FORMULA2

FAMILY CENTERED MATERNITY CARE STUDY
WRITTEN ON A CLIENT
DURING ANTENATAL, LABOUR AND PUERPERIUM
BY
NGUMAH CHARLOTTE
POSNAC32019049
A FINAL YEAR MIDWIFERY STUDENT OF
COLLEGE OF NURSING AND MIDWIFERY SCHOOL, NALERIGU
SUBMITTED TO NURSING AND MIDWIFERY COUNCIL OF
GHANA IN PATIAL FULFILMENT OF THE REQUIREMENT FOR
THE AWARD OF LICENSE TO PRACTICE AS A REGISTERD MIDWIFE
AFRIKIIDS MEDICAL CENTRE,

BOLGATANGA
UPPER EAST REGION
NOVEMBER 2020
PREFACE
Family centered maternity care study is a systematic approach in which comprehensive
nursing care is given to pregnant woman including her family as a whole throughout
pregnancy, labour and puerperium. It is concern with taking care of the special needs of a
pregnant woman and the family. It also deals with the understanding that an expectant
woman is a unique individual with problems and needs.
Pregnancy even though, physiological comes with a lot of changes and the ability foreach
individual to be able to adapt and manage these changes. During this period the student
midwife pays attention to the physiological and spiritual needs of the client and her
family members. The student also helps the client and the family in preparation towards
accepting the newborn baby and also to help solve problems in order to avoid possible
complications which may develop during pregnancy.
The care rendered gives the student midwife the opportunity to use all the knowledge and
skills acquired during the period of training to offer quality care to the client and her
family throughout pregnancy, labour, and puerperium.
In the process of writing this script the student midwife has to gather and analyze the
data, identify problems, plan and implement care which will meet the needs and problems
identified.
The family centered maternity care study is also part of the requirements of the Nursing
and Midwifery Council of Ghana in awarding post basic certificate to students at the end
of their two years training.
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ACKNOWLEDGEMENT
This script was developed through the commendable effort of many people and the
almighty God. My sincere gratitude goes to The Almighty God for the good health,
wisdom and the life given to me throughout the period of my study.
My gratitude also goes to the the Principal of the college, Mr. Valentine Ayamga and the
entire Tutorial Staff of Nursing and Midwifery Training College, Nalerigu, especially and
Madam Esther Arhin and Madam Kwesibia Offie my supervisor who spent their time
providing guidance and correction of the care study.
My special acknowledgement goes to the client Madam A. R. and the entire family for
their cooperation and assistance throughout the care study.
My appreciation is extended to the Afrikids Medical Centre for their guidance and
support especially the Maternity Ward Staff during my period of writing this care study.
My sincere thanks also goes to my Mother, Madam Agnes Nayina Mahama who took
care of my son during my course, my dearest husband, Atubiga A Gervais and my senior
sister Ngumah Felicity for their prayers, kind gestures, and benevolence towards me
during this write up.
I wish to acknowledge the authors of the books I used as references in the compilation of
my script and all friends and loved ones who have been my pillar throughout the study.
I say thank you and God bless you all.
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LITERATURE REVIEW.................................................................................................viii
WHY I CHOSE MY CLIENT............................................................................................xi
CHAPTER ONE..................................................................................................................1
PERSONAL AND SOCIAL HISTORY......................................................................1
HABITS OF DAILY LIVING......................................................................................1
HOME ENVIRONMENT...........................................................................................10
FAMILY HISTORY......................................................................................................2
MEDICAL HISTORY...................................................................................................2
SURGICAL HISTORY.................................................................................................3
MENSTRUAL HISTORY.............................................................................................3
PAST OBSTETRIC HISTORY....................................................................................3
PRESENT OBSTETRIC HISTORY...........................................................................5
CHAPTER TWO.................................................................................................................7
ANTENATAL CARE....................................................................................................7
FIRST CONTACT WITH CLIENT............................................................................7
FIRST HOME VISIT..................................................................................................10
SECOND ANTENATAL VISIT.................................................................................11
SECOND HOME VISIT.............................................................................................13
SUBSEQUENT VISIT TO THE CLINIC.................................................................14
NURSING CARE PLAN DURING ANTENATAL CARE.....................................15
PROBLEMS IDENTIFIED........................................................................................15
NURSING DIAGNOSES.............................................................................................16
LONG TERM OBJECTIVES.....................................................................................16
TABLE ONE: NURSING CARE PLAN DURING ANTENATAL........................17
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CHAPTER THREE...........................................................................................................22
LABOUR.......................................................................................................................22
ADMISSION AND MANAGEMENT OF FIRST STAGE OF LABOUR.............22
MANAGEMENT OF SECOND STAGE OF LABOUR..........................................29
IMMEDIATE CARE OF THE NEWBORN.............................................................31
MANAGEMENT OF THE THIRD STAGE OF LABOUR....................................32
EXAMINATION OF THE PLACENTA...................................................................33
MANAGEMENT OF FOURTH STAGE OF LABOUR..........................................34
SUBSEQUENT CARE OF THE BABY/EXAMINATION OF THE NEWBORN

........................................................................................................................................35
SUMMARY OF LABOUR NOTES...........................................................................36
PROBLEMS IDENTIFIED DURING LABOUR AND DELIVERY.....................38
SHORT TERM OBJECTIVES..................................................................................39
TABLE TWO: NURSING CARE PLAN DURING LABOUR...............................40
CHAPTER FOUR.............................................................................................................45
MANAGEMENT OF PUERPERIUM..............................................................................45
DAY OF DELIVERY..................................................................................................45
FIRST DAY POSTNATAL AND PREPARATION FOR DISCHARGE..............48
FIRST POSTNATAL HOME VISIT.........................................................................50
SECOND DAY POSTNATAL HOME VISIT..........................................................51
THIRD DAY POSTNATAL CLINIC VISIT............................................................54
FOURTH POSTNATAL HOME VISIT....................................................................57
FIFTH DAY POSTNATAL HOME VISIT...............................................................58
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SEVENTH DAY POSTNATAL CLINIC VISIT......................................................61
NURSING CARE PLAN DURING PUERPERIUM................................................63
PROBLEMS IDENTIFIED........................................................................................63
SHORT TERM OBJECTIVES..................................................................................63
TERMINATION OF CARE.......................................................................................70
SUMMARY..................................................................................................................71
CONCLUSION..................................................................................................................72
APPENDIX I: MATERNAL RECORDS..................................................................73
APPENDIX II: LABORATORY INVESTIGATIONS....................................................74
APPENDIX III: PARTHOGRAPH...................................................................................75
APPENDIX IV: APGAR SCORE.....................................................................................76
APPENDIX V: DURATION OF LABOUR.....................................................................77
APPENDIX VI:EXAMINATION OF PLACENTA.........................................................79
APPENDIX VII: SIX HOUR OBSERVATION OF BABY.............................................80
APPENDIX VIII: SIX HOURS OBSERVATION ON MOTHER...................................81
APPENDIX IX: BABY’S WEIGHT CHART..................................................................82
APPENDIX X: REPORT ON THE MOTHER.................................................................83
APPENDIX XI: TABLE FIVE: PHARMACOLOGY OF DRUG...................................84
BIBLIOGRAPHY..............................................................................................................88
SIGNATORIES.................................................................................................................89
INTRODUCTION
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Family centered maternity care study is an evidenced based care rendered to a pregnant
woman, her family and the community at large. It also views the family as a total unit
within which each member of the family is seen as a distinct individual. It is a
philosophical approach to prenatal care and delivery providing care to the pregnant
woman in the context of her family. It is also a way of providing care for women and
their family that integrates pregnancy, childbirth, postpartum and infant care into the
continuity of the family cycle as normal healthy life events. The student uses the
theoretical knowledge acquired to give a comprehensive program of education which
prepares family for active participation throughout pregnancy, labour and puerperium. As
one of the principles for family centered maternity care states “prenatal care is
personalized according to the individual psychological, educational, physical, spiritual
and cultural needs of each woman and her family”, the midwife is able to assess and
recognize the needs of the client. Nursing care plan is drawn to solve the identified
problems during pregnancy, labour and puerperium.
To ensure confidentiality, my client and the family will be addressed with initials in the
script. The care study was carried on madam A. R, a gravida two para one whom I chose
as my client. She was met at Afrikids Medical Centre on her visit to antennal clinic. The
entire study ended with various charts and tables which were used to monitor the mother
and her baby throughout the period.
The script involves four main chapters; chapter one focuses on data collection and
analysis and her histories. The histories are made up of personal and social, family, habits
vi
of daily living, medical and surgical history. It also involves obstetric history, both past
and present obstetric histories.
Chapter two deals with services rendered to the client during the period of pregnancy. It
includes first interaction and antenatal home visits and nursing care plan on antenatal.
In chapter three, management of labour and immediate care of the newborn baby is
discussed. This chapter involves; admission and management of first stage, second, third
and fourth stage of labour, subsequent care of the baby and nursing care plan on labour.
Emphasis is given during the various stages of labour with their corresponding
management.
The fourth chapter deals with total management during puerperium. The scripts also have
summary, conclusion, bibliography, various charts and tables which were used to monitor
the mother and baby throughout the period (pregnancy, labour and delivery and
puerperium).
vii
LITERATURE REVIEW
PREGNANCY
Pregnancy is the physiologic process of a developing fetus within the maternal body.
(Decherney, Lauren, Neri and Ashley, 2013). Pregnancy is defined as the period of
conception to the period of delivery of the foetus (Denis Tiran, 2008)
The duration of pregnancy is 280 days (40 weeks or 9 months and 7 days) counting from
the first day of the last menstrual period to delivery of the foetus, according to Denis
Tiran, (2008)
Pregnancy is divided into three trimesters with each being a three-month period.
The first trimester is from conception up to 12 weeks, second trimester starts from 13 th to
24th week and the third trimester starts from the 25 th to the 40th week of gestation
(Sally,1983).
Pregnancy is associated with physiological and hormonal changes in the
reproductive system. Such physiological changes include enlargement of the
Montgomery’s tubercles of the breast tissues and stretching of the breast, thighs and
abdomen known as striae gravidanum and varicose veins. (Fraser and cooper, 2009).
Pregnancy is also characterized by certain minor disorders or signs and symptoms
such as morning sickness, amenorrhea, heart burns, constipation and frequency of
micturition. (Fraser and cooper, 2009).
Antenatal care is the health care and educations given during pregnancy. It is an
important part of preventive and promotive health care. (National Safe Motherhood
Service Protocol, 2008)
viii
According to National Safe Motherhood Service Protocol, (2008), focus antenatal care
promote quality care, antenatal care services must be organizing in such a manner as to
provide
comprehensive and individualized care. As much as possible all care activities examples
history taking, physical examination and treatment should be provided by same care
provider to the pregnant woman.
LABOUR
Labour may be described as the process by which the fetus, placenta and
membranes are expelled through the birth canal (Jayne and Maureen, 2014). Normal
labour last for about 18 hours in multigravida and 24 hours in primigravida with regular,
rhythmic and painful uterine contraction. (Fraser and cooper, 2009)
Labour comprises of certain signs and symptoms such as show, progressive
dilatation of the cervix and a possible rupture of membranes. (Fraser and cooper, 2009).
Labour is made up of four stages namely, first stage, second stage, third stage and
fourth stage. The first stage starts from the unset painful uterine contractions to full
dilatation of the cervix.
The second stage is the phase between full dilatation of the cervical os and the
birth of the baby. During this stage, the woman feels the urge to expel the foetus and it
starts when the cervix is 10 centimeters dilated and completed when the baby is born.
This stage last for 30 minutes to 1 hour. (Fraser and cooper, 2009).
The third stage of labour starts after delivery of the baby and ends with delivery
ix
of the placenta. It is conducted using active management of the third stage of labour.
(National Safe Motherhood Service Protocol, 2008)
PUERPERIUM
Puerperium generally lasts six weeks and is the period of adjustment after
delivery when the anatomic and physiologic changes of pregnancy are reversed, and the
body returns to normal, non-pregnant state. (Alan H. Decherney, Lauren Nathan, Neri
Laufer and Ashley s. Roman, 2013).
Puerperium has been divided in to the immediate, or the first 24 hours after
delivery, when post-delivery complications may occur; the early puerperium, which
extends until the first week postpartum; and the remote puerperium, which include the
period of time required for involution of the genital organs and return of menses, usually
approximately 6 weeks. (Decherney et al, 2013).
The puerperal period is characterized by physiological and hormonal changes
which include diuresis, breast engorgement, insomnia, backache, waist pain. As indicated
by. (Fraser and Cooper, 2009).
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WHY I CHOSE MY CLIENT
Madam A. A. was met on the 24 th of November, 2020, during one of her regular visits to
the antenatal clinic. When it was her turn for vital signs and other routine activities to be
done, we exchanged greetings and her antenatal record book was taken and opened
through and it was indicated that she did not practice exclusive breastfeeding up, she was
asked why she did that and she explained that the mother in-law did not agree with the
notion that the child will die out of thirst because of hot weather condition. This answer
made me to realize that she had inadequate knowledge on exclusive breastfeeding. She
was therefore educated on exclusive breastfeeding and its benefits. With the consent of
the midwife in charge, my intention was explained to take her as a client for my care
study as she was also 36 weeks pregnant. She was very happy and gave me her consent.
xi
CHAPTER ONE
1.0 ASSSESSMENT OFCLIENTAND FAMILY
1.1 INTRODUCTION
This Chapter focuses on data collection and analysis and her histories. The histories are made up
of personal and social, family, habits of daily living, medical and surgical history. It also
involves obstetric history, both past and present obstetric histories.
1.2 PERSONAL AND SOCIAL HISTORY
Madam A. A a 27-year-old G2P1 alive is from Yarigabisi, in the Upper East Region of Ghana.
She had her education up to secondary school. She lives in a family house opposite the
Yarigabisi primary school. She lives with her child and husband in a chamber and hall room. The
house is 7 kilometers away from the Hospital. She is a trader and sells provisions along the
Gambibgo road. her husband Mr. A.F is a trader by profession. Madam A. A next of kin is her
husband. She has one child who is female. The child is 3 years old in nursery1. She speaks
English, Twi and Frafra. She is fair in complexion slim in body size and measures 157 cm in
height. She is a Christian by Religion. Both couple neither smoke nor drink alcohol. Madam A R
hobbies are singing and watching movies especially Nigerian movies.
1
According to Madam A. A, she normally wakes up at 5:30am; she quickly washes her face and
brushes her teeth. She prepares her child’s food and after which she sweeps the room and her
surroundings. She prepares breakfast for the family and prepares the child for school. She takes
her bath and prepare and goes to the shop. She also indicated that she usually goes out by
6:00am. She usually prepares lunch in the shop... She rests for a while since she has people who
support her in the shop and 3;00pm she starts to prepare supper. She finishes supper by 5:30pm.
According to Madam A. A, she sits in the shop for some time and chats with other people by her
shop who also sells, then leaves the shop around 9: 30pm.she takes her bath then finally retires to
bed at 10:15pm.
1.3 FAMILY HISTORY
Madam A. A. is the fifth child of six children, three (3) males and two (2) females by Mr. Y E.
and madam M.Y. They are all alive in Zuarungu in the Upper East Region of Ghana. Mr. Y E
and M Y are both farmers. The other siblings are all alive, according to her, there are no known
hereditary conditions like diabetes, asthma, hypertension, sickle cell disease and leprosy in the
family as well as mental disorders and congenital abnormalities in the family. However, she
indicated that there was history of multiple pregnancies in her family.
1.4 MEDICAL HISTORY
According to Madam A. A. she has been visiting the hospital on Out Patient Department (O.P.D)
basis anytime she has fever or other signs of malaria or cold. She has never been admitted except
in the case of labour. She has never been transfused. The client also explained that she has no
medical history of diabetes,hypertension, epilepsy, asthma, sickle cell anemia and tuberculosis.
She has no known allergy to drug or food.
1.4.1 SURGICAL HISTORY
2
Madam A. R. stated that, she has not had any surgery like caesarean section, laparotomy,
myomectomy and mastectomy before. She also added that she has never been involved in any
accident resulting to a fracture or injury to any part of the pelvis.
1.4.2 MENSTRUAL HISTORY
The client indicated that she had her menarche at the age of 15 and has since been having normal
cycle of 28 days, with regular and moderate flow usually lasting for 4-5 days. She said she
usually experienced slight dysmenorrhea which subsides after taking paracetamol.
1.5 PSYCHOSOCIAL
Madam A R has been relating well with the house members and her neighbors. On the first visit
to her home it was realized that she is a person who likes associating with friends and also
socialized a lot. Madam A R always attend social gatherings like naming ceremonies, weddings
and funerals within the community and beyond. For this attitude of hers made her outdooring a
very lovely one because a lot of people came from far and near and she is always happy.
1.6 PAST OBSTETRIC HISTORY
1.6.1 PREGNANCY
Madam A. A. Gravida 2 Para 1 alive was carrying her second pregnancy. She mentioned that,
her other pregnancy had been successful with little complaints. She had her first pregnancy in
February 2016, which was carried to term without any complications. She said she attended
antenatal clinic about 8 times and took her five doses of Sulphadoxine Pyrimethamine, and three
doses of tetanus diphtheria injection and dewormer without any complications. She experienced
vomiting in the first trimester of her first pregnancy.
She added that she has never had any spontaneous or induced abortions and has no history of still
3
birth or intrauterine foetal death nor pregnancy induced hypertension. She however indicated that
she had minor disorders like pica, nausea and vomiting at the early stages of her pregnancy
which stopped in her second trimester.
1.6.2 LABOUR
With her first delivery, the client explained that, she did not visit the hospital early even though
labour started early. She was accompanied by her mother in-law, so on reaching the hospital, it
did not keep long and she delivered an alive female infant who cried at birth. Vitamin K injection
was given to her baby. She had a perineal tear and it was sutured and padded. Blood loss was
moderate. According to client, she was also given an injection on her thigh before the placenta
was delivered. She could not remember the birth weight of her baby. She was discharged home a
day after delivery.
1.6.3 PUERPERIUM
client said she did not experience any problem after labour such as puerperal pyrexia, post-
partum hemorrhage, and psychosis or breast engorgement with her first child. The baby did not
experience any minor disorders like sore buttocks and rash.
She explained that her lochia changed from red to brown and then to pale. She had enough
support from her family members. She could not practice exclusive breastfeeding because she
said her mother in law discouraged her. Client did not practice any hormonal family planning
method but did the natural family planning (the cycle bead). According to madam A R the child
was registered at the births and deaths registry and immunized against all the preventable
diseases.
1.7 PRESENT OBSTETRIC HISTORY
Madam A. R was booked at the antenatal clinic when she was 8 weeks pregnant on 2 ND
4
June,2020. She said she could not remember her last menstrual period. Her expected date of
delivery according to the scan was 28thDecember, 2020. From the ANC card, her vital signs as
well as the weight and height were taken and recorded as follows;
Temperature 36.8 oC
Pulse 86 bpm
Respiration 20 cpm
Blood pressure 101/64 mmHg
Body weight 52.1 kg
Height 157 cm
1.8 Laboratory investigations revealed the following;
Haemoglobin level 11.8g/dl
Blood group AB+
Rhesus factor Positive
Urine RE(glucose/protein) All negative
Sickling test Negative
HIV test Non-reactive
G6PD Negative
Urine RE Negative
Venereal Disease Research Laboratory/ Platelet Rich Plasma(VDRL/PRP) Negative
Madam A R outlined that on her first A.N.C attendance head to toe examinations was conducted
by the midwife on duty with no abnormalities detected. Abdominal examinations were done
where symphysio-fundal height no palpable, gestational age 8weeks, there was no decent. She
5
indicated that she was thoroughly examined by the midwife. According to her ANC card, tetanus
diphtheria injection third dose was given on the 2 nd June, 2020. Her first dose of Sulphadoxine
Pyrimethamine was also given on the 28th July, 2020 and an Insecticide Treated Net as part of
malaria prevention. From the ANC card, she was put on the following routine drugs;
1. Tablet Folic acid 5mg daily x 30 days
2. Tablet Fersolate 200mg tds x 30
3. Tablet Multivite 200mg tds x 30 days
Her pregnancy was well monitored by the midwife in charge until she was met on the
24thNovember, 2020 when she was 36 weeks pregnant.
CHAPTER TWO
2.0 ANTENATAL CARE
2.1 INTRODUCTION
6
This care is given to a pregnant woman from the time conception is confirmed until the
beginning of labour. The care is to monitor the progress of pregnancy for early detection of
abnormalities and to improve maternal and foetal health. This chapter talks about the antenatal
care rendered to the client at the clinic as well as the home.
2.2 FIRST CONTACT WITH CLIENT
Madam A. R was first contacted at the antenatal clinic of Afrikids medical Centre on the 24 th
November, 2020 during the District Midwifery Practical. She was 36 weeks pregnant. It was her
ninth visit to the antenatal clinic. With permission from the Midwife in charge at the clinic, the
student Midwife was introduced to Madam A. A. I expressed interest in taking her as a client for
Family Centered Maternity care study and she willingly consented to the request. Client was
taken through the usual antenatal routine. Her vital signs, weight and urine sample were taken.
The results were as follows;
Temperature 36.8 oC
Respiration 20 cpm
Pulse 78 bpm
Blood Pressure 117/73 mmHg
Body Weight 61 kg
2.3 Laboratory investigations
Urine RE (glucose/protein) Negative.
Hemoglobin 11.6g/dl
After interacting with her, she was reassured and every procedure about the examination was
explained to her which she consented to in the examination room. She was asked to empty her
bladder, privacy was ensured and hands were washed and dried. She was assisted to undress for
7
the examination and Madam A. R was helped onto the examination bed. The examination was
done under the supervision of the midwife in charge.
On examination of head, the hair was well kept, free from dandruff and ringworm. Her hair was
silky and long with no signs of alopecia. Her face was not puffy. Sclera was white and
conjunctiva looked pink. There were no discharges from her nose, eyes and ears. Her breath
smelled good as we conversed. She had clean white teeth and pink tongue, gums and lips. There
was no gum bleeding or dental caries. There were no distended veins or enlarged lymph node on
palpation of the neck.
On breast inspection, nipples were centrally situated and erect and areola was darkened. On
breast examination, her breast was hemispherical in shape. There was no crack nipple.
Montgomery’s tubercles and secondary areola were visible denoting the presence of pregnancy.
Her breasts were palpated and no masses, palpable axillary lymph nodes and discharges from the
nipples were found. She was taught to perform self-breast examination. She was told that it is
done every month after menstruation and the client was advised to report to the hospital
whenever she detects any abnormalities like lumps (masses), axillary swelling or blood stain
discharges from the breast.
Her upper limbs were examined; they were equal in size and length. Finger and toe nails were
kept clean, short and neat. Examination of the back also revealed no tenderness, oedema or any
abnormalities of the spine or sacral oedema.
On abdominal examination, the first thing was the inspection of the abdomen and it was globular
in shape, without scars. However, there was striae gravidarum and linear nigrae. Foetal
movement was also seen.
During palpation, client was faced; then palms warmed by rubbing them against each other. On
8
fundal palpation, the upper pole was occupied by the breech. Her abdomen was palpated to
which the left side was smooth and well curved, indicating the foetal back. The right side was
rough indicating the foetal limbs. The fetus was in the left occipito anterior position. On pelvic
palpation, I turned around to face the feet of my client; the presenting part and descent of the
head was assessed. The lie was longitudinal and the attitude was that of flexion. The gestational
age was 36 weeks. The symphysiofundal height was 35 cm and the head descent was 5/5 th above
the pelvic brim and presentation was cephalic.
On auscultation, the foetoscope was warmed by gently rubbing it in my palms before placing it
on the abdomen to listen to the foetal heart rate which was 136 beats per minutes with good
volume and rhythm.
On vulva inspection, the client had shaved her pubic hair and no varicose veins, vulva warts,
scars or abnormal discharges were seen. The lower limbs were equal in size and length. There
was no ankle oedema and pain in the calf muscle or varicosities.
After examination, client was helped to dress and got off the bed. She was thanked and findings
were communicated to her. hands were washed and findings recorded in the antenatal record
book. She complained of having constipation. She was reassured and the reason for the
constipation was explained to her that it was as a result of the hormone progesterone which
causes relaxation of the smooth muscles of the gastrointestinal tract therefore slowing the bowel
movement which has caused the constipation. She was encouraged to take in more fruits and
fluids. Her haemoglobin at 36 weeks revealed 11.6g/dl. She was put on the following routine
medications.
1. Tablet Folic acid 5mg daily x 7 days
2. Tablet Fersolate 200mg tdsx 7 days
9
3. Tablet Multivite 200mg tds x 7 days
Client was advised to take her routine drugs. She was educated on nutrition, mother to child
transmission and malaria prevention. An appointment was booked with her for home visit. She
was informed that the care would end on the seventh day after delivery. She agreed and gave the
location and direction to her house, and gave me her phone number. She was thanked and seen
off.
2.4 FIRST HOME VISIT
On the 26thNovember, 2020 at 3: 00pm, Madam A. A. was visited in her home to observe her
environment and enquire about her health. We spoke on phone which she said she was in the
shop and will come to the house according to her, the husband too was not around but promised
to call him and find out if he will be able to make it.
On arrival, madam A R was greeted and she introduced me to some people in the house too. She
welcomed me. She was asked how she was doing and she responded she was doing well. She
was also asked about her child and she said the girl went to visit her aunt at Zuarungu. She said
her husband would also join us soon.
Madam A. R’s house is a big compound house built with mud and roofed with aluminum sheets.
Their room was a normal chamber and hall size with two windows which were well netted
including the door gate to their room. Madam A. A. lives in a family house owed by her father
in-law which was a compound house with fifteen rooms. Client was congratulated on how clean
her room and compound were. The house was connected to electricity. There were two big
barrels in her pouch where she stored pipe borne water. Refuse was kept in a bucket with a
fitting lid but emptied on daily basis to the public dumping site which was not far from her
home.
10
Client looked tired due to inability to sleep over the night. She was educated on the need to sleep
at least two hours during the day. She has a sister in-law who helps her in her daily activities.
Client was encouraged to have a warm bath before going to bed and also to have enough rest and
to eat adequate diet prepared from local food stuffs available. (For example; tuozafi with ayoyo
soup, beans, aleefu, dawadawa and groundnuts). Her complained of constipation was asked
which she said it was now better since she could go to toilet with ease. She was educated on
exclusive breastfeeding as well as fixing of the baby to breast due to her inadequate knowledge
on exclusive breastfeeding. Client was educated on deep breathing exercise and relaxation during
labour. Her husband arrived immediately we were done discussion and about to leave which she
introduced us and the reason for my visit was explained to him which he consented and was
happy about it and permission was sought to leave. Client and husband were thanked and she
was reminded of her next visit to the antenatal clinic.
2.5 SECOND ANTENATAL VISIT
On the 01st December 2020, Madam A. A. visited the antenatal clinic as scheduled. It was her
Tenth visit. She was welcomed on arrival and a seat was offered for her to rest for some time.
Her health was inquired and she said was fine. She was taken through the routine procedure. Her
vital signs were checked and recorded as well as weight and some laboratory investigations as
follow;
Temperature 36.2oC
Pulse 82bpm
Respiration 22 cpm
Body Weight 61.5kg
11
2.5.1 Laboratory investigations
Protein in urine Negative
Glucose in urine Negative
Procedure was explained to her on head to toe examination and she consented after which she
was asked to empty her bladder; she was then helped onto the examination couch. Privacy was
provided, hands were washed and dried before carrying out the procedure.
Physical examination revealed no abnormalities.
The abdomen was ovoid in shape with foetal movement seen on abdominal inspection.
Abdominal examination revealed symphysiofundal height as 36 centimeters, gestational age of
37 weeks. The lie was longitudinal, presentation was cephalic and head descent 5/5 th above the
pelvic brim. On auscultation foetal heart rate was 136 beats per minute with good volume and
regular rhythm. Her vulva was inspected and it was clean with no varicose veins, vulva warts or
any abnormality. There were no varicose veins or oedema. She was congratulated and helped
out of the couch and assisted to dress up.
My hands were washed and communicated my findings to her and recorded it in her antenatal
record book. She complained of heart burns. She was reassured by explaining that, it is due to the
regurgitation of gastric juice causing heart burns. She was encouraged to take food in bits but in
frequent intervals, to reduce intake of oily and spicy foods and advised to support her back with
pillows while sleeping or sitting. She was encouraged to take the routine drugs given to her as
follows;
1. Tablet Folic acid 5mg daily X 7 days
2. Tablet Multivite 200mgtds X 7 days
3. Tablet Fersolate 200mg tds X 7 days
12
She was thanked for her cooperation and told to always feel free and tell me her problems. She
was informed of her next visit, but she was told to come even before the scheduled date if she
has a problem. She was accompanied out of the clinic and then was reminded of the next home
visit.
2.6 SECOND HOME VISIT
The second home visit to the client was on the 03rd December, 2020 at 4:00 pm. On arrival, her
husband was met who welcomed me and offered me a seat, then served me some water. Madam
A. A. joined us some few minutes afterwards. She smiled on seeing me and welcomed me and
thanked me for the advice given her at the antenatal clinic. They were educated on birth
preparedness plan and complication readiness.
The client said, she had the same blood group with her brother so he would donate blood when
the need arises. Her bag containing the delivery items were asked to be crossed checked and she
brought it out and the items were neatly packed in it including the following; two rubbers as
mackintosh, Dettol, soap, baby dresses, six pieces of clean old and new clothes except perineal
pad. She was advised to keep it by her but she should not delay in the house when labour starts,
and no local oxytocin should be given to her because of its effect on labour. She was educated on
the true signs of labour which include blood stained mucous from the vagina, painful, regular
and rhythmic uterine contraction.
Again, emphasis was made on the need to keep her environment clean, clear all stagnant water
and throw empty cans into the dustbin, destroy mosquito breeding places and continue to sleep
under treated mosquito net to prevent her from getting malaria. She was reminded of her next
visit to the antenatal clinic. permission was sought to leave and bid them goodbye.
13
2.7 SUBSEQUENT VISIT TO THE CLINIC
Madam A. A. visited the clinic on the 08th December, 2020. She was welcomed and offered a
seat. She was asked about her health and that of her family. She indicated that they were all
fairing well but she only complained of having lower abdominal pain and waist pain. Client was
reassured and explaining to her that all that she was experiencing were minor disorders and was
common in late pregnancy and that it was as a result of lightening. The following were checked
and recorded;
Temperature 36.0oC
Pulse 74 bpm
Respiration 22 cpm
Weight 62.0 kg
Protein Negative
Glucose Negative
General examination from head to toe was done and nothing abnormal was found. On abdominal
examination, the abdomen was found to be ovoid in shape and 38 weeks of gestation, with
symphysiofundal height of 37cm. Foetal heart rate was 134 beats per minute. The lie was
longitudinal with cephalic presentation, position left occipito anterior and descent 4/5 th. Hands
were washed and communicated the findings to her and recorded it in her antenatal record book.
Signs of labour were discussed with her and she was urged to call if she sees any blood stained
mucous from the vagina, and then painful, regular and rhythmic uterine contractions. My client
said she still have some of her routine drugs so no drugs where given that day. Client was taken
14
to the labour ward and showed around. She was thanked and reminded of the next home visit but
if anything happens she should call me and bid her goodbye.
1. Tablet Folic acid 5mg daily X 7 days
2. Tablet Multivite 200mgtds X 7 days
3. Tablet Fersolate 200mg tds X 7 days
2.8 NURSING CARE PLAN DURING ANTENATAL CARE
2.8.1 PROBLEMS IDENTIFIED
1. Knowledge deficit on exclusive breastfeeding………….. 24/11/2020
2. Client complained of Constipation…………………………24/11/2020
3. Client complained of sleep pattern disturbance (Insomnia)….26/11/2020
4. Client complained of Heartburns ……………………………01/12/2020
15
5. Client complained of waist and lower abdominal pain ………..08/12/2020
2.8.2 SHORT TERM OBJECTIVES
1. Client will demonstrate adequate understanding of exclusive breastfeeding within 1 hour.
2. Client will have improved bowel action within 24 hours
3. Client sleeping pattern will be improved within 48 hours
4. Client will experience relief of heart burns within 24 hours
5. Client will experience reduction of waist pain and lower abdominal pain within 72 hours.
2.8.3 NURSING DIAGNOSES
1. Knowledge deficit related to inadequate information on exclusive breastfeeding.
2. Alteration in bowel movement (constipation) related to the effects of the hormone
progesterone which causes relaxation of the smooth muscles of the gastrointestinal tract
3. Sleep pattern disturbance related to excessive foetal movement.
4. Alteration in body comfort (heart burns) related to reflux of gastric acid to the esophagus.
5. Alteration in body comfort (waist and lower abdominal pain) related to lightening.
2.8.4 LONG TERM OBJECTIVES
Client will go through adequate preparation physically, psychologically and social wellbeing
throughout pregnancy.
16
1.0 TABLE ONE: NURSING CARE PLAN DURING ANTENATAL
DATE/ NURSING OBJECTIVE/OUT NURSING ORDERS NURSING DATE/ EVALUATION SIGN

DIAGNOSIS COME CRITERIA INTERVENTIONS
TIME TIME
24/11/20 Knowledge Client will 1. Reassure client by explaining 1. Client was reassured. 24/11/20 Goal fully met as
At deficit on demonstrate the benefits of exclusive 2. Client was educated on At evidenced by
3:45pm exclusive adequate breastfeeding to client. the advantages of 4:45pm client verbalized
breastfeeding understanding on 2. Educate client on the exclusive breastfeeding the importance
related to exclusive advantages of exclusive 3. Client was encouraged to of exclusive
inadequate breastfeeding within breastfeeding feed baby on demand. breastfeeding
information one hour evidenced 3. Encourage client to feed 4. Client responded to and accepting to
on exclusive by client verbalizing baby on demand. questions asked practice it.
breastfeeding. the importance of 4. Ask client questions concerning the topic
exclusive concerning topic. 5. Client was encouraged to
breastfeeding and 5. Encourage client to ask ask questions on
willingness to questions. exclusive breastfeeding.
practice it.
NURSING CARE PLAN DURING ANTENATAL
17
DATE/ NURSING OBJECTIV NURSING ORDERS NURSING INTERVENTIONS DATE/ EVALUATI SIGN
DIAGNOSIS E/OUTCO ON
TIME TIME
ME
CRITERIA
24/11/20 Alteration in Client will 1. Reassure client that she will 1. Client reassured that she would 25/11/20 Goal fully
9:00am bowel movement have be able to pass stool once a be able to pass stool once a day. at met as
(constipation) improved day. 2. Client was educated on the 9:00am. evidenced
related to the bowel 2. Educate client on the physiology behind the by client
effects of the action physiology behind the condition. verbalizing
hormone within 24 condition. 3. Client was educated to take that she
progesterone hours 3. Educate client to take enough enough fluids especially in the moved her
which causes evidenced fluids especially in the morning. bowels once
relaxation of the by client morning. 4. Client was educated to eat high daily.
smooth muscles verbalizing 4. Educate client to eat high fiber foods.
of the passing fiber foods. 5. Client was encouraged to
gastrointestinal stool. 5. Encourage client to exercise exercise to prevent constipation.
tract. to prevent constipation.
18
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTIONS DATE/ EVALUATION SIGN
DIAGNOSIS
TIME OUTCOME TIME
CRITERIA
26/11/20 Sleep pattern Client will regain 1. Educate client to lie in a 1. Client was educated to lie 28/11/2 Goal fully met
4:50pm disturbance normal sleep comfortable position. in a comfortable position 0 evidenced by
(insomnia) pattern at night 2. Educate client to take warm 2. Client was educated to 4:50pm client
related to within 48 hours beverage, like milo before take warm beverage, like milo Verbalizing
excessive evidenced by bed time to induce sleep. before bed time to induce sleep. improvement in
foetal client verbalizing 3. Educate client to take a 3. Client educated to take a sleep pattern.
movement. improvement in warm bath before bed. warm bath before bed.
sleep pattern. 4. Educate client to sleep less 4. Client educated to sleep
during the day. less during the day.
5. Educate client to minimize 5. Client educated to
noise by turning off TV or minimize noise by turning off
radio. TV or radio.
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING DATE/ EVALUATION SIGN
TIME DIAGNOSIS OUTCOME INTERVENTIONS TIME
CRITERIA
19
01/12/20 Alteration in Client will 1. Explain to client the 1. Physiology behind heart 02/12/20 Goal fully met as
At body comfort experience relief physiology behind the heart burns explained to client At evidenced by
10:00am (heart burns) of heart burns burns. 2. Client educated to take small 10:00 client verbalized
related to within 24 hours 2. Educate client to take small quantity of food at a time am on phone that
regurgitation evidenced by quantity of food at a time. 3. Client educated to reduce she was relieved
of gastric juice client 3. Educate client to reduce intake of fatty and spicy of heart burns.
into the verbalizing intake of fatty and spicy foods.
oesophagus. relief of heart foods. 4. Client educated to avoid
burns. 4. Educate client to avoid bending over the knee during
bending over the knee during house hold chores.
house hold chores. 5. Client educated not to lie
5. Educate client not to lie down down immediately after
immediately after meals. meals.

TIME DIAGNOSIS OUTCOME INTERVENTIONS TIME
CRITERIA
08/12/20 Alteration in Client will 1 Explain the physiology 1. Physiology behind waist 09/12/20 Goal fully met
20
At comfort experience behind waist pain in third pain in third trimester At evidenced by
10:30am (waist and reduction of trimester to client. explained to client. client having
lower waist pain within 2 Educate client to avoid 2. Client educated to avoid 10:30am relaxed facial
abdominal 24 hours as prolong standing. prolong standing. expression and
pain) related evidenced by 3 Educate client to avoid 3. Client educated to avoid verbalized
to lightening. client having tedious activities. tedious activities. reduction in
relaxed facial 4 Educate client to rest in 4. Client educated to rest in pain.
expression and between her daily activities. between her daily
verbalizing 5 Educate client to sit with activities.
reduction in back supported. 5. Client educated to sit with
pain. her back supported.
21
CHAPTER THREE
3.0 LABOUR
3.1 ADMISSION AND MANAGEMENT OF FIRST STAGE OF LABOUR
On 15th December, 2020 in the morning at about 8:00 am, I received a call from my client
telling me she was in labour. She was instructed to come to the hospital with her items for
confinement and support person to the hospital. Madam A. R. and her husband and sister
in-law arrived at the maternity ward at 8:15am. They were welcomed and offered seats,
her antenatal booklet was taken from her and I started the admission process. She
complained of severe lower abdominal and waist pain.
According to her, the painful and regular uterine contraction started around 7:35am, when
she was preparing for her usual prayers and it intensified, that prompted her to come to
the hospital, as she remembered the education, I gave on the true signs of labour. I used
the opportunity to explain every procedure on be carried out to her to gain her
cooperation and allay anxiety. She was then sent to the examination room where I made a
bed for her. Her delivery items were inspected to ensure everything needed for the
delivery was there. Privacy was provided and I asked her to empty her bladder, during
which urine specimen was taken and tested for protein and sugar, both were negative,
volume of urine was 200mls with a clear color and no sediments found. Her baseline vital
signs were taken and recorded;
Temperature……………………...36.6°C
Respiration……………………….20cpm
22
Pulse………………………………88bpm
Blood pressure……………………100/70mmHg
The procedure for physical examination from head-to-toe was explained to her and
privacy provided by screening the bed and closing nearby windows. A tray was set for
abdominal and vaginal examination containing sterile gloves, two gallipots with one
containing an antiseptic lotion, and the other containing sterile cotton wool swabs,
receiver for used swab, bowls, tape measure and Pinard’s Stethoscope. She was helped to
undress and given a gown to cover herself and helped to lie on the examination couch. I
washed my hands with soap and water and dried with a clean towel. She was examined
from head to toe under the supervision of the midwife on duty,no abnormality was seen.
On examination, she had a well-kept hair, her face was not puffy, sclera was white and
conjunctiva appeared normal. There was no discharge from her nose and ears. Her mouth
was inspected as she opened her mouth to answer questions. Her teeth were white and
there was no bleeding from her gums. The tongue was pink and not dry. No offensive
odour from her mouth and there were no distended neck veins, or enlarged lymph nodes
on palpation of the neck.
On breast inspection, both breasts were normal in shape and size, nipples were centrally
situated and erect, areola was dark and prominent. On palpation, there were no lumps or
axillary swelling or discharge from her breast. She was taught how to perform self-breast
examination, after delivery and menstruation, and advised to report whenever she detects
a lump, axillary swelling or blood-stained discharge from the breast.
23
Her upper and lower extremities were equal in size and length. Finger nails were short
and neat. There was no oedema, varicose veins. Two fingers were placed on the spine,
gently pressed and moved downwards for any defect on the spinal cord but none was
found. Abdominal examination was conducted by inspection, palpation and auscultation
respectively.
On inspection, the abdomen was globular in shape, there were no scars but linear nigra
was prominent and straie gravidarum was present. On palpation, the buttocks of the fetus
occupied the fundus, symphysio fundal height was 36cm, lie was longitudinal and the
gestational age was 39 weeks. On lateral palpation, the fetal back was located at the right
side of the woman’s abdomen, which indicated right occipito anterior position. On pelvic
examination, the head occupied the lower pole of the uterus, and descent of the fetal was
4/5th above the pelvic brim. Uterine contractions were 2 in 10 minutes, lasting 30
seconds. On auscultation, the fetal heart rate was 148bpm with good volume and regular
rhythm.
On vulvar inspection, the hair was shaved and there were no vulva warts, varicosity,
sores, vaginal discharges and hematoma seen. The groins were palpated for swollen
lymph nodes but none was detected. Permission was sought to do vaginal examination
which was granted. She was assisted to assume a dorsal position, with knees flexed. My
hands were washed and dried and sterile gloves donned, after a sterile tray for the
procedure had been set. Vulva swabbing was done with five pieces of cotton swabs,
soaked in 5%(1:20) savlon solution starting from the labia majora, then labia minora, and
lastly the vestibule, using each swab per stroke, from top to bottom. On vaginal
examination, the vagina was warm and moist with distensible walls. The cervix was thin
24
and completely effaced. The cervical dilated 4cm and membranes were intact. The
sacrum was well curved, ischial spines were blunt, and pubic arch was wide, and able to
admit two fingers. The vulva was cleaned and perineal pad applied, my gloves was
removed and discarded and she was assisted to redress after the examination. All findings
confirmed true labour which was communicated to her and that she was in a good
condition, to deliver per vagina. She was encouraged to ask questions and to pass urine
frequently to aid descent of the fetal head. She was also encouraged to take in more fluids
to prevent dehydration, and lie on her left lateral side to prevent supine hypotension.
Hands were washed, dried and I completed the admission process.
All findings were recorded and plotted on the partograph under the supervision of my
ward in charge. Madam A. R. was oriented to the ward, toilet and bathroom. She was
introduced to staff on duty and the clients in the ward. She was encouraged to do deep
breathing exercise during contraction and to rest in-between, to prevent maternal
exhaustion. I engaged her in conversation as a form of diversional therapy. Fetal heart
rate, maternal pulse, and uterine contractions were monitored every 30 minutes and
recorded. Blood pressure and temperature were monitored every 4 hours, urine test was
done every 2 hours and vaginal examination and descent of the fetal head were assessed
every 4hours. She was reassured that she will go through labour successfully.
I continued monitoring Madam A. R.’s progress of labour. My hands were washed and
dried, and all findings were plotted on the partograph, until the time for the next vaginal
examination was due.
At 8:55am;
25
Contractions ……………….2 in 10 minutes lasting 31 seconds.
Fetal heart rate ………………147cpm.
Maternal pulse ………………. 80bpm.
At 9:25am;
Contractions ………………. 3 in 10 minutes lasting 33 seconds.
Fetal heart rate ……………… 144cpm.
Maternal pulse ……………… 80bpm.
At 9:55am;
Contractions ……………….. 3 in 10 minutes lasting 36 seconds,
Fetal heart rate ……………… 140cpm.
Maternal pulse ………………. 76bpm.
At 10:25am;
Contractions ……………… 3 in 10 minutes lasting 38 seconds,
Fetal heart rate ……………. 141cpm.
Maternal pulse …………….. 78bpm.
Privacy was provided and I asked her to empty her bladder, during which urine specimen
was taken and tested for protein and sugar, both were negative, volume of urine was
150mls with a clear color and no sediments found
26
At 10:55am;
Fetal heart rate …………….. 138cpm
Maternal pulse ……………. 78bpm
At 11:25am,
Contractions …………….. 4 in 10 minutes lasting 40seconds,
Fetal heart rate …………….. 139cpm.
Maternal pulse ……………. 77bpm.
Maternal temperature……………… 36.8°C
At 11: 55pm;
Fetal heart rate …………….. 140cpm.
Maternal pulse …………….. 80bpm.
12:25pm vaginal examination was done under aseptic technique and the cervical
dilatation was 8cm, with membranes still intact with molding (+) . Descent of fetal head
was 2/5th, fetal heart rate - 139bpm, contractions 4 in 10minutes lasting 40 seconds, pulse
rate 72bpm, blood pressure 100/70mmHg and respiration were 20cpm.Urine passed was
100mls and was tested for acetone and protein, which were all negative. Her perineum
was cleaned and a sterile perineal pad applied to the vulva. Findings communicated to her
27
and documented on the partograph. She complained of severe waist pain and backache,
especially during contraction. She was reassured by explaining the physiology behind the
pain to her that it is as a result of descent of the fetal head. She was assisted to assume a
position that is comfortable to her hence reducing the backache. Sacral massage was done
to reduce the pain and she was encouraged to empty her bladder frequently and do deep
breathing and relaxation exercise all in a bit to reduce pain. She also complained of
feeling warm and sweating profusely so I opened all the louvers and switched on the fan
in the delivery room. Her face, neck, and arms were cleaned off sweat, with a wet towel
to keep her refreshed.
At 12:55 pm,
Contractions ……………... 4 in 10 minutes lasting 42 seconds.
Fetal Heart Rate ……………. 140cpm.
Maternal Pulse ……………. 80bpm
At 1:25pm,
Contractions ……………… 5 in 10 minutes lasting for 48 seconds
Fetal Heart Rate …………… 142bpm
Maternal Pulse …………… 80bpm.
At 1:55pm, membranes ruptured spontaneously, during contraction. Vaginal examination
was done to check the presentation, moulding, and cervical dilatation, and to rule out
cord prolapse. The liquor was clear, moulding was 1 plus (+), and presentation was
28
cephalic with no cord prolapse. Cervical dilatation 10cm as confirmed by the midwife on
duty. The descent was 0/5th above the pelvic brim and uterine contractions were 5 in
10minutes lasting 50seconds, fetal heart rate 141bpm, maternal temperature 36.9°C, pulse
80bpm and blood pressure 100/60mmHg. All findings were communicated to her, and
she was informed that any moment from now she would have her baby. Madam A. A.
complained of severe lower abdominal pains, waist pains and bearing down sensation as
the contractions became stronger and occurred frequently. She was reassured and
transferred to the second stage room, where she was helped onto the delivery bed. Client
looked anxious and was reassured and progress of labour was explained to her. The
delivery trolley and all the necessary items and instruments were already set in the
delivery room. Top shelf: a bowl containing antiseptic lotion(savlon), 2 draping sheet, 2
dressing towel, receiver for placenta, sterile gauze swabs and cotton wool swabs in
gallipots, kidney dish containing the 2 artery forceps, 1 cord scissors and 1 episiotomy
scissors.
29
Bottom shelf; pre-packed sterile gloves and hand towel, jug to measure blood lost and
blood clot, syringes and needles, cord clamp and baby’s identification band, drugs tray
containing oxytocin, ergometrine, xylocaine, injection vitamin k, mucous extractor,
oxygen cylinder and suctioning machine were all in good condition. The trolley was
pushed to right side of the client. She was encouraged to bear down with each contraction
and rest in between
3.2 MANAGEMENT OF SECOND STAGE OF LABOUR
Madam A. R. was positioned on the delivery bed in a lithotomy position which was her
preference at 2:00pm. The bladder was palpated to ensure it was empty. Reassurance was
given and every procedure to be carried out was explained to her to gain her cooperation
I wore a mackintosh apron and boots as my protective clothing. I washed and dried my
hands, and donned a pair of sterile gloves. The vulva and upper thighs were swabbed,
with clean cotton wool swabs soaked in savlon solution. Her thighs were draped and she
was told that the baby would be delivered onto her abdomen.
Vaginal examination was done again to confirm full dilatation of the cervical os and a
clean perineal pad was applied to anal region to prevent contamination of the delivery
field with fecal matter. I instructed my assistant to check fetal heart rate, and maternal
pulse with each contraction. As the contractions became stronger and expulsive, the
perineum bulged and the anus and the vulva gapped to show the presenting part. She was
encouraged to bear down with uterine contraction and rest in between contraction to
prevent maternal exhaustion. I used my left hand to hold the perineal pad in position to
maintain a sterile delivery field. As labour progressed with good uterine contractions and
maternal effort, the head advanced, flexion was maintained gently by pressing the occiput
30
downwards with my right middle and index fingers to allow the smallest diameter (Sub-
Occipito Bregmatic) to distend the vagina until crowing of the head took place.
As the head crowned, she was asked to stop pushing but pant to prevent rapid expulsion
of the head which might cause perineal tears. The head was born by extension as the
sinciput, face and chin swept the perineum. After delivering the head, I cleaned each eye
with separate sterile gauze from the inner canthus outward. The mouth and the nostrils
were suctioned with a bulb syringe, and I quickly felt for cord around neck but no cord
was found. She was reminded that at this stage the baby will be delivered onto her
abdomen, as I waited for restitution and external rotation of the head to take place. My
hands were placed my hands on each side of the baby’s head and the anterior shoulder
was delivered by downward traction towards the perineum as I encouraged her to bear
down slightly with contraction. The posterior shoulder of the baby was delivered by a
gentle upward traction towards the mother’s abdomen, and the rest of the body was
delivered by lateral flexion, onto the mother’s abdomen.
A live male infant was delivered at 2:20pm who cried lustily after birth. The cord was
clamped and cut and baby was cleaned thoroughly, and wrapped with a warm towel.
Client’s abdomen was palpated to ensure there was no second twin, but nothing was
detected. I instructed my assistant to give injection oxytocin 10units intramuscularly at
2:32pm. The baby’s Apgar score assessed at the first 1 minute was 8/10 and the first
5minutes was 9/10. Her baby was shown to her and she identified the sex as a female and
she was congratulated.
31
3.3 IMMEDIATE CARE OF THE NEWBORN.
The baby’s eyes were cleaned with dry sterile swabs after the head was delivered, from
the inner canthus outward. Baby’s mouth and nostrils were sucked off mucus to clear the
airway. The Apgar score for the first and fifth minutes 8/10 and 9/10 respectively. The
baby weighed 3.4 kilograms with head circumference of 32cm, and full length 43cm. The
baby’s cord was observed for bleeding. An identification band was put on the wrist and
baby wrapped in a clean cloth to provide warmth. Baby was kept on mother’s abdomen
with head turn to one side to aid easy drainage of secretion from the mouth, so as to
prevent aspiration while mother was attended to.
3.4 MANAGEMENT OF THE THIRD STAGE OF LABOUR
The third stage of labour starts from the separation and expulsion of placenta and
membranes up to the control of haemorrhage. After delivery of the baby, madam A.R.
remained in the lithotomy position with the cut end of the cord placed in a receiver near
the perineum. The procedure involved in this stage was explained to her and gloves were
changed. my hand was placed on her fundus to feel for contraction. Then the artery
forceps were released and clamped closer to the vulva. My left hand was placed just
above the symphysis pubis with palm facing the umbilicus and a gentle counter traction
applied in an upward direction pushing the uterus upward to stabilize it. Holding the
forceps horizontally, downward traction was applied on the cord. Placenta was received
in both hands and coaxed membranes out. Hence, placenta and membranes were
delivered by controlled cord traction at 2:30pm. The placenta was quickly examined and
placed in a receiver for further examination. The uterus was rubbed to expel clots and to
32
contract. Vaginal walls, clitoris and perineum were examined for tears but there were
none. The uterus was palpated to ensure that it was well contracted. Madam A: R. was
cleaned and a perineal pad applied to the vulva and she was congratulated. She was
educated on perineal care, the need to keep herself clean (especially her perineum). She
was made comfortable in couch and baby was immediately put to breast. She was also
encouraged to feed baby to initiate lactation. she was congratulated and thanked for her
effort and co-operation.
All used instruments were soaked in 0.5 percent chlorine solution for ten minutes for
decontamination. They were washed with soap under clean running water, rinsed, dried
and packaged for sterilization. Documentation was done into the delivery book and
labour notes written after hand washing. Her husband and sister in-law were
congratulated and reassured that mother and baby were fine and they would be allowed to
see them soon.
3.5 EXAMINATION OF THE PLACENTA
After my client had been cleaned and made comfortable on bed, the placenta was taken
and examined for completeness. The membranes were placed together by holding the cut
cord with one hand and allowing the membranes to hang. The hole through which the
baby was delivered was also identified. The placenta was on both palms with the
maternal surface upwards and inspected the surface for any missing cotyledon or infarcts
but none was found.
The foetal surface was bluish grey in colour and it was smooth, it had a shiny surface
with branches of umbilical vein and arteries visible. The amnion was peeled up to the
umbilical cord and the chorion was inspected but abnormality such as knot, haematoma,
33
tumour or oedema was not detected. The cord was inspected for a number of vessels and
two arteries and a vein were found. The amount of Wharton’s jelly was normal. The cord
length was measured and found to be 50 cm. The placenta weighed 450 grams and the
circumference also measured 60 cm. The placenta was decontaminated and presented it
to the relatives to dispose it off. Delivery instruments and equipment were also
decontaminated in 0.5%chlorine solution for 10 minutes, removed, washed with soap and
rinsed under running water and allowed to air dry. The instruments were then packed for
sterilization.
3.6 MANAGEMENT OF FOURTH STAGE OF LABOUR
The fourth stage starts from the expulsion of the placenta and membranes to six hours
after childbirth. During this time, the mother and baby were monitored closely to exclude
complications such as postpartum haemorrhage. Emphasis was put on the importance of
exclusive breast feeding and assisted madam A.R. to fix the baby to breastfeed to aid the
establishment of lactation and also create bonding between her and the baby. She was
counseled to continue breastfeeding the baby on demand. She was advised to wash her
hands before putting baby to breast and before and after handling baby.
Madam A.R. was encouraged to urinate frequently to help in involution of the uterus and
prevention of postpartum haemorrhage. Client was again advised to change the perineal
pad frequently when soiled to prevent infection and also look out for excessive bleeding.
The uterus was examined for firmness. Symphysio-fundal height was measured to be
18cm as uterus was firmly contracted.
Post-delivery vital signs were checked and recorded as follows;
34
Temperature 36.3 oC
Pulse rate 75 bpm
Respiration 20 cpm
The lochia was bright red on inspection with moderate flow. Vitamin A capsule 200,000
international unit and routine drugs were served to the mother. The vital signs were
checked quarter hourly for the first one hour, half hourly for the next two hours and then
hourly till six hours. The baby was examined from head to toe and no abnormality was
detected. The cord was not bleeding. Baby was normal and the following were recorded
on the baby.
Temperature 36.7oC
Respiration 36 cpm
Apex beat 124 bpm
After an hour monitoring in the labour ward, madam A.R. was transferred into the lying-
in-ward for further monitoring and observation. Her relatives were allowed some time to
see them. She was served a cup of warm tea and they were told to get her some food to
eat. The baby passed meconium and urine indicating patency of both rectum and anus.
3.7 SUBSEQUENT CARE OF THE BABY/EXAMINATION OF THE NEWBORN
After mother and baby had rested for a while, examination to be carried out on the baby
was explained to madam A.R. My hands were washed and dried and placed the baby on a
flat surface, undressed him and draped him to prevent heat loss.
The baby was examined from head to toe to exclude any congenital abnormalities or birth
35
injuries in the presence of her mother. On inspection, the skin was pink all over. The
head was examined for caput succedaneum, cephal haematoma and hydrocephaly which
were all absent. Fontanelles were pulsating without depression and sutures well situated.
Baby had normal eyes of which sclera and conjunctiva had no yellowish discoloration or
discharges. He had a patent nose without discharges. No cleft palate or hare lip was
noticed on the mouth. The suckling reflex was present. There was no tongue tie or false
teeth. There was no swelling lymph node on the neck and it could easily turn.
The abdomen was not distended or tender and there was no bleeding from the cord. The
anus and urethra were present with descended testicles. The back was inspected to
exclude spinal bifida. The toes were examined for webbed and extra digits but they were
absent. The following measurements were checked on the baby;
Weight…………………………………………………3.4 kg
Head circumference …………………………………32 cm
Chest circumference……………………………………30 cm
Full length………………………………………………..43 cm
He was wrapped to provide warmth and bathed him after six hours and the cord dressed
as well
Madam A.R. was advised to frequently change baby’s napkins, to breastfeed baby on
demand and ensure complete emptying of the breast. She was encouraged to ensure skin
to skin contact and maintain the health of the baby by practicing rooming in. She was
also told to observe baby and promptly report any abnormality such as skin discoloration,
rashes or bleeding from the cord.
36
3.8 SUMMARY OF LABOUR NOTES
Madam A.R. delivered spontaneously per vagina to a live male infant with an Apgar
score of 8/10and 9/10 in the first and fifth minutes of life respectively with weight of
3.4kg who cried immediately after birth.
Date of delivery 15/12/2020
Time of delivery 2:20pm
Type of delivery Spontaneous vaginal delivery
Time of delivery of placenta 2:30pm
Oxytocin (10 units) given
Blood loss 250mls
First stage duration 5 hours 30minutes
Second stage duration 25minutes
Third stage duration 10minutes
Total duration of labour 6 hours 5minutes
Sex of baby Male
Delivery done by student midwife Ngumah Charlotte supervised by Madam
3.9 CONDITION OF MOTHER AFTER DELIVERY
Temperature 36.5oC
Pulse rate 72 bpm
Respiration 20 cpm
General condition of mother satisfactory
37
Fundal height 18 cm
Perineum Intact
3.9.1 Records on Baby
Sex Male
Birth weight 3.4 kg
Head circumference 32 cm
Full length 43 cm
Chest circumference 30cm
Apgar score (first minute) 8/10
Apgar score (second min.) 9/10
Urine passed
Meconium passed
Cord clean
Abnormalities not detected
Condition satisfactory
38
3.10 NURSING CARE PLAN
3.10.1 PROBLEMS IDENTIFIED DURING LABOUR AND DELIVERY
1. Client complained of painful uterine contractions at 8:15am
2. Client complained of waist pains
3. Client complained of lower abdominal pains
4. Client was anxious
5. Client was raising her buttocks
1. Impaired body comfort related to painful uterine contractions.
2. Acute pain related to uterine contractions and descent of head.
3. Alteration in body comfort (lower abdominal pain) related to uterine
contractions and decent of head.
4. Emotional disturbance (anxiety) related to unknown outcome of labour
39
5. Risk for perineal trauma related to delivery process (client raising her
buttocks whiles pushing).
1. Client will cope with body discomfort throughout labour.
2. Client will cope with labour pains throughout labour
3. Client will experience relieve of lower abdominal pain after delivery.
4. Client will demonstrate relieve of anxiety within 1 hour
5. Client will maintain intact perineum throughout the delivery process.
3.10. 4 LONG TERM OBJECTIVES
Client will go through labour without complication to herself and the baby.
40
2.0 TABLE TWO: NURSING CARE PLAN DURING LABOUR
DIAGNOSIS OUTCOME
TIME TIME
CRITERIA
15/12/20 Impaired Client will 1. Explain the physiology of 1. Physiology of labour explained 15/12/20 Goal fully met
body comfort regain her labour to client in simple terms. to client in simple terms. evidenced by
At At
related to normal comfort client being
2. Assist client to adopt a 2. Client assisted to adopt a
8:15am 3:00pm
painful throughout calmed and
comfortable position. comfortable position.
uterine labour evidenced relaxed
3. Engage client in diversional 3. Client engaged in diversional
contractions. by midwife throughout
therapy by conversing with her. therapy by conversing with her.
observing client labour.
being calm and 4. Give sacral massage to client. 4. Sacral massage given to client.
relax throughout 5. Remind client of deep 5. Client reminded of deep

labour. breathing exercise and breathing exercise and
encourage her to practice it. encouraged to practice it.
NURSING CARE PLAN DURING LABOUR
41
DIAGNOSIS OUTCOME INTERVENTIONS
TIME TIME
CRITERIA
15/12/20 Acute pain Client will cope 1. Reassure and explain the 1. Client reassured and 15/12/20 Goal fully met as
related to with waist pain physiology of waist pain to physiology behind waist pain evidenced by
At At
descent of the throughout client. explained to her. client verbalizing
10:50 am 3:10pm
presenting labour that she copes
2. Encourage client to walk 2. Client educated to walk
part. evidenced by with it.
around. around.
client
3. Give sacral massage to client. 3. Sacral massage given.
verbalizing that
she copes with 4. Provide diversional therapy 4. Diversional therapy provided
it. by conversing with her. by conversing with client.
5. Assist client to adopt a 5. Client assisted to adopt a
comfortable position. comfortable position.
42
CRITERIA
TIME TIME
15/12/20 Alteration in Client will 1. Explain physiology of first 1. Physiology of first stage of 15/12/20 Goal fully met
body comfort experience relieve of stage of labour to client. labour explained to client. evidenced by
10:50am 3:00pm
(lower lower abdominal 2. Let client adopt client facial
2. Client made to adopt a
abdominal pain after delivery as comfortable position for expression being
comfortable position.
pain) related to evidenced by client herself. cheerful and
3. Client reminded and
uterine facial expression 3. Remind and encourage client verbalizing
encouraged to practice deep
contractions being cheerful and client to practice deep absence of pain
breathing exercise.
and decent of client verbalizing breathing exercise.
head. absence of pain. 4. Perform sacral massage 4. Sacral massage performed.
during contractions. 5. Prescribed analgesics

5. Give analgesics as administered.
prescribed.
43
TIME TIME
CRITERIA
15/12/20 Emotional Client will 1. Reassure client and family 1. Client and family were 15/12/20 Goal fully met
disturbance demonstrate that they are in competent reassured that they are in evidenced by
At At
(anxiety) relieve of hands. competent hands. client showing a
1:55pm 3:30pm
related to anxiety within relaxed and
2. Update client on the progress 2. Client was updated on the
unknown one hour as cheerful facial
of labour. progress of labour.
outcome of evidenced by expression.
3. Engage client in conversation 3. Client engaged in
labour. client having
to divert her mind. conversation to divert her mind.
relaxed and
cheerful facial 4. Explain every procedure to 4. Every procedure was
expression. client before and after explained to client before and
implementation. after implementation.
5. Communicate all findings to 5. Findings were communicated
client. to client.
44
DIAGNOSIS OUTCOME
CRITERIA
TIME TIME
15/12/20 Risk for Client will 1. Explain to client why she 1. Explanations were made to 15/12/20 Goal fully met
perineal maintain intact should not raise her buttocks client why she should not raise her evidenced by
2:00pm 3:00pm
trauma related perineum whiles bearing down. buttocks whiles bearing down. observation of an
to delivery throughout the intact perineum

2. Encourage client to bear 2. Client was asked to bear down
process. delivery process after delivery.
down when cervical os is fully when cervical os is fully dilated.
evidenced by
dilated.
3. Client was told to bear down
midwife
3. Tell client to bear down with with contractions.
observing intact
contraction.
perineum after 4. The anterior shoulder was
delivery. 4. Deliver the anterior shoulder delivered first before the posterior
before posterior shoulder. shoulder.
5. Ask client to pant when the 5. Client was asked to pant as the
fetal head crowns fetal head crowns.
45
CHAPTER FOUR
4.0 MANAGEMENT OF PUERPERIUM
4.1 DAY OF DELIVERY
Madam A.R delivered her baby boy at 7:35pm on the 20th June, 2017. She and her baby’s
general condition were monitored for the first one hour before they were transferred to
the lying-in ward for further observation.
Mother and baby’s vital signs were monitored every fifteen minutes for the first one hour,
half hourly for the next two hours followed by hourly for the next three hours until
discharged. Immediate (post-delivery) vital signs of mother were recorded as;
Temperature 36.5oC
Pulse 72 bpm
Respiration 20 cpm
Blood pressure 110/70mmHg
46
Madam A.R’s perineal pad was inspected and the lochia was red (rubra) in colour with
moderate flow. Her uterus was well contracted with fundal height of 18 cm above the
symphysis pubis and perineum intact without a tear. She was advised to urinate
frequently and walk about instead of staying in bed, to promote drainage of lochia and
prevent haemorrhage. She was encouraged to wash her hands with soap under running
water before and after changing perineal pad to prevent infection. Madam A.R was
assisted to fix the baby to breast. She was educated on the importance of exclusive
breastfeeding and the need to feed the baby on demand more especially at night since the
breast milk contains all the nutrients the baby needs. She was also made to be aware that
breastfeeding also aids in involution of the uterus and that exclusive breastfeeding could
be used as a family planning method. When the baby was positioned and fixed to breast,
it suckled and swallowed well, implying that his suckling and swallowing reflexes were
present and normal.
She was encouraged to eat foods rich in carbohydrates, protein, vitamin, mineral and
fiber to help repair worn out tissues, gain enough energy and ease passing of stool. She
was served with “tuozafi and neri” soup brought by her sister inlaw. The sister inlaw was
congratulated and sought for her support in caring for the baby by helping Madam A.Rin
doing some of the house hold chores to enable her have enough rest.
The vital signs of the baby were checked and recorded as follows;
Temperature 36.7 oC
Respiration 40 cpm
Apex beat 140 bpm
The baby was later examined from head to toe to exclude any congenital abnormality and
47
birth injuries that might have occurred during birth and no abnormality was detected.
After the examination, findings were communicated to the mother. Injection Bacillus
Calmette Guerin (BCG) 0.05mls and oral Polio two drops were given to the baby.
Madam A.Rwas advised not to apply any chemical or hot compress to the injection site.
She was encouraged to continue with the rest of the immunization at the child welfare
clinic until baby attains five years. Client was made aware that the immunization protects
the baby from childhood diseases.
4.2 BABY’S FIRST BATH AND CORD DRESSING
Baby had his first bath after the six-hour observation.
Madam A.R baby was given his first bath on the 15/12/20 at 8:50pm. The procedure was
explained to client and all the necessary items for the baby bath were collected and the
area for the bath was made ready, water was mixed and temperature of water checked
using my elbow. The baby’s temperature was also checked and recorded as 36.7 oC. A
mackintosh apron was worn with disposable gloves. Baby was placed on a protected flat
surface, undressed and covered with a bath towel. The eyes were cleaned with a sterile
cotton wool swab soaked in sterile water from the inner canthus to the outer and the rest
of the face cleaned with moist towel. The nape of baby’s neck was supported with my left
hand, my thumb and index fingers were then used to plug baby’s ears to prevent water
from entering the ears. The hair was washed in a circular manner with a soapy sponge
until it was cleaned. The soap was rinsed out and baby’s hair was dried with a towel. The
rest of the body that is the neck, arms, chest, trunk, abdomen, buttocks and lower
extremities were also bathed, paying attention to the groins and other skin folds.
48
The body of the baby was totally immersed in a basin of water. Baby was dried up and oil
applied to the head and body to keep baby warm, baby was dress up.
Gloves were removed, and hands were washed and dried and put on sterile gloves for the
dressing of the umbilical cord since the tray was set up for cord dressing. With the cord
clamp intact, cord was held at the stem with one swab soaked in spirit. The skin was
swapped 5cm away and around the base of the cord then swabbed the stem from the base
upwards using a swab for each stroke till cord is clean, then the tip of the cord also
swabbed and left exposed. The findings were recorded and communicated to the mother
as well. They were later informed of their possible discharge.
4.3 FIRST DAY POSTNATAL AND PREPARATION FOR DISCHARGE
The first postnatal day was on the 16th December, 2020. The baby’s general condition
was good. Permission was asked from mother and did head to toe examination on the
baby and no abnormalities were detected during the procedure.
Baby was dressed up and wrapped and placed in his cot. The baby weighed 3.4kg. His
vital signs read as follows;
Temperature 36.6 oC
Apex beat 142bpm
Respiration 40cpm
Madam A.R was also examined from head to toe and no abnormality was detected. The
uterus was well contracted and lochia was red in colour with moderate flow. The breast
was heavy and colostrum discharging from the nipples. She was educated on the need for
post-natal exercise andtaught her how to do it. Her vital signs were monitored and
recorded as follows;
49
Temperature 36.8oC
Pulse 82 bpm
Respiration 22 cpm
Blood pressure 100/70mmHg
The fundal height measured 17cm above the symphysis pubis after she had emptied the
bladder. Client complained of lower abdominal pain at 9:30pm. She was reassured and
the physiology of the pain was explained to her that it was due to the contraction of the
uterus to enable the uterus return to its pre gravid state, 1gram of paracetamol served to
help relieve the pain. She was assisted to pack her belongings in readiness for her
discharge. Prior to her discharge, client was educated on some few health related topics.
She was advised not to apply warm compress to the fontanels and sutures of the baby.
She was to change his diapers and napkins whenever soiled.
Madam A.R was discharged. Her husband and sister in-law were helped to pack her
things. They were encouraged to support her in caring for the baby and they promised to
support her. The following drugs were prescribed for her and she was educated on how
and when to take them;
1. Tablet multivitamin 200mg tds x 30 days
2. Tablet Fersolate 200mg tds x 30 days
3. Tablet folic acid 5g daily x 30 days
4. Tablet paracetamol 1g tds x 7 days.
5. Capsule Amoxicillin 500mg tds x 7 days.
They were told that they will be visited at home to support in the care of both the mother
and baby for the next seven days. They finally left at 10:00pm.
50
4.4 FIRST POSTNATAL HOME VISIT
A visit was made to Madam A.R and her new born baby in the evening at 4:00pm on the
16 December, 2020. They warmly welcomed me and offered me a seat. They were
thanked and asked of their health and found baby and mother in good condition and her
pain has reduced. Permission sought to examine her and the baby.
My hands were washed, dried and baby examined from head to toe noting his anterior
fontanelles for bulging, his posture, colour, respiration and conjunctiva. Nothing
abnormal was noticed. Client was encouraged to observe while Baby was topped and
tailed. The cord was dressed with methylated spirit. The mother said baby suckles well.
The vital signs were checked and recorded as:
4.4.1 BABY:
Temperature 36.6 oC
Respiration 40 cpm
Apex heart beat 140 bpm
Madam A.R was also examined from head to toe. On examination, conjunctiva was clear,
there were no abnormal lumps in the breast; and nipples were neither retracted nor very
long but colostrum was seen discharging from the nipples. Fundal height measured 17cm
above the symphysis pubis; and the uterus was firmly contracted. Her perineal pad was
inspected and the lochia was red in colour with moderate flow without any offensive
odour. Perineum and vulva were clean with no abnormal discharge. Client’s vital signs
were checked and recorded as:
51
4.4.2 MOTHER
Temperature - 36.6oC
Respiration - 22 cpm
Pulse - 80 bpm
Blood pressure - 100/80mmHg
Emphasis was made on the need for the client to eat nutritious diets such as dawadawa,
fish, fruits and vegetables. She was encouraged to practice good personal (perineal)
hygiene to prevent infection. She was to report to the hospital if she noticed any
abnormality such as fever, urinary incontinence, any form of bleeding or severe
abdominal pain. Permission was sought to leave and promised to visit in the evening.
4.3 SECOND DAY POSTNATAL HOME VISIT.
Madam AR was visited again on the 17 th December, 2020. On arrival, she was greeted
and asked of how she and her family were faring. She told me they were in good health.
Madam AR offered me a seat, thereafter; permission was sought to examine the baby.
Hands were washed and dried and undressed the baby. It was realized that the diaper was
below the cord. Client was congratulated for the good effort. On examination, there was
no edema or swelling on the head, no discharge from eyes, ears and nose. Baby was
observed for colour changes and signs of jaundice and no abnormality found.
Preparations were made to top and tail baby, after which hands were washed and dried
before dressing the cord using cotton wool swabs and methylated spirit. The tip of the
cord was held with a swab and cleaned the cord systematically starting from the base to
the tip using one swab at a time. Cord inspected for bleeding but there was no bleeding
52
and cord clamp was well applied. Baby passed stool and urine and was topped and tailed.
His vital signs were checked and recorded as:
4.3.1 MORNING
BABY
Temperature - 36.9 oC
Apex beat - 130 bpm
Weight - 3.2 kgs
Madam A.R was examined from head to toe, no abnormality detected. Uterus was firm,
well contracted and measured 16cm above the symphysis pubis. Lochia was red with
moderate flow. She was educated on the importance of postnatal exercise, after which she
was assisted to perform them, in order to regain the tone of the pelvic floor muscles. Her
vital signs were checked and recorded as;
MOTHER
Temperature 36.8oC
Pulse 82 bpm
Respiration 22 cpm
Blood Pressure 100/60mmHg
They were wished well and sought permission to leave and was seen off to the gate.
4.3.2 EVENING
Madam A.R and family were visited again in the evening. They were happy to see me.
53
They were greeted and enquired about their health. They were fine. The procedure was
explained to her, washed and dried my hands and examined the baby from head to toe.
The anterior fontanelle was not bulging, no discharge from the eyes and ears. Breathing
pattern was normal with pink skin colour without any rash. Baby was topped and tailed
and the cord dressed using sterile cotton wool swab and methylated spirit. Baby was
wrapped with cot sheet and given to the mother to suckle. His vital signs were checked
and recorded as;
BABY
Temperature 36.5 oC
Apex beats 130 bpm
Respiration 40 cpm
Weight 3.2 kgs
Madam A.R was examined from head to toe. Her hair was clean and scalp was without
dandruff. Conjunctiva was pink, no discharge from ears and nose. Her breasts were
heavy. Uterus was firm and well contracted. Fundal height measured 16cm above the
symphysis pubis. Lochia was red, the flow was moderate and not offensive. She was
educated on sleeping under insecticide treated bed net. Her vital signs were checked and
recorded as:
MOTHER
Pulse - 80 bpm
54
Madam A.R said she had no problem. She was reminded of her visit to the clinic the next
day. She said she would make it and I left.
4.4 THIRD DAY POSTNATAL CLINIC VISIT
Client visited the clinic on the third day after delivery on 18 th December, 2020. The
mother and baby were looking healthy, cheerful and nicely dressed. She was
accompanied by her husband. The purpose for this visit was to examine them to detect or
exclude any abnormality that might have occurred within the first three days of delivery.
Registration was done and got the baby a card. Baby was undressed and wrapped in a cot
sheet ready to be examined. The procedure was explained to the mother. Hands washed
and dried and the head was examined for swelling, but found none. No discharges from
eyes, ears and nose and the skin were pink with no rashes or bruises. The extremities and
back were examined with no abnormalities observed.
The abdomen was soft and not distended. The umbilical cord was dry and clean. My
hands were washed and dried and the cord was dressed using cotton wool swabs and
methylated spirit. Cord was held at the tip with a swab and cleaned systematically
starting from the base to the tip using one swab at a time. Cord was inspected for
bleeding but there was no bleeding and cord clamp was well applied. The baby’s vital
signs were checked and recorded as:
BABY
Respiration - 42 bpm
Apex beat - 136 bpm
55
Weight - 3.1 kgs
Madam A.R was asked to empty her bladder before physical examination. Privacy was
provided by using a screen. Hands were washed and dried and client was assisted to lie
on the examination couch. Her hair was clean, conjunctiva was pink and ears, nose and
mouth were clean without discharges or abnormality. Her breast was soft and lactated
very well. Her nipples were not cracked. Uterus was firm and well contracted. Fundal
height measured 15cm above the symphysis pubis. Her back and extremities were
examined but no abnormality was found. All findings were communicated to her and
recorded in the postnatal record book. Vital signs for mother read as follows:
MOTHER
Pulse - 84 bpm
Weight - 62 kgs
Her urine was tested to be negative; she also did laboratory investigations on
haemoglobin and it was 11.6g/dl and also for malaria parasites which was also negative.
Breastfeeding on demand was emphasized as it helps in promoting good maintenance of
lactation, and also prevents breast engorgement. She said she has backache during breast
feeding. She was therefore educated on good positioning and attachment of the baby to
breast, she was educated to sit straight with her back supported whenever she is
breastfeeding and take nutritionally adequate diet as advised during the lying in period.
56
She was encouraged to go to the registrar of births and deaths to register the baby. She
was told to report immediately to the clinic if she saw signs of ill-health in herself or the
baby.
After that, she was thanked for coming and she was told to come back to the clinic in the
next 4 days’ time when she will be handed over to the public health nurse for continuity
of care and bid her goodbye.
EVENING
Client was visited in the evening; both mother and baby were examined with no
abnormalities detected. Baby was top and tailed and vital signs checked and recorded as
follows;
BABY
Apex beat - 136 bpm
Weight - 3.1 kgs
MOTHER
Pulse - 84 bpm
57
Weight - 62.1 kgs
Client was informed that, on the fourth, fifth and sixth day, they would be visited once a
day.
4.5 FOURTH POSTNATAL HOME VISIT
On the 19th December, 2020 at 5:00pm, Madam AR was visited. On arrival, they
welcomed me, gave me a seat and water to drink, their health was asked of and she said
they were fine and doing well as she was relief of the backache. However, she
complained of not getting enough sleep due to baby crying and suckling more at night.
She was reassured and explained to her that breast milk contains all the nutrients needed
for the proper growth and nourishment of the baby. Breastfeeding exclusively on demand
and more at night will help protect her against unwanted pregnancy for six months. She
should therefore try to meet the baby’s demand. Her mother was encouraged to help in
taking care of the baby especially during the day so that the client could also have some
rest.
Hands were washed and dried and baby examined from head to toe and no abnormalities
detected. He passed greenish yellow stool.
Baby was given topped and tailed bath. Hands were washed and dried and sterile gloves
worn. The cord was cleaned with swabs soaked in methylated spirit. The baby was
dressed up and wrapped and given to his mother to breastfeed. The baby’s vital signs
were taken and recorded as;
Apex heart beat - 139 bpm
58
Baby’s weight - 3.2 kgs
The mother was also examined. The conjunctiva, nose, mouth and tongue were inspected
and no abnormality was found. The abdomen was palpated and the symphysiofundal
height was 14cm, perineal pad was inspected and lochia was pink with moderate flow.
Her vital signs were checked and recorded as follows;
Pulse - 76 bpm
Blood pressure - 110/60mmHg.
4.6 FIFTH DAY POSTNATAL HOME VISIT.
On the fifth day (20th December, 2020) at about 6:00am, Madam AR was visited. They
were all faring well. She said the baby’s cord fell off that night. The umbilicus stump was
cleaned with sterile cotton wool swabs and spirit. The mother was advised to change the
baby’s soiled nappies regularly and apply nappy below the umbilicus. She was also
advised not to apply any local herbs on the stump as this can cause infection. She was
asked for permission to bath the baby and also to guide the mother to do baby bath. The
procedure was explained to the mother. Water was mixed and the temperature was tested
with my elbow and all items needed for the bathing were assembled and baby was
bathed. The baby was covered with a clean towel and dried her up paying more attention
to the skin folds. Oil was applied on baby’s body and Vaseline on the hair after which it
was combed. He was dressed up, put on a new nappy on him and wrapped him in a clean
59
cot sheet.
The baby’s vital signs were checked and recorded as follows;
BABY
Apex heart rate - 138 bpm
Weight - 3.3 kgs
Madam A.R was examined from head to toe after emptying her bladder. There were no
abnormalities detected. Lochia had changed to serosa (pink). Her perineum, upon
inspection was also neat. Her fundal height also reduced to 13cm. Vital signs checked
and recorded as follows;
MOTHER
Pulse - 78 bpm
My client complained of pain and tenderness in her breast. She was reassured, the
physiology of breast engorgement was explained to her and she was supervised to
properly position and attaches the baby to breast. She was encouraged to empty one
breast at a time, continue breastfeeding on demand and support the breast with a well-
fitting brassiere. She was reminded on personal hygiene, enough rest and sleep, good
nutrition and its effects on lactation. They were thanked and bid good bye.
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4.7 SIXTH DAY POSTNATAL HOME VISIT
21th DECEMBER, 2020 was Madam A.R’s 6th day postnatal and they were visited at
5:30pm. On arrival, the mother had bathed the baby. They were asked of their condition
of health and Madam A.R said they were doing well but she complained of constipation.
She was advised to eat more fruits, vegetables, and fluids to improve bowel action. She
also said that, she is now relieved of the breast engorgement since she took heed to the
advice given to her.
Her mother said baby passed yellowish stool before his bath. Baby’s vital signs were
taken and recorded as follows;
BABY
Pulse - 120 bpm
Weight - 3.4 kgs
MOTHER
Pulse - 80 bpm
Respiration - 20cpm
Blood pressure - 100 /70mmHg
Madam A.R’s fundal height was measured and it had reduced to 12cm, lochia changed
from pink to brown with moderate flow, and no odor. On history taking, condition of
61
mother and baby were good. They were thanked for their cooperation and left.
4.8 SEVENTH DAY POSTNATAL CLINIC VISIT.
Client visited the clinic on the seventh day after delivery as she was told, and it was 22 nd
December, 2020. The mother and baby were looking healthy, cheerful and nicely dressed.
She was accompanied by her sister in-law. The purpose for this visit was to examine
them to detect or exclude any abnormality that might have occurred within the second
week of life and also to come for immunizations.
Baby was undressed and wrapped in a cot sheet ready to be examined. The procedure
was explained to the mother. Hands were washed and dried and the head was examined
for swelling, but found none. No discharges from eyes, ears and nose and the skin were
pink with no rashes or bruises.
The abdomen was soft and not distended. The umbilical stump was completely healed.
The extremities and back were examined with no abnormalities observed. The baby’s
vital signs were checked and recorded as:
BABY
Apex beat - 136 bpm
Weight - 3.5 kgs
Madam A.R was asked to empty her bladder before physical examination. Privacy was
provided by using a screen. Hands were washed and dried and assisted client to lie on the
62
examination couch. Her hair was clean, conjunctiva was pink and ears, nose and mouth
were clean without discharges or abnormality. Her breast was soft and lactated very well.
Her nipples were not cracked. Her back and extremities were examined but no
abnormality was found. Madam A.R’s fundal height was measured and it had reduced to
11cm, lochia changed from pink to brown with moderate flow, and no odor. All findings
were communicated to her and recorded in the postnatal record book. Vital signs for
mother and weight were recorded as follows:
MOTHER
Pulse - 79 bpm
Weight - 62.6 kgs
Her urine was tested to be negative and haemoglobin 11.6g/dl.
Breastfeeding on demand was emphasized as it helps in promoting good maintenance of
lactation and also prevents breast engorgement. She was reminded of the importance of
child spacing and the need to go for family planning. She was also reminded to maintain
a good personal hygiene and to eat nutritionally adequate diet. Madam ARsaid she has
registered the birth of her baby with the births and deaths registrar. She was told to report
immediately to the clinic if she saw signs of ill-health in herself or the baby.
After that, she was thanked for coming and was told to come back to the clinic in 4 weeks
for another examination. Her care was terminated and she was handed over to the Public
63
health nurse for continuity of care. They were bid goodbye
64
4.9 NURSING CARE PLAN DURING PUERPERIUM
4.9.1 PROBLEMS IDENTIFIED
1. Client complained of lower abdominal pain …………..16/12/2020
2. Client said she had backache……………………………18/12/2020
3. Client complained that she could not sleep………………19/12/2020
4. Client complained of engorged breast…………………… 20/12/2020
5. Client complained of constipation ………………………..21/12/2020
1. Alteration in comfort (lower abdominal pain) related to uterine contraction.
2. Alteration in comfort [backache] related to improper posture during breastfeeding.
3. Sleep pattern disturbance related to baby crying and feeding at night.
4. Breast engorgement related to inability to empty breast during breastfeeding.
5. Alteration in bowel movement (constipation) related to painful perineum.
1. Client will experience relieve of lower abdominal pain within 72 hours.
2. Client will experience relieve of backache within 24 hours.
3. Client will regain normal sleep pattern (have at least 6 hours of sleep at night and 2
hours of sleep during the day) within 24 hours.
4. Client will experience relieved of breast engorgement within 72 hours.
5. Client will resume normal bowel movement within 24 hours.
65
4.9.4 LONG TERM OBJECTIVES
1. Client will demonstrate socially, mentally and physically fit to be able to breastfeed
and care for her baby.
2. Client will assume normal duties after puerperium.
66
3.0 TABLE 3: NURSING CARE PLAN DURING PUERPERIUM
DATE/ NURSING OBJECTIVE/ NURSINGORDERS NURSING DATE/ EVALUATION SIGN

OUTCOME INTERVENTIONS
TIME DIAGNOSIS TIME
CRITERIA
16/12/2 Alteration in Client will 1. Reassure client and explain 1. Client reassured and causes 19/12/20 Goal fully met
0 comfort (lower experience relief the cause of the pain to her. of waist pain explained to her. evidenced by
At
abdominal of lower client verbalized
At 2. Encourage client to continue 2. Client encouraged to
8:15am
pains) related abdominal pain that she had been
breastfeeding. continue breastfeeding.
to uterine within 72 hours relieved of pain.
3. Educate client to apply 3. Client educated to apply
8:15am contractions. as evidenced by
warm compress to the lower warm compress to the lower
client verbalizing
abdomen. abdomen.
she is relieved of
pain. 4. Encourage client to urinate 4. Client encouraged to urinate
frequently. frequently.
5. Serve prescribed analgesics. 5. Prescribed analgesics were
served.
NURSING CARE PLAN DURING PUERPERIUM
67
OUTCOME INTERVENTIONS
TIME DIAGNOSIS TIME
CRITERIA
18/12/20 Alteration in Client will 1. Explain to client and the 1. The possible causes of back 19/12/20 Goal fully
comfort experience possible cause of her backache. ach were explained to client. achieved as
At At
( backache) relief of evidenced by
2. Educate client on the need to 2. Client was educated on the
related to poor backache within client verbalizing
adopt a good posture when need to adopt a good posture
9:30am posture during 24 hours as 9:00am she had been
feeding baby. when breastfeeding baby.
breast feeding evidenced by relieved of
3. Educate client to sleep on a 3. Client was educated to sleep
client backache.
firm mattress. on a firm mattress.
verbalizing that
she is relieved 4. Educate client to support her 4. Client was educated support
of backache. back with pillow. her back with pillows.
5. Serve client with 1gram 5. Client was served with 1g of
ofparacetamol as prescribed to paracetamol as prescribed to
help relieve pain. help relieve pain.

DATE/ NURSING OBJECTIVE/ NURSING NURSING DATE/ EVALUATION SIGN
68
TIME DIAGNOSIS OUTCOME ORDERS INTERVENTIONS TIME
CRITERIA
19/12/20 Sleep pattern Client will regain 1. Inform client on the 1. Client was informed on the 20/12/20 Goal fully met
disturbance normal sleep causes of insomnia. causes of insomnia. evidenced by

At At
(insomnia) pattern within 24 midwife’s
2. Educate client to sleep 2. Client was educated to sleep
5:00pm
related to hours as evidenced observation of
during the day when the during the day when the baby is
5:00pm baby crying by midwife’s client having at
baby is asleep. asleep.
and feeding at observation of least 8 hours of
3. Educate her to change 3. Client was educated to
night. client having at sleep in the night
wet nappies of baby before change wet nappies of baby
least 8 hours of and 2 hours of
sleep especially at night. before sleep especially at night.
sleep in the night sleep during the
and 2 hours of sleep 4. Encourage family 4. Family members was day
during the day members to support in encouraged to support in caring
caring for baby. for the baby.

TIME DIAGNOSIS OUTCOME INTERVENTION TIME
69
CRITERIA
20/12/20 Alteration in Client will be 1. Reassure client and explain 1. Client was reassured and 23/12 /20 Goal fully met as
at 6:00 body comfort relieved of the cause of breast cause of breast at 6:00am evidenced by
engorgement explained to
am [breast breast engorgement to her client verbalizing
her
engorgement] engorgement 2. Advise her to feed baby on 2. Client was advised to feed pain in breast has
related to within 72hours demand, ensuring that she baby on demand, ensuring subsided
that she empties one breast
inadequate evidenced by empties one breast at a time
at time
emptying of client 3. Teach her proper 3. She was taught on proper
breast verbalizing pain positioning and attachment positioning and attachment
of baby to breast of baby to breast
in breast has
4. Encourage client to express 4. Client was encouraged to
subsided breast milk when breast is express breast milk when
too full breast is too full
5. Advise client to support 5. Client was advised to
breast with well-fitting support breast with well-
brassiere. fitting brassiere.
6. Encourage client to allow 6. Client was encouraged to
baby empty one breast allow baby empty one
before giving the other breast before giving the
breast. other breast.

OUTCOME INTERVERTIONS
TIME DIAGNOSIS TIME
70
CRITERIA
21/12/20 Alteration in Client will 1. Explain the condition to the 1. Condition was explained to 22/12/20 Goal fully met
At bowel resume normal client to relieve her. the client. At evidenced by
movement bowel movement 2. Encourage client to take in 2. Client encouraged to take in 6:00am client verbalized
6:00pm (constipation) within 12 hours more fluids and diet rich in more fluids and diet rich in that she moved
related to as evidenced by fibre. fibre. her bowel one a
painful client verbalizing 3. Advice client to take a lot of 3. Client was advised to take a day.
perineum. being able to fruits. lot of fruits.
pass stool. 4. Educate client on moderate 4. Client educated on moderate
exercise early in the exercise early in the
morning (kegel exercise). morning (kegel exercise).
5. Encourage to avoid delaying 5. Client encouraged to avoid
when ever she feels like delaying when ever she
going to toilet. feels like going to toilet.

This is the period in which the relationship between the student midwife and client comes to an end. This usually starts from the first
contact with client. Termination of care with Madam AR started on the 2nd of June, 2020 when we met at Afrikids Medical centre. She
was informed and assured of quality care throughout pregnancy, labour and puerperium but was told that care will be terminated on the
7th day after delivery and handed over to the Public Health Unit for continuity of care.
71
She was finally handed over to the community health nurse on the 22 nd December, 2020. She was reminded to attend child welfare clinic
at 6th week for immunization against the childhood preventable diseases and growth monitoring. She was also reminded to register the
baby at the birth and death registry after the naming ceremony. She was told I may not be able to visit her frequently but will comes once
a while to check on them. The necessary information was handed over the to the Community Health Nurse for the continuity of care.
Madam A R and the family were thanked once again for their co-operation during the period of my care study.
72
4.11 SUMMARY
The script is a family centered maternity care rendered to Madam A.R a 27-year-old
gravida 2 para 1 alive, from Yarigabisi in the Upper East Region of Ghana. She lives with
her husband and child. She started her antenatal at 8 weeks on the 2 nd June, 2020. She
was first met at the antenatal clinic of Afrikids Medical Centre when she was 36 weeks
pregnant.
Home visits, one on one interaction, various observation and general examinations
including physical, laboratory investigations were carried out to aid in a successful
family centered care. She went through pregnancy with certain minor disorders which
were managed successfully. Her labour and delivery were managed with a partograph
without complications and she delivered spontaneously per vagina, an alive healthy Male
infant with a birth weight of 3.4 kgs on 15th December, 2020 successfully.
Mother and baby were handed over to the Public health nurse in charge after the 7 th
postnatal clinic visit on the 22th December, 2020. Members of the family were actively
involved in the care and goals and objectives were fully achieved at the stipulated times.
73
4.12 CONCLUSION
The family centered maternity care has given me the opportunity to recognize the various
needs of individuals during pregnancy, labour and puerperium. The knowledge acquired
has given me a better understanding into the care of the client, and this would be
transferred to others in the course of my midwifery career. It has enabled the student to
put into practice, the knowledge obtained from her years of training in the Midwifery
Training school. It is the hope of the student that more efforts are made by relevant
stakeholders of health and nursing to put into practice the nursing process approach to
client and family care in order to achieve quality health care service in the country.
74
APPENDIX I: MATERNAL RECORDS
75
APPENDIX II: LABORATORY INVESTIGATIONS
DATE SPECIMEN LABORATORY RESULT NORMAL REMARKS
2/06/20 Blood Haemoglobin 11.5gldl 11.5-16gldl Not good
24/11/20 Blood Haemoglobin 11.8gldl Better
15\12/20 Blood Haemoglobin 12.6g/dl Normal
2/06/20 Blood VDRL/PRP Non- Non- Normal

reactive reactive
2/6/20 Blood Blood group B+ Normal Normal
2/6/20 Blood Rhesus factor Rhesus Normal Normal

positive
02/06/20 Urine Protein and Negative Negative Normal

acetone
2/06/20 Blood Malaria parasite Negative Negative Normal
2/06/20 Blood HIV test Non- Non- Normal

reactive reactive
76
APPENDIX III: PARTHOGRAPH
77
APPENDIX IV: APGAR SCORE
ASSESSMENT ONE MINUTE FIVE MINUTES
Appearance 2 2
Pulse 2 2
Grimace 1 1
Activity 1 2
Respiration 2 2
TOTAL 8/10 9/10
78
APPENDIX V: DURATION OF LABOUR
STAGES TIME DURATION
First stage 8 : 25 am – 1: 55pm 5hours, 20minutes
Second stage 1 : 55 pm – 2 : 20 pm 25 minutes
Third stage 2 : 20 pm – 2 : 30 pm 10 minutes
Total hours of labour 5 hours, 10 minutes
LABOUR NOTES ON MOTHER AND BABY
Date of delivery 15/12/2020
Time of delivery 02:30pm
Type of delivery Spontaneous vaginal delivery
Time of delivery of placenta 2:45pm
Oxytocin (10units) given
Blood Loss 250mls
Condition of mother after delivery
Temperature 36.1 oC
Pulse rate 72 bpm
Respiration 20 cpm
Blood Pressure 110/70mmgH
General condition of mother Good
Fundal height 18cm
Perineum Intact
79
Condition of baby
General condition Good
Sex of baby Male
Weight 3.4kg
Apgar Score First minute 8/10
Fifth minute 9/10
80
APPENDIX VI:EXAMINATION OF PLACENTA
Circumference 60 centimeters
Weight 450g
Diameter 20 centimeters
Cord length 50 centimeters
Cord insertion centrally inserted
Cord vessels 1 vein and 2 arteries
Lobes and membranes Intact, complete and healthy
Maternal surface Dark red
Fetal surface Greyish blue
81
APPENDIX VII: SIX HOUR OBSERVATION OF BABY
DATE TIME APEX BEAT RESPIRATION TEMPERATU COLOU MECONIU URIN CORD
(beats per (cycle per RE R M E FOR
minute) minute) (degrees BLEEDIN
Celsius) G
15/12/20 3:00pm 123 40 36.0 0C Pink Passed Not

bleeding
15/12/20 3:15pm 120 42 36.4 0C Pink Not
bleeding
15/12/20 3:30pm 118 40 36.2 0C Pink Not
bleeding
0
15/12/20 3:45pm 118 42 36.3 C Pink Not
bleeding
0
15/12/20 4:15pm 120 44 36.2 C Pink Passed Not
bleeding
15/12/20 4:45pm 120 44 36.2 0C Pink Not
bleeding
15/12/20 5:15pm 118 40 36.4 0C Pink Not
bleeding
0
15/12/20 5:45pm 120 40 36.2 C Pink Not
bleeding
0
15/12/20 6:45am 120 42 36.2 C Pink Not
bleeding
15/12/20 7:45am 122 42 36.1 0C Pink Not
bleeding
82
15/12/20 8:45am 120 42 36.4 0C Pink Not
bleeding
83
APPENDIX VIII: SIX HOURS OBSERVATION ON MOTHER
DATE TIME BLOOD TEMPERATU PULSE RESPIRATION LOCHIA STATE OF CONDITION

PRESSURE RE UTERUS
(BEATS PER (CYCLE PER
0
(mmHg) ( C) MINUTE) MINUTE)
15/12/20 3:00pm 100/70mmHg 36.10 C 72 bpm 20cpm Moderate Well contracted Good
15/12/20 3:15pm 110/60mmHg 36.0 0 C 84 bpm 22 cpm Moderate Well contracted Good
15/12/20 3:30pm 110/70mmHg 36.0 0 C 84 bpm 22 cpm Moderate Well contracted Good
15/12/20 3:45pm 100/60mmHg 36.2 0 C 80 bpm 20 cpm Moderate Well Contracted Good
15/12/20 6:45am 100/60mmHg 36.0 0 C 78 bpm 22 cpm Moderate Well Contracted Good
15/12/20 7:45am 100/60mmHg 36.20C 76bpm 22cpm Moderate Well contracted Good
15/12/20 8:45am 110/70mmHg 36.5 0 C 70 bpm 18 cpm Moderate Well Contracted Good
84
APPENDIX IX: BABY’S WEIGHT CHART
85
APPENDIX X: REPORT ON THE MOTHER
86
APPENDIX XI: TABLE FIVE: PHARMACOLOGY OF DRUG
DRUG CLASSIFICATION DOSAGE ROUTE OF MODE OF SIDE REMARKS

OF DRUG OF DRUG ADMINISTRATION ACTION EFFECTS
NAME
Tablet Haematinics 200mg daily Orally To increase 1. Dark stool. 1. Client

Fersolate for 30 days haemoglobin passed dark
level in the 2. stool.
treatment of Gastrointestinal
iron disturbances. 2.
deficiency E.g. Diarrhea, Haemoglobin
anaemia. constipation. level of client
increased.
Tablet Analgesics and 1gm 3 times Orally Helps to Prolonged use Client’s pain
Paracetamol Antipyretics daily relieve pain caused liver was relieved.
and body and kidney
temperature. damage.
Tablet Anti-malaria 3 tablets for Orally Treatment 1. Anorexia Client was

sulphadoxine prophylaxis 5 and protected from
pyrimethamine consecutive prevention of 2. Dizziness malaria
months after malaria in 3. Headaches. without any
quickening pregnancy. side effects.
Injection Oxytocin agent 10 units Intramuscularly on the Stimulate No side effect Uterus was
Syntocinon thigh. uterine observed. well
contraction contracted
and prevent without any
bleeding.
87
Use for bleeding.
induction and
argumentatio
n of labour.
Methylated Antiseptic Quantity External use Maintenance Causes None

spirit needed of epithelia irritation in
and some
prevention of individuals.
infection.
Tablet Antihelminthic 400mg start Orally For treatment 1. Gastrointest Client was
Albendazole of intestinal inal protected from
Once worms. discomfort. worm
Eg diarrhoea
infestation
Injection Vaccine 0.05mls Intradermal right Stimulates Productions of Small popular
Bacillus shoulder production of antibodies which persist
calmette antibodies against for some
Guerine (BCG) against Tuberculosis weeks
Tuberculosis (TB)
Injection Antitetanol Vaccine 0.5ml Intramuscular or Stimulate the Fever Prevention of

tetanus
tetanus subcutaneous formation of
deptheria antibiotics
88
against
tetanus
organism
Polio O Live attenuated 2 drops Oral Stimulates Fever Used to
Vaccine Vaccine body to Gastro- prevent
produce anti- intestinal upset poliomyelitis
bodies
Capsule Vitamin Preparation 200,000lu Oral Prevention of Help in good
Vitamin A start and night vision,
repeated blindness, strengthens
after helps bones bone formation
24hours and teeth
formation
Chloramphenic Prophylaxis against 1 – 2 drops Eye drop instillation Prophylaxis No side effect None
ol neonatal against observed.
Eye drops conjunctivitis. neonatal
conjunctivitis
89
BIBLIOGRAPHY
Alan H. Decherney, Lauren Nathan, Neri Laufer and Ashley s. Roman (2013), Current
Diagnosis and Treatment, Obstetrics and Gynecology (11TH edition)
Client’s Maternal Health Record Book, Registration No 2017/50, Walewale district hospital
Fraser, M., D. and Cooper, A., M. (2016),Myles Textbook for Midwives (16 th Edition), London,
Churchill Livingstone. Myles Textbook for Midwives
Jayne Marshall and Maureen Rayno, (2014), Myles Textbook for midwives (sixteenth edition).
International editionnational safe motherhood service protocol.
Labour and Delivery (August 2000), Reproductive Health Classroom and Clinical
ActivityGuide For Training Midwives, Accra
Waller, F.B (2009); Baillie're’s Nurses Dictionary, (23rd Edition), Edinburgh, Churchill
Livingstone.
Verrals S. (1997); Anatomy and Physiology Applied to Obstetric, (3rd Edition), Edinburgh,
Churchill Livingstone.
90
SIGNATORIES
91

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FAMILY CENTERED MATERNITY CARE STUDY

DURING ANTENATAL, LABOUR AND PUERPERIUM

A FINAL YEAR MIDWIFERY STUDENT OF

COLLEGE OF NURSING AND MIDWIFERY SCHOOL, NALERIGU

SUBMITTED TO NURSING AND MIDWIFERY COUNCIL OF

GHANA IN PATIAL FULFILMENT OF THE REQUIREMENT FOR

THE AWARD OF LICENSE TO PRACTICE AS A REGISTERD MIDWIFE

AFRIKIIDS MEDICAL CENTRE,

Family centered maternity care study is a systematic approach in which comprehensive

woman is a unique individual with problems and needs.

complications which may develop during pregnancy.

family throughout pregnancy, labour, and puerperium.

of their two years training.

wisdom and the life given to me throughout the period of my study.

providing guidance and correction of the care study.

their cooperation and assistance throughout the care study.

during this write up.

I say thank you and God bless you all.

WHY I CHOSE MY CLIENT............................................................................................xi

PERSONAL AND SOCIAL HISTORY......................................................................1

HABITS OF DAILY LIVING......................................................................................1

PAST OBSTETRIC HISTORY....................................................................................3

PRESENT OBSTETRIC HISTORY...........................................................................5

FIRST CONTACT WITH CLIENT............................................................................7

FIRST HOME VISIT..................................................................................................10

SECOND ANTENATAL VISIT.................................................................................11

SECOND HOME VISIT.............................................................................................13

SUBSEQUENT VISIT TO THE CLINIC.................................................................14

NURSING CARE PLAN DURING ANTENATAL CARE.....................................15

LONG TERM OBJECTIVES.....................................................................................16

TABLE ONE: NURSING CARE PLAN DURING ANTENATAL........................17

ADMISSION AND MANAGEMENT OF FIRST STAGE OF LABOUR.............22

MANAGEMENT OF SECOND STAGE OF LABOUR..........................................29

IMMEDIATE CARE OF THE NEWBORN.............................................................31

MANAGEMENT OF THE THIRD STAGE OF LABOUR....................................32

EXAMINATION OF THE PLACENTA...................................................................33

MANAGEMENT OF FOURTH STAGE OF LABOUR..........................................34

SUBSEQUENT CARE OF THE BABY/EXAMINATION OF THE NEWBORN

SUMMARY OF LABOUR NOTES...........................................................................36

PROBLEMS IDENTIFIED DURING LABOUR AND DELIVERY.....................38

SHORT TERM OBJECTIVES..................................................................................39

LONG TERM OBJECTIVES.....................................................................................39

TABLE TWO: NURSING CARE PLAN DURING LABOUR...............................40

FIRST DAY POSTNATAL AND PREPARATION FOR DISCHARGE..............48

FIRST POSTNATAL HOME VISIT.........................................................................50

SECOND DAY POSTNATAL HOME VISIT..........................................................51

THIRD DAY POSTNATAL CLINIC VISIT............................................................54

FOURTH POSTNATAL HOME VISIT....................................................................57

FIFTH DAY POSTNATAL HOME VISIT...............................................................58

NURSING CARE PLAN DURING PUERPERIUM................................................63

SHORT TERM OBJECTIVES..................................................................................63

LONG TERM OBJECTIVES.....................................................................................64

APPENDIX I: MATERNAL RECORDS..................................................................73

APPENDIX II: LABORATORY INVESTIGATIONS....................................................74

APPENDIX III: PARTHOGRAPH...................................................................................75

APPENDIX IV: APGAR SCORE.....................................................................................76

APPENDIX V: DURATION OF LABOUR.....................................................................77

APPENDIX VI:EXAMINATION OF PLACENTA.........................................................79

APPENDIX VII: SIX HOUR OBSERVATION OF BABY.............................................80

APPENDIX VIII: SIX HOURS OBSERVATION ON MOTHER...................................81

APPENDIX IX: BABY’S WEIGHT CHART..................................................................82

APPENDIX X: REPORT ON THE MOTHER.................................................................83

APPENDIX XI: TABLE FIVE: PHARMACOLOGY OF DRUG...................................84