The Maternal Health Program is a set of actions and services administered by

the Department 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
morality. 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 Programis 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.
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. Post-partum
care should extend to more women after childbirth, after a miscarriage or after an unsafe
abortion.

Reduce women’s 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
A starting on the before the 4thmonth of pregnancy. It might
4  month of
th
cause congenital problems in the baby.
pregnancy
Iron 60 mg/400 Daily
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 Do not give

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
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:
Place cupped palm on
uterine fundus and feel for state of
contraction
Massage fundus in a
circular motion
Apply bimanual uterine
compression if ergometrine treatment
done and p[ostpartum bleeding still
persists
Give ergometrine 0.2.
IM and another dose after 15 minutes.
Do not give ergometrine if
woman has eclampsia, pre-eclampsia
or hypertension.
Intestinal parasite Giver mebendazole 500mg tablet single Do not givemebendazole in
infection dose anytime from 4-9 months of the first 1-3 months of
pregnancy if  none was given in the past 6 pregnancy. This might
months cause congential problems
in baby.
Malaria Give sulfadoxin-pyrimethamine to
women from malaria endemic areas who
are in 1st or 2ndpregnancy, 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 post partum 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 client’s condition during delivery of
a baby.

Determine the stage of labor

Labor can be determined when woman’s 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 What to do Not to do

First StageNot yet in Check every hour for Do not do vaginal
ative labor, cervic is emergency signs, frequency and duration examination more
dilated 0-3cm and of contractions, fetal heart rate, etc. frequently than every 4
contractions are weak, Check every 4 hours for fever, hours.
less than 2 to 10 pulse, BP and cervical dilatation
minutes. Record time of rupture of
membranes and color of amniotic fluid.
Assess progress of labor
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 Check every 30 minutes for
labor, cervic is dilated emergency signs
4 cm or more 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 StageCervic Check every 5 minutes for
dilated 10 cm or perineum thinning and bulging, visible
bulging thin perineum descend of the head during contraction,
and head visible emergency signs, fetal heart rate and
mood and behavior.
Continued recording in the
partograph.
Do not apply fundal pressure to
help delivery the baby.
Third StageBetween Deliver the placenta
birth of the baby and Check the completeness of
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 post 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
havecritical 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.

Conclusion
The DOH Maternal Health Program has be eager to decrease the maternal mortality rate of
the country and this program is a good example to that effort.
 Found through:
 2012 updates about maternal deliver by a baby
 philippine data on postpartum hemorrhage
 postpartum hemorrhage care plan
 Prenatal check up DOH Philippines
 prenatal visits recommended by doh
 seminars for philippines obstetric nurse 2012
 updates during pregnancy and during delivery of a pregnant women 2012