Definition

The Maternal Health Program is a set of actions and services

administered by theDepartment of Health to aid women before, during
and after pregnancy. The Philippines is tasked to reduce the maternal
mortality ratio (MMR) by three quarters by 2015 to achieve its millennium
development goal.
This means a MMR of 112/100,000 live births in 2010 and 80/100,000
live births by 2015.
Year

Expected MMR

2010

112/100,000 live births

2015

80/100,000 live births

The maternal mortality ratio (MMR) has declined from an estimated 209
per 100,000 live births in 1987-93 (NDHS 1993) to 172 in 1998. The
Philippines found it hard to reduce mortality. Similarly, perinatal mortality
reduction has been minimal. It went down by 11% in 10 years from 27.1
to 24 per thousand live births.
Year

Actual MMR

1987-1993

209/100,000 live births

1998

172/100,000 live births

The percentage of pregnant woman with at least four prenatal visits

decreased from 77% in 1998 to 70.4 in 2003. In addition, pregnant
women who received at least two doses of tetanus toxoid also decreased

from 38% in 1998 to 37.3% in 2003. Only about 76.8% of pregnant

women received iron supplementation during pregnancy.
The Philippine Health Statistics revealed that maternal deaths are due to:
Complication

Percentage of total maternal deaths

Hypertension

25%

Postpartum Hemorrhage

20.3%

Pregnancy with abortive outcomes

9%

However births attended by health professionals increased from 56% in

1998 to 59.8% in 2003. There was also a notable increase to 51% in
2003 from 43% in 1998 in the percentage of women with at least one
prenatal visit. Only 44.6% of postpartum women received a dose of
Vitamin A.
The underlying causes of maternal deaths are delays in taking critical
actions:
delay in seeking care,
delay in making referral and
delay in providing of appropriate medical management.
Other factors that contribute to maternal deaths includes
closely spaced births,
frequent pregnancies,
poor detection and management of high-risk pregnancies,
poor access to health facilities brought about by geographic
distance and
cost of transportation, and

 as well as health care and health staff who lack competence in

handling obstetrical emergencies.
The overall goal of the Maternal Health Program is to improve the
survival, health and well being of mothers and unborn through a package
of services all throughout the course of and before pregnancy.
Contents [show]

The Strategic Thrust for 2005-2010

Basic Emergency Obstetric Care (BEMOC)
Launch and implement the Basic Emergency Obstetric Care or BEMOC
strategy in coordination with the DOH. The BEMOC strategy entails the
establishment of facilities that provide emergency obstetric care for every
125, 000 population and which are located strategically. The strategy
calls for families and communities to plan for childbirth and the upgrading
of technical capabilities of local health providers.

Improve the quality of Prenatal and Postnatal Care

Pregnant women should have at least four prenatal visits with time for
adequate evaluation and management of diseases and conditions that
may put the pregnancy at risk. Postpartum care should extend to more
women after childbirth, after a miscarriage or after an unsafe abortion.

Reduce womens 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 educational and financial resources,
women with unmanaged chronic illness and
women who had just given birth in the last 18 months.

Appropriate Allocation of Resources

LGUs, NGOs and other stakeholders must advocate for health through
resource generation and allocation for health services to be provided and
are in place in the health system.
To address the problem, packages of health services are provided to the
clients. These essential health care packages are available and are in
place in the health system.

Essential Health Service Package Available in the Health

Care Facilities
These are the packages of services that every woman has to receive
before and after pregnancy and or delivery of a baby.

Antenatal Registration
Pregnancy poses a risk to the life of every woman. Pregnant women may
suffer complication and die. Every woman has to visit the nearest facility
for antenatal registration and to avail prenatal care services. This is the

only way to guide her in pregnancy care to make her prepare for child
birth. The standard prenatal visits that women have to receive during
pregnancy are as follows:
Prental Visits

Period of Pregnancy

1st visit

As early in pregnancy as possible before four months or

during the first trimester

2nd visit

During the 2nd trimester

3rd visit

During the 3rd trimester

Every 2 weeks

After 8th month of pregnancy till delivery.

Tetanus Toxoid Immunization

Neonatal Tetanus is one of the public health concerns that we need to
address among newborns. To protect them from deadly disease, tetanus
toxoid immunization is important for pregnant women and child bearing
age women. Both mother and child are protected against tetanus and
neonatal tetanus. A series of 2 doses of Tetanus Toxoid vaccination must
be received by a woman one month before delivery to protect baby from
neonatal tetanus. And the 3 booster dose shots to complete the five
doses following the recommended schedule provides full protection for
both mother and child. The mother is then called as a fully immunized
mother (FIM).

Micronutrient Supplementation
Micronutrient supplementation is vital for pregnant women. These are
necessary to prevent anema, vitamin A deficieny and other nutritional
disorders. They are:

Nutrient

Dose

Schedule

Remarks

Vitamin

10,000 IU

Twice a week

Do not give Vitamin A supplementation

starting on the

before the 4th month of pregnancy. It

4thmonth of

might cause congenital problems in th

pregnancy

baby.

Iron

60

Daily

mg/400
ug tablet

Treatment of Diseases and Other Conditions

There are other conditions that might occur among pregnant women.
These conditions may endanger her health and complication could occur.
Follow first aid treatment:
Conditions/Diseases

What to do

Difficulty of

Clear airway

breathing/obstruction

Place in her best position

of airway

Refer woman to hospital with

EmOC capabilities

Unconscious

Keep on her back arms at the

side
Tilt head backward (unless
trauma is suspected)
Lift chin to open airway
Clear secretions from throat
Give IVF to prevent or correct
shock
Monitor VS every 15 minutes

Do not give

 Monitor fluid given. If difficulty of

breathing and puffiness
develops, stop infusion
Monitor U.O.
Do not give oral rehydration
solution to a woman who is
unconscious or has convulsions.
Do not give IVF if you are not
trained to do so
Post partum bleeding

Massage uterus and expel clots

If bleeding persists:
o Place cupped palm on
uterine fundus and feel
for state of contraction
o Massage fundus in a
circular motion
o Apply bimanual uterine
compression if
ergometrine treatment
done and p[ostpartum
bleeding still persists
o Give ergometrine 0.2.
IM and another dose
after 15 minutes.
Do not give ergometrine if
woman has eclampsia, preeclampsia or hypertension.

Intestinal parasite

Giver mebendazole 500mg tablet single

Do not give

infection

dose anytime from 4-9 months of

mebendazole i

pregnancy if none was given in the past

the first 1-3

6 months

months of

pregnancy. Thi
might cause
congential
problems in
baby.
Malaria

Give sulfadoxin-pyrimethamine to women

from malaria endemic areas who are in
1st or 2nd pregnancy, 500mg-25 mg tab,
3tabs at the beginning of 2nd to
3rd trimesters not less than one month
interval.

Clean and Safe Delivery

The presence of a skilled birth attendance will ensure hygiene during
labor and delivery. It may also provide safe and non traumatic care,
recognize complications and also manage and refer the women to a
higher level of care when necessary. The necessary steps to follow during
labor, childbirth and immediate postpartum include the following:
Do a quick check upon admission for emergency signs:
Unconscious/convulsion
Vaginal bleeding
Severe abdominal pain
Looks very ill
Severe headache with visual disturbance
Severe breathing difficulty

 Fever
Severe vomiting
Make woman comfortable
Establish rapport with the client by greeting and interviewing to make her
comfortable.
Assess the woman in labor
Assessing the client is a reference guide for a health worker to determine
its status during labor stage. This can be done by taking the history of
the ff:
Last menstrual period (LMP)
Number of pregnancy
Start of labor pains
Age/height
Danger signs of pregnancy
Taking the history through interview will help determine the clients
condition during delivery of a baby.
Determine the stage of labor
Labor can be determined when womans response to contraction is
observed pushing down and vulva is bulging, with leaking amniotic fluid,
and vaginal bleeding. A vaginal examination can be performed to
determine the degree of contraction.
Decide if the woman can safely deliver

By assessing the condition of the client and not finding any indication that
could harm the delivery of a baby, a trained health worker can decide a
safe delivery of a mother.
Give supportive care throughout labor
There are many things that a woman needs to do during labor. This will
help her deliver clean, safe and free from fatigue. These are:
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 ever 2 hours
Encourage to do breathing technique to help energy in pushing
baby out the vagina. Panting can be done by breathing with open
mouth with 2 short breaths followed by long breath. This prevent
pushing at the end of the first stage.
Monitor and manage labor
These re different stages of labor to watch out any danger signs
Stage
First StageNot yet

What to do
Check every hour for

Not to do
Do not do vaginal

in active labor,

emergency signs, frequency

examination more

cervix is dilated 0-

and duration of contractions,

frequently than every 4

3cm and

fetal heart rate, etc.

hours.

contractions are
weak, less than 2

Check every 4 hours for

fever, pulse, BP and cervical

to 10 minutes.

dilatation
Record time of rupture of
membranes and color of
amniotic fluid.
Assess progress of labor
o Refer woman
immediately to
hospital facility with
comprehensive
emergency
obstetrical care
capabilities if after
8 hours,
contractions are
stronger and more
frequent but no
progress in cervical
dilatation, with or
without membranes
ruptured.

First StageIn
active labor, cervix
is dilated 4 cm or
more

Check every 30 minutes for

emergency signs
Check every 4 hours for
fever, pulse, BP and cervical
dilation
Record time of rupture of
membranes and color of
amniotic fluid
Record findings in

partograph/patient record.
Do not allow woman to push
unless delivery is imminent.
It will just exhaust the
woman.
Do not give medications to
speed up labor. It may
endanger and cause trauma
to mother and the baby.
Second

Check every 5 minutes for

StageCervix

perineum thinning and

dilated 10 cm or

bulging, visible descend of

bulging thin

the head during contraction,

perineum and

emergency signs, fetal heart

head visible

rate and mood and behavior.

Continued recording in the
partograph.
Do not apply fundal
pressure to help delivery the
baby.

Third

Deliver the placenta

StageBetween

Check the completeness of

birth of the baby

and delivery of the
placenta

placenta and membranes

Do not squeeze or massage
the abdomen to deliver the
placenta

Others

 Monitor closely within one hour after delivery and give supportive
care
Continue care after one hour postpartum. Keep watch closely for
at least 2 hours.
Educate and counsel on FP and provide FP method if available
and decision was made by a woman.
Birth registration
Importance of BF
Newborn Screening for babies delivered in RHU or at home
within 48 hours up to 2 weeks after birth
Schedule when to return for consultation for postpartum partum
visits
Inform, teach and counsel the woman on important MCH
messages:
1st Visit

1st week post partum preferable 3-5 days

2nd Visit

6 weeks post partum

Support to Breast Feeding

Most mothers do not know the importance of breastfeeding. A support
care groups like nurses have critical role to motivate them to practice
breastfeeding.

Family Planning Counseling

Proper counseling of couples on the importance of FP will help them
inform on the right choice of FP methods, proper spacing of birth and
addressing the right number of children. Birth spacing of three to five
years interval will help completely recover the health of a mother from

previous pregnancy and childbirth. The risk of complications increases

after the second birth