December 01

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The Birth Plan

In 2006, the WHO set out Standards for Maternal and Neonatal Care which is as follows:

All pregnant women should have a written plan for birth and for dealing with unexpected adverse events, such as complications or emergencies, that may occur during pregnancy, childbirth or the immediate postnatal period, and should discuss and review this plan with a skilled attendant at each antenatal assessment and at least one month prior to the expected date of birth

The aim is to help prepare pregnant women, their partner and families prepare adequately for childbirth and how they might respond to complications or unexpected adverse events, should they occur during pregnancy, child birth or after delivery.

I’ve learnt a huge amount about the state of Maternal and Child Health in the Philippines and this video called Natality Fatality captures it well. I hope you have a few minutes spare to watch it. Sophie Angeles, the midwife I met early on in my assignment in Milk Letting (Link here) talks about some of the challenges, such as inability to afford attending the crucial prenatal check-up’s.

 

 

The chronic shortage of Health Workers still astounds me…

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The birth plan in the Philippines is embedded within the Mother and Child book. It’s a combination of health and immunisation records with information for parents during pregnancy up to 2 yrs old. It is considered to be the ‘passport for delivery’ for lying-in clinics and birthing homes.

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It’s essentially a contract ideally completed as early as possible with pregnant women and husbands/partners to help prepare them for child birth. It may help reduce potentially poor outcomes should complications occur, for example,

  • Identifying a birth facility and skilled birth attendant rather than a home delivery,
  • Saving enough money for the maternity/newborn care package
  • Having transport arrangements in place
  • Care for children at home organised during the delivery
  • Identification of a blood donor  and emergency contact numbers

Research in the use of the birth plan in developing countries has shown different, sometimes conflicting results, with few studies demonstrating the effectiveness of these interventions, mainly due to flawed study and sample design. However, there are encouraging results from a WHO review on a number of projects in the use of the birth plan and complication readiness that indicates it is an essential component of safe motherhood activities. (Standards for Maternal and Neonatal Care, WHO, 2006)

Currently, no such research has been undertaken in the Philippines and my assignment is to collect baseline data on the use of the Birth and Emergency plan and Mother & Child book in the rural and urban areas. The field visits have provided me with the valuable insights needed to begin designing baseline KAP (Knowledge, Attitudes and Practices) surveys.

The output of these surveys will inform and guide Save the Children on the Birth Plan Plus strategy in collaboration with the Department of Health (DOH), a new concept being developed for the MNCHN Program. This program aims to improve the health and nutrition status of pregnant and lactating women, newborns, infants and children under-5.

With so much information in my head, I wondered ‘where on earth do I start?’ so I began by brainstorming, a great way to clarify my thoughts and set direction.

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To help us fully understand if the Birth Plan is being discussed prenatally, accomplished and followed or complied with, we aim to conduct the KAP surveys with a small number of participants (30-35) who are from the following groups:

  • Pregnant women for 1st time
  • Pregnant for more than 1 time
  • Post-natal women, ideally 0-3 months after delivery
  • Adolescent mothers (depending on availability of consent)
  • Husbands/partners
  • Health service providers i.e., Doctor, public health nurse, midwife
  • Community-based health worker e.g. Barangay Health Worker

 

After designing 5 surveys (almost identical but tailored to each group) we were able to discuss our initial observations from the field with Dr Calibo and colleagues from the Department of Health, who also reviewed and provided input into the draft surveys as well as the LVPO team, before pre testing, .

We were able to pre test with BHW’s, midwives and pregnant women at some Kabalikat (health volunteer) orientation and family planning sessions in a couple of Barangays in Caloocan City…

 

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Only a few minor adjustments required and we’re ready!

Next stop….”Let’s go!”    Speak soon, Alli 🙂