Page 1 of 22
Additional Notes:
Community Health Nursing
☼2030 Sustainable Development Goals
(SDGs)
1. No Poverty
2. Zero Hunger
3. Good Health and Well-being
4. Quality Education.
5. Gender Equality
6. Clean Water and Sanitation
7. Affordable and Clean Energy
8. Decent Work and Economic Growth
9. Industry, Innovation and
Infrastructure
10. Reduced Inequality
11. Sustainable Cities and Communities
12. Responsible Consumption and
Production
13. Climate Action
14. Life Below Water
15. Life on Land
16. Peace and Justice Strong Institutions
17. Partnerships to Achieve Goal
☼Aromatherapy
Aromatherapy is an alternative form of
holistic therapy that uses essential oils to
help improve and create an emotional and
physical balance in the individual.
Aromatherapy works on three main levels:
through the sense of smell, through
absorption and through absorption via skin
Lavender Oil
▪ improve sleep quality
▪ promote better concentration
▪ encourage hair regrowth
▪ help fight anxiety
Eucalyptus Oil
• insecticidal (kills insects), herbicidal,
acaricidal (kills ticks and mites),
antimicrobial
• help alleviate a cough and
congestion, expectorant, mucolytic
•
with peppermint oil, boosts cognitive
performance, reduce headaches
and promote mental and muscular
relaxation.
Peppermint Oil
• alleviate nausea, head ache, upset
stomach, gas, indigestion, and
anxiety
• antispasmodic, improves the flow of
bile, reduce irritations associated
with irritable bowel syndrome (IBS)
Tea Tree Oil
• antiseptic
• crushed leaves to relieve cough and
poultice to help heal wounds.
• antibacterial, antifungal, antiviral,
and antiprotozoal
Jojoba Oil
• wounds healing (accelerates the
closure of wounds at a cellular level)
• improve skin appearance and
reduce acne
Blue Chamomile Oil
• skin conditions and injuries
• fever and insomnia
• anti-inflammatory effects
• offers a mild anti-anxiety effect for
those who suffer from generalized
anxiety disorder
Rose Oil
• promotes a calm mood and
• fights harmful organisms can makes
skin more permeable.
Bergamot oil
• calming effects
• healthy body weight and help with
vascular and heart health
• encourages normal cholesterol
levels and blood sugar.
Neroli Oil
• commonly added to diet pills due to
its ability to act as an appetite
suppressant
• helps relieve symptoms of
menopause and stress
Page 2 of 22
•
boosts the actions of the endocrine
system, fights harmful organisms, and
soothes irritation.
Oregano Oil
• fighting harmful organisms
• supports liver health
Jasmine Oil
• sleep aids and relaxants
• topically, increases alertness,
breathing rate, and vigor (promote
an uplifted mood and better sense
of well-being)
Copaiba Oil
• Prevents dental carries
• Antimicrobials
• anti-inflammatory
Lemon Balm Oil
• helps with symptoms of menopause
• disordered sleep pattern
• sharpens memory and boosts
problem-solving abilities
• improves recall for people with
Alzheimer’s disease
Pomegranate Oil
• essential fatty acid
• delays the development of colon
and skin cancer
• enhances the immune system
Frankincense Oil
• promotes normal cell growth
☼Immunization Schedule
Page 3 of 22
•
IPV is a vaccine given with the third dose
of Oral Polio Vaccine (OPV), when your
child is 3½ months old.
IPV plus OPV provides your child with the
best protection from polio.
Difference between IPV and OPV
• OPV is given orally, providing
protection in the mouth, in the
intestines, and then in the blood.
Protection in the mouth and
intestines are important as
polioviruses infect the mouth and
multiply in the intestines.
• IPV is an injectable vaccine that
provides protection in the blood . IPV
further strengthens the protection
given by OPV and helps increase the
overall protection of your child
against polio.
Side effects of IPV
These may include temporary
discomfort, redness, soreness and/or
swelling at the injection site; or
low-grade fever.
• Child already received IPV. Does
he/she still need OPV?
• IPV does not replace the benefits of
OPV. Giving IPV with OPV at 3½
months will ensure your child’s
protection from polio.
My 3½ months old child already received
the third dose of OPV along with other
vaccines on schedule. Can my child still be
given IPV?
• Yes, your child can be given IPV
before reaching one year old.
However, it is recommended for your
child to be immunized immediately
and not to wait until the next
vaccination schedule.
My child has not received any vaccine yet
and he is now more than 3 ½ months old.
Will he/ she be given IPV?
• Yes, your child can be given IPV. IPV
is given to children between ages
3½ months and 1 year. Bring your
child immediately to the nearest
Health Center to receive IPV and
other missed vaccines. Make sure
you get an immunization card.
Follow the recommended
immunization schedule as advised
by the health worker
Can I delay the IPV or any of the scheduled
vaccines so that my child will not get
several injections in one visit?
• No. Any delay in vaccination places
your child at risk of getting sick with
the diseases prevented by the
vaccines. Following the
recommended schedule ensures
maximum effectivity of the vaccines.
• One dose of IPV is optimized to be
given to children 3 ½ months old to
ensure maximum protection against
Page 4 of 22
polio. If the schedule is missed, IPV
should be given as soon as possible,
before the child turns one year old.
If my child is sick, will he/she still be given
IPV?
• IPV can be given even if your child
has cough, common colds, diarrhea,
HIV, other immunodeficiency
disorders (e.g. leukemia), as long as
he/she has no high grade fever (>39
ºC). A child with low grade fever
(<39ºC) can receive IPV. When in
doubt, consult the doctor or defer
vaccination until fever is gone.
Since IPV and OPV both protect against
polio, is there a possibility of vaccine
overdose to my child?
• There is no overdose in any kind of
vaccine.
When is it not safe to give IPV to a child?
• Children allergic to Streptomycin,
Neomycin and Polymyxin B or to a
previous IPV dose should not receive
IPV. Children with known bleeding
disorders should not be vaccinated
because bleeding may occur after
injection.
Will there be cross-reactions between IPV
and the other three vaccines given at the
same time?
• IPV will not interfere with other
vaccines. Giving three vaccines on
the same day will not overwhelm
your child’s immune system.
Why does my child need three injections in
one visit?
• Giving the three injectable vaccines
(IPV, pentavalent and PCV) at 3½
months will provide timely and
maximum protection against the
diseases these vaccines prevent.
Any delay increases the risk of your
child getting sick from these
diseases.
Is it safe to give three injections at one visit?
•
•
Yes, it is safe for your child to receive
three (or more) injections at one
time. Many countries have already
been doing this and have proven
that it is generally safe for the child
to receive multiple injections during
the same visit.
Similar with other vaccines, your
child may experience temporary
discomfort such as swelling or
tenderness at the injection sites. If
these happen, do not vigorously
massage the injection sites. Instead,
apply warm and cold compress to
relieve the swelling and tenderness.
Use clean cloth and water to avoid
infection. Keep your child
comfortable and continue
breastfeeding
☼ Green house effect
•
the trapping of the sun's warmth in a
planet's lower atmosphere due to
the greater transparency of the
atmosphere to visible radiation from
the sun than to infrared radiation
emitted from the planet's surface.
Page 5 of 22
•
•
foam-blowing
agents (chlorofluorocarbon (CFCs),
HCFCs
(hydrochlorolurocarbon), halons)
🙢☼🙠
☼ Frequently Asked Questions
Standard Days Method
What is the Standard Days Method?
The standard Days Method or SDM is a new
simple method of family planning.
Developed by the Institute of Reproductive
Health at Georgetown University, SDM was
based on recent research that identifies
more precisely when a woman can
become pregnant during her menstrual
cycle. The method is based on the
identification of a fixed “window” of fertility.
How is SDM used?
The primary greenhouse gases in earth’s
atmosphere are
• water vapor,
• carbon dioxide,
• methane,
• nitrous oxide, and
• ozone.
The main cause of ozone depletion and the
ozone hole is man-made chemicals,
especially man-made ozone-depleting
substances (ODS):
• halocarbon refrigerants,
• solvents,
• propellants, and
SDM users keep track of the days of their
menstrual cycle and avoid intercourse
during days 8 through 19 of the cycle. There
are a variety of ways to ‘track’ the fertile
and infertile days of the woman’s menstrual
cycle. Women can observe the mucus
discharge that comes with ovulation and
record the changes daily or simply count
days.
The Institute for Reproductive Health
designed a special mnemonic device to
assist women in tracking each day of the
reproductive cycle they are on. The device
is string of 32 beads, with each bead
representing one day of the cycle. The
bead for the first day of menstruation is red,
followed by six brown beads. The red and
six brown beads represent the first 7 infertile
days of the cycle. These beads are
followed by 12 white beads which represent
the fertile window. The rest of the beads are
Page 6 of 22
brown, again indicating infertile days. The
woman moves a small rubber ring one bead
per day so she can tell when she is in her
fertile window.
Who can use SDM?
SDM can be used by many people. It is
appropriate for:
● All women with menstrual cycles
between 26 and 32 days
● Couples who want to space
pregnancies
● Couples who can agree whether or
not to have intercourse on a
particular day
What are the advantages and
Disadvantages of SDM?
ADVANTAGES
DISADVANTAGES
•
No side effects
•
Easy to learn,
only by women
teach and use
with 26 – 32 days
•
Affordable
cycle
•
No re-supply
•
•
•
•
•
Can be used
Couples must
commodities
abstain from
Does not need
intercourse
an established
during fertile
logistics system
days (this is seen
Can be provided
as advantage
by community
by many
personnel
couples)
Ideal for low
resource settings
How effective is SDM?
The effectiveness of SDM has been found to
be 95.25%. It was first tested through
computer simulation, using large data set of
more than 7,000 cycles from the World
Health Organization. This test was followed
by a pilot study to determine whether
women could learn the method and
whether couples could use it successfully.
The full scale effective ness study was done
in three countries: Bolivia, Peru and the
Philippines where almost 5090 women were
followed up for 13 cycles.
What is the scientific basis for SDM?
The Institute for Reproductive Health began
developing SDM in 1996. The method’s
development was based on the concept
that the woman has a fixed window of days
during which she can, with varying degrees
of likelihood, become pregnant.
From the beginning of the menstrual cycle
through 6 days prior to ovulation, a
woman’s chances of getting pregnant if she
has intercourse are virtually zero. This is due
to the life span of the sperm. If the sperm is
in the woman’s reproductive tract – it has
gone through her cervix through her uterus,
into the fallopian tube – it does not live
longer than 5 days. If she has intercourse
during those early days of her cycle,
pregnancy is very unlikely.
Prior to ovulation, however, her probability
of pregnancy begins to rise. If she has
intercourse five days before ovulation, her
chances of getting pregnant are about 5 %.
This increases to close to 30 % on the two
days prior to ovulation. If she has
intercourse on any of these 2 days, she has
about 30% chance of becoming pregnant.
The egg lives a very short time after
ovulation. It begins to die almost
immediately after it comes out of the ovary
and moves down the fallopian tube – where
Page 7 of 22
it could meet a sperm. Thus, the probability
of pregnancy from intercourse on the day of
ovulation is only 8 %. And it falls to 0% within
24 hours after ovulation.
Based upon these findings, the standard rile
of avoiding intercourse between day 8 and
day 19 woulkd work best for women whose
cycles are between 26 and 32 days.
Figure 1: The fertile window
How is SDM taught?
Fertile Window
1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 1 1 1 1
0 1 2 3 4 5 6 7 8 9
Fertile Window
1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 1 1 1 1
0 1 2 3 4 5 6 7 8 9
As figure 1 shows, the days during which
SDM users must abstain from intercourse are
the same regardless of cycle length when
the cycle is within 26-32 day range. The
probability of this window covering all fertile
days is highest for cycles within this range,
but it also provides significant coverage for
cycles that are slightly longer or shorter.
The Institute’s early research in the
development of this method involved the
analysis of a large data set of women’s
reproductive cycles obtained from World
Health Organization’s study of the Ovulation
Method. The analysis was designed to
determine what period of the abstinenece
from intercourse would include the days
with the highest probability of pregnancy for
most women. The results of the analysis
showed that a fixed period of abstinence
from day 8 to 19 (a total of 12 days) would
result in a very high theoretical reduction in
the probability of pregnancy. This analysis
also suggests that women are most likely to
ovulate close to the mid-point of their cycle
– and nor necessarily on the 14th day before
the start of the next cycle, as has been the
conventional thinking.
A trained provider can teach SDM
individually or in groups. Beacause
successful use of the method requires that
both partners understand the method and
how to use it, it is beneficial if men can be
included in education sessions. Women and
men can be taught individually, as couples
or in groups.
When should an SDM client consult a service
provider?
●
●
●
●
If her menstrual cycle lasts for less
than 26 or more than 32 days
If she would like more information
about her menstrual cycle
If she has difficulty identifying her
fertile days
If it is difficult for her partner to
abstain from intercourse during the
fertile period
SDM: More Information
www.irh.org
irhinfo@gunet,georgetown.edu
mitos@nfp.com.ph
☼ Community-managed Maternal and
Newborn Care
Maternal Mortality
Page 8 of 22
●
●
●
1/10 Filipino mothers die every day
from complications related to
pregnancy and childbirth
14% of deaths among women aged
15-49 are maternal deaths
172 Filipino mothers die for every
100,000 live births
Child Survival
● 17/1000 babies die within their first 28
days of life
● 29/1000 babies die under 12 months
● 40/1000 children die under the age
of five
WHY are mothers and children dying?
● Not just biological reasons, but also
because of economic,
socio-cultural, political and
environmental factors
● Disparities exist (e.g. geographic:
rural vs. urban, Economic: rich vs.
poor, Socio-cultural: women vs. men,
indigenous peoples, level of
education
What is our role?
● Save the lives of mothers and
newborns
● Combat the Three Delays through
provision of Emergency Obstetric
Care (EmOC)
Emergency Obstetric Care
● Part of Emergency Obstetric Care
which includes pre- and postnatal
care, clean and safe delivery,
neonatal care and family planning
(4 pillars of safe motherhood)
● Assurance of a skilled birth attendant
How can we help save?
● Be equipped with essential skills both
clinical and non-clinical to deliver
●
maternal and newborn health
services effectively
Health is the responsibility of
everyone
Right to Health
● Every woman has a right to a safe
pregnancy and childbirth
Maternal and Child Health Principle of
Primary Health Care
●
●
●
Address MCH problems by providing
promotive, preventive, curative and
rehabilitative services in communities
Participation of people individually
and collectively in the planning,
implementation and evaluation of
their health care
Health in the hands of the people
Rationale
● Few health facilities on the ground
are capable of providing Basic
Emergency Obstetric Care (BEmOC)
● Essential that health professionals in
health facilities are competent to
provide basic skills needed to
contribute to reduce MMR and IMR
in the communities.
Paradigm Shift
Risk Approach
Identifies high
risk pregnancies for referral during the
prenatal period
EmOC Approach
considers all pregnant women to be at risk
of complications at childbirth
Page 9 of 22
Ensure Success of the SHIFT
●
24-hour EmOC facility + skilled attendants
and transportation
●
Improve accessibility, utilization and quality
of services for the treatment of
complications
Address the “Three Delays” of deciding to
seek care, reaching appropriate care and
receiving care
The Three Delays
Factors affecting utilization and Outcomes
Delay in deciding to seek medical
care
Delay in identifying and reaching the
appropriate health facility
Delay in receiving appropriate and
adequate care at the health facility
1.
Delay in deciding to seek medical care
● Failure to recognize danger signs
● Lack of money to pay for medical
expenses and cost of transportation
● Fear of being ill-treated in the health
facility
● Reluctance from the mother or the
family due to cultural constraints
●
●
2.
The woman or family member
present at childbirth lack power to
make decision
Lack of encouragement from
relatives and community members
to seek care
No available person to take care of
the children, the home and livestock
Lack of companion in going to the
health facility
Delay in identifying and reaching the
appropriate facility
● Distance from a woman’s home to a
facility or provider
● Lack of roads or poor condition of
roads
● Lack of emergency transportation
whether by land or water
● Lack of awareness of existing
services
● Lack of community support
3. Delay in receiving appropriate and
adequate care at the health facility
● Lack of health care personnel
● Gender insensitivity of health care
providers
● Shortages of supplies, i.e. emergency
medicines or blood
● Lack of equipment for EmOC
● Lack of competence of health care
providers to deliver EmOC
● Weak referral system includes
transportation and communication
Community-Managed Maternal and
Neonatal Care Framework
Page 10 of 22
REFERRAL
A process where a woman, her
newborn or a patient is advised or
brought from her home or from a
health facility, to seek care in a
health facility providing a wider
range or higher level of services
where the condition of the patient
can be best managed
● Include
- Arranging for transport and care
during transport
- Preparing referral form
- Communicating with referral
institution with emergency care
facilities
● In the event of obstetrical and
newborn complications and/or
emergencies, it is important that
woman and her newborn are
referred to a health facility capable
of giving them the needed care by
having a BEmONC or CEmONC
certification from the DOH
● Prevent delay and ensure it is timely
to prevent death and disability
● With your barangays, develop an
emergency transport system that is
fast enough and available for 24
hours every day
● Get to know and coordinate, call
and communicate with the persons
responsible for receiving referrals to
facilitate procedures and prevent
unnecessary waiting
●
Universal Precautions and Cleanliness
●
●
●
●
●
●
●
●
●
Wash hands
Wear gloves
Protect yourself from blood and
other body fluids during deliveries
Practice safe sharps disposal
Practice safe waste disposal
Deal with contaminated laundry
Sterilize and clean contaminated
equipment
Clean and disinfect gloves
Sterilize gloves
STEPS TO FOLLOW
1. Give emergency management
2. Discuss decision with woman,
partner/spouse and relatives
3. Quickly organize transport and
possible financial aid
Page 11 of 22
4. Inform referral center by cell phone,
landline or radio
5. Ensure support
- Accompany the
woman/newborn to the referral
center if possible
- Have relatives who can donate
blood, go with the woman
- Bring the bay with the mother if
possible
- Bring the ‘Mother and Baby
book’, fill out a referral form
6. During journey
For the woman:
- If journey is long, give
appropriate treatment on the
way
- If the woman is bleeding,
continue to monitor blood loss
and continue measures to
decrease bleeding, according
to cause
- Manage shock
- If the woman has na IV line,
watch infusion
- Keep records of all IV fluids,
medications given, ti,e of
administration and the woman’s
condition
7. During journey
For the baby:
- Keep the baby warm by
skin-to-skin contact with mother
or someone else
- Cover the baby with a blanket
and with a cap on the head
- Protect the baby from direct
sunlight
- Encourage breastfeeding during
the journey
- If the baby does not breastfeed
and the journey is more than 3
hours, consider giving expressed
milk by cup
DOH Referral Levels
●
●
●
●
Primary or Rural Health Unit
Secondary Level or District Hospital
Tertiary Level or Provincial Hospital
Regional Hospital and specialty
centers
BEmOC (Basic Emergency Obstetric Care)
facility is an RHU or hospital able to:
●
●
●
●
●
●
Administer parenteral medications
Administer parenteral oxytocin
Administer parenteral
anti-convulsants for
pre-eclampsia/eclampsia
Perform manual removal of
placenta
Perform removal of retained
placental products
Perform assisted vaginal delivery
(breech, vacuum extraction and
forceps)
CEmOC (Comprehensive Obstetric Care)
facility is a hospital that is able to:
●
●
●
Perform the six functions of a BEmOc
facility, plus
Perform caesarean section and
hysterectomy, and
Give safe blood transfusion
Steps to follow in Prenatal Care
1. Do a quick check for emergency
signs
2. Make the woman comfortable
3. Assess the pregnant woman
4. Get the baseline laboratory
information of the woman on the first
or following the first visit
5. Check for gestational diabetes
6. Check for pallor or anemia
Page 12 of 22
7. Check for
hypertension/pre-eclampsia
8. Check for fever, burning sensation
on urination and abnormal vaginal
discharge
9. Immunize against tetanus
10. Treat for intestinal parasites
11. Prevent anemia and neural tube
defects with iron and folate
supplementation
12. Give preventive intermittent
treatment for falcifarum malaria
13. Give vitamin A
14. Provide health information, advice
and counsel on danger signals and
three delays
15. Encourage the woman to come
back for return visits
What is a Birth Plan?
●
●
●
●
●
A document prepared during the
prenatal care which states the
woman’s conditions during
pregnancy
Her preferences for her place of
delivery
Choice of birth attendant
Her available resources for her
childbirth and newborn baby
The preparations needed should an
emergency situation arise during
pregnancy, childbirth and
postpartum
Preparing an Emergency Plan
●
To plan an emergency consider:
✔ Where should you go?
✔ How will you get there?
✔ Who will pay for transport?
How much will it cost?
✔ What costs will you have to
pay the health facility? How
will you pay for this?
✔ Can you start saving for these
possible costs now?
✔ Who will go with you to the
health center?
✔ Who will help to care for your
home and other children
while you are away?
Planning for delivery at the hospital or health
facility
●
●
●
●
●
How will you get there? Will you
have to pay for transport to get
there?
How much will it cost to deliver at
the facility? How will you pay for
this?
Can you start saving for these costs
now?
Who will go with you and support
you during labor and delivery?
Who will help you while you are
away and care for your home and
other children?
Steps to follow in providing care during
labor, childbirth and immediate postpartum
1. Do a quick check for emergency
signs
2. Make the woman comfortable
3. Assess the woman in labor
- Take the history of labor and
record on the labor form
- Review Mother and Child Book
- Observe the woman’s response
to contractions
4. Determine the stage of labor
- Explain to the woman that you
will perform a vaginal exam
ination and ask for her consent
- Inspect the vulva for
Page 13 of 22
Bulging perineum
Any visible fetal parts
Vaginal bleeding
Leaking amniotic fluid; if
YES: is it meconium
stained, foul smelling?
✔ Warts, keloid tissue or
scars that may interfere
with delivery
✔
✔
✔
✔
●
Cervical dilation
> 4 cm
Early
Active
Labor
●
ge first
stage
of
labor
●
partog
raph
●
●
labor
●
record
Signs
Classify
Manage
Bulging thin
Immine
nt
Delivery
●
Vagina gaping
Recor
d in
Determining Stage of Labor
perineum
Recor
d in
Perform gentle vaginal examination (do not
start during contraction).
●
Mana
Mana
ge
secon
and head visible
d
Full cervical
stage
dilation
of
●
Cervical dilation
at 0-3 cm
●
Contractions
weak and < 2 in
Not yet
in
Active
Labor
●
Recor
d in
labor
record
10 minutes
labor
●
Recor
d in
partog
raph
●
Cervical dilation
-
Multigravida
> 5 cm
-
Late
Active
Labor
●
Mana
ge first
stage
Primigravida
of
> 6 cm
labor
●
Recor
ds in
partog
raph
●
Recor
d in
labor
record
5. Decide if the woman can safely
deliver
o If there is no indication for referral
- Continue to take care of
her
- If woman is in late active
labor, deliver the baby
but prepare for
immediate referral if still
necessary
- If woman is in early labor
and the referral hospital
can be timely reached,
refer urgently
o If the woman or her family refuses
referral, continue to take care of
her but explain the possible
consequences
6. Give supportive care throughout the
labor
Page 14 of 22
o
o
Explain procedures, seek
permission and discuss findings
with the woman and her family
Examine the woman in a place
where she is not exposed to
people other than the examining
person and her choice of
companion
7. Monitor and manage labor
o First stage: not yet in active labor,
cervix is dilated 0-3 cm and
contractions are weak, less than
2 in 10 minutes
- Check every hour for
emergency signs,
frequency and duration
of contractions, fetal
heart rate, mood and
behavior
- Check every four hours
for fever, pulse, blood
pressure and cervical
dilatation
- Record findings in labor
record
- Record time of rupture of
membranes and color of
amniotic fluid
- Assess progress of labor
o
First stage: in active labor, cervix
is dilated at 4 cm or more
- Check every 30 minutes
for emergency signs,
frequency and duration
of contractions, fetal
heart rate, mood and
behavior
- Check every four hours
for fever, pulse, blood
pressure and cervical
dilatation
-
-
Record time of rupture of
membranes and color of
amniotic fluid
Record findings in labor
record and partograph
o
Second stage: cervix dilated 10
cm or bulging thin perineum and
head is visible
- Check every 5 minutes for
perineum thinning and
bulging, visible descend
of the head during
contraction, emergency
signs, fetal heart rate,
and mod and behavior
- Continue recording in the
partograph
o
Assist the delivery
- Ensure all delivery
equipment and supplies
are available and place
of delivery is clean and
warm
- Ensure bladder is empty
- Position woman
comfortable where she
will deliver
- When delivery is
imminent, wash hands,
open delivery kit, ready
oxytocin 10 IU and put on
gloves just before delivery
- Stay with woman and
encourage her. Maintain
constant verbal and eye
contact.
• Await for
spontaneous
pushing efforts by
the woman. Do
not rush her
• Deliver the baby
Page 15 of 22
•
•
o
Give oxytocin 10
IU IM
Watch for vaginal
bleeding
Delivering the baby
- Ensure controlled delivery
of the head
• Keep one hand
on the head as it
advances with
contractions
• Support perineum
with other hand
and cover anus
with pad held in
position by heel of
hand during
delivery
• Discard pad and
replace when
soiled to prevent
infection
• Leave the
perineum visible
between thumb
and index finger
• Ask the woman to
breathe steadily
and not to push
during delivery of
the head
• Encourage rapid
breathing with
mouth open
- Feel gently round the
neck for the cord
• If cord is present
and loose,
delivwer the baby
through the loop
of cord or slip it
over the baby’s
head
•
-
-
-
If cord is tight,
clamp and cut
the cord and
unwind it from
around the neck
Gently wipe the baby’s
face with a clean gauze
or cloth
Await spontaneous
rotation of the shoulders
to antero-posterior
position (within 1-2
minutes
Apply gentle downward
pressure to deliver top
shoulder then lift baby up
to deliver lower shoulder
o
Clamp and cut the cord
- Change gloves. If not
possible, wash gloved
hands with bubbling soap
and water
- Put ties tightly around the
cord at 2 cm and 5 cm
from the baby’s
abdomen
- Cut between ties with a
sterile instrument
- Observe stump for blood
oozing
- Do not bandage or bind
the stump. Leave it open
o
Keep the baby warm
- Thoroughly dry the baby
- Leave baby on the
mother’s chest in
skin-to-skin contact
- Cover the baby; cover
head with a cap
- Put baby to mother/s
breasts
Page 16 of 22
o
o
Third stage: between birth of the
baby and delivery of the
placenta
- Deliver placenta by
controlled cord traction
• Check that the
placenta and
membranes are
complete
• Put the placenta
into a container
for disposal
Supportive Care throughout
Labor
- To provide a supportive,
encouraging atmosphere
for birth, be respectful of
the woman’s wishes.
• Communication
• Cleanliness
• Mobility
• Urination
• Eating, drinking
• Breathing technique
• Pain and discomfort
relief
• Birth companion
- If woman is distressed or
anxious, investigate the
cause.
- If pain is constant
(persisting between
contractions) and very
severe or sudden onset
8. Monitor closely within one hour after
delivery and give supportive care
9. Continue care after one hour
postpartum. Keep watch closely for
at least two hours
10. Educate and counsel on family
planning and provide the family
planning if available
11. Inform, teach and counsel woman
on important MCH messages
12. If the woman delivered in the RHU,
discharge the woman and her baby
Steps in Postpartum and Newborn Care
1. Do a quick check for emergency
signs
2. Make the woman comfortable
3. Assess the postpartum woman and
her baby
4. Check for pallor or anemia
5. Treat for intestinal parasites
6. Prevent anemia with iron/folate
supplementation
7. Give vitamin A if none was given
postpartum
8. Counsel on family planning and
provide the appropriate family
planning method if available
9. Provide health information, advice
and counseling
10. Encourage the woman to come
back with her baby for return visits
Characteristics of an effective
Communication
● Both the client and the provider are
actively sharing and exchanging ideas
on MCH
● Each person accurately understands the
MCH information
● Should touch the understanding,
feelings, norms, values and experiences
of the clients on MCH
● Information should be doable and
realistic
Communication Skill can be improved by
●
Establishing
●
rapport with the
client
●
Showing
empathy
●
Reflecting (i.e.,
Maintaining eye
using own words
to eye contact
to confirm
with speaker
understanding)
Page 17 of 22
●
●
Showing a
●
Interpreting the
genuine interest
feelings and
in the topic and
emotions behind
the client
what is being
Being attentive
said
to the speaker
●
Integrating what
(i.e., not doing
has been further
other tasks at the
said into further
same time and
discussion
not interrupting
●
Asking questions
Guidelines on Managing a Barangay Level
Action Plan with the Community
1. Organize the health team
2. Conduct a situational analysis
a) Data collection
b) Analysis of data
c) Problem identification and
prioritization
3. Planning
4. Implementation
5. Monitoring and Evaluation
Rapid Assessment and Management (RAM)
● Assess first emergency signs
● Do all emergency steps before
referral
- Manage airway and
breathing
- Measure blood pressure
and count pulse
● For vaginal bleeding
- Assess pregnancy status
- Assess amount of
bleeding
- Stop the bleeding
● Stabilize the woman if she is
- Not breathing
- In shock
- Convulsing
- With high fever
Quick check for the woman and/or her
newborn
ASK,
CHECK,
LOOK
LISTEN,
RECOR
FEEL
SIGNS
CLASSIFY
TREAT
If the
woman
has or
is:
Uncons
cious,
Convul
sing,
Bleedin
g,
Severe
abdom
inal
pain,
Looks
very ill,
heada
che
and
Visual
disturb
ance
Severe
breathi
ng
Difficult
y
Fever
Severe
vomitin
g
EMERG
ENCY
FOR
WOMA
N
Rapid
assess
ment
and
manag
ement
Call for
help if
neede
d
Reassur
e the
woman
that she
will be
taken
cared
of
immedi
ately
Ask her
compa
nion to
stay
Refer
D
Why
did
you
com
e?
For
yours
elf
For
the
baby
How
old is
the
baby
?
What
is the
conc
ern?
Is the
woma
n
being
carried
or
bleedi
ng
vaginal
ly,
convuls
ing,
looking
very ill,
uncons
cious,
in
severe
pain, in
labor,
deliver
y is
immine
nt
Check
if the
baby is
or has:
Very
small
Convul
sing
Breathi
ng
difficult
y
Immine
nt
deliver
y or
labor
LABOR
Deliver
y Care
Page 18 of 22
If the
baby
has or
is very
small
Convul
sions
Difficult
breathi
ng
Just
been
born
Any
matern
al
concer
n
Pregna
nt
woman
or after
deliver
y with
NO
danger
signs
A
newbor
n with
NO
danger
sign or
referral
compli
ance
PARTOGRAPH
EMERG
ENCY
FOR
BABY
Rapid
assess
ment
and
manag
ement
Immedi
ate
newbor
n care
Refer
baby
with
mother
USE THIS FORM FOR MONITORING ACTIVE LABOR
10 cm
9 cm
8 cm
7 cm
6 cm
5 cm
4 cm
FINDINGS
Time
Hours in
active
labor
ROUTIN
E CARE
Give
routine
care
Hours
since
ruptured
membra
nes
Rapid
assessme
nt
Vaginal
bleeding
(0 +++)
Amniotic
fluid
(meconi
um
stained
Contracti
ons in 10
minutes
Fetal
heart
rate
(beats/m
inute)
1 2 3 4 5 6 7 8 9 1
0
1
1
1
2
Page 19 of 22
Urine
voided
Tempera
ture
(axillary)
Pulse
(beats/m
inute)
CONSI
STENC
Y
Thin
/
smo
oth
Often
frothy
Thic
k,
clu
mpy
varie
s
varie
s
ITCH
rare
com
mon
sev
ere
unus
ual
unus
ual
SOREN
ESS
rare
com
mon
com
mon
dysur
ia
dysu
ria
Blood
pressure
(systolic/
diastolic)
☼ Current National HIV Testing Diagnostic
Algorithm in the Philippines
• The current HIV testing diagnostic
algorithm in the Philippines include
screening test from referring labs .
• A reactive result from the screening
test will be sent to SACCL for
confirmatory testing, where 2 parallel
screening tests are performed.
• A reactive result on either of these
tests will then require Western blot
and/or nucleic acid test as
supplemental confirmatory tests.
Cervical
dilation
(cm)
Delivery
of
placenta
(time)
Oxytocin
(time
given)
Problem
(note
onset
describe
below)
PRETEST Counseling
Informed consent
First Rapid/ IA Test
(Screening Test)
☼ Clinical Features of Vaginal Discharges
VAGI
TRICHO
CAN
GONO
Positive
Negative
CHLA
NOSIS
MONAS
DIDA
RRHEA
MYDIA
ODOR
fishy
foul
vari
es
varie
s
varie
s
AMOU
NT
incre
ased
profus
e
vari
es
varie
s
varie
s
COLO
R
Gray
-whit
e
Yello
w-gre
en
whit
e
Yello
w
white
Muc
oid
whit
e
Counsel for Negative
Result
Refer to NRL-SACCL
2 Parallel Tests
2IA or Rapid + IA
Page 20 of 22
BOTH POSITIVE
DISCORDANT
BOTH NEGATIVE
o
Selected test kits are as
follows:
▪ Immunoassay tests
✔ Sysmex Ag-Ab
(CMIA- 4th
generation)
✔ Vidas HIV Duo
Ultra (ELFA- 4th
generation)
▪ RDTs
✔ SD Bioline HIV
Ag-Ab
cassette
✔ Alere
Determine HIV
½
✔ Geenius HIV ½
Confirmatory
Assay Kit
o
The combination (SD Bioline +
Determine + Geenius) was
validated using the false
positive samples referred to
NRL and have resulted to
100% specificity.
Release and Counsel for
Negative Result
Supplemental HIV Test
Western Blot (confirmatory)
POSITIVE
NEGATIVE
INDETERMINATE
Counsel for Positive Result
Counsel for Negative Result
Test after 6 weeks
Repeat
Rapid HIV Testing Diagnostic Algorithm
(rHIVda) for the Philippines
•
•
The Disease Prevention and Control
Bureau (DPCB) of DOH, National
Reference Laboratory-San Lazaro
Hospital/STD AIDS Cooperative
Central Laboratory (NRL SLH/SACCL),
and the HIV National Reference
Laboratory of Australia has
conducted the research study to
develop a rHIVda for the Philippines.
rHIVda includes 2 immunoassay
tests and 3 RDTs for local validation
of sensitivity and specificity on
general and key population in the
country .
o
The key population includes
men who are having sex with
men, people in prisons and
other closed settings, people
who inject drugs, sex workers,
and transgender men and
women.
•
Further studies will be undertaken to
validate the sensitivity and specificity
of the combination of immunoassays
(IAs) and RDTs on general
population. Furthermore, the
proposed algorithm is subject to
change depending on its
performance through time and the
availability of new technology in the
market.
T0 reactive
Perform
weeks
Non-reactive
Repeat Test after 2-6
Page 21 of 22
rHIVDA T1
WHO recommends the following in
developing an algorithm:
Reactive
Recommendation 1:
HIV testing services may use combinations
of RDTs or combinations of RDTs/enzyme
immunoassays (EIAs)/supplemental assays
rather than EIA/Western blot combinations.
Perform
inconclusive
rHIVDA T2
weeks
SACCL
Non-reactive
Record as
Repeat rHIVDA after 2-6
Send sample to SLH NRH
Reactive
Perform
Non-reactive
Record as
inconclusive
rHIVDA T3
weeks
Repeat rHIVDA after 2-6
Send sample to SLH NRH
SACCL
Reactive
Release result as Positive
The following tests are used in rHIVda
Confirmatory Testing for NRL-SLH/SACCL:
● T1-Sysmex HISCL HIV Ag+Ab Assay
Kit
● T2- Vidas HIV Duo Ultra or SD HIV-½
3.0 or Alere Determine HIV ½
● T3- Geenius HIV ½ Confirmatory
Assay Kit
Alignment of the Current and Proposed
Algorithm to WHO recommendations
Recommendation 2:
Three different serological assays that do not
share the same false reactivity must be
included in the algorithm.
Recommendation 3:
Among the serological assays, first test must
be the most sensitive of the three.
Succeeding tests, on the other hand, must
have superior diagnostic specificity.
As of 13 May 2020, the Health Technology
Assessment Council has recommended the
INCLUSION of the following medicines in the
Philippine National Formulary (PNF):
1. Zidovudine + lamivudine 60 mg/30
mg dispersible tablet
Indication: Treatment of human
immunodeficiency virus (HIV)
Remarks: Additional pediatric
preparation to the currently listed
lamivudine + zidovudine 150 mg +
300 mg tablet in the PNF
2. Nevirapine 50 mg dispersible tablet –
Indication: Treatment of human
immunodeficiency virus (HIV)
Remarks: Additional pediatric
preparation to the currently listed
nevirapine 200 mg tablet and
50mg/5 mL suspension, 240 mL in the
PNF
Page 22 of 22
3. Lopinavir + ritonavir 40 mg/ 10 mg
oral pellets in capsules
Indication: Treatment of human
immunodeficiency virus (HIV)
Remarks: Additional pediatric
preparation to the currently listed
lopinavir + ritonavir 200 mg/50 mg
tablet or capsule in the PNF