Holy Angel University

College 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 PERCENT DURATION OF

INTERVAL PROTECTED PROTECTION
TT1 As early as 80%
possible during
pregnancy
(preferably 1st
trimester)
TT2 One month after 80% *Gives 3 years
TT1 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 99% *Gives 10 years
next pregnancy – 7 protection for the
months mother
*Infant will be
protected from
neonatal tetanus
TT5 1 year after TT4 or 99% *Gives lifetime
pregnancy – 7 protection for the
months 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 Doses Minimum Route Reason

age at 1st Interval
dose Between
Doses
BCG Birth, or any 1 ID Protection
time after against the
birth 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 A technique of > No health-related > Not recommended Method not • Emotional stress
Planning (NFP) determining the side effects. unless couples are advisable for: • Wrong
fertile period of a > The method willing to follow all 1. Couples calculations
woman by increases self- the rules. who cannot resulting t o
observing the awareness and > Demands communicate pregnancy.
physiologic signs knowledge of human commitment, with each
and symptoms of reproductive cooperation and other about
the fertile and functions. communication sexual
infertile phases of > Can promote between both matters.
the menstrual involvement of male partners. 2. Couples
cycle to avoid or sexual partner > Woman has to keep with unstable
achieve pregnancy. > Acceptable to daily records of her relationships.
couples regardless of signs and symptoms 3. Women who
3 types culture, religion, of fertility. cannot or not
1. Basal Body socio-economic > Some couples willing to
Temperature status and education. experience emotional observe,
(BBT) stress due to need to record and
2. Cervical Mucus abstain from interpret
Method or Billings intercourse at certain fertility signs
Ovulation Method days. and
3. Sympto- symptoms
Thermal Methods 4. Couples not
willing to
abstain from
sexual
intercourse
 during the
fertile phase
of the
woman’s
cycle.
Lactational A woman who > No artificial > Possibility of None None
Amenorrhea continues to fully device used getting pregnant if
Method (LAM) or almost fully > Can be used by the mother does not
breastfeed her women without observe exclusive
infant and who medical assistance breastfeeding.
remains > Inexpensive
amenorrheic > Convenient
during the first 6
months after
delivery is
protected from
pregnancy during
that time.
Pill It is an oral > Easy & effective > Needs to be taken Not advisable • Dizziness
contraceptive > Relieves the daily. when: • Headache
composed of tension of a woman > Decreases milk 1. Pregnancy • Vomiting
synthetic during her ovulation production for some either known
• Spotting
hormones, which, period. women. or suspected.
when taken > Does not interrupt > Dependent on 2. Suffering • Weight gain or
regularly prevents the sexual activity of availability of supply. from or has a weight loss
pregnancy. the couple. family • Fullness of breast
> Reduces history of
dysmenorrheal diseases like
> Prevents anemia high blood
pressure,
weak heart,
 cancer of the
breast and
others.
3. The woman
is over 35 y/o
& a heavy
smoker
DepoMedroxy This is a 3-month > Most private and > Increased appetite Not advisable for • Absence of
Progesterone injectable convenient to use leading to weight a woman who: menstruation by
Acetate contraceptive. It > Long-lasting gain for some women 1. Is pregnant the 12th month of
(DMPA) prevents ovulation (3mos.) > Long acting and or may be use.
so there is no egg > Does not interfere cannot easily be pregnant. • Irregular,
to be fertilized. with sexual discontinued or 2. Has vaginal prolonged
Also, the mucus intercourse removed from the bleeding of menstruation and
produced by the > Highly effective body in case of unknown spotting in the
cervix is thick. complications cause first 3-6 months
This plugs the > Delay in return of 3. Has breast of use.
cervix, making fertility after cancer • Possible weight
sperm penetration discontinuing DMPA 4. Has no gain.
difficult. menstruation
but not
related to
pregnancy or
breast-
feeding
Intra-Uterine It is a small plastic > No fear of getting > May be expelled Not advisable for The woman may:
Device (IUD) device introduced pregnant. from womb. women who: • Experience pain
into the uterus to > Does not interrupt > Does not protect 1. Is pregnant during and
prevent pregnancy. sexual activity. against AIDS & other or think she immediately
The new types of > Does not disrupt STD. is pregnant. after the IUD
IUD prevent breastfeeding. > Requires trained 2. Have insertion.
 fertilization of the > It is easy to use personnel for different • Experience
egg by the sperm. with few instructions insertion and sexual heavy or
to remember. removal. partners. irregular
> Can be easily 3. Has never menstruation.
removed by health had a child.
worker 4. Has infection
of the
reproductive
system.
Condom It is a latex rubber > They are one of > It may break or slip Contraindicated • Inhibit sexual
or synthetic sheath the few “male > Inhibit sexual to those with pleasure
that is placed over responsibility” birth pleasure hypersensitivity
the erect penis control measures to latex.
before coitus. available.
> No health care
visit or prescription
is needed.
> Prevent the spread
of STDs & HIV
Bilateral Tubal Through surgery, a > Effective and safe. > Has to rest for Operation not • Tubal pregnancy
Ligation (BTL) woman’s fallopian > Easy to perform. several days after the advisable to: but very rare.
tubes are tied and > Permanent operation. 1. Couples who
this blocks the > No long term side > Cannot be easily may want
ovum from effects. reversed. more
coming in contact > Does not interfere children
with the sperm. with sexual activity. 2. Women
This is a below 25 y/o
permanent method 3. Women
of preventing pregnant or
pregnancy for maybe
women. pregnant
 4. Women too
fat
5. Women
severely
malnourished
6. Women with
goiter, DM,
HPN
Vasectomy Through surgery, > Effective and safe. > Requires the Operation not • A mild swelling
(for men) the doctor cuts the > Easy to perform. assistance of a trained advisable to: and darkening of
vas deferens > Permanent doctor 1. Couples who the skin on the
which carries the > No long term side > Has to wear a may want operative site, a
sperm from the effects. condom or use any more normal reaction
testicle to the > Does not interfere other family planning children. of the body.
penis. The semen with sexual activity. method after the 2. A male
that comes out operation or until the below 25 y/o.
during sexual tubes have no more 3. A male with
intercourse no sperm cells in them lump in the
loner contains (15-20 ejaculations) scrotum
sperm and will no 4. A male with
longer make a hernia
woman pregnant. 5. A male who
is allergic to
drug
(anesthesia)
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