NCM 107A MATERNAL AND CHILD HEALTH NURSING 1ST SEMESTER || MIDTERMS ESSON 1 : ESSENTIAL INTRAPARTUM L NEWBORN CARE –Ms. Ladiao– EVIDENCE BASED STANDARD PRACTICES ● Is a package of evidence-based practices recommended by WHO, DOH, and PhilHealth, as the standard of care in all births by skilled attendants in all government and private settings. ● It is a basic component of DOH maternal, newborn and child health and nutrition strategy. ● The EINC practices are evidenced-base standards for safe and quality care of birthing mothers and their newborns, within the 48 hours of Intrapartum period ( labor and delivery ) and a week of life for the newborn. ● Developed and field tested by international and local experts, EINC practices reflect current knowledge. ● EINC distinguishes thenecessarypractices inthedeliveryandcareforthenewbornand the mother, from the unnecessary. ● In December 2009, the Secretary of the Department of Health Francisco Duque signed Administrative Order 2009 - 0025, which mandates implementation of the EINC Protocol in both public and private hospitals. ● Likewise, the Unang Yakap campaign was launched. ● UnangYakap(FirstEmbrace)isacampaign of the Philippines’ Department of Health (DOH),incooperationwiththeWorldHealth Organization (WHO),toadopttheEssential Intrapartum Newborn Care ( EINC ) in the Philippines. HAT IS THE RELATIONSHIP OF EINC W PROTOCOL WITH REGARDS TO THE MATERNAL, NEWBORN AND CHILD HEALTH NUTRITION STRATEGY? he MNCHN Strategy is in line with the DOH T Administrative Order 2008 - 0029 that seeks to rapidly reduce maternal and newborn morbidity and mortality.ForemosttothisistheprovisionofBasic and Comprehensive Emergency Obstetric and Newborn Care (BEmONC and CEmONC) capability of health facilities to meet the United Nations MDGs (Millenium Development Goals) (Reducechildmortality)and5(Improvematernal 4 health).Newborncarehasbeenincorporatedinthe provision of these service capabilities. NITEDNATIONSMILLENNIUMDEVELOPMENT U GOALS he eight Millennium Development Goals T (MDGs) – which range from halving extreme povertyratestohaltingthespreadofHIV/AIDSand providing universal primary education, all by the targetdateof2015–fromablueprintagreedtoby all the world’s countriesandalltheworld’sleading development institutions. They have galvanized unprecedented efforts to meet the needs of the world’s poorest. The UN is also working with governments, civil society and other partners to build on the momentum generated by the MDGs and carry on with an ambitious post-2015 development agenda. In most developing countries, the MDGs have formed a critical element of government policy- decisions for performance benchmarking. Although Africa as a whole has experienced remarkable change since the goals were set in 2000, sub- Saharan Africa is claimed to be the region that has witnessed the least MDG progress compared to other developing regions. lthough considerable achievements have been A made on many of the MDG targets universally, progress has not been uniform across the developing regions and nations, leaving substantial gaps. Millions of people are lagging behind, especially the poor and disadvantaged due to their age, sex, ethnicity, disability, and geographic location. MDG1– eradicate poverty and hunger ● Millions continue to live in hunger and poverty, lacking access to basic services ● Despite remarkable progress, about 800 million people continue to live in absolute poverty and suffer from hunger. More than 160 million children below 5-years have 1| MIDTERMS inadequate height for their age because of insufficient food. MDG2– Achieve Universal Primary Education ● In 2015, 57 million children of primary school age did not attend school. ● Compared to children in the richest households, those in the poorest households arefourtimesmorelikelytobe out ofschool.Under-fivemortalityratesare nearly twice as high for children in the poorest households compared to the wealthiest households DG3:PromoteGenderEqualityandEmpower M Women ● Genderinequalitypersists.Womeninmany parts of the world continue to face discrimination in access to economic assets,work,andparticipationinpublicand private decision-making. They are also more likely to live in poverty compared to men. ● In the Caribbean and Latin America, the ratio of women to men in poor households grewfrom108womenforevery100mento 117 for every 100 men between 1997 and 2012,despitethedecreasingrateofpoverty for the entire region. ● With regard to the global labor market, women remain at a disadvantage, as three-quartersofworking-agementakepart in the labor force compared to only fifty percent of working-age women. Women also earn 24 percent less than men worldwide. ● In85percentofthe92nationswithdataon the rate of unemployment based on the level of education between 2012 and ’13, women with tertiary educationtendtohave higher rates of unemploymentcomparedto men with similar levels of education. MDG 4: Reduce Child Mortality ● About 16,000 children die each day before they reach five years ofage,mostlydueto preventable causes. ● Huge gaps still exist between the poorest andrichesthouseholds,aswellasbetween rural and urban areas ● In the developing nations, children from20 percentofthepooresthouseholdsaremore than twice as likely to be stunted as those from 20 percent of the wealthiest. MDG 5: Improve Maternal Health he maternal mortality ratio in developing ● T nations is 14 times higher than in the developed nations. ● Just 50 percent of pregnant women in developing countries can receive the recommendedminimumof4antenatalcare visits ● Inruralareas,44percentofbirthsaredone in the absence of skilled health personnel, compared with 13 percent in urban areas. DG 6: Combat HIV/AIDS, Malaria and Other M Diseases ● An estimated 36 percentofthe31.5million peoplelivingwithHIVindevelopingnations were said to be receiving ART in 2013. MDG 7: Ensure Environmental Sustainability ● Closeto5.2millionhectaresofforestcover were lost in 2010. ● Climate change and environmental degradation undercut progress achieved ● Global emissions of carbon dioxide have increased by more than 50 percent since 1990. The surge in greenhouse gas emissions has impacted climate change with regard to weather extremes, altered ecosystems, and risks to society, which remainurgentandcriticalchallengesforthe universal community. ● The overexploitation of marine fish stocks resulted in the decline inthepercentageof stockswithinthesafebiologicallimits–from 90 to 71 percent between 1974 and 2011. Generally, all species are declining in numbersanddistribution,increasingtherisk of extinction. ● Water shortage affects 40 percent of the global population and is projected to increase. ● Nearly 50 percent of global workers continue to work in vulnerable conditions, and rarelygettoenjoythefruitsassociated with decent work. ● In 2015, an estimated 2.4 billion people (One in three) used unimproved sanitation facilities, including 946 million people still practicing open defecation. ● In2015,880millionpeopleareestimatedto be living in slum-like conditions in the developing region’s cities. ● About84percentoftheruralpopulationhas access to improved drinking water sources compared to 96 percent of the urban dwellers. ● Abouthalfofthepeoplelivinginruralareas have access to improved sanitation facilities, compared to82percentofpeople in urban areas. DG 8: Develop a global partnership for M development ● Conflict remains the greatest threat to human development. ● By 2015, conflicts had forced nearly 60 million people to leave their homes – the highest number recorded since the Second World War ○ Every day, about 42,000peopleare forcibly displaced and compelled to seek protection due to conflicts, which is nearly 4 times the number in 2010 (11,000). ○ 50 percent of the global refugee population is made up of children, whichhasconstitutedtheincreasein the numberofout-of-schoolchildren from 30 percent to 36 percent between 1999 and 2012. | MIDTERMS he MDG targets have led to many ● T successes, though the poorest and most vulnerable people are being leftbehind.As such, targeted efforts will be critical to reaching these disadvantaged people. ● The EINC practices during Intrapartum period ○ Continuous maternal support, by a companion of her choice, during labor and delivery ○ Mobility duringlabor–themotheris stillmobile,withinreason,duringthis stage ○ Position of choice during labor and delivery ○ Non-drug pain relief, before offering labor anesthesia pushing in a ○ Spontaneous semi-upright position ○ Episiotomy will not be done, unless necessary ○ Active management of the third stage of labor (AMTSL) ○ Monitoringtheprogressoflaborwith the use of partograph ● Recommended EINCpracticesfornewborn care are time-bound interventions at the time of birth. ● The 4 Time – bound Interventions ( Core Steps ) involved in EINC: ○ Immediate and thorough drying, ○ Early skin-to-skin contact followed by, ○ Properly-timed clamping and cutting of the cord after 1 to 3 minutes, and. ○ Non-separation ofthenewbornfrom the mother for early breastfeeding initiation and rooming-in. ESSENTIAL NEWBORN CARE 1. Immediate and thorough drying of the newborn prevents hypothermia, which is extremely important to survival. Donein30 secondstooneminute,warmsthenewborn and stimulates breathing. ● Using a clean, dry cloth, thoroughly dry the baby wiping the face, eyes, head, front and back, arms and legs. arlyskin-to-skincontactbetweenmother 2. E and the newborn. ● Keeping the mother and baby in uninterrupted skin-to-skin contact prevents hypothermia, increases colonization with protective family bacteriaandimprovesbreastfeeding initiation and exclusivity. ● if a baby is crying and breathing normally, avoid any manipulation, such asroutinesuctioning,thatmay cause trauma or introduce infection. ● Place the newborn prone on the mother’sabdomenorchestskin–to – skin. ● Covernewborn’sbackwithablanket and head with a bonnet. ● Place an identification band on the ankle. roperly-timed cord clamping and 3. P cutting. Delayed cord clamping until the umbilical cord stops pulsating decreases anemiainoneoutofeverythreepremature babies and prevents brain hemorrhage in one out of two. It prevents anemia in one out of every seven term babies. ● C lamp and cut the cord after cord pulsationshavestopped(typicallyat 1-3 minutes ) ● Put ties tightly around the cord at2 cm and 5 cm from the newborns’ abdomen. ● Cut between ties with sterile instruments. ● Observe for oozing blood. ● Do not milk the cord towards the newborn ● After cord clamping, ensure Oxytocin 10 IU IM is given to the mother. ● When umbilical cord bloodisforced intothebabyabdomen,thepressure can cause tiny blood vessels in the brain to rupture. This is especially dangerous for the most preterm infants, the researchers said. ● Slight bleeding from the umbilical cord stump is generally not serious and usually resolves within the first few weeks afterbirth.Inrarecases, newborn belly button bleeding can indicatethebabyhasaninfectionat the site of the umbilical cord stump. on-separation of the newbornfromthe 4. N motherforearlybreastfeedinginitiationand Rooming-in. reastfeeding within the first hour of life B preventsanestimated19.1%ofallneonatal deaths. ● Observe the newborn. Only when the newborn shows feeding cues ( e.g. opening of mouth, tonguing, licking, 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 baby is ready, advise the mother to: ake sure the newborn’s neck is a. M neither flexed nor twisted. b. Makesurethenewbornisfacingthe breast, with the newborn’s nose opposite her nipple and chin touching the breast. c. Hold the newborn’s body close to the mothers’ body. d. Support the newborn’s whole body, not just the neck and shoulders. e. Wait until her newborn’s mouth is opened wide. f. Move her newborn onto her breast, aiming the infant’s lower lip well below the nipple. | MIDTERMS ookforsignsofgoodattachment g. L and suckling: ● Mouth wide open ● Lower lip turned outward ● Babys’ chin touching breast ● Suckling is slow, deep with some pauses. ● If the attachment or suckling is not good, try again and reassess. UNNECESSARY INTERVENTIONS ELIMINATED ● The unnecessary interventionsduringlabor and delivery, which do not improve the health of mother and child, are eliminated. ● These are: ○ Enemas and shavings ○ Fluid and food intake restriction ○ Routine insertion of intravenous fluids. ○ Fundal pressure to facilitate the second stage of labor is no longer practiced, because it resulted in maternal and newborn injuries and death. undal Pressure is defined as manual F pressure on the fundus of the uterus towards the birthcanalinthesecondstage of labor,withtheaimofexpeditingthebirth of the baby. This fundal pressure is also known as the “Kristeller maneuver” NNECESSARYINTERVENTIONSINNEWBORN U CARE outine suctioning ( may cause trauma or ● R introduce infection ) ● Early bathing, routine separation from the mother ● Foot printing, ( causes cross-contamination) ● Application of various substances to the cord ● Giving pre-lacteals or artificial infant milk formula or other breast-milk substitutes. ● Wiping or removal of vernix caseosa (birthing custard) if present ● Transferring of the newborn to the nursery or neonatal intensive care unit without any indication. | MIDTERMS ESSON 2 : UNDERSTANDING LABOR AND L DELIVERY –Ms. Cristales– LABOR ➔ Seriesofeventsinwhichuterinecontraction will expel the fetus and placenta out from the woman’s body ➔ Partosin Greek means “to labor” ➔ Woman in labor is calledparturient PRELIMINARY SIGNS OF LABOR ➔ descent/ dipping ➔ Primiparas: occurs2 weeks before labor ➔ Multiparas: occurs a day before or in the dayof labor Signs of Lightening: ● Relief of dyspnea ● Relief of abdominal tightness ● Increased frequency in urination ● Shooting pains ● Increased amount of discharges Other Signs: ❖ Goodell’s Sign (Ripening of the Cervix) ➔ Cervix becomes as soft as the butter ❖ Braxton-Hicks Contraction (False Labor) ➔ Increase level of activity by the mother ➔ Health teaching: remind mother to conserve energy ❖ Show ➔ Blood-tinged mucus vaginal discharge ❖ Rupture of the Membranes ➔ Indication for hospitalization ➔ Nitrazine testing: pH is alkaline, it will turn to blue-green ➔ Take note of the time afterit ruptured ◆ Management will depend on it ➔ Take note of the color of amniotic fluid ➔ PROM = premature rupture of membrane area Intensity Increase Unchanged uration and D in walking BLOODY SHOW Present Absent CERVICAL DILATATION ffaces E dilates and U sually longer effacement and close cervix P’s OF LABOR (Essentials) PASSENGER ➔ Refers tofetus ➔ The body part with the widest diameter is the head Fetal Head ➔ Head has 7 bones (2 frontal,2temporal,1 occipital) ➔ Suture: thin spaces in-between bones; it willallowoverlappingofcranialboneswhen passing through the birth canal Fontanels ➔ Significantmembrane-covered spaces ➔ Lambda –posteriorfontanel ➔ Bregma –anteriorfontanel ➔ Found at the junction of the main suture lines ➔ Compress during birth to aid in molding ➔ Helpsestablishpositionoffetalheadduring IE TRUE VS FALSE LABOR TRUE FALSE CONTRACTION Interval Location Regular Irregular - Has pattern - Ex. Braxton Hicks COntraction Back to front Abdominal umbar L to hypogastric Molding ➔ Change in the shapeof the fetal skull ➔ Produced by the force of uterine contraction ➔ Pressing vertex against cervix | MIDTERMS Fetal Attitude ➔ Degree of flexion ➔ Relation of fetal parts to each other a. Good flexion/ complete flexion b. Moderate flexion/ military position c. Partial extension/ poor flexion d. Very poor flexion/ complete extension b. Breech Presentation ● Either buttocks or feet that first contact the cervix Station ➔ Relationship of the fetalpresentingpartsto the level of the Ischial spine ➔ Station +4 = crowning Fetal Lie ➔ Relationship between the long axis of the fetalbodyandthelongaxisofthewoman’s body ➔ Most ideal islongitudinal c. Transverse / shoulder presentation ➔ The presenting parts usually one of the shoulder (acromion process) ➔ Delivered via cesarean section Fetal Position ➔ Relationship of the fetal reference point to one of the quadrants of the maternal pelvis Fetal Presentation a. Cephalic Presentation Landmarks: ● Vertex ● Brow ● Face ● Mentum / chin etal F Reference Point Maternal Pelvis Side Quadrant cciput(O) O - head Right (R) Anterior entum(M) M - chin Left (L) Posterior acrum(S) S - buttocks cromion(A) A - shoulder andmarks: L Presentation ● Vertex → ● Face → ● Breech → ● Shoulder → Caput Succedaneum ➔ Diffuse swelling of the scalp in a newborncausebythepressureform the uterus or vaginal wall Transverse eference Point R occiput mentum sacrum acromion / scapula Engagement | MIDTERMS ettling of the presenting parts ofthefetus ➔ S farenoughintothepelvis,tobeatthelevel of the ischial spine ➔ Floating → presenting part not engaged ➔ Dipping →descendedbutnotreachedthe ischial spine PSYCHE ➔ Mental state or readinessof the mother ➔ Psychological state or feelings that a woman bring into labor STAGES OF LABOR PASSAGEWAY ➔ Refers tobirth canal ➔ Should be adequate in size and contour ➔ Soft passages (cervix, vagina, perineum) ➔ Bony passage ➔ Ideal female pelvis isgynecoid Cervical Changes ● Effacement → shortening and thinningof the cervix ● Dilatation → enlargement of the cervical canaltopermitthepassage of the fetus Mechanisms of Labor (EDFIEEE) ● Engagement ● Descend ● Flexion ● Internal Rotation ● Extension ● External Rotation ● Expulsion L ❖ ocation of placenta matters ❖ Placenta previa ➢ Low lying ➢ Partial ➢ Total / complete POWER ➔ Refers tohow the baby is expelled ➔ Supplied by the fundus of the uterus ➔ Implemented by the uterine contractions ➔ Causes cervical dilatation and expulsion of the fetus Contractions– “Power of Labor” Characteristics of the Uterine Contractions a. Intensity b. Frequency ● Beginning of 1 contraction to the beginning of the next contraction c. Duration ● Beginning to end of one contraction d. Interval ● Endof1contractiontothebeginning of the next Phases of Uterine Contraction a. Increment– increase b. Acme– peak c. Decrement– decrease TAGE S 1: DILATATION STAGE AND EFFACEMENT STAGE (CERVICAL STAGE) ➔ ➔ ➔ ➔ tarts onset of true labor S Ends with the full dilatationof the cervix Primi:8-12 hours Multigravida:6-8 hours PHASES OF LABOR (FRIEDMAN) HASE P STAGE / LATENT ACTIVE TRANSITION ND 2 STAGE ervical C Dilatation 1-4 cm 4-7 cm 8-10 cm Complete Interval 15-30 min 3-5 min 1 ½ - 2 min 1 ½ - 2 min Duration 15-30 sec 30-60 sec 60-90 sec Same Intensity Mild Moderate Strong Strong a. Latent Phase ➔ Properpositioning-sideortodesired position,backrub,supportsystemto stay with the client b. Active Phase ➔ Client is less talkative; more anxious, may not want to be alone, fears losing control ➔ Drugs for comfort: best given this time ➔ Maternal problem: hyperventilation (tingling sensation, or numbness of nose and lips, fingertips or toes, pallor, dizziness lightheadedness, spotsbeforetheeyes,orcarpopedal spasms) ➔ Encourage woman to slow her breathing and take shallow breaths ➔ Offer client a paperbag/breathinto cupped hands ➔ Stay with client c. Transition Stage ➔ May have a strong desire to push– should not be ➔ Lamaze suggest pant blow-pattern problem: backache, ➔ Maternal pressureonthebladderandrectum, and legs trembling ➔ Care involves comfort, coach breathing techniques, provide psychological comfort, don’t leave the client alone STAGE 2: FETAL STAGE (EXPULSION STAGE) ➔ Startsfromfull(10cm)cervicaldilatationto the birth of infant ➔ The uncontrollable urge to push and the vaginal tissues bulges and the rectum dilates ➔ Crowning occurs ➔ Maternal behavior: progress from irritability to participation | MIDTERMS ontinue to offer psychological support; ➔ C inform patient of progress of labor ◆ Praise ◆ Reassurance ◆ Encouragement ◆ Inform mother of progress ◆ Support system ◆ Touch ➔ Proper position:upright (default position) When to transfer to DR? ● Primi: 10 cm ● Multi: 8-9 cm EPISIOTOMY STAGE 4: POSTPARTUM STAGE ● 1-4 hourspostpartum ● Recovery Stage ● Hemorrhage– bleeding of 500 ml Interventions: ● VS every 15 mins ● Monitor bleeding/ lochia ● Palpate fundus every 15 mins ● Check for bladder distention ● Check perineum ● Administer meds ● Check for laceration, hematoma ● Episiorrhaphy: surgical repair of injurytothevulvabysuturing;repair of episiotomy ESSON 3 : IMMEDIATE CARE OF NEWBORN L –Ms. Cristales– DELIVERY OF THE NEWBORN Promotion of Early Latching On acilitates delivery of the fetus and ➔ F relieves pressure to the fetal head ➔ Done not to tear the perineum as the head extends ➔ Types: ◆ Midline ◆ Medio-lateral Advantages: ● Promotes maternal-child bonding ● Divertstheattentionofthemotherfrompain experience ● Initiate sucking reflex of the newborn ● Promotes uterine contraction ★ InEINC,thisisnotdoneanymoreinstead they use the Ritgen's Maneuver– extracting the fetal head,usingonehand to pull the fetal chin from between the maternal anus and the coccyx, and the otheronthefetalocciputtocontrolspeed of delivery. GOALS OF THE IMMEDIATE NEWBORN CARE 1. Establish, maintain and support respiration 2. Provide warmth, and prevent hypothermia 3. Ensure safety and prevent injury and infection 4. Identify actual or potential problems that may require immediate attention STAGE 3: PLACENTAL STAGE ➔ From birth of the fetus to delivery of the placenta ➔ Occurs 15-20 mins after thedeliveryofthe fetus ➔ The fundus lies just below the umbilicus STABLISH RESPIRATION AND MAINTAIN E CLEAR AIRWAY ● Wipe mouth and nose ● Suction secretions ● Stimulate infant to cry ● Position infant ● Keep the nares open Brandt-Andrews Maneuver ● expression of the placenta by grasping the umbilical cord with one hand and placing the other hand on the abdomen, with the fingers over the anterior surface of the uterus at the junction of the lower uterine segment and the corpus uteri ● maneuver to prevent uterine inversion Asphyxia Neonatorum ● Failuretoinitiatebreathinginthefirst60 secondsoflifecommonlyduetoclogged air passages. ● To prevent, ensure a patent airway. Signs of Placental Separation 1. Uterus becomes globular and rises up in the abdomen 2. Lengthening of the cord 3. Sudden gush of blood from the vagina Mechanism of Placental Separation ● Schulze's–fetal side ● Duncan –maternal ROVISION OF WARMTH, ANDMAINTENANCE P OF NORMAL BODY TEMPERATURE Characteristics of Newborn’s Temperature: a. Lose 2-3 degreescentigrade of heat at birth b. Immature temperature regulating system c. Has little amount of subcutaneous fat layer d. Has larger body surface he NB’s temp may be higher than the ★ T mother at birth but may start dropping continuously thereafter | MIDTERMS TABILIZING AND MAINTAINING NORMAL S TEMPERATURE ● Dry the head and body ● Put on bonnet ● Wrap with warm blanket ● Place under droplight ● Delay initial bath ● Maintain ambient temperature of the room ● Avoid unnecessary exposure PROCESSES OF HEAT LOSS 1. Evaporation: loss of heat as water evaporates from the NB’s body– dry 2. Convection: loss of heat to the cool air-wrap, flexion to minimize body surface exposed to cool air 3. Conduction:lossofheattocoolsurfacesin directcontact–donotputNBincoldunlined surfaces 4. Radiation: heat loss due to cool surfaces not in contact with the body. (walls, floor, ceiling). Wrap, use droplight ★ Kangaroo Mother Care ○ method of care of preterm infants. ○ The method involves infants being carried, usually by the mother, with skin-to-skin contact. ○ This guide is intended for health professionals responsible for the care oflow-birth-weightandpreterm infants. NEWBORNS PRODUCE HEAT BY 1. Burning down fat ● Brownfatsarefoundinthescapula, sternum, kidneys, and adrenals ● This is easily burned and produces lots of heat ● Major source of heat production ● If inexcess,mayresulttometabolic acidosis 2. Increasing activity / metabolism ● Utilizes more glucose and oxygen which may result to respiratory distress and hypoglycemia afety Alert: prevent complication of cold ★ S stress; metabolic acidosis, hypoglycemia and respiratory distress L ● eave cord exposed to air ● Apply pressure if bleeding is noted ● Note any indication of infection PREVENTION OF INFECTION Crede’s Prophylaxis: ● Introduced by Dr. Crede in 1884 ● Prophylactic treatment against gonorrheal conjunctivitis ● Ophthalmia ○ inflammation of the eye ○ Caused by Neisseria gonorrhoeae PREVENTION OF HEMORRHAGE Vitamin K Injection (Phytomenadione) ● Given at vastus lateralis ● 0.5 mg for premature ● 1.0 mg for full term ● Macrosomia–associatedwithanincreased risk of several complications, particularly maternal and/or fetal trauma during birth and neonatal hypoglycemia andrespiratory problems; newborn with an excessive birth weight; larger than 4000to4500grams(or 9 to 10 pounds) ANTHROPOMETRIC MEASUREMENT ● Head circumference ● Chest circumference ● Abdominal circumference ● Weight ● Length IDENTIFICATION ● Identification band ● Footprints ● Fingerprints ● Crib Tag INITIAL FEEDING Breastfeeding ● Can be started as soon as the cord is cut and per demand thereafter Formula Feeding ● Sterile water is given within4-6hoursafter birth ● Subsequent feedings are given every 2-3 hours APGAR SCORING SIGN ★ Nonshivering Thermogenesis ○ The distribution of brown adipose tissue (brown fat) CARE OF THE CORD ● No bathing until cord falls off ● Use only recommended antiseptic to cleanse the cord 0 1 2 1 min 5 min Heart rate Absent ess L than 100 Over 100 2 2 espiratory R Effort Absent low, S irregular Good cry 1 2 uscle M Tone Limp ome S flexion ctive A motion 1 2 eflex R Irritability o N response Grimace Cry 1 2 Color Pale Body All pink 1 2 | MIDTERMS ink, P extr. blue Total Score 6 10 Interpretation: 7-10: good adjustment, vigorous 4-6: moderately depressed, needs airway clearance 3 and below: severely depressed, needs resuscitation ESSON 4 : PUERPERIUM L –Ms. Cristales– BUBBLE HE APPROACH Breast ➔ Lactation status ➔ Inspect and palpate breast ➔ Condition: soft, filling, firm, engorged, red, pain ➔ Nipples: normal, red, pain, cracked, inverted ➔ Health teachings ◆ Well fitting bra ◆ Advise mother not to soak when bathing ◆ Not use alcohol when cleansing Uterus ➔ Assess fundus ➔ Location ➔ Position ➔ Consistency: firm, boggy (massage) ★ Involution– natural process that involves your pregnant uterus returning to its pre-pregnancy state ★ Subinvolution– when it does not go back to pre pregnancy state Bladder ➔ Assess bladder prior to and after voiding ➔ Indwelling catheter: color, quantity, quality, odor, etc. ➔ Intake / output, # of voids Bowel ➔ Auscultate bowel sounds ➔ Absent, hypoactive, active, hyperactive ➔ Palpate abdomen: soft, distended ➔ 5 - 30 per minute Stages of Lochia 3 The duration of each stage and the way lochia looks can vary ochia L Rubra - 1st stage - dark or bright red blood - lasts for 3 to 4 days - flows like a heavy period - small clots are normal - mild, period-like cramping ochia L Serosa - second stage - Pinkishbrowndischargethatisless bloody and more watery - lasts for 4 to 12 days - flow is moderate - less clotting or no clotting ochia L Alba - 3rd stage - yellowish white discharge - little to no blood - light flow or spotting - lasts from about 12 days to 6 weeks - no clots Episiotomy ➔ Assess perineum ➔ UseREEDA[scaleusedtoassessalltypes of postpartum perineal trauma and healing in vaginal birth] ➔ Hemorrhoids: present, edematous, thrombosed, soft, painful ➔ C/S Incision: clear, dry, and intact ◆ Closed dressing and intact, open to air ➔ Dressing: clean, dry, and intact Lochia ➔ Discharge from uterus following delivery ➔ Color ➔ Amount ➔ Odor | MIDTERMS E ● mphasis on self ● Requires much assistance ● Desire to review birth experience Taking-Hold Phase ● Day 2 or Day 3 ● Lasts 10 days to several weeks ● Less dependent ● Patient more eager to learn about infant; providing more infant and self care ● Desire to take charge ● Still need for acceptance and nurturing by others Homan’s ➔ 0 – negative ➔ Plus (+) positive (indicate: R or L) ➔ Calf pain might be normal due to stress of delivery ➔ Clonus: 2-2 beats of clonus, 3=3 beats of clonus ➔ edema Letting-Go Phase ● Independent ● Providing all infant care ● Emphasis shifts to entire family ● Reassertion of relationship with partner ● Sexual intimacy resumes ● Resolution of individual roles THEORIES OF LABOR ONSET OXYTOCIN STIMULATION THEORY ➔ neartermofpregnancy→Posteriorpituitary gland produces oxytocin→Uterus becomes sensitive→Uterine contractions PROGESTERONE DEPRIVATION THEORY ➔ pregnancy draws near term ➔ Decreaseproductionofprogesteronebythe placenta and corpus luteum ➔ Increase oxytocin ➔ Uterus becomes sensitive to oxytocin ➔ Regular rhythmic contraction of the uterus Reflexes (Deep Tendon): ● 0 → no response ● 1+ → diminished response; low normal ● 2+ → average response; normal ● 3+ → brisker than average; may not be abnormal ● 4+ → hyperactive; very brisky; jerky, clonic response; abnormal Emotional ● Maternal-infant ● Mother:holds,cuddles,asksquestions,and cares for infant ● Bonding or not bonding with infant ● Postpartum Blues ○ It is normal ○ May happen 4 days after delivery and may last up to 2 weeks ○ low mood and mild depressive symptoms that are transient and self-limited ● Psychosis ○ whenpeoplelosesomecontactwith reality HASES OF P ADJUSTMENT MATERNAL Taking-In Phase ● Day 1 ● Patient very dependent POSTPARTUM PROSTAGLANDIN THEORY ➔ Fetal membranes produces arachidonic acid ➔ Converted by the maternal decidua into prostaglandin ➔ As pregnancy draws near term, increase production of arachidonic acid ➔ Increase prostaglandin in the amniotic fluid UTERINE STRETCH THEORY ➔ any hollow muscular organ when stretched to its capacity will contract and empty ➔ Consider the most acceptable theory of labor THEORY OF AGING PLACENTA ➔ as placenta ages, there is decrease production of progesterone that maintains the relaxation of the smooth muscle of the uterus FETAL ADRENAL RESPONSE THEORY ➔ increase in fetal cortisol ➔ Decrease formation of progesterone ➔ Increase production of prostaglandin HILDBIRTH PREPARATION C Pregnancy andbirtharehealthyandhappyevents in which the woman participates verall goal: prepare parents physically and O psychologically while promoting wellness | MIDTERMS Prenatal Exercises ● Walking ● Tailor sit ● Squatting ● Lying position ● Pelvic floor ● Pelvic rock ● Calf stretch ○ Relieve cramping ● "Hee, hee, hee, hoo" pattern CHILDBIRTH PREPARATION METHODS Lamaze ➔ By Dr. Fernand Lamaze ➔ Psychoprophylaxis method ➔ He based his theory on Pavlov's Theoryof Conditioning ➔ Most popular ➔ Effleurage Read Method ➔ Fear→ Tension→ Pain Bradley Method ➔ Drug free labor ➔ Natural childbirth ➔ Conducted by certified professionals ➔ 12 weeks of classes ➔ Imitation of nature ➔ Requirement: ◆ Darkly lighted room ◆ Quiet environment ◆ Relaxation technique ◆ Closed eyes / appearance of sleep Kitzinger ➔ Promotes birth as a natural sexual event ➔ Physical interaction with the partner ➔ Go with the flow ◆ Psychosexual ➔ Emphasis on the positive interaction of the parents who have conceived this bay together DIFFERENT METHODS OF DELIVERY ● Birthing Chair ● Birthing bed ● Squatting position ● Leboyer method ● Underwater BREATHING TECHNIQUES 1. Cleansing Breath ● Exaggerated, deep breath ● Done through the nose or mouth ● Used before and after every contractions ● Allow increase oxygen to the baby 2. Focal Point concentration during ● Increase contractions ● May be internal or external 3. Slow paced Breathing ● Begins with a cleansing breath ● Take 2 breaths / 15 seconds 4. Modified Paced Breathing ● Breathing silently through the mouth 5. Approx. 4 breaths / 5 seconds Patterned Paced Breathing ● Uses 3 breaths / 1 blow | MIDTERMS
