Scope and Standards of maternal and child health
Practices in the Philippines
Scope of maternal and child health nursing
Practices
 Preconceptional health care
 Care of woman during 3 trimesters of
pregnancy and puerperium (sometimes
termed 4th trimester of pregnancy)
 Care of infants during the perinatal period
(beginning at 20 wks of pregnancy to 4 wks.
After birth)
 Care of children from birth to young
adulthood
 Care in setting as diverse as a birthing room,
a pediatric intensive care unit or the home.
Legal considerations of maternal-child practices
 Nurses are legally responsible for protecting
the rights of clients including confidentiality
and are accountable for the quality of the
individual nursing care and that of other
health care team members.
Ethical consideration of maternal-child practices
 Conception issues especially those related to
surrogate motherhood.
 Abortion
 Fetal rights versus rights of the mother
 Resuscitation (for how long should it be
continued?)
 Difficulty maintaining confidentiality of
records when there are multiple caregivers
Ethical and Social Issues in Perinatal Nursing
 Abortion
 Substance; when it involves a pregnant
woman, it can cause fetal injury and thus has
legal and ethical implications.
 Informed consent; has 4 key components;
disclosure, comprehension, competency,
and voluntariness. It occurs prior to initiation
of the procedure or specific care and
addresses the legal and ethical requirement
of informing the client about the procedure.
 The nurse’s responsibilities related to informed
consent includes;
 Ensuring the informed consent form is
completed with signatures from the
client (or parents or legal guardians if the
client is a child)
 Serving as a witness to the signature
process
 Determining whether the client or
parents or legal guardians understand
what they are signing by asking them
pertinent questions.
 The roles of nurse in clinical and ethical
decision making.
 Recognizing that nurses have both
responsibilities and rights to care for the
whole person, we believe that nurses
have a responsibility to:
o Be aware of personal values and how
they relate to professional practices
o Develop a basic knowledge of
ethical principles and concepts
o Understand processes and resources
available to assist them in ethical
decision making
o Be aware of the changing legal and
health care policy issues to be
considered during ethical decision
making.
 Some ethical principles related to patients
care includes:
 Autonomy: the right to self-determination
 Respect for others: Principle that all
persons are equally valued
 Beneficience: Obligation to do good
 Nonmaleficence: Obligation to do no
harm
 Justice: Principle of equal treatment of
others or that others be treated fairly
 Fidelity: Faithfullness or obligation to keep
promises
 Veracity: obligation to tell the truth
 Utility: The greatest good for the individual
or an action that is valued
 Note: a key way for nurses to respect
autonomy is though support of
childbearing women, including
adolescent women.
Family Planning
Remember: The total risk of birth control are much less
than the total risks of a pregnancy.
 The family planning program
 EO 199: created the PFPP (Phil. Family
planning program)
 Goal is to provide universal access to family
planning information and services whenever
and wherever these are needed.
 Family planning program enables couples and
individuals to:
 Decide freely and responsibly
 Have information and means to do so
 Have access to a full range of natural and
artificial methods of planning pregnancy
 Modern methods of family planning.
 Safe, effective, non-abortifacient and legal
methods, whether natural or artificial, that
are registered with FDA to plan pregnancy.
 DOH states “family planning can reduce
maternal mortality”
 Reproductive Health (RH) – the state of
complete physical, mental, and social well-
being.
 Sexual health- state of physical, mental and
social well-being in relation to sexuality
 Reproductive health care – the access to a full
range of methods, facilities, services and
supplies that contribute to reproductive health
and well-being.
 Reproductive health rights – rights of individuals
and couples to decide freely and responsibly
whether or not to have children; the number,
spacing and timing of their children.
  Family Planning
 Increase Education
 Empower Women
 Improve infant health
 Improve maternal health
 Decrease HIV/Aids
 Save the environment
 Support partnership
 End hunger and poverty
CONTRACEPTION
 Types:
1. Natural contraception
2. Mechanical Contraception
3. Hormonal contraception
4. Surgical contraception
Introduction to Genetics
 Genome- the complete copy of genetic material
in an organism (abt. 50K-100K)
- A normal genome is abbreviated as 46XX or
46XY. If a chromosomal aberration exists, it is
listed after the sex chromosome patter,
(down syndrome- extra chromosome 21,
abbreviated as 47XX21 or 47XY21)
 Phenotype- the person’s outward appearance
 Genotype – the person’s actual gene
composition.
 Homozygous – a person who has two like genes
for a trait on two like chromosomes
 Heterozygous – if the genes differ (a healthy
gene from the mother and an unhealthy gene
from the father, or vice versa)
 Inherited or genetic disorder – can be passed
from one generation to the next
 Karyotype – is the schematic arrangement of the
chromosomes within a cell to demonstrate their
numbers and morphology
 Hereditary- derived from parents
 Familial- transmitted in the gametes through
generations
 Congenital – present at birth (not always
genetically determined (e.g. congenital
syphilis, toxoplasmosis)
Genetic Inheritance of a disease
 Autosomal Dominant Disorders
o Either a person has two unhealthy genes
(homozygous dominant or is heterozygous),
with the gene causing the disease.
o Common findings usually present in a family:
1. One of the parents of a child with the
disorder also will have the disorder (a vertical
transmission picture)
2. The sex of the affected individual is
unimportant
3. There is usually a history of the disorder in
other family members
 Autosomal Recessive Disorders
o Such diseases do not occur unless 2 genes
for the disease are present (Rh
incompatibility)
o A recessively inherited disease is present in
the family if:
1. Both parents of a child with the disorder
are clinically free of the disorder
2. Sex of the affected individual is
unimportant in terms of inheritance
3. The family history for the disorder is (-)
that is, no one can identify anyone else
who had it (horizontal transmission
pattern)
4. A known common ancestor between
the parents sometimes exists.
 X-linked Dominant Inheritance
o Transmitted only by the female sex
chromosome.
o Family characteristics seen with this type of
inheritance:
1. All individuals with the gene are affected
(the gene is dominant)
2. All female children of affected men are
affected; all male children of affected
men are unaffected.
3. It appears in every generation
4. All children of homozygous affected
women are affected.
 X-Linked Recessive Inheritance
o Because males have only one X
chromosome, the disease will be manifested
in any male children who receive the
affected gene from their mother
o A family genogram will reveal:
1. Only males in the family wil have the
disorder.
2. A history of girls dying at birth for
unknown reasons often exists (females
who had the affected gene on both X
chromosomes)
3. Sons of an affected man are unaffected
4. The parents of affected children do not
have the disorder
 Multifactorial (Polygenic) Inheritance
o Appears to occur from multiple gene
combinations possibly combined with
environmental factors
 o A family history, for instance, may reveal no
set patter.
o Some of these conditions have a
predisposition to occur more frequently in
one sex (cleft palate occurs more often in
girls than boys), but they can occur in either
sex.
RISK FACTORS FOR GENETIC DISORDERS
 Factors that increase your risk of having a baby
with a genetic disorder include:
o Family history of a genetic disorder
o Prior child with a genetic disorder
o One parent has a chromosomal abnormality
o Advanced maternal age (35 or older)
o Advanced paternal age (40 or older)
o Multiple miscarriages or prior stillbirths
o It is important to know that some birth
defects, developmental delays, and/or
illnesses can be caused by prenatal
exposure to drugs, alcohol, or other
environmental factors.
Types of Disorders that can be seen during pregnancy
 Single gene disorder
o Occur when a change in one gene causes a
disease. Examples include cystic fibrosis,
sickle cell anemia, and hemophilia.
 Chromosomal abnormalities
o Occur when there are missing or extra
chromosomes or pieces of chromosomes.
Down syndrome, the most common
chromosomal abnormality, is caused by an
extra chromosome #21. Chromosome
abnormalities can be inherited from a parent
or they can happen by chance.
 Multifactorial or complex disorders
o Is caused by a combination of genetic
predispositions and environmental factors,
which makes it harder to predict who may
be at risk. Examples include heart disease,
cleft lip or cleft palate, and spina bifida.
 Teratogenic Disorder
o Occurs when the baby is exposed to
substances during pregnancy that causes
abnormalities, otherwise known as
“teratogens”. Babies are very sensitive in the
first trimester, when all of the organs are
developing. Teratogens include alcohol,
drugs, lead, high levels of radiation exposure,
and certain medications, infections and toxic
substances
Testing for Genetic Disorder
1. Screening tests – check the risk of your baby
having certain genetic disorders
2. Diagnostic Tests – can detect if certain genetic
disorders are actually present in the baby.
 Note: Screening and diagnostic tests are
optional. They are available to all women, even
those who do not have any known risk factors.
Screening Tests
1. Carrier screening
o Blood test that tries to determine if either
parent carries a genetic change for inherited
disorders that could be passed on to the
baby. can be performed on a saliva sample,
best time to be done before getting
pregnant, but can be done during
pregnancy as well
2. Prenatal Genetic Screens
o Series of first and second trimester screens
that use blood samples from the mother as
well as ultrasounds to check the baby’s risk of
having certain common genetic disorders.
Examples include Down syndrome and
certain birth defects, such as spina bafida.
3. Noninvasive Prenatal Testing (NITP) or cell-free
DNA screening
o Blood test that checks DNA from the
placenta that is found in the mother’s blood.
This screens for the most common
chromosome abnormalities, such as down
syndrome and trisomy 18, and is most
commonly used in high-risk pregnancies.
4. Diagnostic tests
o Performed during pregnancy to detect if
certain genetic disorders are present in the
baby, such as cystic fibrosis or down
syndrome. Diagnostic tests are generally safe
procedures when performed by an
experienced physician.
Routine diagnostic tests include:
 Chorionic villus sampling – tests a sample of
tissue taken from the placenta in the first
trimester.
 Amniocentesis – tests a sample of the amniotic
fluid taken from the womb in the second
trimester.
Genetic Counseling
 If you are pregnant or planning a pregnancy,
you may be referred to a genetic counselor to:
 Assess your personal risk of having a baby with a
genetic disorder
 Review your testing options
 Coordinate genetic screenings and diagnostic
tests and interpret the results
 Provide emotional support and educationa;
resources for you and your family.
 Help you make informed decisions about your
pregnancy and your baby’s treatment, and
prepare for appropriate medical care
Treatment for fetal genetic Disorders
 Treatment depends on the genetic disorder and
the individual pregnancy. In general, if your baby
is diagnosed with a genetic disorder during
pregnancy your treatment will include:
 Specialized care from a maternal-fetal medicine
physician
  Individualized care based on the genetic via the birth canal but fails to fully emerge
disorder, your pregnancy, and your family’s out. This could be because of small
references. obstructions, or the mother being tired and
 Treatment options ranging from medical therapy exhausted and hence being unable to push
during pregnancy, such as fetal interventions, to the baby out.
surgery immediately after birth o In these cases, the doctor makes use of
 A multidisciplinary, collaborative healthcare specially created tongs which resembles
team, including genetic counselors, imaging forceps, and insert them slowly into the birth
specialists, fetal specialists, fetal and neonatal canal. These are then used to gently grab
surgeons as needed, and neonatologists and the baby’s head and guide it outwards
pediatricians experienced in the treatment of through the canal.
children with genetic disorders. 5. Vacuum Extraction
 Support services for you and your family. o Similar to the forceps delivery method, this
delivery technique is used in the case of a
Most common Types of Childbirth options vaginal birth. For example, if the baby is on its
way out but has stopped moving further
1. Vaginal delivery down the canal, the vacuum end has a soft
o Baby is born through the birth canal of a cup which is placed in the top of the baby’s
woman’s body, the delivery is termed as a head. Vacuum is created so that the cup
vaginal delivery. It may or may not be holds the head, and the baby is gently
assigned with epidurals or pain-relieving guided outwards through the canal.
medications. The exact time of birth cannot 6. Vaginal Birth After Caesarean (VBAC)
be predicted in such a case, but most o Most of the time, after woman has had a
vaginal births tend to happen once 40 weeks caesarean delivery, her chances of having a
of pregnancy have been completed. vaginal delivery after that are pretty much
2. Natural Childbirths nullified. But VBAC technique are making it
o This is one of the type of birth that is steadily possible to have successful vaginal deliveries.
gaining popularity. In this method, there are
no medical procedures or invasive therapies
involved, and the process takes place in the
most natural manner possible. This is mostly a
personal choice and the mother needs to be
committed throughout the way.
o Various exercises and positions are taken into
account while carrying out delivery in natural
ways. A midwife usually stays with the mother
to ensure the delivery is successful and the
mother is in good spirits. The delivery can
take place at the hospital or even at home,
with all preparations done beforehand.
o Water birthing or pool birthing with the help
of upthurst (buoyancy) pressure of the water
can alleviate labour pain in this procedure.
Water birthing is the most natural and
painless way of bringing new life to the world.
3. Caesarean Section
o Things don’t always go according to plan. A
mother might want to undertake vaginal
delivery but if complications arise, caesarian
delivery is an option.
o In this method, baby is delivered by opening
up the abdomen of the mother and
surgically opening the uterus to remove the
baby. The name is derived from the Latin
word “caedare” which means “to cut”.
Hence, this type of cur is called a C-section.
o Parameters which make it necessary to
undertake C-section are the presence of
twins or triplets, breech or transverse
presentation, or a very large baby.
4. Forceps delivery
o This is a rather peculiar type of delivery
method and is required in certain cases of
vaginal birth. This is an assistance to the usual
vaginal delivery when the baby is on its ways