NCM 109 RLE

Define and state the purpose of the following:

1. Midwifery Law

Republic Act No. 7392

An Act Revising Republic Act No. 2644, As Amended, Otherwise Known as the Philippine Midwifery Act

Section 23. Practice of Midwifery Defined.- The practice of midwifery

consist in performing or rendering, or offering to perform or render, for a
fee, salary, or other reward or compensation, services requiring an
understanding of the principles and application of procedures and
techniques in the supervision and care of women during pregnancy, labor
and puerperium management of normal deliveries, including the
performance of internal examination during labor except when patient is
with antenatal bleeding; health education of the patient, family and
community; primary health care services in the community, including
nutrition and family planning, in carrying out the written order of
physicians with regard to antenatal, intra-natal and post-natal care of the normal pregnant mother, in giving
immunization, including oral and parenteral dispensing of oxytoxic drug after delivery of placenta, suturing
perineal lacerations to control bleeding, to give intravenous fluid during obstetrical emergencies provided they
have been trained for that purpose; and may inject Vitamin K to the newborn: Provided, however, That this
provisions shall not apply to students in midwifery schools who perform midwifery services under the supervision
of their instructors, nor to emergency cases.

2. AMSTL

Active Management of the Third Stage of Labor (AMTSL) decreases the chance and intensity of postpartum
hemorrhage (PPH). Postpartum hemorrhage is the loss of more than half a liter of blood during delivery, and it
occurs in about 1 in 10 births accounting for about 100,000 maternal
deaths per year. The third stage of labor is the time after the birth of the
baby through the delivery of the placenta.

AMTSL as a prophylactic intervention is composed of a package of three

components or steps:
a. administration of a uterotonic, preferably oxytocin,
immediately after birth of the baby;
b. controlled cord traction (CCT) to deliver the placenta;
c. and massage of the uterine fundus after the placenta is
delivered.

3. RITGENS MANEUVER
 Ritgen's maneuver denotes extracting the fetal head, using one hand to pull the fetal chin from between the
maternal anus and the coccyx, and the other on the fetal occiput to control speed of delivery. Ritgen's
maneuver was performed during a uterine contraction, rather than, as originally recommended, between
contractions.

4. BRANDT ANDREWS MANEUVER

It is an obstetric technique that is applied to extract the placenta and the umbilical cord in
the last stage of labor, once the mother expels the child.

5. CREDES MANEUVER

Crede's maneuver is the application of manual pressure

over the lower abdomen which promotes complete emptying of the bladder.

6. MCROBERT'S MANEUVER

The McRoberts maneuver is used during childbirth when one or both of your baby's shoulders are stuck in your
pelvis during a vaginal delivery. When your baby's shoulders are stuck behind your pelvis, it prevents them from
fully descending the birth canal and coming out of your vagina.

7. LOCHIAS

After a baby is born, the placenta detaches from the uterine wall and is expelled along with other tissues needed
to sustain the pregnancy.

Lochia is the name of the collective discharge that leaves the uterus via the vagina in the days and weeks following
childbirth.
 Lochia discharge consists of:

 The mucous membrane that lines the uterus during pregnancy

 Red blood cells

 White blood cells

 Amniotic fluid

 Tissue from the pregnancy

Lochia lasts for about six weeks, starting with heavier bleeding that may contain clots, and gradually turning to a
whitish or yellowish discharge.

For about 10% of people, lochia lasts longer than six weeks.2

Lochia typically smells similar to a menstrual period and may smell slightly metallic, stale, or musty. It shouldn't
smell foul.

Stages of Lochia

There are three stages, or "types," of

lochia. The duration of each stage can vary
from person to person.

Lochia Rubra

Characteristics of lochia rubra include:

 Occurs on days two to five after delivery

 The time when bleeding is heaviest

 Blood is dark red or reddish-brown

 May pass clots, but they should not be larger than a golf ball

 Can feel a gush when getting up from sitting or lying down, but it should settle down shortly after

Lochia Alba

Characteristics of lochia alba include:

 Starts around day four

 Lasts about two weeks

 A mixture of blood and discharge

 More watery3

 Pinkish to brownish in color

Lochia Serosa

Characteristics of lochia serosa include:

 Starts around week two

 Lasts until about six weeks after birth

 Pink to yellow/white in color

 Occasional spot of blood

 Made up mainly of white blood cells

REFERENCES:

AMTSL - Maternal and Neonatal Directed Assessment of Technology. (n.d.). Www.mnhtech.org. Retrieved March
30, 2023, from http://www.mnhtech.org/technology/technology-briefs/amtsl/

‌Jönsson, E. R., Elfaghi, I., Rydhström, H., & Herbst, A. (2008). Modified Ritgen’s maneuver for anal sphincter injury
at delivery: a randomized controlled trial. Obstetrics and Gynecology, 112(2 Pt 1), 212–217.
https://doi.org/10.1097/AOG.0b013e31817f2867

Brandt-Andrews maneuver: history, techniques, clinical considerations - science - 2023. (n.d.). Warbletoncouncil.
Retrieved March 30, 2023, from https://warbletoncouncil.org/maniobra-de-brandt-andrews-
4046#:~:text=The%20Brandt-Andrews%20maneuver%20It%20is%20an%20obstetric%20technique

Ritgens AND Creedes Maneuver - STUDY GUIDE: RITGEN’S AND CREDE’S MANEUVER I. TOPIC OUTLINE - Studocu.
(n.d.). Studocu. Retrieved March 30, 2023, from https://www.studocu.com/ph/document/urdaneta-city-
university/bs-nursing/ritgens-and-creedes-maneuver/29800484

McRoberts Maneuver: Purpose, Procedure & Results. (n.d.). Cleveland Clinic.

https://my.clevelandclinic.org/health/treatments/23155-mcroberts-maneuver

Postpartum Bleeding: What Is Normal? (n.d.). Verywell Health. https://www.verywellhealth.com/lochia-5186843‌‌