1.

Overview on the Framework for MCN NCM 109

FRAMEWORK FOR MCN FOCUSING ON AT RISK, HIGH RISK, AND SICK CLIENTS O.B. LEC.

I. NATIONAL HEALTH SITUATION ON MCN

● Women’s and children’s health is valuable by itself (CEDAW &
CRC)
● Investing in women & children’s health
� makes economic sense
� Has political benefits, including social stability &
human security
� Makes the health system work better
● Proven and affordable ways of saving the lives of women &
children are available

Relatively Flat MMR Reduction, Philippines

● Stunting, an indicator of chronic malnutrition, refers
to linear growth retardation and cumulative growth
deficits in children.

Maternal, Neonatal & Child Health Status

● The Philippines is one of 68 countries contributing to 97%

maternal deaths globally.

Causes of Death in children

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II. CURRENT STATE OF MATERNAL AND NEWBORN

CARE PRACTICES IN PH HOSPITALS

Newborn Care Practices in 51 Philippine Hospitals, 2009

● Performance and timing of evidence-based interventions in
immediate newborn care are below essential newborn care
standards recommended by the WHO.
● Hospital practices prevented Philippine newborns from
benefiting from their mother’s natural protection in the first hour
of life.

Maternal, Newborn & Child Health

● Maternal & neonatal health has fallen far behind advances
in child survival
● Inextricable link between maternal and infant survival
● Maternal and child health indicators mirror the overall
effectiveness of the health system
● Saving the lives of mothers & their children requires more
than just medical interventions
● It requires an enabling environment that empowers women
and respects their rights

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a) Fewer family members are present as support in a time of

crisis. Nurses must fulfill this role more than ever before.
2. Single parents are increasing in number
a) A single parent may have fewer financial resources; this is
more likely if the parent is a woman.
b) Nurses need to inform parents of care options and to serve
as a backup opinion when needed.
3. An increasing number of mothers work outside the home.
a) health care must be scheduled at times a working parent
can bring a child for care.
b) Problems of latch-key children and the selection of child
care centers need to be discussed.
4. Families are more mobile than previously; there is an
increase in number of homeless children.
a) Good interviewing is necessary with mobile families so a
health data base can be established; education for health
monitoring is important.
5. Abuse is more common than ever before.
a) Screening for child or intimate partner abuse should be
included in family contacts. Be aware of the legal
responsibilities for reporting abuse.
6. Families are can health-conscious than previously.
a) families are ripe for health education; providing this can
be a major nursing role.
7. Health care must respect cost containment. Referral to
specialists
a) Comprehensive care is necessary in primary care settings
because referral to specialists may no longer be an option.

Statistical Terms Used to Report MCH

● Birth rate – number of births per 1,000 population.
● Fertility rate – the number of pregnancies per 1,000
women of child-bearing age.
A.O. 2008-0029 ● Fetal death rate – the death in utero of a child (fetus)
● “Implementing Health Reforms for Rapid Reduction of weighing 500g or more, roughly the weight of a fetus of 20
Maternal and Neonatal Mortality” weeks or more gestation.
● Objectives : contributes to the national health goals of � the overall quality of maternal health and prenatal
improving women’s health by : care
1. Collaborating with LGUs in establishing sustainable, � the number of fetal deaths (over 500g) per 1,000
cost-effective approach of delivering maternal and live births.
newborn health services � Maternal factors: maternal disease, premature
2. Establishing core knowledge base and support system cervical dilation, or maternal malnutrition.
towards quality maternal and newborn health service � Fetal factors: fetal disease, chromosome
provision abnormality, or poor placental attachment.
● Strategies : ● Neonatal death rate – reflects not only the quality of care
� Provision of BEmONC in all birthing facilities available to women during pregnancy and childbirth but
� Integration of FP, STI prevention and adolescent health also the quality of care available to infants during the first
into the maternal- newborn service package month of life
� Reliable sustainable support systems that include safe � - the number of deaths per 1,000 live births
blood supply network and locally initiated behavior occurring at birth or in the first 28 days of life.
change interventions � Leading causes : prematurity (early gestational
� Sustainable financing through Philhealth accreditation age), low birthweight (weight less than 2,500g),
of birthing center and membership coverage of the and congenital anomalies.
poor. ● Perinatal death rate- the sum of the fetal and neonatal rates
� Maternal Death review – refers to a qualitative and � the number of deaths of fetuses more than 500g and in
in-depth study of the causes of maternal death with the the first 28 days of life per 1,000 live births.
primary purpose of preventing future deaths through ● Maternal mortality rate – death from childbirth.
changes or additions to programs, plans and policies ● Infant mortality rate – the number of deaths per 1,000 live births
occurring at birth or in the first 12 months of life.
� Fetal and infant death review – refers to a qualitative
● Childhood mortality rate – the number of deaths per 1,000
and in-depth study of the causes of fetal and infant
population in children, 1-14 years of age.
death with the primary purpose of preventing future
deaths through changes or additions to program, plans, IV. GENETIC COUNSELING
and policies. \
● Provides services to help people understand the disorder
about which they are concerned & the risk that it will occur
in their family
● Non-directive: counsellor does not tell the individual or
parents what decision to make but educates them about
III. TRENDS IN MATERNAL AND CHILD HEALTH options for dealing with the disorder
● Interpreted by families subjectively
1. Families are smaller than in previous decades.

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● Family’s values & beliefs influence whether they seek diseases that “run in the family”, mental
counselling & what they do with the info that is provided retardation/ developmental delay
� Helping family decide about Genetic
REASONS for Referral to Genetic Counselor Counseling
● Pregnant women who will be 35 yrs of age or older when infant ▪ If counseling is appropriate, the
is born physician discusses it with the woman
● Men who father children after age 40 & offers to refer her & her partner to an
● Members of a group with an increased incidence of specific appropriate centre
disorder � Teaching about Lifestyle
● Carriers of autosomal disorders ▪ Teach pregnant woman about factors in
● Women who are carriers of x- linked disorders her lifestyle that can be modified to
● Couples closely related by blood (Consanguineous relations) reduce the risk of defects to her
● Family history of birth defect/mental retardation offspring (eliminate alcohol
● Family history of unexplained stillbirth consumption, smoking, improving diet)
● Women who experience multiple spontaneous abortion � Providing emotional support
● Pregnant women who are exposed to known/suspected ▪ Many women delay telling
teratogens/other harmful agents either before/during pregnancy friends/family re: pregnancy till they
● Pregnant women with abnormal prenatal screening results (triple know that prenatal test results are
scan/suspicious ultrasound findings) normal; when results are abnormal,
women face more difficult decisions
whether to terminate or continue
Availability
pregnancy
● Often available through facilities that provide maternal-fetal medicine
� Final decision rests with the couple
services
● State dept. Of mental health & mental retardation/rehab services � Counseling can raise issues (undergo prenatal
● Org. that focus on specific birth defects- provide valuable support & diagnosis, what to do if condition can’t be
assistance in obtaining needed services for individuals & families prenatally diagnosed & what options are
affected by the disorder acceptable if prenatal diagnosis shows abnormal
results); open family conflicts if info from other
Focus on FAMILY family member is needed or if family values
● Involves obtaining medical records or performing PE or lab differ on issues like abortion of abnormal fetus
studies on numerous family members � Helping the family deal with abnormal results
● 1 family member may have a birth defect but studies the entire � Prenatal diagnostic tests detect disorders
family involving serious physical & often mental defects;
● Counselling is impaired if family members are unwilling to the woman/couple whose test results are abnormal
provide medical records/agree to exams/lab studies; those who must confront painful decisions
seek counselling may be unwilling to request cooperation from � In many cases, there are 2 choices: continue
other family members/to share genetic info. they acquire pregnancy or terminate it; “no
decision”=continue pregnancy
Process of Genetic Counseling � Reinforce info. given to these anxious families
� Physician/Genetic Counselor discusses
● Often slow process: some tests may be performed @ only 1 or a few lab
in the world & several wks may be needed to complete them abnormal results & available options

Diagnostic Methods that may be used in Genetic Counseling

● PRE-CONCEPTION SCREENING
� Family history- identify patterns of disease/ birth
defects
� Exam of family photos
� PE for obvious/subtle signs of birth defects
� Carrier testing
� Persons from ethnic groups with higher incidence of
some disorders
� Persons with family history suggesting that they may
carry a gene for specific disorder
� Chromosomal analysis
� DNA analysis (Deoxyribonucleic Acid)
● PRENATAL DIAGNOSIS FOR FETAL ABNORMALITIES
� Maternal tests- screen for abnormalities
� Chorionic villus sampling
� Amniocentesis
� Ultrasonography
� Percutaneous umbilical blood sampling
● ANTEPARTUM NURSES
� Initial Antepartum Interview
▪ Identify pregnant woman/family who may
benefit from genetic counselling
▪ Assist families with decision making,
teaching & emotional support
� Identifying families for referral
▪ Personal & family hx of the woman & her
partner may reveal factors that increase the
risks for having a child with birth defect;
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