EMONC

EMONC
CAPACITY ENHANCEMENT
PROGRAM FOR MIDWIVES ON
MATERNAL AND NEWBORN
CARE
Reasons for High Maternal
and Newborn Mortality Rate
• Young age at marriage & first
pregnancy
• Domestic violence and gender
inequality
• Poor maternal health
• Poor hygiene during and after
delivery
Three DELAYS
1. DELAY IN DECIDING TO SEEK MEDICAL

CARE.
 Failure to recognize danger signs

 Lack of money
 Unplanned/unwanted pregnancy
 Lack of companion in going to health facility
 No person to take care of children/home.
 Fear of being ill treated in health facility
Three DELAYS
2. DELAY IN IDENTIFYING and REACHING

THE APPROPRIATE FACILITY
 Distance from a woman’s home to health
facility/provider
 Lack of/poor condition of roads
 Lack of emergency transportation
 Lack of awareness of existing services
 Lack of community support
Three DELAYS
3. DELAY IN RECEIVING APPROPRIATE and

ADEQUATE CARE AT HEALTH FACILITY
 Lack of health care providers
 Shortage of supplies
 Lack of equipments
 Lack of competence of health providers
 Weak referral system
MDG 4:
Reduce Child Mortality
Reduce Under 5-mortality rate

from 80.0 to 26.7 (per 1,000 LB)
Reduce Infant mortality rate

from 57.0 to 19.0 (per 1,000 LB)
MDG 5: Improve Maternal Health
To accomplish MDG 5: Reduce maternal
mortality by 75% by 2015
(for the Philippines the target is to reduce

MMR from 209 to 52 deaths per 100,000
live births).
How will we make it happen?
(Current tools to avert maternal death and disability)
• A skilled health care professional attends

every childbirth
• Every woman has access to Emergency
Obstetric and Newborn Care (EmONC)
• Family planning services to help women
space their pregnancies
Source: Averting Maternal Death and Disability Program

Skilled Care
During Childbirth
The single most important way to reduce
maternal deaths is to ensure that a skilled
attendant is present at every birth.
Source: A Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of

Maternal Mortality, 1999.
A SKILLED ATTENDANT is an
accredited health professional (a
midwife, nurse or doctor) who has been
educated and trained to proficiency in
the skills needed to manage normal
pregnancies, childbirth and the
immediate postnatal period, and in the
identification, management and
referral of complications in women
and newborns.
*Manage was added in 2000 by the Inter-Agency Group for Safe Motherhood in
recognition that some skilled attendants will also have competencies to manage
complications.
Source: A Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of
Maternal Mortality, 1999.
EMERGENCY OBSTETRIC and NEWBORN
CARE (EmONC)
… the elements of obstetric & newborn care

needed for the management of normal and
complicated pregnancy, delivery, postpartum
periods and the newborn.
Early detection and treatment of problem
pregnancies to prevent progression to an
emergency.
Management of emergency complications* BEmONC
Definition CEmONC
EmONC Key Functions
Parenteral (IV or IM) Assisted Vaginal Delivery

administration of Antibiotics Administration of
Oxytocin corticosteroid for preterm
Anticonvulsants labor
Manual Removal of Placenta Essential Newborn Care
Removal of Retained Surgery (Cesarean
Products of conception Section)
Blood Transfusion
The Midwifery Act of 1992
Practice of Midwifery defined
1. care of women during pregnancy, labor and
puerperium; management of normal deliveries
2. health education of the patient, family and
community;
3. primary health care in the community, including
nutrition and family planning
4. carrying out the written order of physician with
regard to antenatal, intranatal and postnatal of the
normal pregnant mother,
5. giving immunization
Skills required by R.A.7392
Internal examination during labor
Repair of obstetric perineal lacerations
Intravenous fluid insertion
Oxytocics after delivery of placenta

Vitamin K for newborn
Principles of Professional Conduct
In providing professional services, a certain
level of competence is necessary.
Professionals shall undertake only those
services that they can reasonably deliver with
professional competence.
Keep up with new knowledge and techniques
in their field, continually improve their skills
and upgrade their level of competence, and
take part in a lifelong continuing education
program.
Source: Code of Good Governance for the Professions in the Philippines signed June 23, 2003.
The Way Forward
1. Recognize signs &
symptoms of obstetric
complications
2. Know when & where to
seek care if complications
arise
3. Invest in community
education:
• Eliminate delays
4. Create women friendly
policies
References
1. National Demographic and Health Survey 2008 National Statistic Office
(NSO) Philippines and ORC Macro
2. Making Pregnancy Safer World Health Organization Geneva 2002
3. Averting Maternal Death and Disability Program materials Columbia
University New York
4. Managing Complications in Pregnancy and Childbirth World Health
Organization Geneva 2003
5. Pregnancy, childbirth, postpartum and newborn care: A guide for
essential practice - Updated second edition: Pregnancy, childbirth,
postpartum and newborn care 2003 World Health Organization
6. Promoting Quality Maternal and Newborn Care: A Reference Manual for
Program Managers. Copyright © 1998 Cooperative for Assistance and
Relief Everywhere, Inc. (CARE).
7. The Millennium Project Background Paper Task Force on Child Health
and Maternal Health March 2003, Freedman Lynn et al
8. Linangan ng Kababaihan (Likhaan) Safe Motherhood poster
Thank you!!!

EMONC

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EMONC

1. DELAY IN DECIDING TO SEEK MEDICAL

 Failure to recognize danger signs

2. DELAY IN IDENTIFYING and REACHING

3. DELAY IN RECEIVING APPROPRIATE and

Reduce Under 5-mortality rate

Reduce Infant mortality rate

(for the Philippines the target is to reduce

• A skilled health care professional attends

Source: Averting Maternal Death and Disability Program

Source: A Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of

… the elements of obstetric & newborn care

Parenteral (IV or IM) Assisted Vaginal Delivery

Internal examination during labor

Repair of obstetric perineal lacerations

Intravenous fluid insertion

Oxytocics after delivery of placenta

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