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OUTLINE
I. framework for maternal and child health nursing
II. the childbearing and childbearing family community
III. Female reproductive system
iv. male reproductive system
v. female internal structures
vi. menstruation
vii. human sexuality
viii. responsible parenthood
framework for mcnh
definition
- According to WHO
- “Maternal health refer to the health of
women during pregnancy, childbirth, and
postpartum period.”
- “Promoting, preventing, therapeutic or
rehabilitation facility or care for the
mother and child.”
background
- Women in the childbearing period (15-49
years) constitute about 25% of the
population.
- Children on other hand contribute about
40-45% of the population in developing
countries.
- This group is characterized by relative
high mortality and morbidity rates.
- 99% of all maternal deaths occur in
developing countries.
- Maternal mortality is higher in women
living in rural areas and among poorer
communities
- Young adolescents face a higher risk of
complications and death as a result of
pregnancy than other women.
- Between 1990 and 2015, maternal
mortality worldwide dropped about 44%
- Between 2016 and 2030, as part of the
Sustainable Development Goals, the target
is to reduce the global maternal mortality
ratio to less than 70 per 100k live births
- The maternal mortality ratio in developing
countries in 2015 is 239 per 100k live
births versus 12 per 100k live births in
developed countries
goals and philosophies of mchn
- Preconceptual health care
- Care of women during three trimester of
pregnancy and the puerperium
▪ the period of about 6 weeks after
childbirth which mother’s
reproductive organs return to
their original nonpregnant
condition
- Care of children during the perinatal
period (6 weeks before conception to 6
weeks after birth)
- Care of children from birth through
adolescent
- Care in settings as varied as the birthing
room, pediatric intensive care unit, and the
home
philosophies of mchn
- MCHN is family centered, assessment
data must include a family and individual
assessment
- Community centered, the health of the
families depends on and influences the
health of communities
- Research oriented, because the research is
the means whereby critical knowledge
increases
- Serves as an advocate to protect the rights
of all family members, including the fetus
- Includes a high degree of interdependent
nursing functions, because teaching and
counselling are so frequently required
- Promoting health is an important
nursing role, because this protects the
health of the next generation
- Pregnancy or childhood illness can be
stressful and can alter family life
including both subtle and extensive ways
- Personal, cultural, and religious attitudes
and beliefs influence the meaning of
illness and its impact to the family
- Challenging for a nurse and its major
factor in promoting high-level wellness in
families
common measures to ensure family-centered mchn care
Principle:
1. The family is the basic unit of society.
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2. Families represents racial, ethnic, cultural,
and socio-economic diversity. aims of maternal health care
3. Children grows both individually and as
part of a family. 1. To improve and promote maternal health.
2. To insure that the pregnant women and her
nursing interventions fetus are in the best possible health.
3. To detect early and treat properly
• Consider the family as a whole as well as its complications.
individual members 4. To prepare the women for labor, lactation, and
• Encourage families to reach out to their care for her infant.
community so that members are not isolated 5. To prevent and reduce maternal morbidity rate.
from their community or from each other 6. To prevent and reduce maternal mortality rate.
• Encourage family bonding through rooming-in
both maternal and child health hospital maternal mortality
settings.
• Assess families for strength as well as specific Nearly 2/3rd of maternal deaths worldwide results
needs or challenges. from five causes:
1. Hemorrhage (24%)
• Respect diversity in families as a unique
2. Sepsis (15%)
quality of that family.
3. Unsafe Abortion (13%)
• Encourage families to give care to a newborn
4. Eclampsia (pregnancy induced
or ill child.
hypertension) (12%)
• Share or initiate stimulation in nursing care
5. Obstructed labor (8%)
with family members so that care is family
oriented.
The other 1/3rd of maternal deaths worldwide
results from indirect causes, or an existing medical
framework for mchn condition made worse by pregnancy or deliver:
1. Malaria
I. Health Promotion 2. Anemia
II. Health Maintenance 3. Hepatitis
III. Health Restoration 4. AIDS
IV. Health Rehabilitation 5. Tuberculosis
6. Malnutrition
measuring mch
some factors that contribute to mortality &
• morbidity – defined as an incidence of ailing
morbidity
health
• fertility rate – reflects what proportion of • The 4 too’s of pregnancy:
women who could have babies 1. Too young
• fetal deaths – deaths of the product of 2. Too old
conception occurs prior to expulsion, 3. Too many
irrespective of duration of pregnancy 4. Too soon
• neonatal death rate – pertains to the first 28 days • In other words, young or old age of pregnancy,
of life; reflects not only the quality of care short intervals between pregnancies, and high
available to women during pregnancy and parity. Other factors include low socio-
childbirth, but also quality of care available to economic status and in adequate maternal care.
infants during first month of life
• perinatal death rate – defines as the time maternal mortality rate – is the number of maternal
beginning where fetus reaches 500 grams and deaths that occur as a result of the reproductive
ending about 6 weeks after birth; is the sum process per 100k live births.
of the fetal and neonatal rates
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maternal health care 2. Influenza
3. Rubella Sero-negativity
MHC 4. Varicella

antenatal care
Preconception Antenatal Intra-natal Prenatal
Care
•
Care Care Care
General Objective:
- The general objective of antenatal
preconception care (prenatal) care is to prepare the mother
both physically and psychologically to
- is defined as a set of interventions that aim give birth to a healthy newborn
to identify and mo__ biomedical (favorable outcome of pregnancy) and to
behavioral and social risks to the woman’s be able to care for it
health pregnancy outcome through
prevention and management. Certain steps The four-visit ANC model outlined in WHO
should be taken before conception or early clinical guidelines:
in pregnancy to maximize health
outcomes. first visit: 8-12 weeks
• Behavioral - Confirm pregnancy and EDD (Estimated
1. Alcohol Misuse Date of Delivery), classify women for
2. Domestic Abuse basic ANC (four visits) or more
3. Drug Abuse specialized care
4. Folic Acid - Screen, treat, and give preventive
5. OTC Medications measures. Develop a birth and emergency
6. Psychosocial Concerns plan.
7. Smoking - Advise and counsel
• Chronic Diseases - Assess maternal and fetal well-being
1. Asthma - Exclude PIH, anemia, multiple
2. Diabetes pregnancies
3. Heart Disease - Give preventive measures
4. Hypothyroidism - Review and modify birth and emergency
5. Obesity plan
6. Oral Health - Advise and counsel
• Genetics
1. Cystic Fibrosis intra-natal care
2. Maternal Phenylketonuria
3. Sickle Cell Disease Normal delivery is defined as a process of delivery of
4. Genetic Disorders-European Jewish a single fetus and other products of conception
Descent within 24 hours through the normal birth canal and
• Medications without complications
• Sexually Transmitted Infections • Objectives of intra-natal care: safety of mother
1. Bacteriosis Vaginosis and fetus, by helping the pregnant to have a
2. Chlamydia normal delivery, and providing emergency
3. Gonorrhea services when needed
4. Hepatitis B • Determination of place of birth, with a well-
5. Hepatitis C organized back up system
6. HIV
7. Cervical Cytology
postnatal care
8. Syphilis
• Vaccination postnatal care highlights
1. Human Papillomavirus

• Provide postnatal care in first 24 hours for
every birth
1. Delay facility discharge for at least 24
hours
2. Visit women and babies with home
births within first 24 hours
• Provide every mother and baby a total of four
postnatal visits on:
1. First day (24 hours)
2. Day 3 (48-72 hours)
3. Between days 7-14
4. Six (6) weeks
care of mother after delivery
1. Postpartum examination
2. Medical care
3. Follow up
4. Health education
5. Family planning services
6. Psychological and social support
advanced-practice roles for nurses in mch
1. Clinical nurse specialists
- are nurses prepared at the master’s degree
level who are capable of acting as
consultants in their area of expertise, as
well as serving as role models,
researchers, and teachers of quality
nursing care
- Examples of areas of specialization are
neonatal, maternal, child, and adolescent
health care, childbirth education, lactation
consultation
2. Case manager
- is a graduate level nurse who supervises a
group of patients from the time they enter
a health care setting until they are
discharged from setting
3. Women’s health nurse practitioner
- is a nurse with advanced study in the
promotion of health and prevention of
illness in women. Such a nurse plays a
vital role in educating women about their
bodies and sharing with them methods to
prevent illness. In addition, they care for
women with illnesses such as STIs
offering information and counselling them
about reproductive life planning
4. Family nurse practitioner
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- is an advanced practice role that provides
health care not only to women but to
total family. In conjunction with a
physician, an FNP can provide prenatal
care for a woman with an uncomplicated
pregnancy. The FNP takes the health and
pregnancy history, performs physical and
obstetrical examination, orders appropriate
diagnostic and laboratory test
5. Neonatal Nurse Practitioner
- is an advanced practice role for nurses
who are skilled in the care of newborns,
both well and ill
6. Pediatric Nurse Practitioner
- is a nurse prepared with extensive skills in
physical assessment, interviewing, and
well-child counselling and care
7. Nurse-midwife -
- an individual educated in the two
disciplines of nursing and midwifery and
licensed according to the requirements.
Has played an important role in assisting
women with pregnancy and childbearing.
trends in health care environment
1. Cost containment
- refers to systems of health care delivery
that focus on reducing the cost of health
care by closely monitoring the cost
personnel, use and brands of supplies,
number of procedures carried out, and
number of referrals required
- has had dramatic effects on health care,
most noticeably in limiting the number of
hospital days and ancillary personnel (ex.
unlicensed assistive personnel) perform
many task under the supervision of the
nurse
2. Alternative settings and styles for health care
hospital have responded to consumer’s
demand for a more natural childbirth
environment by refitting labor and delivery
suites as birthing rooms
3. Strengthening the ambulatory care system
4. including family in health care
5. Increase in the number of intensive care units
6. Regionalization of intensive care
7. Increase reliance on comprehensive care settings
8. Increasing the emphasis on Family-Centered Care

the childbearing and childbearing family
community
the family
- is defines by US Census bureau (2005) as
a “group of people related by blood,
marriage, or adaptation living together.”
- Allender and Spradley (2004) defines a
family in a much broader context as two
or more people who live in the same
household (usually), “share a common
emotional bond, and perform certain
interrelated social task.”
family types
• family orientation (the family is born into or
oneself, mother, father, siblings if any)
• family of procreation (a family one stablishes, or
oneself, spouse or significant other, and
children)
the dyad family
- is consist of two people living together
usually a woman and a man, without
children
- this are viewed temporary arrangements,
but if the couple choose child free living
this can also be a lifetime arrangements
the nuclear family
- the traditional nuclear family structure is
composed of a husband, wife, and
children. this is the most common
structure all throughout the history
- today however, in US, it has declines to
about 50% of families due to increase rate
in divorce, single parenthood, and
remarriage, and the greater acceptance in
alternative lifestyle
- advantage: ability to provide, support a
family members because of a small size
people, feel of genuine affection for each
other
the cohabitation family
- are composed of homosexual couple who
live together like a nuclear family but
remain unmarried
the extended (multigenerational family)
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- extended family includes not only the
nuclear family but also other family
members such as grandmother,
grandfather aunts, uncles, cousins, and
grandchildren
- advantage: contains more people to serve
as resources during crises and provide
more role models for behaviors or values
- disadvantage: family resources, both
financial and psychological must be
stretched to accommodate all family
member
the single-parent family
- this increase in a single parent families is a
result of both the high rate of divorce and
increasing common practice of women
raising children outside marriage
- health problem ex. parent is ill, low
income is often an additional problem
encountered
- difficulty with role modeling or clearly
identifying their roles in the family
the blended family
- blended or remarriage or reconstituted
family. a divorced or widowed person
with children marries someone who also
has children
- advantage: increased security and
resources for the new family, they are
exposed to different ways of life and may
become more adopt to new situations
- disadvantage: sibling rivalry, each spouses
may encounter difficulties in helping rear
the other children, finances can be limited
the communal family
- comprise group of people who has chosen
to live together as an extended family
- their relationship to each other is
motivated by social or religious values
rather than kinship
- some communes describe as cults or
comprise a group of people who follow a
charismatic leader
the gay or lesbian family
- a homosexual unions, individuals of the
same sex live together as partners for
companionship, financial security, and
sexual fulfillment
- includes children from previous
heterosexual marriage or through artificial

insemination, adoption, or surrogate
mother
the foster family
- children whose parents can no longer care
for them may be placed in a foster or
substitute home by child protection
agency
the adoptive family
- families of great many types (nuclear,
extended, single parent, gay and lesbian)
adopt children today
methods of adoption
• agency adoption
• international adoption
• private adoption
caring for adoptive families
• Regardless of type of adoption, the new
parents should visit a health care facility
shortly after a child is placed in their home so
that a vase of health information on the child
can be obtained, potential problem can be
discussed, and solutions can be explored.
family function role
• Financial Manager
• Problem Solver
• Decision Maker
• Nurturer
• Health Manager
• Gate Keeper
family task
• Essential for a family to perform to survive as
a healthy unit:
1. Physical maintenance: a healthy family
provides food, shelter, clothing, and health
care for its members
2. Socialization of family members: the task
involves preparing children to live in the
community and to interact with people
outside of the family
3. Allocation of resources: determining which
family needs will be met and their order of
priority is allocation of resources
4. Maintenance of order: this task includes
opening an effective means of
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communication among family members,
establishing family values, and enforcing
common regulations for all family
members
5. Division of labor: the issue here is who will
fulfill certain roles such as family
provider, caregiver, and home manager
6. Reproduction, recruitment, and release of a
family member: often not a great deal of
thought is given to this task
7. Placement of members into the larger society:
this task consists of selecting community
activities, such as school, religious,
affiliation, or political group that correlate
with the family’s beliefs and values,
selecting a birth setting, instituting health
promotion, or choosing a hospital
8. Maintenance of motivation and morale: a sense
of pride in the family group, when created
help members defend the family against
threat and serve as support people to each
other’s crises
family life cycle
• Families, like individual, pass through
predictable developmental stages (Duvall and
Miller, 1990)
Stage 1: Marriage and Family: to achieve 3 tasks:
1. Establish a mutually satisfying
relationship
2. Learn to relate well to their families or
orientation
3. If applicable, engage in reproductive life
planning
Stage 2: The Early Childbearing Family: important role
during this period is health education about the
well childcare and how to integrate a new member
in a family
Stage 3: The family with preschool children is a busy family.
Children at this age demand a great deal of time
because their imagination is at peak, safety
considerations such as unintentional injuries
(accidents) become a major health concerns.
Stage 4: The family with school age children: have the
important responsibility of preparing their children
to be able to function in complex world while at the
same time maintaining their own satisfying
marriage relationship.
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- Important nursing role: monitoring of tasks and activities, governance of the
Children's Health in terms of family structure, decision making and
immunization, dental care and healthcare problem solving and leadership within the
assessments, monitoring child's safety. family unit.
Stage 5: The family with adolescent children: primary goal
of a family with teen agers differs considerably Genogram: a diagram that details family structure.
from the goal of the family in previous stages Provides information about family history and the
which was strengthen family ties and maintain roles of the various family members over time
family unity. usually through various generations.
- Violence, accidents, homicide, and
suicide: major cause of death in The family in crisis
adolescence.
- Role of the nurse: needs to spend time • Nursing assessment of the family often occurs
counselling members on safety. when the family is in crisis. The way family
Stage 6: The launching center family: for many families. react to crisis depends largely on the particular
the stage at which children leave to establish their crisis, their past experiences with problem
own households is the most difficult stage because solving, their perception of the event.
it appears to represent the breaking up of the
family. The family as part of the community
- Nurse role: serve as a counselor to such a
family. • Community - entire city, school district. a
Stage 7: The family of a middle year: family returns two- geographic district, a street name or a natural
partner nuclear unit, as it was before childbearing. markings.
The partners may view this stage either as the • Because the health of individuals is influenced
prime time of their lives. by the health of their community, it is
Stage 8: The family in retirement or older age: this important to become acquainted in the
stage are more apt to suffer from chronic and community in which you practice.
disabling conditions than younger ones.
Female reproductive system
Challenging patterns of family life
1. Mobility patterns
2. Poverty
3. Reduce government aid programs
4. The homeless family
5. Increasing number of one parent families
6. Increasing divorce rate
7. Decreasing family size
8. Dual parent employment
9. Increased family responsibility for health
monitoring
10. Increased abuse in families

Assessment a family structure and function

Major organs
• The well family
- Assessment of psychosocial family
wellness requires measurement of how the
family relates and interacts as a unit,
including communication patterns,
bonding, roles, role relationships, division
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▪ Vagina
▪ Ovaries [gonads]
▪ Uterine tubes [fallopian tubes]
▪ Uterus

the vagina
▪ a 3-4 inch long
dilatable canal located
between the bladder and ▪ Stretch from the uterus to the ovaries and
rectum measure about 8 to 3 centimeters in length.
▪ contains rugae, ▪ The ends of the fallopian tubes lying next to
which permits the ovaries feather into ends called fimbria.
considerable stretching without tearing
▪ Millions of tiny hair like cilia lined the fimbria
▪ serve as a passageway of menstrual
and interior of the fallopian tubes.
discharges copulation and fetus
▪ Responsible for transport of mature ovum
from ovary to the uterus.
ovaries
▪ Fertilization typically occurs in the outer 3rd
▪ also known as fallopian.
female gonads
▪ They produce
eggs (also called ova)
every female is born
with a lifetime supply
of eggs
▪ They also produce hormones: estrogen and
progesterone

effects of estrogen in the body

1. Stimulates growth of the ductile structures of
the breast
2. Causes hypertrophy of the myometrium 1. Release egg from ovary.
3. Increases quantity and pH of cervical mucus. 2. Egg reaches midpoint of fallopian tube where
causing it to become thin and watery and can it is fertilized by sperm.
be stretched to a distance of 10 to 13 3. Implantation of ritualized egg into the
centimeters. (Spinbarrkeit Test of ovulation) endometrium of uterus.

Effects of progesterone in the body Uterus

1. Increases endometrial tortuosity. ▪ Pear-shaped muscular organ in the female

2. Inhibits uterine motility. reproductive tract.
3. Decrease muscle tone of gastrointestinal and ▪ The fundus is the upper portion of the uterus
urinary tract. where pregnancy occurs.
4. Facilitates transport of the fertilized ovum ▪ The cervix is the lower portion of the uterus
through the fallopian tubes. that connects with the vagina and serves as a
sphincter to keep the uterus closed during
Fallopian tubes pregnancy until it is time to deliver a baby.
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▪ 3 inches long, 2 inches wide, one inch thick short hair. Protects the surrounding
and weighing 50 to 60 grams in non-pregnant tissues from trauma.
women. Labia majora or greater lips
▪ Organ of menstruation, site of implantation, - are the part around the vagina containing 2
retainment and nourishment of the products of glands (Bartholin's glands) which helps
conception. lubrication during intercourse.
Labia minora or lesser lips
- are the thin hairless ridges at the entrance
of the vagina, which joins behind and in
front. In front they split and close the
clitoris.
The clitoris
- small erectile structure at the anterior
junction of the labia minora
- Comparable to the penis and it's being
extremely sensitive
vestibule
- Narrow space seemed when the labia
▪ Composed of three muscles layers such as the minora are separated
perimetrium, myometrium, and endometrium. urethral meatus –
(End the medium thickens during the - external opening of the urethra
menstrual cycle to allow implantation of a vaginal orifice/introitus
fertilized egg).
- external opening of the vagina, covered by
▪ Pregnancy occurs when the fertilized egg
a thin membrane called hymen
implants successfully into the endometrial
perineum
lining.
- area from the lower border of the vaginal
orifice to the anus
Endometrium
▪ The endometrium is the innermost layer
as a lining for the uterus.
▪ During the menstrual cycle the
endometrium grows to a thick blood
vessel rich glandular tissue layer.
▪ This represents an optimal environment
for the implantation of a blastocyst upon
its arrival in the uterus.
▪ The endometrium is central echogenic
(detectable using ultrasound scanners) and
has an average thickness of 6.7 mm.
▪ During pregnancy, the blood vessels in the
male reproductive system
endometrium further increases in size and
number, forming the placenta.
▪ Placenta supplies oxygen and nutrition to
the embryo and fetus.

External genitalia
mons pubis or veneris
- Pad of fat which lies over the symphysis
pubis covered by skin and at puberty by
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fluid secretions that support and nourish the
sperm.
▪ Urethra - this is a tube that extends from the
bladder to the external opening at the end of
the penis. The urethra carries both urine and
sperm.
▪ Seminal vesicles - these are two small glands
above the prostate gland that make up much of
the fluid in semen.

Hormones/male reproductive system/function

testosterone
- regulate sex drive (libido), bone mass, fat
distribution, muscle mass and strength,
The male reproductive system contains the external and the production of red blood cells and
genitals (the penis, testes, and the scrotum) and sperm. A small amount of circulating
internal parts, including the prostate gland, vas testosterone is converted to estradiol, a
deferens, and urethra. A man's fertility and sexual form of estrogen.
traits depend on the normal functioning of the male
Androgen
reproductive system, as well as hormones released
- any of a group of hormones that primarily
from the brain.
influence the growth and development of
the male reproductive system. The
Organs and functions predominant and most active androgen is
testosterone, which is produced by the
the male reproductive system is responsible for
male testes. The other androgens, which
reproduction. It is made of the following parts:
support the functions of testosterone, are
produced mainly by the adrenal cortex-
▪ penis - the organ used for urination and sexual
the outer portion of the adrenal glands-
intercourse. It has spongy tissue which can fill and only in relatively small quantities.
with blood to cause an erection. It contains the
urethra which carries both urine and semen.
▪ Scrotum - this is a loose bag of skin that hangs
female internal structures
outside the body, behind the penis. It holds the uterus
testes in place.
• 3 divisions
▪ testes (or testicles) - these are a pair of egg-
- Fundus
shaped glands that sit in the scrotum on the
- Body
outside of the body. They produce sperm and
testosterone which is the male sex hormone. - Isthmus
▪ Epididymis - this is a highly coiled tube that lies
at the back of the testes. All sperm from the
testes must pass through the epididymis where
they mature and start to ‘swim’.
▪ Vas deferens - this is a thick-walled tube joint to
the epididymis. It carries sperm from the
epididymis up to the prostate gland and
urethra.
▪ Prostate gland - this is a walnut sized gland that
sits in the middle of the pelvis. The urethra
runs through the middle of it. It produces the

The function of the uterus:
1. To receive the ovum from the fallopian
tube
2. Provide the place for implantation and
nourishment during fetal growth
3. Furnish protection to a growing fetus
4. At maturity of the fetus, expel it from the
woman's body
The cervix
• The junction of the canal at the isthmus is the
internal cervical OS.
• The distal opening to the vagina is the external
cervical OS. The level of the external OS is at the
level of the ischial spines (an important
relationship in estimating the level of the fetus
in the birth canal).
Uterine and cervical coats
• The uterine wall consists of three separate
coats or layers of tissue:
1. Endometrium - inner one of mucus
membranes
2. Myometrium - a middle one of muscle fibers
3. Perimetrium - outer one of connective tissue
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Positional deviation of the uterus
• anteversion - tipped far forward
• retroversion - tipped backwards
• anteflexion - body of the uterus bent sharply
forward at the junction with the cervix
• Retroflexion - body is bent sharply backwards
just above the cervix
vagina
• its function is to act as the organ of
intercourse and to convey sperm to the cervix
so sperm can meet with the ovum in the
fallopian tube
• With childbirth, it expands to serve as the birth
canal
breast
• in many women, breast tissue extends well into
the axilla
• Milk glands of breasts are divided by
connective tissue partitions into approximately
20 lobes
• All the glands in each lobe produce milk by
acinar cells and deliver it to the nipples by a
lactiferous duct
• The nipples has approximately 20 small
openings through which milk is secreted
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• An ampulla portion of the duct just posterior to
the nipple serves as a reservoir for milk before
breastfeeding
• And nipple is composed of smooth muscle that
is capable of erection on manual or sucking
stimulation
• on stimulation, it transmits sensations to the
posterior pituitary gland to release oxytocin
• oxytocin acts to constrict milk glands cells and
push milk forward into the ducts that lead to
the nipple

The female pelvis four types:

1. gynecoid pelvis
• inlet is round
• wide
• This is the typical female pelvis
• Most favorable for a normal spontaneous
delivery
2. Android pelvis
• wide
• Heart-shaped
• This is the typical male pelvis
3. anthropoid pelvis
• present in some males and females
• serve to support and protect the reproductive
▪ 15% in Asian women, 15 to 30%
and other pelvic organ
in white women
• Bony ring formed by four united bones:
• pelvic inlet is long oval
1. 2 innominate (flaring hip) bones that
▪ AP diameter > transverse
form the anterior and lateral portion
diameter
of the ring
• Long and narrow sacrum (often with six
2. Coccyx
sacral segment)
3. sacrum, which form the posterior
• Straight pelvic sidewalls
aspect
4. platypelloid pelvis
• Three parts of each innominate bones
1. ilium • opposite of anthropoid pelvis
2. ischium • Wide but shallow
3. pubis • Also called flat pelvis
• For obstetric purposes, the pelvis is further
divided into the false pelvis (superior half) end ovulation
the true pelvis (the inferior half)
• is when a mature egg is released from the
False pelvis - upper portion above brim, supportive ovary, pushed down the fallopian tube, and is
structure for uterus during last half of pregnancy available to be fertilized
• Approximately every month an egg will
true pelvis - below brim; pelvic inlet, midplane, mature within one of the ovaries
pelvic outlet. Fetus passes through during birth
when does ovulation occur? –
• the timing of ovulation varies with the length
of a woman's menstrual cycle

• In the average 28 days menstrual cycle, the LH
surge usually occurs between cycle days 11 to
13 and ovulation follows about 36 to 48 hours
later, on or close to cycle day 14
Ovulation days are …
picture
ways to know one is ovulating
1. check the calendar
- affiliation most often occurs halfway
through your menstrual cycle - the
average cycle lasts 28 days, counting from
the first day of one (day one) to the first
day of the next period.
2. Ovulation predictor kit
- ovulation kits look for a rise in the
luteinizing hormone, which causes women
to ovulate and release and egg
- The stick of ovulation tests are similar to
pregnancy tests
- They show lines, and one of the lines is a
control line
- If the second line is a dark or darker than
the first line, that indicates you will soon
ovulate
3. listen to your body
- in 20% of women, your body informs you
when it is ovulating, in the form of a
twinge of pain or a series of cramps in
your lower abdominal area (usually
localized to one side - the side you're
ovulating from). Called mittelschmerz -
German for “middle pain” - this monthly
reminder of fertility is not to be the result
of the maturation or release of an egg from
an ovary
4. get to know your cervix
- as your body senses the hormone shifts
that indicate an egg is about to be released
from the ovary, it begins to ready itself
from the incoming hordes of sperm and
give the egg its best chance of getting
fertilized
- During the beginning of a cycle, your
cervix - is low, hard and closed. But as
ovulation approaches, it pulls back up,
softens a bit, and opens just a little, to let
the sperm through on their way to their
target.
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- Check your cervix daily, using one or two
fingers, and keep a chart of your
observation
- the other cervical sign you can watch for
is the appearance, increase in quantity, and
change in consistency of cervical mucus
5. chart your temperature
- your BBT changes throughout your cycle
as fluctuations in hormone levels occur.
During the first half of your cycle before
ovulation, estrogen dominates.
- During the second-half after ovulation,
there is a surge in progesterone, which
increases your body temperature as it gets
your uterus ready for a fertilized,
implantable egg.
Menstruation
• A menstrual cycle (female reproductive cycle)
• Defined as episodic uterine bleeding in
response to cyclic hormonal changes
• The process that allows for conception and
implantation of a new life
• Purpose: to bring an ovum to maturity and
renew a uterine tissue bed that will be
responsible for its growth should it be
fertilized
• Menarche - first menstrual period
Characteristics of normal menstrual cycles
• Beginning (menarche) – average age at onset, 12.4
years; average range 9-17 years
• Interval between cycles – average 28 days cycle;
of 23-35 days not usual
• Duration of menstrual flow – difficult to estimate;
average 30-80 ml/menstrual period; suturing a
pad or tampon in less than 1 hour is heavy
bleeding
• Color of menstrual flow – dark red, a
combination of blood, mucus, and endometrial
cells
• Odor – similar to marigold
Physiology of menstruation
• Four Body Structures:
1. Hypothalamus (GnRH)
2. Pituitary Gland (FSH, LH)

3. Ovaries
▪ Follicular phase (day 1-13)
▪ ovulatory phase (day 13-15)
▪ the luteal phase (day 15-28)
4. Uterus
▪ Phases of menstrual cycle:
- First – proliferation
- second – secretory
- third – ischemic
- final – menses
Hypothalamus
• The release of luteinizing hormone releasing
hormone (LHRH, sometimes abbreviated
GnRH for gonadotropin releasing hormone) by
the hypothalamus initiates the menstrual cycle;
the presence of estrogen represses the hormone
• This is transmitted from the hypothalamus to
the anterior pituitary gland and signals the
anterior pituitary gland to begin producing the
GnRH, Follicle-stimulating hormones and
luteinizing hormone (FSH and LH). Because
the production of LHRH is cyclical, menstrual
periods also cycle.
Pituitary gland
• under the influence of LHRH, the anterior lobe
of the pituitary gland (the adenohypophysis)
produces 2 hormones that act on the ovaries to
further influence the menstrual cycle:
1. FSH, a hormone that is active early in the
cycle and is responsible for maturation of
the ovum
2. LH, a hormone that becomes most active at
the midpoint of the cycle and is
responsible for ovulation, or release of
the mature egg cell from the ovary, and
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growth of the uterine lining during the
second-half of the menstrual cycle
ovary
• under the influence of FHS and LH, called
gonadrotopic hormones because they cause
growth (trophy) in the gonads (ovaries), one
ovum matures in one or the other ovary and is
discharged from it each month
• the ovarian cycle refers to periodic changes
that occur in the ovary every month during the
reproductive life
• cyclical changes in the ovaries occur in
response to two anterior pituitary hormones:
▪ Follicle stimulating hormone
▪ luteinizing hormone
• The changes that occur in the ovary during
each cycle can be divided into 3 phases:
1. Follicular phase (day 1-13)
2. ovulatory phase (day 13-15)
3. the luteal phase (day 15-28)
• These phases run in parallel with the phases of
the uterine cycle and together comprise the
menstrual cycle.
▪ Follicular phase:
- at the beginning of each menstrual
cycle, the hypothalamus secrets
GNRH in a pulsatile manner to
stimulate anterior pituitary gland the
secret FSH and LH.
- FSH is responsible for the growth of
several primary follicles
- the follicular phase is controlled by
FSH, encompasses days 1 to 13 of a
28 day cycle
- only one follicle on one of the ovaries
reaches maturity (graafian follicle)
which secrets estrogen
- estrogen has negative feedback on the
pituitary to stop FSH
- estrogen causes the uterine lining
(endometrium) to grow thicker
▪ Ovulatory phase:
- the estrogen peak stimulates secretion
of LH. The LH peak leads to:
- The follicle to burst open, releasing
the mature ovum into the abdominal
cavity a process called ovulation and
corpus luteum formation.

- Ovulation occurs on day 14 of a 28
day cycle
- note: high estrogen also suppresses
FSH secretion so no further follicles
grow
▪ Luteal phase:
- After ovulation, LH levels remain
elevated and cause the remnants of
the follicle to develop into a yellow
body called the corpus luteum
- In addition to producing estrogen, the
corpus luteum secrets a hormone
called progesterone
- when progesterone reaches a high
level it inhibits the secretion of LH
leads
- degeneration of the corpus luteum (if
fertilization does not take place)
- and so estrogen and progesterone
drop and separation of the
endometrium (menstruation) and
stimulate the hypothalamus to secret
more GnRH, a new cycle is started
uterus
• Uterine cycle
- refers to the changes that are found in the
uterine lining of the uterus. These changes
come about in response to the ovarian
hormones estrogen and progesterone.
- There are four phases to this cycle:
1. Proliferative
2. Secretory
3. Ischemic
4. Menstrual
First phase of menstrual cycle. Proliferative face:
- when estrogen levels are high enough, the
endometrium begins to regenerate.
- Estrogen stimulates blood vessels to
develop. The blood vessels in turn bring
nutrients and oxygen to the uterine lining,
and it begins to grow and become thicker.
- The proliferative phase ends with
ovulation on day 14
Second phase of menstrual cycle. Secretory phase:
- After ovulation, the corpus luteum begins
to produce progesterone. The hormone
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causes the uterine lining to become rich in
nutrients in preparation for pregnancy.
- Estrogen levels also remain high so that
the lining is maintained. If pregnancy
doesn't occur, the corpus luteum gradually
degenerates, and the woman enters the
ischemic phase of the menstrual cycle.
Third phase of menstrual cycle: Ischemic Phase:
- on day 27 and 28, estrogen and
progesterone levels fall because the corpus
luteum is no longer producing them.
- Without this hormones to maintain the
blood vessel network, the uterine lining
becomes ischemic. When the lining start
to slough, the woman has come full cycle
and is once again at day 1 of the menstrual
cycle.
Final phase of a menstrual cycle: Menses:
- day 1 of the menstrual cycle is marked by
the onset of menstruation. During the
menstrual phase of the uterine cycle, the
uterine lining is shed because of low
levels of progesterone and estrogen. At the
same time, a follicle is beginning to
develop and starts producing.
- The menstrual phase ends when the
menstrual period stops on approximately
day 5.
- Duration 1-5 days
- The following products are discharged
from the uterus as the menstrual flow or
menses:
▪ Blood from the ruptured capillaries
▪ Mucin from the glands
▪ fragments of endometrial tissue
▪ they microscopic, atrophied, and
unfertilized ovum
cervix
• Cervical mucus changes:
- changes in cervical mucus takes place
over the course of the menstrual cycle.
Some women use this characteristics to
help determine when ovulation is likely to
happen.
- During the menstrual phase the cervix
doesn't produce mucus. As the
proliferative phase begins, the cervix

begins to produce a tacky crumbly type of
mucus that is yellow or white.
- As the time of ovulation becomes near, the
mucus becomes progressively clear, thin
and lubricative, with the properties of raw
egg white.
- At the peak of fertility (i.e. during
ovulation) the mucus has a distensible,
stretchable called spinbarkheit.
- After ovulation the mucus becomes
scanty, thick, and opaque.
Cervical changes
• The fern test (arborization)
- ability to form a Fern like pattern on a
microscope slide when allowed to dry
- when estrogen is high
• The spinbarkeit test
- Is the ability to stretch into long strands
- due to increase progesterone level
human sexuality
• Sexuality is a multidimensional phenomenon
that includes feelings, attitudes, and actions.
• It has both biological and cultural components.
• It encompasses and gives direction to a
person's physical, emotional, social, and
intellectual responses throughout life.
• Each person is born a sexual being, and they
are gender identity and gender role behavior
evolve from and usually conform to the
societal expectations within that person's
culture.
Biological gender
• Is the term used to denote chromosomal sexual
development: male (XY) or female (XX).
• Gender identity or sexual identity is the inner
sense a person has of being male or female,
which may be the same as or different from
biological gender.
• Gender role is the behavior a person conveys
about being male or female, which, again, may
or may not be the same as biological gender or
gender identity.
Development of gender identity
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• The amount of testosterone secreted in utero (a
process termed sex typing) may affect this
characteristic.
• How appealing parents or other adult role
models portray their gender roles may also
influence how a child envisions himself or
herself.
• For example, both sons and daughters often
relate better to whichever parent is kinder and
more calm. This may result in a son assuming
characteristics often regarded as feminine or
daughters developing interests typically
regarded as masculine.
• Gender role is also culturally influenced.
Responsible parenthood
• As defined in the Directional Plan of
POPCOM, is the will and ability of parents to
respond to the needs and aspirations of the
family and children.
• It is a shared responsibility of the husband and
the wife to determine and achieve the desired
number, spacing, and timing of their children
according to their own family life aspirations,
taking into account psychological
preparedness, health status, socio-cultural, and
economic concerns.
Quality of responsible parenthood
1. Marriage should be done at the right age as
right age of marriage helps to start a new life
and new family in our right time.
2. The size of a family should be decided by both
parents together.
3. Being responsible parents also refers to
becoming parents at the right age where both
of them are physically and mentally mature to
start a family.
4. Proper spacing between the births of children
is also necessary for health of a mother and
child. There's also assures that every child
receives the attention and care they deserve.
Reproductive life planning
• It involves personal decisions based on each
individual's background, experiences, and
sociocultural beliefs.

• It involves thorough planning to be certain that
the method chosen is acceptable and can be
used effectively.
Natural family planning
• Periodic abstinence methods are varied
but involve determining the fertile period
each month and then avoiding sexual
relations during that time.
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• surgical methods of contraception are
tubal ligation in women and vasectomy in
men
• Counsel individuals who wish to undergo
these procedures that they are largely
irreversible

Oral contraceptives
• are combinations of estrogen and
progesterone
• They provide one of the most reliable
forms of contraception outside of
abstinence
• Women older than 40 years who smoke
are not candidates for oral contraceptive
use because of the danger of
cardiovascular complications
• Counsel them to find a form of
contraception that is reliable and allows
them to remain sexually active

subcutaneous implants
• subcutaneous implants (renewed every
five years) and subcutaneous injections
(renewed every three months) are new
methods of contraception
• They are almost 100% effective

intrauterine devices (IUD)

• IUD are placed in the uterus to prevent
fertilization and implantation
• Women with IUDs are at greater risk for
pelvic inflammatory disease than others
• Counsel them to limit the number of
sexual partners and be aware of the signs
and symptoms of PID

barrier methods
• include the diaphragm, cervical cap call
ma vaginal spermicides, and condom
(male and female)
• Such methods are low in cost but are not
as effective as ovulation suppressant
methods
• Use of diaphragms has been associated
with UTIs

morning after pill

• involves administration of a high dose of
estrogen that prevents FSH release
preventing ovulation

Surgical methods