Holy Angel UniversityCollege of Nursing

Community Health Nursing- Pandan

Submitted By:

Submitted To:

September 20, 2006

MATERNAL & CHILD CARE

The mother and child are the most vulnerable members of the community. They

are the ones usually affected by the changes in the overall health situation. The health

condition of the mother and child is a very important indicator of the adequacy of health

care in the country. Maternal and child cares start long before pregnancy and extends

long after infancy. However, the most critical period is during childbearing until a few

years after childbirth.

PRENATAL CARE

- This is essential for ensuring the overall health of newborns and their mothers

(Pilliteri, 2003).

- A good prenatal care results in proper monitoring of the progress of the

pregnancy (DOH, 1997)

Purpose

o Establish a baseline of present health

o Determine the gestational age of the fetus

o It checks the health condition of the mother and baby as they undergo

changes that take place from conception to the time the mother goes

into labor.

o Monitor fetal development

o Identify the woman at risk for complications by anticipating and

preventing problems before they occur

o Provide time for education about pregnancy and possible dangers

Prenatal Visit

- A time to establish baseline data relevant to planning health-promotion

strategies now and with every subsequent visit.

- It should be started during the first 3 months of pregnancy.

Health Teachings

Teaching the client regarding the presumptive, probable, and positive finding

of pregnancy.

Relating assessment information and health-promotion activities throughout

the pregnancy.

Obtaining a health history, including screening for the presence of teratogens

and any problems the woman may experience.

Instructing the client regarding the discomforts of early pregnancy during the

first, second and third trimester of pregnancy.

Instructing regarding the danger signs of pregnancy.

The importance and proper breastfeeding technique should be included in the

health teaching.

DIAGNOSING PREGNANCY

- Pregnancy is officially diagnosed on the basis of the symptoms reported by the

woman and the signs elicited by a health care provider. These signs and

symptoms are traditionally divided into three classifications: presumptive,

probable, and positive.

Presumptive Signs of Pregnancy

Experienced by the woman but cannot be documented by the

examiner.

1. Breast changes

2. Morning sickness

3. Amenorrhea

4. Frequent urination

5. Fatigue

6. Uterine enlargement

7. Linea nigra

8. Melasma

9. Striae gravidarum

Probable Signs of Pregnancy

Can be documented by the examiner

1. Serum laboratory tests

2. Chadwick’s sign

3. Goodell’s sign

4. Hegar’s sign

5. Sonographic evidence of gestational sac

6. Ballotement

7. Braxton Hicks sign

8. Fetal outline felt by the examiner

Positive Signs of Pregnancy

True diagnostic finding

1. Demonstration of a fetal heart separate from the mother’s

2. Fetal movement felt by the examiner

3. Visualization of the fetus by ultrasound

HEALTHY PREGNANT WOMEN

A Healthy Pregnant Mother:

     1. Eats enough to gain weight regularly.

          - drinks 8 or more glasses of water a day

          - eats nutritious food

          - a pregnant woman should have gained:

               1 kilogram - within the first 3 months of pregnancy

               5 kilograms - within the second three months of pregnancy

               5 kilograms - within the last three months of pregnancy

     2. Takes a bath everyday.

     3. Visits the Health Center for regular monthly prenatal check-ups.

     4. Has received 2 shots of tetanus toxoid during her pregnancy.

     5. Does not smoke nor drink alcohol.

     6. Stays away from the smoking persons.

     7. Stays away from sick persons.

     8. Rests more and does less work than usual.

     9. Takes food rich in calcium everyday.

HIGH RISK FACTORS

Pregnant mothers with any following high risk factors have a higher chance of

encountering problems during pregnancy and delivery:

     1. She is less than 17 years old or more than 35 years old.

     2. She has more than four children.

     3. She had severe bleeding from the vagina during her pregnancy.

     4. She does not have a good history in her previous pregnancies like:

          - two or more abortions

          - 2 or more babies born before the expected delivery

          - difficult delivery

          - given birth to twins

          - last baby was born dead or died soon after birth

     5. She previously delivered by Ceasarean section.

     6. Her baby was born less than 2 years ago.

     7. She weighs less than 45 kgs. or more than 80 kgs.

     8. She is very pale and looks tired.

     9. She has tuberculosis, diabetes, heart, and/or kidney disease.

Health Teachings

     1. Eat more nutritious food during pregnancy and location.

     2. Avoid taking medicine unless prescribed by the doctor.

     3. Breastfeed their babies by discussing the importance of breastfeeding.

     4. Space pregnancy at least 2 years apart.

     5. In women with short or inverted nipples, squeeze the nipples daily during

pregnancy. This will make it easier for their child to suck.

DISCOMFORTS OF EARLY PREGNANCY

1. Breast Tenderness

2. Palmar Erythema (Palmar pruritus)

3. Constipation

4. Nausea, Vomiting & Pyrosis

5. Fatigue

6. Muscle Cramps

7. Hypotension

8. Varicosities

9. Hemorrhoids

10. Heart Palpitations

11. Frequency of Urination

12. Abdominal Discomfort

13. Leukorrhea

14. Backache

15. Headache

16. Dyspnea

17. Ankle Edema

18. Braxton Hicks Contractions

DANGER SIGNS OF PREGNANCY

1. Vaginal Bleeding

2. Persistent Vomiting

3. Chills and Fever

4. Sudden Escape of Clear Fluid from the Vagina.

5. Abdominal or Chest Pain

6. Pregnancy-Induced Hypertension (PIH)

7. Increase or Decrease in Fetal Movement

HEALTH PROMOTION DURING PREGNANCY

A. Promoting Nutritional Health During Pregnancy

Nutrition is a state of well-being achieved by eating the right food in every meal

and the proper utilization of the nutrients by the body.

     - Proper nutrition is eating a balanced diet in every meal. A balanced diet is made up

of a combination of the three basic food groups eaten in correct amounts. The grouping

serves as a guide in selecting and planning everyday meals for the family.

Benefits of Proper Nutrition

     - It helps in the development of the brain, especially during the first years of the

child's life.

     - It speeds up the growth and development of the body including the formation of

teeth and bones.

     - It helps fight infection and diseases

     - It speeds up the recovery of a sick person

     - It makes people happy and productive

The Important Vitamins and Minerals are:

1. PROTEIN – will make the mother’s body and baby grow.

Rich sources are fish, meat, beans, eggs and mild.

Protein requirement is increased by 30 grams, from 44 grams to 74 grams for

pregnant women.

2. CALCIUM – will keep gums and teeth healthy and help in the growth and

development of bones and hair.

Foods rich in calcium are milk, cheese, dilis and shellfish.

3. IODINE – prevent goiter and promote proper mental and physical development of

the growing fetus.

Rich sources are seafoods like seaweeds, alamang fish, tahong, halaan, tulya

and iodized salt.

4. IRON – prevent anemia and increase production of RBC.

Sources of iron are dried dilis, tulingan, alamang, seaweeds, tahong, liver,

internal organs and green leafy vegetables.

ANEMIA DURING PREGANCY (Nutritional Anemia)

1. Iron Deficiency Anemia

Caused by insufficient intake food rich in iron especially during

pregnancy.

Increase requirement of iron during pregnancy

Signs and Symptoms:

i. Headache, dizziness and pallor

ii. Pica – craving from non-substance food

- is being experience by pregnant women with severe anemia

Management:

a. Correction of IDA through diet by eating iron rich food like green leafy vegetable and

liver.

b. Correct IDA through Fe supplement.

5. CARBOHYDRATES – provide energy needed by the mother in her daily

activities.

Food rich in carbohydrates are rice, corn, cassava, camote, bread and other

bakery products such as cakes, cookies and other kakainin.

Food rich in fats are butter, oil, margarine, lard and coconut milk.

A pregnant woman requires an additional 300 kcal per day.

Eat enough carbohydrates – rich foods to maintain the ideal weight increase

for certain trimester of pregnancy.

o Energy needs increased slightly during the first trimester, substantial

increase in maternal tissue during second trimester, and the placenta

and fetus grow a great deal during the third trimester.

* Decrease intake of carbohydrates when there is:

a. Frequent vomiting

b. Swelling of legs

c. Abnormal rapid increase in weight

2. VITAMINS

a. Vitamins A – rich foods will

Increase resistance against infection

Prevent blindness

Make hair and skin healthy

Prevent death from pneumonia, diarrhea and measles.

Vitamin A is increased 25% is needed to allow for storage in the fetus

as well as to maintain healthy eyes, skin, and blood tissue.

Sources of Vitamin A are:

o Green leafy vegetables such as malunggay, sili, gabi,

kangkong, alugbati and others.

o Yellow fruits and vegetables such as carrots, squash, mango,

ripe papaya and melon.

o Liver, meat, poultry and eggs.

b. Vitamin C – rich foods will

Increase body resistance against common illness like cough and colds

Keep gums and teeth healthy

Good sources of vitamin C are guava, tomato, mango, pineapple,

papaya, calamansi and other fruits and green leafy vegetables like

malunggay, camote tops, pechay and kangkong.

c. Vitamin E

Protection of cell structure especially RBC and it also aids in the

storage Vitamin A in the liver.

d. Vitamin D

Normal requirement is increase by 50% to 100% to facilitate and

maximize calcium and phosphorous absorption for skeletal

development of both the mother and the fetus.

e. Vitamin K

For normal clotting ability of blood

f. Vitamin B

For blood clotting

3. MINERALS

a. Calcium and Phosphorus – for bone and teeth development

b. Magnesium – for healthy bones, muscles, and blood tissue.

c. Iron – to increase hemoglobin levels supply in the maternal tissue,

placenta and fetus.

d. Zinc – essential for growth and enzymatic action

e. Iodine – to prevent maternal goiter

4. Drink at least eight (8) glasses of water per day

B. Exercise

- It is important to prevent circulatory stasis in the lower extremities.

- It offers a general feeling of well-being

Benefits

1. Lowered cholesterol level

2. Reduced risk of osteoporosis

3. Increased energy level

4. Maintenance of health body weight

5. Decreased risk of heart disease

6. Increased self-esteem and well-being

7. Possible reduction in the rate of cesarean birth

Perineal and Abdominal Exercises

1. Tailor Sitting

- The woman should place one leg in front of the other. As she sits

in this position, she should gently push on her knew until she feels

her perineum stretch

Purpose: Stretches the perineal muscles without occluding blood

supply to the lower legs.

2. Squatting

- The woman tend to squat on their tiptoes. For the pelvic muscles

to stretch, the woman must keep her feet flat on the floor.

Purpose: Useful in second-stage labor that it also stretches the

perineal muscles.

3. Kegel Exercises

- The woman tightens the muscle of the perineum.

Purpose: Helpful in the postpartum period, promotes perineal

healing, and help prevent stress incontinence in later life.

4. Abdominal Muscle Contractions

- Can be done in a standing or lying position along with pelvic

floor contractions. The woman merely tightens her abdominal

muscles, and then relaxes them.

Purpose: Help strengthen the abdominal muscles during

pregnancy and therefore help prevent constipation as

well as help restore abdominal tone after pregnancy.

5. Pelvic Rocking

- The woman arches her back, trying to lengthen or stretch her

spine. She holds the position for 1 minute, and then hollows her

back.

Purpose: Helps relieve backache during pregnancy and early labor

by making the lumbar spine more flexible.

Health Teachings

1. Never exercise to a point of fatigue.

2. Always rise from the floor slowly to prevent orthostatic hypotension.

3. To rise from the floor, roll over to the side first and then push up to avoid strain

on the abdominal muscles.

4. For leg exercises, to prevent leg cramps, never point the toes (extend the heel).

5. To prevent muscle strain, do not attempt exercises that hyperextend the lower

back.

6. Do not hold your breath while exercising because this increases intra-abdominal

and intrauterine pressure.

7. Do not continue with exercises if any danger signal of pregnancy occurs.

8. Do not practice second-stage pushing. Pushing increases intrauterine pressure

and could rupture membranes.

C. Tetanus Toxoid Immunization

- Tetanus can start from unclean instruments used during cord cutting and

improper cord treatment. Tetanus in the newborn can be prevented by giving Tetanus

Toxoid (TT) injections to the mother. However, one injection is not enough. At least

2 injections given one month apart will protect the baby. When a mother has received

a total of 5 injections, all the babies that she will deliver should have been protected.

The TT injections also protect the mother from tetanus.

*TETANUS TOXOID Immunization Schedule for Women

VACCINE MINIMUM AGE INTERVAL

PERCENT PROTECTED

DURATION OF PROTECTION

TT1 As early as possible during pregnancy (preferably 1st trimester)

80%

TT2 One month after TT1

80% *Gives 3 years protection for the mother *Infants born to the mother will be protected from neonatal tetanus.

TT3 6 months after TT2 90% *Gives 5 years protection for the mother*Infants will be protected from neonatal tetanus

TT4 1 year after TT3 or next pregnancy – 7 months

99% *Gives 10 years protection for the mother *Infant will be protected from neonatal tetanus

TT5 1 year after TT4 or pregnancy – 7 months

99% *Gives lifetime protection for the mother *All infants born to that mother will be protected

Note:

a. Give tetanus toxoid at the 6th or 7th month to woman who didn’t have this before.

b. If the woman received DPT in infancy 3 or 3 dose of DPT during infancy, this

should be considered as TT1 and TT2. The succeeding dose will TT3 and so

forth.

PREPARATION FOR DELIVERY

First Stage (True labor contraction until full cervical dilatation)

1. Wash hands with soap and water, prepare room and bed; set up the things needed

for delivery.

2. Explain to mother the course of labor and reasons for procedures.

3. Palpate abdomen to determine presentation.

4. Listen to fetal heartbeat.

5. Take blood pressure, temperature and pulse.

6. Examine the vulva to determine if there is low, bleeding or bulging.

7. Examination for edema.

8. Note interval, duration and intensity of uterine contraction.

9. Empty bladder when full.

10. Put Kelly pad or newspaper under buttocks of mother.

11. Give enema if indicated.

12. If mother has taken a bath, scrub from waist to knee with soap and water.

13. Give soft diet during early labor.

Second Stage (Full cervical dilatation until birth of the baby)

1. Cleanse vulva with soap and water/mild disinfectant.

2. Put on mask and scrub hands with clean brush in soap and water.

3. Put on clean gown or apron.

4. Wear sterile rubber gloves.

5. Set up sterile area.

6. Line Kelly pad with clean dressing towel.

7. As the head crowns encourage the mother to bear down slowly to avoid sudden

expulsion of the head and prevent extensive laceration of the perineum.

8. Protect perineum; do not press the head of the fetus to avoid injury of the brain.

9. Grease hand on either side between extended fingers and palms of hands. Feel to

determine if the cord is around the neck. If it is loose, slip it over the shoulder or

head. If it is tight, clamp it with clamps and cut in between. Wipe mouth nose

with dry gauze.

10. As head restitutes and rotates, give steady, gentle downward pull to allow the

anterior shoulder to go under the symphysis pubis, slowly give upward lift to

allow the posterior shoulder to slide over the perineum.

11. After the trunk and legs are born. Lay the baby on his/her right with a clean

receiver on the abdomen of the mother if he/she breaths readily. If not, with face

downward, hold up by the feet; remove mucus from throat with care as indicated.

Third Stage (Placental Stage)

1. The mother

a. Place placenta basin against the perineum and lay maternal end of the cord

with the clamp in the basin.

b. Do not interfere with the delivery of the placenta. When signs of

separation are present, apply fundal pressure contraction and deliver the

placenta.

c. Signs and symptoms of placental preparation:

C.1. Lengthening of the cord

C.2. Gushing of blood

C.3. Raising of the fundus two fingers above globular in shape

d. Note the amount of blood lost

e. Watch for hemorrhage at least one hour after delivery.

f. Instruct member of the family to watch mother for hemorrhage for at least

two hours just after the nurse or midwife has left the house after delivery.

The first two hours after delivery are dangerous due to atony of the uterus.

g. Reiterate encouragement family planning.

2. The Baby

a. As soon as the baby is breathing normally and pulsation of the cord ceases,

clamp the cord with two clamps and cut between them.

b. Wipe eyes of the baby with cotton (from inner cantus, outward) and instill

10% argyrols to both eyes.

c. Place baby in receiving blanket and have helper keep him warm in a safe

place.

d. Examine baby for trauma and malformation take and record weight, length,

temperature and general condition.

e. Dress cord aseptically

f. Spread vernix caseosa

g. Put dress of baby and keep him warm

h. Fill up birth certificate

POSTNATAL CARE

Care of the Mother after Delivery

A mother who has just given birth should:

     1. Take a bath daily.

     2. Gently massage the breasts towards the nipples to prevent or lessen breast swelling

and increase milk flow.

     3. Get enough rest and do less heavy work.

     4. Breastfeed right after birth.

     5. Clean the breast with warm water before breastfeeding.

     6. Eat healthy food to produce more breastmilk.

To Take Care of the New Born Baby:

     1. Breastfeed the baby right after birth.

     2. Give sponge bath daily. After the cord drops off, give baths daily.

     3. Keep the baby warm enough.

     4. Protect the baby from flies and mosquitoes.

     5. Keep the baby in the clean place.

     6. Keep the baby from the sick persons.

     7. Bring the baby to the Health Center for immunization against the 6 common

childhood diseases.

The baby's cord is a common site of infection.

To prevent the infection:

     - Keep the baby's cord clean and dry.

     - It is better to use a belly band but if the mother wants to use a thin cloth and be sure

that it is loose enough to let air in.

- Baby diapers should not cover the navel so that the cord does not wet with urine.

Breastfeeding

Exclusive breastfeeding of infants recommended for the first six months of their

lives and breastfeeding with complementary foods thereafter. Breastfeeding has many

physical and psychological benefits for children and mother as well as economical

benefits for families and societies.

The Benefits of Breastfeeding

To Infants

Provides a nutritional complete food for the young infant.

Strengthens the infant’s immune system, preventing many infections.

Safely rehydrates and provides essential nutrients to a sick child,

especially to those suffering from diarrheal diseases.

Reduces the infant’s exposure to infection.

Clean and has the right temperature.

Helps in child spacing. It is always ready for the baby and needs no

preparation.

Safe – more digestible than cow’s milk.

To Mother

Reduces a woman’s risk of excessive blood loss after birth.

Provides a natural method of delaying pregnancies.

Reduces the risk of ovarian and breast cancers and osteoporosis.

It helps stop bleeding after delivery.

Breastfeeding on demand helps the mother against another pregnancy.

It is good psychologically for both mother and child. It helps them to bond

together, become attached to each other and love one another better.

It is economical and convenient.

The Three E’s of Breastfeeding

1. Exclusive Breastfeeding

It means that the baby should receive only breast milk for the first 4-6 months of

life. Breast mil already contains almost everything the baby needs.

2. Early Start

Breastfeeding should start immediately after birth until tolerated but needs to be

supplemented with food rich in iron. This is a good time for the baby to learn to suck. In

most cases, the real milk of the mother comes in on the second or third day. Mothers

should be encouraged to let their babies suck even if the milk has “not come out” yet

because as the baby sucks:

He gets the “colostrums”.

The milk will be stimulated to flow earlier.

The uterus will contract and return to shape.

3. Extended Breastfeeding

Breastfeeding can continue for as long as the mother feels comfortable doing it.

However, the baby will need other foods in addition to breast milk upon reaching the age

of 4-6 months. Breastfeeding should continue for another 12-18 months while the child

gets more and more solid foods.

Proper Breastfeeding Procedures

1. Care of the breast

Wash the breast with clean water or with a wet piece of cloth or cotton. Do not

use soap or alcohol as this can cause irritation and dryness. In case the mother takes a

bath daily, there is no need to clean her breast before every breastfeeding. Hold the breast

and use to it that the thumb is gently pressing the nipple.

2. Proper positioning

Here are the correct steps to follow in positioning the baby for breastfeeding.

a. Let the mother sit or lie somewhere comfortable so that she is relaxed. A low seat is

usually best.

b. Show her how to hold the baby in her arms. The baby faces the breast while the baby’s

stomach is against the mother’s stomach.

c. Let the back of the baby’s shoulders rest on the mother’s arm. The baby’s head should

be free to bend back a little.

d. She should touch the baby’s cheek or the side of the baby’s mouth. This will stimulate

the rooting reflex.

e. She should wait until the baby’s mouth is open and ready to start sucking.

f. The mother should hold and offer the whole breast. She should not pinch the nipple or

areola.

g. She should aim the baby’s lower lip towards the base of the areola.

These are the signs that the baby is in good position for breastfeeding.

a. The baby’s whole body is close to the mother; the baby is facing the mother; and

the stomach of the baby is touching the mother’s stomach.

b. The baby’s mouth and chin are close to the breast.

c. The baby’s mouth is wide open.

d. More part of the areola is seen above the baby’s upper lip and less of it can be

seen below his/her lower lip.

e. The baby takes slow deep sucks.

f. The baby is relaxed and happy.

g. The mother does not feel pain on her nipple.

These are also signs that the baby is in a bad position while sucking. These are:

a. The baby’s stomach is not touching the mother’s stomach.

b. The baby’s mouth and chin are separated form the breast.

c. There is too much areola seen below the lower lip of the baby.

d. The baby takes many quick and small sucks.

e. The baby uses or refuses to suck because he/she does not get the milk.

f. The mother may feel pain on her nipple.

Nursing Consideration

Practical advice: When advising pregnant mothers, it is necessary that you have a

checklist of things that are useful for her to know before she delivers. Advise the mothers

that:

Breast milk is the best food for their baby. The quality of the milk will

always be good regardless of their diet.

The size and shape of the breasts do not matter. Small breasts and large

breasts both produce perfect milk in sufficient quantity.

Breastfeeding need not spoil their figure. It should help them to lose

weight after their babies are born. If they wear a good bra or other support

while they breastfeed, their breast will return to good shape after they

wean their babies.

Bottle feeding is dangerous because it causes much illness.

Let the baby suck soon after delivery – it will help their milk to flow

freely.

Make one or two of their dresses open at the front so that you’re their

babies can breastfeed easily.

All mothers feel more emotional and sensitive than usual for a few weeks

after delivery.

EXPANDED PROGRAM ON IMMUNIZATION

- The objective was to reduce the morbidity and mortality among infants and

children caused by the six childhood immunizable diseases.

Routine Immunization Schedule for Infants

Vaccine Minimum age at 1st

dose

Doses Minimum Interval Between

Doses

Route Reason

BCG Birth, or any time after birth

1 ID Protection against the possibility of infection from other family members

DPT 6 weeks 3 4 weeks IM Reduces the chance of severe pertussis.

OPV (Polio) 6 weeks 3 4 weeks Oral Protection against polio.

Hepatitis B 6 weeks 3 4 weeks IM Reduces the chance of being infected with Hepatitis B and become a carrier.

Measles 9 months 1 SQ 0% of measles is prevented by immunization at this age.

FAMILY PLANNING

- It includes all the decisions an individual or couple make about having children.

These decisions usually include if and when to have children, how many

children to have, and how they are spaced.

Benefits of Family Planning

For the Mothers

- It delays pregnancy until the mother is ready to have another baby.

- It provides a mother who may be suffering from some chronic illness enough

time for treatment and recovery.

- It prevents young mothers (below 18 y/o) and old mothers (above 35 y/o) from

getting pregnant because it is dangerous at their age.

For the Children

- It can result to a healthy mother who can in turn produce healthy children.

- It can provide a happy home filled with love and attention.

- It will give time and opportunity for parents to attend to the growth and

development of the children.

For the Fathers

- It enables him to give his children a good education and a better home.

- It gives time for his own advancement

- It enables him to give his family a happy and contended life.

For the Family

- It gives the family members more opportunities to enjoy each other’s company

with love and affection.

- It enables the family to have a home savings for the improvement of their

standard of living and for emergencies.

Different Methods of Family Planning

Methods How it works Advantages Disadvantages Precautions Common Side Effects

Natural Family Planning (NFP)

A technique of determining the fertile period of a woman by observing the physiologic signs and symptoms of the fertile and infertile phases of the menstrual cycle to avoid or achieve pregnancy.

3 types1. Basal Body Temperature (BBT)2. Cervical Mucus Method or Billings Ovulation Method3. Sympto-Thermal Methods

> No health-related side effects.> The method increases self-awareness and knowledge of human reproductive functions.> Can promote involvement of male sexual partner> Acceptable to couples regardless of culture, religion, socio-economic status and education.

> Not recommended unless couples are willing to follow all the rules.> Demands commitment, cooperation and communication between both partners.> Woman has to keep daily records of her signs and symptoms of fertility.> Some couples experience emotional stress due to need to abstain from intercourse at certain days.

Method not advisable for:1. Couples

who cannot communicate with each other about sexual matters.

2. Couples with unstable relationships.

3. Women who cannot or not willing to observe, record and interpret fertility signs and symptoms

4. Couples not willing to abstain from sexual intercourse during the fertile phase of the woman’s

Emotional stress Wrong calculations

resulting t o pregnancy.

cycle.Lactational Amenorrhea Method (LAM)

A woman who continues to fully or almost fully breastfeed her infant and who remains amenorrheic during the first 6 months after delivery is protected from pregnancy during that time.

> No artificial device used> Can be used by women without medical assistance> Inexpensive> Convenient

> Possibility of getting pregnant if the mother does not observe exclusive breastfeeding.

None None

Pill It is an oral contraceptive composed of synthetic hormones, which, when taken regularly prevents pregnancy.

> Easy & effective> Relieves the tension of a woman during her ovulation period.> Does not interrupt the sexual activity of the couple.> Reduces dysmenorrheal> Prevents anemia

> Needs to be taken daily.> Decreases milk production for some women.> Dependent on availability of supply.

Not advisable when:1.

Pregnancy either known or suspected.

2. Suffering from or has a family history of diseases like high blood pressure, weak heart, cancer of the breast and others.

Dizziness Headache Vomiting Spotting Weight gain or

weight loss Fullness of breast

3. The woman is over 35 y/o & a heavy smoker

DepoMedroxyProgesteroneAcetate(DMPA)

This is a 3-month injectable contraceptive. It prevents ovulation so there is no egg to be fertilized. Also, the mucus produced by the cervix is thick. This plugs the cervix, making sperm penetration difficult.

> Most private and convenient to use> Long-lasting (3mos.)> Does not interfere with sexual intercourse> Highly effective

> Increased appetite leading to weight gain for some women> Long acting and cannot easily be discontinued or removed from the body in case of complications> Delay in return of fertility after discontinuing DMPA

Not advisable for a woman who:1. Is pregnant

or may be pregnant.

2. Has vaginal bleeding of unknown cause

3. Has breast cancer

4. Has no menstruation but not related to pregnancy or breast-feeding

Absence of menstruation by the 12th month of use.

Irregular, prolonged menstruation and spotting in the first 3-6 months of use.

Possible weight gain.

Intra-Uterine Device (IUD)

It is a small plastic device introduced into the uterus to prevent pregnancy. The new types of IUD prevent fertilization of the

> No fear of getting pregnant.> Does not interrupt sexual activity.> Does not disrupt breastfeeding.> It is easy to use with few instructions

> May be expelled from womb.> Does not protect against AIDS & other STD.> Requires trained personnel for insertion and

Not advisable for women who:1. Is pregnant

or think she is pregnant.

2. Have different sexual

The woman may: Experience pain

during and immediately after the IUD insertion.

Experience heavy or

egg by the sperm. to remember.> Can be easily removed by health worker

removal. partners.3. Has never

had a child.4. Has infection

of the reproductive system.

irregular menstruation.

Condom It is a latex rubber or synthetic sheath that is placed over the erect penis before coitus.

> They are one of the few “male responsibility” birth control measures available.> No health care visit or prescription is needed.> Prevent the spread of STDs & HIV

> It may break or slip > Inhibit sexual pleasure

Contraindicated to those with hypersensitivity to latex.

Inhibit sexual pleasure

Bilateral Tubal Ligation (BTL)

Through surgery, a woman’s fallopian tubes are tied and this blocks the ovum from coming in contact with the sperm. This is a permanent method of preventing pregnancy for women.

> Effective and safe.> Easy to perform.> Permanent> No long term side effects.> Does not interfere with sexual activity.

> Has to rest for several days after the operation.> Cannot be easily reversed.

Operation not advisable to:1. Couples who

may want more children

2. Women below 25 y/o

3. Women pregnant or maybe pregnant

4. Women too fat

Tubal pregnancy but very rare.

5. Women severely malnourished

6. Women with goiter, DM, HPN

Vasectomy(for men)

Through surgery, the doctor cuts the vas deferens which carries the sperm from the testicle to the penis. The semen that comes out during sexual intercourse no loner contains sperm and will no longer make a woman pregnant.

> Effective and safe.> Easy to perform.> Permanent> No long term side effects.> Does not interfere with sexual activity.

> Requires the assistance of a trained doctor> Has to wear a condom or use any other family planning method after the operation or until the tubes have no more sperm cells in them (15-20 ejaculations)

Operation not advisable to:1. Couples who

may want more children.

2. A male below 25 y/o.

3. A male with lump in the scrotum

4. A male with hernia

5. A male who is allergic to drug (anesthesia)

A mild swelling and darkening of the skin on the operative site, a normal reaction of the body.

Health Teachings regarding Family Planning

1. Educate them regarding the various methods such as periodic abstinence,

chemical and mechanical barriers, hormonal therapy, and surgical

intervention.

2. Methods for how chosen contraceptive works.

3. Correct use of chosen method (including a demonstration of its use)

4. Effectiveness on STD transmission

5. Advantages and disadvantages of having a child.

6. Determining the need for family planning

7. Explaining reasons for most unplanned pregnancies.

8. Assisting female client to determine ovulation through basal body

temperature, changes in vaginal secretions, and other physiologic

indicators.

BIBLIOGRAPHY

BOOKS

DOH, Philippines (1997). Barangay Health Workers: Training Manual.

Adele Pillitteri (2003). Maternal and Child Health Nursing: Care of the

Childbearing and Childrearing Family. 4th edition.

Barbara Kozier, Glenora Erb, Audrey Berman, Shirley Synder (2004).

Fundamentals of Nursing: Concepts, Process, and Practice. 7th edition.

Jean Reyala et.al. (2000). Community Health Nursing Services. 9th

edition.

ELECTRONIC MEDIA SOURCES

http://www.doh.gov.ph/cvhw/index.asp?cat_id=2&topic_id=6