MCN LECTURE

An MCN Nurse: ROLES

MODULE 1
1. Considers the family as a whole and as a
partner in care
OVERVIEW OF MATERNAL AND CHILD NURSING 2. Serves as an advocate to protect the right of
all family members , including the fetus
Maternal and Child Nursing
3. Demonstrate a high degree of independent
- “The nursing specialty that deals with the nursing functions because teaching and
care of women throughout their pregnancy counseling are major interventions
and childbirth and the care of their 4. Promotes health and disease prevention
newborn children” (National Center for because these protect the health of the
Biotechnology Information, 2006) Susan next generation
Kaplan Jacobs ,J Med Libr Assoc. 2006 5. Serves as important resource for families
Apr; 94(2 Suppl): E56–E64. during childbearing and childrearing as
these can be extremely stressful times in a
“Maternal-child nursing” has three subordinate
life cycle
terms in the CINAHL subject headings hierarchy:
6. Respects personal, cultural, and spiritual
1. obstetric nursing (“care of normal, attitudes and beliefs influence the meaning
uncomplicated pregnancies only”), 7. Encourages developmental stimulation
during both health and illness so children
2. perinatal nursing (“nursing care of
can reach their ultimate capacity in adult
childbearing families who are at risk for
life
increased maternal, fetal, or neonatal
8. Assesses families for strengths as well as
mortality”), and
specific needs or challenges
3. pediatric nursing 9. Encourages family bonding through
rooming-in and family visiting in maternal
PRIMARY GOAL
and child healthcare facility
- The promotion and maintenance of optimal 10. Encourages early hospital discharge options
family health to ensure cycles of optimal to reunite families as soon as possible in
childbearing and childrearing order to create a seamless, helpful
transition process
SCOPE OF PRACTICE
11. Encourages families to reach out to their
1. Preconception health care community so the family can develop a
2. Care of women during the trimesters of wealth of support people
pregnancy and the puerperium ( 6 weeks
GLOBAL HEALTH GOALS
after childbirth)
3. Care of the infants during the perinatal Health-related Millennium Development Goals
period ( the time span beginning at 20 and Targets
weeks of pregnancy to 4 weeks after birth)
- Goal 1: Eradicate poverty and hunger
4. Care of children form birth through late
Target 1.C: Halve, between 1990 and 2015,
adolescence
the proportion of people who suffer
5. Care in a variety of hospital and home care
from hunger.
settings
- Goal 4: Reduce child mortality
PHILOSOPHY OF MCN Target 4.A: Reduce by two-thirds, between
1990 and 2015, the under-five mortality
1. Family centered; assessment should always
rate.
include the family as well as an individual
- Goal 5: Improve maternal health
2. Community centered; the health of families
Target 5.A: Reduce by three quarters,
is both affected by and influences the
between 1990 and 2015, the maternal
health of communities
mortality ratio.
3. Evidence based; critical knowledge
Target 5.B: Achieve, by 2015, universal
increases
access to reproductive health.
4. A challenging role for nurses and a major
- Goal 6: Combat HIV/AIDS, malaria and
factor in keeping families well and optimally
other diseases
functioning
Target 6.A: Have halted by 2015 and begun
to reverse the spread of HIV/AIDS.
Target 6.B: Achieve, by 2010, universal
 access to treatment for HIV/AIDS for all neonatal mortality to at least as low as 12
those who need it. per 1000 live births and under-5 mortality
Target 6.C: Have halted by 2015 and begun to at least as low as 25 per 1000 live births.
to reverse the incidence of malaria and - 3.3 By 2030, end the epidemics of AIDS,
other major diseases. tuberculosis, malaria and neglected tropical
- Goal 7: Ensure environmental diseases and combat hepatitis, water-borne
sustainability diseases and other communicable diseases.
Target 7.C: Halve, by 2015, the proportion - 3.4 By 2030, reduce by one third premature
of people without sustainable access to safe mortality from non-communicable diseases
drinking water and basic sanitation. through prevention and treatment and
- Goal 8: Develop a global partnership for promote mental health and well-being.
development - 3.5 Strengthen the prevention and
Target 8.E: In cooperation with treatment of substance abuse, including
pharmaceutical companies, provide access narcotic drug abuse and harmful use of
to affordable essential drugs in developing alcohol.
countries. - 3.6 By 2020, halve the number of global
deaths and injuries from road traffic
SUSTAINABLE DEVELOPMENT GOALS (SDGs)
accidents.
- 3.7 By 2030, ensure universal access to
sexual and reproductive health-care
services, including for family planning,
information and education, and the
integration of reproductive health into
national strategies and programmes.
- 3.8 Achieve universal health coverage,
including financial risk protection, access to
quality essential health-care services and
access to safe, effective, quality and
- The Sustainable Development Goals (SDGs)
affordable essential medicines and vaccines
are a collection of 17 global goals set by
for all.
the United Nations General Assembly in
- 3.9 By 2030, substantially reduce the
2015 for the year 2030. The SDGs are part
number of deaths and illnesses from
of Resolution 70/1 of the United Nations
hazardous chemicals and air, water and soil
General Assembly, the 2030 Agenda
pollution and contamination.
- The 17 SDGs are broader and more
- 3.a Strengthen the implementation of the
ambitious than the MDGs, presenting an
WHO Framework Convention on Tobacco
agenda that is relevant to all people in all
Control in all countries, as appropriate.
countries to ensure that "no one is left
- 3.b Support the research and development
behind."
of vaccines and medicines for the
- The new agenda requires that all 3
communicable and non-communicable
dimensions of sustainable development –
diseases that primarily affect developing
economic, social and environmental – are
countries, provide access to affordable
addressed in an integrated manner.
essential medicines and vaccines, to protect
- SDG 3: Ensure healthy lives and promote
public health, and, in particular, provide
wellbeing for all at all ages
access to medicines for all.
- 3.c Substantially increase health financing
and the recruitment, development, training
and retention of the health workforce in
developing countries, especially in least
developed countries and small island
developing States.
- 3.d Strengthen the capacity of all countries,
in particular developing countries, for early
- 3.1 By 2030, reduce the global maternal warning, risk reduction and management of
mortality ratio to less than 70 per 100 000 national and global health risks.
live births.
- 3.2 By 2030, end preventable deaths of
newborns and children under 5 years of
age, with all countries aiming to reduce
PHILIPPINE HEALTH GOALS 2. In collaboration with the Centers for health
Development and relevant national offices:
NATIONAL SAFE MOTHERHOOD PROGRAM
Establishment of Reliable Sustainable Support
Vision Systems for Maternal-Newborn Service Delivery
through such initiatives as:
For Filipino women to have full access to health
services towards making their pregnancy and a. Establishment of Safe Blood Supply Network
delivery safer with support from the National Voluntary Blood
Program
Mission
b. Behavior Change Interventions in collaboration
Guided by the Department of Health FOURmula
with the Health Promotion and Communication
One Plus thrust and the Universal Health Care
Service
Frame, the National Safe Motherhood Program is
committed to provide rational and responsive c. Sustainable financing of maternal - newborn
policy direction to its local government partners in services and commodities through locally initiated
the delivery of quality maternal and newborn revenue generation and retention activities
health services with integrity and accountability including PhilHealth accreditation and enrolment.
using proven and innovative approaches
Component B: National Capacity to Sustain
Objectives Maternal-Newborn Services

The Program contributes to the national goal of 1. Operational and Regulatory Guidelines
improving women’s health and well-being by:
a. Identification and profiling of current FP users
Collaborating with Local Government Units in and identification of potential FP clients and those
establishing sustainable, cost-effective approach of with unmet need for FP (permanent or temporary
delivering health services that ensure access of methods)
disadvantaged women to acceptable and high
b. Mainstreaming FP in the regions with high
quality maternal and newborn health services and
unmet need for FP
enable them to safely give birth in health facilities
near their homes c. Development and dissemination of Information,
Education Communication materials
2. Establishing core knowledge base and support
systems that facilitate the delivery of quality d. Advocacy and social mobilization for FP
maternal and newborn health services in the
2. Network of Training Providers
country
a. 31 Training Centers that provide BEmONC Skills
Training
MATERNAL AND CHILD NURSING INITIATIVES IN
THE PHILIPPINES 3. Monitoring, Evaluation, Research, and
Dissemination with support from the Epidemiology
NATIONAL SAFE MOTHERHOOD PROGRAM
Bureau and Health Policy Development and
Program Components Planning Bureau
Component A: Local Delivery of the Maternal– a. Monitoring and Supervision of Private Midwife
Newborn Service Package Clinics in cooperation with PRC Board of Midwifery
and Professional Midwifery Organizations
This component supports LGUs in establishing and
mobilizing the service delivery network of public b. Maternal Death Reporting and Review System in
and private providers to enable them to deliver the collaboration with Provincial and City Review
integrated maternal-newborn service package. In Teams
each province and city, the following shall continue
c. Annual Program Implementation Reviews with
to be undertaken:
Provincial Health Officers and Regional
1. Establishment of critical capacities to provide Coordinators
quality maternal-newborn services through the
POLICIES AND LAWS
organization and operation of a network of Service
Delivery Teams consisting of: Republic Act No. 10354: Responsible Parenthood
and Reproductive Health Law (RPRH Act of 2012)
a. Barangay Health Workers
1. Administrative Order 2008-0029: Implementing
b. BEmONC Teams composed of Doctors, Nurses
Health Reforms to Rapidly Reduce Maternal and
and Midwives
Neonatal Mortality
2. Department Order 2009-0084: Guidelines primacy to ensure maternal and child health, the
Governing the Payment of Training Fees relative to health of the unborn, safe delivery and birth of
the Attendance of Health Workers to Basic healthy children, and sound replacement rate, in
Emergency Obstetric and Newborn Care Skills line with the State’s duty to promote the right to
Training Course at Duly Designated Training health, responsible parenthood, social justice and
Centers full human development;
3. Administrative Order 2011-0011: Establishment Section 3. Guiding Principles for Implementation. –
of Basic Emergency Obstetric and Newborn Care This Act declares the following as guiding
Training Centers in Regional Hospitals and Medical principles:
Centers
(d) The provision of ethical and medically safe,
4. Administrative Order 2015-0020: Guidelines in legal, accessible, affordable, non-abortifacient,
the Administration of Life Saving Drugs During effective and quality reproductive health care
Maternal Care Emergencies by Nurses and services and supplies is essential in the promotion
Midwives in Birthing Centers of people’s right to health, especially those of
women, the poor, and the marginalized, and shall
5. Administrative Order 2016-0035: Guidelines on
be incorporated as a component of basic health
the Provision of Quality Antenatal Care in All
care;
Birthing Centers and Health Facilities Providing
Maternity Care Services Section 3. Guiding Principles for Implementation. –
This Act declares the following as guiding
6. Administrative Order 2018-0003: National Policy
principles:
on the Prevention of Illegal and Unsafe Abortion
and Management of Post-Abortion Complications (e) The State shall promote and provide
information and access, without bias, to all
Republic Act No. 10354: Responsible Parenthood
methods of family planning, including effective
and Reproductive Health Law (RPRH Act of 2012)
natural and modern methods which have been
Section 2. Declaration of Policy. proven medically safe, legal, non-abortifacient, and
effective in accordance with scientific and
The State recognizes and guarantees the human
evidence-based medical research standards
rights of all persons including their right to equality
and nondiscrimination of these rights, the right to Section 3. Guiding Principles for Implementation. –
sustainable human development, the right to This Act declares the following as guiding
health which includes reproductive health, the principles:
right to education and information, and the right to
(f) The State shall promote programs that: (1)
choose and make decisions for themselves in
enable individuals and couples to have the
accordance with their religious convictions, ethics,
number of children they desire with due
cultural beliefs, and the demands of responsible
consideration to the health, particularly of women,
parenthood.
and the resources available and affordable to them
Section 3. Guiding Principles for Implementation. – and in accordance with existing laws, public morals
This Act declares the following as guiding and their religious convictions: Provided, That no
principles: one shall be deprived, for economic reasons, of the
rights to have children;
(a) The right to make free and informed decisions,
which is central to the exercise of any right, shall Section 3. Guiding Principles for Implementation. –
not be subjected to any form of coercion and must This Act declares the following as guiding
be fully guaranteed by the State, like the right principles:
itself;
(g) The provision of reproductive health care,
(b) Respect for protection and fulfillment of information and supplies giving priority to poor
reproductive health and rights which seek to beneficiaries as identified
promote the rights and welfare of every person
(h)The State shall respect individuals’ preferences
particularly couples, adult individuals, women and
and choice of family planning methods that are in
adolescents;
accordance with their religious convictions and
Section 3. Guiding Principles for Implementation. – cultural beliefs,
This Act declares the following as guiding
Section 3. Guiding Principles for Implementation. –
principles:
This Act declares the following as guiding
(c) Since human resource is among the principal principles:
assets of the country, effective and quality
reproductive health care services must be given
(i) Active participation by nongovernment (p) That a comprehensive reproductive health
organizations (NGOs), women’s and people’s program addresses the needs of people
organizations, civil society, faith-based throughout their life cycle.
organizations, the religious sector and communities
Administrative Order 2008-0029: Implementing
is crucial
Health Reforms to Rapidly Reduce Maternal and
Section 3. Guiding Principles for Implementation. – Neonatal Mortality
This Act declares the following as guiding
• This policy issuance provides the strategy
principles:
for rapidly reducing maternal and neonatal
(j) While this Act recognizes that abortion is illegal deaths through the provision of a package
and punishable by law, the government shall of maternal, newborn, child health and
ensure that all women needing care for post- nutrition (MNCHN) services. The goal of
abortive complications and all other complications rapidly reducing maternal and neonatal
arising from pregnancy, labor and delivery and mortality shall be achieved through
related issues shall be treated and counseled in a effective population-wide provision and use
humane, nonjudgmental and compassionate of integrated MNCHN services as
manner in accordance with law and medical appropriate to any locality in the country.
ethics;
The strategy aims to achieve the following
• Section 3. Guiding Principles for intermediate results:
Implementation. – This Act declares the
1. Every pregnancy is wanted, planned and
following as guiding principles:
supported;
(k) Each family shall have the right to determine
2. Every pregnancy is adequately managed
its ideal family size: Provided, however, That the
throughout its course; The strategy aims to
State shall equip each parent with the necessary
achieve the following intermediate results:
information on all aspects of family life, including
reproductive health and responsible parenthood, in 3. Every delivery is facility-based and managed
order to make that determination; by skilled birth attendants/skilled health
professionals; and
(l) There shall be no demographic or population
targets and the mitigation, promotion and/or 4. Every mother and newborn pair secures
stabilization of the population growth rate is proper post-partum and newborn care with
incidental to the advancement of reproductive smooth transitions to the women’s health
health; care package for the mother and child
survival package for the newborn.
Section 3. Guiding Principles for Implementation. –
This Act declares the following as guiding Administrative Order 2011-0011: Establishment of
principles: Basic Emergency Obstetric and Newborn Care
Training Centers in Regional Hospitals and Medical
(m) Gender equality and women empowerment
Centers
are central elements of reproductive health and
population and development; Basic Emergency Obstetric and Newborn Care
(BEmONC)-Capable network of facilities and
(n) The resources of the country must be made to
providers that can perform the following six signal
serve the entire population, especially the poor,
obstetric functions:
and allocations thereof must be adequate and
effective: Provided, That the life of the unborn is (1) parenteral administration of oxytocin in the
protected; third stage of labor;
Section 3. Guiding Principles for Implementation. – (2) parenteral administration of loading dose of
This Act declares the following as guiding anti-convulsants;
principles:
(3) parenteral administration of initial dose of
(o) Development is a multi-faceted process that antibiotics;
calls for the harmonization and integration of
Basic Emergency Obstetric and Newborn Care
policies, plans, programs and projects that seek to
(BEmONC)-Capable network of facilities and
uplift the quality of life of the people, more
providers that can perform the following six signal
particularly the poor, the needy and the
obstetric functions:
marginalized; and
(1) performance of assisted deliveries
(Imminent Breech Delivery);
 (2) removal of retained products of conception; and consequent service delivery scheme of the
and ANC package
(3) manual removal of retained placenta. The four –visit model
Basic Emergency Obstetric and Newborn Care First visit : 8-12 weeks
(BEmONC)-
Second visit : 24-26 weeks
These facilities are also able to provide emergency
Third visit : 32 weeks
newborn interventions, which include the
minimum: Fourth visit: 36-38 weeks
(1) newborn resuscitation; Essential Newborn Care Protocol ( AO 2009-0025)
(2) treatment of neonatal sepsis/infection; and
(3) oxygen support. It shall also be capable of
providing blood transfusion services on top
of its standard functions.
Comprehensive Emergency Obstetric and
Newborn Care (CEmONC)
• The policy ensures the provision of globally
Capable facility or network of facilities that can accepted evidence-based essential newborn
perform the six signal obstetric functions for care focusing on the first week of life.
BEmONC, as well as provide
• Emphasis is given to care interventions that
1. caesarean delivery services, should be provided to the newborn from
2. blood banking and transfusion services, birth until the first 6hours of life .

3. and other highly specialized obstetric A. Ensure Quality Provision of Time-Bound

interventions. Interventions

It is also capable of providing neonatal emergency 1. Within the first 30 seconds

interventions, which include at the minimum, the 1.1 Dry and provide warmth to the newborn
following: and prevent hypothermia
(1) newborn resuscitation; 2. After thorough drying
(2) treatment of neonatal sepsis/infection; 2.1 Facilitate bonding between the mother and
(3) oxygen support for neonates; her newbonr through skin-to-skin contact to
reduce likelihood of infection and hypoglycaemia
(4) management of low birth weight or preterm
newborn; and A. Ensure Quality Provision of Time-Bound
Interventions
(5) other specialized newborn services.
3. While on skin-to skin contact ( up to 3 minutes
These facilities can also serve as high volume post-delivery)
providers for Intrauterine device (IUD) and
Voluntary Surgical Contraception (VSC) services, 3.1 Reduce the incidence of anemia in term
especially tubal ligations. newborns and intraventricular hemorrhage in
preterm newborns by delaying or non-immediate
It should also provide an itinerant team that will cord clamping (clamp and cut the cord after cord
conduct out-reach services to remote communities. pulsations have stopped, typically 1-3 minutes.)
The itinerant team is typically composed of 1
physician (surgeon), 1 nurse and 1 midwife. A. Ensure Quality Provision of Time-Bound
Interventions
Administrative Order 2016-0035: Guidelines on
the Provision of Quality Antenatal Care in All 4. Within 90 minutes of age
Birthing Centers and Health Facilities Providing 4.1 Facilitate the newborn’s early intiation to
Maternity Care Services breastfeeding and transfer of colostrum through
The order seeks to improve the quality of antenatal support and initiation of breasfeeding .
care through the provision of technical guidance in 4.2 To prevent opthalmia neonatorum through
the shift in ANC concept from the high risk proper eye care ( administer erythromycin or
approach to the four-visit model of focused ANC tetracycline ointment or 2.5% povidone-iodine
drops)
B. Non-immediate Interventions -usually given These are:
within 6 hours
1. enemas and shavings,
After birth
2. fluid and food intake restriction, and
1. Give Vitamin K Prophylaxis
3. routine insertion of intravenous fluids.
2. Inject Hepatitis B and BCG vaccinations
4. Fundal pressure to facilitate second stage of
3. Examine the newborn. Check for birth labor is no longer practiced, because it
injuries, malforamations or defects resulted to maternal and newborn injuries
and death.
4. Cord care
5. Unnecessary interventions eliminated
Essential Intrapartum and Newborn Care (EINC)
Evidence-based Standard Practices 6. Likewise, the unnecessary interventions in
newborn care which include
The EINC practices are evidenced-based standards
for safe and quality care of birthing mothers and 1. routine suctioning,
their newborns, within the 48 hours of Intrapartum 2. early bathing,
period (labor and delivery) and a week of life for 3. routine separation from the mother,
the newborn. 4. foot printing,
5. application of various substances to the
In December 2009, the Secretary of the
cord,
Department of Health Francisco Duque signed
6. and giving pre-lacteals or artificial infant
Administrative Order 2009-0025, which mandates
milk formula or other breast-milk
implementation of the EINC Protocol in both public
substitutes.
and private hospitals. Likewise, the Unang Yakap
campaign was launched. *ANATOMY OPEN NA LANG PPT HAHAHA
The EINC practices during Intrapartum period
Anatomy of
1. Continuous maternal support, by a companion of Reproductive System 071819 (1).pptx
her choice, during labor and delivery
*MENSTRUATION OPEN ULIT PPT
2. Mobility during labor – the mother is still mobile,
within reason, during this stage
3. Position of choice during labor and delivery 4
neuriendocrinology and menstruation 071819 (1).pptx
4. Non-drug pain relief, before offering labor
anesthesia HUMAN SEXUALITY

5. Spontaneous pushing in a semi-upright position SEXUALITY

6. Episiotomy will not be done, unless necessary • Is a multidimensional phenomenon that

includes feelings, attitudes, and actions
7. Active management of third stage of labor
(AMTSL) • It has both biologic and cultural
components
8. Monitoring the progress of labor with the use of
partograph • It encompasses and gives direction to a
person’s physical, emotional, social and
Recommended EINC practices for newborn care
intellectual responses throughout life
are time-bound interventions at the time of birth
BIOLOGIC GENDER
1. Immediate and thorough drying of the newborn
- chromosomal sexual development
2. Early skin-to-skin contact between mother and
the newborn - male (XY) and female (XX)

3. Properly-timed cord clamping and cutting GENDER/SEXUAL IDENTITY

4. Unang Yakap (First Embrace) of the mother and - inner sense a person has of being a male or a
her newborn for early breastfeeding initiation female

Unnecessary interventions eliminated - sex a person thinks of himself

The unnecessary interventions during labor and - maybe the same or different from biologic
delivery, which do not improve the health of gender
mother and child, are eliminated.
-develops throughout the entire lifespan
GENDER ROLE
• male or female behavior a person exhibits
• activities of a person undertakes
• maybe the same or different from biologic
gender or gender identity INFLUENCE OF THE MENSTRUAL CYCLE
• culturally influenced • during the luteal phase of menstruation
• more interchangeable nowadays there said to be an increase in since there's
vasocongestion in the woman's lower pelvis
PRENATAL SEX DETERMINATION which makes her more ready for plateu and
• starts @ 12 weeks of intrauterine life. orgasm.

• (+) Wolffian duct - male INFLUENCE OF PREGNANCY

• (+) Mullerian duct - female • 1st Trimester - decrease in urge for sex due
to the physiologic changes to patient.
• concepts, questions or inquiries about sex
differs or vary with age. • 2nd Trimester - increase in libido due to
vasocongestion in the lower pelvis and
DEVELOPMENT OF GENDER IDENTITY breast, increase in oxytocin.
1. amount of testosterone secreted in utero • 3rd Trimester - increase in libido due to
2. how appealing parents or adult role models preoccupation and fear of labor and
portray their gender roles delivery. .

3. culturally influenced PEAK SEXUAL RESPONSE

4. role of women and men in society • male's sexual response is at peak during his
late teen years.
5. expectations from the child
• female's peak sexual response is on her late
HUMAN SEXUAL RESPONSE 30s because male are sexually oriented first
than female.
SEXUAL ACTIVITY
Changes in sexual desire
• 1st trimester: ↓ libido
• 2nd trimester: ↑ sexual enjoyment due to
↑ blood supply to pelvic area
• 3rd trimester: sexual desire may remain high
or decrease because of ↑ abdominal size
MODULE 2

FERTILIZATION: THE BEGINNING OF PREGNANCY

This is also referred to as conception, and impregnation,

it is the union of an ovum and spermatozoon and this
usually occurs in the ampullar portion of the fallopian
tube. OVULATION is when a mature ovum is released, it
would only take 24 hours to 48 hours at the most to
become fertilized by a spermatozoa.
 These villi will also produce various placental hormones
present during pregnancy which are HCG (Human
Chorionic Gonadotropin ), HPL (human placental
lactogen), estrogen and progesterone.Later on you will
learn more about these great hormones and their
function.

PLACENTA – It grows from a few identifiable

trophoblastic cells at the beginning of pregnancy , its
major function is to serve as a transport allowing all but
a few substances to cross from the mother into the
fetus.

THE AMNIOTIC MEMBRANES – is a dual-walled sac with

the chorion as the outermost part and the amnion as
the innermost part. The two fuse together as the
pregnancy progresses and by the term, they appear to
be as a single sac. They have no nerve supply so when
they spontaneously ruptures or artificially neither the
pregnant woman nor the fetus experiences any pain
(Coad&Dunstall.2011).

THE AMNIOTIC FLUID - the fetus continuously

swallows this fluid and it is absorbed from the fetal
intestine into the fetal blood stream, at term it is
approximately 800-1200 ml. The most important
purpose of the amniotic fluid is to shield the fetus
against pressure or blow to the mother’s abdomen. It
also protects the umbilical cord from pressure thus
protecting the fetal oxygen supply.

THE UMBILICAL CORD – is formed from the fetal

membranes, the amnion and chorion and provides a
circulatory pathway that connects the embryo to the
chorionic villi of the placenta. Its function is to
transport oxygen and nutrients to the fetus from the
placenta and to return waste products from the fetus
to the placenta. An umbilical cord contains only one
vein (carrying blood from the placenta to the fetus)
and two arteries (carrying blood from the fetus back

PLACENTAL HORMONES OF PREGNANCY

HUMAN CHORIONIC GONADOTROPIN – This is the first

placental hormone produced that can be found in
maternal blood and urine as early as the first missed
After fertilization, the fertilized ovum will now become period. Its purpose is to act as a fail-safe measure to
a zygote . after 3-4 days it migrates towards the body of ensure the corpus luteum of the ovary continues to
the uterus and that is where implantation will take produce progesterone and estrogen so the
place in approximately 8 to 10 days. Implantation is an endometrium of the uterus is maintained. It also plays a
important step in pregnancy because as many as 50% of role in suppressing the maternal immunologic response
zygotes never achieve it (Gardosi,2012). so placental tissue is not detected and rejected as a
foreign substance.
EMBRYONIC & FETAL STRUCTURES
ESTROGEN – is often referred to as “the hormone of
DECIDUA OR UTERINE LINING - after fertilization
women”. It contributes to the woman’s mammary gland
the corpus luteum in the ovary continues to function
development in preparation for lactation and stimulates
rather than atrophies, Human Chorionic
uterine growth to accommodate the developing fetus.
Gonadotropin secreted by the trophoblast cell will
cause the uterine endometrium to continue to grow in PROGESTERONE – This is often referred to as
thickness and vascularity instead of sloughing off as in a “hormones that maintains pregnancy”, it is necessary to
usual menstrual cycle. The endometrium is now maintain the endometrial lining of the uterus during
called decidua and it will be discarded after birth of the pregnancy. It is present in the maternal serum or blood
child. as early as 4th week of pregnancy. It also prevents
premature labor as it reduces the contractility of the
CHORIONIC VILLI – these resembling probing fingers will
uterus during pregnancy.
reach out from the trophoblast cell into the uterine
endometrium to begin formation of the placenta.
HUMAN PLACENTAL LACTOGEN – it is a hormone with birth because Vitamin K is necessary for blood clotting
both growth promoting and lactogenic (milk-producing and is synthesized by the action of bacteria in the
properties). By 6th weeks it will be produced by the intestines. At 32 weeks gestation sucking and
placenta increasing to a peak level at term. It promotes swallowing reflex are now mature but will become
mammary gland growth development in preparation for strong when fetus reaches its term. At 36 weeks
lactation and stimulates uterine growth to gestation, the ability of the of the GI tract to secrete
accommodate the developing fetus. enzymes essential for carbohydrate and protein
digestion is present. Amylase an enzyme found in saliva
ORIGIN & DEVELOPMENT OF BODY TISSUE
that is necessary for digestion of complex starches will
CARDIOVASCULAR SYSTEM only mature at 3 months after birth. Newborns also
This is one of the first systems to become functional in doesn’t have lipase an enzyme needed for fat
intrauterine life. digestion that is why breast milk is best for newborns
16th day of life of the fetus = there is already a network because it can easily be digested without these
of blood vessels and single heart tube. enzymes. The liver is active throughout intrauterine life
24th day of life of the fetus = fetal heartbeat is evident. functioning as a filter between the incoming blood and
10th to 12 th week of pregnancy = the fetal heartbeat the fetal circulation and as a deposit site for fetal stores
maybe heard with a Doppler. such as iron and glycogen.
After the 28th week of pregnancy = the heart rate
MUSCULOSKELETAL SYSTEM
stabilizes and a 110 to 160 beats/min is assessed.
First 2 weeks of life, cartilage prototypes provide
RESPIRATORY SYSTEM position and support to the fetus. Ossification of
3rd week of intrauterine life = the respiratory and this cartilage into bone begins at about the 12 th week
digestive tracts exist as a single tube. and continues all through fetal life and into adulthood.
End of 4th week = a septum begins to divide the
REPRODUCTIVE SYSTEM
esophagus from the trachea.
A child’s sex is determined at the moment of conception
3 months gestation = spontaneous respiratory practice
by a spermatozoon carrying an X or a Y chromosome
movements begins and continue throughout pregnancy.
and can be ascertained as early as 8 weeks by
SURFACTANT = this develops at approximately 24th
chromosomal analysis. The male or father of the baby
week of pregnancy. Its primary function is to improve
carries XY chromosomes, while the mother carries an X
the infant’s ability to maintain respirations in
chromosomes. The father will determine the fetal sex, if
the outside environment after birth (Rojas-Reyes,
X will be paired with Y it will become XY (male fetus). If
Morley & amp; Soll 2012).
X will be paired with X it will become XX (female fetus).
NERVOUS SYSTEM The testes first form in the abdominal cavity and do not
3rd week of gestation = the top portion of the neural descend into the scrotal sac until 34th to 38th week of
plate will differentiate into the neural tube which will intrauterine life.
form the CNS (Central Nervous System) which is the
URINARY SYSTEM
brain and spinal cord. The neural crest will form the PNS
Kidneys are present as early as the end of the 4 th week
(Peripheral Nervous System). All parts of the brain (
of intrauterine life, the presence of kidneys does not
cerebrum, cerebellum, pons and medulla oblongata)
appear to be essential for life before birth because the
form in utero but not completely mature at birth. Brain
placenta clears the fetus of wastes products. Urine is
growth continues at high levels until 5 or 6 years of age.
formed by the 12 th week and is excreted in the
The eye and inner ear develop as a projection of the
amniotic fluid by the 16 th week of gestation.
original neural tube. By 24 weeks the ear is capable of
responding to sounds and the eyes exhibits a pupillary INTEGUMENTARY SYSTEM
reaction indicating sight is present. The skin of a fetus appears thin and almost translucent
until subcutaneous fat begins to be
ENDOCRINE SYSTEM
deposited underneath it at about 36 weeks, skin is
The fetal pancreas produces insulin needed by the fetus
covered with lanugo, soft downy hairs that serves as
(insulin doesn’t cross the placenta). The thyroid and
insulation to preserve warmth in utero as well as cream
parathyroid glands play a vital roles in fetal metabolic
cheese like substance vernix caseosa which is
function and Calcium balance.
important for lubrication and from keeping the skin
The fetal adrenal glands supply a precursor necessary
from macerating in utero. Both vernix and caseosa are
for estrogen synthesis by the placenta.
present at birth.
DIGESTIVE SYSTEM
IMMUNE SYSTEM
4th week of intrauterine life the digestive tract
Immunoglobulin (Ig) G maternal antibodies cross the
separates from respiratory tract and begins to
placenta into the fetus as early as the 20th week and
grow rapidly.
certainly by the 24th week of intrauterine life to give a
MECONIUM – this is a collection of cellular wastes, bile, fetus temporary passive immunity against diseases for
fats, mucoproteins, mucopolysaccharides and portion of which the mother has antibodies. IgA and IgM
the vernix caseosa that accumulates in the intestine as antibodies (the types which develop to actively
early as the 16th week. Meconium is sticky in counteract infection ) cannot cross the placenta, their
consistency and appears black or dark green (obtaining presence in the newborn is a proof that the fetus has
its color from bile pigment). The GI tract is sterile at been exposed to an infection.
 PANCREAS: Increases insulin production but insulin is
less effective due to estrogen, progesterone. This allows
for more glucose to to be circulating in the maternal
blood stream to be available to the fetus.

INTEGUMENTARY SYSTEM CHANGES

The uterus increases in size the abdominal wall
stretches then causes rupture and atrophy of
small segments of the connective layer of the skin
PHYSIOLOGICAL CHANGES OF PREGNANCY leading to striae gravidarum in the thighs and
abdominal wall. The umbilicus also stretches by 28th
Physiological changes that occur during pregnancy are
week of pregnancy and becomes obliterated and
the basis for the signs and symptoms used to confirm a
pushed and appears it has turned inside out protruding
pregnancy. They can be categorized as local (confined to
as a round bump at the center of the abdominal wall.
the reproductive organs) or systemic (affecting the
A narrow brown line called linea nigra may form
entire body).
running from the umbilicus to the symphysis
REPRODUCTIVE SYSTEM CHANGES pubis. Darkened or reddened areas may appear on the
Reproductive tract changes are those involving the face as well and on cheeks and nose known
uterus, ovaries, vagina and breasts. The most obvious as melasma or chloasma or the “mask of pregnancy”.
alteration in a woman’s body during pregnancy is the
RESPIRATORY SYSTEM CHANGES
increase in the size of the uterus to accommodate the
A local change that often occurs here is congestion or
growing fetus.
stuffiness of the nasopharynx as a response to
UTERINE CHANGES: increased estrogen levels. Towards the end of
UTERUS – increases in size to accommodate the pregnancy the diaphragm is displaced by as much as
growing fetus. 4cm upward.
Length: from 6.5 cm to 32 cm Width: from 4cm to 24 cm
CARDIOVASCULAR AND HEMATOLOGIC SYSTEM
Depth: from 2.5 to 22 cm Weight: from 50g to 1000g
CHANGES
BREAST CHANGES – typical changes are feeling of Changes in the circulatory system are extremely
fullness, tingling or tenderness that occurs because significant to the health of the fetus because they
of the stimulation of the breast tissue by the high determine whether there will be adequate placental
estrogen level in her body. As the pregnancy and fetal circulation for oxygenation and nutrition.
progresses, breast size increases because of the growth
GASTROINTESTINAL SYSTEM CHANGES
in the mammary alveoli and in fats deposit. The areola
Nausea and vomiting are experienced earlier in
of the nipple darkens and its diameter increases from
pregnancy and this is the first sensation a woman
about 3.5cm to 5cm. There is additional darkening of
experiences with pregnancy. It is most apparent early in
the skin surrounding the areola in some women,
the morning on rising and if tired during the day. It is
forming a secondary areola. The breast will begin to be
known as morning sickness, it is felt at the same time
ready for the secretion of milk, by the 16th
the HCG and progesterone begins to rise.
week colostrum, the thin watery, high protein fluid that
is the precursor of breast milk can be expelled from the GENITOURINARY SYSTEM CHANGES
nipples. As vascularity of the breasts increases, blue Like any other systems, the urinary system undergoes
veins may become prominent over the surface of the specific physiologic changes during pregnancy, including
breasts. The sebaceous glands of the alterations in fluid retention and renal, ureter and
areola (Montgomery’s tubercles) which keep the nipple bladder functions. These changes are due to the
supple and helps to prevent nipples from cracking following : effects of high estrogen and
and drying during lactation, enlarge and become progesterone, compression to the bladder and ureters
protuberant. by the growing uterus, increase blood volume to
the kidneys that results to increase in urine production
ENDOCRINE SYSTEM CHANGES
and lastly postural influences by the pregnant woman.
Almost all aspects of the endocrine system increase
during pregnancy in order to support fetal growth MUSCULOSKELETAL SYSTEM CHANGES
PLACENTA: Produces estrogen and progesterone (which
Calcium and Phosphorus needs are increased during
helps maintain pregnancy), HCG (which allows detection
pregnancy because an entire fetal skeleton must be
of early pregnancy).
built. The ovarian hormones relaxin and placental
PITUITARY GLAND: It produces increased levels of
progesterone softens the woman’s pelvic ligaments and
prolactin (milk production); produces oxytocin which is
joints to create pliability and to facilitate the passage of
necessary for labor contraction.
the baby through the pelvis at birth.
THYROID: Increases levels of hormones that increase
the basal metabolic rate by 20% and can lead IMMUNE SYSTEM CHANGES
to increase emotional lability, perspiration, tachycardia Immunologic competency during pregnancy decreases ,
and palpitations. probably to prevent a woman’s body
ADRENAL GLANDS : Increases level of corticosteroids from rejecting the fetus as if it were a transplanted
and aldosterone inhibits immune response organ. Immunoglobulin G (IgG) production
thereby preventing rejection of fetus.
is decreased , that makes a woman prone to infection
during pregnancy.

Antepartal: Clinical Approach to Pregnancy

PRESUMPTIVE SYMPTOMS OF PREGNANCY

AMENORRHEA Absence of menstruation

MELASMA Dark pigment forms on face

QUICKENING Fetal movement felt by woman

LINEA NEGRA Line of dark pigment forms on the abdomen

STRIAE GRAVIDARUM Stretchmarks form on the abdomen

TINGLING SENSATION Feelings of tenderness, fullness, tingling,

in BREAST enlargement and darkening of areola

NAUSEA & VOMITING Upon arising or when in fatigue

FREQUENT URINATION Sense of being have to void more often than

usual.

FATIGUE General feeling of tiredness.

PROBABLE SYMPTOMS OF PREGNANCY

CHADWICK’S SIGN Color change of vagina from pink to violet

GOODELL’S SIGN Softening of the cervix

HEGAR’S SIGN Softening of the lower uterine segment

BALLOTTEMENT When lower uterine segment is tapped on a

bimanual examination the fetus can be felt to
rise against the abdominal wall

BRAXTON HICKS Periodic uterine tightening occurs

CONTRACTION
FETAL OUTLINE FELT Fetal outline can be palpated through abdomen
BY EXAMINER

POSITIVE SYMPTOMS OF PREGNANCY

PRESENCE OF FETAL Presence of fetal heartbeat heard through

HEARTBEAT stethoscope or Doppler

FETAL MOVEMENTS FELT An examiner can feel fetal movements about 20-
BY EXAMINER 24th weeks

VISUALIZATION OF THE If a woman is pregnant, a characteristic ring

FETUS by ULTRASOUND indicating the gestational sac will be revealed and
with a beating fetal heart

The first prenatal visit is a time to establish baseline data relevant to a woman’s health and identify health promotion
strategies that will be important at every prenatal visit. This begins by obtaining a detailed health and sexual history
including screening for the risk of teratogen (any factor that may adversely affect the fetus) exposure as well as any
concerns a woman has about her pregnancy.

The overall purposes of prenatal care includes:

1. To establish a baseline of present health of the mother.
2. To determine the age of gestation of the fetus.
3. To monitor maternal well being and fetal development.
4. To identify women who are at risk in developing maternal complications.
5. Provide health education about pregnancy, lactation and newborn care.

Women should schedule a first prenatal visit as soon as they suspect that they are pregnant, the return appointments
are usually scheduled every 4 weeks.

FLOW OF PRENATAL VISIT TO AN OBSTETRICIAN

PRENATAL VISITS UP TO LABOR AND DELIVERY

ASSESSING MATERNAL WEIGHT GAIN weighs more than 500-600 grams ) whether infants
were born alive or not.
WEIGHT GAIN in pregnancy occurs from both fetal
growth and an accumulation of maternal stores and G-gravida; the current pregnancy T-term, number of full
increases by 1.5 lb per month during the first trimester term infants born at 37 weeks age of gestation and
and 1 lb per week during the last two trimesters. To beyond P-preterm, number of preterm infants born
summarize the weight increases there is an (infants born before 37 weeks) A-abortions, the number
approximately 4.5 lb during first trimester, 12 lb second of pregnancies ending before 24 weeks L-living, it is
trimester and 12 lb last trimester. Assure the pregnant the number of living children.
woman that this a lot of weight gain can easily be lost
PREPARING FOR CHILDBIRTH: PARENTING
afterwards.
Preparation for Labor and Delivery
AGE OF GESTATION (AOG) DETERMINATION BY
FUNDIC HEIGHT (FH) - Major approaches to prepare childbirth –
pregnant couples are taught about anatomy,
A. BARTHOLOMEW – at 20 weeks, FH approximates 20
pregnancy, labour and delivery, relaxation
cm at the level of the umbilicus.
techniques, breathing exercises, hygiene, diet,
(view the drawing in this module) comfort measures ( sacral pressure and
effleurage ).
B. McDONALD’S RULE – FH in cm x 2/7 = AOG in
months.
Preparation for Labor and Delivery
FH in cm x 8/7= AOG in
weeks. GRANTLY DICK READ METHOD

C. EXPECTED DATE OF CONFINEMENT (EDC) NAEGELE'S - Fear leads to tension and tension leads to pain
RULE

LMP + 7 days – 3 months + 1 year LAMAZE METHOD

THE GRAVIDA-PARA NOTATION - Psycho prophylactic method based on stimulus

response and conditioning. Classes on or after
G = Gravida or total number of pregnancies
the 26th week up to end.
P = Para or outcomes of pregnancies
LEBOYER METHOD
T = full Term
- Lights are dimmed, room is warm with
P = Premature minimum of noise. Skin-to-skin contact is
initiated immediately after delivery
A = Abortion
CLINIC APPOINTMENTS
L = Living children
• First 7 Lunar months – every month
• 8th and 9th Lunar months – every other week /
OBSTERIC HISTORY TERMS twice a month
• 10th lunar month – every week until labor pain
are important in the conduction of maternal health sets in
history during the first prenatal visit GRAVIDA is the
state of being pregnant and the total number of
pregnancies including present pregnancy PARA is the
number of pregnancies reaching the age of viability (the
earliest age at which fetuses survive if they are born is
generally accepted at 24 weeks or at the point a fetus
SIGNS INDICATING POSSIBLE COMPLICATIONS NURSING CONSIDERATIONS IN THE MANAGEMENT OF
OF PREGNANCY PREGNANCY INDUCED HYPERTENSION.

DANGER SIGNS OF PREGNANCY • Visual disturbances

- Visual disturbances or continuous headaches
1. VAGINAL BLEEDING - Early.onset or spotting of
may signal cerebral edema or acute
bleeding should be reported to the Obstetrician
hypertension
As soon as possible
- Be certain a woman is not reporting symptoms
she had before she
2. PERSISTENT VOMITING - A vomiting which
became pregnant.
occurs 3-4 times a day and almost results to a
- If she had the same visual and difficulties and
lost in weight on the pregnant woman of 10 lbs.
headaches. Before pregnancy as she is reporting
now, she may need to see an Opthalmologist
3. CHILLS AND FEVER - Any fever during pregnancy
rather than her Obstetrician to help her with
should also be reported to the Obstetrician as
the problem
soon as possible

4. SUDDEN ESCAPE OF CLEAR FLUID FROM THE P – PROMOTE BED REST

VAGINA - Another danger signal that should be
E – ENSURE HIGH PROTEIN INTAKE (1g/1kg/1day)
taken into immediate action or consideration.
A – ANTI HYPERTENSIVE DRUGS (HYDRALAZINE)
5. ABDOMINAL OR CHEST PAIN - Any signs of this APRESOLINE
can be fatal to the pregnant woman
C – CONVULSIONS (MAGNESIUM SULFATE)
6. PREGNANCY INDUCED HYPERTENSION - Refers E – EVALUATE PHYSICAL PARAMETERS
to a potentially severe and even fatal elevation
of blood pressure that occurs during pregnancy. BLOOD PRESSURE, URINE OUTPUT, RESPIRATIONS,
PATELLAR REFLEXES

Myths about Pregnancy

7. INCREASED OR DECREASED FETAL MOVEMENT -
Fetal kick is usually done for monitoring - Mom’s belly reveals baby’s gender
- Ask the woman about typical fetal - Cocoa butter prevents stretch marks
movements and whether she has noticed any - Pregnant mother should avoid cats
increase or decrease in this rate recently. - Moms can give colds to their developing babies
Emphasize the need for a woman to report any - Pregnant women should not wear high heels
changes she notices so that further testing - Exercise during pregnancy can strangle the baby
and follow-up can be done. - Skipping breakfast starves the baby
- Pregnant women should avoid rock concerts
Pregnancy- Induced Hypertension - Pregnant women should not dye hair
SYMPTOMS THAT SIGNALS PIH IS DEVELOPING - Sex during pregnancy hurts the baby
- Pregnant women shouldn’t fly
a. RAPID WEIGHT GAIN
- Rapid weight gain (over 2 lb per week in the MODULE 3
second trimester, 1 lb per week in the third
trimester) INTRAPARTAL PERIOD
b. Swelling of the face or fingers MODULE 3: Theories of Labor Onset
c. Flashes of light or dots before The eyes
d. Dimness or blurring of vision
e. Severe, continous headache Oxytocin Stimulation Theory
f. Decreased urine output\
Pregnancy nears term  Oxytocin produced
by posterior pituitary gland  Oxytocin
produced by posterior pituitary gland
• Some edema of the ankles
- Some edema of the ankles during Uterine Stretch Theory
pregnancy is normal , particularly
- “Any hallow muscular organ when stretched to
If it occurs after a woman has been on
its capacity will contract and empty.
Her feet for a long period of time
- “The uterine muscle stretches from the
• Swelling of the hands
increasing size of the fetus, which results in
- Ask the pregnant mother if she
release of prostaglandins.
has noticed that her ring is tight
• Swelling of the face Progesterone Deprivation Theory
- Difficulty opening of the eyes in the
 progesterone from placenta Uterine
morning due to edema of the eyelids
contraction
Indicates edema too extensive to be normal
Prostaglandin Theory Braxton Hick’s contractions

- Fetal membrane produce large amounts of ➢ irregular painless contractions of pregnancy

arachidonic acid; becomes stronger, longer, more frequent
- Arachidonic acid is converted by maternal
SHOW:
decidua into prostaglandin Prostaglandin
initiates contractions Pressure exerted by presenting part
Theory of Aging Placenta
Rupture of several blood vessels in cervix
Placenta “ages” – becomes less efficient

Blood is mixed with operculum

 progesterone  prostaglandin Cervix dilates

Show is released

Regular and strong uterine contractions Rupture of the Membrane

Fetal Adrenal Response Theory ➢ gush or steady trickle of clear fluid from the
vagina
- According to Hippocrates (Father of Medicine),
➢ caused by dilatation of the cervix and uterine
there is a hormone that causes uterine
contractions
contraction from fetal adrenal and pituitary
➢ Risks associated with ROM:
gland. Rising fetal cortisol levels reduces
• uterine infection
progesterone formation and increase
• prolapse on the umbilical cord
prostaglandin formation.
Differentiation between False and True Labor
Fetus presses on the cervix.
Contractions
- This stimulates the release of oxytocin from the
FALSE TRUE
posterior pituitary.
begin and remains begin irregularly but
irregular become regular and
predictable
Components of
Labor Process-1 (1).pptx
felt first abdominally and felt first in lower back
remain confined to the and sweep around to the
SIGNS OF LABOR
abdomen and groin abdomen in a wave
Lightening
often disappear with continue no matter what
➢ descent of the fetal presenting part into the ambulation and sleep the woman’s activity
pelvis
➢ primipara – occurs 10 –14 days before labor do not increase in increase in duration,
begins duration, frequency and frequency and intensity
➢ multipara – occurs before labor onset intensity
➢ may result to:
o Relief of respiratory discomfort do not achieve cervical achieve cervical
o Urinary frequency dilatation dilatation
o Leg pains caused by compression of
sciatic nerve
o Muscle spasms INVASIVE AND NON-INVASIVE ASSESSMENT OF FETAL
o Increase vaginal discharge WELL-BEING
o Decrease in fundal height.

Ripening of the Cervix

 cervix becomes “buttersoft” and tips forward

 seen in pelvic exam

Increase in level of activity

 due to increase in adrenal gland secretion

(epinephrine) 2 weeks prior to labor Fetal Movement:

 prepares the mother for labor Sandovsky method:

• have woman eat meal, snack (eg milk)

• mother lie in a left recumbent
 • mother observes and record how many fetal • transducer is placed over abdomen to monitor
movement she feels over the next hour. uterine contractions and FHR
• monitor patient for 30 minutes after the test to
RESULTS:
see that contractions are quiet and preterm
• Normal: minimun of twice every 10 minutes labor does not begin
or average of 10-12 per hour
• if less than 10 per hour, mother repeats the
test for the next hour
• woman report if fewer than 10 movements
in the chosen two hours

Cardiff method (count-to-ten)

• mother observes and record the time interval it

takes for her to feel 10 fetal movements
• Begin at the same time each day (usually in the
morning, after breakfast) and count each fetal
movement
• Expected findings – 10 movements in 1 hour or
less
• Warning signs
✓ more then 1 hour to reach 10
movements
✓ less then 10 movements in 2 hours(non-
reactive- fetal distress)
✓ longer time to reach 10 FMs than on
previous days
✓ movement are becoming weaker, less
vigorous

NON STRESS TEST

• measures the response of the FHR to fetal

movement
• when fetus moves, the FHR should increase
about 15 beats per minute and should be
elevated for 15 seconds.
• done for 10 to 20 minutes
• can be done between 32 – 34 weeks’ gestation
• position: semi-fowler’s, lateral tilt (not supine)

Fetal Biophysical Scoring

CONTRACTION STRESS TEST

Basis

• Healthy fetus can withstand a decrease in

Oxygen supply during a physiologic stress of an
Scoring:
oxytocin – stimulated contraction
• A compromised fetus will demonstrate late 8 –10 = Maximal score
decelerations indicative of uteroplacental
insufficiency 6 – 7 = Worrisome
• Requirement: 3 contractions with 40 seconds 0 – 4 = severe fetal compromise
(or more) duration within 10 minute period
• Stimulation: DIAGNOSTIC PROCEDURES
➢ Nipple stimulation Ultrasound:
➢ Oxytocin stimulation
• Position : Semi-fowler’s (not supine) ✓ to diagnose pregnancy as early as 6 weeks’
gestation
 ✓ to confirm the presence, size, and location of THE SECOND STAGE OF LABOR
placenta and amniotic fluid
• Contractions (severe)
✓ to establish that a fetus is growing and has no
• Bearing down - bulging – crowning
gross anomalies
• Urge to push
✓ to establish sex if penis is revealed
• Transfer to DR
✓ to establish presentation and position of the
• Position:
fetus
➢ Lithotomy
✓ to predict maturity by measurement of the
➢ Dorsal recumbent
biparietal diameter of the head
➢ Left lateral position
• (8.5 cm = 40 weeks’ gestation,
➢ Squatting position
>2500gm)
• Delivery
Preparation: ➢ NSD
➢ Ritgen’s manuever
Abdominal UTZ
➢ Episiotomy
➢ woman drinks a full glass of water every 15 ➢ Mediolateral
minutes beginning 90 minutes before the ➢ Median
procedure
➢ should NOT void before the procedure

Transvaginal UTZ

➢ no need for a full bladder

➢ warm gel to room temp or slightly warmer (cold
gel may cause uncomfortable uterine cramping)

STAGES OF LABOR

1st stage - Dilatation / Cervical

 13-18 h - primi
THE THIRD STAGE OF LABOR
 8-9 h - multiparas
DELIVERY OF PLACENTA
2nd stage – Expulsion
Placental Stage:
 2h – primi
➢ Begins with the birth of the infant and ends
 20 min - multiparas
with the delivery of the placenta.
3rd stage - Placental
TWO PHASES OF PLACENTAL DELIVERY
 20 min
1. Placental Separation
th
4 stage - Immediate recovery/post-partum • Shultze
➢ separation starts from the center
 From 1-4 h
➢ shiny and smooth fetal side is delivered first
➢ 80% of deliveries
• Duncan
➢ Separation starts from edges of placenta
maternal surface delivered first looks raw, red,
irregular with ridges and cotyledons that
separates.
2. Placental Expulsion
➢ naturally by bearing down effort by the mother
CARE OF WOMAN DURING THE FIRST STAGE OF LABOR ➢ manually by gentle pressure on the contracted
B - Back rubs uterine fundus by physician or nurse-midwife
A - Ambulation; LLP; Trendelenburg METHODS OF PLACENTAL SEPARATION
S - Sacral pressure
E – Effluerage Shultze
- Empty bladder (q 2-3hr) 3. separation starts from the center
M – Medications 4. shiny and smooth fetal side is delivered first
A - Assess: FHR, VS, Amniotic fluid, uterine contraction 5. 80% of deliveries
D - dry lips
- dry linen Duncan
- don’t offer food (NPO)
6. separation starts from edges of placenta
maternal surface delivered first looks raw, red,
irregular with ridges and cotyledons that
separates
SIGNS OF PLACENTAL SEPARATION

1. Lengthening of the cord.

2. A sudden gush of vaginal blood occurs
3. The placenta is visible at the vaginal opening
4. The uterus contracts and feel firm again

THE FOURTH STAGE OF LABOR

➢ The first 1 to 4 hours after birth of the placenta

➢ Repair of laceration
➢ Episiorrhapy
➢ repair of episiotomy and laceration.
➢ Episiotomy- surgical incision of the perineum
and the posterior vaginal wall.
➢ Usually done during second stage of labor to
quickly enlarge the opening for the baby to pass
through.

CARE OF WOMAN ON THE FOURTH STAGE OF

DELIVERY

➢ Perineum is cleansed
➢ Legs lowered from stirrup at the same time
➢ Sterile sanitary pad is applied
➢ If chilling occurs, provide blanket
➢ Danger: hemorrhage

Assess bladder

DISPLACED UTERUS

PREVENTS UTERINE CONTRACTION

HEMORRHAGE

Administer Oxytocin as prescribed

• to promote uterine contraction

• to decrease bleeding
• usually given after delivery of placenta
• Pitocin – 4u bolus; 30 – 40 u/li
• Methergin – IM MATERNAL RESPONSES TO LABOR

DANGER SIGNS OF LABOR Physiologic Effects of Labor on the Mother:

Cardiovascular System:

contraction

pressure against uterine arteries

 blood supply to uterus

 amount of blood in general circulation

 peripheral resistance

 Bp (15mmHg – systolic)
CARDIOVASCULAR SYSTEM: Gastrointestinal System

➢ Increase Cardiac output ( 40 – 50 %) Shunting of blood to life-sustaining organs

➢ Increase PR Pressure on the stomach and intestines from
➢ Blood loss 300 – 500ml contracting uterus
➢ not detrimental because there was  in blood
volume during pregnancy
Fairly inactive during labor
HEMAPOIETIC SYSTEM:

➢ Leukocytosis ( WBC) 25, 000 – 30,000

cells/mm3 Slow digestion
➢ Respiratory system Delayed gastric emptying
➢  RR
➢ Total consumption of oxygen increase by 100 % Neurologic and Sensory response
during 2nd stage ➢ Pain -  PR, RR
Temperature Regulation ➢ Early labor – pain is due to contracting
uterus/cervix (T11– 12 nerves)
 muscular activity ➢ During birth – pain is centered in perineum (S2
– S4 nerves)
➢ the response to fatigue
slight elevation of temperature ➢ by the time the date of birth approaches, a
woman is generally tired from the normal
discomforts of pregnancy and has not slept well
diaphoresis – helps to cool and limit warming for the past month.
➢ the response to Fear
Fluid Balance: ➢ not aware of the labor process can lead a
➢ Insensible water loss increases during labor due woman to feel out of control and increase the
to diaphoresis and the increase in rate and level of pain she might experience.
depth of respirations. MODULE 4
Urinary system POST PARTUM/ POSTPARTAL PERIOD
 fluid intake insensible heat loss • This refers to the 6 week period after childbirth
or fourth trimester of pregnancy.
• Retrogressive maternal changes like involution
of the uterus and vagina.
Kidney will concentrate urine to preserve both fluids • Progressive maternal changes like production of
and electrolyte milk for lactation, restoration of normal
menstrual cycle and beginning of a parenting
role.
Specific gravity: 1.020 – 1.030 (normally increases) PHYSIOLOGIC CHANGES DURING THE POSPARTAL
PERIOD

• Retrogressive physiologic changes that occur

Musculoskeletal system
during the post- partal period include those
Relaxin related specifically to the reproductive system
as well as other systemic changes
• INVOLUTION – is the process whereby the
Soften pelvic cartilage reproductive organs return to their
nonpregnant state. A woman is in danger of
hemorrhage from the denuded surface of the
Symphysis pubis and coccyx uterus until in- volution is complete (Poggi,
2007).
More relaxed and movable • REPRODUCTIVE SYSTEM
• A.UTERUS
➢ immediately after birth, weighs about 1000
Stretch apart to increase pelvic ring gms.
➢ at the end of the first week, it weighs 500 gms.
➢ by the time involution is complete (6 weeks), it
weighs approximately 50 gms, similar to its
prepregnancy weight.
1. Contraction pinch large vessels at the placental
site to prevent hemorrhage. This contraction
reduces the size of the uterus
 2. the fundus of the uterus may be palpated ➢ Progestin, estrone, and estradiol are at pre
through the abdominal wall, halfway between pregnancy state by 1 week.
the umbilicus and the symphysis pubis, within a ➢ FSH remains low for about 12 days and then
few minutes after birth. begins to rise as new menstrual cycle is
3. One hour later, it will have risen to the level of initiated.
the umbilicus, where it remains for
URINARY SYSTEM - extensive diuresis begins to
approximately the next 24 hours.
take place after birth.
4. It decreases one fingerbreadth per day—on the
- urine output increases from 1500 ml to 3000
first postpartal day, it will be palpable one
ml/day during first day to fifth day after birth.
fingerbreadth below the umbilicus;
- hydronephrosis / increased size of uterus remains
5. On the second day, two fingerbreadths below
present for 4 weeks
the umbilicus; and so on.
- Diaphoresis is also present after birth.
6. UTERINE DISCHARGE:
- In early puerperium, the bladder is less sensitive to
LOCHIA - uterine flow, consisting of blood,
fullness thereby, overdistention occurs frequently.
fragments of decidua, white blood cells, mucus,
Urinary tract infection is common.
and some bacteria.
- Lactose level in urine is high as the body prepares
7. ENDOMETRIUM
for breastfeeding.
➢ by 10th day - regeneration of the epithelium is
completed CIRCULATORY SYSTEM - Continuous increase in
➢ by 16th day – the endometrium is restored fibrinogen level after delivery.
➢ At about 6 weeks – the endometrium of - Blood volume back to pre-pregnant state on the
placental site is restored 3rd week post-partum.
8. CERVIX - Blood loss with vaginal birth – 300 to 500 ml.
➢ a uterine cervix is soft and malleable. - internal - Cesarean birth – 500 to 1000 ml.
and external os are open. - WBC may be as high as 30,000 cells/mm. Part of
➢ by the end of 7 days, the external os has the body’s defense system and aid in healing.
narrowed to the size of a pencil opening; the
cervix feels firm GASTROINTESTINAL SYSTEM - Woman is hungry
➢ The internal os closes as before, but after a and thirsty after delivery.
vaginal birth the external os usually remains - Constipation is common due to dehydrating effect
slightly open and appears slitlike or stellate (star of labor, enema and decrease muscle tone in the
shaped), intestine.
9. VAGINA INTEGUMENTARY SYSTEM - the stretch marks on a
➢ soft, with few rugae. woman’s abdomen (striae gravidarum) still appear
➢ returns to prepregnant stage by 3rd or 4th reddened and may be even more prominent.
week. - Excessive pigment on the face and neck
10. PUERPERIUM (chloasma) and on the abdomen (linea nigra) will
➢ develops edema and generalized tenderness become barely de- tectable in 6 weeks’ time.
➢ presence of ecchymosis
➢ Labia minora and majora remain atrophic and EFFECTS OF RETROGRESSIVE CHANGES
softened and never returning to prepregnant 1. EXHAUSTION
state. 2. WEIGHT LOSS
11. BREAST
➢ The breasts are usually soft during the first two VITAL SIGNS CHANGES
post-partum days. On the 3rd to the 5th day
➢ reflect the internal adjustments that occur as a
they may become engorged (full and firm).
woman’s body returns to its prepregnant state.
Engorgement is brought about by hormone
1. TEMPERATURE - always taken orally or
Prolactin which is stimulated by the baby's
tympanically
sucking to promote lactation. And lactation is
➢ first 24 hours temp is slightly elevated/
also stimulated by decrease level of estrogen
increased
and progesterone.
➢ an increased of temp of 38C after 24 hours may
➢ Colostrum is secreted continuously during
mean postpartal infection
pregnancy.
➢ * If a woman’s breast is engorged on the 3rd&
➢ Breast feeding relieves breast engorgement.
4th ppd temp will slightly increased for a few
PHYSIOLOGIC CHANGES DURING THE PERIODOLOGIC hours bec of vascularity
CHANGES 2. PULSE - after birth, to accommodate the
increased blood volume returning to the heart,
SYSTEMIC CHANGES - the same body systems that are stroke volume increases thus Pulse rate is
involved in pregnancy also involved in postpartal slightly lower than normal (60 – 70 bpm)
changes as the body return to its prepregnant state. ➢ * need to evaluate pulse because rapid and
HORMONAL / ENDOCRINE SYSTEM ENDOCRINE thready pulse during this time could be a sign of
CHANGES - Human chorionic gonadotropin (hCG) and hemorrhage.
Human placental lactogen (hPL) is undetectable 1 day 3. BLOOD PRESSURE - Blood pressure should also
after delivery. be monitored carefully during the postpartal
 period, because a decrease in this can indicate NURSING CARE OF WOMAN AND FAMILY DURING THE
bleeding. In contrast, an elevation above 140 FIRST 24 HOURS AFTER BIRTH
mm Hg systolic or 90mmhg diastolic –
I. ASSESSMENT
postpartal induced HPN.
1. Health History - family profile,
PROGRESSIVE CHANGES ( Building New Tissues) pregnancy hx, labor and birht hx, infant
data, postpartal course.
1. LACTATION
2. Laboratory Assessment - hgb and hct
➢ Breast milk forms in response to the decrease in
should be measured within 12 – 24
estrogen and progesterone levels that follows
hours after delivery ( determine blood
delivery of the placenta
loss that cause anemic).
➢ which stimulates prolactin production
3. Physical Examination - this includes:
➢ milk production.
general appearance, hair, skin, breast,
➢ 3RD & 4TH day PPD Engorgement –feeling of
abdomen, puerperium and vaginal
tension in the breasts).
discharge
➢ * When the infant begins to suck the nipple its
II. NURSING DIAGNOSES and RELATED
releases Oxytocin to form new milk.
INTERVENTIONS
2. RETURN OF MESNTRUAL FLOW
1. Nursing Diagnosis: Pain related to
➢ after placental delivery production of estrogen
uterine cramping (afterpains)
and progesterone ends.
Outcome Evaluation: Client states
➢ increase production of FSH in Pituitary Gland.
degree of pain is tolerable;
➢ which result to the start of OVULATION.
demonstrates knowledge of measures
➢ *A woman who is not breastfeeding can expect
for adequate pain relief.
her menstrual flow to return in 6 to 10 weeks
2. Nursing Diagnosis: Risk for infection
after birth.
(uterine) related to lochia and denuded
➢ If she is breastfeeding, a menstrual flow may
uterine surface
not return for 3 or 4 months (lactational
Outcome Evaluation: Client’s
amenorrhea
temperature remains below 100.4° F;
Psychological Adaptation—Maternal and Paternal lochia is present and without foul odor.
Adjustment 3. Nursing Diagnosis: Disturbed sleep
pattern related to exhaustion from and
Maternal Adjustment (Reva Rubin, 1961)—know these excitement of childbirth
characteristics that you will see in the mother. Outcome Evaluation: Client states she
➢ Taking In Phase—dependent phase is able to sleep and feels rested during
➢ 1st 24 hours range 1-2 days, focus on self and postpartal period.
meeting basic needs, reliance on others to meet 4. Nursing Diagnosis: Risk for
needs of comfort, rest, closeness, nourishment, bathing/hygiene self-care deficit related
relives birth, excited and talkative to exhaustion from childbirth
➢ Taking Hold Phase—dependent/independent Outcome Evaluation: Client takes daily
phase responsibility for own hygiene. Client
- Starts end of 3rd day pp, last for 10 days to appears clean, dressed, and well
several weeks, focuses on care of baby, desire groomed.
to take charge, still need nurturing and 5. Nursing Diagnosis: Imbalanced
acceptance by others, eagerness to learn nutrition, less than body requirements,
(period to teach most receptive time to learn), related to lack of knowledge about
possible experience pp “blues” postpartal needs
➢ Letting Go Phase—interdependent phase Outcome Evaluation: Client ingests a
- Focuses on forward mov’t of family as unit with 2200- to 2700- kcal diet and drinks 6 to
interacting members, reassertion of relationship 8 glasses of fluid daily.
with partner, resumption of sexual intimacy, 6. Nursing Diagnosis: Risk for impaired
resolution of individual roles. urinary elimina- tion or constipation
➢ Postpartum Blues— Postpartum blues are related to loss of bladder and bowel
considered a transient period of depression, sensation after childbirth
occurs 1st few days of puerperium Outcome Evaluation: Client voids more
- What to assess? than 30 mL/hr without urinary
- Common symptoms are labile, crying, mood retention, beginning 1 hour after birth,
swings, anger, depression, let down feelings, and has a bowel movement by
fatigue, headaches, anxiety, postpartum day 4. No urinary
- resolves 10-14 days incontinence is noted.
7. Nursing Diagnosis: Risk for ineffective
peripheral tis- sue perfusion related to
immobility and increased es- trogen
level
Outcome Evaluation: Client
demonstrates negative Homans’ sign
 and absence of erythema or pain in LACTATION AND BREASTFEEDING
calves of legs.
LACTATION - describes as the production of breast milk
8. Nursing Diagnosis: Pain related to
and secretion of mammary gland after delivery.
primary breast engorgement
Outcome Evaluation: Client states pain Hormones during breastfeeding:
from breast en- gorgement is at a
tolerable level. - Prolactin levels rise with nipple stimulation
9. Nursing Diagnosis: Health-seeking - Alveolar cells make milk in response to prolactin
behaviors related to future breast when the baby sucks
health - Oxytocin causes the alveoli to squeeze the
Outcome Evaluation: Client states the newly produced milk into the duct system
importance of once-yearly breast
examination by a health care provider
(or a yearly mammogram, if appropriate LACTATION&BREAS
TFEEDING LEC PPT.pdf
for her age) and her intention to
schedule this examina- tion yearly.

MANAGEMENT OF PUERPERIUM
FAMILY
PLANNING2-1.pdf
1. Assessment for evaluation
A. Check height, consistency of the fundus
every four hours. On delivery day and less
frequent thereafter.
B. Check vital signs every four hours.
C. Check amount, color and odor of lochia
every four hours.
D. Check perineum for swelling and bleeding.
E. Assess bonding.
F. Assess emotional status.
G. Assess for pain.
2. Provide comfort measures.
A. After pains is more common in multi areas
due to poor muscle tone.
• Early ambulation
• Frequent voiding
• Present during breastfeeding,
analgesic is given 1/2 hour before
breastfeeding
B. Perineal Discomfort.
1. Ice to reduce swelling (first 24 hours).
2. Sitz bath and perineal light (after 24
hours).
3. Perineal care after each voiding.
4. Analgesics if measures failed.
5. Perineal exercises – Kegel exercise.
6. Provide perineal care
C. Breast engorgement
1. Well fitting brassiere at all times
2. 2. Ice pack for non-breast feeders.
3. Warm soaks breast feeders.
4. Analgesics, last resort.
3. Provision of rest.
A. planned nursing care.
B. regulated visiting hours.
4. Discuss Sexual Relations
A. can resume if episiotomy heals and
bleeding stops, usually 3-4 weeks.
B. use method of contraception except pills if
breast-feeding.
C. discontinue if bleeding occurs
5. Discuss Nutrition.
• requires 3000 calories if breastfeeding
and 2300 or 2400 if not breastfeeding.
6. Breastfeeding