Maternal & Child Health Nursing & local NGOs to improve the lives of the people in their country

by the year 2030.

Primary Goal of mchn - The 17 Goals of SDG:
- Promotion & maintenance of optimal family health to ensure ‣ Eliminate Poverty
cycles of optimal childbearing & childrearing ‣ Erase Hunger
philosophy of mchn ‣ Establish Good Health & Well-Being
- Maternal & child health nursing is: ‣ Provide Quality Education
‣ Family & community centered ‣ Enforce Gender Equality
‣ Research oriented ‣ Improve Clean Water & Sanitation
- Nursing Theory provides a foundation for nursing practice. ‣ Grow Affordable & Clean Energy
- A maternal & child health nurse serves as an advocate of life. ‣ Create Decent Work & Economic Growth
- Maternal & child health nursing uses a high degree of ‣ Increase Industry, Innovation, & Infrastructure
independent nursing functions.
‣ Reduce Inequality
- Promoting health is an important nursing role.
‣ Mobilize Sustainable Cities & Communities
- Pregnancy or childhood illness can be stressful.
‣ Influence Responsible Consumption & 

- Personal, cultural, & religious attitudes & beliefs influence the
Production
meaning of illness & its impact on the family.
‣ Organize Climate Action
- Maternal & child health nursing is a challenging role for the
‣ Develop Life Below Water
nurse & is a major factor in promoting high-level wellness in
families.
‣ Advance Life On Land
‣ Guarantee Peace, Justice, & Strong Institutions
Mortality Rate ‣ Build Partnerships for the Goals
Maternal mortality rate
- The number of resident maternal deaths within 42 days of As part of the Global Strategy & goal of Ending Preventable
pregnancy termination due to complications of pregnancy, Maternal Mortality, WHO is working with partners
childbirth, & the puerperium in a specified geographic area towards:
(country, state, county, etc.) - Addressing inequalities in access to & quality of reproductive,
- Every day, approximately 830 women die from preventable maternal, & newborn health care services;
causes related to pregnancy & childbirth. - Ensuring universal health coverage for comprehensive
- 99% of all maternal deaths occur in developing countries. reproductive, maternal, & newborn health care;
- Maternal mortality is higher in women living in rural areas & - Addressing all causes of maternal mortality, reproductive &
among poorer communities. maternal morbidities, & related disabilities; &
- Young adolescents face a higher risk of complications & death as - Strengthening health systems to collect high quality data in order
a result of pregnancy than other women. to respond to the needs and priorities of women & girls; &
- Skilled care before, during & after childbirth can save the lives - Ensuring accountability in order to improve quality of care &
of women & newborn babies. Between 1990 & 2015, maternal equity.
mortality worldwide dropped by about 44%.
- Between 2016 & 2030, as part of the Sustainable Development Health Care
Goals, the target is to reduce the global maternal mortality ratio Current Trends in Perinatal & Women’s Health Care
to less than 70 per 100 000 live births. - High quality, longer lives free of preventable disease, disability,
- The major complications that account for nearly 75% of all injury & premature death.
maternal deaths are: - Achieve health equity, eliminate disparities, & improve the health
‣ Severe bleeding (mostly bleeding after childbirth) of all groups
‣ Infections (usually after childbirth) - Create social & physical environment that promote good health
‣ High blood pressure during pregnancy (pre-eclampsia and - Promote quality of life, healthy development, & healthy
eclampsia) behaviours across all life stage
‣ Complications from delivery Family Centered Care
‣ Unsafe abortion - Care describe safe, high-quality care that recognizes & adapts to
infant mortality both the physical & psychosocial needs of the family, including
the new-born.
- Situation & trends:
‣ In 2017, 4.1 million (75% of all under-five deaths) occurred - Principles of Family-Centered Care:
within the first year of life. ‣ Childbirth is usually a normal, healthy event in the life of a
‣ The risk of a child dying before completing the first year of family.
age was highest in the WHO African Region (51 per 1000 ‣ Childbirth affects the entire family, & family relationships will
live births), over six times higher than that in the WHO need to be restructured.
European Region (8 per 1000 live births). ‣ Families can make decisions about care if they are given
‣ Globally, the infant mortality rate has decreased from an adequate information & professional support.
estimated rate of 65 deaths per 1000 live births in 1990 to ‣ Maintain & focus on family or other support can benefit a
29 deaths per 1000 live births in 2017. woman as she seeks to maintain health
‣ Annual infant deaths have declined from 8.8 million in 1990
to 4.1 million in 2017.
JCIA (Joint Commi!ion International) Safety & Quality
- 5 core measures for perinatal:
Sustainable Development Goals 1. Decrease the rate of elective deliveries
- In 2015, 195 nations agreed with the United Nation that they 2. Decrease the rate of CS birth
can change the world for the better. 3. Increase the rate antenatal administration of steroids in
- This will be accomplished by bringing together their respective preterm labor
governments, businesses, media, institutions of higher education, 4. Decrease the rate of new-born septicaemia or
bacteraemia
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 5. Increase the rate of exclusive breastfeeding. fallopian tubes
- Captures the ovum
The Reproductive System - Allow transport of the fertilized ovum to the uterus.
- The site of fertilization
- Functions:
1. Production of Gametes uterus
- Implantation site for the fertilized ovum.
2. Fertilization
3. Development & Nourishment of a New Individual - Layers:
4. Production of Reproductive Hormones ‣ Perimetrium - outer
‣ Myometrium - middle
Male Reproductive System ‣ Endometrium - inner
Penis ➡ Sheds during
- An elongated, cylindrical structure consisting of a body, called menstruation
shaft, & a cone-shaped end, called gland. ➡ Where the egg is
- Composed of three cylindrical masses of erectile tissue each implanted
surrounded by a fibrous tissue.
- It’s lies in front of the penis * Estrogen thickens uterine lining
* Fundus - thickest
- The organ for copulation in male
- It servers as both urinary and reproductive organ cervix
- Connection of the vagina & the uterus
erectile tissues - Protective portal of the body of the uterus.
1. Corpus Spongiosum: is the mass of spongy tissue which - Closes during pregnancy
surrounds urethra & involves in erection by allowing rushing of
- No nerve endings
blood into it. (causes erection during urination)
vagina
2. Corpus Cavernosa: a pair of sponge-like regions of erectile - Passageway from the external genitals to the uterus
tissue which contains most of the blood in the penis during - Provides for the discharge of menstrual products out of the body.
penile erection; shuts down urethra from the bladder. (causes - Female organ for coitus
erection during intercourse)
external female reproductive organ
scrotum - The external organ collectively is called vulva.
- Is a pouch-like structure that hangs in front of the anus & behind
the penis. - The distance between anus to vagina is called perineum.
- Composed of skin & dartos muscle mons pubis
- Shows increased pigmentation & scattered hair
- Also known as mons veneris
- Protects & regulates the temperature of the testes - It covers the front portion of
the symphysis pubis,
testes - It is covered with pubic hair
- A pair of oval, compound grandular organs contained in the
scrotum. - Protects the clitoris
- Same size but different position; left side is positioned lower labia majora
because it has higher spermatic cord. - Longitudinal, raised folds of
- Functions: pigmented skin.
‣ To serve as the site of spermatogenesis - It is coved by hair & sebaceous
glands
‣ To produce testosterone
- It protects the labia minora &
vas deference vaginal introitus.
- Also known as ductus deferens
- Is about 40cm long & connects the epididymis with the prostate labia minora
- Its main function is to rapidly squeeze the sperm from their - Are soft folds of silky thin skin
which is water proof.
storage site in the urethra.
- It increases in size during puberty & decreases in menopause
urethra - Should always be kept moist to keep it open
- The male urethra is the passageway for both urine & semen.
epididymis Clitoris
- It provides a reservoir for maturing spermatozoa, when they are - Located between the minoras
ejaculated they are motile and capable to fertilized ovum. - It is partly covered by a fold of skin called prepuce, or clitorial 

hood.
Accessory glands
- It secretes smegma, has a unique odor that may be stimulating to
1. Seminal Vesicle: are 2 gland composed of many lobes.
the male.
- The epthelium lining the seminal vesicle secretes an alkaline,
viscous, clear fluid rich in high-energy fructose, vaginal Vestibules
- Is a boat shape depression enclosed by labia majora.
prostaglandins, fibrinogen & amino acid.
2. Prostate Glands: encircle the upper part of the urethra and
Hymen
- Is a thin, elastic collar or semi-collar of tissue that surrounds the
lies below the neck of the bladder.
vaginal opening.
- It secretes a thin, milky, alkaline fluid containing high level of ‣ Imporferate hymen - closed hymen
zinc, calcium, citric acid & acid phosphatase.
- This fluids protects the sperm from the acidic environment of bartolin glands
the vagina & the male urethra.
- Lubricate the vaginal canal.
breasts
Female Reproductive System Alveoli
ovaries - Secrete milk after childbirth (acinar cells within alveoli)
- Produces female germ cell & sex hormones
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Lactiferous ducts
- Collect milk from the alveoli & conduct it outside Four Phases of Sexual Response
1. excitement
Menstruation - It occurs with physical & psychological stimulation that
- Is a cyclic bleeding in response to cyclic hormonal changes. causes parasympathetic nerve stimulation.
- It occurs when the ovum is not fertilized - Male: erection, increased in length & diameter, scrotal
- It begins about 14 days after ovulation in a 28 day cycle. thickening & elevation of the testis.
- Cycle depends on 20-45 days (Hall, 2015) - Female: vaginal lubrication, inner 2/3 of the vagina
Menstrual flow / menses lengthens & distends, external genitals become congested &
- Is composed of blood which mixed with fluid, cervical & vaginal darker in color (congested with blood, hence the
secretions, bacteria, mucus, leukocytes, & other cellular debris. darkening), and the clitoris increase in size.
- It is dark red in color & has a distinct odor (fleshy; should not be - In both sexes, there is an increase in heart & respiratory
fishy). rates & blood pressure.
- Duration 2 to 8 days *most sensitive area is the neck
- Average blood loss per day from 25 to 80 ml
- 2. Plateau
0.5mg to 1 mg of iron loss per day - Stage before orgasm
- Amenorrhea: the absence of menstruation - Male: Vaso congestion leads to full distention of the penis,
- Menorrhagia: excessive bleeding; heavy or long menstruation pre-orgasmic emission of 2-3 drops of mucoid substance,
- Metrorrhagia: in between bleeding testis continue to elevate close to the
body to facilitate ejaculating
Female Reproductive Cycle pressure.
pre-orgasmic
emission
sometimes
clears the
urethra
w/ sperm
ovarian cycle
- Female: clitoris drawn forward and retracts under the
follicular phase: 1-14 days
clitoris prepuce, the lower part of the vagina becomes
- Primordial follicle matures under influence of FSH & LS up to the
extremely congested (forming the orgasmic platform; makes
time of ovulation.
tighter space for the penis), increased nipple engorgement.
Luteal phase: 15-28 days - In both sexes, heart rate increases to 100-175 beats/min.
- Ovum leaves follicle & RR of 40 breaths/min. (Rapid breathing & heart rate is to
- Corpus luteum develops under LH influence & produces high compensate the erection)
levels of progesterone & low levels of estrogen.
*withdrawal is not safe because of the mucoid substance
menstral or endometrial cycle 3. orgasmic / orgasm
Day 1-6
- The shortest stage in the sexual response cycle, it is also
1. menstrual phase:
- The primary endometrium was shed experienced as intense pleasure affecting the whole body.
- Estrogen levels are low - Male: rhythmic contraction occurs in 0.8 seconds interval,
- Cervical mucus is scant, viscous, & opaque followed immediately by 3-7 propulsive ejaculatory
contractions, ejaculation with rhythmic contraction capable
2. proliferative phase: Day 7-14 of expelling semen to 60cm (2ft)
- Estrogen peaks just prior to ovulation - Female: strong rhythmic muscular contraction occurs at 0.8
- Cervical mucus at ovulation is clear thin, watery, alkaline, & seconds interval, number of contraction ranges from 3-15,
more favorable to sperm pelvic throbbing located in vagina & lower pelvis.
- Body temperature may rise sharply & remain elevated under *female’s orgasm can’t be faked
the influence of progesterone.
4. resolution
3. Secretory Phase: Day 15-26 - Male: 1st stage - 50% of the erection lost
- Estrogen drops sharply and progesterone dominates
2nd stage - can last longer depending on the
- Endometrium is prepared for the implantation of the maintenance of physical condition.
fertilized ovum
3rd stage - is refractory period
4. Ischemic phase
- Both estrogen and progesterone - time necessary to complete cycle again
level drops - ranges from minutes to few hours to few
- If there’s no fertilization occurs, days.
the corpus luteum begins to - Female: blood returns from engorged wall of the vagina,
degenerate. labia majora & minora return to unexcited state. Clitoris
- Necrosis of the endometrium rapidly returns from under hood, normal size uterus decent,
begins, after 1 to 2 days cervix dips into a seminal pool. (Doesn’t have resolution)
bleeding starts.
- Starting of the another cycle
Development & Physiology of The
Fetus
conception / fertilization
- The union of a single egg/ovum & a sperm, marks the beginning
of pregnancy
‣ Ovum: egg cell from the female; stays up to 24 hrs
‣ Sperm: from the ejaculation during sexual intercourse; a
teaspoon of semen contains 200 to 500 millions of sperm.
*occurs in the fallopian tubes with in few hours after ovulation, it takes about
65-75 minutes.
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implantation 3. Decidua Vera
- 7-9 days after ovulation - Portion lining the rest of the uterus.
- Fertilized ovum able to implant in the upper part of the posterior primary germ layer
wall of the uterus
- Monozygotic: One ovum, one sperm split into two
‣ Identical twins
- Dizygotic: Ovary produces two ovum at the same time
‣ Different gender

ectoderm
- Upper layer of the embryonic disk
‣ Epidermis, sweat gland, nails, hair, & lens of the eyes
Mesoderm
- Middle layer
‣ Dermis, wall of the digestive tract, kidneys & ureter,
reproductive organs, connective tissue, skeleton, muscles, &
cardiovascular.
Endoderm
- Lower layer
‣ Respiratory tract epithelium, lining of the digestive tract,
*cilia in the fallopian tube moves the fertilized egg to the upper part of the
primary tissue of liver and pancreas, urethra, urinary
uterus
bladder, & vagina.
Embryonic & Fetal Structure membranes
decidua chorion
- Refers to the pregnant endometrium - Covering of the fetal side of the
placenta, contains the major umbilical
blood vessels that branch out over the
surface of the placenta. (near the
body)
amnion
- It forms on the side opposite to the
developing blastocyst, the developing
embryo draws the amnion around
itself to form a fluid filled sac.
‣ Amniotic Fluid: 800-1200mL of clear fluid/liquid
➡ Functions:
1. Maintain a constant body temperature
2. Serves as a source of oral fluid & as repository for
waste
3. It cushion the fetus from trauma by blunting
dispersing outside forces
4. Freedom from movement from musculoskeletal
1. Decidua Basalis development
- Portion under the blastocyst, where chorionic villi top the 5. Fluids keeps the embryo from tangling with the
maternal blood vessels. membranes
‣ Chronic Villi: Finger-like projection. Develops out of 6. Acts as extension of fetal extracellular space.
7. Acts as wage during labor
8. Provide fluid for analysis to determine fetal health
and maturity.
➡ Oligohydramnios: less amniotic fluid
➡ Polyhydramnios: more amniotic fluid

umbilical cord
- From the Latin word funis
- 53cm or 21in length
- 2cm or 3/4in thickness
- 1 vein: carrying blood from the
placental villi to the fetus
the trophoblast & extend into the blood filled spaces of
- 2 arteries: carrying blood from the
the endometrium.
fetus back to the placenta
2. Decidua Capsularis
- Portion covering the blastocyst ‣ Wharton Jelly: gives the cord body & prevents pressure
on the vein & arteries
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placenta
- Comes from the Latin word flat cake
- Is the means of metabolic and nutrient
exchange between the embryonic &
maternal circulation.
- Size of 29cm in diameter & 2-3 cm
thickness
- Weighs 1/6 of the weight of the fetus.
- 2 sides of the placenta:
‣ Fetal side: chorion, shinny, where
the umbilical cord is attached to
‣ Maternal side: amnion, it is attached to the uterus,
irregular appearance

*meconium: first feces of the baby inside the womb

*contains 18-20 cotyledons
*incomplete placenta means there is a cotyledon left inside & the defense
mechanism of the uterus would be vaginal bleeding

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