SYSTEMS PLUS COLLEGE FOUNDATION

MacArthur Highway, Balibago, Angeles City

COLLEGE OF NURSING

NORMAL SPONTANEOUS VAGINAL BIRTH (NSVB) – CASE STUDY

In Partial Fulfilment of the Requirements

In the Nursing Care Management NCM 107

Submitted by:

Del Castillo, Hiyan Jade R.

Gonzales, Rosenda Tallia N.
Macul, Ivy Mae F.
Advincula, Ehmevieve Joy D.
Villaraiz, Ariane D.
Gulpan, Christylyn M.
Lutero, Cerelyn A.

NUR03A

Submitted to:

PROF. DANIELLA ANN MADO

Clinical Instructor, NCM 107
 I. INTRODUCTION

Pregnancy happens when a sperm fertilizes an egg after it is released from the
ovary during ovulation. The fertilized egg then travels down into the uterus and is placed
there. Pregnancy is the outcome of successful implantation.

A full-term pregnancy lasts 40 weeks on average. A lot of factors can affect

pregnancy. Women who get a prenatal diagnosis and treatment early in their pregnancy
have a better chance of having a healthy pregnancy and baby. Knowing what to expect
throughout the pregnancy is crucial for keeping track of both the mother's and the baby's
health. (Cherney, Watson, & Lamoreux, 2019)

The weeks of pregnancy are divided into three trimesters, each with its own set of
medical milestones for both the mother and the foetus. During the first trimester, a baby
grows quickly (weeks 1 to 12). The brain, spinal cord, and organs of the foetus begin to
develop. The baby's heart will start to beat as well.

The risk of miscarriage is relatively significant during the first trimester. According to
the American College of Obstetricians and Gynaecologists (ACOG), one out of every ten
pregnancies ends in miscarriage, with 85 per cent of miscarriages occurring in the first
trimester (Wilson, 2017). An anatomy scan ultrasound will most usually be performed during
the second trimester of pregnancy (weeks 13 to 27).

This test looks for any developmental anomalies in the foetus’s body. If the mother
wants to know before the baby is delivered, the test results can also indicate the sex of the
kid. The mother will most likely begin to feel the baby kick, punch, and move about inside
the uterus. A kid in utero is deemed "viable" after 23 weeks. This suggests it might be able
to live outside of the mother’s womb. Babies delivered this early are more likely to have
major medical problems.

The longer the woman can carry the pregnancy, the greater the chances of the baby
being delivered healthy (Wilson, 2017). The mother's weight gain will accelerate throughout
the third trimester (weeks 28 to 40) and she may feel more exhausted. The baby can now
open and close its eyes as well as perceive light.

Their skeletons are also developing. As labour approaches, the mother may
experience pelvic pain and swollen feet. Braxton-Hicks contractions, which do not lead to
labour, may begin to occur in the weeks leading up to the mother’s due date (Wilson, 2017).
 One of the most common issues that women face during pregnancy is urinary tract
infections (UTIs). Bacteria can enter a woman's urethra, or urinary tract, and spread to her
bladder. The foetus puts additional strain on the bladder, which can trap bacteria and lead
to illness. A UTI is characterized by discomfort, burning, and frequent urine.

Cloudy or blood-tinged urine, pelvic pain, lower back pain, fever, nausea, and
vomiting are all possible side effects. A UTI affects nearly one-fifth of pregnant women.
Emptying the bladder frequently, especially before and after intercourse, can help prevent
these infections. Stay hydrated by drinking plenty of water. Do not use harsh soaps or
douches in the vaginal area.

Most UTIs can be treated with medications if identified early. They will be given
antibiotics that are safe for pregnancy even though it is effective against bacteria. (Biggers,
2021).

A healthy pregnancy diet should be similar to a usual healthy diet, with the addition
of 340 to 450 calories each day. A healthy diet should include a variety of foods, such as
complex carbs, protein, vegetables, fruits, grains, legumes, as well as healthy fats. If the
mother eats a healthy diet already, she simply has to make minor adjustments.

During pregnancy, fluids, fiber, and iron-rich meals are especially vital. (Butler,
2020). Some vitamins and minerals are required in greater quantities by pregnant women
than by non-pregnant women. Just two examples are folic acid and zinc. When a mother
learns she is pregnant, she may want to enhance her vitamin and mineral intake with
supplements.

Before using any supplements or over-the-counter (OTC) drugs, read the nutrition
labels and obtain medical advice. Vitamin toxicity or overdose is possible side effects of
supplement use, albeit they are uncommon.

A complete prenatal vitamin, on the other hand, is likely to have a good combination
of nutrients that the mother will require for a healthy pregnancy (Kubela, 2020). One of the
finest ways to care for your growing kid is to take care of yourself (Warwick, 2020).

A. LATEST STATISTICS OF NORMAL PREGNANCES

The World Economic Forum (2021) delineated that birth-rates are declining globally
due to the following reasons. Birth-rates are falling globally. In many countries, COVID-19
has suppressed population growth by causing a decline in births, migration and life
expectancy. Even before the pandemic, urbanization was driving population decline.

Most children these days are wanted or planned children, especially in the
developed world. Deciding to have a baby is contingent on being optimistic about the future
– and optimism is difficult to muster during a global pandemic. In fact, the Brookings
Institute estimates that 300,000 babies were not born in the US as a result of economic
insecurity related to the pandemic.

Table 1: Estimated impact of COVID-19 on birth in late 2020 by age group

A decline in fertility is just one way the pandemic is suppressing population growth in
many developed nations. The other: closed borders. In 2020, Australia recorded its first
population decline since World War I, due to stricter COVID-related border controls.

Canada granted permanent-resident status to 180,000 applicants in 2020, far short

of the target of 381,000 – and most of the new permanent residents were already in the
country on student or work visas. A third, grim factor is also at work: the death toll of the
disease itself.

Researchers predict that life expectancy in the United States has declined by a full
year as a result of COVID deaths. Racial minorities were particularly hard hit, with African
American life expectancy suppressed by two years and Latino life expectancy by three
years.
 Officially, the pandemic is responsible for more than 3 million deaths – but that figure
could be far higher, since some countries may be under-reporting deaths. This is probable,
for example, in India, where the pandemic is claiming 4,000 lives a day; many authorities
believe the real count is far higher.

The biggest force is urbanization. The largest migration in human history has
happened over the last century and it continues today as people move from the country to
the city. Moving from the country to the city changes the economic rewards and penalties
for having large families. Many children on the farm mean lots of free hands to do the work.
Many children in the city mean lots of mouths to feed. That’s why we do the economically
rational thing when we move to the city: we have fewer kids.

We can expect that a great defining moment of the 21st century will occur in three
decades or so when the global population starts to decline. COVID might have even pushed
the start of this decline forward – but it certainly didn’t cause it.

The Philippine Setting

The Commission on Population and Development (PopCom) projected an increased

birth rate when the Covid-19 pandemic started as more families stayed home and access to
family planning methods is limited.

Instead, there was a significant drop in the number of births in 2020, with just
1,516,042 million registered -- the lowest since 1986, which recorded 1,493,995 births.
Based on a preliminary report of the Philippine Statistics Authority as of June 2021, the total
is also lower than 2019’s 1.675 million.
 Table 2: Number of registered births in 1986 vs. 2019 vs. 2020 in millions.

Undersecretary for Population and Development Juan Antonio Perez III attributed
the birth-rate decline to the combined impacts of fewer marriages, women delaying
pregnancies during the pandemic, and the increase in women using modern family planning
methods.
Perez noted the Social Weather Stations’ November 2020 survey, which disclosed
that unintended or unplanned pregnancies were among major concerns of a majority of
Filipino women during the pandemic’s progression.

They were also anxious about Covid-19’s effects on their well-being as well as their
families, their unborn children, and the country’s overall condition, according to the study
The slowing trend of marriages, pregnancies, and childbirths will likely continue this year,
Perez said.

“The number of those who gave birth between January and March 2021 were at
268,000, compared with the normal trend of 350,000. If that continues, we can see an even
smaller addition to the population by year-end,” he said.
 Table 3: Number of births vs. normal trends during January and March 2021

He also said there may be instances of delays in the registry of births, more so in the
provinces, as midwives may have met difficulties in reporting them due to the pandemic.

On another note, complications of pregnancy are health problems that occur during
pregnancy. These are rather common and numerous. They can involve the mother’s
physical and mental condition that affects the health of the mother, the baby, or both.

Table 4: Rate of pregnancies among races during 2017 to 2018

Pregnancy complications can range from mild and annoying discomforts to severe,
sometimes life-threatening illnesses. Many problems are mild and do not progress;
however, when they do, they may harm the mother or her baby. Regardless of health
problems during pregnancy, if the baby is delivered full term and both the mother and baby
is healthy, the pregnancy can be considered normal.

Preterm birth is less than 37 weeks of gestation, early term is 37–38 weeks, full term
is 39–40 weeks and late and post term is 41 weeks or more. In the USA, in 2018, the per
cent born with low birth weight was 8.31%, and the per cent born preterm was 10.23%.

Preterm birth and low birth weight accounted for about 17% of infant deaths (deaths
before 1 year of age). Babies who survive may have breathing problems, feeding
difficulties, cerebral palsy, developmental delay, vision or hearing problems, etc. Hence,
normal pregnancies are considered full term.

Preterm birth rates decreased from 2007 to 2014. This decline is due, in part, to
declines in the number of births to teens and young mothers. However, the preterm birth
rate rose for the fifth straight year in 2019.

Additionally, racial and ethnic differences in preterm birth rates remain. For example,
in 2019, the rate of preterm birth among African-American women (14.4%) was about 50
per cent higher than the rate of preterm birth among white or Hispanic women (9.3% and
10% respectively).

B. CURRENT TRENDS ON NORMAL PREGNANCY (NEW APPROACH/METHOD OF

TREATMENT)

First and foremost, pregnancy is not a disease; it is a “state of being”. All mammals,
humans included, are on this planet for one purpose and one purpose only, to procreate for
the purpose of the continuance of the species. No religious arguments will be discussed in
this paper as they are all irrelevant to the process of a normal human pregnancy.

This paper is being written so it can be used as a quick review for physicians that
may not do Obstetrics as their primary specialty. Many countries allow General Practitioners
and Family Practitioners to manage pregnancies and deliver babies, as long as they have
privileges to do this in the hospital.

Pregnancy (gestation) is the physiologic process of a developing foetus within the

maternal body. Several terms are used to define the developmental stage of human
conception and the duration of pregnancy.

For obstetric purposes, the gestational age or menstrual age is the time elapsed
since the first day of the last normal menstrual period (LNMP), which actually precedes the
time of oocyte fertilization. The gestational age is expressed in completed weeks. The start
of the gestation (based on the LNMP) is usually 2 weeks before ovulation, assuming a 28-
day regular menstrual cycle.

The developmental or foetal age is the age of the conception calculated from the
time of implantation, which is 4 to 6 days after ovulation is completed. The menstrual
gestational age of pregnancy is calculated at 280 days or 40 completed weeks. The
estimated due date (EDD) may be estimated by adding 7 days to the first day of the last
menstrual period and subtracting 3 months plus 1 year (Naegele's rule).

The period of gestation can be divided into units consisting of 3 calendar months
each or 3 trimesters. The first trimester can be subdivided into the embryonic and foetal
periods. The embryonic period starts at the time of fertilization (developmental age) or at 2
through 10 weeks' gestational age. The embryonic period is the stage at which
organogenesis occurs and the time period during which the embryo is most sensitive to
teratogens.

The end of the embryonic period and the beginning of the foetal period occurs 8
weeks after fertilization (developmental age) or 10 weeks after the onset of the last
menstrual period.
Bernstein HB, VanBuren G. Chapter 6. Normal Pregnancy and Prenatal Care.

Methods of Treatment
Good prenatal care includes good nutrition and health habits before and during
pregnancy.

Take folic acid: If you are considering becoming pregnant, or are pregnant, you
should take a supplement with at least 400 micrograms (0.4 mg) of folic acid every day.
Taking folic acid will decrease the risk for certain birth defects. Prenatal vitamins almost
always contain more than 400 micrograms (0.4 mg) of folic acid per capsule or tablet.

Talk with your provider about any medicines you take. This includes over-the-counter
medicines. You should only take medicines your provider says are safe to take while you
are pregnant. Avoid all alcohol and recreational drug use and limit caffeine. Quit smoking, if
you smoke.

Go for prenatal visits and tests: You will see your provider many times during your
pregnancy for prenatal care. The number of visits and types of exams you receive will
change, depending on where you are in your pregnancy:
  First trimester care
 Second trimester care
 Third trimester care

Talk with your provider about the different tests you may receive during your
pregnancy. These tests can help your provider see how your baby is developing and if there
are any problems with your pregnancy. These tests may include:
 Ultrasound tests to see how your baby is growing and help establish a due date
 Glucose tests to check for gestational diabetes
 Blood test to check for normal foetal DNA in your blood
 Foetal echocardiography to check the baby's heart
 Amniocentesis to check for birth defects and genetic problems
 Nuchal translucency test to check for problems with the baby's genes
 Tests to check for sexually transmitted disease
 Blood type testing such as Rh and ABO
 Blood tests for anaemia
 Blood tests to follow any chronic illness you had before becoming pregnant

Throughout these years, labour and delivery during pregnancy have created many
innovations for the mothers to become more suitable in delivering the baby. Not only the
amenities have changed in the last few years, but women are also now more informed
whenever they go into labour.

From midwives to birthing balls and hydrotherapy, an expectant mother will often
spend several months researching her labour and delivery options during pregnancy.
Written below are the following innovations and trends that can be used in the pregnancy of
a woman.

In a birth centre-hospital hybrid, the rising interest in independent birth centres has
prompted hospitals to create natural, home-like environments within a hospital campus.
These centres allow pregnant women who want the best of the world to have a natural birth
along with the services of a hospital right outside their door whenever if needed. Nitrous
oxide has been increasingly used as a relaxer for mothers during labour.

This technique is inhaled through a mask with a mixture of 50 per cent nitrous gas
and 50 per cent oxygen provides relief during contractions. Although many of those patients
do still end up getting an epidural, nitrous oxide allows them to labour longer without it. The
use of Hypnobirthing techniques has increased.
 Hypnobirthing is one of the birthing methods that uses self-hypnosis and relaxation
techniques to help a woman feel physically, mentally, and spiritually prepared and to reduce
her awareness of fear, anxiety, and pain during childbirth. The process of Hypnobirthing is
usually done by breathing, relaxation, visualization, and meditative techniques for a calm,
natural birth. Although the mother is deeply relaxed, she is also actively involved in the
birthing process.

This concept has been around for perhaps centuries, but Marie Mongan popularized
the actual term and specific techniques in her 1989 book, Hypnobirthing. The immersion in
a water tub or hydrotherapy for the relief of pain during labour is quite common, but the
number of hospitals that include tubs in their birth suites is growing.

Many hospitals now offer this option. In the fourth stage of labour, the delayed cord
clamping technique has seemingly increased in hospitals to provide prevention of iron
deficiency to the infant, fewer infants requiring phototherapy for jaundice, and increasing the
haemoglobin levels and iron stores and the reduced need for transfusions by delaying the
cutting of the cord 1-3 minutes after birth or when pulsations stop.

C. SIGNIFICANCE OF THESE FIGURES ON YOUR PART AS A NURSING

STUDENT

These figures are highly significant on our part as a nursing student as it allows us to
gain an insight on how trends in pregnancy cases will look like in the following years to
come.

Borrowing such an important knowledge could prove highly beneficial and significant
to our career in nursing practice or our further endeavours in the field of health care
because it opens our learning to the different factors that affect and sway these trends.

Another reason why these figures are important and significant to our part as nursing
students is that it enlightens us on the new innovations and interventions surrounding
normal pregnancy and normal spontaneous vaginal birth, which we will definitely encounter
during our nursing practice once we are inducted in our roles and responsibilities as health
care providers in a healthcare institution such as in a hospital or a health centre.

These figures are important because they indicate the prevalence of abnormal
pregnancies and deliveries, and hence the increased risks. While the majority of women
have healthy pregnancies and deliveries, rates of complications are rising for both
pregnancy and childbirth.
 While some complications relate to health problems that existed before pregnancy,
others occur unexpectedly and are unavoidable. A well-trained nurse, even an entry-level
or student nurse must be prepared for all contingencies.

Nurses will increasingly encounter a myriad of pregnancy-related medical problems

and hence ethical dilemmas as well. Perinatal ethical issues include an individual’s right to
choose, the right to privacy, to know the truth and to be free from injury or harm. Examples
of perinatal ethical dilemmas include abortion, drug testing and abuse in pregnancy, and
sanctity of life versus quality of life for extremely premature or severely disabled infants.

The term “normal pregnancy” is becoming more difficult to even define as mothers
are expecting and even demanding perfect babies and a made-in-Hollywood postpartum
recovery. The expectations for the nurse practitioner will also be perfect.

II. THE DISEASE PROCESS

a. Definition of the disease

Pregnancy, or also called as gestation, is the biological process where
one of more children develops inside the womb of a mother.

The pregnancy process begins when the gamete (sperm cell) enters
and fertilizes the female gamete (egg cell) after it has been produced by the
ovary during a female’s ovulation period. During the onset of pregnancy, the
fertilized egg cell is then funnelled down into the uterus where it will
eventually develop into a baby

b. Risk Factors

UTI

Bacteriuria is the presence and the growth of microorganisms in the

urinary tract. The range of clinical effect varies from asymptomatic bacteriuria
(ABU) to urinary tract infection (UTI) (cystitis or acute pyelonephritis).UTI is a
common health problem among women due to the anatomy of the urinary
tract.

Pregnancy increases the risk of recurrent bacteriuria and acute

pyelonephritis due to the compression of ureters by gravid uterus causing
stasis of urine flow. Hormonal and immunological changes in pregnancy are
other contributing factors: high level of progesterone secretion which leads to
 stasis and decreases immunity. Physiological proteinuria and glycosuria
promote microorganism growth in the urine of pregnant woman.

In pregnant women, risk factors for UTI included:

 Anemia
 Sexual activity
 Lower socioeconomic classes
 Past history of UTI

Common UTI Symptoms in Pregnant Women

 Strong and frequent urge to use the bathroom
 Burning while urinating
 Regularly passing only small amounts of urine
 Cloudy, red, pink or cola-colored urine
 Pelvic pain, usually in the center of the pelvis

Polycystic Ovary Syndrome (PCOS)

Pregnant women with polycystic ovary syndrome (PCOS) are at higher risk for
certain complications, and her baby is at a higher risk of hospitalization or death.

Conditions common to COS like metabolic syndrome and increased androgens may
heighten the risks to infants. Pregnant women with PCS are three times as likely to have a
miscarriage. Women with gestational diabetes, as well as their children, are at higher risk
for type 2 diabetes later in life. This is a type of diabetes that only pregnant women get.

In pregnant women, the primary risk factors for polycystic ovary syndrome (PCOS)
included:

● Irregular menstruation

● Family history of infertility and diabetes

● Unpleasant mood

● Lack of physical exercise

Common PCOS Symptoms in Pregnant Women:

● Irregular menstrual periods

● Cysts on the ovaries

● Infertility
● Weight gain

● Acne

● Excessive face and body hair

● Thinning or balding head hair

● Insulin resistance

Obesity II

Obesity is caused by the increase in the size and the amount of fat cells in the body.
Obesity is increasingly common worldwide and is a serious medical condition. Treatments
include lifestyle changes, such as heart- healthy eating and increased physical activity,
approved weight-loss medicines, and even surgery.

Obesity is associated with increased risk of almost all pregnancy complications such
as gestational hypertension, preeclampsia, gestational diabetes mellitus (GDM), delivery of
a large gestational age (LGA) infant, and a higher incidence of congenital defects. Risks
increase as the obesity level increases

In pregnant women, the primary risk factors for obesity include:

● Unhealthy lifestyle habits and environments
● Commute patterns
● Technology
● Age (45-74)
● Family history and genetics
● Race and ethnicity (non-Hispanic backs)
● Gender (women)

Common Obesity Il Symptoms in Pregnant Women:

Doctors measure body mass index (BMI) and waist circumference to screen and
diagnose overweight and obesity. Ranges of BMI are used to describe levels of risk: Class
2 (moderate-risk) obesity, if BMI is 35.0 to 39.9
● Difficulty sleeping. Obesity is associated with sleep apnea
● Back and/or joint pains
● Excessive sweating
● Intolerance to heat
● Infections in skin folds
● Fatigue
● Depression
● Feeling of shortness of breath (dyspnoea)

c. Signs and Symptoms

Missed period
Missing your period is the most often first sign of pregnancy for women
around the world. This is often followed by undergoing a self-pregnancy test
and a visit to the nearest OB-GYN

Nausea and vomiting

Morning sickness is a common medical condition that is present in
more than half of all expecting mothers and may include nausea and vomiting
as well as loss of appetite as common symptoms.
Although it is called morning sickness, some women do not just
experience these symptoms during the morning but also throughout the entire
day.

Breast changes
Due to hormonal changes in the body, the pregnant woman’s breast
will experience various changes such as the nipples becoming darker and the
appearance of the veins in the breast area being much more obvious.

Fatigue
Fatigue and tiredness is very common in pregnancy as the body
produces more progesterone. Progesterone is needed to maintain the course
of the foetus’s growth and the stability of pregnancy but it do slow down a
woman’s metabolism, thus causing a depletion in energy reserves.

Frequent urination
Since pregnancy causes an increase in body fluid levels and an
increase kidney efficiency, expecting mothers are likely to experience more
frequent urges to urinate, especially during the first few weeks of becoming
pregnant and as the swelling uterus presses against the bladder of the
mother.

Food cravings
Pregnant women are more likely to experience cravings for certain
foods, especially those that are high in calcium and those that provide a lot of
energy such as milk and other dairy products. Women are also likely to be
repulsed by foods that they may be previously liked.
 Other symptoms of pregnancy
Many of these symptoms may also be indicative of other conditions
and it may still be best for a mother to consult their physician when in doubt. 
 back pain
 out of breath
 constipation
 headaches
 heartburn and indigestion
 itchy skin
 leg cramps
 moodiness or mood changes
 vaginal discharge
 vaginitis
 Varicose veins
 leg edema

III. ANATOMY AND PHYSIOLOGY (WITH PICTURES)

Figure 1: Normal Pregnancy Figure 2: Multiple Pregnancy (Twins)

 Figure 3. Growth of Fetus during Pregnancy by Months

Pregnancy.  Pregnancy is a biological process that occurs when a male

gamete (sperm cell) enters and fertilizes the female gamete (egg cell) after it has
been produced by the ovary during a female’s ovulation period. During the onset of
pregnancy, the fertilized egg cell is then funnelled down into the uterus where it will
eventually develop into a baby.

On average, a normal or “full-term” pregnancy will last about forty weeks or

just over 9 months, as measured from the LMP (last menstrual period) to the delivery
of the baby. A pregnancy is often divided into three segments which health care
professionals refer to as “trimesters”

Because there are various factors that can affect a pregnancy and its
development, it is highly recommended for women who are expecting to undergo
early pregnancy diagnosis and prenatal care in order to experience a normal
pregnancy and give birth to a healthy baby.

As discussed earlier, there are three trimesters that make up a normal pregnancy.
The first of these is called the “first trimester” which occurs at Week 1 to Week 12.

In the first trimester, conception begins when the sperm cells penetrate the egg cell,
which then develops into a zygote or a fertilized egg cell, which will then travel down
through the female fallopian tube to the womb or the uterus where the zygote will implant
itself in the walls of the uterus.

The zygote is made up of various cells which will form the placenta and the foetus
during the first trimester. The placenta will eventually connect the foetus to the mother and
will provide nutrients and oxygen to the growing baby.
 The next stage is the second trimester which will occur during Week 13 to Week 28.
During this stage, the mother will be able to find out the sex of her baby and be able to
diagnose for birth defects using ultrasound machines.

The final stage of the pregnancy is called the third trimester which occurs during
week 29 to week 40. Any baby born before 37 weeks of age are considered pre-term
babies, those who are born during the 37 th and 38th weeks of pregnancy are considered as
“early term” and those who are born at 39 weeks or later are called as “full term” babies.

Full-term babies have the best health conditions than pre-term and early term
infants, and to some extent – even late term (babies born through 41 weeks to 41 weeks
and 6 days) and post term babies (babies born after 42 weeks). Therefore, to have a fully
normal pregnancy, it is advisable to deliver at or after 39 weeks of gestation to allow the
growing baby to fully develop its lungs, brain, liver, and other organs.

IV. MEDICAL MANAGEMENT

a. Diagnostic and laboratory procedures

DIAG GENERAL INDICATION OR NORMAL ANALYSIS AND ABNORMA NURSING
NOST DESCRIPTION PURPOSE VALUES INTERPRETATION L FINDINGS RESPONSI
IC/LA BILITIES
BORA
TORY
PROC
EDUR
E

Abdo A procedure It is used to The pelvic In a normal pregnancy, Fetal growth Assess
minal that uses high- detect pregnancy structures or ultrasound can provide an abnormalitie baseline
Ultras energy sound as early as 3 fetus is normal. estimate of the gestational s, fetal vital signs.
ound waves to look weeks after age to within five to seven malformatio
or at tissues and conception, days of accuracy. ns, Central Assess fetal
Ultras organs inside confirm or revise Nervous heart
onogr the body. The gestational age System sounds to
aphy sound waves with reasonable anomalies, monitor the
make echoes accuracy, cardiovascul wellbeing of
that form diagnose multiple ar disorders, the fetus.
pictures of the gestations in gastrointesti
tissues and early pregnancy, nal
organs on a assess fetal well- disorders,
computer being, evaluate renal
screen amniotic fluid disorders,
(sonogram). volume, and amniotic
diagnose a broad fluid
variety of fetal abnormalitie
malformations. s, abnormal
fetal well-
being

Syphili Syphilis tests All pregnant Negative Result Results of nontreponemal Positive Discuss the
tell if a person testing may be reported as Result test
s Test women are tested
has this positive, also called reactive, procedure
disease. They for syphilis and c or negative, also called non- that slight
look reactive. If positive, the discomfort
hlamydia early in
for antibodies t results may also indicate the may be felt
o the pregnancy. Tests amount of antibody present in when the
bacterium, or the sample used for testing. skin is
for these
germ, that punctured.
causes syphilis. infections may be A positive nontreponemal test
Some tests result means that a patient Encourage
repeated later in
look for the may have syphilis. A follow-up
the woman
syphilis germ pregnancy if treponemal test is required to
itself. confirm a positive diagnosis. to relax
woman has
Negative test results indicate
during the
certain risk that a patient may not have
syphilis, although additional procedure.
factors.
testing may be needed if a
patient is experiencing
symptoms.
She will also be
tested For treponemal testing,
results are typically reported
for gonorrhea if
as reactive or nonreactive. A
she is 25 or reactive test result indicates
that a patient has had syphilis
younger or lives
at some point in the past.
in an area where
 b. IVF, O2 Therapy, Nebulization, NGT

Type Of Medical General Description Indication Or Purpose Nursing Responsibilities

Management
O2 Therapy A form of respiratory Supplemental oxygen via a  Review the protocol at your
care involving administrati low flow oxygen system that health authority prior to
on of supplemental oxyge is, providing oxygen via a initiating any high-flow oxygen
n for relief of hypoxemia a nasal cannula at 3 liters per systems, and consult your
nd prevention of damage  minute (LPM) while respiratory therapist.
to the tissue cells as a res conducting a spinal  Oxygenation is reduced in the
ult of oxygen lack (hypoxi anesthesia. As for the supine position. Hypoxic
a). Acts as supplemental maternal aspect, oxygen patients should be placed in an
oxygen for parturient therapy is currently upright position unless
undergoing delivery under recommended when contraindicated (e.g., if they
spinal anesthesia. parturient suffer from a major have spinal injuries or loss of
trauma, sepsis, or an acute consciousness).
illness.   Check the function of the
equipment and complete a
respiratory assessment at
least once each shift for low-
flow oxygen and more often for
high-flow oxygen.
 Oxygen saturation levels and
delivery equipment should be
documented on the patient’s
chart.
Nitrous Oxide Nitrous oxide is classified It is a form of labor analgesia. A  Nurses must continuously
as a dissociative sedative that has a quick onset assess the mother and fetus
anesthetic. It is a after it is inhaled and leaves the throughout labor and
colorless non-flammable system quickly once its use is document assessments in
gas, with a pleasant, discontinued. Nitrous oxide will accordance with the individual
slightly sweet odor and not completely eliminate pain, institutional policy. While a
taste. It is used in surgery but it can help dull pain and patient is using nitrous oxide,
and dentistry for its lessen anxiety. vital signs should continue to
anesthetic and analgesic be taken as required for a
effects. It is known as laboring woman based on her
"laughing gas" due to the risk status and stage of labor.
euphoric effects of If maternal or fetal well-being
inhaling it, a property that is thought to be compromised,
has led to its recreational following hospital guidelines
use as an inhalant drug. for notification of the OB
and/or anesthesia teams and
performing the required
intrauterine resuscitation
nursing interventions (e.g.,
 maternal position change,
obtaining IV access, oxygen
administration and
discontinuing nitrous oxide
administration) are
recommended

c. Medications

NAME GENERAL INDICATION OR ROUTE OF SIDE EFFECTS NURSING

OF THE DESCRIPTIO PURPOSE ADMINISTRATIO AND ADVERSE RESPONSIBILITIE
DRUG N/ N, DOSAGE AND REACTIONS S
CLASSIFICA FREQUENCY OF
GENERI TION ADMINISTRATIO
C NAME N

BRAND
NAME

Amoxicilli PHARMACOT Treatment of susceptible P.O - 250 mg Side Effects: Increase fiber and
n HERAPEUTIC infection due to every 8 hours 4 Diarrhea, loose fluid intake for the
: Penicillin. Escherichia coli/ E.coli times daily, or stools, nausea, side effects such as
CLINICAL: through inhibiting the 500 mg every 12 skin rashes, diarrhea and loose
Antibiotic. bacterial cell wall hours twice daily. urticaria. stools. Maintain
synthesis by binding to fluid balance in
PCN-binding proteins. patients at risk.
Sufficient hydration
has been shown to
reduce the risk of
 nausea.
Encourage the
patient to bathe in
warm water using
a mild soap, then
air dry the skin and
gently pat to dry.
Encourage the
patient to keep the
skin clean, dry, and
well lubricated to
reduce skin trauma
and risk for
infection.

Malungga Vitamin Supplement that improves P.O- 1-2 cap/day Lower blood Drink more
y flow of breastmilk for Should be taken pressure water. Fluids
Supplem lactating mothers. Helps with food. (Hypotension) and increase blood
ents augment breast milk in slow heart rate volume and help
nursing women (Bradychardia). prevent dehydration,
LactaFlo
Uterine
w both of which are
contractions from
important in treating
moringa bark
hypotension.
Monitor vital signs.
Note skin color,
temperature, and
moisture.
Cold, clammy, and
pale skin is secondary
to a compensatory
increase in
sympathetic nervous
system stimulation
and low cardiac
output and oxygen
desaturation.

Assess uterine
contraction
pattern; provide
rest (analgesia);
provide comfort
measures; monitor
maternal vital
signs; frequently
 monitor fetal status

Oxytocin Uterine Ind: Introduction of -Introduction of Side-Effects: Assess baselines

- Pitocin smooth stimulation of labour, stimulation of Occasional: for vital signs, B/P,
muscle Control of Postpartum labour: IV: Adults: hypotension, foetal heart rate.
stimulant bleeding 0.5-1 nausea, vomiting Determine
multiunit/min. frequency,
To produce uterine
May gradually duration, strength
contractions during third
increase in Adverse Reaction: of contractions.
stage of labour and to
increments of 1-2 Hyper tonicity may
control postpartum Any significant drop
mill units/min occur with tearing
bleeding/haemorrhage. in blood pressure
q30-60mins until of uterus,
should be
desired increased
immediately treated
contraction bleeding,
by a position
pattern is abruptioplacentae
change, a bolus of
established. (i.e., placental
intravenous fluid, or
-Control of abruption
vasopressors if
postpartum
necessary.
bleeding: IV
infusion: Adults: Monitor uterine
10-40 units in tone, intrauterine
1000mL fluid at pressure,
rate sufficient to contractions that
sustain uterine last longer that
contractions and 1min, occur more
control atony. - frequently than
IM: Adults: 10 every 2 min, or
units (total dose) stop.
after deliver

Erythrom Macrolide Ind: Prevention of Prevention of Rare: Sensitivity Cleanse the infant's
ycin- antibiotics gonoccal opthalmia opthalmia reaction with eyes as needed
Erythrom neonatorum, superficial neonatorum: increased before application.
ycin ocular infections. Ophthalmic route: irritation, burning,
Observe for
Ophthalm Treatment of blepharitis, Neonates: Apply itching,
irritation. Notify
ic conjunctivitis, keratitis, a ribbon inflammation.
physician for any
ointment chlamydial trachoma. (approximately 1
reaction that occur.
cm) of 0.5%
ophthalmic
ointment into
each lower
conjunctival sac
immediately after
birth (i.e., within 1
hour).
 Administration:
Pull the lower
eyelid down
gently and
squeeze a one-
half–inch ribbon
of the ointment
into the sac, avoid
touching the eye
or lid.

Vitamin K fat-soluble Prevention or treatment of 05-1mg given Haemolysis, or Observe infant on

(AquaME vitamins, vitamin K dependent once IM within 1 hyperbilirubinemia the sclera and oral
PHYTON Antifibrinolytic bleeding. (haemorrhagic hour of birth for , especially in a mucosa, yellowing
, Agents disease of the new-born) prophylaxis. May preterm infant or of skin immediately
Mephyton be delayed for when a large dose after blanching, and
, breastfeeding in is used. specific body parts
Konakion delivery room. involved. Assess
oral mucosa,
posterior portion of
hard palate and
conjunctival sacs
in dark-skinned
new-borns.

Lidocaine Amide Local Anaesthesia Infiltration, Nerve Generally Question for

Hydrochl Anaesthetic Block: Local associated with hypersensitivity to
Inhibits conduction of
oride anesthetic high dose: Lidocaine, amide
nerve impulses. Causes
dosage varies drowsiness, anaesthetics,
temporary loss of
with procedure, dizziness, Obtain baseline
feeling/sensation.
degree of disorientation, light B/P, pulse,
anesthesia, headedness, respiratory rate,
vascularity, hypotension ECG, serum
duration. electrolytes.
Maximum:
Monitor ECG, vital
4.5mg/kg or 300
signs closely during
mg. Do not repeat
and following drug
with 2 hours.
administration for
cardiac
performance.
Monitor for
therapeutic serum
level (1.5-6mcg/ml).
For Lidocaine given
by all routes,
monitor vital signs,
LOC. Drowsiness

d. Diet
TYPE OF DIET
A low-fat diet during
pregnancy minimizes the
harmful effects of maternal
obesity on the newborn's body
composition, reducing the
child's risk of developing
obesity and related diseases
later in life. Typically, an
additional 300 calories per
day is needed. Eat from a
variety of food groups:
Fruits and Vegetables:
provide Important nutrients,
esp. vitamin C and folic acid.
2-4 servings of fruit and 4
servings of vegetables daily.
Bread and Grains: provide
important nutrients such as
iron, B vitamins, and fiber. 6-
11 servings of daily.
Protein: Lean meat, poultry,
fish, eggs, and beans contain
protein, B vitamins, and iron
needed. 3 servings daily.
Dairy Products: Good sources
of calcium include low fat milk,
cheese, and yogurt. 4
servings daily.
Prenatal vitamins should be
GENERAL INDICATION OR NURSING RESPONSIBILITIES
DESCRIPTION PURPOSE
Nutritional A normal pregnancy diet
management during a is not about restricting
normal pregnancy calories or losing weight.
It’s all about healthy
eating, so avoid popular
weight loss diets. The
healthy diet must ensure
adequate nutrition for the
health of the mother and
baby. In order to get the
nutrients needed, eat from
a variety of food groups
throughout the day.
should be consider
a warning sign for
high serum levels
of Lidocaine. May
change the position
of the patient to
reduce
hypotension.
➢ Assess weight to
determine if caloric
intake is adequate (2500
daily). An average
weight gain during
pregnancy is 11.2 to
15.9 kg. 1st trimester:
0.4 kg per month. Last
two trimesters: weight
gain of 0.4 kg per week.
➢ Proper health and
nutrition education to
ensure that the pregnant
woman is getting the
right amount of nutrients.
Advise woman to obtain
calories from the food
groups and servings
indicated. Encourage
preparations of healthy,
low fat snacks at the
start of the day.
➢ The DRI for protein in
women is 46g/d. If
protein needs are met,
overall nutritional needs
are met as well except
for vitamins C, A, and D.
Take daily prenatal
vitamins.
➢ When the woman has a
history of
taken up to three months
before conception.
hypercholesterolemia,
advise her to consume
lean meat, olive oil, and
to remove the skin from
poultry.

➢ Milk is a rich source of

protein and calcium, and
for women who are
lactose intolerant, add
lactase supplement, take
calcium supplements, or
buy lactose-free milk.
Yogurt or cheese can
also be a substitute.

➢ Vegetable oils such as

olive, corn, and safflower
contains needed linoleic
acid. Advise the woman
to avoid animal fats such
as butter. Encourage
intake of omega-3 oils
found in fish, fortified
eggs, and spreads.

➢ Advise the woman not to

use mineral oils as
laxative because it
prevents the absorption
of fat-soluble vitamins.

➢ Sodium maintains fluid in

the body, so advise the
pregnant woman to
continue adding salt into
her food if not restricted.

➢ Advise the woman to

drink extra amounts of
water to promote kidney
function. Encourage
intake of 2 to 3 glasses
of fluid daily over three
servings of milk.

➢ Look for signs of good

nutrition such as shiny
hair, moist and pink
mouth mucous
membranes, neck has a
normal contour of the
thyroid gland, skin is
smooth with normal color
and turgor, extremities
have a normal muscle
mass, strength, and
mobility, nails are
smooth, pink, and
normal in contour, and
vital signs are normal.
 e. Activity
GENERAL
TYPE OF DESCRIPTION INDICATION OR PURPOSE NURSING RESPONSIBILITIES
ACTIVITY

Frequent Walking Walking is a moderate Moving your body in pregnancy may No matter where you are in your
due to Near Date of aerobic activity that not always sound appealing, especially pregnancy, certain conditions or
Delivery doctors recommend to if you’re still in the throes of morning complications may cause your
most pregnant folks sickness. However, keeping fit and doctor to suggest taking a step
because it’s safe, active has numerous benefits that may back from exercise.
effective, and help you feel better in the long run.
accessible. Each case is different, so contact
The American College of Obstetricians your healthcare provider for
Walking is considered a and Gynecologists (ACOG) shares that guidance if you have any of the
safe activity during walking and other moderate exercise following:
pregnancy because it during pregnancy may lower your risk
works your of developing gestational diabetes,  heart or lung diseases
cardiovascular system preeclampsia,  cerclage
without taxing your  risk for preterm labour with
muscles and joints. multiples
 preeclampsia or high blood
pressure
 severe anaemia

Swimming According to the Exercise in general is encouraged Advice the patient to use a good
American College of during pregnancy, since it keeps the fitting swim suit and always use
Obstetricians and body healthy and prepares it for the sunscreen. Staying hydrated is
Gynaecologists, rigors of labor ahead. Swimming is a also one of the things that should
swimming is one of the low impact form of exercise, so your be considered. Tell the patient to
safest forms of exercise bones and joints will thank you. always swim with others and
during pregnancy. carefully watch herself.
Being surrounded by water can also
Swimming is a low help to elevate some pressure on your
impact exercise that body from the extra weight you’re
builds strength and carrying during pregnancy. Better
aerobic capacity. sleep is one of the benefits.

By focusing on Like many forms of aerobic exercise,

exercises that build better night sleep may come from
core strength and don’t spending some time in the pool. Water
twist the abdomen, it’s can be a great form of pain relief,
possible to get in a safe particularly during pregnancy when you
swimming workout even may be experiencing swelling or
late in your pregnancy. discomfort due to weight gain.
Swimming may help the neurological
system of your unborn baby. It can
typically be done safely in all three
trimesters.

f. Surgical Management

i. Definition of the Operation: Normal Spontaneous Vaginal Birth (NSVB)

A Normal Spontaneous Vaginal Delivery (NSVD) is when a woman goes into

labour without the aid of any labour-inducing drugs or methods, and is able to deliver
the baby without requiring a doctor’s aid through caesarean section, vacuum
extraction, or with forceps (NYE Partners, n.d.).
 Vaginal delivery is safest for the foetus and the mother when the new-born is
full-term at the gestational age of 37 to 42 weeks. Vaginal delivery is preferred
considering the morbidity and the mortality associated with operative caesarean
births has increased over time (Lagrew et al, 2018, as cited in Desai and Tsukerman,
2021).

The advantages of a successful vaginal delivery are numerous to both the

baby and the mother. With a vaginal delivery, there is a higher chance of being able
to breastfeed successfully shortly after delivery, decreased hospital stay after
childbirth, rapid recovery physically and psychologically, and increased mother-child
bond and attachment.

For the baby, the benefits of vaginal delivery include improved hormonal and
endocrinological functions such as blood sugar regulation, respiratory function,
temperature regulation, and an increase in exploratory behaviours. Other benefits
include better long-term growth, immunity, and development compared to children
born as a result of a caesarean section (Buhimschi and Buhimschi, 2006, as cited in
Desai and Tsukerman, 2021).

ii. Procedure (preoperative, intraoperative, and post operative)

1. Pre-operative interview
In order to give good treatment to patients, healthcare providers
must first be aware of any previous records that may have an impact on the
patient's health. During the pre-operative phase, the care provider needs
access to the patient's medical history in order to determine whether the
treatments and medications they'll be delivering to the patient are safe and
won't harm their health.

Another thing to consider is that health care providers must do an

examination and interview with the patient in order to determine the current
risk associated with a particular surgery. Make certain you collect both
objective and subjective information.

Gather information about previous operations, diseases, previous

pregnancies and abortions or terminations, food and drug allergies, adverse
aesthetic reactions, haemorrhagic difficulties, current medications for a
specific disease or disorder, and family health history. To ensure that the
data we have acquired is reliable, the health care practitioner must ensure
that the subjective data can fit inside the objective data.
 In the procedures that the health care provider will be performing,
the health care provider should additionally collect data regarding the
patient's own knowledge. Asses the patient’s:
 Knowledge about normal delivery of the baby.
 Understanding about the possibility of C-section delivery due to
UTI
 Expected length of hospitalization
 Have been notified about the different procedure that the health
care provider will conduct and the risk it contains.
 Is already oriented about the possibility of being connected so
some postsurgical equipment.
 Special precaution that is planned for the infant and herself.

2. Pre-operative diagnostic procedure

Preoperative diagnosis is necessary for mothers who are doing
normal spontaneous vaginal birth (NSVB). You need to do a thorough
assessment of the mother as well as the child inside the womb. Before
undergoing surgery, the woman must go through the diagnostic procedures
that her doctor has advised, the following are included:

 Circulatory and renal function tests, as well as foetal heart rate,

are among the diagnostic procedures that a woman must
undertake before surgery. 
 Diagnostic methods for the circulatory system include a full blood
count, as well as PT and PTT. 
 Urine testing is required to determine renal function. 
 Vital sign determination, serum electrolyte and pH, blood type
and cross-matching, and ultrasound to identify foetal presentation
and maturity are among the other diagnostic methods. 

It's vital to prepare for the possibility of postpartum bleeding to

reduce morbidity. For the normal spontaneous vaginal birth (NSVB), two to
four units of packed red blood cells should be supplied.

3. Pre-operative teaching
Even in normal delivery, there are still complications that could happen
to the patient that could lead to more complicated procedure. The health
care provider will need to inform the patients about the risk of the procedure
and the necessary interventions that is needed in order to give the best
 possible health care. The health care provider can also teach the patient on
how they could gain the highest stability as possible while doing the
procedure.

One of the most important things about a normal delivery is the

proper breathing. Proper breathing will help the mother to push during
contractions only. The patient should be in the most comfortable position
possible while doing the procedure; there could be a complication if the
patient is uncomfortable.

The health care provider needs to orient about the foods she should
eat and what she should not before doing the procedure. Make sure to tell
the patient that following the pre-operative teachings will help him and her
baby to reach the best possible wellness as possible.

4. Intraoperative care measures

Prior before the delivery for pregnancy or surgery, immediate
preoperative care measures aims to increase the rate of success for the
patients while in labour. In normal and normal spontaneous vaginal delivery
operation, these are the following procedures that a patient must complete
before the procedure start:
 Baseline data such as BP, temperature & foetal heart rate. The
patient will be assessing for the vital signs before the procedure to
monitor all the status upon for the operation.
 In normal spontaneous vaginal delivery operation, a nurse will
prepare for incision site by intravenous insertion. Intravenous
antibiotics should be administered routinely within 60 min before
the normal spontaneous vaginal delivery skin incision.
 Administration of medicine will be provided for prevention of
heartburn while lying down for the surgery.30 minutes before the
surgery, the patient will also be given medicine to decrease the
acidity in the stomach.
 A nurse will assist the patient to the operation room accompanied
by a one support system for the patient for the entire process of
operation.
 Briefing for patient’s care. The patient will be instructed for the
following process before the procedure.

5. Postoperative care measures

 Postoperative care is the care you receive after a surgical procedure.
The type of postoperative care you need depends on the type of surgery, so
for a normal pregnancy and delivery, only an episiotomy is considered.
Episiotomy is a surgical incision made in the perineum which is the area of
skin between the vagina and the anus. The incision enlarges the vaginal
opening to allow the baby's head to pass through more easily and to
prevent tearing of the mother's skin. Most women will not need one but may
need stitches to close tears or cuts in their perineum and the post-operative
care is similar.

Postpartum (vaginal delivery) recovery takes a while. Most women

are fully recovered after 6-8 weeks, but some may need a few months. For
a normal pregnancy and delivery, the hospital stay is about 48 hours. The
postpartum pain may be worse for an episiotomy or stitches to close
perineum tears or cuts. This may take up to 6 weeks to heal and absorb the
stitches. In the meantime, don’t touch the stitches and get medical
treatment if they get more painful or red or leak fluid.

To relieve soreness, place an ice pack on the area and sit on a pillow
instead of a hard surface. Use a squirt bottle with warm water to keep the
area clean while urinating. After a bowel movement, press a clean pad or
washcloth against the sore area, and wipe from front to back. That will ease
pain and help avoid infection.

It's common to have vaginal bleeding and discharge for several

weeks. There will be bright red blood that will turn pinkish or brownish, then
yellow or creamy before stopping in about six weeks. Discharge may be
heaviest in the first 10 days and clots may pass, especially in the first week
after birth. Call the doctor if clots are bigger than a quarter. Use sanitary
pads, not tampons, since tampons can bring bacteria into the vagina.

Contractions for a few days after delivery are normal. They can feel
like period cramps. They happen because the uterus is shrinking and goes
from about 2.5 pounds right after delivery to just a couple of ounces 6 weeks
later. These pains are more noticeable when nursing as chemicals are
released that tighten the uterus. Use a heating pad or a non-prescription pain
reliever.

Vaginal delivery stretches out the bladder and can cause nerve and
muscle damage for a short time. That can make it hard to go to urinate. Try
 pouring water over the genitals to lessen the sting from urine. There may be
leakage when coughing or laughing. This should get better on its own. Kegel
exercises can speed recovery.

Trouble defecating is often a pain medication side effect. To ease

constipation, drink plenty of water and eat high-fiber foods. The opposite
problem may occur. Gas or poop may leak as the muscles and tissue in the
rectum can be stretched or torn during childbirth. Avoid dairy, gluten, or fatty
foods and artificial sweeteners as they can cause diarrhoea. Haemorrhoids
can also make it easier for poop to escape. For haemorrhoids (swollen veins
in your bottom) after delivery, apply witch hazel to ease pain and itching.
These conditions usually get better within a few months after delivery.

In the first 3-4 days postpartum, breasts make colostrum, a nutrient-

rich substance that boosts the baby's immune system. Breasts will then swell
with milk. Nursing or pumping will ease the swelling and tenderness. Place
cold washcloths on breasts between feedings. Avoid rubbing breasts, as that
causes more milk to be made. If not breastfeeding, wear a firm, supportive
bra.

About 6 weeks after delivery, the nurse or doctor will check the vagina,
cervix, uterus, and vital signs. It's usually fine to start having sex and
exercise again.

iii. Instruments/equipment and machines/materials needed during the

surgery (provide pictures)

Foetal Monitor

Figure 4: Foetal Monitor Machine

Electronic foetal monitoring is a process that uses equipment to continually record

the foetus' heartbeat and the woman's uterus' contractions during labour. The method
utilized is determined by your ob-gyn or hospital's policy, your risk of complications, and
how your labour is progressing. For external monitoring, instruments that detect foetal
heartbeats are placed around the pregnant woman's abdomen.
Electrodes that measure foetal heartbeats are attached to the foetus’s scalp for
internal monitoring.

Ultrasound

Figure 5: Ultrasound Machine

An ultrasonic scan creates an image of a person's internal body structures using

high-frequency sound waves. Ultrasound is often used to examine a developing foetus
(unborn baby), abdominal and pelvic organs, muscles and tendons, and the heart and blood
vessels of a person.

Scalpel

Figure 6: Scalpel Tool

The scalpel, which was created by ob-gyns for ob-gyns, decreases the danger of
foetal harm from nicks, cuts, or lacerations during normal spontaneous vaginal birth
deliveries while also protecting doctors, nurses, and other medical professionals from
sharps injuries. A scalpel, sometimes known as a lancet or bistoury, is a small bladed
instrument used in surgery and anatomical dissection.

Surgical Bed
 Figure 7: Surgical Bed

The instruments, equipment, machines, and materials required for a normal

spontaneous vaginal birth surgery varies based on the clinical scenario. Modern disposable
and reusable items are utilized to make normal spontaneous vaginal birth procedure safer
for the surgeon, the patient, and the baby.
A surgical bed or table, which can move up and down, based on the surgeon’s
needs, is typical. The surgical table includes rests for the patient’s arms, a safety strap or
belt to ensure the patient does not fall off the table, and a ramp or merely a rolled blanket to
achieve left lateral tilt of the patient. A blanket warmer is often present to provide warming
for both the mother and new-born.

Anaesthesia Monitoring Equipment

Figure 8: Anaesthesia Monitoring Equipment

At the head of the surgical table is the anaesthesia equipment, which includes
monitors for patient vital signs, organizational cabinets, medications for achieving adequate
anaesthesia, and airway equipment. All equipment needed for obtaining and maintaining a
patient’s airway should be readily available

Surgical Tray
 Figure 9: Surgical Tray Set

There are standardized “surgical trays” specifically for normal spontaneous vaginal
birth. This tray contains the surgical instruments traditionally used during the procedure but
may vary by region or hospital.
This tray may include several kinds of scissors (bandage, Metzenbaum, straight and
curved Mayo), several kinds of clamps (Kelly, Kocher, Allis, Babcock), sponge forceps,
several kinds of tissue forceps (Adson, Russian, Ferris Smith, smooth), retractors (bladder
blade, Army Navy, Richardson), knife handles, needle drivers, suction (Yankauer or Poole),
or other instruments. Having the appropriate instruments readily accessible can save
precious time in an emergency.

Artery Forceps

Figure 10: Artery Forceps

Artery forceps are surgical instruments used to close ruptured blood vessels. The
instrument also called a haemostat they are available at Surgical Holdings for grasping and
compressing an artery to control bleeding, typically using handles that can be held in place
by a locking mechanism. Artery forceps are used to compress an artery to stem bleeding.
The main uses of artery forceps is for controlling bleeding and for the retraction of
tissues, skin, and etc. artery forceps otherwise called Haemostatic forceps. The haemostat
used to block the flow of blood and tips close the blood vessels. It’s also used to hold the
tissue and skin. It has a ratchet and two blades with uniform serrations. Transverse
serration is present only at the tip

Foley catheter
 Figure 12: Foley Catheter

A catheter is a hollow tube that is inserted into the bladder through the urethra to
remove urine from your bladder. It can be left in place for hours or days to alleviate your
need to go to the bathroom or to use a bedpan if you are restricted to bed or are numb and
can't feel the need to urinate.

Obstetric Haemorrhage Toolkit

Figure 13: Toolkit

Obstetric Haemorrhage Toolkit is a toolkit to help obstetrical providers, clinical

staff, hospitals and healthcare organizations develop methods within their facilities for
timely recognition and an organized, swift response to haemorrhage (California
Maternal Quality Care Collaborative [CMQCC], 2019).
It contains the following: Vaginal retractors; long weighted speculum, Long
instruments (needle holder, scissors, Kelly clamps, Intrauterine balloon, Banjo curette,
Bright task light, Procedural instructions (balloon), Hysterectomy tray, #1 chromic or
plain catgut suture & reloadable straight needle for B-Lynch sutures, Intrauterine
balloon, and Procedural instructions (balloon, B-Lynch, arterial ligations).
Medications: Oxytocin (Pitocin) 10-40 units per 500-1000mL solution (2 pre-
mixed bags), Oxytocin (Pitocin) 10 units (2 vials), 15-methyl PGF2α (Hemabate,
Carboprost) 250 micrograms per mL, avoid with asthma; use with caution with
hypertension (1 ampule), Misoprostol (Cytotec) 200 microgram tablets (5 tabs), and
Methylergonovine (Methergine) 0.2 milligrams per mL, avoid with hypertension (1
ampule) (CMQCC, 2019). 
 Suction Machine

Figure 14: Suction Machine

A suction machine, also known as an aspirator, is a type of medical device that
is primarily used for removing obstructions — like mucus, saliva, blood, or
secretions — from a person’s airway.
When an individual is unable to clear secretions due to a lack of consciousness
or an on-going medical procedure, suction machines help them breathe by maintaining
a clear airway. In practice, care professionals use suction machines as an integral part
of a treatment plan when a patient’s airway is partially or completely obstructed.

Hand Held Doppler

Figure 15: Handheld Doppler

The Medline 4 MHz Handheld Foetal Doppler, by Medline, is a dependable tool

healthcare worker can use with a patient to measure vascular blood flow and determine any
irregularities or potential disease indicators. This vascular Doppler is a non-invasive option
for getting diagnostic information that can potentially avoid the patient's need for
arteriography or venography.
This Vascular Doppler will assist a clinician diagnose potentially deadly conditions
like blood clots, heart valve defects, congenital heart disease or bulging or blocked arteries.
The data this handheld Doppler provides can also assist detecting pulmonary hypertension,
a condition that can lead to heart failure. This tool will also give data that the doctors and
healthcare workers use to evaluate patients' venous health post-surgery.
The Medline 4 MHz Handheld Vascular Doppler is lightweight, portable and durable
and hosts several convenient features. With the handheld Doppler device comes a
headphone plug to closely hear vascular sounds and will assist hearing-impaired
individuals. The probe is waterproof and is interchangeable so the user can change
frequencies.
The 4 MHz probe will relay great data for a proper understanding of vein and artery
health. The large LCD screen presents probe frequency and blood rate. It powers on and
operates with a simple push of a button.

16-Gauge Intravenous (IV) Cannula

Figure 16: 16-Gauge Intravenous Cannula

A cannula is a tube that is inserted into the body to perform the function of delivering
or removing any bodily fluid or taking samples. A cannula surrounds the inner or outer area
of a needle (trocar) and increases the effective length of the needle by half the length of the
original needle. It is commonly called an intravenous cannula (IV cannula).
Peripheral venous cannulation (cannula inserted directly into the peripheral veins of
the body) is the most common method to deliver intravenous therapy. The ultimate goal of
intravenous management is to deliver treatment safely and effectively without any major
discomfort or damage to tissues and without compromising venous access.
This is especially important when long-term treatment is advocated. There are
various indications and contraindications for peripheral cannulation; however, research
suggests that intravenous cannulas are often inserted in patients when it can easily be
avoided.

Blood Tubes
 Figure 17: Blood Tubes

A Vacutainer blood collection tube is a sterile glass or plastic test tube with a colored

rubber stopper creating a vacuum seal inside of the tube, facilitating the drawing of a
predetermined volume of liquid. Vacutainer tubes may contain additives designed to
stabilize and preserve the specimen prior to analytical testing.
Tubes are available with a safety-engineered stopper, with a variety of labelling
options and draw volumes. The colour of the top indicates the additives in the vial.

iv. Responsibilities of the nurse during the surgery

1. Before the procedure
Before
 Assess foetal heart sounds as the mother needs to be aware about
her infant’s health
 Apply recommended fasting time before the surgery to ensure
physiological stability and to avoid any possible intraoperative and
postoperative complication
 Assess any bleeding or spotting that may occur so that appropriate
steps can be taken.
 To create a trusting environment, answer the mother's inquiries
honestly. Like in every patient, we should build rapport to our clients
to make sure that we are gathering the right data that we will be
needing
 Include the mother in the planning of both the mother's and the
baby's care. The mother should be the one deciding for the baby
because she is the legal guardian.

2. During the procedure

During
 Monitor patients’ vital signs to check for the patient’s stability
 Provide support to the patient as most mothers are awake but
simply numb even if it’s a surgical procedure, so we need to provide
support for the comfort of the mother.
  Assess for the patient’s stability during the procedure because
sudden change in stability can be an effect of a complication that
the health care provider must check
 The first thing is to check the patient’s vital and other baselines. It is
crucial to keep the patient under constant surveillance and check
her blood pressure as often as every 5 to 10 minutes.
 At the same time, it is necessary to check the foetus’ condition, as
well. The nurse should monitor the heartbeat of the foetus as well
as the movements of the unborn to make sure that the well-being of
the unborn baby is intact
 The next important thing is to monitor the contractions of the uterus
of the mother to check if she in labour. The constant monitoring will
help in predicting when the labour will be induced
 The nurses will assess the general examination of the patient to see
if her health is progressing or deteriorating. It is imperative to
examine the patient in the left lying position to take off the pressure
of the weight of the uterus from her organs and abdominal artery
 In case a woman is bleeding, it is vital for the overall health of the
patient for the nurses to know how much blood is lost. The amount
of blood loss will also help calculate how much fluid should be
replaced in the patient. If the blood loss is massive, then the patient
may even require a blood transfusion. To know the amount of blood
lost, the nurses will have to check how many perineal pads are
saturated in every hour.

3. After the procedure

After
 Assess the infant. Assessment of the infant is necessary to make
sure the infant is breathing and does not have any congenital
malformation
 Monitor urine output and colour following insertion of indwelling
catheter. Note any blood-tinged urine. This reveals hydration level,
circulatory status, and possible bladder trauma associated with
surgical procedure.
 Educate patient postoperatively; including demonstration of leg
exercises, proper coughing and deep breathing techniques,
splinting, and abdominal tightening exercises. Provides routine to
prevent complications associated with venous stasis and hypostatic
pneumonia, and to lessen stress on the operative site. Abdominal
 tightening reduces distress associated with gas formation and
abdominal distension.
 Educate proper relaxation techniques; position for comfort as
possible. Use Therapeutic Touch, as appropriate as it may help in
decreasing anxiety and tension, promote comfort and enhance
sense of well-being.
 Check for Homan’s Sign to determine presence of thrombus
formation
 Elevate HOB to promote circulation and venous return

V. NURSING MANAGEMENT
a. Nursing Care Plan

Assessme Nursing Short-term Nursing Rationale Expected

nt Diagnosis and Long- Intervention outcome
term s
Objectives
Subjective: Possible Short Term: Independent
After getting pregnancy : After 12-24
the patient’s induced After 8 Keep an eye - A hours of
weight she hypertensio hours of on the comparison intervention
stated “ay n related intervention, patient's of s, the
grabe, mali decrease the patient blood pressures patient’s
ba tong venous will engage pressure. gives a blood
timbangan return as in exercises For the initial fuller view pressure is
bat parang evident by that will evaluation, of the noticed to
biglang taas high blood lower his or measure in problem's go back to
naman g pressure her blood both arms or vascular normal.
timbang pressure thighs three involvemen
ko?” and heart times, 3-5 t.
workload. minutes
Objective: apart, while
the patient is
High blood at rest, then
pressure sitting, then
Increase in Long-Term: standing.
weight
Edema After 12-24 Examine the
Vital sign: hours of color of skin,
T: 36.7 nursing its wetness,
P: 78 intervention warmth, and
R: 20 s, changes the time it
BP: 140/90 in blood takes for - Pallor,
pressure is capillaries to chilly, moist
noticed. refill. skin, and a
slow
Note capillary
whether the refill time
edema is could all be
dependent signs of
or general. peripheral
vasoconstri
ction.
Provide a
tranquil, - It could be
restful a sign of
setting with heart
minimal failure,
activity or renal
noise. failure, or
vascular
Maintain disease.
your activity
- Aids in the
limitations.
reduction of
Teach
sympatheti
relaxation
c
and guided
stimulation 
imagery
and the
techniques.
promotion
of
Dependent:
relaxation.

As directed,
restrict
- It has the
sodium, fat,
ability to
and
attenuate
cholesterol
stressful
in your diet.
stimuli and
generate a
 soothing
impact.

- Proper diet
will help the
patient to
improve
health.

Assessme Nursing Short-term Nursing Rationale Expected

nt Diagnosi and Long- Intervention outcome
s term s
Objectives
Subjective: Acute Short Term: Independent:
“ang sakit pain Examine the - Aids in After 12
lagi pag related to After 3 pain, taking determining hours of
umiihi ako, urinary hours of note of its the severity nursing
siguro dahil tract intervention location, of intervention
na din to sa infection s, the characteristic discomfort s, the
UTI ko.” as patient s, and and may patient was
evidence should be severity (0- identify the able to say
Objective: by pain able to 10scale). presence of that the pain
during follow developing is gone and
Restlessnes micturitio instructions problems. show
s n of the actions of
Vital sign: procedure. - Urinary relief.
T: 36.7 retention
P: 78 and
R: 20 Take note of increased
BP: 140/90 the flow and pressure in
Long-Term: qualities of the upper
your urine. urinary tract
After 12 may cause
hours of decreased
nursing flow.
intervention
s, the - Anxiety or
patient will fear
express reduction
verbally that
pain promotes
alleviation Encourage relaxation
or control. the patient to and comfort.
express his
or her
concerns.
Acceptance,
being with the
patient, and
providing
appropriate
information
are all ways - Reduces
to actively muscle
listen to these tension,
worries and encourages
provide relaxation,
support. and may
help with
Provide coping.
relaxation
techniques - Muscle or
such as a joint
backrub or stiffness is
deep reduced.
breathing Ambulation
exercises. restores
organ
function and
Assist with provides a
stretches and sense of
range-of- well-being.
motion
- Immediate
exercises.
medical
attention is
required.
 Abdominal
muscle
rigidity,
involuntary - Relieves
guarding, and discomfort,
rebound improves
soreness comfort, and
should all be encourages
investigated rest.
and reported.

Dependent:

Medications,
such as
analgesics
and
antibiotics,
should be
given as
directed.

Assessmen Nursing Short term/ Nursing Rationale Expecte

t diagnosi Long term intervention d
s outcome

Subjective: Risk for S: After 8 ▶ Monitor ▶ To measure the After 8

ineffectiv hours of amount of amount of blood hours of
“Halos ilang e nursing bleeding by loss. nursing
linggo na perfusion interventions weighing all intervention
ako related to the patient pads. s, the
nakapangan hemorrha will patient was
ak pero ge demonstrate able to
malakas pa adequate ▶Frequently ▶ Early recognition demonstrat
rin ang perfusion monitor vital of possible adverse e adequate
pagdurugo and stable signs. effects allows for perfusion
ko” (I’m still vital signs. prompt intervention. and stable
bleeding vital signs.
heavily after ▶ To help expel And the
weeks of clots of blood and it patient
giving birth) is also used to verbalizes
as ▶ Massage check the tone of reduction of
verbalized the uterus. the uterus and pain
by patient. ensure that it is
clamping down to After 24 –
Objectives: L: -After 24 – prevent excessive 48 hours of
Restlessnes 48 hours of bleeding. nursing
s nursing intervention
Confusion intervention ▶ Encourages there were
Irritability there will be venous return to no signs of
V/S taken no signs of facilitate circulation, hemorrhage
as follow: hemorrhage and prevent further in the
in the bleeding. patient.
T: 36.8 patient. ▶ Place the
P:105 mother in ▶ Promotes
R: 24 Trendelenbur relaxation and may
B.P: 100/70 g position. enhance patient's
coping abilities by
refocusing
attention.
▶ Provide
comfort
measure like
back rubs,
deep
breathing.
Instruct in
relaxation or Dependent:
visualization
exercises. ▶ To promote
Provide contraction and
diversional prevents further
activities bleeding.

Dependent:

▶ Administer
medication as
indicated (e.g
pitocin,
methergin)

b. Actual FDAR

CLINICAL INSTRUCTOR:  Prof. Daniela Ann Mado

CASE STUDY NO. 1 - GROUP 1
REASON FOR ADMISSION: Normal Delivery via Normal Spontaneous Vaginal Birth
(NSVB)
ADMITTING IMPRESSION: Pain due to Uterine Contractions
Focus Progress note
Acute pain possibly evidence by facial mask of pain
and verbalization.
Data: Continues uterine contraction, Facial
mask of pain “Bigla nalang humilab ang tyan
ko, parang manganganak na ko”(I feel a
sudden contraction, I thought I am in labor as
verbalized of patient.

Action: Assess status of the client and fetus.

Apply external uterine and fetal monitoring.
Encourage rest with patient in side lying
position. Monitor patient’s vital signs closely,
every 15 mins.

Response: The patient was identified with the

decrease of activity intolerance

CLINICAL INSTRUCTOR:  Prof. Daniela Ann Mado

CASE STUDY NO. 1 - GROUP 1
REASON FOR ADMISSION: Normal Delivery via Normal Spontaneous Vaginal Birth
(NSVB)
ADMITTING IMPRESSION: Uterine cramping
Focus Progress note
Risk for Infection related to exposure to Data: Pain and inflammation at the incision
pathogens site. Uterine cramping. “Pag gumagalaw ako
sumasakit tahi ko” as verbalized of patient.

Action: Assess signs and symptoms of

infection (e.g., elevated temperature, pulse,
WBC; abnormal odor or color of vaginal
discharge, or fetal tachycardia). Administer
parental broad-spectrum antibiotic.

Response: There is no sign of infection and

the patient can verbalized the decrease of
pain at the incision site.

VI. LEARNING DERIVED

Throughout the duration of this study, the researchers have gained a lot of valuable
information regarding the circumstances surrounding pregnancies and especially the inner
workings of the process called Normal Spontaneous Vaginal Birth

Through tedious and extensive research, the researcher-students have learned what
a patient should eat during her pregnancies, what activities should the mother perform, what
medication the patient will be taking, and the specific interventions that have to be
performed by the nurse as a responsibility, during, after, and before the surgery.

In addition, the student-researchers have also developed a sense of understanding

on how a patient that will undergo Normal Spontaneous Vaginal Birth might be manage,
therefore equipping them with an insight that they could possibly use during their actual
practice once they have fully transitioned into healthcare professionals.
 In addition to the above learning and understanding gained by the student-
researchers, they have also derived the following learning in accordance with the 3 aspects
of learning, and these are as follows:

Cognitive Learning
After conducting the following case study about Normal Spontaneous Vaginal Birth, the
researcher-students will be able to:
• Define what is Normal Spontaneous Vaginal Birth
• Identify the various tools and instruments used during surgery
• Describe the ideal diet for a maternal patient that is about to undergo Normal
Spontaneous Vaginal Birth
• Explain the various responsibilities of the nurse before, during, and after the surgical
procedure
• Recall the various diagnostics procedures used on maternal patients that are about
to undergo Normal Spontaneous Vaginal Birth
• Explain how risk factors can affect a pregnancy
• List down the various signs and symptoms leading to a normal pregnancy and a
normal spontaneous vaginal birth
• Compare the nursing interventions used in patients with a normal pregnancy versus
those with risk factors such as Urinary Tract Infection, PCOS, and Type II Obesity

Psychomotor Learning
After conducting the following case study about Normal Spontaneous Vaginal Birth, the
researcher-students will be able to:
• Describe and explain the necessary steps to be taken in order to do Normal
Spontaneous Vaginal Birth
• Demonstrate proper vaginal birth
• Arrange the process of giving teachings systemically for better understanding of the
patient
• Teach the patient about the procedure
• Point out the possible outcome of the procedure
• Construct a Nursing care plan about the patients’ needs and potential risk
• Organize proper diet for the patient
• Respond to the patients request and needs
• Answer the patients question about the procedure

Affective Learning
After conducting the following case study about Normal Spontaneous Vaginal Birth, the
researcher-students will be able to:

• Explain to the patient how crucial the first and second trimester can be to the
physical and mental aspects of the foetus.
• Describe how practices and complication can affect the overall health of the
mother and foetus during pregnancy.
• Propose their insights on the current trends and new approach in normal delivery
• Integrate the value of proper procedure of vaginal delivery for the prevention of
any complication and problems on the pregnant patient.
• Use the risk factors associated with pregnancy to formulate better intervention for
the situation of a pregnant patient
• Recognize the needs of the patient in any side effects and adverse reaction for
the medication of normal spontaneous delivery.
 • Performs actions required for nursing intervention logically and appropriately
based on situations acquired.

VII. REFERENCES

Mills, J. R., Huizinga, M. M., Robinson, S. B., Lamprecht, L., Handler, A., Petros, M., ... & Chan, K.
(2019). Draft opioid-prescribing guidelines for uncomplicated normal spontaneous vaginal
birth. Obstetrics & Gynecology, 133(1), 81-90.

Entringer, A. P., Pinto, M., Dias, M. A. B., & Gomes, M. A. D. S. M. (2018). Cost-effectiveness analysis of
spontaneous vaginal delivery and elective cesarean for normal risk pregnant women in the Brazilian
Unified National Health System. Cadernos de saude publica, 34.

Francisco, A. A., De Oliveira, S. M. J. V., Steen, M., Nobre, M. R. C., & De Souza, E. V. (2018). Ice pack
induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial. Women and
Birth, 31(5), e334-e340.

Kopeć-Godlewska, K., Pac, A., Różańska, A., & Wójkowska-Mach, J. (2018). Is vaginal birth without an
episiotomy a rarity in the 21st century? Cross-sectional studies in Southern Poland. International journal
of environmental research and public health, 15(11), 2462.

Wong, J. W. (2019). A case of vaginal birth after cesarean delivery in a patient with uterine
didelphys. Case reports in obstetrics and gynecology, 2019.

Hobson, S., Cassell, K., Windrim, R., & Cargill, Y. (2019). No. 381-assisted vaginal birth. Journal of
Obstetrics and Gynaecology Canada, 41(6), 870-882.

Toohill, J., Sidebotham, M., Gamble, J., Fenwick, J., & Creedy, D. K. (2017). Factors influencing
midwives’ use of an evidenced based Normal Birth Guideline. Women and Birth, 30(5), 415-423.

Afzal, M. B., Bushra, N., Waheed, K., Sarwar, A., & Awan, N. U. (2019). Role of placental blood drainage
as a part of active management of third stage of labour after spontaneous vaginal delivery.  Journal
Pakistan Medical Assoc, 69(12), 1790-1793.

Hong, K., Cha, D. H., Shim, S. S., Shim, S. H., Kwak, D. W., Ryu, H. M., ... & Park, H. J. (2018). OB28:
Maternal Body Mass Index and physical activity in relation with onset of spontaneous labor in full term
women expecting normal spontaneous vaginal delivery. 대한산부인과학회 학술발표논문집 , 104, 214-
214.

Bends, R., Toub, D. B., & Römer, T. (2018). Normal spontaneous vaginal delivery after transcervical
radiofrequency ablation of uterine fibroids: a case report. International journal of women's health, 10, 367.

Kiwan, R., & Al Qahtani, N. (2018). Outcome of vaginal birth after cesarean section: A retrospective
comparative analysis of spontaneous versus induced labor in women with one previous cesarean
section. Annals of African medicine, 17(3), 145.

Keedle, H., Peters, L., Schmied, V., Burns, E., Keedle, W., & Dahlen, H. G. (2020). Women’s experiences
of planning a vaginal birth after caesarean in different models of maternity care in Australia. BMC
pregnancy and childbirth, 20(1), 1-15.

Caudwell-Hall, J., Atan, I. K., Rojas, R. G., Langer, S., Shek, K. L., & Dietz, H. P. (2018). Atraumatic
normal vaginal delivery: how many women get what they want?. American journal of obstetrics and
gynecology, 219(4), 379-e1.

Peters, L. L., Thornton, C., De Jonge, A., Khashan, A., Tracy, M., Downe, S., ... & Dahlen, H. G. (2018).
The effect of medical and operative birth interventions on child health outcomes in the first 28 days and
up to 5 years of age: A linked data population‐based cohort study. Birth, 45(4), 347-357.
Bonet, M., Ota, E., Chibueze, C. E., & Oladapo, O. T. (2017). Routine antibiotic prophylaxis after normal
vaginal birth for reducing maternal infectious morbidity. Cochrane Database of Systematic Reviews, (11).

Prosser, S. J., Barnett, A. G., & Miller, Y. D. (2018). Factors promoting or inhibiting normal birth. BMC
pregnancy and childbirth, 18(1), 1-10.

Bilge, A. D. (2019). Mode of delivery, birth weight and the incidence of congenital nasolacrimal duct
obstruction. International journal of ophthalmology, 12(7), 1134.

Ayerle, G. M., Schäfers, R., Mattern, E., Striebich, S., Haastert, B., Vomhof, M., ... & Seliger, G. (2018).
Effects of the birthing room environment on vaginal births and client-centred outcomes for women at term
planning a vaginal birth: BE-UP, a multicentre randomised controlled trial. Trials, 19(1), 1-13.

Hinic, K. (2017). Understanding and promoting birth satisfaction in new mothers. MCN: The American
Journal of Maternal/Child Nursing, 42(4), 210-215.

VIII. APPENDIX

Table 1: Estimated impact of COVID-19 on birth in late 2020 by age group

 Table 2: Number of registered births in 1986 vs. 2019 vs. 2020 in millions.

Table 3: Number of births vs. normal trends during January and March 2021
Table 4: Rate of pregnancies among races during 2017 to 2018