Republic of the Philippines

North Eastern Mindanao State University

Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

Patient Analytical Report

Part I: Syllabus

A Case Study on

Home Birth

GENERAL LEARNING OBJECTIVE

Specific Concepts References

Time Learning
Learning (Based from Discussant Methodology (APA
Allotment Outcome
Objectives the format) format)

Finding
Determine out the
the impact of LABORATORY Qualitative results of
Ms. X 2 weeks
Home ASSESSMENT Case Study the case
Delivery study
conducted
To identify
the risk Finding
factors and out the
effective Qualitative results of
VITAL SIGNS Ms. X 2 weeks
interventions Case Study the case
to prevent study
Home conducted
Delivery
To raise
awareness Finding
and to MOTHER-TO- out the
prevent BE Qualitative results of
Ms. X 2 weeks
another ASSESSMENT Case Study the case
incident of FORM study
Home conducted
Delivery
 Republic of the Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

In Partial Fulfillment of the Requirements for Clinical Practicum 102A(CP102-A)

Case Study on
Non Institutional Delivery

Prepared By:

Abatonon, Cristie Acejo, Johnila

Alqueza, Zenny Rose Baldovino, Sun Shine Eunice
Bautista, Nanette Marie Bautista, Adriannie T.
Biazon, Rose Ann Bautista, Jessa Mae

Submitted to:
Borja, Mary Karen Rose RN
 Republic of the Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

INTRODUCTION

Non-Institutional delivery means giving birth at home instead of at a hospital or birthing center. Non-
Institutional delivery or home delivery is a practice of childbirth in a nonclinical setting that takes place
in a residence. Wherein a traditional birth attendant is involved in the process of birth that takes place
in a residential roof. This non-institutional delivery plays a vital role as the place is prone to maternal
death occurrence due to obstetric complication such as hemorrhage, hypertensive disorders, sepsis,
abortion, embolism, and all other direct causes of death to the mother. Exposing as well the newborn
baby to health deficit factors that can lead to death. The factors that prevent women from receiving
adequate health care during pregnancy and childbirth includes limited availability and poor quality of
health services.
Lack of information on available services, certain cultural beliefs, attitudes, and poverty. Home
delivery is responsible for high numbers of maternal and newborn deaths by being the place of
occurrence of obstetric complications during labor and delivery with the help of traditional birth
attendants. Despite all of that, the death rate is significant because the mother and the newborn are
exposed in the delivery room owing to several causes demonstrating the risk that could arise if the
baby and the mother both die during the delivery. This study conducted by the Midwifery students of
North Eastern Mindanao University with their clinical exposure and learning experiences, focuses on
the risks associated with home birth for both the mother and the child. With the creation of this case
study, it will become clear why birth deliveries are not performed in birthing clinics, bed and breakfasts,
and hospitals. Aside from that, the risk and fatality rate that it bears during the birth process without
the application of suitable assessments, instruments, and expertise.
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

RELATED LITERATURE REVIEW

From the perspective of the Penchansky and Thomas model, this study explains why
women choose not to give birth in a medical institution and highlights potential
obstacles to accessing health services.19). Afghan women frequently give birth at
home in unclean settings; just one-third of births take place in medical facilities. The
main strategy for lowering maternal mortality is institutional delivery. Using the
Afghanistan Mortality Survey 2010 (AMS 2010), which was available to researchers,
the parameters connected to place of delivery among Afghan women were
investigated. The AMS 2010 results were gathered from 18,250 women using an
interviewer-led questionnaire.
Although there was a difference in design between the two studies, the results of the
most recent Afghanistan Mortality Survey 2010 (AMS 2010) revealed a dramatic
decrease in the pregnancy-related mortality ratio to 327 per 100,000 live births
compared with those of a prior study conducted in 2001.3,4 Reducing maternal and
neonatal mortality are top priorities in Afghanistan because there are still growing
concerns regarding pregnancy complications and child health. About two out of every
five deaths among women between the ages of 15 and 49 are caused by pregnancy-
related complications. One Afghan woman passes away from pregnancy-related
causes every two hours, according to the AMS 2010.
Therefore, it is important to comprehend the social, economic, demographic, and
familial dynamics that take into account all of the variables that affect Afghan women's
decision-making regarding where to give birth. The purpose of the study is to
investigate the influencing factors connected to non-institutional births among Afghan
women while controlling for additional relevant confounders utilizing the AMS 2010.

one Author MOHAMMAD DAUD AZIMI

Two Authors AHMAD MAISAM NAJAFIZADA
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

UTILIZED THEORY

In accordance to the new research by (Negative Incentives for Non institutional Birth
Are Associated with a Higher Rate of Facility-Based Births in the Eastern Visaya
Region, Philippines, 2021). In the Philippines, the “no home-birthing policy”
implemented in 2008 has encouraged local governments to endorse ordinances that
prohibit non institutional deliveries (NIDs). Which means that pregnant women must
have access to high-quality care throughout their entire pregnancy in order to reduce
avoidable mortality and morbidity. Facility-based deliveries (FBDs) in particular are
thought to play a significant role in lowering the maternal death ratio in low- and middle-
income nations (LMICs). In order to lower maternal mortality by primarily encouraging
FBDs, the Department of Health (DOH) in the Philippines published the Maternal,
Newborn, and Child Health and Nutrition (MNCHN) Strategy in 2008. The MNCHN
Manual of Operations, published in 2011 and containing a crucial clause on the
restriction of deliveries aided by traditional birth attendants, significantly updated the
strategy (TBAs). It also emphasized how TBA-assisted deliveries contributed to the
three disruptions in the diagnosis of difficulties, referral of those issues, and care of
those comorbidities resulted in maternal and infant fatalities.

India still figured among countries with high level of maternal morbidity and mortality,
and launched various MCH programmes to attain 80 percent institutional delivery and
100 percent safe delivery since 2005 with NRHM. The study examines the reasons
and predictors of non-institutional delivery, including exploring the likely association
with antenatal checkups (ANC) and safe delivery by using data of nationally
representative survey (NFHS-3) and by applying bivariate probit model. Surveys show
that Indian women opt for non-institutional/home delivery (52-61 percent), citing
reasons such as 'not necessary' (72 percent), and 'cost too much' (26 percent). Non-
institutional delivery is the highest in Central, East and NorthEast (70-77 percent) with
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

most births assisted by dais/TBA or by friends/relatives (NFHS-3). Bivariate probit

analysis indicates that not all non-institutional deliveries are high-risk to women (8
percent) with higher probability of both 3+ANC visits and safe non-institutional
deliveries (p<0.01). Southern states show higher probability of both 3+ANC visits and
safe delivery (p<0.01). Policy should address the dynamics of non-institutional delivery
to improve maternal and child care, perhaps from socio-cultural perspectives, beyond
services and incentives.
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

BACKGROUND OF THE STUDY

The common birth in the Filipino generation has certain benefits and drawbacks for
the medical community as well as for the mother's and baby's health. This study
enables us to discuss the value of appropriate care during childbirth as well as the
institutional procedures that must be followed by experts in their fields, such as
midwives, when an assessment is required during childbirth or delivery. The
information offered in this case study is backed by accepted works that follow the
proper citation guidelines, as well as by the experiences of the midwifery students who
carried out this study.
In conclusion, even if there are numerous data and papers available online, this case
study will contribute more to provide further details on home births and the risks they
pose to both the mother and the child. Home birth is not safe for all pregnant woman
to give birth at home. For example, certain medical conditions, such as preeclampsia
or type 1 diabetes, require more advanced care than can be offered at home. Also, for
people who have had a prior cesarean delivery, commonly referred to as a C-section
or who are pregnant with multiples like twins or triplets, home birth can be riskier than
giving birth in a hospital.
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

PATIENT’S DEMOGRAPHIC PROFILE

PATIENT INFORMATION:
Name: Patient X Civil Status: Single
Address: Purok 2, Poblacion Cortes S.D.S Religion: Banal
Date of Birth: April 24, 1992 Age: 39
Nationality: Filipino
CURRENT HEALTH STATUS/GENERAL SURVEY
Number of visits: 2 Number of Trimester:
OB score: G 4 P 4 T 4 P 0 A 1 L 3
Vital signs:
BP: 110/60mmHg T: 35.2 PR: 97 bpm FHR: 140 bpm RR: 15
Height: 5’0 Weight: 48
Estimated Date of Birth: 11/03/2022 FP Method used: N/A
Tetanus toxoid: 5 dosage Blood type: N/A
Patient’s behavior: Responsive
CHIEF COMPLIANT: Difficult of sleeping
HISTORY OF PRESENT ILLNESS: NONE
PAST HEALTH HISTORY: Miscarriage
CURRENT MEDICATION WITH INDICATION: cefhalexin, mefenamic acid,
Ferrous sulfate
ALLERGIES: No known medicine, food, or environmental allergies
FAMILY HISTORY: Anemia
FUNCTIONAL HEALTH ASSESSMENT: Active
GROWTH AND DEVELOPMENT: Observable

REVIEWS OF SYSTEM

Nails: Capillary refill within 4 seconds

HEENT
Eyes: pale conjunctiva
Nose: Symmetrical
Ears: Symmetrical
Neck: no thyroid enlargement
Mouth/Throat: pale lips
HEART AND LUNGS: She has regular rate and rhythm with no murmurs, rubs and
gallops.
BREAST: Areola are increased size
ABDOMEN: Striae gravidarum and linea negra are present because recent
pregnancy.
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

EXTREMETIES: absence of varicose veins and muscles has a symmetrical size and
length
GENITOURINARY: Normal
MUSCULOSKELETAL: Normal
PSYCHOSOCIAL AND LIFESTYLE FACTORS
LIFESPAN CONSIDERATIONS: None
Obstetric History and Assessment
PRESENT PREGNANCY:
Last Menstrual Period: January 27, 2022 Age of Gestation: 37 weeks
Estimated Date of Delivery: November 3,2022
Any medical/obstetric problems since the start of pregnancy: dizziness and
fatigue
Pregnancy planned/unplanned: Unplanned
F.2 OBSTETRICAL HISTORY:
G4P4T4P0A1L3
Maternal Weight: 47kg
Gestational Age:
Method of delivery of previous infant: 8 weeks Miscarriage
F.3 MEDICAL HISTORY: G3 died after 4 years
F.4 SOCIAL HISTORY: None
F.5 FAMILY PLANNING HISTORY/PLANS: None
F.6 PHYSICAL EXAMINATION:
INTEGUMENTARY
Skin: Dry and pale
Hair: Dry hair
Nails: Capillary refill within 4 seconds
HEENT
Eyes: Pale conjunctiva
Nose: no presence of discharge
Ears: symmetry
Neck: no thyroid enlargement
Mouth/Throat: pale lips and an absence of throat redness
HEART AND LUNGS:
BREAST: Hyperpigmentation of nipples and areola and increased size
ABDOMEN: striae gravidarum and linea negra are present
EXTREMETIES: absence of varicose veins and muscles has a symmetrical size and
length.
GENITOURINARY: Normal
MUSCULOSKELETAL: Normal
Tetanus Toxoid immunization: 5 doses
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

PATHOPHYSIOLOGY

Planned Home Birth for low-risk woman

Booking visit with a home birth midwife

Complication (Caseload program) Assess suitability at
Identified within booking/during antenatal
antenatal transfer period
36 weeks- Home visit by midwife to assess and
criteria
prepare for birth setting

Commencement of labour at home in absence of any added risk

Complication identified
within intrapartum
transfer criteria Potential complication or minor deviation from low-
(meconium-stained risk criteria normal (isolated elevated blood pressure)
liquor labor)
Midwife calls consultant-management plan made with
woman consultation and midwife for further observation,
Transfer to hospital care- in intervention or transfer
partnership with homebirth
midwife
Problem progress Problem stable or
Midwife calls consultant on to transfer criteria resolved
call management plan made
with woman, consultant and
midwife. Ambulance transfer to hospital- midwife in Birth occurs at home
charge of birth suite notified of impending
transfer
Midwife supports mother and baby
and continues observations and for
Transfer to hospital care- Midwife at least 4 hours
continues care in partnership.
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

Hematology

Hemoglobin: 108 g/dl

Hematocrit: 0.33
Leukocyte: 17.83
- Granulite: 0.82
- Lymphocytes: 0.11
- Eosinophils:
- Monocytes: 0.07
Platelet Count: 176

ULTRASOUND

Fetus is in congenital lie

Fetal directed towards the lower uterine segment

Fetal back is on mother’s right side
Head Measurement: 7.6cm
- Biparietal Diameter: 28.3cm
- Femoral length: 6.3cm

Fetal parts movement

(Head, Abdominal circumstances, Femoral length)
Fetal Weight: 1871g+/227g compatible to 31-32 weeks
FHT: 140 bpm
Amniotic Fluid: Adequate
Placenta mostly mostly situated anteriorly on mother’s side.

Impression:
- Single lie intrauterine pregnancy cephalic.
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

M.DRUG STUDY
Drug Brand Indications Nursing Route of Contraindications
Name Name Interventions administration
Ferrous Feospan To treat and Encourage Oral If you have an
sulfate prevent iron the mother to allergy reaction of
deficiency take ferrous iron supplement.
anemia sulfate two
times a day
for fast
recovery.
Mefenamic Fonstel To relieve Advise the Oral Contraindicated to
Acid mild to patient to take patient with
moderate mefenamic asthma, urticaria,
pain, acid to relieve or other allergic
including whenever the reaction.
menstrual patient is in
pain. pain.
Oxytocin Oxytocin Induction of Encourage Intramuscular Should not be
labor in the patient to Injection administered to
patients allow the patients with fetal
with nurses to distress,
medical administer hydramnios, partial
indication oxytocin to placenta previa,
for initiation prevent prematurity
of labor, bleeding. borderline
such as Rh cephalopelvic
problems disproportion and
maternal any condition and
diabetes, any related
pre- medical condition.
eclampsia.
Cefalexin Keflex Treatment of Encourage Oral Contraindicated to
respiratory the patient to patient with known
tract take cefalexin allergy to
infections, to prevent cephalosporins
Urinary tract
infection. group of
infections.
antibiotics.
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

Procedures Performed

Procedure Indication Date Nursing

intervention
Vital Signs Detecting or Evaluate the use
monitoring medical of continuous vital
problems. Vital November sign monitoring in
gives us a glimpse 4-5, 2022 the medical unit as
into our overall a strategy to
wellbeing. enhance patient
safety.
Mother to be Getting the Motivational
assessment information about interviewing for
the mother and the November getting the
baby. 4-5, 2022 information about
the mother and the
baby.

Identify potentially As soon as the

fatal or disabling newborn is
Newborn disorders in infants delivered, they are
Assessment as early as immediately
possible, November assessed, using a
frequently before 4-5, 2022 variety of routine
the baby shows tests to quickly
any signs or determine their
symptoms of an health.
illness or condition.
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

Midwifery Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Subjective:

"Sa wala pa After 8 hour Dependent: After 8 hours of

ako kalibangon of midwifery medication of Midwife
ga sakit na ako interventions, pain delivery intervention the
Tiyan After a the patient patient was able
minute." Home will achieve to rest and
verbalized: Delivery timely Independent: monitored every
"before I went healing and vital signs and 1 hour.
through in this free from monitoring
pain my further
stomach was infection.
already
aching."

objectives:

PR: 97 bpm
RR: 15 cpm
Tempt: 35.2
bp:110/60
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

Discharge Plan

HEALTH
MEDICATIONS TREATMENT
TEACHING

Treatment of
respiratory tract
Cefalexin Bed rest
infections, Urinary
tract infections

To relieve mild to
moderate pain,
Mefenamic Acid Bed rest
including
menstrual pain.

To treat and
Ferrous Sulfate prevent iron Bed rest
deficiency anemia
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

L. Learning Outcome

Non-institutional delivery means giving birth at home instead of at hospital or birthing

center. Non-institutional delivery is responsible for high numbers of maternal and
newborn deaths by being the place of occurrence of obstetric complications during
labor and delivery with the help of traditional birth and attendants. The Bachelor of
Science in Midwifery students aims to help the number of pregnant women to
practice institutional delivery, determine the risk factors of home delivery and develop
responsibilities for childbirth. The students also elaborated of how and what to raise
awareness and to prevent another incident of Home Delivery. This awareness will
allow us to understand things from multiple perspectives, make sounder decisions,
build stronger relationships, and communicate more effectively and decide more
accurately and correctly.
 Republic of the
Philippines
North Eastern Mindanao State University
Formerly Surigao del Sur State University
Tandag City, Surigao del Sur
Telefax No. 086-214-4221
086- 214-4221
www.sdssu.edu.ph

SCHOOL OF MIDWIFERY EDUCATION

Reference (APA format 7th edition)

Negative Incentives for Noninstitutional Births Are Associated with a Higher Rate of
Facility-Based Births in the Eastern Visaya Region, Philippines. (2021, September
30). Global Health: Science and Practice.
https://www.ghspjournal.org/content/9/3/565

Measure DHS. Afghanistan Mortality Survey 2010: Afghan Public Health Institute,

Ministry of Public Health, Central Statistics Organization, Kabul,

Afghanistan, ICF Macro, Calverton, Maryland, USA, IIHMR, Jaipur, India

and WHO/EMRO, Cairo, Egypt, 2011.

https://www.researchgate.net/publication/323848020_Dynamics_of_Non-

institutional_Delivery_and_Associated_risks_to_Maternal_and_Child_Healt

h_in_India_a_need_to_look_beyond_care_services_and_incentives