Maternal and Child Health Services

Mothers:

1. MWRA (Married Women Reproductive Age):
• 15-49 years old=average age of reproduction for Filipino women
• 15 years old=average age of menarche (start of menstruation/reproduction)
• 49 years old=average age of menopause
• Ovulation takes place only for 35 years
• Age of menarche + 35 (constant)=average age of menopause
• EO 209: Family Code by President Corazon Aquino-married women
• PD 651: Birth & Death Registration Law-PHN must register the attended delivery to the Office of the Local Civil Registrar within 30 days
• Prepare & accomplish the birth certificate
• Ask the mother for a marriage contract, if none=use mother’s surname
• According to the new House Bill stating that with the father’s blessing/consent (even without marriage), the child can still use his/her father’s surname, granting the father affix his signature on the birth certificate.
2. MCRA (Married Couple Reproductive Age): Both husband & wife play a significant role in the family

Elements of Reproductive Health Act (HB 4110):

1. Family Planning:
• Problem of Over Population: NSO usually determines the census every 5 years
• In the Philippines, approximately 85M population→ NSO predicted an increase of 1.7M/year
• Among ASEAN Countries, Philippines ranked # 7 & globally ranked # 4

DOH National Family Planning Program:

Goals:

1. Safe Pregnancy
• Right age to be pregnant=20-35 years old, not less than 20 & not more than 35, Right interval of pregnancy=once in 2 or 3 years Supportive of safe pregnancy=done in home setting, Home Base Mother’s Record (HBMR): the record used for care of mothers in CHN
• Laboratory Examinations:
1. Benedict’s Test: test for sugar in the urine; test for diabetes
• Heat test tube with 5 cc of Benedict’s Solution (blue) in the burner then add 3-5 gtts of urine (amber yellow) then heat again. Observe for the change in color:
• Blue : (-) sugar in urine, Green : trace of sugar in urine +1 + , Yellow : traces of sugar in urine +2 ++ , Orange : more traces of sugar in urine +3 +++ , Brick Red : surely diabetic +4 ++++
• Adverse Effect of Diabetes: Macrosomia (too large baby)=teratogenic
• Advise mother to take sugar in moderate
2. Acetic Acid Test: test for albumin in urine; test for Pregnancy Induced HPN
• Collect urine in test tube, heat it in burner then add 3-5 gtts of acetic solution (clear white). Observe for change in color:
• If it remains clear: (-) CHON or albumin in urine
• If it turns cloudy: (+) CHON=proteinuria
• 2 Categories of PIH:
1. Pre-eclampsia: HPN, Edema & Proteinuria (HEP)
2. Eclampsia: Coma or convulsion
2. Safe Motherhood: prenatal, post natal
3. Healthy Reproductive Life

Policies:

1. Non coercive (give freedom of choice)
• AC 114: Role & Function of PHW, BQ: What is the role of PHN to the Family Planning Program of DOH? Answer: Facilitator
• Never force/command/dictate to the couple what contraceptive method to use
2. Integration of Family Planning in all Curricular Program:
• LOI 47 DECS states that Family Planning is to be integrated in all school curricular programs, either baccalaureates or non-baccalaureates, enrolled separately as one unit
3. Multi-Sectoral Approach: establish relationship with other agencies which can either be:
1. Intrasectoral
2. Intersectoral-Local or International (WHO, Unicef, USAID, Japhiego)
4. Unacceptability of Abortion:
• Is the termination of pregnancy before reaching the age of viability
• According to Church, methods of contraception III & IV are pro-abortion
• “E” Contraceptives are used for legal cases such as rape so may give over the counter pills (pills with high amount of progesterone & estrogen) given one pack then after 12 hours another pack

Methodologies:

1. Biological
1. Basal Body Temperature (BBT)
• Get the temperature early morning before waking up which should be monitored daily at the same time
• There should be a sudden drop of temperature between 0.3-0.6°C followed by an increase of temperature by 0.3-0.6°C which means that the woman is fertile
• Example: 5:30 am
• Mon 37.5°C---decrease by 0.4
• Tues 37.1------
• Wed 37.1
• Thurs 37.1------increase by 0.4
• Fri 37.4°C---
2. Sympto-thermal
3. Cervical Mucus Test
1. Billing’s Method by Dr. Billing
2. Spinnbarkheit (came from a German word Spinner which means to play with the cervical mucus with the finger) or Wet & Dry Method:
1. Wet Cervical Mucus (Fertile): abundant, stretchy & transparent
2. Dry Cervical Mucus (Safe & Not fertile): whitish, pasty & adhesive
4. Lactation Amenorrhea Method (LAM): RA 7600-Breastfeeding & Rooming In Law
• DOH organized Maternal & Child Family Health Institute (MCFHI) with the following members:
1. All government hospitals
2. Private hospitals (volunteer)
• Normal involution (uterus goes back to normal) of the uterus: after 45 days or 5-6 weeks or 1 ½ months if not breastfeeding
• Frozen breast milk is to be put out of the freezer 2 hours before feeding
• Left over milk should be discarded & should not be re-preserved or re-frozen because it is already contaminated
5. Calendar (Rhythm)
• Deleted already since 1998 because it’s not recommended for irregular cycle of menstruation
• Menstrual cycle should be regular; obtain 4-6 months cycle
• Example:
• Aug 29 days Nov 28 days
• Sep 30 days Dec 29 days
• Oct 26 days Jan Fertile
• Short cycle: 26 days, subtract 18=26-18=8th day
• Longest cycle: 30 days, subtract 11=30-11=19th day
• Fertile Period: on the 8th -19th day from the start of menstrual cycle
2. Behavioral
1. Abstinence
2. Withdrawal
3. Temporary
1. 1. Chemical
1. Oral Pills (Logentrol)-has low dose of estrogen & progesterone that inhibits ovulation
2. Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depo-provera- inhibits ovulation making women amenorrheic;
   1991, DMPA was found to be causing cancer of the cervix 1994, DMPA is given IM 4x a year every 3 months (90 days interval)
3. Implants: Norplant-it inhibits ovulation effective for 5 years but seldom advocated for use because it is usually expensive; the client buys the device (consists of 5 capsules) & have it implanted at the health center by minor surgical incision in:
1. upper inner arm because it is nearest to the brain
2. external oblique
3. thigh
4. gluteal muscles
2. Mechanical: IUD, Cervical cap, Diaphragm, Condom
4. Permanent
1. 1. Vasectomy (reversible)-since year 2000 in the Philippines
2. 2. BLT
2. Mother & Child Nutrition
3. Prevention & Control of Infertility & other Reproductive/Gynecological Disease
4. Prevention & Control of Abortion & Its Complications
5. Prevention & Control of Male & Female Reproductive Tract Infections: STD, HIV, Hepatitis B
6. Health Education on Human Sexuality
7. Violence Against Women