Maternal Health Nursing Skills

Mary Lourdes Nacel G. Celeste, RN, MD


Reproductiv e Life FAMILY PLANNING Planning

Reproductive Life Planning
Includes all decisions an individual or couple make about having children: If and when to have children How many children to have How children are spaced Conception, fertility and counseling



Responsible Parenthood
A responsible person is a man or woman who is able and willing to give the proper response to the demands of a given situation. With specific reference to marriage and family life, the responsible spouse is one who gives the proper responses to the needs of his/ her spouse, as well as his own, and of their life together. Similarly, responsible parents give proper responses to the needs of their children.

Family planning refers more specifically to the voluntary and positive action of a couple to plan and decide the number of children they want to have and when to have them. RN. MD 6 .Responsible Parenthood Although some people object to the idea. we tend to equate family planning with responsible parenthood. MLNG CELESTE.

RN. MD 7 .Responsible Parenthood The concept of family planning includes these elements: Responsibility of parents to themselves and to each other Responsibility to their present and future children Responsibility to their community and country MLNG CELESTE.

RN.Responsible Parenthood Purposes of Family Planning improvement of health promotion of human right to determine reproductive performance relation of demographic change to economic development MLNG CELESTE. MD 8 .

RN. when the desired number of children is reached Helping those who do not have children to have children MLNG CELESTE.Responsible Parenthood The ultimate goal of family planning is directed towards: Birth spacing. MD 9 . to allow the mothers time to rest and regain their health before the next pregnancy Birth limitation.

family and community MLNG CELESTE. MD 10 .Responsible Parenthood Advantages of family planning To the mother: enables the mother to regain her health after the delivery gives mother enough time and opportunity to love and provide attention to her husband and children provides mother who has chronic illness enough time for treatment and recovery without further exposure to the physiologic burden of pregnancy prevents high risk pregnancy gives mother more time to herself. RN.

RN.Responsible Parenthood To the children.the practice of family planning will make them healthier happier feel wanted and satisfied secure MLNG CELESTE. MD 11 .

Responsible Parenthood To the fathers lightens his burden and responsibility in supporting his family enables him to give his children a good home. RN. MD 12 . good education and better future enables him to give his family a happy and contented life gives him time for his personal advancement provides a father who has chronic illness enough time for treatment and recovery from his illness MLNG CELESTE.

MD 13 . and for emergencies MLNG CELESTE.Responsible Parenthood To the family gives the family members more opportunity to enjoy each other’s company with love and affection enables the family to save some amount for improvement of standard of living. RN.

RN. MD 14 . less pollution. potable water supply. to participate in socio-civic activities MLNG CELESTE.Responsible Parenthood To the community improves the economic and social status of the community better job opportunities health status will improve extra resources in the community (less congestion. etc) members will have more time to socialize with each other.

Contraceptive Any device used to prevent fertilization of an egg MLNG CELESTE. RN. MD 15 .

RN.Considerations: Personal values Ability to use method correctly How method will affect sexual enjoyment Financial factors Status of couple’s relationship Prior experiences Future plans Contraindications MLNG CELESTE. MD 16 .


Contraceptives 40 million women in United States use some form of contraception 65% of women of childbearing age  ? PHILIPPINES MLNG CELESTE. RN. MD 18 .

Contraceptives 1. MD 19 . Abstinence 0% failure rate Most effective method to prevent STDs Difficult to comply with MLNG CELESTE. RN.

Natural Family Planning No chemical or foreign material into the body Failure rate of approximately 25% MLNG CELESTE. MD 20 . RN.Contraceptives 2.

MD 21 .Contraceptives Fertility Awareness Methods Calendar (rhythm) method Basal body temperature Cervical mucus (Billings) method Symptothermal method Ovulation awareness Lactation amenorrhea method Coitus interruptus MLNG CELESTE. RN.

Calendar/ Rhythm (Natural Family Planning) Action – periodic abstinence from intercourse during fertile period. RN. MD 22 . based on the regularity of ovulation. variable effectiveness MLNG CELESTE.

MD 23 Calendar/ Rhythm (Natural Family Planning) . thin.Teaching – fertile period may be determined by a drop in the basal body temperature before and a slight rise aftre ovulation and/ or by a change in cervical mucus from thick. clear. RN. cloudy and sticky during nonfertile period to more abundant. stretchy and slippery as ovulation occurs MLNG CELESTE.

1. MD 24 .from which you can calculate your FERTILE days MLNG CELESTE. RN. Calendar (rhythm) method Entails keeping a day-by-day record of your cycle for 6 consecutive months noting the onset of bleeding as day 1 and the last day before your next menstrual bleeding as the final day of your cycle This 6 month record will show you your longest and shortest cycles.

Calendar (rhythm) method MLNG CELESTE. RN. MD 25 .1.

MLNG CELESTE. RN. Calendar (rhythm) method The first day of menstrual bleeding (day 1 of your period) counts as the first day of the cycle. an egg will be released by one of the ovaries. MD 26 .1. Approximately 14 days (or 12 to 16 days) before the start of the next period.

MD 27 . possibly longer.1. RN. Calendar (rhythm) method While the egg from the woman lives for only around 24 hours. MLNG CELESTE. sperm from the man can survive for up to 3 days.

Calendar (rhythm) method First unsafe day: subtract 18 from the number of days in your shortest cycle Last unsafe day: subtract 11 from the number of days in your longest cycle Ex: shortest: 26 – 18 = day 8 longest: 31 – 11 = day 20 UNSAFE PERIOD!! Days 8 -20 -avoid coitus or use a contraceptive MLNG CELESTE. MD 28 .1. RN.

RN.SHORTEST CYCLE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 18 DAYS LONGEST CYCLE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 11 DAYS UNSAFE TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 UNSAFE TIME MLNG CELESTE. MD 29 .

RN. then rises to about half a degree higher than normal and remains thus for up to three days: UNSAFE period! Not a very efficient method unless combines with calendar and mucus methods MLNG CELESTE. MD 30 .2. Basal Body Temperature Involves taking the temperature every morning BEFORE the woman gets out of bed and recording it The temperature drops slightly 24 hours before ovulation.

3. MD 31 . RN. Cervical Mucus (Billings) Method Involves becoming aware of the normal changes in the cervical secretions that occur throughout your cycle by inserting the forefinger into the vagina first thing in the morning MLNG CELESTE.

secretion increases and becomes thicker. thin. more liquid. Cervical Mucus (Billings) Method A few days after menstrual bleeding: little secretion. this secretion or mucus becomes copious.3. as soon as this change begins and for 3 full days later: UNSAFE PERIOD!! MLNG CELESTE. MD 32 . less viscous. vagina is dry Gradually. clear. slippery or stringy. RN. cloudy white and sticky As ovulation approaches.

Cervical Changes Spinnbarkeit test Cervical mucus is thin.3. MD 33 . RN. watery and can be stretched into long strands high level of estrogen: ovulation is about to occur MLNG CELESTE.

due to crystallization of sodium chloride on mucus fibers MLNG CELESTE. MD 34 . RN. Cervical Changes Ferning or arborization of cervical mucus At the height of estrogen stimulation just before ovulation Ferning.3.

Symptothermal method Combines BBT and cervical mucus methods MLNG CELESTE. MD 35 . RN.

MD 36 .Ovulation awareness Use of over-the-counter OTC ovulation test kit which detects the midcycle LH (luteinizing hormone) surge in the urine 12 to 24 hours before ovulation 98 to 100% accurate MLNG CELESTE. RN.

RN. MD 37 . there is some natural suppression of ovulation Not dependable.Lactation amenorrhea method As long as a woman is breastfeeding an infant.woman may be fertile even if she has not had a period since childbirth After 6 months. she should another method of contraception MLNG CELESTE.

Coitus interruptus Oldest method Couple proceeds with coitus until the moment of ejaculation. MD 38 . RN. spermatozoa may be deposited in the vagina MLNG CELESTE. then the man withdraws and spermatozoa are emitted outside the vagina Offers little protection because ejaculation may occur before withdrawal is co mplete and despite the care used.

Oral Contraceptives Composed of varying amounts of estrogen combined with small amount of progesterone 99. RN. MD 39 .Contraceptives 3.5% effective MLNG CELESTE.

MD 40 . Oral Contraceptives Estrogen suppresses FSH and LH. thereby suppressing ovulation Progesterone decreases the permeability of cervical mucus MLNG CELESTE. RN.3.

3. RN.Varying levels of estrogen and progesterone MLNG CELESTE.Fixed doses of estrogen and progesterone .Constant amount of estrogen with increased progesterone Triphasic . MD 41 . Oral Contraceptives Monophasic . 21-28 day cycle Biphasic .

RN. MD 42 . Oral Contraceptives Benefits of OC’s: DECREASED incidences of: Dysmenorrhea Premenstrual dysphoric syndrome Iron deficiency anemia Acute PID with tubal scarring Endometrial and ovarian cancer and ovarian cysts Fibrocystic breast disease MLNG CELESTE.3.

Oral Contraceptives Side Effects Nausea Weight gain Headache Breast tenderness Breakthrough bleeding Monilial vaginal infections Mild hypertension Depression MLNG CELESTE. RN.3. MD 43 .

3. MD 44 . Oral Contraceptives Absolute Contraindications to OC’s Breastfeeding Family history of CVA or CAD History of thromboembolic disease History of liver disease Undiagnosed vaginal bleeding MLNG CELESTE. RN.

RN. MD 45 .3. Oral Contraceptives Possible Contraindications to OC’s Age 40+ Breast or reproductive tract malignancy Diabetes Mellitus Elevated cholesterol or triglycerides High blood pressure Mental depression MLNG CELESTE.

Migraine or other vascular type headaches Obesity Pregnancy Seizure disorders Sickle cell or other hemoglobinopathies Smoking Use of drug with interaction effect

Other Contraceptives
Continuous or extended regimen pills Mini-pills Estrogen-progesterone patch Vaginal rings



Estrogen-progesterone patch



Highly effective, weekly hormonal birth control patch that’s worn on the skin Combination of estrogen and progestin Absorbed on the skin and then transferred into the bloodstream Can be worn on the upper outer arm, buttocks, upper torso or abdomen Worn for 1 week, replaced on the same day of the week for 3 consecutive weeks. No patch-4th week

Emergency Postcoital Contraceptives
“Morning-after pills” High level of estrogen Must be initiated within 72 hours of unprotected intercourse




RN. Norplant) 6 nonbiodegradable Silastic implants with synthetic progesterone embedded under the skin on the inside of the upper arm Slowly release the hormone over the next 5 years Suppress ovulation. stimulating thick cervical mucus and changing the endometrium so implantation is difficult MLNG CELESTE. Other Contraceptives Subcutaneous implants (eg.4. MD 52 .

MD 53 .4. Other Contraceptives Intramuscular injections -administered every 12 weeks Medroxyprogesterone (depo-provera) -100% effective MLNG CELESTE. RN.

INTRAUTERINE DEVICES T-shaped plastic device with copper With progesterone Mechanism of action not fully understood Must be fitted by physician. RN.Contraceptives 5. MD 54 . nurse practitioner or midwife Insertion performed in ambulatory setting after pelvic examination and pap smear Device is contained within uterus – string protrudes into vagina Effective for 5-7 years (mirena type) or 8 years (Copper T380) MLNG CELESTE.




Side Effects: Spotting or uterine cramping Increased risk for PID Heavier menstrual flow Dysmenorrhea Ectopic pregnancy



6. Barrier Methods
Vaginally inserted spermicidal products Diaphragms Cervical caps Condoms




goal: to kill the sperm before the sperm enters the cervix -Nonoxynol-9 -gel, creams, films,foams, suppositories

DIAPHRAGM -mechanically blocks sperm from entering the cervix -soft latex dome supported by a metal rim -can be inserted 2 hours before intercourse; removed at least 6 hours after coitus or within 24 hours -size must fit the individual -washable, may be used for 2-3 years

MD 60 . RN.6. BARRIER METHODS CERVICAL CAP -similar to diaphragm but smaller -thimble-shaped rubber cap held onto the cervix by suction MLNG CELESTE.


g. never petroleum-based lubricant. help prevent venereal disease.MALE CONDOM Action – prevents the ejaculate and sperm from entering the vagina. K-Y jelly. RN. effective if properly used. OTC Teaching – apply to erect penis with room at the tip every time before vaginal penetration. partner should use contraceptive foam or cream immediately MLNG CELESTE. e. MD 62 .. hold rim when withdrawing the penis from the vagina. use water-based lubricant. if condom breaks.

tied/ cauterized to block passage of ova and sperm ABDOMINAL INCISION MINILAPAROTOMY LAPAROSCOPY FOR TUBAL STERILIZATION MLNG CELESTE. Surgical Methods Tubal Ligation -28% of all women in US -fallopian tubes are cut. MD 63 . RN.7.

RN. Surgical Methods Vasectomy .11% of all men in US -incisions are made in the sides of scrotum. vas deferens is cut and tied.7. MD 64 . then plugged or cauterized -blocks passage of sperm -viable sperm for 6 months post op -reversible 95% MLNG CELESTE.

MD 65 . RN. hysterotomy MLNG CELESTE. saline induction. Elective Termination of Pregnancy Procedure to deliberately end a pregnancy before fetal viability Induced (mifepristone-progesterone antagonist. misoprostolprostaglandin analog Medically induced D&C.8. D&E.

RN. Celeste. MD .Physical Assessment of a Pregnant Woman Mary Lourdes Nacel G.

RN. asking permission from the patient to perform the examination 3.Genital & Pelvic Examination the most intimate examination that a woman may be ever subjected to must never be performed without: 1. valid reason for performing the examination MLNG CELESTE. MD 67 . a careful explanation to the patient about the examination 2.

4. 3. 6. AT THE FIRST VISIT: The diagnosis of pregnancy during the first trimester Assessment of the gestational age Detection of abnormalities in the genital tract Investigation of a vaginal discharge Examination of the cervix Taking a cervical (Papanicolaou) smear MLNG CELESTE. RN. MD 68 . 5.Indications 1. 2.

Indications 1. 5. MD 69 . 7. 3. 2. Performance of artificial rupture of the membranes to induce labor MLNG CELESTE. 4. AT SUBSEQUENT ANTENATAL VISITS: Investigation of a threatened abortion Confirmation of PROM with a sterile speculum To confirm the diagnosis of preterm labor Detection of cervical effacement and/ or dilatation in a patient with a risk for preterm labor Assessment of the ripeness of the cervix prior to induction of labor Identification of the presenting part in the pelvis Performance of a pelvic assessment IMMEDIATELY BEFORE LABOR 1. 6. RN.

Drape properly. MD 70 . Explain that the procedure may be slightly uncomfortable. RN. After the procedure. Instruct woman not to hold or squeeze your hands. Lithotomy poles and stirrups are required. Provide good lighting. provide tissue to wipe perineum of lubricant. hold her breath. The procedure must be carefully explained to the patient.Preparation The bladder must be empty. MLNG CELESTE. *The lithotomy position provides better access to the genital tract. close eyes tightly. The patient is put in lithotomy (or dorsal) position. clench fist and contract perineal muscles. Let the support person stay at the head of the bed.

Slide your hips down to the edge of the table. MD 71 . you will be more comfortable. You can cover your lower abdomen and thighs with the drape sheet to feel less exposed and more comfortable during the procedure. MLNG CELESTE.TO THE FEMALE CLIENT You will be asked to place your feet in the footrests at the end of the table. and the exam will be more complete. and relax as much as possible. If your buttocks and abdominal and vaginal muscles are relaxed. Let your knees spread wide apart. RN.

TO THE FEMALE CLIENT You'll feel less tense if you Breathe slowly and deeply with your mouth open. Relax your shoulders. RN. Let your stomach muscles go soft. MLNG CELESTE. MD 72 . Relax the muscles between your legs. Ask the clinician to describe what is being done as it is happening.

TO THE FEMALE CLIENT Remember that the exam is not emotional or sexual for your clinician. RN. MD 73 . Talk with your clinician about your fears any pelvic pain you may have your experience of abuse Talking with your clinician about your experience will help your clinician tailor the exam to your special needs help you feel as comfortable as possible understand how your physical and emotional health may be affected MLNG CELESTE.

The client may have more pelvic pain.Sexual Abuse and Other Concerns Some women are very anxious about having a pelvic exam because of difficult experiences that may include sexual abuse. and discomfort during the pelvic exam if she has been sexually abused in the past heard alarming stories about GYN exams had other negative sexual experiences MLNG CELESTE. MD 74 . fear. RN.

If the client wants to see what's going on and/or know what the vagina and cervix look like. She may hold the client’s hand or just talk to her to ease her tension. RN. a mirror may be requested. MLNG CELESTE. It is also okay to have a trusted friend or relative with the client during the exam. MD 75 . Her presence may help the client to feel more relaxed. the client may request to have another woman in the room.If the clinician is a man.

RN. the exam lasts just a few minutes. MD 76 .Four Steps Usually. There are four steps: The External Genital Exam The Speculum Exam The Bimanual Exam The Rectovaginal Exam MLNG CELESTE.

Step 1. or other conditions. She will gently feel for glands. discoloration. discharge. MLNG CELESTE. RN. swelling and other abnormalities. cysts. The External Genital Exam The clinician visually examines the soft folds of the vulva and the opening of the vagina to check for signs of irritation. MD 77 . genital warts.

The position of the cervix or uterus may affect comfort as well. MD 78 . the client may feel the chill of the metal.Step 2. Most clinicians lubricate the speculum and warm it to body temperature for more comfort. RN. so that the cervix can be seen. She will likely feel more discomfort if she is tense or if the vagina or pelvic organs are infected. When opened. which normally are closed and touch each other. The client may feel some degree of pressure or mild discomfort when the speculum is inserted and opened. it separates the walls of the vagina. The Speculum Exam The clinician inserts a metal or plastic speculum into the vagina. If a metal speculum is used. MLNG CELESTE.

or abnormal discharge from the cervix. These tests may not be done unless the client has concerns about infections and/or asks for testing. the clinician checks for any irritation. The client should talk with her clinician if she has symptoms or concerns about her partner(s).Step 2. MLNG CELESTE. RN. human papilloma virus. chlamydia. The Speculum Exam Once the speculum is in place. MD 79 . or other sexually transmitted infections may be taken by collecting cervical mucus on a cotton swab. growth. Tests for gonorrhea.

The Speculum Exam MLNG CELESTE. RN. MD 80 .

RN.Insertion of a Speculum MLNG CELESTE. MD 81 .

and any other problems. You may have some staining or bleeding after the sample is taken. The cells are tested for abnormalities — the presence of precancerous or cancerous cells. the vaginal walls that were covered by it are also checked for irritation. MLNG CELESTE.Pap Smear Usually a small spatula or tiny brush is used to gently collect cells from the cervix for a Pap test. injury. As the clinician removes the speculum. RN. MD 82 .

Pap tests cannot identify specific sexually transmitted infections. MLNG CELESTE.) thinning of the vaginal lining from lack of estrogen commonly related to menopause The cell sample will be sent to a laboratory. Pap tests need to be repeated if there is too much blood present for an accurate reading or if there are not enough cells to be examined.Pap Smear Pap tests can detect the presence of abnormal cells in the cervix infections and inflammations of the cervix symptoms of sexually transmitted infections (With the exception of trichomoniasis. but they may detect symptoms. The results will be sent back to the clinician within a few days/ weeks. RN. MD 83 .

RN. the clinician will advise the client on follow-up care: If noncancerous abnormalities and infections are found. Have growths removed with cryotherapy. she will need careful follow-up and may also be advised to  Repeat the Pap test in a few weeks or have them at more frequent intervals. If early precancerous or suspicious growths are found. MLNG CELESTE. laser surgery. MD 84 .Pap Smear If the results are abnormal. the client needs to complete the prescribed treatment and repeat the tests as advised.  Have other tests. If cancerous growths are found  Discuss options with clinician.  Have a colposcopy and biopsy. or electrocautery.  See another provider or specialist.

Pap Smear Remember — Most abnormalities that are detected are not cancer. MLNG CELESTE. Early treatment of precancerous growths can prevent cancer from developing. MD 85 . RN. Follow-up examinations are necessary if an abnormal condition is found.

RN. MD 86 .Pap Smear MLNG CELESTE.

RN.Pap Smear MLNG CELESTE. MD 87 .

Pap Smear MLNG CELESTE. MD 88 . RN.

MD 89 .Pap Smear MLNG CELESTE. RN.

MD 90 .Pap Smear MLNG CELESTE. RN.

MD 91 .Pap Smear Findings of Pap’s Smear Class I – Normal findings Class II – Normal with atypical cells present (inflammatory reaction) Class III – Suggestive of malignancy. with signs of malignancy present Class V – Definitely malignant cells MLNG CELESTE. RN. with benign and malignant cells Class IV – Probably malignant.

MD 92 .Step 3. the clinician inserts one or two lubricated fingers into the vagina. The Bimanual Exam Wearing an examination glove. The clinician can then feel the internal organs of the pelvis between the two fingers in the vagina and the fingers on the abdomen. MLNG CELESTE. RN. The other hand presses down on the lower abdomen.

which might indicate infection swelling of the fallopian tubes enlarged ovaries. and position of the uterus an enlarged uterus. shape.Step 3. RN. cysts. The Bimanual Exam The clinician examines the internal organs with both hands to check for size. MD 93 . or tumors MLNG CELESTE. which could indicate a pregnancy or fibroids tenderness or pain.

Deep breathing through the mouth helps. MD 94 . The Bimanual Exam The bimanual part of the exam causes a sensation of pressure. MLNG CELESTE.Step 3. The client may find it somewhat uncomfortable. The client should tell the clinician if she feels pain. RN.

MD 95 . RN.The Bimanual Exam MLNG CELESTE.

The Bimanual Exam MLNG CELESTE. RN. MD 96 .

RN. Some clinicians insert one finger in the anus and another in the vagina for a more thorough examination of the tissue in between. on the lower wall of the vagina. and in the rectum. This is normal and lasts only a few seconds. MD 97 . MLNG CELESTE. They also check for possible tumors located behind the uterus. the client may feel as though she needs to have a bowel movement. Rectovaginal Exam Many clinicians complete the bimanual exam by inserting a gloved finger into the rectum to check the condition of muscles that separate the vagina and rectum. During this procedure.Step 4.

MD . Celeste. RN.Perinatal Exercises Mary Lourdes Nacel G.

Perinatal Exercises Purposes: Help prevent the need for cesarean section Help strengthen pelvic and abdominal muscles Help reduce discomfort Help hasten recovery Exercises – should be done in moderation and must be individualized MLNG CELESTE. RN. MD 99 .

Let abdomen and ribcage expand and compress naturally as you inhale and exhale. As strength improves. lie in comfortable position on floor for 10 minutes with eyes closed. 3. RN. also. Warm up with gentle stretching before exercise program increase blood flow to muscles and loosen them up. 2. MLNG CELESTE. 4. let breathing slow down. Allow rest between each exercise. Always let breath flow freely.PRE-EXERCISE POINTERS 1. 5. MD 100 . Do each exercise slowly and thoroughly. When you finish. try holding positions from 3 to 5 counts. add one repetition of each exercise until you’re up to 10. take time to relax fully.

7. Avoid extreme motions like deep lunges or twisting movements. If there is a prenatal exercise class in your area. Avoid lying flat on your back for prolonged periods. it may become uncomfortable and the position allows less blood flow to the uterus. Kegel’s while standing in line at grocery store. join it. 9. talking on the phone. Lying on your side increases blood flow. squatting while peeling potatoes. watching television.PRE-EXERCISE POINTERS 6. Think of opportunities for exercises during day. MD 101 . 8. RN. It is fun to get into shape with other pregnant women. etc. MLNG CELESTE.

Use this when watching TV. Tailor Sitting 1. MD 102 .A. RN. push knees gently towards the floor until you feel the perineum stretch. knees bent. Done at least 15 min/day Sit on floor with thighs apart. legs parallel to each other. Do this for 15 minutes daily. reading or entertaining friends. one ankle should NOT be on top of the other. It strengthens the thigh and stretches the perineal muscles 2. MLNG CELESTE.

bend knees rather than the back. practice for 15 minutes daily MLNG CELESTE. Squatting 1.B. Helps to stretch muscle of the pelvic floor. Done at least 15min/day When lifting something from the floor. RN. MD 103 . do not squat on tiptoes but keep feet flat on the floor. 2. incorporate this into daily activities.

(10x) 2. Contract and relax the muscles surrounding the vagina as rapidly as possible 10 – 25x 3. 1. Squeeze the muscle surrounding the vagina as if stopping the flow of urine.C. RN. MD 104 . Imagine that you are sitting in the bath tub of water and squeeze muscles as if sucking water into the vagina. It may lead to increased sexual enjoyment. 10x MLNG CELESTE. hold for 3 seconds then relax. Hold for 3 seconds then relax. Each is a separate exercise and should be done 3x a day. Pelvic Floor Contractions (Kegel’s Exercise) It is designed to strengthen pubococcygeus muscle.

MD 105 .D. then relax and repeat as often as you can. Abdominal Muscle Contractions 1. can be done on lying or standing position along with pelvic floor contractions. MLNG CELESTE. may be done as often as she wishes Tighten abdominal muscles. help prevent constipation 3. RN. strengthen the abdominal muscles 2.

E. Pelvic Rocking 1. MD 106 . She holds the position for 1 minute. and then hollows her back. Can be done on a variety of positions The woman arches her back. RN. . Makes the lumbar spine more flexible 3. Helps to relieve backache during pregnancy and early labor this at the end of the day (5x) MLNG CELESTE. trying to lengthen or stretch her spine.

Pelvic Tilt 1. MD 107 . PELVIC TILT – SUPINE Do daily and after delivery. Position: Backlying. MLNG CELESTE. knees bent. Exercise: Press small of back against floor by tightening abdominal muscles and buttocks muscles.F. RN.

MLNG CELESTE. PELVIC TILT – STANDING Position: Stand with back to wall. Pelvic Tilt 2.F. feet about three inches from base of wall. Exercise: Tighten stomach and buttocks and press low back against the wall so that your back is touching the wall. Your knees must be relaxed or slightly bent to do this. RN. MD 108 .

PELVIC TILT . Hold. Hold.F. MLNG CELESTE. RN. pelvic floor and back muscles and arch back to produce hollow. MD 109 . Tighten buttocks.ALL FOURS Position: On hands and knees. Exercise:Tighten stomach muscles and arch back toward the ceiling. Pelvic Tilt 3.

Good muscle tone is important for maintaining good posture. for effective pushing.G. MLNG CELESTE. Exercise: Lift head and shoulders off floor. MD 110 . do not drop back. RN. Slowly return to starting position.Modified Purpose: Strengthen abdominal muscles. low back flat (pelvic tilt). knees bent. and for early return of figure postpartum. reaching hands toward knees (lift trunk to about 45° angle). Position: Backlying. SIT-UPS . Sit ups 1.

but reach up and across to the outside of the opposite knee. RN. Position: Backlying. knees bent.Modified Purpose: Strengthen oblique abdominal muscles.G. Sit ups 2. MD 111 . OBLIQUE (DIAGONAL) SIT-UPS . Exercise: As above. low back flat. MLNG CELESTE.

MLNG CELESTE. arms at sides. ankles crossed. Exercise: Pinch buttocks. MD 112 . RN. squeeze pelvic floor muscles. GLUTEAL / PELVIC FLOOR SETTING Position: Backlying. legs straight.H. squeeze thighs together. raise head off floor.

I. MD 113 . Roll knees outward. MLNG CELESTE. ADDUCTOR LENGTHENING Position: Sit on floor with legs straight and slightly apart. Exercise: Slowly lean body forward towards the floor with arms stretched out in front of you. Hold forward for 3 to 5 seconds. RN. Your knees may bend slightly. Do not jerk or bounce.

Jogging: Wear good shoes. MD 114 . listen to your body and slow down when necessary. MLNG CELESTE. ankles and feet). Bicycling and Swimming: Excellent activities with reasonable limitations. Don’t push yourself! 3. other “sudden stop and start” Activities. Do not overexert yourself.SPECIFIC ACTIVITIES 1. hip joints. Basketball. Remember: increased weight and laxity of ligaments means more strain on lower body (lower spine. Jog at a slower pace. RN. Keep pelvic floor muscles strong with Kegel exercises. Tennis. 2. More awkward as bulk increases. shorter distances. supportive bra. less frequently. knees.

ideal alternative to more strenuous exercise. Skating. and avoid exercising to the point of exhaustion. downhill. It is generally advised that you not begin any new sport or activity during pregnancy. and at different speeds. Know your limits. RN. but you may still continue to exercise gently. 5. Stop when something hurts. MLNG CELESTE. Walking: Most highly recommended for the pregnant woman. Horseback Riding: Danger of falling! Advise against. Consult your obstetrician or nurse practitioner as needed. In general. you can continue your pre-pregnant routine of exercising. or when you become fatigued. You may want to taper off your sports participation during the last few months.4. Avoid exercising in very hot or humid weather. or at high altitudes if you’re not used to it. Walk uphill. Patient Teaching: Consult your obstetrician or nurse practitioner early in your pregnancy. MD 115 .

MD .Leopold’s Maneuvers Mary Lourdes Nacel G. Celeste. RN.

LEOPOLD’S MANEUVERs systematic method of observation and palpation to determine fetal position woman empties her bladder. MD 117 . RN. lies supine with her knees flexed slightly examiner warms hands to avoid contraction of abdominal muscles gentle but firm touch MLNG CELESTE.

Press gently and firmly with finger pads. MLNG CELESTE. RN. usually a fetal head. infrequently a fetal breech. Place hands on either side of the fundal area so that the fingers of both hands almost touch each other (face the woman's head). also moves the entire fetus usually indicates a fetal breech. A very hard round well-defined shape that can be moved back and forth (balloted) usually indicates a fetal head. which when moved back and forth between the finger pads.LEOPOLDS MANEUVERs First Maneuver Palpation of the Uterine Fundus Will usually indicate the fetal part situated in the fundus. MD 118 . A somewhat hard and roundish shape.

Palpation of the Uterine Fundus First Maneuver MLNG CELESTE. MD 119 . RN.

Second Maneuver Determines small parts and back of fetus along the sides of maternal abdomen
Lateral Palpation of the Uterus Examiner faces woman's head Palpate with one hand on each side of abdomen Palpate fetus between two hands Assess on which side is the fetal back or spine and which side has small parts or extremities



Generally provides information regarding the location of the fetal back and the fetal small parts consisting of arms and legs. Hands should alternately apply pressure against the opposite hand. Directing alternating pressure against each hand is the technique. Alternating hands using firm resistance while the other hand gently and firmly applies pressure and rotates in a circular fashion. This technique can be used up and down the entire length of the uterus.

Second Maneuver Determines small parts and back of fetus along the sides of maternal abdomen



Third Maneuver (Lower uterine segment or uterine pole)
Face the woman's head and spread your hands widely apart. Grasp the uterine contents just above the symphysis pubis (firmly but gently). Hold presenting part between index finger and thumb. Assess for cephalic versus Breech Presentation Move the fetal presenting part gently back and forth in your hand Fetal head will shift more easily back and forth Fetal breech will move the whole body.



The 3rd Leopold's Maneuver (Pawlick's grip) will provide either initial information or confirm prior data gained from the previous steps of Leopold's maneuvers. Anchoring the uterine fundus with the non-dominant hand assist in identifying the location of the fetal back and small parts.

RN.Third Maneuver (Lower uterine segment or uterine pole) MLNG CELESTE. MD 125 .

Place hands on either side of the lower abdomen with finger pads at the lower uterine pole (bikini line) and thumbs directed toward the umbilicus.Fourth Maneuver (pelvic palpation of the uterus . Carefully move fingers of each hand towards each other in a downward and inward manner using gentle pressure. and station (level of descent of the presenting part).assess the presenting part) Provides information about the presenting part: breech or head. Examiner faces woman's feet . MLNG CELESTE. MD 126 . attitude (flexion or extension). RN.

the sinciput is on the side opposite the fetal back. RN.The nurse's thumbs should point towards the woman's umbilicus. If there is a head palpated in the pelvis. Assess if a prominence on one side of the abdomen can be palpated higher than a prominence on the other side. MLNG CELESTE. the fetal presentation is referred to as a cephalic or vertex presentation. The first prominence felt indicates the sinciput (forehead) of the infant and is on the same side as the fetal small parts. MD 127 . Therefore. The prominence felt further down the pelvis is the fetal occiput back of the head) and is on the same side as the fetal back.

MD 128 .assess the presenting part) MLNG CELESTE. RN.Fourth Maneuver (pelvic palpation of the uterus .

Breech is less well defined that moves only in conjunction with the body. Poor attitude if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head). Not engaged (not firmly settled in the pelvis) if the presenting part moves upward so an examiner’s hands can be pressed together. resistant surface.1st What is at the uterine fundus? MANEUVER Head is more firm. If brow is very easily palpated. Knees and elbows of fetus feel with a number of angular nodulation. Good attitude if brow corresponds to the side (2nd maneuver) that contained the elbows and knees. th 4 What is the fetal attitude? (degree of flexion) MANEUVER Fingers on both sides of the uterus (2 inches above inguinal ligaments) pressing down and inwards. hard. nd 2 Where is the fetal back? MANEUVER Fetal back is smooth. fetus is at posterior position (occiput pointing towards woman’s back). rd 3 What is at the inlet of the pelvis? MANEVER By grasping the lower portion of the abdomen (just above the symphisis pubis. Also palpates infant’s anteroposterior position. hard and round that moves independently of the body. The fingers of the hand that do not meet obstruction above the ligament palpates the fetal brow. .

Celeste.Taking FHT Mary Lourdes Nacel G. MD . RN.

MD 131 . RN.Fetal heart rate FHR should be 120-160 beats per minute Can be heard with a Doppler : 10 – 11th week of pregnancy Fetoscope: 18-20 weeks MLNG CELESTE.

MD 132 .Fetal heart rate Assist the patient to a supine position. To assess FHR in a fetus 20 weeks or younger. If there are no earpieces. position Doppler/Stethoscope/ fetoscope on the abdominal midline above the symphysis pubis. RN. Place the earpieces in your ears and press gently on the patient’s abdomen. midway between the umbilicus and the symphysis pubis. Start listening at the midline. use Leopold’s maneuvers and position the listening instrument over the fetal back. when you can palpate fetal position. As needed. Move the instrument from side to side to locate the loudest heart tones then palpate the maternal pulse. turn the device on and adjust the volume. Drape her with a blanket to minimize exposure. MLNG CELESTE. Apply water soluble lubricant to her abdomen or the monitoring device. After 20 weeks AOG.

RN. Auscultate FHR during a contraction and for 30 seconds afterward to identify the response to the contraction. In high risk labor. Record FHR. vaginal examinations and medications. During labor. ambulation. Auscultate FHR before administration of medications. assess FHR every 60 minutes during the latent phase. MLNG CELESTE. and every 5 minutes during the 2nd stage of labor. and artificial rupture of membranes. assess FHR every 30 minutes during the latent phase. every 30 minutes during the active phase and then every 15 minutes during the 2nd stage of labor. monitor FHR during the relaxation period between the contractions to determine baseline. try to locate the fetal thorax/ back by Leopold’s maneuver. MD 133 . In a low-risk labor. then reassess FHR for 60 seconds.Fetal heart rate If the maternal radial pulse and FHR are the same. every 15 minutes during the active phase. changes in the characteristics of contractions.



Fetal Heart Rate Patterns Tachycardia (>160 bpm) Bradycardia (<120 bpm) Indicative of… Maternal or fetal infection Fetal hypoxia (ominous sign) Fetal hypoxia or stress Maternal hypotension after epidural initiation Intervention Depends on the cause Place client on her left side Increase fluids to counteract hypotension Stop oxytocin (Pitocin) if in use None required Early deceleration (deceleration begins and ends with uterine contraction) Late deceleration (HR decreases after peak of contraction and recovers after contraction ends) Head compression :not ominous Vagal stimulation Fetal stress and hypoxia Deficient placental perfusion Supine position Maternal hypotension Uterine hyperstimulation Change maternal position Correct hypotension Increase IV fluid rate as ordered Discontinue oxytocin Administer oxygen as ordered Change maternal position Administer Oxygen Depends on the cause Variable deceleration (transient decrease in HR anytime during contraction Decreased variability Cord compression Hypoxia or hypercarbia Fetal sleep cycle Depressant drugs Hypoxia CNS anomalies .



Measuring Fundic Height
Mary Lourdes Nacel G. Celeste, RN, MD

Fundic Height
McDonald’s Rule – determines during midpregnancy, that the fetus is growing in utero by measuring the fundal (uterine) height Typically, the distance from the fundus to the symphysis in centimeters is equal to the week of gestation between the 20th and 31st weeks of pregnancy.

Fundic Height
Measure from the notch of the symphysis pubis to over the top of the uterine fundus as the woman lies supine. Place the zero line of the tape measure on the anterior border of the symphysis pubis and stretch tape over midline of abdomen to top of fundus. The tape should be brought over the curve of the fundus. The height of the fundus in centimeters equals the number of weeks gestation plus or minus 2. (inaccurate in the 3rd trimester esp after 32 wks) Typical measurements Over the symphysis pubis: 12 wks At the umbilicus: 20 wks At the xiphoid process: 36 wks Rises about 1cm per week; after which it varies MLNG CELESTE, RN, MD 140

Fundic Height



RN. drops at 34 weeks level because of lightening MLNG CELESTE.Location of the fundus: 12 weeks  16 weeks  20weeks  24 weeks  30 weeks  36 weeks  40 weeks  at the level of the symphysis pubis halfway between symphysis pubis and umbilicus at the level of the umbilicus two fingers above umbilicus midway between umbilicus and xiphoid process at the level of xiphoid process two fingers below umbilicus. MD 142 .

Celeste. MD .Computation of EDC & AOG based on LMP Obstetrical Number Mary Lourdes Nacel G. RN.

EDC LAST MENSTRUAL PERIOD – first day of the last menses MLNG CELESTE. MD 144 . RN.

2009 Date of consult: August 31. MD 145 .AOG COMPUTATION OF AGE OF GESTATION Example: LMP: January 1. 2009 AOG: Total # of days from LMP up to date of consult 7 January February March April May June July August 30 days 28 31 30 31 30 31 31 Total = 242 days AOG = 242 7 34 to 35 weeks MLNG CELESTE. RN.

RN. P. currently considered any time after 20-wk gestation). MD 146 . L) Gravida – the total number of pregnancies regardless of duration (includes present pregnancy) Para – number of past pregnancies that have gone beyond the period of viability (capability of the fetus to survive the outside of the uterus.Obstetrical History/ Number G__ P__ (T. A. regardless of the number of fetuses or whether the infant was born alive or dead Term infant – an infant born between 38 and 42 weeks of gestation Preterm – an infant born before 38 weeks Post term – an infant born after 42 weeks Abortion – pregnancy that terminates before the period of viability (20 wks) Live birth – a live birth is recorded when an infant born shows sign of life MLNG CELESTE.

Celeste. RN. Lie & Position Station Mary Lourdes Nacel G.Fetal Presentation. Attitude. MD .

RN.Presentation part of fetus that presents to (enters) maternal pelvic inlet   Cephalic/vertex – head presentation (>95% of labors) Breech MLNG CELESTE. MD 148 .


MD 150 .Breech presentation Complete – flexion of hips and knees Frank (most common) – flexion of hips and extension of knees Footling/incomplete – extension of hips and knees MLNG CELESTE. RN.


RN.Attitude/ habitus relationship of fetal parts to each other. MD 152 . usually flexion of head and extremities on chest and abdomen to accommodate to shape of uterine cavity Vertex – head is maximally flexed Military – head is partially flexed Brow – head is maximally extended Face – head is partially extended MLNG CELESTE.


MD 154 . longitudinal (parallel) transverse (right angles) oblique (slight angle off a true transverse lie) MLNG CELESTE.Lie Lie – relationship of spine of fetus to spine of mother. RN.


moderate extension– brow (B) Breech presentation – sacrum (S) / Sa Shoulder presentation – scapula (SC) / A (acromion) MLNG CELESTE. RN. MD 156 .Position relationship of fetal reference point to mother’s pelvis Fetal reference point Vertex presentation – dependent upon degree of flexion of fetal head on chest. full flexion–occiput (O). full extension–chin (M).

Position Relation of the presenting part to a specific quadrant of a woman’s pelvis Right anterior Left anterior Right posterior Left posterior MLNG CELESTE. RN. MD 157 .

e. indicating vertex presentation with fetal occiput on mother’s left side toward the front of her pelvis  Fetal position reflects the orientation of the fetal head or butt within the birth canal.. LOA = left occiput anterior. RN. MD 158 . MLNG CELESTE.g.Maternal pelvis is designated per her right/left and anterior/posterior  Expressed as standard three letter abbreviation.

" This will close as the baby grows during the 1st year of life. where the bones meet. Early in labor. is a gap. Feeling this fontanel on pelvic exam tells you that the forehead is just beneath your fingers. it is open. When attaching a fetal scalp electrode. it becomes easier to feel the fontanel.Anterior Fontanel The bones of the fetal scalp are soft and meet at "suture lines." or "soft spot. The anterior fontanel is an obstetrical landmark because of its' distinctive diamond shape. MLNG CELESTE. but at birth." Over the forehead. it is usually difficult (if not impossible) to feel the anterior fontanel. RN. MD 159 . After the patient is nearly completely dilated. it is better to not attach it to the area of the fontanel. called the "anterior fontanel.

In cases of fetal scalp swelling or significant molding. the "posterior fontanel. they can identify the fetal head position as it is engaged in the birth canal. MLNG CELESTE." This junction of suture lines in a Y shape that is very different from the anterior fontanel. MD 160 . but in most cases. these landmarks may become obscured.Posterior Fontanel The occiput of the baby has a similar obstetric landmark. RN.




Left occiput anterior (LOA) MLNG CELESTE. RN. MD 164 .

MD 165 .Right occiput anterior (ROA) MLNG CELESTE. RN.

RN. MD 166 .Left occiput transverse (LOT) MLNG CELESTE.

MD 167 . RN.Right occiput transverse (ROT) MLNG CELESTE.

Occiput posterior (OP) MLNG CELESTE. RN. MD 168 .

MD 169 .Occiput Anterior (OA) MLNG CELESTE. RN.

MD 170 . RN.Left occiput posterior (LOP) MLNG CELESTE.

MD 171 .Right occiput posterior (ROP) MLNG CELESTE. RN.



MD 174 . a presenting part below zero station Engagement – when the presenting part is at station zero MLNG CELESTE. +1 to +5. RN.Station level of presenting part of fetus in relation to imaginary line between ischial spines (zero station) in midpelvis of mother   –5 to –1 indicates a presenting part above zero station (floating).



MD . RN. Celeste.Perinatal Care Mary Lourdes Nacel G.

sacral pressures. RN.Monitor vital signs and FHR Provide comfort measures (ambulate if tolerated and if BOW is not ruptured yet. side lying is usually most comfortable. back rubs) Breathing techniques MLNG CELESTE. MD 178 .

MD 179 .Slow-Paced Breathing Every woman beginning labor should be taught this simple technique for coping with labor. a pretty picture.. RN. Instruct the laboring woman to do the following: Assume a comfortable position. Try to maintain a relaxed state throughout the con-traction. Close her eyes or Concentrate on a focal point while doing the breathing (e. a button on some-one's shirt). adequate intake of oxygen. MLNG CELESTE. The use of a specific breathing pattern during labor contractions has two objectives: Helping the woman relax by distracting her from the intense contraction sensations.g. Rest and sleep between contractions is important. Begin the Breathing Technique This technique is done only during contractions. Ensuring a steady.

MD 180 . For some women. like a big sigh. 3. 1. Slow-Paced Breathing This technique can be used in early labor and for as long as the mother is comfortable with it. MLNG CELESTE. 2. Maintain a steady rate of approximately 6 to 9 breaths during a 60-second contraction (the cleansing breaths do not count). Take a cleansing breath as soon the contraction begins. This is simply a deep quick breath. Breathe slowly and deeply in through the nose and out through slightly pursed lips or the nose over the duration of the contraction. this may last throughout the entire first stage of labor. Inhalation is through the nose. exhalation is through slightly pursed lips. RN.Cleansing Breath Begin and end each breathing technique with a cleansing breath.

At beginning of contraction. 4th. MLNG CELESTE. Take deep breath at the end of contraction. take a fairly deep breath. MD 181 . If there is an urge to push. Then engage in shallow breathing. RN. puff out every 3rd. or 5th breath.During transition phase: Take a deep breath and exhale slowly and completely.

Ice chips. RN. MD 182 . Keep room cool. Change soiled and damp linen promptly. quiet and privacy. Provide mouth care. MLNG CELESTE. lubricate lips. uncluttered.Comfort Measures for the Laboring Woman Do not leave alone in active labor. Promote participation of coach.

RN. Celeste. MD .Insertion of Catheter Mary Lourdes Nacel G.

Catheterization INSERTION OF CATHETER / Catheterization involves the introduction of a catheter through the urethra into the urinary bladder MLNG CELESTE. MD 184 . RN.

To prevent urine from contacting an incision after perineal surgery 8. MD 185 . To provide for intermittent or continuous bladder drainage and irrigation 7. 2. To access the amount of residual urine if the bladder is to be emptied completely 3. To obtain a urine specimen to assess the presence of abnormal constituents and the characteristic of the urine 4. To relieve discomfort due to a bladder distention and to provide gradual decompression of a distended bladder. To empty the bladder completely prior to surgery to prevent inadvertent injury to adjacent organ such as to the rectum or the vagina 5.Catheterization Purposes: 1. To facilitate accurate measurement of urinary output for critically ill client whose output needs to be monitored hourly MLNG CELESTE. RN. To manage incontinence when all other measures have failed 6.

hence asepsis technique should be maintained and the catheter should be inserted gently. MD 186 . sepsis and trauma. When catheterization is ordered to relieve bladder distention. 2. RN.Catheterization Points to consider: 1. There are 2 hazards in the process. gradual decompression of the bladder should be done to prevent engorgement of the vessels as well as improve the muscle tone of the bladder by adjusting the intravesical pressure MLNG CELESTE. namely.


French 14. MLNG CELESTE. After catheter insertion. RN. Straight or Robinson catheter – a single lumen tube with a small eye or opening about ½ inch from the insertion tip 2. Catheters are sized by the diameter of the lumen and are graded on French scale numbers. The larger the number. the balloon is inflated to hold the catheter in place within the bladder. Small sizes such as French 8 – 10 are used in children. Retention or Foley catheter.contains a second smaller tube throughout its length on the inside.Catheterization Types of catheter: 1. This tube is connected to a balloon near the insertion tip. MD 188 . 16 and 18 are for adults. the larger the lumen size.

towel disposable gloves water soluble lubricant sterile gloves sterile drapes (optional) antiseptic solution cotton balls or gauze squares forceps basin for urine sterile catheter (straight) specimen container if required bag or receptacle for disposal of the cotton balls MLNG CELESTE. RN.Straight Catheter Equipment: lamp or flashlight mask. MD 189 . washcloth. if required by hospital blanket/ drape soap. basin of warm water.

MD 190 of microorganisms) . Use a new swab for each stroke. separate the labia majora with the thumb and finger and clean the labia minora on each side using forceps and cotton balls soaked in antiseptic. (Percuss and) Palpate the bladder to assess urinary retention. 7. Clean the meatus. Drape the client with sterile drapes (expose the perineum). 5. 9. 11. Adjust the light to view the urinary meatus. 10. 4. 8. RN. Explain the procedure to the client. Assist client to a supine position. 2. with knees flexed and thighs externally rotated. Move downward from the pubic area to the anus. Don disposable gloves. Pour antiseptic solution over the cotton balls if they are not already prepared. 6. Prevent unnecessary exposure. gown or cap if required by agency. Put on a mask. With the nondominant hand. (prevents transfer MLNG CELESTE. 3.Straight Catheter Procedure: 1. Lubricate insertion tip of the catheter and place it in a sterile container/ area ready for use. Drape the client.

Remove the catheter slowly. Keep the drainage end in the urine receptacle. 15. Pinch the catheter. MD 191 20. Dry the perineum with a towel or drape. do not allow the labia to close over it. Inspect the meatus for any swelling. Empty or partially drain the bladder and then remove the catheter. When the urine flows. excoriation. . 13. Collect specimen if required (usually 30 ml) by transferring the drainage end into a sterile bottle. 16. Document the catheterization. Clean from the meatus downward on either side. discharge. MLNG CELESTE. Limit amount of urine drained to 700-1000 ml. 18. transfer the hand from the labia to the catheter to hold it in place and prevent its expulsion by a possible bladder contraction. 17. Assess the urine. then work outward. RN. rapid removal of large amounts of urine is thought to induce engorgement of the pelvic blood vessels and hypovolemic shock. Insert the catheter gently with the uncontaminated gloved hand into the urinary meatus until urine flows. Once the meatus is cleaned.Straight Catheter 12. Expose the urinary meatus by retracting the tissue of the labia minora in an upward direction. 19. 14.

RN. 17. 18. 19. Inflate the balloon by injecting the contents of the prefilled syringe into the valve of the catheter. 16. 21. Suspend it off the floor but keep it below the level of the patient’s bladder. Tape the catheter to the inside of the female’s thigh. Secure drainage bag to the bedframe using its hook. Ensure effective balloon inflation applying slight tension on the catheter until you feel resistance (well anchored in the bladder). MD 192 . Document catheterization.5 – 5 cm (1-2 in) beyond the point at which the urine began to flow to ensure that the balloon near the insertion tip will be inflated inside the bladder and not the urethra.FOLEY/ INDWELLING/ Retention Catheter Additional Equipment: syringe prefilled with fluid (usually 15 ml) Follow steps as for straight catheterization up to #15. where it could produce trauma. MLNG CELESTE. Insert the catheter an additional 2. 20. Make sure the emptying base of the drainage bag is closed.

Use betadine or cleansing product to clean the urethral opening. vagina). MD 193 . Lubricate the catheter. If pain is felt which inflating the balloon.How to insert a catheter (women) 1. lubricant. 6. drainage receptacle. Slowly insert the catheter into the meatus. 2. 5. Make sure you do not touch the outside of the gloves with your hands. Wash your hands. Spread the labia and locate the meatus (opening which is located below the clitoris and above the vagina). Once the urine flow starts. and attach the drainage bag. Secure the catheter. RN. MLNG CELESTE. Begin to gently insert and advance the catheter. syringe with water to inflate the balloon. deflate the balloon. 4. Assemble all equipment: catheter. In women clean the labia and urethral meatus using downward strokes. Avoid the anal area. Hold the catheter in place while you inflate the balloon. cleaning supplies. Apply the sterile gloves. sterile gloves. 3. 7. and attempt to inflate the balloon again. 8. advance the catheter another 2 inches. Care must be taken to ensure the catheter is in the bladder. advance the catheter another 2 inches. 9. stop.










Celeste. MD .Procedure on Childbirth Mary Lourdes Nacel G. RN.

RN.Vaginal Delivery Mary Lourdes Nacel G. MD . Celeste.

RN. MD 205 .PROCEDURE ON CHILDBIRTH (Conduct of Normal Delivery) Purpose: To provide safe outcome for the mother and to deliver a healthy baby Equipment: Standard delivery room equipment Delivery table with stirrups Instrument table Anesthesia machine Resuscitator with heating machine for infant Sterile pack containing: Drapes Leggings Towels Gowns Sponges MLNG CELESTE.

1 for cutting the umbilical cord) 2 cord clamps/ kelly forceps 4 allis clamps (for episiotomy repair) 2 needle holders Suture needles 2 ring forceps (to aid in the delivery of the placenta and membranes) 1 vaginal retractor (to aid in inspection of the birth canal) MLNG CELESTE. RN.PROCEDURE ON CHILDBIRTH (Conduct of Normal Delivery) Sterile instruments 2 scissors ( 1 for episiotomy. MD 206 .

RN. MD 207 . (To maintain asepsis).PROCEDURE ON CHILDBIRTH (Conduct of Normal Delivery) Procedure: Nursing Action/ Rationale 1. Drape and cleanse perineal area. Observe strict aseptic technique in gowning and gloving. MLNG CELESTE. (To prevent introduction of microorganisms into the uterine cavity) 2.

Perineal Preparation MLNG CELESTE. MD 208 . RN.

(To prevent fecal contamination) 6. (Fundal pressure may cause uterine damage) 7. (Caused by the pressure of the fetal head on the pelvic nerves) 9. Avoid the use of fundal pressure to hasten delivery. Assess the necessity for episiotomy when the head crowns slightly. (This is a technique of using the abdominal muscles to assist in uterine expulsive efforts during contractions) 5. MD 209 lacerations caused by pressure of the fetal head) . if a tear seems inevitable. Wipe the perineum with sponges and antiseptic solution using a downward and backward motion. Catheterize patient PRN. (To prevent bladder trauma) 4. Avoid too rapid delivery. Instruct patient to push.PROCEDURE ON CHILDBIRTH (Conduct of Normal Delivery) 3. These may be relieved by changing the position of the legs. Assess for leg cramps which may occur when the head crowns. (To prevent perineal MLNG CELESTE. RN. (To preserve the flexion of the fetal head) 8. a midline or right or left mediolateral episiotomy may be performed.

Types of Episiotomy MLNG CELESTE. RN. MD 210 .

(To prevent injury to the mother and infant) 11. Loosen the cord and slip over the head. occlude the cord with 2 clamps and cut between them. This consists of covering the anus with sterile towel and exerting upward and downward pressure on the area beneath the fetal chin while maintaining pressure against the occiput with the other hand to control the emerging head and to effect delivery between contractions.PROCEDURE ON CHILDBIRTH (Conduct of Normal Delivery) 10. (To prevent interference with fetal oxygenation) MLNG CELESTE. If unable to loosen coils. Control the delivery by Ritgen’s maneuver. MD 211 . Feel and look for the cord around the back of the neonate as soon as the head is delivered. RN.


RN. MD 213 .Ritgen’s maneuver MLNG CELESTE.

Rotation of the head is indication that the shoulders have rotated externally) 14. Remove mucus and fluid from the neonate’s face and suction oropharynx. Clamp the cord at about 2. Do not hasten completion of the delivery.) MLNG CELESTE. 15.PROCEDURE ON CHILDBIRTH (Conduct of Normal Delivery) 12. (To prevent aspiration of the mucus when the newborn gasps during initial respiration) 13. MD 214 . (As soon as the head is delivered . RN. Lift the head for delivery of the posterior shoulder. Wait until the head rotates externally. Pull the head gently downward and backward until the anterior shoulder is behind and against the symphysis pubis. there is usually a lull in contractions. (Whether sustained benefit is obtained by waiting for cessation of pulsation before clamping the cord has not been established. Observe for continued uterine contractions and for the shoulder to lie directly anterposteriorly .5 cm (or depending upon the hospital policy) from the umbilicus.


RN.Normal Spontaneous Delivery MLNG CELESTE. MD 216 .

RN.Umbilical cord MLNG CELESTE. MD 217 .

Circulating nurse should administer oxytocin IM to the patient (To administer effective uterine contractions for the purpose of expelling the placenta and preventing uterine atony) 18. Observe for resumption of contraction and for indications that the placenta has separated from the uterine wall.16. RN. (There is sudden gush of blood. (To prevent heat loss and hypothermia) 17. If membranes begin to tear. Express the placenta by pushing downward on the fundus with moderate pressure and with slight tension on the cord. Place newborn in a heated crib . the uterus rises upward in the abdomen. (Excessive pressure on the relaxed uterus may cause inversion) MLNG CELESTE. MD 218 . grasp with clamp and tease out slowly. changes from discoid to a globular shape and the cord lengthens outside the vagina ) 19.

RN. To identify the gross changes that may have pathological significance) 21.20. Inspect the vaginal canal and cervix for lacerations or injury. Examine the placenta carefully. (a. MLNG CELESTE. MD 219 . Repair the episiotomy. (The examination is carried before the episiotomy repair. if bleeding should occur following repair. otherwise. b. inspection at that time would cause tension on recently placed sutures and could damage the episiotomy wound) 22. To make certain that none of the placental membranes have been retained in the uterus.

MD 220 .Placenta MLNG CELESTE. RN.

23. Remove soiled linen. and blanket. One of the mother’s first needs is to be reassured that her infant is normal) MLNG CELESTE. Estimate blood loss. (Chilling accompanied by shaking often occurs immediately following delivery. Help the mother to hold the infant and inspect it if she wishes. RN. (Observe the saturation sponges and towels as well as the amount of bleeding) 24. replace end of the delivery table and lower the patient’s legs from the stirrups simultaneously. (To prevent injury or muscle spasm) 25. Apply a sterile perineal pad. (Early contact with the infant assists in the motherinfant bonding process. warm gown. MD 221 .) 26.

MD . RN.Cesarean Childbirth Mary Lourdes Nacel G. Celeste.




MD 226 .Scheduled or Unscheduled C/S Scheduled Cesarean Birth . cephalopelvic disproportion) .If labor cannot be induced and birth is necessary Clients have some time to prepare for the cesarean birth MLNG CELESTE. hydrocephaly) .If it is to be a repeat cesarean birth (eg.If labor is contraindicated (eg. complete placenta previa. RN.

MD 227 . RN.- - Unscheduled/ Emergency Cesarean Birth Usually a result of some difficulty in the labor process/ failure to progress in labor Placenta previa Abruptio placenta Fetal distress MLNG CELESTE.

or breech presentation.When the reason for the initial cesarean is a nonrecurring situation such as placenta previa.Low transverse uterine incision: trial of labor is recommended . prolapsed cord. MD 228 .Classic uterine incision: trial of labor is CI MLNG CELESTE. the client may be able to have a vaginal birth with the next pregnancy .Vaginal Birth after Cesarean (VBAC) . RN.

Vaginal birth (which stretches and sometimes tears the perineal tissues) and episiotomy (which may minimize tissue injury) usually cause perineal edema and tenderness. MLNG CELESTE. RN.POSTPARTUM PERINEAL CARE I. promote healing and prevent infection. Postpartum perineal care aims to relieve discomfort. MD 229 .

RN. you’ll use a water-jet irrigation system or a peribottle to clean the perineum. Remove the nozzle. MLNG CELESTE. wash your hands and put on gloves. Instruct the patient to sit on the commode. place the nozzle parallel to the perineum and turn on the unit.Cleaning the perineum Typically. Next. MD 230 . Help the patient to stand up and assist her in applying a new perineal pad before returning to bed. insert the prefilled cartridge containing the antiseptic or medicated solution into the handle. fill it with cleaning solution and instruct the patient to pour it over the perineal area. If you’re using a peribottle. Turn off the unit. If you’re using a water jet irrigation system. Assist the patient to the bathroom. Discard the cartridge. Dry the nozzle and store it for later use. Rinse the perineum for at least 2 minutes from front to back. and push the diposable nozzle into the handle until you hear it click into place.

When inspecting the wound area. ensue adequate lighting. put on gloves. MLNG CELESTE. and place the patient in the lateral Sims’s position. MD 231 . redness and foul-smelling discharge. RN.Assessing healing progress To inspect the perineum. be alert for such signs of infection as unusual swelling.

MD 232 . RN.cleansing the vulva and perineal area Purposes: 1. To clean the perineum in the following after a bowel or bladder elimination prior to any vaginal examination or treatment 2. To provide for personal cleanliness and comfort MLNG CELESTE. 3. To prevent vaginal or perineal wound infection and unpleasant odor.PERINEAL CARE Perineal Care.

If the patient defecated.PERINEAL CARE Special considerations: Avoid burning the patient by using the right temperature of the flushing water Observe special care in order to avoid discomfort when a patient has a perineal wound or stitches. MLNG CELESTE. MD 233 . RN. Avoid unnecessary exposure. empty the bedpan first before giving perineal flushing.

RN. MD 234 .PERINEAL CARE Equipment: Bedpan with cover Screen Flushing tray with the following: jar with dry cotton balls jar with cotton soaked with cleansing solution flushing pitcher with warm water pick up forceps in antiseptic solution emesis basin for soiled cotton balls bed protector ordered medicine or perineal pad (if necessary) drape MLNG CELESTE.

Wash your hands. MLNG CELESTE. Explain procedure. Set up screen to cover the patient. Position the patient in a back lying position with the knees flexed or (dorsal recumbent position). Flush the perineal area with warm water.PERINEAL CARE Procedure: Assemble all your equipment. Drape exposing only the part to be cleansed. MD 235 . Place rubber protector and bedpan. RN.

Get another cotton ball. RN. Dry using the same stroke as above. Clean groin. MD 236 . Discard used cotton balls into the emesis basin. MLNG CELESTE.PERINEAL CARE Using pick up forceps. (To prevent spread of contamination). Apply medication as ordered or perineal pad as necessary. Do likewise in the opposite side. get cotton balls soaked with cleansing solution and clean from the midline of symphysis pubis down to anus. Never retrace stroke. Flush thoroughly with sterile water. Clean starting from mons veneris by way of external labium towards anus.

MD . Celeste.Sitz Bath Mary Lourdes Nacel G. RN.

depending on the client’s health. Special tubs or chairs are preferred because when the legs are also immersed. or a hip bath. The temperature of the water should be from 40 to 43 C (105 to 110 F). is used to soak a client’s pelvic area. RN. as in a regular bathtub. Some sitz tubs have temperature indicators attached to the water taps.SITZ BATH (Kozier) A sitz bath. MD 238 minutes. unless the client is unable to tolerate the heat. The duration of the bath is generally 15-20 MLNG CELESTE. Disposable sitz baths are also available. Determine hospital protocol. The client sits in a special tub or chair and is usually immersed from the midthighs to the iliac crests or umbilicus. . blood circulation to the perineum or pelvic area is decreased.

Following the sitz bath. assist the client out of the tub. dizziness. weakness. 239 . Help the client to dry. Maintain the water temperature. Provide support for the client’s feet. a footstool can prevent pressure on the backs of the thighs. Observe the client closely during the bath for signs of faintness. and provide support for comfort.SITZ BATH To provide a sitz bath. accelerated pulse rate and pallor. MD MLNG CELESTE. RN. the nurse carries out the following steps: Assist the client into the tub. Provide a bath blanket for the client’s shoulders and eliminate drafts to prevent chilling.

and into the basin. RN. through the tubing.SITZ BATH (Pilliteri) Purpose: To aid healing of the perineum through application of moist heat Procedure: 1. Wash your hands. MLNG CELESTE. Principle: using correct temperature of water eliminates risk of thermal injury. MD 240 . clean towel. Assemble equipment. 2. assist and modify as necessary. 3. ascertain whether client is able to ambulate to bathroom. identify client and explain procedure. thereby reducing inflammation and aiding healing. Hang the bag overhead so a steady stream of water will flow from the bag. Adequate flow of warm water increases circulation to the perineum. Fill collecting bag with warm water at a temperature of 100 F to 105 F (38 C to 41 C). Place sitz bath on toilet seat. Assess client’s condition. including sitz bath. 4. perineal pad.

6. assist client with drying perineum and applying clean pad (holding pad by the bottom side or ends). help with removal of perineal pad from front to back. MD 241 . RN. Record completion of procedure. MLNG CELESTE. use robe or blankets to prevent chilling and provide for privacy. 7. Assist client with ambulating back to room 9. Institute health teaching. Evaluate client’s tolerance and response to procedure.SITZ BATH 5. Have call bell within reach. After 20 minutes. Assist client while ambulating to bathroom. After 20 minutes. 10. heat is no longer therapeutic because vasoconstriction occurs. condition of perineum and client’s condition and response. ask client to report how she feels. Assist client to seat in basin. such as continuing sitz baths when at home. Instruct client to use clamp on tubing to regulate water flow. 8.

MD . Celeste.Perilight Administration Mary Lourdes Nacel G. RN.

RN. to provide perineal heat for the comfort of the patient b. to aid in the healing of the episiotomy or laceration keeping the suture dry Nursing objectives: Avoid burning the patient by prolonged exposure or too-close proximity to light. Facilitate healing by optimal use of light and heat.PERILIGHT ADMINISTRATION the application of warmth to the perineal area by means of lamp Rationale: a. MLNG CELESTE. Prevent cross contamination by thorough cleaning of lights between patients’ use. MD 243 .

MD 244 .PERILIGHT ADMINISTRATION Equipment: Perineal light Padding for stirrups Screen Sterile perineal pad Bag for disposal of used perineal pad Prescribed medication MLNG CELESTE. RN.

Plastic and rubber absorb and conduct heat. RN. a clean washcloth should be placed between it and the thigh. Position the patient flat on her back in bed.PERILIGHT ADMINISTRATION Procedure: Explain the procedure to patient. (Importance of the procedure: It will make her comfortable and promote healing of the episiotomy). MLNG CELESTE. If the bed has stirrups. to protect the patient from being burned by the heated tubing. If a foley catheter is in place. Screen the patient. MD 245 . they should be padded for comfort. A distended bladder may cause discomfort during the procedure. The patient should empty her bladder prior to the procedure.

bleeding or any other problems. The perineal area must be checked frequently during the procedure for redness which would indicate that the light was too hot or the time span was too long. MLNG CELESTE.PERILIGHT ADMINISTRATION Position the perineal light far enough from the perineum to avoid burning the tender skin. RN. The lamp should not be left on for more than 20 minutes. A bulb over 60 watts must be used. Observe patient’s reactions. Suture should be observed for proper healing and signs of infection. approximately 12 inches is considered safe. Wash the perineal light in a utility room with a germicide. MD 246 . Expose the perineum to perineal light several times a day.

Celeste. MD . RN.Breast Care Mary Lourdes Nacel G.

minimize breast stimulation Nursing woman – successful lactation is dependent on infant sucking and maternal production and delivery of milk (letdown/milk ejection reflex). monitor and teach preventive measures for potential problems MLNG CELESTE. breasts are larger.Breasts – progress from soft filling with potential for engorgement (vascular congestion related to increased blood and lymph supply. firmer. RN. MD 248 . ice packs. and painful) Non-nursing woman – suppress lactation Mechanical methods – tight-fitting brassiere.

expose to air Position nipple so that infant’s mouth covers a large portion of the areola and release infant’s mouth from nipple by inserting finger to break suction Rotate breastfeeding positions MLNG CELESTE. and dry thoroughly. MD 249 . RN.Nipple – irritation/cracking Nipple care – clean with water. no soap. absorbent breast pads if leaking occurs.

MD 250 .Engorgement nurse frequently (every ½-3 h) and long enough to empty breasts completely (evidenced by sucking without swallowing) warm shower or compresses to stimulate letdown alternate starting breast at each feeding mild analgesic 20 min before feeding and ice packs between feedings for pronounced discomfort MLNG CELESTE. RN.

check with physician before taking any medication MLNG CELESTE. may be relieved by heat and massage prior to feeding Medications – most drugs cross into breastmilk. MD 251 .Plugged ducts – area of tenderness and lumpiness often associated with engorgement. RN.

Expression of breast milk to collect milk for supplemental feedings to relieve breast fullness or to build milk supply may be manually expressed or pumped by a device and refrigerated for no more than 48 h or frozen in plastic bottles (to maintain stability of all elements) in refrigerator freezer for 2 wk and deep freezer for 2 months (do not thaw in microwave or on stove) MLNG CELESTE. RN. MD 252 .

and by wearing Five minutes on each breast is loose clothing sufficient at first – teach Redness or swelling can proper way to break suction indicate infection and should Most of the areola should be always be investigated infant’s mouth to ensure proper sucking MLNG CELESTE. MD 253 .LACTATION PRINCIPLES Breast Care – Antepartum Initiating Breast Feeding and Postpartum Soap on nipples should be Relaxed position of mother is avoided during bathing to essential – support prevent dryness dependent arm with pillow Nipples can be “prepared” Both breasts should be offered antepartum by exposure to at each feeding sun. RN. air.

RN. MD 254 .BREASTFEEDING Non-allergenic Meet infant ‘s specific nutritional needs Immunologic properties help prevent infection Easily digested Constipation unlikely Overfeeding less likely No formula or bottles to buy No formula and bottle to prepare Oxytocin release help involution Mother more likely to eat well balance diet May help with mother’s weight loss Enhances mother/infant attachment through skin to skin contact Frozen -20c (6 mos) Refrigerated 4c ( 24 H) BOTTLEFEEDING Father or others may feed infant day or night Feed less frequently (34H) Amount of milk taken at each feeding known A D V A N T A G E S MLNG CELESTE.

RN.BREASTFEEDING Feed more frequently (2-3 H) More frequent diaper changes Amount of milk taken at each feeding unknown Medications taken by mother present in milk Discomfort of som mothers to nurse in public Expense of pumping and storing milk for periods when mother is unavailable ( such as work) BOTTLEFEEDING Expense of formula. bottles Washing bottles Fixing and refrigerating formula Carrying bottles on outings May cause constipation D I S A D V A N T A G E S MLNG CELESTE. MD 255 .

RN. MD 256 .Breastfeeding Cradling Position for feeding  The infant should be held with head slightly higher than the rest of the body  Cradle hold with infant’s head in the bend of the mother’s elbow and arm supporting the infant’s body  OTHERS:  Football hold  Side lying position  Across lap MLNG CELESTE.

RN. MLNG CELESTE.  When the mouth is wide open and the tongue is down. MD 257 .Breastfeeding Cradling Latching on  The mother should use the infant's rooting reflex to allow positioning of the nipple in the infant’s mouth  Brushing the nipple against the infant’s lower lip will cause the infant to open the mouth. the mother quickly brings the infant closer to the breast so the infant can latch on the nipple and areola.


MD 259 .BREAST CARE Rationale: Maintain proper support and cleanliness Prevent trauma and infection Materials: Mild soap and water Clean wash cloth and towel MLNG CELESTE. RN.

MD 260 . Change them when they become soiled. Tender. using circular motion from the nipple out. MLNG CELESTE. RN. Postpartum. Use nursing pads if nipples leak.The client should always wash wash her hands thoroughly before handling the breasts. The breasts are washed with warm water and soap on a washcloth. painful cracked nipples should be exposed to air. the woman should wear well-fitting brassiere . but gently. Medications may be taken as ordered. The breasts should be dried well.

Celeste. MD .Inverted Nipples Mary Lourdes Nacel G. RN.

To determine whether you have flat or inverted nipples: Place your thumb and forefinger on the edges of the areola (dark area around the nipple) just behind the nipple. A breast-feeding baby latches on more easily to a nipple when it is erect. However. If the nipple is flat or inverted. MD 262 . Special techniques and breast shells sometimes are recommended to prepare inverted nipples for breastfeeding. Inverted nipples may naturally become more erect after the birth of your baby. it will flatten or retract into the breast instead of pointing out.INVERTED NIPPLEs Inverted nipples fold inward instead of pointing out. RN. their effectiveness is questionable. MLNG CELESTE. Squeeze the tissue gently. Women with inverted nipples may have a hard time getting started with breastfeeding.

A less effective breastfeeder may need some time to figure out how he/she can draw the nipple into the mouth with latch-on. try the interventions mentioned for flat nipples. If nipples invert. MD 263 . Most women can produce enough milk in one breast to exclusively breastfeed their babies. RN. If one breast is less affected. with stimulation. a mother has one or more severely inverted nipples. Nipple eversion devices are available. your baby can breastfeed on only one breast. or "dent" inward. Using a breast pump to draw the nipple out just prior to breastfeeding may also help. some mothers find it helps to wear them in the bra between feedings. Although the benefit of using hard plastic breast shells is not conclusive. Breast shells exert a small amount of traction to help draw the nipple outward.INVERTED NIPPLEs Techniques for flat or inverted nipples: An effective breastfeeding baby usually has little trouble breastfeeding even if his/her mother's nipples appear to be flatter. Occasionally. MLNG CELESTE.

with the tongue protruding over the lower gum. MLNG CELESTE. RN. The nipple should be straight back in the mouth. Bring the infant to the breast. chin and umbilicus. MD 264 .Proper breast-feeding technique The infant should be lined up: mouth. The tip of the infant's nose and chin should touch the breast with equal pressure. The gum line should overlap the areola as much as possible. The head is neutral. the mouth wide . with the tip nestled into the infant's soft palate. The infant's lips are flanged.

.Proper breast-feeding technique.

RN.Early Breast-Feeding Attempts New mothers should initiate breast-feeding as soon as possible after giving birth. MD 266 .Babies who are put to breast earlier have been shown to have higher core temperatures and less temperature instability. MLNG CELESTE. and the baby is more alert. When mothers initiate breast-feeding within one-half hour of birth.Early breast-feeding is associated with fewer nighttime feeding problems and better mother-infant communication. the baby's suckling reflex is strongest.

glucose water and formula supplementation have been shown to promote early weaning and nipple confusion. this was demonstrated with ultrasonography over a decade ago.The frequent use of an artificial nipple early in life has been shown to promote a less effective mouth movement. Early and subsequent use of pacifiers. before considering the use of supplementation. RN. MLNG CELESTE. with direct observation of breast-feeding. the physician should encourage the staff and the patient to address breast-feeding problems first. MD 267 . water.32 For this reason.Nipple Confusion Nipple confusion occurs when a baby has not had the opportunity to establish the correct mouth movements for proper breast-feeding.

such as the rooting reflex. RN. Breast-Feeding on Demand and Rooming-In Rooming-in and breast-feeding on demand should be an integral part of routine postpartum care. Breast-feeding "on demand" means feeding when the baby shows early signs of hunger. MLNG CELESTE. Breastfeeding on demand promotes more frequent feeding. Rooming-in allows mothers to respond to feeding cues much more effectively than a busy nurse could. which prevents sore nipples. breast engorgement and early weaning. MD 268 . or when the baby is awake and his or her hands are coming to the mouth.A woman with normal breasts produces sufficient colostrum during the last trimester and at delivery to sustain twins or a large term baby until her milk comes in.

formula may need to be added to breast milk. the mother can pump her breast milk and it can be stored for gavage or nipple feedings. something commercial formulas do not have. and phosphorus. Formula is digested more slowly than breast milk and may not be as well tolerated. RN. Although commercial milk formulas are designed to be close to breast milk. In addition.The benefits of breast milk: A mother’s breast milk is the preferred milk for all babies. Breast milk contains all the nutrients needed for growth and development. breast milk contains antibodies from the mother to help protect babies from infection. most are based on cow's milk. Very premature babies may need human milk fortifiers added to breast milk to meet their increased needs for protein. Even if baby cannot breastfeed. Depending on the amount of milk needed for feedings. even the most premature babies. MLNG CELESTE. This protection is especially important when babies are sick or premature and may have higher chances of developing an infection. MD 269 . calcium. The fats in breast milk are more easily digested.

RN. MD 270 .Benefits of Breast-Feeding Promotes mother-infant bonding Promotes uterine involution Economical for family and society Convenient Better cognitive development in children Lower incidence of premenopausal breast cancer Lower incidence of premenopausal ovarian cancer Lower incidence of maternal osteoporosisPerceived Barriers to Breast-Feeding Loss of freedom Embarrassment Jealousy (paternal and sibling) Difficulty returning to work or school Physical discomfort Weaning Lack of confidence (afraid that baby is starving) Perception that formula is equal to breast milk MLNG CELESTE.

using expressed breast milk. Infant should regain birth weight by two weeks of age.Hospital Discharge Breastfeeding Instructions Feed the infant on demand--on "hunger four-day follow-up visit. RN. two on day 2. Make use of lactation support telephone numbers. Expect weight loss of <8 percent at the two. Count wet diapers: one on day 1. Avoid nipple confusion by adopting this policy: three to four weeks of exclusive breastfeeding. MD 271 .“ Listen and feel for infant's swallowing. three on day 3. Report any signs and symptoms of dehydration and jaundice. six per day from day 6 on. with three or more stools per day. MLNG CELESTE. then no more than one bottle a day.

After this time. Mothers should be encouraged to use only breast milk. MLNG CELESTE. RN. Bottle-feeding should be delayed for three to four weeks to prevent nipple confusion and early weaning. the baby should also be at the breast so that nipple stimulation occurs and nipple confusion is prevented. nipple confusion and premature weaning seem to be less of a problem if bottles are limited to about one per day. The clinician should routinely discuss bottle use and the issue of nipple confusion before discharge. If supplementation is necessary. not formula. when using bottles.Breast-Milk Expression Expressing breast milk is a skill that should be taught to all new mothers. MD 272 .

Chest Thrusts for A Pregnant Woman Mary Lourdes Nacel G. RN. MD . Celeste.

therefore. attempting to dislodge the object with a sudden upward thrust to the upper abdomen ( a Heimlich maneuver) is difficult. Late in pregnancy. MD 274 . therefore a rescuer might use successive chest thrusts instead. MLNG CELESTE. This is because of a lack of space between the uterus and the end of the sternum and because a person cannot reach from the rear around the woman’s enlarged abdomen. RN.CHOKING If a pregnant woman chokes on a piece of meat or any foreign object blocks the airway.

MLNG CELESTE.CHEST THRUSTS FOR PREGNANT WOMAN OR OBESE PERSON CONSCIOUS 1. give CPR. 4. 2. Put your other hand over the fist and give quick inward thrusts. 5. Continue giving thrusts until the object is dislodged. If the person is not breathing and does not have a pulse. Make a fist with one hand and put the thumb side of the fist against the center of the person's breastbone. perform rescue breathing. RN. use the method for unconscious people. ONCE THE OBJECT IS DISLODGED If the person is not breathing and has a pulse. If the person becomes unconscious while you’re doing this. Make sure your thumb is on the breastbone–not the ribs–and that you are not near the tip of the breastbone. 3. Stand behind the person. placing your arms under the person's armpits and around his or her chest. MD 275 .

placing one hand on the center of the person's breastbone and then placing your other hand on top of it. finger sweeps and 2 slow breaths until the object is expelled and air goes in.UNCONSCIOUS 1. open the airway with a head tilt and a chin lift and give 2 slow breaths. compressing the chest 1 1/2 to 2 inches. Give 5 quick thrusts. 3. MLNG CELESTE. Kneel beside the person. MD 276 . If air still will not go in. Do a finger sweep (see above). continue giving chest thrusts. 2. RN.



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