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College of Midwifery
Related Learning Activities

NORMAL SPONTANEOUS
DELIVERY WITH NEWBORN CARE

Presented By: Midwifery Batch 2020

Besmonte, Mary Ann Pauline T.
Duata, Mayvelyn M.
Garcia, Jhuanne Christine S.
Santos, Flordeliza C.

Presented To:

Dean Mary Ann D. Valenzuela, RN., MAN

College of Nursing

Editha M. Vicente, RN
Clinical Coordinator

Mrs. Melinda Macasinag, RM., RN

Clinical Instructor
 Table of Content
I. Title Page ………………………………………………………………………………1
II. Table of Content ……………………………………………………………………….2
III. Acknowledgement ……………………………………………………………………..3
IV. Theoretical Framework ………………………………………………………………...4
V. Anatomy & Physiology……………………………………………………………….5-6
VI. Learning Objective
VII. General Data of the Patient
A. Biographic Data
B. Chief Complain
C. History of Present Illness
D. Past Health History
E. Family Health History
F. Lifestyle
 Personal Habit
 Diet
 Sleep & Rest Pattern
 Recreation & Hobbies
 Activities of Daily Living
G. Social Data
 Family Relationship
 Ethic Affiliation
 Educational History
H. Obstetrical History
 Admitting Diagnosis
 Final Diagnosis
 PMP
 Last Menstrual Period
 Exact Delivery Date
 Age of Gestation
 Fetal Heart Tone
 Fundic Height
 Regularity/Regular Flow (Days Cycle)
 Amount
 Coitarch
 Number of Sexual Partner
I. Prenatal Care
 Pregnancy Test
 Quickening
 1st Trimester
 2nd Trimester
 Ultrasound
VIII. Review of System
IX. Drug Study
X. Midwife Care Plan
XI. Discharge Planning
 ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE SYSTEM

The female reproductive system contains two main parts; which hosts the developing fetus, produces
vaginal and uterine secretion and can pass sperm to the fallopian tube; and the ovaries which produces
the female’s egg cells. These parts are internal; the vagina meets the external organs at the vulva, which
includes the labia, clitoris and urinary meatus. The vagina is attached to the uterus through the cervix,
while the uterus attached to the ovaries via the fallopian tube into the uterus. If, in this transit, it
equivalent among males is the male reproductive system.

EXTERNAL GENETALIA

Mons Pubis

The rounded mass of fatty tissue lying over the joint of the pubic bones, in women typically more
prominent and also called the mons Veneris.

Labia Minora

The smaller inner folds of the vulva. Just posterior to mons veneris spread two hairless folds of
connective tissue, the labia minora. Normally the folds of labia minora.

Labia Majora

The larger outer folds of the vulva. Labia majora are two folds of adipose tissue covered by loose
connective tissue and epithelium; they are positioned lateral to labia minora.

Hymen

Thin membrane found at the entrance to vaginal orifice. Often, this membrane is perforated before the
onset of menstruation, allowing flow of menses. The hymen varies greatly in shape.

Clitoris

The clitoris is the human female’s most sensitive erogenous zone and generally the primary anatomical
source of human female sexual pleasure.

Bulb of Vestibule

The vestibular bulbs are homologous to the bulb of penis and adjoining part of the corpus spongiosum
of the male, and consist of two elongated masses of erectile tissue, placed one on either side of the
vaginal orifice and united to each other in front by a narrow median band termed the pars intermedia.

Vulva Vestibule

The vulva vestibule (or vulva vestibule) is a part of the vulva between the labia minora into which the
urinary meatus (urethral opening) and the vaginal opening. Its edge is marked by Hart’s line. It
represents lower end of urogenital sinus from stage of embryo.
Urinary Meatus

The urinary meatus, also known as the external urethral orifice, is the opening or meatus of the urethra.
It is the point where urine exits the urethra in males and in females, and also where semen exits the
urethra in males.

INTERNAL GENITAL

Vagina

The vagina is a fibromuscular (made up of fibrous and muscular tissue) canal leading from the outside
of the body to the cervix of the uterus or womb. It is also referred to as the birth canal in the context of
pregnancy. The vagina accommodates the male penis during sexual intercourse. Semen containing
spermatozoa is ejaculated from the male at orgasm, into the vagina potentially enabling fertilization of
egg cell (ovum) to take place.

Cervix

The cervix is the neck of the uterus, the lower, the narrow portion where it joins with the upper part of
the vagina. It is cylindrical or conical shape and protrudes through the upper anterior vaginal wall.
Approximately half its length is visible, the remainder lies above the vagina beyond view. The vagina
has a thick layer outside and it is the opening where the fetus emerges during delivery.

Uterus

The uterus or womb is major female reproductive organ. The uterus provides mechanical portion,
nutritional support, and waste removal for the developing embryo (weeks 1 to 8) and fetus (from week
9 until the delivery). In addition, contractions in the muscular wall of the uterus are important in pushing
out the fetus at the time birth. The uterus contains three suspensory ligaments that help stabilize the
cardinal ligaments also prevent the inferior movement of the uterus. The uterus is a pear-shaped
muscular organ. Its major function is to accept a fertilized ovum which becomes implanted into the
endometrium and derives nourishment from blood vessels which becomes implanted into the
endometrium and derives nourishment from blood vessels which develop exclusively for this purpose.
The fertilized ovum become an embryo, develops into a fetus a gestates until childbirth. If the egg does
not embed in the wall of the uterus, a female begins menstruation.

Fallopian Tube

The Fallopian tube are two tubes leading from the ovaries into the uterus. On maturity of an ovum, the
follicle and the ovary’s wall rupture, allowing the ovum to escape and enter the Fallopian tube. There
it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This
trip takes hours or days. If the ovum is fertilized while in the fallopian tube, then it normally implants
the endometrium when it reaches the uterus, which signals the beginning of pregnancy.

Ovaries

The ovaries are small, paired organs located near the lateral walls of the pelvic cavity. These organs are
responsible for the production of the egg cells (ova) and the secretion of hormones. These organs are
responsible for the production of the egg (ovum) is released is called ovulation. The speed of ovulation
is periodic and impacts directly to the length of menstrual cycle. After ovulation, the egg cell is captured
by the Fallopian tube, after traveling down the fallopian tube to the uterus, occasionally being fertilized
on its way by an incoming sperm. During fertilization the egg cell plays a role; it releases certain
molecules that are essential to guiding the sperm and allows the surface of the egg to attach to the
sperm’s surface. The egg can then absorb the sperm and fertilization can then begin. The Fallopian
tubes are lined with small hairs (cilia) to help egg cell travel.

MENSTRUAL CYCLE

The menstrual cycle is the regular natural change that occurs in the uterus and ovaries that make
pregnancy possible. The cycle is required for the production of oocytes, and for the preparation of the
uterus for pregnancy. Up to 80% of women report having some symptoms during the one to two weeks
prior to menstruation. Common symptoms include acne, tender breasts, bloating, feeling tired, irritably,
and mood changes. These symptoms interfere with normal life and therefore quality as premenstrual
syndrome in 20 to 30% of women. In 3 to 8% they are severe.

The first period that usually begins between twelve and fifteen years of age, a point in time known as
MENARCHE. They may occasionally start as early as eight, and this onset may still be normal. The
average age of the first period is generally later in the developing world and earlier in the developed
world. The typical length of time between the first day of one period and the first day of the next is 21
to 35 days in women. Menstruation stops occurring after menopause which usually occurs between 45
to 55 years of age. Bleeding usually lasts around 2 to 7 days.

FERTILIZATION

Fertilization (also referred to as conception, impregnation, or fecundation) is the union of an ovum and
a spermatozoon. This usually occurs in the outer third of fallopian tube, the ampullar portion & fritz,
2005).

Usually only one ovum reaches maturity each month. Once it is released, fertilization must occur fairly
quickly because an ovum is capable of fertilization for only 24 hours (48 hours at the most). After that
time, it atrophies and becomes nonfunctional. Because the functional life of a spermatozoon is about 48
hours, possibly as long as 72 hours (48 hours before ovulation plus 24 hours afterward).

As the ovum is extruded from the graafian follicle of an ovary with ovulation, it is surrounded by a ring
of mucopolysaccharide fluid (the zonapellucida) and a circle of cells (the corona radiata). The ovum
and these surrounding cells (which increase the bulk of the ovum and serve as protective buffers against
injury) are propelled into a nearby fallopian tube by the currents initiated by the fimbrae – the fine,
hairlike structures that the line the openings of the fallopian tubes. A combination of peristaltic action
of the tube and movements of the tube cilia help propel the ovum along the length of the tube.

Normally, an ejaculation of semen averages 2.5ml of fluid containing 50 to 200 million spermatozoa
per millimiter, or an average of 400 million sperm per ejaculation. At the time of ovulation, there is a
reduction in the viscosity (thickness) of the cervical mucus, which makes it easier per spermatozoa to
penetrate it. Sperm transport is so efficient close to ovulation that spermatozoa deposited in the vagina
during intercourse generally reach the cervix within 80 seconds and the outer end of a fallopian tube
within 5 minutes after deposition. This is one reason why douching is not an effective contraceptive
measure.

Spermatozoa moves by means of their flagella (tails) and uterine contractions through the cervix and
the body of the uterus and into the fallopian tubes, toward the waiting ovum. All the spermatozoa that
achieve capacitation reach the ovum and cluster around the protective layer of the corona cells.
Hyaluroniclase (a proteolytic enzyme) is apparently released by the spermatozoa and acts to dissolve
the layer of cells protecting the ovum.

Immediately after penetration of the ovum, the chromosomal material of the ovum and spermatozoon
fuse. The resulting structure is called a zygote because the spermatozoon and ovum each carried 23
chromosomes (22 autosomes and 1 sex chromosomes) the fertilized ovum has 46 chromosomes. If an
X-carrying spermatozoon entered the ovum, the resulting child will have two X chromosomes and will
be female (XX). If a Y-carrying spermatozoon fertilized the ovum, the resulting child will have an X
and Y chromosome and will be male (XY).

Fertilization is never a certain occurrence, because it depends on an atleast three separate factors: equal
maturation of both sperm and ovum, the ability of the sperm to reach to ovum, and the ability of the
sperm to penetrate the zonapellucida and cell membrane and achieve fertilization.

From the fertilize ovum (zygote), the future child and also the accessory structures needed for the
support during intrauterine life (e.g., placenta, fetal membranes, amniotic fluid, umbilical cord) are all
formed.

IMPLANTATION

Once the fertilized is complete, the zygote migrates over the next 3 to 4 days toward the body of the
uterus, aided by the currents initiated by the muscular contractions of the fallopian tubes. During this
time, mitotic cell division, or cleavage, begins. The first cleavage occurs at about 24 hours; cleavage
divisions continue