LET’S BEGIN!

Unit 7: Communication and Teaching with Children and

Families.
Intended Learning Outcomes
At the end of the unit, you are expected to:

1. Recognize Filipino Culture, Values and Practice in Relation to

Maternal and Child Care.
2. Classify Myths and Beliefs related to Pregnancy.
3. Define Birth Practices of Selected Cultural Groups.

Introduction
In this unit, you will learn about effective communication is responsive to
the needs of the whole patient and family dynamic; it is essential to
patient-centered and family centered care, the basic building block of
the medical home concept (www.medical homeinfo.org) endorsed by
the American Academy of Pediatrics (AAP) as a cornerstone of care.
Taking time to build rapport and understand the child and family.

Unlocking of Difficulties
Let’s define some terms that you will encounter in this lesson:
1. Beliefs - trust, faith, or confidence in someone or something.
2. Culture - is the characteristics and knowledge of a particular group
of people, encompassing language, religion, cuisine, social habits,
music and arts. ... The word "culture" derives from a French term,
which in turn derives from the Latin "colere," which means to tend
to the earth and grow, or cultivation and nurture.
3. Myths - a traditional story, especially one concerning the early
history of a people or explaining some natural or social
phenomenon, and typically involving supernatural beings or
events.
4. Values - a person's principles or standards of behavior; one's
judgment of what is important in life.
5. Food cravings - can be caused by a variety of physical or mental
factors. They may be a sign of hormonal imbalances, a suboptimal
diet, high stress levels, or a lack of sleep or physical activity. Food
cravings are seldom a sign that you're lacking the nutrients found
in that food.

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Lecture Notes
Communication and Teaching with Children and Families.
 The family strengths perspective identifies and builds on positive
attributes in family functioning.
 Family strengths qualities are
(a) commitment,
(b) appreciation and affection,
(c) positive communication,
(d) time together,
(e) a sense of spiritual well-being, and
(f) the ability to cope with stress and crisis.
 With the family strengths approach, nurses help families define
their visions and hopes for the future instead of looking at what
factors contribute to family problems. Family strengths
assessment can be used in nursing practice, nursing education,
and everyday life.
 Nursing care traditionally has been practiced within the
complexity of families and has included culturally competent,
holistic care (Campinha-Bacote, 1999; Leininger & McFarland,
2002; Munoz & Luckmann, 2005).
 It is well known that the family environment may have a positive
or a negative effect on individuals in the family, depending on
the family's values, beliefs, and ability to manage change.
 Historically, ecomaps, genograms, and family assessment tools
have assisted nurses in better understanding family systems,
subsystems, and relationships (Friedman, Bowden, & Jones,
2003; McCubbin & McCubbin, 1993; Smilkstein, 1978; Stanhope
& Lancaster, 2004).
 When using a family strengths framework to design nursing care,
nurses enhance their care by moving beyond culture and holism
and plan their care based on an assessment of each family's
strengths, thereby helping the families they serve enhance their
strongest characteristics.

Related Studies on Maternal and Child Nursing.

Filipino Culture, Values and Practice in Relation to Maternal and Child

Care.

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 Source:
https://images.app.goo.gl/P8EzivtgJhRFfmc38
A. Nursing care planning to Respect Cultural Diversity
 It involves an awareness and acceptance
of cultural differences, self-awareness, knowledge of a
patient's culture, and adaptation of skills." Our
demographics are changing and our healthcare
providers would be wise to hire Nurses from a variety
of backgrounds that reflect their changing patient
population.
 Diversity in the Nursing field is essential because it provides
opportunities to administer quality care to patients. 
 Diversity in Nursing includes all of the following: gender,
veteran status, race, disability, age, religion, ethnic
heritage, socioeconomic status, sexual orientation,
education status, national origin, and physical
characteristics.
 Communication with patients can be improved and patient
care enhanced when healthcare providers bridge the divide
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 between the culture of medicine and the beliefs and
practices that make up a patient's' value system. 
 When the Nursing workforce reflects its patient
demographic, communication improves thus making the
patient feel more comfortable.
 A Person who has little in common with you cannot
adequately advocate for your benefit.
 Otherwise, you might as well have a history teacher in
charge of advanced algebra. 
 If you have Nurses who understand their patient’s culture,
environment, food, customs, religious views, etc, they can
provide their patients with ultimate care.
 Every healthcare experience provides an opportunity to
have a positive effect on a patient’s health.
 Healthcare providers can maximize this potential by
learning more about patients' cultures.
 In doing so, they are practicing cultural competency or
cultural awareness and sensitivity.
 According to www.acog.org, Cultural competency,
or cultural awareness and sensitivity, is defined as, "the
knowledge and interpersonal skills that allow providers to
understand, appreciate, and work with individuals from
cultures other than their own.
 It involves an awareness and acceptance of cultural
differences, self-awareness, knowledge of a patient's
culture, and adaptation of skills."
 Diversity and inclusion is the combination of different
cultures, ideas, and perspectives that brings forth greater
collaboration, creativity, and innovation, which leads to
better patient care and satisfaction.
 This is the direction in which healthcare needs to go in
order to better the health of our current and future
demographics.

B. Myths and Beliefs related to Pregnancy

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 Source:
https://images.app.goo.gl/oiZVUBQ2CWiiw1cM7

 There are numerous dos and don’ts, advices and instructions that are
given to a pregnant woman by relatives and others.

 The internet is also swarming with information and tips, sometimes

by gynecologists and other times stuff that are just hearsay.

 Some of these myths include theories on how to choose the date of

birth or sex of your child or how best to have a fair or healthy baby
and much more.

 Unravel the truth and split facts from fiction by understanding the
below mentioned pregnancy myths.

Expected mom has to eat for two 

 This is probably one of the first tips that a pregnant lady hears when
she announces her pregnancy.

 In reality and especially during the beginning of pregnancy the

quality of what one swallows is far more important that the amount.

 In fact increase in diet can make one gain weight quickly without any
particular effect on the baby's health.

Pregnant women have weird food cravings –

 Watermelon in December or chocolate at middle of night, it is

believed all pregnant women get weird and sometimes crazy
cravings.

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  But the said phenomenon is not universal, some women feel no
particular craving throughout their pregnancy and the cravings are
not related to health of the baby in any way.

Round belly means it's a girl and long belly means it's a boy 

 A woman with a round belly is associated with a female birth.

 And if the future mother has a belly rather forward then it is

believed that the baby is a boy.

 There is nothing scientific in the said assumption; it is just a myth

that has made its way in some people’s minds.

If one moisturizes the skin well there would be no stretch marks –

 If only it was so simple, in fact it's all about hormones. If one already
tends to have stretch marks on the breasts or thighs then there is a
good chance that one will have them on your stomach too.

 But this should not prevent one from moisturizing the skin very
regularly, in order to limit the damage.

If it moves all the time, it's going to be an active baby 

 Although the baby may be always moving in the belly but it does not
necessarily mean that he will be hyper active baby when he comes
into the world.

 Nothing can predict in advance the character of a child; one will only
experience after birth what kind of child it will be.

Impact of the full moon on birth

 There is a belief in some people that the dates of full moon are often
linked to date of deliveries.

 But there is no scientific proof that can prove this theory.

Heartburn during pregnancy means the baby will have lot of hairs –

 Heartburn is related to the upward rise of the stomach, pushed by

the growing uterus.

 They are more common from the second trimester of pregnancy.

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  There is no relation whatsoever between heartburn and a hairy baby.
Simple hygienic diets will help one limit them.

Wear a sheath early in pregnancy –

 A soft belt can sometimes help support your stomach, but be careful
not to wear it continuously.

 In fact, the abdominal muscles will no longer perform their work, if

they are permanently supported by a sheath.

Pregnant women shouldn’t indulge in sports 

 Combat sports and rigorous physical activity should indeed be

avoided.

 But if one can take care of herself when she is pregnant, then there
is no question of stopping all sports activities.

 On the contrary, some activities are quite suitable for the pregnant
woman such as walking, soft gymnastics or swimming.

At the end of the pregnancy, the baby does not move anymore

 Beware of this misconception that is formed due to the weight gain

of the baby, more importantly in late pregnancy.
 Indeed the baby has less room to move than the 2nd trimester of
pregnancy but one will always feel an activity or some movement
several times a day.
 If one does not feel any movement for 24 hours, it is best to consult
the gynecologist.

At end of pregnancy, one should indulge in some physical activities to give

birth more quickly 

 Giving birth is a natural process that will start when the time comes.
 Indulging in cleaning or other activities at the end of the third
trimester will not facilitate the delivery in any way.

Birth Practices of Selected Cultural Groups

Cultural practices and preferences when having a baby

 Different cultures have different values, beliefs and practices.

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 A woman’s cultural background can affect their needs and expectations
during pregnancy and childbirth, as well as how they and their family
raise children.
 Many women giving birth believe it is important to follow the
traditional pregnancy and birth practices of their culture.

For example:

 during pregnancy, women from some cultures do not eat certain

foods
 during labour, women from some cultures avoid moving too much;
some stay lying down, some prefer to sit or squat
 in some cultures, the father does not attend the birth, but the
mother or mother-in-law does
 after childbirth, some women follow strict rules, such as staying in
bed for several days
Women with special cultural needs
 Every woman has a right to healthcare that is suited to her individual
needs, including cultural needs.
 This means that healthcare professionals and hospitals will respect
your wishes as much as possible.
 Many antenatal clinics (clinics in hospitals that care for pregnant
women) provide special services for women with specific cultural
needs.
 These include cultural liaison officers who can help explain your
needs to health professionals and provide you with extra support
both before and after the birth.

Four important cultural considerations 

1. Family dynamics 

 Men are household leaders in various cultures, and some Ob/Gyn

patients defer to their partner for medical decisions.
 Additionally, some patients feel strongly that procedures such as a
hysterectomy reduce a woman’s body image or womanhood.
 Doctors must approach these conversations differently from the
way we might discuss less intimate procedures.
 The topic of sexuality has become more mainstream, but
conversations can become awkward quickly without a culturally
competent provider.

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  Pregnancy providers should be open-minded and get to know
their patients’ situations and preferences without making
assumptions.
 For example, we see patients with a variety of circumstances and
unique situations, such as women with more than one partner,
same-sex couples, and patients who are surrogates for other
couples. 

2. Provider gender 

 Some patients request a male or female doctor due to cultural or

personal preferences.
 Usually that is an option, particularly at an academic medical
center.
 When it is not, we recommend that the doctor have a
conversation with the patient to find solutions to make the
situation more comfortable. 
 For example, a patient who was in labor with a premature baby.
 She felt uncomfortable having men except her partner in the
room during delivery and recovery.
 However, her baby needed immediate specialized care after birth,
and all the pediatricians on staff that night were men.
 So, to respect the patient’s wishes and properly care for her baby,
we partitioned the room with screens – the male doctor could be
present without invading the patient’s privacy.

3. Religious and cultural beliefs

 Certain medical procedures associated with pregnancy, such

as circumcision  and blood transfusions in emergency situations,
are not acceptable by all religions.
 Some cultures also have guidelines or traditions around co-
sleeping , baptism, and baby-naming. And patients might seek
traditional remedies before or along with treatments prescribed
by their doctor. 
 Additionally, food is largely related to religious and cultural
beliefs.
 We work to match offerings in the hospital with specific diets and
personal likes and dislikes.
 Our intake team asks about vegan, gluten-free, kosher, and other
needs and preferences in order to optimize nutrition and increase
comfort during their stay.

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4. Communication

 Some patients and doctors still adhere to a paternalistic model of

health care in which “doctor knows best.”
 Patients might be hesitant to ask questions out of fear of
judgment, so doctors must provide every opportunity for open
communication.
 Additionally, men and women, as patients and doctors, tend to
have different communication styles.
 Effective, culturally competent communication between doctors
and patients is essential in pregnancy care.
 In the Ob/Gyn setting, we must ensure that patients are
comfortable enough to be honest with us, particularly during
sensitive and sometimes painful discussions. 
 We must communicate in ways that make women feel cared for
without judgment.
 And we must ask the right questions to ensure that patients
understand why we are making certain recommendations and
how we will care for them in a thoughtful, open-minded manner. 

Focused Questions
Instructions: Read carefully each question and write your correct answer in
our google classroom.
1. What is the Filipino Culture, Values and Practice in Relation to
Maternal and Child Care?
2. What are Myths and Beliefs related to Pregnancy?
3. What are the Birth Practices of Selected Cultural Groups?

Related Readings
https://www.slideshare.net/SalmanKhan84/communication-with-
children-familiesRetrieved on Nov.21,2020
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719884/Retriev
ed on Nov.21,2020
https://www.pregnancybirthbaby.org.au/cultural-practices-and-
preferences-when-having-a-babyetrieved on Nov.21,2020
Learning / Assessment Activities
Instructions: Read carefully and write your correct answer in our google
classroom.

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 1. Write down the Four important cultural considerations. 

2. Site an example of a Religious and cultural beliefs.

3. Write down any other Myths and Beliefs related to Pregnancy.

References
Delan Devakumar, Jennifer Hall, Zeshan Qureshi and Joy Lawn (2019).
Oxford Textbook of Global Health of Women, Newborns, Children and
Adolescents
Susan L. Ward, and Shelton M. Hisley (2016). Maternal Child Nursing Care
with The Women’s Health Companion:Opimizing Outcomes for Mothers,
Children and Families 2nd Edition.E.A, Davis Company
Flagg, J., & Pillittere, A. (2018). Maternal and child health nursing: Care of
the childbearing and childrearing family vol. 1 (18th ed). Quezon City: C an E
Publishing Inc.
Flagg, J., & Pillittere, A. (2018). Maternal and child health nursing: Care of
the childbearing and childrearing family vol. 2 (18th ed). Quezon City: C an E
Publishing Inc.
Gregory KD, Ramos DE, Jauniaux ERM. Preconception and prenatal care. In:
Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem
Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017: chap 6.

Hobel CJ, Williams J. Antepartum care. In: Hacker NF, Gambone JC, Hobel
CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology. 6th ed.
Philadelphia, PA: Elsevier; 2016: chap 7.

Williams DE, Pridjian G. Obstetrics. In: Rakel RE, Rakel DP, eds. Textbook of
Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 20.

Unit 8: Maternal and Child Care Entrepreneurial Opportunities.

Intended Learning Outcomes

At the end of the unit, you are expected to:

1. Paraphrase Maternal and Child Care Entrepreneurial Opportunities.
2. Recognize Post-Partal Care.
3. Describe Immediate Care of the Newborn.

Introduction

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Philippines has been addressing its Maternal Health and
Child Care (MHCC) challenges for the past decade and 2 of
its Millennium Development Goals (MDG) are targeting it.
It has been continuously increasing its public health
allocation and devolving the public health programs to the
local communities.

Unlocking of Difficulties
Let’s define some terms that you will encounter in this lesson and some
Obstetrical terms.
1. Contraception - birth control) prevents pregnancy by interfering with
the normal process of ovulation, fertilization, and implantation.
There are different kinds of birth control that act at different points
in the process
2. Lochia - is the vaginal discharge after giving birth, containing blood,
mucus, and uterine tissue. Lochia discharge typically continues for
four to six weeks after childbirth, a time known as the postpartum
period or puerperium.
3. Condoms - a thin rubber sheath worn on a man's penis during
sexual intercourse as a contraceptive or as a protection against
infection.
4. Foam - Spermicidal foams, jellies, and vaginal sponges prevent
pregnancy by killing sperm and blocking the opening of the cervix.
These methods stop sperm from entering the uterus and reaching
an egg. You can buy foams, jellies and the sponge from a
drugstore or at some clinics without a prescription
5. Vaginal suppositories - are solid medications that are inserted
into the vagina with a special applicator. The body absorbs drugs
from vaginal suppositories quickly. They work faster than
medications you take by mouth. This is
because suppositories melt inside the body and absorb directly
into the bloodstream.

Lecture Notes
Maternal and Child Care Entrepreneurial Opportunities.
Opportunities in Maternal Health and Child Care (MHCC) & Micro, Small,
and Medium Enterprises (MSMEs)
 State of Maternal Health and Child Care (MHCC) in the Philippines
The Challenge of Achieving the Millennium Development Goals
Complications arising from pregnancy and childbirth are regarded as
one of the major leading causes of death in the Philippines. (WHO,
2012).

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  Maternal deaths account for 14 percent of all deaths of women in
reproductive age (DOH, 2011).
 While there are significant gains in reducing infant mortality rate
(IMR) and child mortality rate (age under five) in the last twenty
years, the achievement in reducing the maternal deaths are
decelerating.
 The rate of progress is needed to reach the MDG targets – MDG 5
maternal health and MDG6 child mortality - are less than the actual
rate of progress (United Nations, 2012).
 From 1990 to 2006, IMR was reduced to half (57 infant deaths per
1000 live births in 1990 to 25 in 2008).
 The child mortality rate also went down from 80 to 34 per 1000
children (FES, 2011).
 Given these improvements in gross children birth rate, the country
still needs to reach the 14:1000 thresholds before the end of 2015.
 On the other hand, maternal mortality ratio (MMR) is pegged at 99
over 100,000 live births (UNICEF, 2012).
 The World Health Organization (WHO) reports that MMR in the
Philippines is 66 to 140 (2013).
 The rate of reduction of the MMR went down from 3.8% in 1990 to
2000 to 1.7 % in 2000 to 2010. With nearly more than one year to
go, the Philippines faces the perennial task of achieving the mortality
rate of 43 is to 100,000 (UNICEF, 2012).
 The teenage pregnancy rate is also increasing. In 2010, a total of
1,324 under the age of 15 years old gave birth (WHO, 2010).
 The Young Adult Fertility and Sexuality Survey (YAFS) reports that
Filipino girls in the age of 15 to 19 more than doubled in the last six
years, from 6% in 2006 to 13.6% in 2013 (Rodriguez, 2014).
 The country also records a 55% adolescent birth rate (UNICEF,
2012).
 This makes the Philippines the 3rd highest country in Southeast Asia
with regard to teenage pregnancy (2014).

Birthing Clinics
 A birthing center is a homey, low-tech birthing option for moms-
to-be who desire a natural childbirth experience.
 Usually, birth centers are freestanding facilities, but sometimes
they're adjacent to or inside a hospital. In most birthing centers,
midwives (and not OB-GYNs) are the primary care providers.

How it’s different from a hospital

 At birthing centers, care is typically led by midwives, though birthing

centers may work in collaboration with OB-GYNs, pediatricians and

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 other healthcare professionals — meaning they consult them if the need
arises.
 But giving birth at a birthing center and giving birth at a hospital differ in
a number of ways.
 While a labor room in a hospital looks like, well, a room in a hospital,
birthing rooms at a birthing center are much swankier.
 And procedures that are standard or at least common in a hospital
setting (such as continuous fetal monitoring, routine IVs and induction
of labor) aren’t routine at a birthing center.

The benefits

1. Comfy digs.

 Birthing centers usually have soft lighting, a queen or double bed (which
means your partner can cuddle with you, if you’re up for it), a television,
a rocking chair, couches for family and friends and a shower, Jacuzzi tub
and, sometimes, a kitchen.
 In many facilities, families are encouraged to personalize the room by
hanging pictures, lighting candles or turning up the tunes. 

2. Greater privacy.
 Birthing centers always provide private rooms for expectant mothers —
whereas at a hospital, unless your insurance covers a private room
(many don’t), you’ll be moved to a semi-private room after delivery.

3. More freedom.
 You can walk around and be as active as you like, wear what you want,
and give birth in whatever position feels most comfortable.
 You even get to eat a light meal or snack and drink during and after
labor (no food or drinks during the pushing phase though).
 At a hospital, on the other hand, all food and fluids (except for ice
chips) are usually a no-go, your movements will probably be limited
(since there is usually continuous electronic fetal monitoring), and
you’ll likely have to give birth lying on your back on the bed.

4. Families stay together.

 With a hospital delivery, your baby will be taken to a different room for
his or her first checkup, and a few times more for other procedures.
 At a birthing center, however, unless he needs emergency care, your
baby won’t be whisked off to another room after the birth (and family
and friends won’t be sent away either — unless you want them to be).
 Everything — from preventative care like the vitamin K shot to baby’s
first bath and checkup — happens in the same room.

5. A shorter stay.

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  Because fewer medications and medical interventions are involved,
recovery time is shorter than at a hospital.
 Most families leave the center four to eight hours after birth,
compared to 24 to 48 hours at a hospital.
 And a shorter stay means you’ll spend less money. 

6. Reduced risk of a C-section.

 The rate of C-sections for women who chose a birth center to deliver is
around 6% (compared to just under 26% for similar low-risk women in
hospitals).

7. No epidural.

 Most birthing centers don’t give epidurals. Instead, they turn

to alternative pain relief options, such as hydrotherapy, breathing
exercises, massage and acupuncture.
 Some centers also offer nitrous oxide gas.

The downsides

1. Lack of centers.
 The number of birth centers around the country is limited (and
services may be in high demand) — especially if you live in a small
town.
2. Possible transfer to a hospital.
 If there is a problem or emergency, you’ll be transferred to a
hospital.
 Fortunately, fewer than 2 percent of transfers are due to
emergencies (they’re mostly due to mom having an extremely
difficult labor and/or requests for an epidural.)
 However birthing centers do have IVs, oxygen and infant
resuscitators on hand for use during the transfer process.

3. No insurance coverage.

 Some insurance companies don’t cover births at a birthing center.

Contact your insurance provider to discuss your coverage.

When you can’t give birth at a birthing center

 Birthing centers handle only low-risk pregnancies.

 If you have hypertension, diabetes or gestational diabetes, your baby is in
the breech position, you’re pregnant with multiples, or you have other
issues that may cause complications, a birthing center isn’t the right
option for you.

Day Care

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  Also called day nursery, nursery school, or crèche (French:
“crib”), institution that provides supervision and care of infants
and young children during the daytime, particularly so that their
parents can hold jobs.

Post-Partal Care

 The postpartum period refers to the first six weeks after childbirth.

 This is a joyous time, but it’s also a period of adjustment and healing
for mothers.

 During these weeks, you’ll bond with your baby and you’ll have a
post-delivery checkup with your doctor.

Mother
Adjusting to motherhood

 Adjusting to everyday life after the birth of a baby has its

challenges, especially if you’re a new mother.

 Although it’s important to care for your baby, you also have to
take care of yourself.

 Most new mothers don’t return to work for at least the first six
weeks after birth.

 This allows time to adapt and develop a new normal. Since a

baby has to be fed and changed often, you may experience
sleepless nights. It can be frustrating and tiresome.

 The good news is that you’ll eventually fall into a routine.

In the meantime, here’s what you can do for an easier transition:

 1. Get plenty of rest. Get as much sleep as possible to cope with

tiredness and fatigue. Your baby may wake up every two to three

16
 hours for feeding. To make sure you’re getting enough rest, sleep
when your baby sleeps.

 2. Seek help. Don’t hesitate to accept help from family and

friends during the postpartum period, as well as after this period.
Your body needs to heal, and practical help around the home can
help you get much-needed rest. Friends or family can prepare
meals, run errands, or help care for other children in the home.

 3. Eat healthy meals. Maintain a healthy diet to promote healing.

Increase your intake of whole grains, vegetables, fruits, and
protein. You should also increase your fluid intake, especially if
you are breast-feeding.

 4. Exercise. Your doctor will let you know when it’s OK to

exercise. The activity should not be strenuous. Try taking a walk
near your house. The change of scenery is refreshing and can
increase your energy level.

Assessment:

Routine Postpartum Assessment and Patient Education

 Primary responsibilities of nurses in postpartum settings are to assess

postpartum patients, provide care and teaching, and if necessary,
report any significant findings.
 It is imperative for nurses to distinguish between normal and
abnormal findings and to have a clear understanding of the nursing
care necessary to promote patients’ health and well-being.
 Many nurses find it useful to use the acronym BUBBLE-LE to
remember the necessary components of the postpartum assessment
and teaching topics.

These include:
BUBBLE-LE
B Breasts
U Uterus
B Bowel function
B Bladder
L Lochia
E Episiotomy/perineum
L Lower extremities
E Emotions
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 BREASTS
The breasts are assessed for:
 Signs of engorgement, including fullness, around postpartum days 3
and 4
 Hot, red, painful, and edematous areas, which could indicate mastitis
 Nipple condition and latch-on technique of mothers who are
breastfeeding

UTERUS
The fundus is assessed for:
 By approximately one hour post delivery, the fundus is firm and at
the level of the umbilicus.
 The fundus continues to descend into the pelvis at the rate of
approximately 1 cm or finger-breadth per day and should be nonpalpable
by 14 days postpartum.
 In addition, patients are assessed for uterine cramping and treated
for pain as needed.
Patients or a family member can be taught to assess the firmness of
the fundus and to provide massage in the event of a boggy uterus or
excessive bleeding.
 Patients are encouraged to void before palpation of the uterine
fundus because a full bladder displaces the uterus and can lead to
excessive bleeding.

BOWEL
Assessment of the bowel is important in all postpartum patients. It is
especially vital for patients following C-sections. The bowel is assessed for:
 Bowel sounds
 Return of bowel function
 Flatus
 Color and consistency of stool
 Prescribed stool softeners or laxatives are administered as needed to
treat constipation and ease perineal discomfort during defecation.

BLADDER
Assessment of urination and bladder function includes:
 Return of urination, which should occur within six to eight hours of
delivery
 For approximately 8 hours after delivery, amount of urine at each
void.
 Patients should void a minimum of 150 mL per void; less than 150 mL
per void could indicate urinary retention due to decreased bladder tone

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 post delivery (in the absence of preeclampsia or other significant health
problems).
 Signs and symptoms of a urinary tract infection (UTI), including
frequent urination, bladder spasm, cloudy urine, persistent urge to
urinate, and pain with urination
 The bladder should be nonpalpable above the symphysis pubis.
 Patients are encouraged to drink adequate fluid each day and to
report signs and symptoms of a urinary tract infection, including
frequency, urgency, painful urination, and hematuria.

LOCHIA
Lochia is assessed during the postpartum period:
 Saturating one pad in less than an hour, a constant trickle of lochia,
or the presence of large (i.e., golf-ball sized) blood clots is indicative of
more serious complications and should be investigated immediately.
 A significant amount of lochia despite a firm fundus may indicate a
laceration in the birth canal, which should be addressed immediately.
 Foul-smelling lochia typically indicates an infection and needs to be
addressed as soon as possible.
 Lochia should progress from rubra to serosa to alba.
 Any changes in this progression could be considered abnormal and
should be reported.
 Lochia rubra is present on days 1–3, lochia serosa on days 4–10, and
lochia alba on days 11–21.
 It is important to note that patients who had a C-section will typically
have less lochia than patients who delivered vaginally; however,
some lochia should be present.
 After discharge, patients should report any abnormal progressions of
lochia, excessive bleeding, foul-smelling lochia, or large blood clots to
their physician immediately.
 Patients are instructed to avoid sexual activity until lochial flow has
ceased.

EPISIOTOMY/PERINEUM
The acronym REEDA is often used to assess an episiotomy or laceration of
the perineum.
REEDA stands for:
REED
A
R Redness
E Edema
E Ecchymosis
D Discharge

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REED
A
A Approximation
 Redness is considered normal with episiotomies and lacerations;
however, if there is significant pain present, further assessment is
necessary.
 The use of ice packs during the immediate postpartum period is
generally indicated.
 There should be an absence of discharge from the episiotomy or
laceration, and the wound edges should be well approximated.
 Perineal pain must be assessed and treated.
 Performing Kegel exercises are an important component of
strengthening the perineal muscles after delivery and may be begun
as soon as it is comfortable to do so.

LOWER EXTREMITIES
 To assess for deep vein thrombosis (DVT), the lower extremities are
examined for the presence of hot, red, painful, and/or edematous
areas.
 An elevated temperature may also be present.
 The legs for assessed for adequate circulation by checking the pedal
pulses and noting temperature and color.
 In addition, the lower extremities are assessed for edema.

EMOTIONS
 Emotions are an essential element of the postpartum assessment.
 Postpartum women typically exhibit symptoms of the “baby blues”
or “postpartum blues,” demonstrated by tearfulness, irritability, and
sometimes insomnia.
 The postpartum blues are caused by a multitude of factors, including
hormonal fluctuations, physical exhaustion, and maternal role
adjustment.
 This is a normal part of the postpartum experience.
 If symptoms last longer than a few weeks or if the postpartum
patient becomes nonfunctional or expresses a desire to harm herself
or her infant, she should be instructed to report this to her certified
nurse-midwife or physician immediately.

Nurses and other healthcare professionals need to be aware of the

normal physiologic and psychological changes that take place in women’s
bodies and minds after delivery in order to provide comprehensive care
during this period.

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Nursing Diagnosis:
 Childbearing, from the standpoint of psychological medicine, is the
most complex event in human experience.
 Recently delivered mothers are vulnerable to the whole spectrum of
general psychiatric disorders, as well as those resulting from the
physical and psychological changes of childbirth.
 The old classification under three headings – the maternity blues,
post-partum ('postnatal') depression and post-partum ('puerperal')
psychosis – is an oversimplification.
 A four-part classification would be appropriate:
 Post-partum psychosis,
 mother-infant relationship disorders,
 Post-partum depression and
 Post-partum anxiety and stress-related disorders.
 Each, with sub-headings, will be discussed here in terms of diagnosis,
treatment and prevention.

Planning and Intervention

Postpartum & Post-Delivery Care Plans

 Having a baby is a life-changing event, both emotionally and
physically, and proper postpartum care is crucial to your
recuperation after giving birth and to your adjustment to life as a
new parent.
 For the first two weeks after giving birth, allow yourself to focus on
caring for yourself and your child.  
 Your body needs to recover after the physical stress of pregnancy,
labor, and delivery.
 For the first few weeks after you give birth, give yourself time to rest
and take special care of your body as it heals from nine months of
pregnancy and delivery.

Bathing and Sitz Baths

 To prevent infections after delivery, it is preferable to take showers
rather than a tub baths for two weeks.
 If showers are not possible, fill the tub with three to four inches of
water, and leave the drain open and the water running.
 This is called a sitz bath and may be continued as long as needed for
comfort.

Vaginal Bleeding

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  Normal bleeding after delivery is similar to a heavy menstrual period
and it should decrease by the third or fourth day after birth, but can
last for up to four to six weeks.
 You may notice an increase in bleeding or blood clots on your first or
second day at home because your activity has increased.
 If you experience a heavy bleeding (soaking a pad every hour for two
to three hours) or begin cramping, it is a sign of over-activity and you
must rest.
 If the bleeding or cramping continue, please call our office.
 Menstrual periods often resume between 5 and 12 weeks after giving
birth unless you are breastfeeding.
 Nursing may suppress periods for some women, but breastfeeding is
not a form of birth control since it is still possible to become
pregnant while nursing.

Constipation and Hemorrhoids

 After giving birth, it is essential to maintain normal bowel habits and
avoid constipation.
 Consume extra fluids and a healthy, high-fiber diet. 
 If necessary, your physician may also recommend a stool softener
such as Colace® or Surfak®. 
 If a laxative is needed, Colace and Milk of Magnesia® are safe to take
while nursing. 
 If hemorrhoids are a problem, use medicated cream or suppositories.
To relieve additional discomfort from hemorrhoids try lying on your
side with your upper leg slightly bent, and take therapeutic Sitz
baths.

Episiotomy
 To sooth an episiotomy incision, take Sitz baths while you heal.
 Stitches should dissolve within four to six weeks and do not have to
be removed.
 Over-the-counter or prescription pain medications can also provide
relief, but discomfort should decrease daily.

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  However, if any unusual pain develops, call your physician.

Source:
https://www.kcobgyn.com/obstetrics/pregnancy/post-partum-care

Cesarean Birth
 A Cesarean birth is a major surgery and the recovery period is longer
than it is after a vaginal birth.
 Special care and attention is needed during recuperation after a C-
section and it is especially important to keep an eye on the incision
as it heals.
 If any of the following symptoms should occur, call your physician:

 Red, hard, tender or hot area around your incision

 Separation and/or bleeding of incision
 Moderate or large amount of oozing or drainage
 Fever higher than 100º F

 However, if there are no concerns with healing after a Cesarean

section, a heating pad can help with localized pain.
 You should wait two weeks to drive after a cesarean section and
lifting should be limited to 15 to 20 pounds for the first six weeks.

Nursing and Breast Care

 Initial attempts at nursing can be painful, but tenderness and
discomfort should decrease once let-down (a tingling sensation that
occurs in the breast right before and when milk comes into the milk
ducts, a sign you need to feed your baby) has occurred and should
cease altogether within a few days. However, if you have sore,
cracked, or bleeding nipples, express a few drops of breast milk on
the nipples after nursing and allow to air dry.
 To prevent future irritation, always keep your nipples clean, change
the nursing pads when they become moist and avoid wearing pads
with plastic liners.

23
  For a more comfortable breastfeeding experience, experiment with
different nursing positions to see what works best for you and your
baby.
 For example, try holding your baby so that he is lying on his side with
his head resting in the bend of your arm and make sure that his
mouth covers one inch or more of your nipple and areola when
sucking.
 For additional comfort, use pillows to help support your arm and
baby.  
 If you are not nursing, wear a good support bra at all times while
your breasts are engorged. 
 You may use ice packs under the armpits and to the side of each
breast during the first couple of days of engorgement and take
Tylenol® or ibuprofen for discomfort.
 Do not be surprised if you have a slight elevation in temperature for
a day or two while your breasts are engorged, and you should expect
milk to be leaking from the breasts during this period.
Exercise
 You may start mild exercise after two weeks rest and recovery after
giving birth, but more strenuous exercise should be delayed for four
to six weeks.
 Begin with easier exercises and increase them gradually if you are
comfortable and it does not cause pain.
 If you had a Cesarean, do not begin an exercise program for at least
six weeks after delivery and with your physician’s permission.

Postpartum Diet
 It is important to maintain a healthy and balanced diet while
pregnant and you should continue prioritizing your personal nutrition
after your baby is born. 
 Eat a wide variety of foods, emphasizing fruits, vegetables, lean
meat, and healthy proteins.
 Limit processed foods and empty calories from high starch and
sugary foods as much as possible.
 Do not rush into dieting in an effort to lose your pregnancy weight,
but if you are concerned about reducing, cut down on high fat and
high sugar foods and alcohol, but do not over-restrict breads and
cereals or fruits and vegetables.
 If you are nursing, you will need to consume a few hundred
additional healthy calories a day, and you should continue taking
prenatal vitamins.

Sexual Intercourse and Contraception

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  Sexual intercourse is appropriate when it is comfortable for you,
usually six weeks after giving birth, but is preferable to wait until
your vaginal discharge is clear.
 Vaginal tenderness may be eased by using a water soluble cream (K-Y
Jelly®), or a contraceptive foam or cream to lubricate the area, but
do not use VASELINE®.
 Before intercourse is resumed, you and your partner should consider
your contraceptive options.
 Condoms, foam or vaginal suppositories may be used without a
prescription and are compatible with breastfeeding.
 Be sure to discuss other forms of birth control with your doctor at
your postpartum checkup.

Causes for Concern

 After leaving the hospital, call your physician if you have any of the
following:

 Heavy vaginal bleeding, soaking a pad every hour for three hours
 Severe chills or fever over 100.4º F
 Frequency or burning with urination (emptying your bladder)
 A red, hard, tender area on the breast
 A red, hard, tender or hot area along the leg veins
 Shortness of breath and/or chest pain
 Any other unexplained signs or symptoms

Postpartum Medical Checkups

Your healthcare provider will need to see you for your postpartum checkup,
usually five to six weeks after you give birth. This appointment provides an
opportunity to discuss any questions or concerns you have, including
contraception, physical recovery, and your emotional well-being. Call your
physician to schedule a visit before leaving the hospital or soon after going
home.

Postpartum Emotional Care

 Having a baby is a special time in your life, full of anticipation and joy,
but it can also be a time of great stress and anxiety as you adjust to
life with a child.
 In the weeks and months after giving birth, try to be especially
attentive to your own emotional feelings and those of your partner.
 It is perfectly normal to experience complicated and even difficult
emotions after you have a child, but be mindful if those feelings
become extreme.

25
Evaluation:

WHO recommendation on routine postpartum maternal assessment

 All postpartum women should have regular assessment of
vaginal bleeding, uterine contraction, fundal height, temperature
and heart rate (pulse) routinely during the first 24 hours starting
from the first hour after birth.
 Blood pressure should be measured shortly after birth.
 If normal, the second blood pressure measurement should be
taken within six hours.
 Urine void should be documented within six hours. 

Documentation:
 Nursing documentation is essential for good clinical communication.
 Appropriate documentation provides an accurate reflection of
nursing assessments, changes in clinical state, care provided and
pertinent patient information to support the multidisciplinary team
to deliver great care.
 Documentation provides evidence of care and is an important
professional and medico legal requirement of nursing practice. 
Required documentation:
 Minimum documentation required to reflect safe patient care.
 On admission and at the commencement of each shift, all ‘required
documentation’ must be completed to comply with the National
Safety & Quality Health Service Standards.
 There is an expectation that shift required documentation is
completed within 3 hours of shift start time.

Immediate Care of the Newborn

 Directly after birth there should be attention to the condition of the

newborn.
 The World Health Organisation (WHO) states that such attention is
an integral part of care in normal birth. Immediate care involves:

Drying the baby with warm towels or cloths, while being placed on
the mother's abdomen or in her arms.
This mother-child skin-to-skin contact is important to maintain the
baby's temperature, encourage bonding and expose the baby to the
mother's skin bacteria.
Ensuring that the airway is clear, removing mucus and other material
from the mouth, nose and throat with a suction pump.
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 Taking measures to maintain body temperature, to ensure no
metabolic problems associated with exposure to the cold arise.
Clamping and cutting the umbilical cord with sterile instruments,
thoroughly decontaminated by sterilisation.
This is of utmost importance for the prevention of infections.
A few drops of silver nitrate solution or an antibiotic is usually placed
into the eyes to prevent infection from any harmful organisms that
the baby may have had contact with during delivery (e.g. maternal
STDs ).
Vitamin K is also administered to prevent haemorrhagic disease of
the newborn .
The baby's overall condition is recorded at 1 minute and at 5 minutes
after birth using the Apgar Scale .
Putting the baby to the breast as early as possible.
Early suckling/breast-feeding should be encouraged, within the first
hour after birth and of nipple stimulation by the baby may influence
uterine contractions and postpartum blood loss but according to the
WHO, this should be investigated.
About 6 hours or so after birth, the baby is bathed, but the vernix
caseosa (whitish greasy material that covers most of the newborn's
skin) is tried to be preserved, as it helps protect against infection.

Health Education on Post -partum and Newborn Care.

Discharge Planning

What Is Discharge Planning?

 Medicare states that discharge planning is “a process used to decide
what a patient needs for a smooth move from one level of care to
another.”
  Only a doctor can authorize a patientʼs release from the hospital, but
the actual process of discharge planning can be completed by a social
worker, nurse, case manager, or other person.
 Ideally, and especially for the most complicated medical conditions,
discharge planning is done with a team approach.

In general, the basics of a discharge plan are:

 Evaluation of the patient by qualified personnel

 Discussion with the patient or his representative
 Planning for homecoming or transfer to another care facility
 Determining whether caregiver training or other support is needed
 Referrals to a home care agency and/or appropriate support
organizations in the community
 Arranging for follow-up appointments or tests

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  The discussion needs to include the physical condition of your family
member both before and after hospitalization; details of the types of
care that will be needed; and whether discharge will be to a facility
or home.
 It also should include information on whether the patientʼs condition
is likely to improve; what activities he or she might need help with;
information on medications and diet; what extra equipment might be
needed, such as a wheelchair, commode, or oxygen; who will handle
meal preparation, transportation and chores; and possibly referral to
home care services.

Focused Questions
Instructions: Read carefully and write your correct answer in our google
classroom
1. What is Maternal and Child Care Entrepreneurial Opportunities?
2. What is Maternal and Child Care Entrepreneurial Opportunities?
3. What is the sequence of Immediate Newborn Care?

Related Readings
http://webfoundation.org/docs/2017/09/Philippines-Open-Data-
Opportunities-in-Maternal-Health-and-Child-Care-and-MSMEs-
print.pdfRetrieved on Nov.21,2020
https://wildirismedicaleducation.com/blog/postpartum-careRetrieved on
Nov.21,2020
https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-
and-postpartum-care/care-during-childbirth/who-recommendation-
routine-postpartum-maternal-assessmentRetrieved on Nov.21,2020
https://www.hon.ch/Dossier/MotherChild/birth/immediatecare_neonate.
html#:~:text=Immediate%20care%20involves%3A,to%20the%20mother's
%20skin%20bacteria.Retrieved on Nov.21,2020

Learning / Assessment Activities

Instructions: Read carefully and write your correct answer in our google
classroom.
1. Write down a Post-partum Assessment of your patient.
2. Make a Sample Post-partum Diagnosis.
3. Make a Post- partum Discharge plan of your patient.

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References
Delan Devakumar, Jennifer Hall, Zeshan Qureshi and Joy Lawn (2019).
Oxford Textbook of Global Health of Women, Newborns, Children and
Adolescents
Susan L. Ward, and Shelton M. Hisley (2016). Maternal Child Nursing Care
with The Women’s Health Companion:Opimizing Outcomes for Mothers,
Children and Families 2nd Edition.E.A, Davis Company
Flagg, J., & Pillittere, A. (2018). Maternal and child health nursing: Care of
the childbearing and childrearing family vol. 1 (18th ed). Quezon City: C an E
Publishing Inc.
Flagg, J., & Pillittere, A. (2018). Maternal and child health nursing: Care of
the childbearing and childrearing family vol. 2 (18th ed). Quezon City: C an E
Publishing Inc.
https://www.brown.edu/campus-life/health/services/patient-bill-rights-
and-responsibilities

https://www.google.com/search?q=i+reproductive+health+bill&oq=I.
%09Reproductive+Health+Bill&aqs=chrome.1.69i57j33i22i29i30l7.4243j0j7
&sourceid=chrome&ie=UTF-8

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