MDG COUNTDOWN:

CAPACITY ENHANCEMENT
PROGRAM FOR MIDWIVES
ON MATERNAL AND
NEWBORN CARE

Presentation Overview
1. Maternal and Newborn deaths

in the Philippines
2. Three delays
3. Millennium Development Goals
4. Interventions to lessen

maternal & newborn mortality

(SBA, EmOC, FP)
5. Philippine Midwifery Law and
Midwifery Ethics

Too many mothers and newborns

are dying every year

Most maternal deaths occur during labor, delivery and

the immediate post-partum period

Percent of maternal deaths in developing

countries

0-1 day

2-7 days

8-14 days

15-21 days

22-30 days

31-42 days

Day of maternal death after delivery

Source: X. F. Li et al., International Joumal of Gynecology & Obstetrics 54 (1996): 1-10

Leading Causes of Maternal

Mortality

USAID website (2006) adapted from Maternal Health Around the World World Health
Organization, Geneva, 1997

82,000 Filipino children die annually,

most could have been prevented

Source: CHERG estimates of under-five

deaths, 2000-03

The Philippines is one of the 42 countries that account for 90% of

global under-five mortality
Source: H. Sobel Unang Yakap Essential Newborn Care
Presentation

Reasons for High Maternal

and Newborn Mortality
Rate
Young

age at marriage & first

pregnancy
Domestic violence and
gender inequality
Poor maternal health
Poor hygiene during and after
delivery

Attendants and Place of

Delivery

Source: Philippine Health Statistics, 2003

Three DELAYS

1. DELAY IN DECIDING TO SEEK

MEDICAL
CARE.

Failure to recognize danger signs

Lack of money
Unplanned/unwanted pregnancy
Lack of companion in going to health facility
No person to take care of children/home.
Fear of being ill treated in health facility

Three DELAYS

2. DELAY IN IDENTIFYING and

REACHING THE APPROPRIATE FACILITY
Distance from a womans home to health
facility/provider
Lack of/poor condition of roads
Lack of emergency transportation
Lack of awareness of existing services
Lack of community support

Three DELAYS

3. DELAY IN RECEIVING APPROPRIATE

and ADEQUATE CARE AT HEALTH
Lack of health care providers
FACILITY
Shortage of supplies
Lack of equipments
Lack of competence of health providers
Weak referral system

MDG 4:
Reduce Child Mortality
Reduce Under 5-mortality rate
from 80.0 to 26.7 (per 1,000
LB)
Reduce Infant mortality rate
from 57.0 to 19.0 (per 1,000
LB)

MDG 5: Improve Maternal

Health
To accomplish MDG 5: Reduce maternal
mortality by 75% by 2015
(for the Philippines the target is to reduce
MMR from 209 to 52 deaths per 100,000
live births).

209

203

197

191
186

180

172

162

52

How will we make it

happen?
(Current tools to avert maternal death
and
disability)
A skilled
health care professional

attends every childbirth

Every woman has access to
Emergency Obstetric and
Newborn Care (EmONC)
Family planning services to help
women space their pregnancies
Source: Averting Maternal Death and Disability Program

Skilled Care
During Childbirth
The single most important way to reduce
maternal deaths is to ensure that a skilled
attendant is present at every birth.

Source: A Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of

Maternal Mortality, 1999.

A SKILLED ATTENDANT is an
accredited health professional (a
midwife, nurse or doctor) who has been
educated and trained to proficiency in
the skills needed to manage normal
pregnancies, childbirth and the
immediate postnatal period, and in the
identification, management and
referral of complications in women
and newborns.
*Manage was added in 2000 by the Inter-Agency Group for Safe Motherhood in
recognition that some skilled attendants will also have competencies to manage
complications.
Source: A Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of
Maternal Mortality, 1999.

EMERGENCY OBSTETRIC and

NEWBORN CARE (EmONC)
the elements of obstetric & newborn care

needed for the management of normal and

complicated pregnancy, delivery, postpartum
periods and the newborn.
Early detection and treatment of problem

pregnancies to prevent progression to an

emergency.
Management of emergency complications* BEmONC

Definition

CEmONC

EmONC Key Functions

Parenteral (IV or IM)

administration of
Antibiotics
Oxytocin
Anticonvulsants
Manual Removal of
Placenta
Removal of Retained
Products of conception

Assisted Vaginal

Delivery
Administration of
corticosteroid for
preterm labor
Essential Newborn Care
Surgery (Cesarean
Section)
Blood Transfusion

Evidence Based interventions for

Main Causes of Maternal
AMTSL
Mortality
Partograph
Oxytocin
Clean delivery;
Antibiotics
Family
Planning &
Post Abortion
Care

Iron Suppl
Malaria tx
HIV Tx

MgSO4

USAID website (2006) adapted from Maternal Health Around the World World Health
Organization, Geneva, 1997

Functioning referral system

The Midwifery Act

of 1992

Practice of Midwifery defined

1. care of women during pregnancy, labor and
puerperium; management of normal
deliveries
2. health education of the patient, family and
community;
3. primary health care in the community,
including nutrition and family planning
4. carrying out the written order of physician
with regard to antenatal, intranatal and
postnatal of the normal pregnant mother,
5. giving immunization

Internal examination during labor

Skills
R.A.7392
Repairrequired
of obstetric by
perineal
lacerations
Intravenous fluid insertion
Oxytocics after delivery of placenta
Vitamin K for newborn

Principles
of
Professional
In providing professional services, a
Conduct
certain level of competence is necessary.
Professionals shall undertake only those

services that they can reasonably deliver

with professional competence.
Keep up with new knowledge and
techniques in their field, continually
improve their skills and upgrade their
level of competence, and take part in a
lifelong continuing education program.
Source: Code of Good Governance for the Professions in the Philippines signed June 23, 2003.

The Way Forward

1. Recognize signs &
symptoms of obstetric
complications
2. Know when & where
to seek care if
complications arise
3. Invest in community
education:
Eliminate delays
4. Create women
friendly policies

References
1.
2.
3.
4.
5.

6.

7.
8.

National Demographic and Health Survey 2008 National

Statistic Office (NSO) Philippines and ORC Macro
Making Pregnancy Safer World Health Organization Geneva
2002
Averting Maternal Death and Disability Program materials
Columbia University New York
Managing Complications in Pregnancy and Childbirth World
Health Organization Geneva 2003
Pregnancy, childbirth, postpartum and newborn care: A guide
for essential practice - Updated second edition: Pregnancy,
childbirth, postpartum and newborn care 2003 World Health
Organization
Promoting Quality Maternal and Newborn Care: A Reference
Manual for Program Managers. Copyright 1998 Cooperative
for Assistance and Relief Everywhere, Inc. (CARE).
The Millennium Project Background Paper Task Force on Child
Health and Maternal Health March 2003, Freedman Lynn et al
Linangan ng Kababaihan (Likhaan) Safe Motherhood poster

Thank