CARE DURING CARE DURING PREGNANCYPREGNANCY

BASIC TRAINING FOR BASIC TRAINING FOR BARANGAY HEALTH WORKERS BARANGAY HEALTH WORKERS

Calasiao, PangasinanCalasiao, Pangasinan

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Program Goal:Program Goal:

•Improve the health status of women Improve the health status of women especially the poor and contribute to the especially the poor and contribute to the achievement of the Millennium achievement of the Millennium Development Goal which is the reduction Development Goal which is the reduction of the Maternal Mortality Rate by 75% by of the Maternal Mortality Rate by 75% by 2015.2015.

A gloomy picture .A gloomy picture . . . . . . . . .

- It It is said that when a is said that when a woman becomes pregnant, woman becomes pregnant, she puts her life in danger she puts her life in danger – like putting one of her – like putting one of her feet to the grave…feet to the grave…

In most cases, the first health-In most cases, the first health-oriented person to get in contact with a oriented person to get in contact with a pregnant woman in the community is the pregnant woman in the community is the BHW. When a woman is pregnant, she BHW. When a woman is pregnant, she needs to keep herself healthy in order to needs to keep herself healthy in order to have a healthy baby.have a healthy baby.

Good prenatal careGood prenatal care will result in the will result in the proper monitoring of the progress of the proper monitoring of the progress of the pregnancy. It checks the health condition pregnancy. It checks the health condition of the mother and baby as they undergo of the mother and baby as they undergo changes that take place from conception changes that take place from conception to the time the mother goes into labor.to the time the mother goes into labor.

Another purpose of prenatal care is Another purpose of prenatal care is to detect early problems that may arise so to detect early problems that may arise so that these can be acted upon on time.that these can be acted upon on time.

The BHW should know the The BHW should know the ff:ff: A. Early Signs of A. Early Signs of

PregnancyPregnancyB. Making a List of B. Making a List of Pregnant WomenPregnant Women

C. Health Tips for Pregnant C. Health Tips for Pregnant WomenWomenD. High Risk D. High Risk

PregnancyPregnancyE. Follow-up E. Follow-up VisitsVisitsF. Preparations for Labor F. Preparations for Labor

and and DeliveDeliveryry

A. Early Signs of A. Early Signs of PregnancyPregnancy

• Menstruation stopsMenstruation stops• Nausea and vomitingNausea and vomiting• Frequent urinationFrequent urination• Feeling lazy and Feeling lazy and

sleepysleepy• Feeling dizzyFeeling dizzy• Enlargement of the Enlargement of the

breastsbreasts

B. Making a List of B. Making a List of Pregnant WomenPregnant Women

A good list should have the ff. A good list should have the ff. items:items:

• NameName• AddressAddress• AgeAge• Number of pregnanciesNumber of pregnancies• Date of last deliveryDate of last delivery• Date of last menstrual periodDate of last menstrual period

Once you have a list of pregnant Once you have a list of pregnant women in your community, where women in your community, where do you put or keep the list?do you put or keep the list?

The ideal thing is The ideal thing is to get a big to get a big notebook where notebook where you can record the you can record the names of all the names of all the people in yourpeople in your

community (number of community (number of households), their ages (date households), their ages (date to birth), and other to birth), and other information about them. For information about them. For pregnant women, you should pregnant women, you should have those information cited have those information cited above.above.

C. Health Tips for Pregnant C. Health Tips for Pregnant WomenWomen1. Proper 1. Proper

NutritionNutritionWe have said that one of the We have said that one of the early signs of pregnancy is early signs of pregnancy is nausea and vomiting.nausea and vomiting.

What do you think What do you think happens to the happens to the nutritional status nutritional status of a woman if she is of a woman if she is vomiting? What vomiting? What should be done to should be done to counteract this?counteract this?

We have to advise these women to We have to advise these women to eat crackers as soon as they wake eat crackers as soon as they wake up and take it in small amounts. up and take it in small amounts. Hard candies and biscuits are also Hard candies and biscuits are also advisable and should be taken as advisable and should be taken as frequently as possible. This way, frequently as possible. This way, nutritional losses are replaced and nutritional losses are replaced and the feeling of nausea and vomiting the feeling of nausea and vomiting will disappear. They may also take will disappear. They may also take sips of lukewarm soup.sips of lukewarm soup.

How long does this period last? How long does this period last?

During the second half of the During the second half of the pregnancy she will no longer be pregnancy she will no longer be vomiting and her appetite will vomiting and her appetite will soon come back.soon come back.

What foods should you advise her to What foods should you advise her to take?take?

They should be taking a lot of They should be taking a lot of vegetables, fruits, milk and food vegetables, fruits, milk and food rich in iron such as fish, rich in iron such as fish, malunggay, kangkong or other malunggay, kangkong or other green, leafy vegetablesgreen, leafy vegetables

2. Personal 2. Personal CleanlinessCleanliness

A pregnant woman should A pregnant woman should practice personal cleanliness. practice personal cleanliness.

What do you think are the What do you think are the reasons for her to wash her reasons for her to wash her

genitals?genitals?The most The most important reason important reason is that it will is that it will help prevent help prevent infection not infection not only for the only for the mother but also mother but also for the baby in for the baby in her wombher womb..

3. Tetanus Toxoid 3. Tetanus Toxoid immunizationimmunization

What are the most common What are the most common causes of death among causes of death among

newborn infants?newborn infants?

Tetanus in the newborn. Tetanus in the newborn. Tetanus can start from Tetanus can start from unclean instruments used unclean instruments used during cord cutting and during cord cutting and improper cord treatment.improper cord treatment.

Tetanus in the newborn can be Tetanus in the newborn can be prevented by giving Tetanus prevented by giving Tetanus Toxoid (TT) injections to the Toxoid (TT) injections to the mother. However, one injection is mother. However, one injection is not enough. At least 2 injections not enough. At least 2 injections given one month apart will given one month apart will protect the baby.protect the baby.

When a mother has received a When a mother has received a total of 5 injections, all the total of 5 injections, all the babies that she will deliver babies that she will deliver should have been protected. The should have been protected. The TT injections also protect the TT injections also protect the mother from tetanus.mother from tetanus.

4. Preparation for 4. Preparation for breastfeedingbreastfeedingThere are many things to remember There are many things to remember

about breastfeeding. BHWs should about breastfeeding. BHWs should focus and always remember the focus and always remember the benefits of breastfeeding to the benefits of breastfeeding to the mother.mother.

Benefits of Breastfeeding to Benefits of Breastfeeding to Mothers:Mothers:

• When the baby is immediately When the baby is immediately allowed to suck on the breast allowed to suck on the breast right after delivery, the mother’s right after delivery, the mother’s chances of bleeding after delivery chances of bleeding after delivery are considerably reduced. This is are considerably reduced. This is because sucking the breast will because sucking the breast will stimulate contraction of the stimulate contraction of the uterus.uterus.

• Exclusive breastfeeding during Exclusive breastfeeding during the first 6 months will delay the the first 6 months will delay the next pregnancy.next pregnancy.

• It is convenient in terms of not It is convenient in terms of not having to prepare a bottle. All having to prepare a bottle. All she has to do is to give her she has to do is to give her breast and the baby is fed. The breast and the baby is fed. The mother can also sleep while mother can also sleep while feeding.feeding.

A pregnant woman needs to start A pregnant woman needs to start prenatal visits during the first 3 month prenatal visits during the first 3 month of pregnancy because:of pregnancy because:

• It is during this time that the different It is during this time that the different parts of the baby’s body is forming, parts of the baby’s body is forming, and the mother needs the appropriate and the mother needs the appropriate health information and guidance.health information and guidance.

5. Schedule of 5. Schedule of prenatalprenatal check-ups check-ups

• Information gathered during this time will Information gathered during this time will be the basis for her follow-up visits be the basis for her follow-up visits particularly for high risk cases.particularly for high risk cases.

These are the direct obstetrical These are the direct obstetrical complications:complications:

- Hemorrhage- Hemorrhage- Prolonged / obstructed labor- Prolonged / obstructed labor- PP sepsis- PP sepsis- Complications of abortion- Complications of abortion- Pre-eclampsia/eclampsia- Pre-eclampsia/eclampsia- Ectopic pregnancy- Ectopic pregnancy- Ruptured Uterus- Ruptured Uterus

6. Danger signs of 6. Danger signs of PregnancyPregnancy

There are signs during There are signs during pregnancy that will help pregnancy that will help indicate whether a pregnant indicate whether a pregnant woman should immediately woman should immediately consult a midwife or other consult a midwife or other high level of health workers high level of health workers for proper care. for proper care.

The danger signs of pregnancy are:The danger signs of pregnancy are:• Vaginal bleeding – no matter how Vaginal bleeding – no matter how

little, if it occurs anytime during little, if it occurs anytime during pregnancypregnancy

• Puffiness of the face and handsPuffiness of the face and hands• Headache, dizziness, blurring of Headache, dizziness, blurring of

visionvision• Hypertension – when the bloods Hypertension – when the bloods

pressure rises to 140/90 and abovepressure rises to 140/90 and above• Signs of labor before the 9Signs of labor before the 9thth month month

of pregnancyof pregnancy• Breaking of bag of waterBreaking of bag of water• Abdominal pains/ contractionsAbdominal pains/ contractions

EMERGENCY SIGNSEMERGENCY SIGNS

– Unconcious/ConvulsingUnconcious/Convulsing

– Vaginal BleedingVaginal Bleeding– Severe abdominal painSevere abdominal pain– Looks very illLooks very ill– Severe headache with visual Severe headache with visual

disturbancedisturbance– Severe difficulty of breathingSevere difficulty of breathing– FeverFever– Severe vomitingSevere vomiting

7. Spacing the next 7. Spacing the next pregnancypregnancy

It is good to start advising It is good to start advising pregnant women to space pregnant women to space their next pregnancy. Ideally, their next pregnancy. Ideally, there should be at least a 2 there should be at least a 2 year gap between year gap between pregnancies.pregnancies.

D. High Risk D. High Risk PregnancyPregnancy

Certain conditions predispose a Certain conditions predispose a woman to be a risk during woman to be a risk during pregnancy. These are:pregnancy. These are:

• Age less than 18 or greater Age less than 18 or greater than 35than 35

• First or 4First or 4th th and more and more pregnancy pregnancy

• Pregnant within 15 months Pregnant within 15 months from the previous deliveryfrom the previous delivery

• Pale or with severe anemiaPale or with severe anemia

OR, simply…- too young (below 20 yrs. old)- too old (above 35 yrs. old)- too many children (more than

4)- too soon (birth-spacing of less

than 3 yrs- too sickly (with chronic illness as HPN, Diabetes,TB etc)

If the pregnant woman has any If the pregnant woman has any of these conditions listed in of these conditions listed in

the the Home-Based Mother’s Record, Home-Based Mother’s Record,

she should be closely she should be closely monitored and referred. She monitored and referred. She will probably need to deliver will probably need to deliver

her baby in the hospital.her baby in the hospital.

Why do women die ?Why do women die ?

- complications related to pregnancy - complications related to pregnancy occurring during :occurring during :

* labor* labor

* delivery &* delivery &

* puerperium* puerperium

- HPN complicating pregnancy, child-- HPN complicating pregnancy, child-birth and cesarean section, pre-birth and cesarean section, pre-eclampsia /eclampsia, hemorrhage, eclampsia /eclampsia, hemorrhage, miscarriages or stillbirths.miscarriages or stillbirths.

- Post Partum (PP) Hemorrhage Post Partum (PP) Hemorrhage cases are mostly due to uterine cases are mostly due to uterine atony & placental separationatony & placental separation

- Other hemorrhages are due to Other hemorrhages are due to pregnancy with abortive pregnancy with abortive outcomes and Hemorrhage outcomes and Hemorrhage related to pregnancy (i.e. ectopic related to pregnancy (i.e. ectopic pregnancy and placenta previa, pregnancy and placenta previa, etc)etc)

Now, with a shift in a new Now, with a shift in a new standard, standard, all pregnancies are all pregnancies are considered at risk. considered at risk. There will be There will be no such thing as low-risk no such thing as low-risk pregnancy because most pregnancy because most obstetrical complications are not obstetrical complications are not predictable but can be treated if predictable but can be treated if detected early.detected early.

There is a shift of focus now in There is a shift of focus now in pregnancy to delivery and pregnancy to delivery and postpartum. Therefore, readiness postpartum. Therefore, readiness is the “key word” accompanied is the “key word” accompanied by quality obstetrical care.by quality obstetrical care.

E. Follow-up E. Follow-up VisitsVisits

On the first prenatal check-up, On the first prenatal check-up, the pregnant woman is given a the pregnant woman is given a Home-Based Mother’s Record by Home-Based Mother’s Record by the midwife. The BHW should the midwife. The BHW should help the midwife and mother in help the midwife and mother in filling-up and interpreting the filling-up and interpreting the content of the HBMR and remind content of the HBMR and remind them of the date of the next visit.them of the date of the next visit.

It is very important for a pregnant It is very important for a pregnant woman to have a complete prenatal woman to have a complete prenatal check-up. For those who fail to show up check-up. For those who fail to show up for her clinic appointment, the BHW for her clinic appointment, the BHW should find out why.should find out why.

Visit her and check the actual condition Visit her and check the actual condition of the home and environment. Then of the home and environment. Then motivate her to go for her regular motivate her to go for her regular check-up at the BHS or health center.check-up at the BHS or health center.

F. Preparations for Labor F. Preparations for Labor and Deliveryand Delivery

The mother prepares for the ff:The mother prepares for the ff:1. Things needed by the mother1. Things needed by the mother

a.a. duster with opening in frontduster with opening in frontb.b. sterile or ironed soft sterile or ironed soft

cloth/sanitary napkinscloth/sanitary napkins

2. Things needed for the 2. Things needed for the newbornnewborn• Clean ironed baby’s clothesClean ironed baby’s clothes• Clean ironed baby’s blanketClean ironed baby’s blanket• Clean ironed diapersClean ironed diapers• 2 big safety pins2 big safety pins• Clean ironed soft clothClean ironed soft cloth

It is the best for the family to It is the best for the family to know and be prepared for the know and be prepared for the expected expenses. They should expected expenses. They should also be prepared for the also be prepared for the possibility of transporting the possibility of transporting the mother to the hospital when mother to the hospital when needed.needed.

Members of the family should Members of the family should also prepare for the coming of a also prepare for the coming of a new member. This new member new member. This new member of the family needs love and of the family needs love and nurturing.nurturing.

Reasons why there are mothers Reasons why there are mothers die giving birth what experts die giving birth what experts

classified as the THREE classified as the THREE DELAYS:DELAYS:

1.1. Delay in deciding to seek medical careDelay in deciding to seek medical care

2.2. Delay in reaching appropriate care, andDelay in reaching appropriate care, and

3.3. Delay in receiving care at health facilitiesDelay in receiving care at health facilities

1. Delay in deciding 1. Delay in deciding to seek medical careto seek medical care

• Failure to recognize danger signsFailure to recognize danger signs• Absence of skilled attendantsAbsence of skilled attendants• Lack of money to pay for medical Lack of money to pay for medical

expenses and cost of expenses and cost of transportationtransportation

• Pregnancy is unplanned or Pregnancy is unplanned or unwantedunwanted

• Poor quality of obstetrical carePoor quality of obstetrical care

1. Delay in deciding 1. Delay in deciding to seek medical careto seek medical care

• Fear of being ill-treated in the health Fear of being ill-treated in the health facilityfacility

• Lack of encouragement from relatives Lack of encouragement from relatives and community members to seek careand community members to seek care

• No available person to take care of the No available person to take care of the children, the home and livestockchildren, the home and livestock

• Lack of companion in going to the Lack of companion in going to the health facilityhealth facility

• Reluctance from the mother or the Reluctance from the mother or the family due to cultural constraintsfamily due to cultural constraints

2. Delay in identifying 2. Delay in identifying and reaching the and reaching the

appropriate facilityappropriate facility• Distance from a woman’s home to Distance from a woman’s home to

a facility or providera facility or provider• Lack of roads or poor condition of Lack of roads or poor condition of

roadsroads• Lack of emergency transportation Lack of emergency transportation

whether by land or waterwhether by land or water• Lack of awareness of existing Lack of awareness of existing

servicesservices

2. Delay in identifying 2. Delay in identifying and reaching the and reaching the

appropriate facilityappropriate facility• Lack of referral systemLack of referral system• Lack of communication with referral Lack of communication with referral

facilityfacility• Lack of moral, financial and logistical Lack of moral, financial and logistical

support from neighbors, the barangay support from neighbors, the barangay captain and barangay officials or the captain and barangay officials or the mayormayor

3. Delay in receiving 3. Delay in receiving appropriate and appropriate and

adequate care at the adequate care at the facilityfacility• Lack of healthcare personnelLack of healthcare personnel

• Unprofessional attitudes of health Unprofessional attitudes of health care providerscare providers

• Shortages of suppliesShortages of supplies• Lack of basic equipmentLack of basic equipment• Poor skills of health care providersPoor skills of health care providers• Health is not prioritized by the Health is not prioritized by the

barangay and municipal officialsbarangay and municipal officials• Lack of budget from the LGULack of budget from the LGU

Safe Motherhood

What a Pregnant woman What a Pregnant woman must have:must have:

• A Birth Plan with the readiness to A Birth Plan with the readiness to respond to any complicationsrespond to any complications

• PHILHEALTH membership and is able PHILHEALTH membership and is able to avail of the benefits accordinglyto avail of the benefits accordingly

• Saved/ allotted money to prepare for Saved/ allotted money to prepare for her childbirth and services that the her childbirth and services that the newborn will be availingnewborn will be availing

• Plans for desired Family Planning Plans for desired Family Planning (FP) services (spacing or limiting (FP) services (spacing or limiting methods)methods)

Birth Plan Form(Lifted from the Mother and Child Book)I know that any complication can develop during delivery. I know that I should deliver my baby in a health facility.I will be attended at delivery by _______________________________________

Name of doctor/nurse/midwife or others, specify.I plan to deliver at __________________________________________________ Name of hospital/health center/clinic

This is a Philhealth accredited facility ___________Yes ___________ No

The estimated cost of the maternity package in this facility is P ______________. (Inclusive of newborn care)

The mode of payment is ____________________________________________.

The available transport is ___________________________________________.

I have contacted _____________________ to bring me to the hospital/maternity

Name

clinic/health center.

I will be accompanied by ____________________________________________.Name

_______________________________will take care of my children/home while I Name

am in the health facility.In case of a need for blood transfusion, my possible donors are:________________________________________________________________

Name Address________________________________________________________________

Name Address________________________________________________________________

Name AddressIn case of complications, I will be referred right away to:Contact person: ___________________________________________________Address: _________________________________________________________

THANK YOU!!!

THANK YOU!!!