Maternal and Child Nursing - Lecture
Primary Goal of Maternal and Child Health Nursing
 Promotion and maintenance of optimal family
health to ensure cycles of optimal childbearing and
childrearing.
Scope of Practice:
 Preconceptual health care
 Care of women during 3 trimesters of pregnancy
and puerperium (6 wks. after childbirth)
 Care of infants during the perinatal period (6 wks.
before conception to 6 wks. after birth)
 Care of children from infancy through adolescence
 Care in settings as varied as the birthing room,
pediatric intensive care unit, and the home
Philosophy of Maternal & Child Health Nursing
1. Maternal & Child Health Nursing is family-
centered.
2. Maternal & Child Health Nursing is community-
centered.
3. Maternal & Child Health Nursing is research-
oriented.
4. Nursing theory and evidence-based practice
provide a foundation for nursing care.
5. A maternal & child health nurse serves as an
advocate to protect the rights of all family
members, including the fetus
6. Maternal & child health nursing uses a high degree
of independent nursing functions because teaching
and counseling are frequently required, and are
the major interventions.
7. Promoting health and disease prevention are
important nursing roles because these protect the
health of the next generation.
8. Maternal & Child Health nurses serve as important
resources for families during childbearing and
childrearing as these can be extremely stressful
times in a life cycle and can alter family life.
9. Personal, cultural, and religious attitudes and
beliefs influence the meaning and impact of
childbearing and childrearing on families.
10. Maternal & Child Health Nursing is a challenging
role for the nurse and is a major factor in
promoting high-level wellness in families.
Safe Motherhood Program
 Pregnancy and childbirth are among the leading
causes for death, disease and disability in women
of reproductive age in developing countries.
 The Philippine government commitment to the
MDGs is among others, a commitment to work
towards the reduction of maternal mortality ratios
by three-quarters and under five mortality by two-
thirds by 2015 at all cost.
Goal 3: Ensure healthy lives and promote well-being for
all at all ages
Targets
o By 2030, reduce the global maternal mortality ratio
to less than 70 per 100,000 live births
o By 2030, end preventable deaths of newborns and
children under 5 years of age, with all countries
aiming to reduce neonatal mortality to at least as
low as 12 per 1,000 live births and under-5
mortality to at least as low as 25 per 1,000 live
births
o By 2030, reduce by one third premature mortality
from non- communicable diseases through
prevention and treatment and promote mental
health and well-being
o By 2030, ensure universal access to sexual and
reproductive health-care services, including for
family planning, information and education, and
the integration of reproductive health into national
strategies and programmes
Joyren Uy – BSN 2B Page 1
 Maternal and Child Nursing - Lecture
Female Reproductive Anatomy
External
1. Mons pubis or Mons Veneris
o An important landmark in measuring fundic height
o Protects symphysis pubis from trauma
o Covered with curly hair (escutcheon)
o Growth of pubic hair is stimulated by testosterone,
while pattern of hair growth is governed by
estrogen.
2. Labia Majora
o Are 2 thick folds of adipose tissues originating from
the mons and terminating in the perineum.
Main function:
o to provide covering and protection to the external
organs located under it
3. Labia Minora
o Are 2 thin folds of connective tissue that joins
anteriorly to form the prepuce and posteriorly to
form the fourchette.
o It is moist, highly vascular, sensitive and richly
supplied with sebaceous glands.
4. Clitoris
o Highly sensitive and erectile tissue situated under
the prepuce of the labia minora.
o Known as the “seat of a woman’s sexual arousal
and orgasm”.
o It is supplied with many sebaceous glands that
produce cheese-like secretion called smegma.
5. Vestibule
o Triangular space between the labia minora where
the vaginal introitus , urethral meatus , Bartholin’s
glands and Skene’s glands are located.
6. Bartholin’s glands
o Also known as vulvovaginal glands, paravaginal and
major vestibular glands.
o Secretes mucus that helps to keep the vaginal
introitus lubricated.
o Its alkaline nature enhances sperm survival.
7. Skene’s glands
o A pair of glands also known as paraurethral and
minor vestibular glands.
o Situated at each inner side of the urethral meatus.
o Secretions of the Skene’s and Bartholin’s glands
increases with sexual stimulation to provide
lubrication to the vagina thereby facilitating coitus.
8. Vaginal orifice
o Also known as introitus is the external opening of
the vagina located just below the urethral meatus.
o The Grafenberg or G-spot is a very sensitive area
located at the inner anterior surface of the vagina.
9. Hymen
o A thin, circular membrane made of elastic tissue
situated at the vaginal opening that separates the
female internal organs from the external organs
10. Urethral meatus
o Located just below the clitoris
11. Nerve supply
o The anterior portion’s nerve supply is derived from
the L1 (and the posterior portion is derived from
S3).
12. Blood supply
o Blood supply to the vulva is provided by the
pudendal artery and inferior rectus artery.
Joyren Uy – BSN 2B Page 2
 Maternal and Child Nursing - Lecture

INTERNAL present in the vagina, making the

1. Vagina
 A hollow, membranous and muscular canal, about
8 – 12 cm long, located in front of the rectum and
behind the bladder.
 It’s upper portion is separated from the rectum by
the cul-de-sac of Douglas.
 It’s surface is lined by stratified squamous
epithelium.
 The external opening of the vagina is encircled by
the vulvocavernosus muscle that acts as a
voluntary sphincter; Kegel’s exercise improves the
tone of this muscle.
 Innervation to the vagina is provided by the
uterovaginal plexus or Lee Franken Hauser plexus
and S1 – S3 nerves.
vaginal environment acidic); this low
vaginal pH helps control the growth of
pathogenic microorganisms that may
cause vaginal infections.
Blood Supply
 Upper portion: supplied by the
cervicovaginal branch of uterine artery
 Middle portion: supplied by the
inferior vesical artery
 Lower portion: supplied by the rectal
and pudendal artery

Functions:
 Organ of copulation
 Discharges menstrual flow
 Birth canal
Rugae
 Function is to allow the vaginal canal
to stretch during coitus and enlarge
considerably during delivery
Fornix
 The cervix projects into the vagina
forming four recesses or depression
around the vagina’s upper portion that
are called fornices, and posterior
fornix (it is in this area that vaginal 2. Uterus
secretions collect and semen pools. o It is 2.5 – 3 inches long;
Vaginal pH o 1 inch thick, 2 inches wide
 Before puberty: vaginal pH is alkaline o weighs 50 – 70 gms.
(6.8 – 7.2) Functions:
 After puberty: vaginal pH is acidic (4 –  Organ of reproduction
5)  Organ of menstruation
 With the advent of puberty, ovary  Contracts to expel the fetus during labor,
begins to produce increasing amounts and to seal torn blood vessels after
of estrogen which stimulates mucus delivery of the placenta.
production in the cervix. Parts: of the Uterus
 Cervix mucus is rich in glycogen; Fundus
glycogen is converted to lactic acid by Most muscular area of the uterus
Doderlein bacilli (a bacteria normally
Joyren Uy – BSN 2B Page 3
 Maternal and Child Nursing - Lecture
Thickest & most contractile portion
Palpation of its height is used to assess
uterine growth, and during the postpartum
period to assess for uterine involution.
During labor, fundus is palpated to assess
uterine contractions and labor progress.
Ideal site for implantation of the zygote.
Cornua
 Areas of the uterus at which fallopian
tube are attached.
Isthmus
 Upper third of the cervix which is very
thin, becoming prominent only near
the end of pregnancy and during labor
to form the lower uterine segment
together with the cervix.
Corpus
 This is the body of the uterus which
makes up 2/3 of the said organ.
 It houses the fetus during pregnancy.
Cervix
 Chiefly composed of elastic and
collagenous tissues, 10% muscle fibers
 Contains many sebaceous glands that
secrete clear, viscid and alkaline
mucus.
Parts of Cervix:
 Internal os: opens to the corpus
 Cervical canal: located between
the internal and external os
 External os: opens to vagina
Layers of the Uterus
Perimetrium:
 outermost, serosal layer attached to the broad
ligaments.
Myometrium:
 the middle, muscular layer responsible for
uterine contractions during labor.
Endometrium:
 the innermost, ciliated, mucosal layer
containing numerous uterine glands that
secrete a thin alkaline fluid to keep the uterine
cavity moist.
 Consists of 2 layers:
o Glandular layer
o Composed of columnar
epithelium; this layer peels off
during menstruation and
thickens during the
proliferative and secretory
phase.
o Basal layer
o The layer adjacent to the
myometrium and gives rise to
the new endometrium after
menstruation and delivery.
Uterine Ligaments
(a) Cardinal/transverse – Cervical/Mackenrodt
ligaments (2)
 Lower portion of the broad ligaments.
 It is the main support of the uterus.
 Damage to this would result to uterine
prolapse.
(b) Broad ligaments/Peritoneal ligaments (2)
 It supports the sides of the uterus and assists
in holding the uterus in anteversion

c) Round ligaments (2)
 Connect the uterus to the labia majora.
 During pregnancy, these ligaments
hypertrophies and
Joyren Uy – BSN 2B Page 4
 Maternal and Child Nursing - Lecture

 gives stability to the uterus. Functions:

d) Uterosacral ligaments (2)  Transport ovum from ovary to the uterus
 These ligaments connect the supravaginal  The site of fertilization
cervical portion of the uterus to the 2nd and  Provides nourishment to the ovum during its
3rd sacral vertebra, passing on each side of the journey.
rectum.
 They help keep the uterus in its normal
position by maintaining traction on the cervix.

e) Anterior ligament (1)

 Connects the anterior portion of the
supravaginal cervix to the posterior surface of
the bladder.
 Overstretching of this ligament will cause the
bladder
 to “drop” and to herniate into the vagina
(cystocele)

f) Posterior ligament (1)

Parts of Fallopian Tube
 Connects the posterior portion of the uterus to
1) Interstitial/Intramural
the rectum.
 Thick-walled,
 It forms a deep pouch called the Cul-de-sac of
 located inside the uterus;
Douglas, the lowest part of the abdominal
 1 cm long.
cavity, so that blood, pus, or other drainage of
2) Isthmus
the abdominal area tends to collect here.
 Narrowest portion
 Damage to this ligament will lead to herniation
 About 1 cm long;
of rectum to the vagina (rectocele).
 Site of tubal ligation
3) Ampulla
Blood Supply in Uterus
 Middle portion
 widest part
(a) Uterine artery
 Site of fertilization
 A branch of the internal iliac or hypogastric artery
4) Infundibulum
which divided into 2 main branches:
 The most distal portion
 Cervicovaginal branch that supplies the upper
 Has fingerlike projections called fimbria
portion of vagina and lower portion of cervix.
 Main branch which divides into fundal, tubal
 ovarian arteries
(b) Ovarian artery
 A direct branch of the aorta

3. Fallopian Tube (Oviducts)

 Each tube is about 4 inches (10 cm) long and ¼ inch
in diameter.
 Blood supply is from ovarian artery

Joyren Uy – BSN 2B Page 5

 Maternal and Child Nursing - Lecture

4. Ovaries
 Almond shape glandular organ.
 Each weighs between 6-19 g;
 1.5 – 3 cm wide; 2 – 5 cm long.
Functions:
 Responsible for development & maturation of
ovum (oogenesis)
 Ovulation
 Hormone production – main source of estrogen &
progesterone in non-pregnant women.

Hormones influencing the Mammary Glands:

A. Estrogen
 Stimulates development of the ductile
structures of the breast.
B. Progesterone
 Stimulates the development of the
acinar structures of the breast
C. Human placental lactogen (HPL)
 Promotes breast development during
5. Mammary Glands pregnancy.
External structures: D. Oxytocin
 Nipple  Let-down reflex;
 Areola  Is inhibited by progesterone.
 Montgomery tubercles E. Prolactin
Internal structures  Stimulates milk production
 Lobes  Is inhibited by estrogen.
 15 – 20 lobes are found in each breast
that are divided into several lobules.
 Lobules
 Composed of clusters of acini cells.
- Acini cells
o These are the milk-secreting cells of
the breasts that are stimulated by
prolactin hormone.
- Lactiferous ducts
o Ducts that serve as passageway of
milk.
- Lactiferous sinus
o Dilated portion of the ducts located
behind the nipple that serve as
reservoir of milk.

Joyren Uy – BSN 2B Page 6

 Maternal and Child Nursing - Lecture

Parts of the Penis

1. Shaft or body
Male Reproductive Anatomy 2. Glans penis
 Enlarged end which is the most
Andrology sensitive part.
3. Prepuce or foreskin
 study of the male reproductive system. The
 A fold of retractable skin covering the
male reproductive system consists of both external and
glans, at which it is removed during
internal divisions
circumcision.
4. Urethral meatus
 A slit like opening located at the tip of
the penis which serves as passageway
of both semen and urine.

The Male External Organs

1. Penis
 Male organ of copulation and urination.
 Blood flow is controlled by ANS; 2. Scrotum
 Blood supply is provided by penile artery.
 Is a sac-like structure containing the testes that
 The sympathetic nervous system inhibits penile
hangs behind the penis.
erection.
 Is covered by sparse hair after puberty, wrinkled
 The ischiocavernosus muscle at the base of the
and has a darker coloration than the rest of the
penis, under stimulation of the parasympathetic
body.
nervous system, then contracts, trapping both
 Has NO subcutaneous fat because the scrotum
venous and arterial blood in the three sections of
must be kept cool.
erectile tissue.
 This leads to distention (and erection) of the penis.

Joyren Uy – BSN 2B Page 7

 Maternal and Child Nursing - Lecture

 The skin of the scrotum is lined by fascia and a

smooth muscle layer, the Dartos.
- Contracts when environmental temperature is
cold to pull the testes closer to the body
- Relaxes when the environmental temperature
is too hot, causing the testes to descend away
from the body which lowers its temperature.
- If temperature is too warm or too cold,
spermatogenesis will not take place;
testosterone production will not be affected.

The Male Internal Organs

1. Testes
Oval shaped glandular organs. Parts of the Test
Descend in the scrotum after 28 wks.
gestation I. Seminiferous tubules
Temperature inside the scrotum is 1°C (2- - spermatogenesis takes place
3°F) lower than body temperature. - The testes produce about 176 sperm cells
Each testis is about 4 – 5 cm long. a day
Function - This tube leads to the tightly coiled
a. Hormone production: epididymis.
- Testosterone stimulates
spermatogenesis and is responsible for II. Leydig or Interstitial cells
the development of secondary male - Produce testosterone
characteristics. - Found around the seminiferous tubules.
- Beginning puberty, the hypothalamus
secretes gonadotropin releasing III. Sertoli cells or supporting cells
hormone (GnRH) which stimulates the - Plays a role in sperm transport.
Leydig cells to release testosterone
and other androgens.
b. Spermatogenesis
- Production and maturation of sperm cell
begins at puberty and continue until old
age in a continuous manner.
- Beginning puberty, the hypothalamus
secretes gonadotropin releasing hormone
(GnRH) which stimulates the anterior
pituitary gland to release FSH which in turn
causes the cell division and development
of spermatogonia to sperm cells.

Joyren Uy – BSN 2B Page 8

 Maternal and Child Nursing - Lecture

2. Epididymis caused by the urine that passes through it

 Long, coiled tube approximately 20 feet long and enhancing sperm survival.
at which the sperm travels for 12 – 20 days after it
leaves the testis.
 It takes about 64 days for the sperm to become
mature.

3. Vas Deferens
 Forms the passageway of the sperm cells from the
epididymis in the testis to the urethra.
 It is surrounded by arteries, veins and a thick
fibrous covering
 The contractile power of this part of the duct
system propels the spermatozoa to the urethra
during ejaculation.
 At the end of the vas deferens , just before it joins
the seminal vesicles, there is a dilated portion
which functions as a storage area of sperm cells
before ejaculation.
 The presence of acidic secretions in this portion
causes the sperm not to be very motile. 7. Cowper’s / Bulbourethral Gland
 2 small glands located below the prostate.
4. Ejaculatory Duct  Secrete an alkaline fluid that helps to neutralize
 Passageway of the semen the acidic nature of the urethra and provides
additional lubrication during intercourse.
5. Seminal Vesicle
 2 pouch-like organs consisting of many saclike 8. Semen
structures located next to the ductus deferens and  Is a mixture of secretions from the seminal
lying behind the bladder and in front of the vesicles, prostate gland, Cowper’s gland,
rectum. ejaculatory duct and sperm cells.
 Each vesicle is about 4 cm long, the thick, mucoid  The seminal vesicles produce about 60% of the
secretion of the seminal vesicles is high in sugar & fluid, the prostate gland 30%, the testes 5%, and
protein and slightly alkaline in nature (7-8 pH), the bulbourethral glands 5%.
causing sperm cells to become more motile once Composition:
surrounded by this nourishing fluid. o Volume: 2 – 5 ml
 Its secretions also contain prostaglandins, a o count: 100 million/ml
substance thought to cause contractions of the o pH: 7.2 – 7.4 (alkaline)
female reproductive tract to help transport the o high in basic sugar and protein, particularly
sperm cells. mucin.

6. Prostate Gland
 It secretes a thin, milky alkaline fluid that helps to
neutralize the acidic nature of the male urethra

Joyren Uy – BSN 2B Page 9

 Maternal and Child Nursing - Lecture
The Sperm Cell
Spermatozoa are the only human cells that contain
flagella. They are made up of three basic parts: the
head, the middle- piece, and the tail.
1. Head
- The head is an oval-shaped structure, in
which size ranges from 5 to 8 µm.
- The head consists of two parts:
A. Acrosome
- The size of this organelle is 40% to 70% of
total sperm head area, and is located at
one end of the sperm cell.
- It contains proteolytic enzymes that help
to destroy the outer layer of the egg cell,
thereby allowing the sperm to enter into it
easily.
B. Nucleus
- It contains all the 23 chromosomes of the
sperm cell, that is, half the genetic
information that will have the new
organism.
- This is the only part of the sperm cell that
enters into the egg cell. For this reason, it
is a key part of the spermatozoon, as it is
the one that unites with the egg’s nucleus
to form a 46-chromosome cell called
zygote.
2. Neck and Middle-piece
- The neck and the middle piece are the parts that
can be found between the head and the tail.
Function:
o is to connect both ends of the sperm cell.
-
- The neck contains millions of spirally arranged
- mitochondria.
Function:
o to provide the sperm with all the energy
required by the flagellum to allow it to
swim in the female reproductive tract.
3. Tail
- Sperm tail defects or alterations can lead to male
fertility problems, being asthenozoospermia the
most frequent one
- The tail, also known as flagellum, is a long
structure.
Main function:
o to allow sperm motility by means of a
slithering, snake-like movement.
o The length of the tail is about 50 µm,
allowing a swimming velocity of 3
millimeters per minute approximately.
PUBERTY
 is the stage of life at which secondary sex changes
begin.
 In most girls, these changes are stimulated when the
hypothalamus synthesizes and releases gonadotropin-
releasing hormone (GnRH), which then triggers the
anterior pituitary to release follicle-stimulating hormone
(FSH) and luteinizing hormone (LH).
Joyren Uy – BSN 2B Page 10
 Maternal and Child Nursing - Lecture

 FSH and LH are termed gonadotropin (gonad= Role of Estrogen

“ovary”; tropin = “growth”) hormones not only because  It also closes the epiphyses of long bones in girls
they begin the production of androgen and estrogen, the same way testosterone closes the growth plate
which in turn initiate secondary sex characteristics, but in boys.
also because they continue to cause the production of eggs  The beginning of breast development is termed
and influence menstrual cycles throughout thelarche, which usually starts 1 to 2 years before
women’s lives (Eggers, Ohnesorg, & Sinclair, 2014). menstruation.

Role of Androgen
Androgenic hormones are the hormones
responsible for:
a. muscular development
b. physical growth
c. increase in sebaceous gland secretions
that cause typical acne in both boys and
girls during adolescence.
In males, androgenic hormones are produced by
the adrenal cortex and the testes and, in females,
by the adrenal cortex and the ovaries.
The level of the primary androgenic hormone,
testosterone, is low in males until puberty
(between ages 12 and 14 years) when it rises to
influence pubertal changes in the testes, scrotum,
penis, prostate, and seminal vesicles;
the appearance of male pubic, axillary, and facial
hair;
laryngeal enlargement with its accompanying voice
change;
maturation of spermatozoa; and
closure of growth plates in long bones (termed
adrenarche).
In girls, testosterone influences the
following:
a. Enlargement of the labia majora and
clitoris
b. formation of axillary and pubic hair.

Joyren Uy – BSN 2B Page 11