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FAMILY & COMMUNITY MED

1.2B SAFE MOTHERHOOD PROGRAM & WOMENS HEALTH

SESSION OBJECTIVES
Review the pertinent issues concerning womens
reproductive health and well being
Review the national objectives for health
concerning womens health
Review the strategies to achieve optimum womanmothers health

BACKGROUND
150 million women in developing countries will
become pregnant yearly (WHO)
600,000 will die.
The average maternal mortality ratio (MMR)
estimated at 400 per 100,000 live births.
At least 7 million pregnancies will result in still
births or infant deaths in the first week of life due
to pregnancy related complications.
Childbirth must not carry with the risk of death or
disability for the woman and her infant.
Preventable deaths due to pregnancy and
childbirth are both too high in developing
countries.
In the Philippines, the situation of mothers
although better than the average from developing
countries, has not change much in the last 5 - 10
years.
There are 14 million Filipino women in the
reproductive age group ( 15 -49 years old ).
Of this, 9 million are married or have partners, 6
million are considered to be at risk if they become
pregnant because :
1.) They are either too young (less than 20 years
old)
2.) Too old (more than 35 years old)
3.) Have more than four pregnancies
4.) Have too close or un spaced pregnancies
(less than 15 months)
5.) Too sick, mostly anemic or underweight
Average fertility rate of 3.7 (number of children per
woman),
Estimated 2.3 million women are expected to get
pregnant every year.
Two million of those who become pregnant will
deliver.

ORIGINS OF THE PROGRAM

The global Safe Motherhood Initiative was
launched at an international conference in
Nairobi, Kenya in 1987.

To draw attention to the dimensions and

consequences of poor maternal health in
developing countries and to mobilize action to
address the high rates of death and disability
caused by complications of pregnancy and
childbirth.
Goal set during the conference, and later on
adopted by several United Nations
conferences, was to reduce maternal mortality
by half by the year 2000.
The Philippines following a commitment to this
initiative hosted its own Safe Motherhood
Conference in 1988.
During this conference, attended by key
leaders from government, the private sector
and non-governmental organizations outlined
the strategies to be adopted in the Philippines
to bring down the 1988 MMR from
approximately 220 per 100,000 live births to
110 in 1999.
However, the 1998 National Demographic and
Health Survey (NDSH) revealed a ratio of 172
per 100,000 live births which is still way to
high and off target from the desired 110.
To celebrate the decade effort in addressing
Safe Motherhood concerns worldwide, a
global meeting was again convened in
October 1997 in Colombo, Sri Lanka.
The meeting reviewed the key lessons and
strategies learned from the first ten years of
the initiative, articulate a clear consensus on
the most effective strategies, and mapped out
a plan to mobilize resources at country-level to
implement the strategies.
The revitalization of the Safe Motherhood
Task Force
Formulation of the National Safe Motherhood
Policies and Framework
Holding of the First National Safe Motherhood
Congress
All intended to reciprocate the international
initiatives and supplement efforts at countrylevel consensus building among key
stakeholders in Safe Motherhood.

VISION
Healthy empowered Filipino mothers able to make
decisions for themselves and their families and to
contribute to the socio-economic development of
the Philippines
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MISSION
The Department of Health (DOH) in partnership
with the Local Government Units (LGUs), private
sector and other agencies concerned with the
health of Mothers shall commit to lead and provide
quality maternal health services to make
pregnancy, childbirth and motherhood a safe
experience for all mothers.
GOAL
To improve the well-being of mothers through a
comprehensive approach of providing, preventing,
promotive, curative and rehabilitative health care

WHY THE SAFE MOTHERHOOD & WOMENS HEALTH

PROGRAM
To reduce the maternal mortality and morbidity.
To support efforts at the local level to provide
women's health services to targeted groups of
women.
at the national level to strengthen DOH capability
to support LGUs in carrying out these
services/activities.

SPECIFIC OBJECTIVES OF THE WHSMP

Improving the quality and range of women's health
and safe motherhood services
Strengthening the capacity of LGUs to manage the
provision of these services, and of the DOH to
provide policy, technical, financial and logistical
support
Enhancing the effectiveness and sustainability of
health interventions through the participation of
local communities and non-government
organizations in the project.
Expanding the knowledge base upon which to
draw policy and technical guidance for women's
health programs

4 PILLARS OF THE SAFE MOTHERHOOD PROGRAM

Antenatal Care to prevent complications and
ensure that problems during pregnancy are
detected early and treated appropriately
Clean and safe obstetric delivery to ensure that
all birth attendants have the knowledge skills and
facilities (supplies, equipment and infrastructure)
to perform clean and safe delivery and provide
post-partum care to the mother and the newborn
Emergency obstetric care to ensure that
essential care for risk pregnancies and
complications that arise during delivery and postpartum and available and accessible to all women
Family planning to ensure that individuals and
couples have the knowledge and services to
make informed choices on the timing, number and
spacing of children

PROJECT AREAS
World Bank Assisted Provinces (36) Rehabilitation
and construction of rural health units (RHUs)
barangay health stations (BHS).
ADB Assisted Provinces (41) Rehabilitation and
construction of Provincial hospitals, District
hospitals, RHUs and BHS.

SPECIFIC STRATEGIES
Training "To have all births attended by a
knowledgeable, caring and skilled health care
provider"
Information Dissemination "To make informed
decision and promote better health seeking
behavior"
Social Mobilization - "Multi-sectoral participation
and cooperation for action towards a common goal
through self-reliant efforts."
Community Participation - "Encourage the bottomup approach to problem-solving and decisionmaking"
Promotion of gender sensitivity at all levels - "All
humans are born free and equal in dignity and
rights."
Quality Assurance Schemes - "Sentrong Sigla
Concept"
Maternal Mortality Audit "No blame system of
investigating maternal deaths."
Upgrading Facilities and Equipment for Obstetric
Emergencies "Every pregnancy faces risks.
There is no such thing as a no risk pregnancy."
Making Quality Care Accessible - "Every woman
has a right to safe delivery and quality maternal
care services".

WOMENS HEALTH & DEVELOPMENT PROGRAM

To develop a sound technical basis for policy and
action on gender and women's health issues.

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To promote the integration of a gender perspective

into health policies and programs.
To develop database and test interventions
especially on preventing emerging issues such as
violence against women.
To increase the participation of non-government
organizations especially women's groups in
designing, implementing and evaluating health
policies and programs.
To advocate for policies and laws promotive and
protective of women's health and rights.
To advocate for and disseminate information on
the health situation of women with a gender
perspective.
To mobilize resources of women's health.

VISION
Filipino women fully participating in decision
making on their health and able to access quality
health services from competent, caring,
communicative and gender responsive health care
providers.
MISSION
Develop a gender sensitive health care system,
promoting women's health and is responsive to all
her needs.
GOAL
Institutionalization of the woman's perspective in
all program and services at all levels of the health
care delivery system
STRATEGIES
Capability Building
Gender Sensitivity Training and Mainstreaming.
Information, Education and
Advocacy campaigns
Community organizing
Research
Legislative lobbying
Collaboration with non-government
Organization and women's group.

WHAT DOES THE WOMENS HEALTH & SAFE

MOTHERHOOD PROGRAM OFFER?
The project provides technical, material and
financial inputs for national and local levels. These
inputs include the following:

Maternal Care:
Strengthening existing maternal care services
of the DOH and LGU hospitals through the
provision, on a nationwide basis of :
Micronutrients (iodine, iron, Vitamin A.) to
pregnant women and lactating mother
Obstetrical kits for midwives
Traditional birth attendant (TBA) kits
Disposable home delivery kits for low-income
Emergency obstetrical drug and supplies
Civil Works:
Improving the quality of services in, and
accessibility of, first referral level hospital and
health units through:
Upgrading 92 obstetric facilities of selected first
level hospital
Renovating 234 rural health units
Upgrading of 344 selected barangay health
stations
Construction of 15 maternity waiting homes and
10 lying-in clinics in selected health facilities
Provision of necessary drugs and medical
supplies and equipment and furniture.
Training:
Provisional of in-service training gendersensitive for regional and provincial public
sector health providers responsible for
delivering maternal care
Development, piloting and expansion of
distance learning programs.
Logistics:
Strengthening logistics services and
capabilities of the public health system, so as to
improve the supply of drugs and medicines,
reagents and other medical supplies to health
service facilities.
Strengthening the capacity of the DOH to
provide guidance, technical assistance, training
and logistical and financial support for the
proper implementations of the national public
health programs.
Community Participation and Development:
Strengthening the capabilities of NGOs involved in
women's health issues in selected areas and
establishing partnerships between the NGOs, the
DOH, the LGUs and local communities and other
advocacy groups involved.
Reproductive Tract Infection:

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Improving the quality and accessibility of

health services for sexually and nonsexually transmitted reproductive tract
infections, through the provision of
diagnostic, referral and first line treatment
services based on the syndromic
approach, as well as the provision of
counseling services.
Cervical cancer:
Improving the quality of accessibility of
services to identify and manage cervical
cancer through the provision of supplies of
pap smear and cervical biopsies and
cryosurgery machine.
Life cycle approach
Carrying out a pilot on the life cycle
approach for the delivery of women's
health services
Information and education campaign
Producing, distributing and disseminating,
on a nationwide basis, an integral IEC
program, and related material for
promoting maternal care and other
women's health services
Social Marketing:
Carrying out community - based initiatives
in women's health care, family planning
education and related information and
communication programs
Research
Conducting research and carrying out to
assess the cost-effectiveness of various
service delivery options
Conducting research on priority issues
affecting women's health.
Carrying out project related monitoring
and evaluation studies.
Quality Assurance pilots in Antique
With the inputs, the project is expected to
contribute to improvement of womens health:
Reduction of maternal mortality
Reduction of the incidence of low birth
weight babies
Promotion of pre-natal attendance of
pregnant women
Increasing the rate of supervision of
deliveries by trained attendants

Providing referral services for all high risk

pregnancies and for all obstetrics
emergencies.
Lowering the incidence of iron deficiency,
anemia and iodine deficiency disorders
among women of reproductive age in
endemic areas.

CLINICAL INFORMATION FOR THE WHSMP

ANTENATAL CARE
Preparing for Pregnancy
A woman should be in good health before
becoming pregnant.
A sick woman needs more nutrients and
rest. Although pregnancy is a normal
event, it may be an additional burden for
her body.
A sick woman is more likely to have a
miscarriage or a premature birth.
A sick woman is more likely to become
anaemic and is prone to infection.
A sick woman is more likely to give birth to
a low-birth-weight baby.

PRE-CONCEPTIONAL CARE
Every woman who is planning to become pregnant
should have a health check-up to:
Ensure that she is physically ready
Detect any medical problems that need
treatment
Find out if she has to observe any special
precautions during pregnancy and
childbirth
BUILDING OR IRON RESERVES
A woman who intends to become pregnant should
build up her nutritional iron reserves because she
will need more iron during her pregnancy.
Sources of iron:
Meat, fish, poultry - the iron they contain can be
absorbed easily in the body
Green and leafy vegetables, cereals, and legumes
- Vitamin C is needed to enhance absorption of
iron from these foods.
AVOIDANCE OF EXPOSURES
Active or passive smoking, alcohol, intake of some
drugs, x-rays and exposure to harmful chemicals
such as pesticides used in the home or farm can
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result in abortion, congenital abnormalities,

stillbirth or an unhealthy baby.
A woman should always consult a health worker if
she is sick and should never resort to selfmedication

A COUPLE WANTING TO HAVE A CHILD MAY

EXPERIENCE A DELAY IN PREGNANCY
Most couples will eventually have a child within
two years.
The cause of not being able to have a child is
attributable 50 percent to the woman and 50
percent to her partner.
If the woman is not able to conceive within two
years, both the woman and her partner should see
an obstetrician who can help them find out if there
is a problem and advise them on what they can
do.

PROBLEMS ARISING EVEN THERES NO RISK

The services of a trained birth attendant, who will
know what to do in case there is a problem, should
be arranged.
Emergency transport to a facility where essential
obstetric services are available should be
prepared in case it will be needed.

PRENATAL CARE
Uncover risk conditions that may result in maternal
complications and deaths
Identify common maternal complications and/or
causes of maternal deaths are bleeding, infection,
hypertensive disease of pregnancy and obstructed
labor.
Prenatal care may identify women who are at risk
for bleeding, infection, hypertensive disease of
pregnancy, obstructed labor and other conditions.
Measures can be taken to avoid or treat any
problems early, before the condition becomes
serious or life-threatening.

SUMMARY OF THE MATERNAL HEALTH PACKAGE

Antenatal registration (pre-natal consultation)
Tetanus toxoid administration
Nutrition including Vitamin A fortification, folate
supplementation
Treatment of existing diseases
Recognition and early detection and management
of complications, before, during and after delivery
Clean and safe delivery
Promotion and support to breast feeding and
management of breast complications
Information services for family planning
STD/ HIV prevention and management
Dental care

PRENATAL CARE
Regular prenatal check - ups are important. One
or two visits are NOT enough to identify problems.
Only regular monitoring, will enable early detection
and management of most problems. Prenatal
check - ups include various activities that are
intended to identify and/or prevent problems that
may develop during pregnancy, delivery and
postpartum. These include:
Taking the client's medical history and doing a
physical examination to identify conditions in
the mother and her baby that will need closer
follow - ups and/or treatment.
Giving iron/folate supplement to prevent or
treat anemia
Giving tetanus toxoid immunization to prevent
neonatal tetanus
Giving malaria prophylaxis if it is needed
Giving advice on nutrition, hygiene,
breastfeeding, avoidance of unhealthy
practices during pregnancy, preparations for
delivery, neonatal care, family planning and
other related concerns
Managing diseases and other problems that
may affect the pregnancy
Referring the client to another facility if there
are problems that need further intervention.
RISK CONDITIONS & DANGER SIGNS
Maternal age younger than 20 years or older than
35 years. A primigravida whose height is less than
145 cm.
Less than two years between deliveries.
More than four deliveries
A previous difficult delivery
A previous caesarean section
A previous miscarriage or stillbirth
A previous premature or low-birth-weight baby
A history of, or current, bleeding

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A history of, or current, hypertension history of, or

current, multiple pregnancy or abdomen too large
for age of gestation
Maternal illness such as anaemia, tuberculosis,
heart disease, diabetes, malaria, liver disease and
kidney disease
Malnutrition
MEANING OF RISK CONDITIONS
The woman is more likely to have problems during
pregnancy and delivery
The baby is more likely to be born unhealthy or
dead. The woman will need close follow - up
during the entire period of pregnancy and delivery
The woman needs to be referred to a physician
who can give advice on the appropriate place for
delivery.
She may need surgery or a special intervention
that is not possible in some settings.

DANGER SIGNS DURING PREGNANCY

Vaginal bleeding
Severe headache, dizziness and blurring of vision
Puffiness of the face, hands and feet
High fever
Pallor
WHAT DO WE WANT MOTHERS TO KNOW?
There is a need for early and regular prenatal
check-up for risk assessment and prevention of
complications before they develop. This will help
mothers prepare and cope with pregnancy; will
identify mothers who are at risk and who will need
close monitoring or referral.
It is important for mothers to submit for prenatal
check-up once during the first trimester, twice
during the second trimester and four times during
the third trimester and as often when needed.
Submit for tetanus toxoid immunization during
their pregnancy. When they receive at least two
(2) doses of tetanus toxoid immunization, they
protect their children against neonatal tetanus.
Five (5) doses of TT immunization are needed to
protect a mother and her baby against the
disease, during her pregnancy and for lifetime
immunity.
Have blood pressure monitored as often as
possible but at least once a month.

PREVENTING TETANUS
Receiving tetanus immunization (5 doses for
lifetime protection)
Ensuring a clean delivery
Keeping the cord clean
TETANUS IMMUNIZATION SCHEDULE
DOSE
TIMING
PERIOD OF
PROTECTION
st
TT1
1 contact
None
TT2
1 month after TT1
3 years
TT3
6 months after
5 years
TT2
TT4
1 year after TT3
10 years
TT5
1 year after TT4
All child bearing
years

NUTRITION IN PREGNANCY
PROTEIN will make the mother's body and baby
grow. - example of food sources are fish, meat,
beans, eggs and milk.
CALCIUM will keep gums and teeth healthy, and
help in the growth and development of bones and
hair. - example of food sources are cheese, dilis
and shellfish.
IODINE will prevent goiter, promote proper mental
and physical development of the growing fetus. example of food sources are seafoods like
seaweeds, alamang, fish, tahong, halaan, tulya
and iodized salt
IRON will prevent anemia, increase production of
red blood cells. Sources of iron are dried dilis,
tulingan, alamang, seaweeds, tahong, liver,
internal organs, malunggay, camote tops, gabi
leaves, petchay, saluyot, alugbati, kangkong,
whole grain cereal.
Iron Supplementation:
A pregnant woman should take 120 mg of
elemental iron and 1 mg folate daily for three to
four months with meals
Lactating women should take 120 mg
elemental iron and 1 mg folate daily for 2
months post-partum with meals
Tea and coffee inhibits iron absorption while
fruit juices do not.
CARBOHYDRATES will provide energy needed
by the mother in her daily activities. Food rich in
carbohydrates are rice, corn, cassava, camote,
bread, and other bakery products such as cakes,
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cookies, bread and other "kakanin", such as

suman, puto, biko, kutsinta, and others. Food rich
in fats are butter, oil, margarine, lard and coconut
milk.
Decrease intake of carbohydrates when there is:
Frequent vomiting.
Swelling of legs
Abdominal rapid increase in weight.
Eat enough carbohydrate-rich foods to maintain
the ideal weight increase for certain trimester of
pregnancy.
VITAMIN A - rich foods will increase resistance
against infection, prevent blindness, make hair
and skin health, and prevent death from
pneumonia, diarrhea, and measles. Good source
of Vitamin A are - A) green and leafy vegetables
such as leaves of malunggay, sili, gabi, kangkong,
alugbati and other leafy vegetables found in your
area. B) yellow fruits and vegetables such as
carrots, squash, mango, ripe papaya, melon and
tiesa. C) liver, meat, poultry and eggs
VITAMIN C - rich foods will increase body
resistance against common illnesses like coughs
and colds, keep gums and teeth healthy. Good
sources of vitamin C are guava, tomatoes, mango,
pineapple, papaya, calamansi, and other fruits and
green leafy vegetables like malunggay, camote
tops, pechay and kangkong.
SELF CARE PRACTICES
Good hygiene is important during pregnancy and
after delivery.
Taking a bath daily prevents infection and
refreshes the body.
Should take a bath after delivery to freshen herself
and feel comfortable.
To prevent infection of the perineum or abdominal
wounds, wash the area using cooled boiled water.
Mothers should wear loose and clean garments to
allow proper circulation of the blood and for
comfort.
Regular exercise.
Take a walk before sunrise and after sunset.
Regular exercise helps in the circulation of the
blood and body fluids.
Mothers should maintain an ideal weight increase
of :
2 lbs. within the first trimester
11 lbs. in the second trimester.

11 lbs. in the third trimester.

The total weight gain is 24 lbs. throughout the
pregnancy. Mothers should monitor her weight
monthly.

DENTAL HEALTH
Submit for dental examination. The gums of
pregnant women usually becomes tender and can
bleed easily during brushing. Eat vitamin C - rich
foods to keep teeth and gums healthy.
Mothers should brush their teeth every after meal.

AVOIDANCE OF:
Avoid cigarettes, alcoholic drinks, too much coffee,
excessive soft drinks and sweets. They should
avoid taking any medicine not prescribed by their
doctor.
Excessive softdrinks and sweets may lead to rapid
weight increase which may endanger the mother
and her child.
Cigarettes may result in the baby's low birth
weight, while use of unprescribed medicine or
alcohol may cause congenital deformities or even
death of the child.
EMERGENCY OBSTETRIC CARE
Constipation
Hemorrhoids
Heartburn
Morning sickness/nausea and vomiting
Varicose veins
Vaginal discharge
Leg cramps
Backache

SOLUTIONS TO COMMON DISCOMFORTS IN

PREGNANCY
Constipation
Increase her usual fluid intake by 2-4 glasses
per day.
Eat lots of fruits and vegetables
Walk.
Avoid straining during bowel movements.
Hemorrhoids
Sit only on hard surfaces.
Avoid constipation.
Lie with hips up on
Heart Burn or Indigestion
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Eat small, frequent meals instead of three large

ones.
Limit spicy or greasy foods.
Avoid lying down right after eating.
Eat papaya.
Don't drink with meals; try to drink 30 minutes
Morning Sickness/Nausea and Vomiting
Eat small, frequent meals instead of three large
ones.
Don't drink with meals; try to drink 30 minutes
before and/or after a meal.
Eat bread or crackers before getting up in the
morning.
Suck on cracked ice or ice chips.
If the woman gets so ill that she becomes
dehydrated or the condition persists for more than
the first trimester, she may have hyperemesis
gravidarum.
Give her sips of Oresol and refer her to hospital.
Varicose Veins
Keep legs up when sitting.
Walk and try to move around.
Avoid socks or stockings with elastic tops.
Vaginal Itchiness/White Cheesy Discharge
Wear cotton and loose underwear.
Frequent change underwear.
Avoid sweets.
Avoid wearing tight paths, especially jeans.
Wash the vagina with water + vinegar solution
(1 part vinegar to 1 part water) three times a
day for 1 week.
If condition persists despite these actions refer
her to RHU physician.
Leg Cramps
Keep feet and legs elevated whenever
possible.
Lightly massage the lower legs.
If leg cramps occur, have the mother straighten
her knee and bend her foot back towards her
leg or suggest that she stand up on the
cramping leg.
Drink lots of fluid.
Backache
Always straighten back when standing or
sitting, do not slouch.
Wear low-heeled shoes.
Massage the affected area.
Do pelvic rocks for exercise.

HOW TO DO PELVIC ROCK

Start from any of these positions; standing with
legs slightly apart; lying supine, with knees flexed
and slightly apart; or getting down on your hands
and knees.
Curl the lower back and hold it for a few seconds.
Straighten the lower back.
Repeat the movement 20-25 times.

ABDOMINAL PAIN IN PREGNANCY

Abdomen painful
Ectopic
Fluid replacement
when touched
pregnancy
Refer
(even when
Abruptio placenta immediately to
touched very
Ruptured uterus
the hospital.
lightly
Non-obstetric
Have a friend or
conditions, such s relative go with
appendicitis,
the mother. She
ruptured ovarians needs an
cyst, etc
operation and
may also need a
blood transfusion
Diarrhea and
Gastro-enteritis
Advice the
vomiting
mother to drink
plenty of fluids,
such as ORS,
boiled water,
home fluids
See her again the
following day. If
she is not better,
refer her to the
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FCM III
The woman is in
the third trimester
and the pain
comes and goes

Labor

Painful urination

Urinary infection

1.2B SAFE MOTHERHOOD PROGRAM & WOMENS HEALTH

RHU physician
If she is not AT
RISK: Look after
her at home in
the usual way.
If she is AT RISK:
refer her
immediately
Advise her to
drink plenty of
fluids.
Refer her to the
RHU physician

Spotting only

VAGINAL BLEEDING IN PREGNANCY

The mother is
Placenta previa
DO NOT do an
past 20 weeks or
Abruptio placenta internal exam.
5 months
Refer
pregnant.
Fever and/or foulsmelling vaginal
discharge

Profuse bleeding
with passage of
clots

Profuse bleeding
which has now
stopped

Septic abortion

Incomplete
abortion
Molar pregnancy

Completed
abortion

Give amoxycillin
1gm. PO.
Fluid
replacement;
Give paracetamol
500mg. PO is
there is fever.
Refer to the
hospital
immediately
Give ergometrine
0.2 mg
Fluid
replacement.
Refer to the
hospital
immediately with
a friend or
relative willing to
donate blood.
Advise rest for 3
days.
Fluid replacement
Give ferrous
sulfate 60 mg
with folic acid; 2
tablets daily for 2

Threatened
abortion

months.
Advise her to
practice family
planning.
If the mother is
very pale. Refer
her to the
hospital. She may
need a blood
transfusion
Advice bed rest
until 3 days after
the bleeding has
stopped.
Advice avoidance
of sexual
intercourse for 1
week after the
bleeding has
stopped.
Refer to the
hospital if
bleeding and/or
pain gets worse
or if bleeding
continues

PREDISPOSING FACTORS TO PROM

Incompetence of the cervix
Vaginal infection
Malpresentation
Multi-fetal pregnancy
Too much amniotic fluid Women having one or
more of the above conditions are at risk of preterm
rupture of the bag of waters.
Actions:
If labor does not start within 12 hours after the
bag of waters has ruptured, give 1 gm.
Amoxycillin; two 500 mg. Capsules or four 250
mg capsules.
REFER to the hospital immediately.

PREMATURE RUPTURE OF MEMBRANES

When the bag of waters ruptures before the onset
of painful regular uterine contractions. The
pregnant woman will complain of a watery vaginal
discharge which is not urine.
Uterine and neonatal infection

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HYPERTENSIVE EMERGENCIES OF PREGNANCY

OTHER SIGNS
PROBABLE
ACTION
CAUSE
BP is 140/90 or
Eclampsia
If she has
higher
dentures, revoe
She is having
them.
convulsions.
Keep the airway
She may have
open.
pitting edema
Put a tongue
and/or
guard between
generalized
her teeth.
edema
Place her in a
semi-prone
position.
Give diazepam
10 mg.
REFER
immediately to
the hospital.
You should go
with her to
make sure her
airway is clear
and she can
breathe during
the journey
BP is below
Epilepsy
Give diazepam
140/90
Cerebral malaria
10 mg.
She is having
Meningitis
REFER
convulsion.
Schistosomiasis
immediately to
the hospital
Give dizepam
BP is higher than Severe pre160/100.
eclampsia
10 mg.
She may have
Give
epigastric pain
hydralazine 10
She may have
mg.
pitting and/or
REFER
generalized
immediately to
edema.
the hospital.
Keep her very
quiet. Make her
lie on her left
side during
transport
BP is between
Mild pre REFER
140/90 and
eclampsia
immediately to
higher but not
the hospital.
more than
Keep her very
160/100
quiet. Make her

She may have

pitting and/or
generalized
edema

lie on her left

side during
transport.

ENSURING A SAFE & CLEAN DELIVERY

Couple should decide beforehand where the
mother will deliver and who will help her
The place of delivery depends on the risk
status of the mother
High risk pregnancies should deliver in centers
with essential obstetrics services
A woman without risk, may deliver in the home
If delivery will occur in a health facility:
Arrange for transportation
Having clothes, blankets, towels for the mother
and baby
Money for medicines and other needs
Have a relative accompany her
Have a relative or friend with same blood type
If delivery will be at home:
Arrange the services of a trained birth attendant
as early as possible
Making the house /room clean as possible
Having blankets, mats washed and ironed
Ensuring soap and plenty of clean boiled water
Money for other needs
Arranging for transportation
Having a relative or friend with same blood type
accompany the patient to the hospital if to be
referred
LABOR & DELIVERY
Encourage women and their families to seek the
services of a trained person to help the woman
during delivery
A trained birth attendant can help to:
Prevent infection by keeping the delivery clean
Recognize and act in problems early
Take care of the mother and her baby
PROBLEMS DURING LABOR & DELIVERY
Abnormal Signs of Labor and Delivery
1.) Labor duration of more than 12 hours
2.) Fever
3.) Swollen genitals
4.) Foul smelling vaginal discharge
5.) Amniotic fluid that is stained with green or
black meconium
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FCM III

1.2B SAFE MOTHERHOOD PROGRAM & WOMENS HEALTH

6.) Prolapse of the cord

7.) Profuse bleeding
8.) Hypertension

POST PARTUM COMPLICATIONS

Fever higher than 38C
Foul smelling vaginal discharge
Profuse bleeding
Pallor

POST PARTUM CARE

Encourage women to use post-partum services
Equally as essential with PNC because
Death can ensue due to post-partum infection
Deaths from post-partum infection are
preventable
Will identify women who have signs of infection
early enough for treatment before the problem
becomes serious
ACTIVITIES IN POST- PARTUM CARE
Checking for post-partum fever
Character of the lochia
Uterine involution
Pallor
Breastfeeding problems
Checking for cord infection
Iron and folate supplementation
Advice on breastfeeding, nutrition, hygiene, family
planning and child care
Vitamin supplementation for the mother to
increase the resistance of the child against
infection if breastfeeding
Child immunization
Provision of family planning services
Management of diseases and other problems that
may arise after delivery
Referral for other medical problems

May resume sexual intercourse 4-6 weeks after

delivery as long as it does not cause pain to the
woman
The woman can become pregnant even if her
menses have not yet returned
If pain during intercourse proceeds, see a health
worker
ABORTION
Abortion is unsafe if it is performed by untrained
persons and or done in unclean conditions
The leading of cause of maternal deaths
May lead to profuse bleeding and infection
Introduction of chemicals, sticks wire, tree bark
into the vagina cause laceration, perforation,
infection or sterility
Unsafe abortion by drinking herbal preparations
may have adverse effects
Use of pressure on the womans abdomen may
cause damage to internal abdominal pelvic organs
Is safe if it is performed by a trained health worker
in a proper facility
Statistically , safe abortion or medical termination
of pregnancy leads to fewer complications than
continuation of pregnancy and delivery
SIGNS OF ABORTION
Profuse or prolonged vaginal bleeding
Pallor
Foul smelling vaginal discharge
Fever higher than 38C
Hypogastric pain in cases
END OF TRANX

OTHER RECOMMENDATIONS
Encourage the post-partum woman to bathe daily
Keep the perineum clean especially if she has
stitches
Use sanitary napkins as perineal pads
Encourage mobilization to help the uterus return
back to normal size
Encourage her to eat all food types except if there
is medical restriction

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