MIDWIFERY 101- CP

Learning Objectives:

At the end of the lesson, the students should be able to:

a. Identify the terminologies of pregnancy;

b. Identify the signs and symptoms of pregnancy;
c. Identify the signs of true labor;
d. Determine the care during the stage of labor;
e. Observe the placental separation;
f. Apply immediate care of the newborn;
g. Discuss the management of the fourth stage of labor;
h. Discuss management of puerperium; and
i. Apply the care of perineal wound

I . Pregnancy

Terminologies of Pregnancy

Gravida- number of times pregnant. Regardless of duration, including the present

pregnancy

A. Nulligravida –a woman who is not now and never has been pregnant.
B. Primigravida- pregnant for the first time
C. Multigravida – pregnant for the first time

Para- number of pregnancies that lasted more than 20 weeks regardless of outcome

A .Nullipara- a woman who has not given birth to a baby beyond 20 weeks gestation

B. primipara – a woman who has given birth to one baby Smore thwn 20 weeks
gestation

C. Multipara – a woman who has had two or more births at more than 20 weeks
gestation…twins or triplets count as 1 para.

Signs and Symptoms of Pregnancy

1. Presumptive Signs of Pregnancy - more on subjective signs

 Fatigue
 Amenorrhea
 Nausea and vomiting
 Skin changes
 Breast changes
 Vaginal cganges
 Quickening
 Urinary frequency
 Weight changes

2. Probable Signs of Pregnancy - objective sign

 Positive pregnancy test
 Hegars sign
 Chadwicks sign
 Abdominal straiae gravidarum
 Ballotment
 Braxton Hicks contraction
 Uterine enlargement
 Goodels sign
3. Positive Sign of Pregnancy
 Fetal Heart sound / Fetal heartbeat
 Normal Heart Rate
 Fetal movement
 Ultrasound Study
 X - ray

II. Prenatal Care

 History taking
 Vital sign and weight taking
 Identification of high risk factors

 Environmental Risk Factors in Pregnancy
1. German measles
2. Sexually transmitted disease
a. Chlamydial infection
b. Syphilis
c. Herpes
d. Gonorrhea
e. HIV - human immunodeficiency infection
3. Drugs, alcohol, tobacco
4. Radiation exposure
5. Other risk factor
 Leopolds maneuver - are performed in pregnancy after the uterus
become large enough to allow sssdifferentiation of fetal parts by
palpation
 First maneuver
 Second maneuver
 Third maneuver
 Fouth maneuver
 Mc Donalds Methods & Rule ( measuring fundic height using tape
measure )
McDonalds rule; In months; Fundic Height ( cm ) multiplied ( x ) 2/
7

Example: 25 cm X 2 = 50 = 7 months
7 7
In weeks : Fundic Height ( cm ) multiplied ( X ) 8/7
Examples: 25 cm X 8 = 200 = 28 – 29 weeks
7 7
 Methods of Calculating AGE OF Gestation AOG by weeks
 Neagle’s Rule
Formula in finding expected/ estimated date of confinement ( EDC )
or estimated due date ( EDD )
Add 7 days to the first day of last menstruation period ( LMP )
Substract 3 month
Add 1 year
Example:
First day of LMP – September 16, 1998
Add 7 days = 23
Subtract 3 months –
June 23 add 1 year –
June 1999 will be esti-
Mated due date ( EDD
 Auscultation for FHB
 AOG and EDC computation
 Immunization
Types of immumization
 Urine Exam for albumin and sugar
 Mothers class

III. Labor and Delivery

A. Signs and Symptoms of true labor
 Contractions – regular, increase in frequency, intensity and duration
 Intervals of contraction- shorter between contractions
 Pain / discomfort – back then radiates to the abdomen, not relieved by
walking
 Bloody show – present
 With effacement and dilatation; fetal descent progresses
 Montoring Progress of Labor
 Uterine contractions
 Duration
 Interval
 Intensity
 Partograph
 Vaginal Examination

o Cervical changes in the first stage of labor

1. Effacement
2. Dilation
o Second stage of labor ( Expulsion stage )
From full dilatation of cervix to birth of baby
o Third stage of labor placental stage
From birth of baby to expulsion of placenta
Assessmsnt:
1. Signs of placental separation
a. Calkin’s sign – earliest sign of placental separation
Change in shape of uterus
( discoid uterine shape to globular )
b. Sudden gush of vaginal blood
c. Lengthening of umbilical cord
Types of placental Delivery
 Shultz: placental separates from center to the edge
 Duncan; Placental separates from edge to the center
o Fourth stage of labor ( Recovery stage )
Time after birth of immediate recovery: critical period of 1 – 2 hours.
Assessment :
a. Fundal firmness, postion
b. Lochia: color, amount
c. Perineum
d. Vital signs
e. IV if running
f. Infant’s heart rate, airways, color, muscle tone, reflexes , warmth,activity state
g. Bonding / family integration

PROCEDURE :

1. Catheterization
2. Enema
3. Perineal flushing

o Care During the first stage of labor

1. Vital signs
2. Comfort measures
3. Diet
4. Positioning
5. Emotional support

o Care During the second stage of labor

1. Draping
2. Observation of mechanism of labor
Mechanism of labor
A .engagement
b.descent
c. flexion
d. internal rotation
f.extension
external rotation

h.expulsion

3. Ritgen’s maneuver

4. Delivery Technique

o Observation of the Signs of placental Separation

o Delivery and inspection of the placenta
o Injection of Oxytocic
o Inspection of the perineum
o Measure blood loss
o Identification and classification of laceration
o Repair of lacerations
o Repair of lacerations
o Perineal Flushing
o After Care

 Immediate Care of the Newborn

1. Apgar Scoring
2. Suctioning of Mucous
3. Maintain body temperature
4. Bonding
5. Cord dressing
6. Eye prophylaxis
7. Rectal Temperature Taking
8. Identification
9. Vitamin K Injection
10. BCG Administration
11. Anthropometric Measurement
12. Newborn Screening
13. Regisration of birth

 Management of the Fourth Stage of labor

1. Vital Signs
2. Watch for Uterine Atony
3. Observation of lochia
4. Observation of Distended Bladde

 Management of Puerperium
1. Vital Signs
2. Physical Assessment
3. Breast Care
4. Measurement of Fundal Height
5. Observation of Lochia ( color, odor, amount )
6. Care of Perineal Wound
7. Elimination of Bowel and Bladder
8. Inspection of lower extremities for edema, varicosities, milk legss
9. Ambulation
10. Family Planning Counciling
11. Health Instructions