of institutional capacities of DOH and PhilHealth being the lead national agencies
that provide support to local planning and development through appropriate standards capacity
buildup of implementers and financing mechanisms

Aims of MNCHN Strategy

1. Every pregnancy is wanted, planned, and supported
2. Every pregnancy is adequately managed throughout its course
3. Every delivery is facility-based and managed by skilled birth attendants or skilled health
professionals
4. Every month-and-newborn pair secures proper postpartum and newborn care with smooth
transitions to the women’s health care package for the mother and child survival package for the
newborn

The MNCHN Core Package of Service

A. Pre-pregnancy Package
1. Nutrition
• Nutrition counseling
• Promotion of the use iodized salt
• Provision of micronutrient supplements
a. Iron and folate: 60 mg elemental iron/400 ug folic acid 1 tablet daily 3-6 months
b. Vitamin A at least 5,000 IU every week or a daily multivitamin supplement may be taken as option
when the required Vitamin A is not available
2. Promotion of healthy lifestyle
3. Advice on FP and provision of FP services
4. Prevention and management of lifestyle-related diseases
5. Prevention and management of infection
6. Counseling on STD/HIV/AIDS, nutrition, personal hygiene, and the consequences of abortion
7. Adolescent health services
8. Provision of oral health services

B. Pre-natal Package
1. Pre-natal visits (at least 4 through pregnancy) and pre-natal assessment
At least four visits throughout the course of pregnancy: at least one visit in the first and second
trimesters and at least two visits in the third trimesters
Pre-natal assessment includes:
• Weight and blood pressure monitoring measurement of fundic height against the age of gestation
• Fetal heart beat and fetal movement count to assess the adequacy of fetal growth and well-being
2. Micro-nutrient supplementation
• Iron and folate (60 mg/400 ug) once a day for 6 months or 180 tablets
• Vitamin A 10,000 IU twice a week from the fourth month of pregnancy; and
• Elemental iodine 200 mg given once during pregnancy
 Southern Luzon State University
College of Allied Medicine
AY 2024-2025 | 1st Semester | FINAL
NCM04: Community Health Nursing 1:
Individual and Family as Clients

3. Tetanus toxoid immunization

• 0.5 ml of TT is injected intramuscularly on the deltoid muscle
4. Promotion of exclusive breastfeeding, newborn screening, and infant immunization
5. Counseling on healthy lifestyle
6. Early detection and management of complications of pregnancy
7. Prevention and management of other conditions where indicated: hypertension, anemia,
diabetes, tuberculosis, malaria, schistosomiasis, STI/HIV/AIDS
8. Birth planning and promotion of facility-based delivery

Home-based Mother’s Record (HBMR)

• HBMR is a simplified record of history of present and past pregnancies, and measures of the TBA,
BHW, or health professional
• HBMR has been concluded to:
o Provides a means of promoting continuity of care through a woman’s reproductive life
o Promotes early recognition of women who are at risk of developing conditions
o Encourages self-care where appropriate and referral suited to the needs of the woman
o Supports initiation of appropriate care
o Serves as a useful record of care and health information and source of health statistics
o Guides the health workers in providing for the health education needs of the client

BIRTH PLAN

Birth Plan - a written document prepared during the first prenatal consultation. Plan may change
anytime during pregnancy if an abnormality develops.
- Contains information on:
• The woman’s condition during pregnancy
• Preferences for her place of delivery and choice at birth attendant.
• Available resources (transportation, companion, money) for her childbirth and newborn
baby.
• Preparations needed (blood donor, referral center) should an emergency arise during
pregnancy, childbirth and postpartum.
Emergency Plan – Discuss how to prepare for an emergency in pregnancy.

C. Childbirth Package
1. Skilled birth attendance/skilled health professional-assisted delivery and facility-based
deliveries including the use of partograph. Most maternal deaths occur during labor or the first 24
hours postpartum, and the most complications cannot be predicted or prevented. It is logical that
the best strategy to prevent maternal deaths is to promote facility-based childbirth with a skilled
health professional attendance.
2. Proper management of pregnancy and delivery complications and newborn complications
• The DOH, PhilHealth, and WHO recommend essential intrapartum and newborn care (EINC)
practices in hospitals and other birthing facilities in the country
 Southern Luzon State University
College of Allied Medicine
AY 2024-2025 | 1st Semester | FINAL
NCM04: Community Health Nursing 1:
Individual and Family as Clients

• EINC is called Unang Yakap. EINC practice during the intrapartum period consist of measures that
based on scientific evidence, are necessary for safe and quality care of the woman during
childbirth.
3. Access to Basic Emergency Obstetric and Newborn Care (BEmONC) or Comprehensive
Emergency Obstetric and Newborn Care (CEmONC) services.

D. Post-partum Package
1. Post-partum visits: within 72 hours and on the 7th post-partum check
2. Micro-nutrient supplementation
• Iron and folate (60 mg/400 ug) once a day for 3 months or 90 tablets
• Vitamin A 200,000 IU within 4 weeks after delivery
3. Counseling on nutrition, child care, FP, and other available services

E. Newborn (1st week of life) Care Package

A. Intervention within the first 90 minutes
• Immediate and thorough drying
• SSC between mother and NB
• Cord clamping 1-3 minutes after birth
• Early initiation of BF within an hour after birth
• Non-separation of baby from the mother, also known as rooming-in
B. Essential newborn care after 90 minutes to 6 hours
• Vitamin K prophylaxis
• Hepatitis B and BCG vaccination
Examination of the baby for birth injuries, malformations, or defects
• Additional care for a small baby (a baby with a birth weight of < 2,500 gms) or twin
C. Care prior to discharge: after the first 90 minutes
• Support for unrestricted, per demand breastfeeding, day and night
• Ensuring warmth of the baby
• Washing and bathing (hygiene)
• Monitoring for danger signs and resuscitation, if necessary
• NBS (blood spot) and NB hearing screening (if available)
• Discharge teachings

F. Child Care Package

1. Immunization
2. Nutrition
3. Exclusive BF up to 6 months
4. Sustained BF up to 24 months with complementary feeding
5. Micro-nutrient supplementation
6. IMCI
7. Injury prevention
8. Oral health
9. Insecticide – treated net for mothers and children in malaria endemic areas
 Southern Luzon State University
College of Allied Medicine
AY 2024-2025 | 1st Semester | FINAL
NCM04: Community Health Nursing 1:
Individual and Family as Clients

Name of Student : _________________________________________

Course/Year/ Section : _____________________

ACTIVITY #2

DEVELOPING BIRTH AND EMERGENCY PLAN

INSTRUCTIONS:

1. Interview a Pregnant Individual. Identify a pregnant person (e.g., friend, family member, or community
member) willing to participate in the activity. Conduct an interview to understand their preferences, needs,
and concerns about childbirth and emergency situations. Obtain their consent before the interview and ensure
confidentiality.
2. Gather Information. Ask about their chosen birthing location (e.g., hospital, birthing center, home). Discuss
their preferred healthcare provider (e.g., doctor, midwife). Inquire about their support system, including who
they want present during labor and delivery. Understand their knowledge of emergency preparedness, such as
transportation and contacts in case of complications.
3. Accomplish the Birth and Emergency Plan (See example below). Using the information gathered, create
an organized birth and emergency plan. Include personal information, preferences, and emergency
preparedness details. Ensure that the plan is clear, concise, and actionable.
4. Ensure your submission follows the guidelines provided in class. Submit the finalized birth and emergency
plan on or before December 15, 2024.

Example:
 Southern Luzon State University
College of Allied Medicine
AY 2024-2025 | 1st Semester | FINAL
NCM04: Community Health Nursing 1:
Individual and Family as Clients

BIRTH AND EMERGENCY PLAN

I know that any complication can develop during delivery. I know that I should deliver in
a health facility.

I will be attended at delivery by ________________________________________.

I plan to deliver at _________________________________________________.

This is a Philhealth accredited facility _____Yes _____ No

The estimated cost of the maternity package in this facility is Php ___________
(inclusive of Newborn Care).

The mode of payment is ____________________________________________.

The available transport is ____________________________________________.

Have contracted _______________________ to bring me to the hospital/health center.

I will be accompanied by _____________________________________________.

___________________________ will make take care of my children/home while I am in
the health facility.

In case of a need for blood transfusion, my possible donors are:

Name Address Contact Number

In case of complications, I will be referred right away to: ________________________

Contact Person: ____________________________________________________
Address: __________________________________________________________
Tel. No.: __________________________________________________________

Finally, I will exclusively breastfeed my baby up to six months _____Yes _____No