II.

PATIENT CARE
Standard: The organization informs the community about the services it provides and the hours
of their availability.

V. INDIVIDUAL-BASED PRIMARY CARE SERVICES

MATERNAL AND NEWBORN CARE
I. INTRODUCTION
Purpose
The purpose of this policy is to ensure the provision of high-quality, safe, and effective
maternal and newborn care within the primary care facility. This includes prenatal,
intrapartum, and postpartum care, as well as care for newborns. This is to eliminate
preventable maternal, stillborn, and neonatal deaths, and promote the well-being of women
and newborns using a rights-based and multi-sectoral approach provided through a
continuum of care.

Scope
This policy applies to all healthcare providers, staff, and patients involved in maternal and
newborn care services at the primary care facility.

II. POLICY AND PROCEDURE

Objective
To promote the health and well-being of mothers and newborns through comprehensive and
standardized care practices.

Policy statement:
Baliangao Municipal Health Office is dedicated to providing evidence-based maternal and
newborn care that meets or exceeds national and international standards. The facility ensures that
all mothers and newborns receive appropriate, timely, and compassionate care throughout the
prenatal, intrapartum, and postpartum periods.
Procedure
A. Antenatal Care

1. Micronutrient Supplementation:

○ Administer important minerals and vitamins, such as zinc, iodine, calcium, vitamin A
capsules, and iron tablets.

1
 ○ Promote the use of iodized salt.

Table 1. Summary of antenatal micronutrient Supplementation.

2. Tetanus Toxoid Immunization:

○ Follow the recommended immunization schedule (Table 2).

○ A series of 2 doses of Tetanus Toxoid vaccination must be received by a woman one

month before delivery to protect the baby from neonatal tetanus.

○ And the 3 booster dose shots to complete the five doses following the recommended
schedule provides full protection for both mother and child.

○ The mother is then called a “fully immunized mother” (FIM).

Table 2. Tetanus Toxoid or Tdap immunization schedule.

3. Family Planning:

○ Provide IEC and FP counseling, focusing on modern methods, fertility awareness,

informed choice, birth spacing, responsible parenthood, and respect for life.

○ Offer appropriate contraceptive provisions.

4. Oral Health Services:

○ Ensure the provision of oral health services to pregnant women.

5. Counseling:

○ Offer counseling on STI/HIV/AIDS, nutrition, personal hygiene, and the consequences of

abortion.

○ Conduct STI screening.

6. Adolescent and Youth Health Services:

○ Provide peer and professional counseling and reproductive health education.

2
 7. Promotion of Healthy Lifestyles:

○ Advice on smoking cessation, healthy diet, regular exercise, and moderate alcohol intake.

○ Manage lifestyle-related diseases like diabetes and cardiovascular disease (CVD).

8. Prevention and Management of Diseases:

○ Include tuberculosis, malaria (provide insecticide-treated bed nets in malaria-infested

areas), schistosomiasis, and anemia in the care plan.

9. High risk Pregnancy and Early Referral (Appendix A)

B. Prenatal

1. Prenatal Visit Schedule

Table 3. The standard prenatal visits that women
have to receive during pregnancy.

2. Essential Antenatal Care Services:

○ Monitor height and weight.

○ Measure blood pressure.

○ Conduct screening and blood testing, including CBC, blood typing, urinalysis, VDRL or
RPR, HbSAg, blood sugar screening, pregnancy test, cervical cancer screening using
acetic acid wash, and Pap smear.

○ Provide micronutrient supplementation (iron, folate, and Vitamin A).

○ Offer malaria prophylaxis where appropriate.

○ Conduct deworming and birth planning.

3. Promotion of Exclusive Breastfeeding:

○ Promote exclusive breastfeeding, newborn screening, BCG, and Hepatitis B birth dose
immunization.

4. Family Planning Counseling:

○ Discuss modern FP methods, especially lactation amenorrhea (LAM), health-caring, and

health-seeking behaviors.

○ Provide contraception counseling, including surgical procedures where appropriate, such

as bilateral tubal ligation (BTL) and no-scalpel vasectomy (NSV).
3
 5. STI-HIV Management:

○ Conduct laboratory screening and manage complications of STI-HIV cases.

6. Healthy Lifestyle Counseling:

○ Focus on smoking cessation, healthy diet, nutrition, regular exercise, STI control, HIV
prevention, and oral health.

7. Management of Early Pregnancy Complications:

○ Address early bleeding in pregnancy and administer antenatal loading doses of steroids
for threatened premature delivery.

○ Detect and manage pregnancy complications early.

8. Fetal Health Monitoring:

○ Measure fundic height, fetal heartbeat, and fetal movement count to assess fetal growth
and well-being.

9. Prevention and Management of Conditions:

○ Include hypertension, anemia, diabetes, tuberculosis, malaria, schistosomiasis, and

STI/HIV/AIDS in the care plan.

10. Support Services:

○ Facilitate antenatal registration through active tracking by WHTs.

○ Develop birth plans, conduct home visits, and ensure safe blood supply and transportation
and communication support.

C. Intrapartum Care

For the Mother:

1. Labor Monitoring:

○ Monitor vital signs and labor progress using a partograph.

○ Identify early signs and symptoms of prolonged labor, hypertension, abnormal

presentation, and bleeding, and provide appropriate management.

○ Actively manage the third stage of labor.

○ Provide immediate postpartum nursing care before discharge from the delivery room.

For the Newborn:

1. Thermal Care:

○ Dry the baby to keep them warm.

○ Provide thermal care through mother-newborn skin-to-skin contact, maintain a delivery

room temperature of 25-28°C, and wrap the newborn in clean, dry cloth.

4
 ○ Initiate breastfeeding within the first hour after birth.

○ Delay cord clamping (1-3 minutes or until cord pulsation stops).

2. Emergency Care Services (Appendix B):

○ Administer oxytocin, anticonvulsants, antibiotics, and intravenous fluids as needed.

○ Conduct assisted vaginal deliveries and manage placental issues.

○ Provide newborn resuscitation, treat neonatal sepsis, and offer oxygen support.

D. Postpartum Care

For the Mother:

1. Postpartum Check-up:

○ Identify early signs and symptoms of postpartum complications like hemorrhage,

infection, and hypertension.

○ Provide micronutrient supplementation, including iron and folate.

○ Counsel on:

1. proper nutrition,

2. exclusive breastfeeding,

3. skin-to-skin contact, and

4. essential neonatal care.

2. STI-HIV Management:

○ Conduct laboratory screening and manage complications of STI-HIV cases.

○ Provide family planning services and contraception, including surgical procedures where
appropriate.

3. Management of Conditions:

○ Include hypertension, diabetes, anemia, tuberculosis, malaria, schistosomiasis, and

STI/HIV/AIDS in the care plan.

For the Baby:

1. Postnatal Care:

○ Perform necessary care within 24 hours after birth:

1. cord care,

2. breastfeeding,

3. Vitamin K injection,

4. eye prophylaxis,

5. delayed bathing, and

5
 6. immunizations (BCG and Hepatitis B)

○ Counsel on postpartum/postnatal check-up, home care, and immunization.

○ Provision of other support services:

1. birth registration,

2. safe blood, and

3. transportation and communication support.

2. Neonatal Care:

○ Perform time-bound interventions within the first 30 seconds, 90 minutes, and 6 hours of
life. (Appendix C.1)

○ Provide non-time-bound interventions as necessary (Appendix C.2).

○ Conduct newborn resuscitation if needed (Appendix D).

○ Offer additional care for small babies or twins, including Kangaroo Mother Care (KMC)
and special breastfeeding support (Appendix E).

E. Discharge Planning

1. Plan for Discharge When:

○ Breastfeeding well and gaining weight adequately for 3 consecutive days.

○ Body temperature is between 36.5 and 37.5°C for 3 consecutive days.

○ The mother is confident in caring for the newborn.

F. Postnatal Care

1. Immediate Medical Attention:

○ Advise the mother to return or go to the hospital immediately if jaundice, difficulty

feeding, convulsions, limited movement, respiratory issues, or abnormal temperature are
present.

2. Routine Check-ups:

○ Schedule postnatal visits at 48-72 hours, 7 days, and 6 weeks of life.

○ Plan additional follow-up visits as needed based on any complications or health concerns.

IV. Compliance and Monitoring

Compliance Monitoring: Compliance with this policy will be monitored regularly. Any
deviations will be promptly addressed, with corrective actions taken to ensure alignment
with standards.

Effective Date: This policy is effective as of the date of signing.

III. REFERENCES

6
 American College of Obstetricians and Gynecologists (ACOG). (2018). ACOG Practice Bulletin
No. 192: Management of Intrauterine Growth Restriction. Obstetrics & Gynecology, 131(3),
e91-e103. Retrieved from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/
articles/2018/05/management-of-intrauterine-growth-restriction
Centers for Disease Control and Prevention. (2016). Updated recommendations for use of tetanus
toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women—
Advisory Committee on Immunization Practices (ACIP), 2012. Morbidity and Mortality
Weekly Report, 65(4), 102-110. Retrieved from
https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6504a5.pdf
Department of Health, Republic of the Philippines. (2017). Administrative Order No. 2017-0005:
Guidelines on the Implementation of the National Safe Motherhood Program. Retrieved from
https://doh.gov.ph/sites/default/files/publications/Administrative-Order-No-2017-0005.pdf
Royal College of Obstetricians and Gynaecologists (RCOG). (2011). Green-top Guideline No.
37a: Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium.
Retrieved from https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg37a/
World Health Organization (WHO). (2015). WHO Recommendations on Health Promotion
Interventions for Maternal and Newborn Health 2015. Retrieved from
https://apps.who.int/iris/handle/10665/172427
World Health Organization (WHO). (2018). Managing complications in pregnancy and childbirth:
a guide for midwives and doctors. 2nd edition. Retrieved from
https://www.who.int/publications/i/item/9789241550215
World Health Organization. (2016). WHO recommendations on antenatal care for a positive
pregnancy experience. Retrieved from
https://iris.who.int/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1

IV. APPENDICES
● Appendix A: High-Risk Pregnancy and Early Referral Procedure

● Appendix B: Emergency Care Services for Intrapartum Care

● Appendix C.1: Time-Bound Interventions in Neonatal Care (First 30 Seconds, 90 Minutes, and 6
Hours of Life)

● Appendix C.2: Non-Time-Bound Interventions in Neonatal Care

● Appendix D: Newborn Resuscitation Guidelines

● Appendix E: Additional Care for Small Babies or Twins (Kangaroo Mother Care and Special
Breastfeeding Support)

V. REVISION HISTORY
Rev 0: Initial release.
Rev 1: Updated procedure for immediate action, Date: MM-DD-YYYY.

Prepared By: Noted by: Approved By: Date

7
 Signed:

ROEL JAY T. ABRICA, RN, MN, MAN CHOLLA J. MAGALLON, RN RODANTE T. CHIONG, MD, MPH, FPSMSG
NURSE-I NURSE-II MUNICIPAL HEALTH OFFICER

8
 APPENDIX A: High-Risk Pregnancy and Early Referral Procedure

I. HIGH RISK PREGNANCY

Identification of High-Risk Pregnancies

1. Screening and Assessment:

○ Conduct thorough medical and obstetric history reviews during prenatal visits.

○ Identify risk factors such as advanced maternal age, previous obstetric complications,
chronic medical conditions (e.g., hypertension, diabetes), multiple gestations, and
abnormal fetal growth patterns.

○ Use standardized risk assessment tools and checklists to evaluate the risk level of each
pregnancy.

Management of High-Risk Conditions

1. Monitoring:

○ Increase the frequency of prenatal visits for high-risk pregnancies.

○ Perform regular monitoring of vital signs, fetal growth, and development using
ultrasound and other diagnostic tools.

○ Conduct routine laboratory tests to monitor for complications such as preeclampsia,

gestational diabetes, and infections.

2. Intervention:

○ Provide appropriate medical interventions based on identified risk factors.

○ Administer necessary medications, including antihypertensives, insulin, or other

treatments as indicated.

○ Offer lifestyle counseling and education on diet, exercise, and stress management tailored
to the specific needs of high-risk patients.

3. Emergency Preparedness:

○ Develop an individualized care plan for each high-risk patient, including emergency
contact information and detailed instructions for seeking immediate medical attention if
complications arise.

○ Educate patients and their families about the signs and symptoms of potential
complications and when to seek urgent care.

II. EARLY REFERRAL PROCESS

1. Referral Criteria:

○ Establish clear criteria for referral to higher-level care facilities, such as:

■ Severe preeclampsia or eclampsia

■ Uncontrolled gestational diabetes

9
 ■ Preterm labor or threatened preterm labor

■ Placental abruption or previa

■ Severe fetal growth restriction

■ Any condition requiring specialized obstetric or neonatal care

2. Referral Procedure:

○ Prepare a detailed referral letter, including the patient’s medical history, risk factors,
current condition, and reason for referral.

○ Coordinate with the receiving facility to ensure they are prepared to accept the patient
and provide the necessary care.

○ Arrange for safe transportation of the patient to the referral facility, ensuring continuous
medical support during transfer if needed.

3. Follow-Up:

○ Maintain communication with the referral facility to receive updates on the patient’s
condition and treatment.

○ Ensure proper documentation of the referral and follow-up actions in the patient’s
medical record.

○ Schedule a follow-up visit with the patient after discharge from the referral facility to
reassess her condition and continue with postpartum care.

III. Emergency Management of Specific Conditions

1. Difficulty Breathing/Obstruction of Airway:

○ Clear the airway and place the patient in the best position for breathing.

○ Refer the patient to a hospital with Comprehensive Emergency Obstetric and Newborn
Care (CEmONC) capabilities immediately.

2. Unconsciousness:

○ Keep the patient on her back with arms at the side, tilt the head backward, and lift the
chin to open the airway.

○ Clear secretions from the throat, give IV fluids to prevent or correct shock, and monitor
vital signs every 15 minutes.

○ Refer to a CEmONC facility immediately.

3. Postpartum Bleeding:

○ Massage the uterus and expel clots.

○ If bleeding persists, perform bimanual uterine compression and administer ergometrine

0.2 mg IM (if no contraindications).

○ Refer to a CEmONC facility immediately.

4. Intestinal Parasite Infection:

○ Administer mebendazole 500 mg tablet as a single dose anytime from 4-9 months of
pregnancy, if none was given in the past 6 months.

○ Refer if complications arise.

10
 5. Malaria:

○ Administer sulfadoxine-pyrimethamine to women from malaria-endemic areas who are in

their 1st or 2nd pregnancy (500 mg-25 mg tab, 3 tabs at the beginning of the 2nd to 3rd
trimesters with at least one month interval between doses).

APPENDIX B: Emergency Care Services for Intrapartum Care

I. Summary of Emergency Case Services:

The following emergency care services must be able to administer if complications occur:
1. Administration of Oxytocin:
o Parenteral administration of oxytocin in the third stage of labor to prevent postpartum
hemorrhage.
2. Administration of Anticonvulsants:
o Parenteral administration of loading doses of anti-convulsant:
o magnesium sulfate for the management of eclampsia
3. Administration of Antibiotics:
o Parenteral administration of initial dose of antibiotics for suspected infections in the
mother or newborn.
4. Manual Removal of Placenta:
o Conduct manual removal of the placenta if retained placenta is suspected to prevent
postpartum hemorrhage.
5. Administration of Steroids:
o Administer loading doses of steroids for threatened premature labor to enhance fetal
lung maturity.
o Immediate referral to referral hospital.
6. Intravenous Fluid and Blood Transfusion:
o Administer intravenous fluids, blood volume expanders, and/or blood transfusion in
cases of severe hemorrhage or shock.
 Immediate referral to referral hospital.

7. Newborn resuscitation.
o Perform newborn resuscitation following the Neonatal Resuscitation Program (NRP)
guidelines if the newborn is not breathing or has poor muscle tone.
8. Treatment of Neonatal Sepsis:
o Administer antibiotics and supportive care for suspected neonatal sepsis based on
Pediatrician’s diagnosis and order.
9. Oxygen support for newborns.
o Provide oxygen support for newborns with respiratory distress or other conditions
requiring supplemental oxygen.
II. References:

11
American Academy of Pediatrics. (2020). Neonatal Resuscitation Program (NRP). Retrieved from
https://www.aap.org/en-us/continuing-medical-education/life-support/NRP/Pages/Neonatal-Resuscitation-
Program.aspx

American College of Obstetricians and Gynecologists. (2017). Practice Bulletin No. 183: Postpartum
Hemorrhage. Retrieved from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/
2017/10/postpartum-hemorrhage

American College of Obstetricians and Gynecologists. (2019). Practice Bulletin No. 202: Gestational
Hypertension and Preeclampsia. Retrieved from https://www.acog.org/clinical/clinical-guidance/practice-
bulletin/articles/2019/01/gestational-hypertension-and-preeclampsia

Centers for Disease Control and Prevention. (2020). Group B Strep (GBS). Retrieved from
https://www.cdc.gov/groupbstrep/index.html

National Institute for Health and Care Excellence (NICE). (2015). Preterm labour and birth. Retrieved from
https://www.nice.org.uk/guidance/ng25

Royal College of Obstetricians and Gynaecologists. (2011). Green-top Guideline No. 26: Assisted Vaginal Birth.
Retrieved from https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg26/

World Health Organization. (2017). Managing possible serious bacterial infection in young infants when referral
is not feasible. Retrieved from https://www.who.int/maternal_child_adolescent/documents/bacterial-
infection-infants/en/

World Health Organization. (2018). Managing complications in pregnancy and childbirth: A guide for midwives
and doctors. Retrieved from https://www.who.int/publications/i/item/9789241550215

12
 APPENDIX C.1: Time-Bound Interventions in Neonatal Care
(First 30 Seconds, 90 Minutes, and 6 Hours of Life)

I. Time-Bound Interventions
A. Within the first 30 seconds
Objective: Dry and provide warmth to the newborn and prevent hypothermia
● Put on double gloves just before delivery

● Use a clean, dry cloth to thoroughly dry the newborn by wiping the eyes, face, head,
front and back, arms and legs.

● Remove the wet cloth.

● Do a quick check of newborn’s breathing while drying

● Do not put the newborn on a cold or wet surface

● Do not bathe the newborn earlier than 6 hours of life

o If the newborn must be separated from his/her mother, put him/her on a warm
surface, in a safe place close to the mother.
B. After thorough drying
Objective: Facilitate bonding between the mother and her newborn through skin-to-skin
contact to reduce likelihood of infection and hypoglycemia
● Place the newborn prone on the mother’s abdomen or chest, skin-to-skin.

● Cover the newborn’s back with a blanket and head with a bonnet.

● Place the identification band on the ankle

● Do not separate the newborn from the mother, as long as the newborn does not exhibit
severe chest in-drawing, gasping or apnea and the mother does not need urgent
medical/surgical stabilization e.g. emergency hysterectomy.

● Do not wipe off the vernix if present.

13
Check for multiple births as soon as the newborn is securely positioned on the mother.
Palpate the mother’s abdomen to check for a second baby or multiple births. If there is a second
baby (or more), get help. Deliver the second newborn. Manage like the first baby.

C. While on skin-to-skin contact (up to 3 minutes post-delivery)

Objective: Reduce the incidence of anemia in term newborns and interventricular
hemorrhage in preterm newborns by delaying or non-immediate cord clamping
● Remove the first set of gloves immediately prior to cord clamping.

● Clamp and cut the cord after cord pulsations have stopped (typically at 1 to 3
minutes). Do not milk the cord towards the newborn.

a. Cut ties tightly around the cord at 2 cm and 5 cm from the newborn’s abdomen.

b. Cut between ties with sterile instruments.

c. Observe for oozing blood.

i. After cord clamping, ensure 10 IU Oxytocin IM is given to the mother.

Follow other protocols per PCPNC.

D. Within 90 minutes of age

Objective: Facilitate the newborn’s early initiation to breastfeeding and transfer of colostrum
through support and initiation of breastfeeding
● Leave the newborn on the mother’s chest in skin-to-skin contact. Health workers
should not touch the newborn unless there is a medical indication.

● Observe the newborn. Advice the mother to start feeding the newborn once the
newborn shows feeding cues (e.g. opening of mouth, tonguing, licking, and rooting).
Make verbal suggestions to the mother to encourage her newborn to move toward the
breast e.g. nudging.

● Counsel on positioning and attachment. When the newborn is ready, advise the mother
to position and attach her newborn.

● Advise the mother not to throw away the colostrum.

● If the attachment or suckling is not good, try again and reassess.

o A small amount of breast milk may be expressed before starting breastfeeding to

soften the nipple area so that it is easier for the newborn to attach.

Objective: To prevent ophthalmia neonatorum through proper eye care

● Administer erythromycin or tetracycline ointment or 2.5% povidone-iodine drops to
both eyes after the newborn has located the breast.

● Do not wash away the eye-antimicrobial.

14
 Appendix C.2: Non-Time-Bound Interventions in Neonatal Care

– usually given within 6 hours after birth, and should never be [JS1] made to compete with the time-
bound interventions.

1. Give Vitamin K prophylaxis

- Inject a single dose of Vitamin K 1mg IM

- if parents decline intramuscular injections, offer oral vitamin K as a 2nd line.

2. Inject Hepatitis B and BCG vaccinations

- Inject hepatitis B vaccine 0.5mL IM and BCG 0.05mL intradermally.

3. Examine the newborn.

a. Check for birth injuries, malformations or defects.

● Weigh the newborn and record

● Look for possible birth injury and/or malformations.

● Refer for special treatment and/or evaluation if available.

● If the newborn has feeding difficulties because of the injury/malformation, help the
mother to breastfeed. If not successful, teach her alternative feeding methods.

15
Appendix D: Newborn Resuscitation Guidelines

I. Newborn Resuscitation
1. Start resuscitation if the newborn is not breathing or is gasping after 30 seconds of drying or
before 30 seconds of drying if the newborn is completely floppy and not breathing.
2. Clamp and cut the cord immediately.
3. Call for help.
4. Transfer the newborn to a dry, clean, and warm surface. Keep the newborn wrapped or under
a heat source if available.
5. Inform the mother that the newborn needs help to breathe.
6. Refer to the Department Circular for the step-by-step newborn resuscitation guideline.

II. Additional References:

Figure 1. Newborn Resuscitation Guidelines. (American Academy of Pediatrics, 2020)

Initial Steps:

1. Preparation:
○ Ensure all necessary resuscitation equipment is readily available and functioning.

○ Check and prepare the radiant warmer, suction device, resuscitation bag and mask,
endotracheal tubes, and medications.

16
 2. Assessment Immediately After Birth:
○ Dry the newborn thoroughly and assess the need for resuscitation based on the following
criteria:

■ Is the baby breathing or crying?

■ Is there good muscle tone?

■ Is the baby full-term?

If the Answer to All Three Questions is "Yes":

● Provide routine care (warmth, clear airway, dry, and ongoing evaluation).

If the Answer to Any of These Questions is "No":

● Initiate the resuscitation protocol as follows:

Steps of Resuscitation:

1. Initial Stabilization:
○ Warm the baby and maintain normal body temperature.

○ Position the head and neck to open the airway.

○ Clear the airway of secretions if needed.

○ Dry the baby and stimulate breathing if not breathing or gasping.

2. Ventilation:
○ Begin positive pressure ventilation (PPV) within the first 60 seconds if the newborn is not
breathing or the heart rate is below 100 beats per minute (bpm).

○ Use a resuscitation bag and mask to deliver breaths at a rate of 40-60 breaths per minute.

○ Reassess after 30 seconds. If the heart rate is below 60 bpm, proceed to chest
compressions.

3. Chest Compressions:
○ If the heart rate remains below 60 bpm despite adequate ventilation, start chest
compressions.

○ Use the "two-thumb encircling hands" technique.

○ Perform compressions at a ratio of 3:1 (three compressions to one breath) with a

compression rate of 90 compressions and 30 breaths per minute.

4. Advanced Resuscitation:
○ If the heart rate remains below 60 bpm after 60 seconds of coordinated chest
compressions and ventilations, consider administering epinephrine.

17
 ○ Insert an umbilical venous catheter (UVC) for medication administration.

○ Administer epinephrine 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution)

intravenously every 3-5 minutes as needed.

○ Continue resuscitation efforts and reassess regularly.

5. Post-Resuscitation Care:
○ Once the newborn's condition stabilizes, provide appropriate post-resuscitation care
including temperature maintenance, glucose monitoring, and ongoing respiratory support
if needed.

○ Transfer the newborn to a neonatal intensive care unit (NICU) if necessary for further
monitoring and care.

III. References:
American Academy of Pediatrics. (2020). Neonatal Resuscitation Program (NRP). Retrieved
from https://www.aap.org/en-us/continuing-medical-education/life-support/NRP/Pages/
Neonatal-Resuscitation-Program.aspx
World Health Organization. (2012). Basic Newborn Resuscitation: A Practical Guide. Retrieved
from https://www.who.int/maternal_child_adolescent/documents/newborn_resuscitation/en/
Centers for Disease Control and Prevention. (2017). Neonatal Guidelines. Retrieved from
https://www.cdc.gov/ncbddd/advanced-maternal-age/pregnancy.html

18
 APPENDIX E: Additional Care for Small Babies or Twins
(Kangaroo Mother Care and Special Breastfeeding Support)

If the newborn is preterm, 1-2 months early or weighing 1,500 -2,499 grams (or visibly small where a
scale is not available).

1. If the newborn is delivered 2 months earlier or weighs < 1,500 grams, refer to a specialized
hospital.

2. For a visibly small newborn or a newborn born >1 month early:

- Teach the mother how to keep the small newborn warm in skin-to-skin contact
via Kangaroo Mother Care (KMC).

Start kangaroo mother care when:

a. The newborn is able to breathe on its own (no apneic episodes).
b. The newborn is free of life-threatening disease or malformations.
Reminders:
● The ability to coordinate sucking and swallowing is not a
prerequisite to KMC.

● Other methods of feeding can be used until the newborn

can breastfeed.

● KMC should last for as long as possible each day.

● If the mother needs to interrupt KMC for a short period,

the father, a relative or friend should take over.

- Provide extra blankets for the mother and the newborn, plus a bonnet, mittens and
socks for the newborn.
- If the mother cannot keep the newborn skin-to-skin because of complications,
wrap the newborn in a clean, dry, warm cloth and place it in a cot.
a. Cover with a blanket.

b. b. Use a radiant warmer if the room is not warm or the baby is small.

- Give special support for breastfeeding:

a. Encourage the mother to breastfeed every 2-3 hours.

- Weigh the newborn daily.

- When the mother and newborn are separated, or if the newborn is not sucking
effectively, use alternative feeding methods.

19
 FAMILY PLANNING SERVICES

I. INTRODUCTION

Purpose
To ensure every Filipino, especially the residents of the Municipality of Baliangao, has
universal access to accurate information, medically safe, legal, effective, affordable, and
acceptable family planning methods.

Scope
This policy applies to all staff involved in family planning services within Baliangao
Municipal Health Office.

II. POLICY AND PROCEDURE

Objective
To provide accessible, equitable, and high-quality family planning services that help
individuals and couples achieve their desired family size and improve reproductive health
outcomes.

Policy statement:
The Baliangao Municipal Health Office is committed to offering accessible, equitable,
and high-quality family planning services to help individuals and couples achieve their
desired family size and improve reproductive health outcomes, ensuring seamless service
delivery and improved reproductive health outcomes.

Procedure:

1. Strengthening advocacy at all levels

● Conduct advocacy events and campaigns to raise awareness about family planning,
ensuring alignment with UHC goals of increasing health literacy and community
engagement.

● Organize family planning awareness events targeting community leaders,

policymakers, and the general public to advocate for supportive policies and resource
allocation.

● Encourage the involvement of policy and decision-makers in family planning

initiatives to promote integrated and sustainable health systems.

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2. Health system strengthening
The RHU will adopt a two pronged strategy that focuses on preservice and in-service
training and capacity building.

a. Pre-service Training and Capacity Building:

i. Integrate family planning into the training curriculum for all healthcare workers, ensuring
consistency with UHC’s emphasis on comprehensive and continuous education for health
professionals.

ii. include all health workers at all levels of health care delivery:

1. home health promoters,

2. nurses,

3. midwives, and

4. clinical officers.

b. In-service Training and Capacity Building:

i. Include family planning as part of the overall reproductive health in-service training
program, focusing on quality assurance, continuity, sustainability, monitoring, and
evaluation.

ii. Train media personnel to disseminate accurate information about family planning and
correct prevailing misconceptions, aligning with UHC goals of accurate health
communication.

3. Service delivery for family planning

a. At community level

i. Barangay Health workers shall be trained to provide the following:

● Information, education and counselling services

● Distribution of IEC materials on FP

● Lactation Amenorrhea Method

ii. Ensure these services are part of the HCPN to maintain consistency and quality across all
service points.

b. Barangay Health Stations and RHU

i. Doctor, Nurse and Rural Health Midwife shall be trained and provide the following:

● Information, education and counselling services

● Service Provision

o condoms,

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 o oral contraceptive pills,

o injectable contraceptives,

o IUD,

o PSI

● Implement universal infection prevention measures

● Lactation Amenorrhea Method (LAM)

ii. Ensure integration with HCPN for coordinated care and referral systems.

4. FP Coordinator Responsibilities:
● Ensure the continuous availability of family planning commodities, supporting the UHC
goal of accessible and uninterrupted healthcare services.

5. Coordination with POPCOM:

● Collaborate with the Population Commission (POPCOM) to generate demand for family
planning services, aligning with UHC’s objective of comprehensive health promotion and
community engagement.

6. Outreach Services:
● Conduct quarterly outreach family planning services to reach underserved areas, ensuring
equity and access as outlined in UHC and HCPN goals.

7. Referral System:
● Streamline the referral system for family planning at all levels of the health system to ensure
seamless service delivery, supporting the HCPN’s focus on integrated and efficient
healthcare networks.

Compliance and Monitoring:

● Compliance with this policy will be monitored regularly.

● Any deviations from the policy will be addressed promptly, with corrective actions taken as
needed to ensure ongoing alignment with standards.

Effective Date:

● This policy is effective as of the date of signing.

III. REFERENCES (if applicable)

IV. APPENDICES (if applicable)

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 V. REVISION HISTORY
Rev 0: Initial release.
Rev 1: Updated procedure for immediate action, Date: MM-DD-YYYY.

Prepared By: Noted by: Approved By: Date

Signed:

ROEL JAY T. ABRICA, RN, MN, MAN CHOLLA J. MAGALLON, RN RODANTE T. CHIONG, MD, MPH, FPSMSG
NURSE-I NURSE-II MUNICIPAL HEALTH OFFICER

23
 NUTRITION SERVICES

I. INTRODUCTION

Purpose
To standardize procedure and ensure every Filipino, especially the residents of the
Municipality of Baliangao, has universal access to accurate information, medically safe,
legal, effective, affordable, and acceptable family planning methods.

Specifically to:
1. To reduce the rate of malnutrition specifically stunting, wasting and underweight children

2. To promote and educate mothers and lactating women the importance of exclusive and
complementary breastfeeding

3. To increase commitment of local chief executives and other partners

4. To Continue and promote The Expanded Program on Immunization

Scope
This policy applies to all staff involved in the provision of nutrition services, including
but not limited to nutritionists, dietitians, healthcare providers, and administrative staff
within the Baliangao Municipal Health Office.

II. POLICY AND PROCEDURE

Objective
To provide comprehensive nutrition services that promote healthy eating habits, prevent
nutrition-related diseases, and manage existing conditions to improve overall patient
health and well-being.

Policy statement:
The Baliangao Municipal Health Office is committed to providing comprehensive
nutrition services to enhance the health and well-being of patients to every barangay.
These services aim to prevent and manage nutrition-related conditions through
assessment, education, and individualized care plans.
Procedure:
Implement the Nutrition Program components
1. Pinggang Pinoy Food Guide

a. Promote balanced meals based on the Pinggang Pinoy proportions.

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 b. Steps:

i. Educate: Conduct workshops and seminars for health workers and community
members on the Pinggang Pinoy Food Guide.

ii. Distribute Materials: Provide visual guides and educational materials to

households, schools, and barangay health centers.

iii. Monitor: Regularly assess dietary habits in the community and provide feedback
to ensure adherence to the guide.

2. Infant and Young Child Feeding

a. Exclusive Breastfeeding

i. This is for infants 0 to 6 months, no other food introduced to the infant aside from
breastmilk to gain optimum nutrition for growth and development.

ii. Steps:

1. Training: Train healthcare providers on the benefits and techniques of

exclusive breastfeeding.

2. Support Groups: Establish breastfeeding support groups in communities.

3. Education: Provide mothers with information and resources on exclusive

breastfeeding.

b. Complementary Feeding

i. This is from 6 months and 1 day to 23 months. The introduction of food aside
from breastmilk. Infants shall be given appropriate complementary foods at age
six months in order to meet their evolving nutritional requirements. This means
that it should be given: timely, adequate, safe, and properly fed.

ii. Steps:

1. Education: Educate mothers on introducing appropriate complementary foods.

2. Demonstrations: Conduct food preparation demonstrations.

3. Follow-Up: Regularly follow up with mothers to ensure proper feeding practices.

c. Exclusive Breastfeeding- Complementary Feeding- this is from 6 months and 1 day to 23

months. The introduction of food aside from breastmilk. Infants shall be given
appropriate complementary foods at age six months in order to meet their evolving
nutritional requirements. This means that it should be given: timely, adequate, safe, and
properly feed.

Micronutrient Supplementation
Micronutrient deficiencies is also a major health problem seen in most children.
It is the provision of pharmaceutically prepared vitamins & minerals for treatment or
prevention of specific micronutrient deficiency.

1. Vitamin A supplementation- shall continue to be provided to infants and children 6-59

months of age. Vitamin A supplementation shall be given to children at risk, particularly
those with measles, persistent diarrhea, severe pneumonia and severely malnourished
children to help re-establish body reserves of vitamin A and protect against severity of
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 infections and prevent complications. Postpartum women shall be given vitamin A capsule
within one month after delivery to increase vitamin A concentration of her breast-milk as
well as vitamin A status of their breastfed children. Children with signs of xeropthalmia shall
be treated with vitamin A. Children during emergencies shall be given priority for vitamin A
supplementation following schedule for high risk children.

2. Iron Supplementation- shall be provided to pregnant and lactating women and low birth
weight babies and children 6-11 months of age. In addition, anemic and underweight children
1-5 years of age shall be provided with iron supplements including adolescent girls enrolled
in Grades 7-10.

3. Iodine Supplementation- shall be provided to women of reproductive age group, school age
children in areas when the Urinary iodine Excretion of less than 50 ug/L in more than 20% of
the population. Priority will be given to all pregnant women who do not have access to
iodized salt.

4. Calcium supplementation for pregnant women- shall be provided to reduce the risk of
developing gestational hypertensive disorders and associated health problems thereby
improving maternal and new born health and nutrition outcomes through provision of daily
calcium supplementation.

Universal Salt Iodization- recommends the use of iodized salt to prevent iodine deficiency disorder.
Food Fortification- enhancing of micronutrient content of widely consumed food.
Mother Baby Friendly Health Initiative- To promote and support and protect breastfeeding and Infant
and Young Child Feeding Practices in all health facilities, and the need to transform these facilities
(government and private-hospitals and Lying-in) rendering maternal and new born care services into
Mother Baby Friendly Health Institution.
Philippine Integrated Management of Acute Malnutrition (PIMAM) - Supports the implementation
and expansion of quality treatment for children suffering from the most severe and acute form, of under
nutrition which is severe acute malnutrition (SAM). These children with SAM are at most risk of dying
as a result of their under nutrition.
It has four guiding principles:
1. Maximum coverage and access – to achieve the greatest possible coverage by making
services accessible and acceptable to the highest possible proportion of a population in need;

2. Timeliness – early case-finding and mobilization so that most of the cases of SAM can be
treated before complications develop;

3. Appropriate care – simple and effective Out-patient and In-patient Therapeutic Care;

4. Care when and where it is needed – continuous and appropriate support with other
interventions.
Four Components:

1. Outpatient Therapeutic Care (OTC)-Management of non-complicated cases of

SAM using ready to use therapeutic foods (RUTF)at the community level;

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 2. Inpatient Therapeutic Care (ITC) – Management of complicated cases of SAM
at the hospital level

3. Community Mobilization – involves engagement with the community to

promote a common understanding of acute malnutrition and promote services
offered;
4. Management of Moderated Acute Malnutrition (MAM) – It targets cases of
MAM with supplementary food, some basic medicines, monitoring and
nutritional education.
Immunization – ensure that infants /children and mothers have access to routinely recommended
infant/childhood vaccines.

Compliance and Monitoring:

● Compliance with this policy will be monitored regularly.

● Any deviations from the policy will be addressed promptly, with corrective actions taken as
needed to ensure ongoing alignment with standards.

Effective Date:
● This policy is effective as of the date of signing.

III. REFERENCES (if applicable)

IV. APPENDICES (if applicable)

V. REVISION HISTORY
Rev 0: Initial release.
Rev 1: Updated procedure for immediate action, Date: MM-DD-YYYY.

Prepared By: Noted by: Approved By: Date

Signed:

ROEL JAY T. ABRICA, RN, MN, MAN CHOLLA J. MAGALLON, RN RODANTE T. CHIONG, MD, MPH, FPSMSG
NURSE-I NURSE-II MUNICIPAL HEALTH OFFICER

27
 DENTAL SERVICES

Policy statement:
Baliangao Municipal Health Office shall provide quality oral health services to improve
oral health outcomes and enhance the overall well-being of patients.

Purpose:
To ensure quality, affordable, accessible and available oral health care delivery

Procedure:

1. Preventive oral health services and dental interventions

a. Toothbrushing using fluoride toothpaste
b. Topical application of fluoride varnish
c. Pit and fissure sealants

2. Promotion of oral health at home

a. Oral health instruction or advice
b. Effective brushing technique with the right amount of fluoride toothpaste, duration and
frequency to avoid oral diseases and emergencies.
c. Emphasize twice daily toothbrushing and flossing.
d. Reduce eating and drinking sugary, sweetened beverages and starchy foods
e. Visit dental clinic twice a year for oral assessment, monitoring and prophylaxis

3. Dentist shall protect him/herself at all times against possible infections transmitted via airborne
or droplet.

4. Shall cater only to covid19 fully vaccinated with booster dose clients for 5 years old and above.

5. Dental Services shall be available daily in the RHU.

Compliance and Monitoring:

● Compliance with this policy will be monitored regularly.

● Any deviations from the policy will be addressed promptly, with corrective actions taken as
needed to ensure ongoing alignment with standards.
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Effective Date:

● This policy is effective as of the date of signing.

Prepared By: Noted by: Approved By: Date

Signed:

ROEL JAY T. ABRICA, RN, MN, MAN CHOLLA J. MAGALLON, RN RODANTE T. CHIONG, MD, MPH, FPSMSG
NURSE-I NURSE-II MUNICIPAL HEALTH OFFICER

29
 REFERRAL TO COMMUNITY-BASED REHABILITATION SERVICES

Policy statement:
Baliangao Municipal Health Office shall establish an accessible and inclusive
community-based rehabilitative facility that empower individuals with disabilities,
promote their participation in society, and improve their overall well-being.
Purpose:
To establish guidelines for providing community-based rehabilitation services to enhance
the quality of life for individuals with disabilities through comprehensive, community-
centered care.
Procedure:

1. Initial consult shall be done in the RHU main health center.

2. A referral to physiatrist shall be made for the physical therapy management instructions/order.

3. Physiatrist order shall be carried out and client shall be enrolled in the program.

4. Follow-up check-up with Physiatrist shall be done according to scheduled follow-up check-up.

5. The client shall be out of the program once fully recovered or the therapy is not necessary
anymore.
Compliance and Monitoring:

● Compliance with this policy will be monitored regularly.

● Any deviations from the policy will be addressed promptly, with corrective actions taken as
needed to ensure ongoing alignment with standards.

Effective Date:

● This policy is effective as of the date of signing.

Prepared By: Noted by: Approved By: Date

Signed:

ROEL JAY T. ABRICA, RN, MN, MAN CHOLLA J. MAGALLON, RN RODANTE T. CHIONG, MD, MPH, FPSMSG
NURSE-I NURSE-II MUNICIPAL HEALTH OFFICER

30
31
 REFERRAL TO DEVELOPMENTAL AND MENTAL HEALTH EVALUATION

Policy statement:
Baliangao Municipal Health Office shall provide appropriate evaluation and management
to clients with developmental and mental illness

Purpose:
To ensure proper referral of patients with developmental and mental health illness to
proper authority

Procedure:

Clients/Patients with Developmental Delay/Abnormality

1. Initial assessment shall be made on first contact in RHU main center.

2. For pediatric age group:

Counseling of caregiver regarding the condition of the client.

Refer to developmental physician for the specific therapy appropriate for the client.
For adults:
Counseling of caregivers regarding the condition of the client.
Provide assistive devices if necessary.

3. Regular check-up shall be made

Patients with Mental Illness

1. Initial assessment shall be done in the RHU main center.

2. Appropriate initial medicine shall be given to the patient.

3. Counseling of the care giver.

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4. Refer to psychiatrist for management.

5. If medicines prescribed by psychiatrist are available in the pharmacy, the RHU shall provide.

6. Regular consultation and refilling of prescription must be done.

Compliance and Monitoring:

● Compliance with this policy will be monitored regularly.

● Any deviations from the policy will be addressed promptly, with corrective actions taken as
needed to ensure ongoing alignment with standards.

Effective Date:

● This policy is effective as of the date of signing.

Prepared By: Noted by: Approved By: Date

Signed:

ROEL JAY T. ABRICA, RN, MN, MAN CHOLLA J. MAGALLON, RN RODANTE T. CHIONG, MD, MPH, FPSMSG
NURSE-I NURSE-II MUNICIPAL HEALTH OFFICER

33
 REFERRAL TO SUBSTANCE ABUSE SERVICES

Policy statement:
Baliangao Municipal Health Office shall provide holistic approach in rehabilitating
surrendered drug personalities, focus on healing of the body, mind and soul through
counseling and therapeutic sessions

Purpose:
Lead in the implementation in a unified and rational health response in the fight against
drug abuse through a more effective drug abuse promotion, treatment and rehabilitation

Procedure:

1. Drug Dependency Examination (DDE) shall be done by an accredited physician

2. Secure clearance from Philippine National Police

3. Secure certificate of no pending case from the Municipal Trial Court

4. Submit DDE to CBDRP coordinator for enrollment to the program for voluntary submission and
voluntary through representation for treatment and rehabilitation

5. A certificate of completion shall be given to PWUDS who graduated from the program

Treatment Modality

1. Multidisciplinary team approach

Treatment method in rehabilitation of drug dependents which avails of the services and skills of
a team composed of psychiatrist, psychologist, social worker, occupational therapist and other
related disciplines in collaboration with the family and the drug dependent.

2. Therapeutic community approach

Highly structured program wherein the community is utilized as the primary vehicle to foster
behavioral and attitudinal change. The patient receives the information and impetus to change
from being part of the community. Role modelling and peer pressure play significant part in the
program.
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 Its goal is to change the patient’s self-destructive thinking and behavioral pattern, teach them
personal responsibility, positivize their self-image, create a sense of human community and
provide an environment in which human beings can grow and take responsibility and credit for
growth.

3. Hazelden-Minnesota Model

This views addiction as a disease, an involuntary condition caused by factors largely outside a
person’s control. This consists of didactic lectures, cognitive-behavioral psychology, alcoholic
anonymous principles and bibliotherapy.

4. Spiritual approach

This uses the Bible as the primary source of inspiration to change. It encourages patients to turn
away from drug addiction and renew their relationship with the Lord.

Compliance and Monitoring:

● Compliance with this policy will be monitored regularly.

● Any deviations from the policy will be addressed promptly, with corrective actions taken as
needed to ensure ongoing alignment with standards.

Effective Date:

● This policy is effective as of the date of signing.

Prepared By: Noted by: Approved By: Date

Signed:

ROEL JAY T. ABRICA, RN, MN, MAN CHOLLA J. MAGALLON, RN RODANTE T. CHIONG, MD, MPH, FPSMSG
NURSE-I NURSE-II MUNICIPAL HEALTH OFFICER

35