CARE OF MOTHER AND CHILD

MODULE 1

1.1 CFRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING

 Primary goal of Maternal and Child Health Nursing: Promotion and maintenance
of optimal family health to ensure cycle of optimal childbearing and child rearing.

SCOPE OF PRACTICE:
1. Preconceptual Health care
2. Care of women during three trimesters of pregnancy and puerperium ( the 6
weeks after childbirth)
3. Care of infants (perinatal period)
4. Care of children (birth – young adulthood)
5. Care in settings (birthing room, Pediatric Intensive Care Unit (PICU) or home

A PHILOSOPHY OF MATERNAL AND CHILD HEALTH NURSING:

 Family centered, (Assessment should include the family as well as the individual)
 Community centered, (The health of the families is both affected by and
influences the health of communities.)
 Evidenced based,(Critical knowledge increases )
 A challenging role for nurses and a major factor in keeping families well and
optimally functioning
 A Maternal and Child Health Nurse:
‒ Considers the family as a whole and as a partner in care
‒ Serves as an advocate
‒ Demonstrates a high degree of independent nursing functions
‒ Promotes health and disease prevention
‒ Serves as an important resource for families
‒ Respects personal, cultural and religious attitudes and beliefs
‒ Encourages developmental stimulation
‒ Assess families for strengths as well as specific needs or challenges
‒ Encourages family bonding
‒ Encourages early hospital discharge options
‒ Encourages families to reach out to their community

MATERNAL AND CHILD HEALTH GOALS AND STANDARDS: NATIONAL

HEALTH GOALS
 In order to achieve an optimal health for the Filipino family health goals are made,
in which in the Philippines, we have these directions for the health sector:
 Though the country’s health status has significantly improve as evidenced by:
maternal and child health services have improved, more children living beyond
infancy, higher number of women delivering in health care facilities and more
births are attended by professional service providers. By means of sustaining
and improving we must be guided by these goals
 The governments vision for the Philippines has been translated by the DOH into
the Philippine Health Agenda 2016-2022 which is the All for Health towards
health for all./ lahat para sa kalusugan ! Tungo sa kalusugan para sa lahat.
TRANSITIONING FROM THE MDGS TO THE SDGS:
 In 2015 a set of Sustainable Development Goals (SDGs) replaced the
Millennium Development Goals.
‒ The 2030 Agenda for Sustainable Development brings together the three
aspects of sustainable development – the economic, environmental and
social - and includes 17 Global Goals, 169 targets and 230 indicators that
apply to all countries, with the aim of achieving them by the year 2030.
 LEAVE NO-ONE BEHIND
‒ A central part of the 2030 Agenda for Sustainable Development is the
commitment to ensure that the benefits of achieving the goals are
felt by everyone equally, including those hardest to reach. (such as
persons with disabilities, people living with HIV, older persons,
indigenous peoples, refugees, internally displaced persons and
migrants.)
 VOLUNTARY NATIONAL REVIEWS
‒ UN member countries are encouraged to conduct regular progress
reports, called Voluntary National Reviews, reviewing the progress
the country has made to date at a national and sub-national level.

1. Sustainable Development Goal 1: NO POVERTY

 “End poverty in all its forms everywhere.”
 SDG 1 is to end extreme poverty globally by 2030.
 Poverty is more than the lack of income or resources: People live in poverty if
they lack basic services such as healthcare, security, and education. They
also experience hunger, social discrimination, and exclusion from decision-
making processes.

2. Sustainable Development Goal 2: ZERO HUNGER

 "End hunger, achieve food security and improved nutrition, and promote
sustainable agriculture".
 Goal 2 states that by 2030 we should end hunger and all forms of malnutrition.
 This would be accomplished by doubling agricultural productivity and incomes
of smallscale food producers (especially women and indigenous peoples), by
ensuring sustainable food production systems, and by progressively
improving land and soil quality. This would be accomplished by doubling
agricultural productivity and incomes of small-scale food producers
(especially women and indigenous peoples), by ensuring sustainable food
production systems, and by progressively improving land and soil quality.
 Chronic malnutrition, which affects an estimated 155 million children
worldwide, also stunts children's brain and physical development and puts
them at further risk of death, disease, and lack of success as adults.

3. Sustainable Development Goal 3: GOOD HEALTH AND WELLBEING

 "Ensure healthy lives and promote well-being for all at all ages.“
 Aims to reduce under-five mortality to at least as low as 25 per 1,000 live
births.
 Aims to reduce maternal mortality to less than 70 deaths per 100,000 live
births.
 Aims to achieve universal health coverage, including access to essential
medicines and vaccines.
 Goal 3 will be to reduce adolescent pregnancy (which is strongly linked to
gender equality), provide better data for all women and girls, and achieve
universal coverage of skilled birth attendants

4. Sustainable Development Goal 4: QUALITY EDUCATION

  "Ensure inclusive and equitable quality education and promote lifelong
learning opportunities for all.“
 Ensure that, by 2030, all girls and boys complete free, equitable, and quality
primary and secondary education.

5. Sustainable Development Goal 5: GENDER EQUALITY

 "Achieve gender equality and empower all women and girls.“
 Providing women and girls with equal access to education, health care,
decent work, and representation in political and economic decision-making
processes will nurture sustainable economies and benefit societies and
humanity at large.

6. Sustainable Development Goal 6: CLEAN WATER AND SANITATION

 "Ensure availability and sustainable management of water and sanitation for
all.“
 Safe drinking water and hygienic toilets protect people from disease and
enable societies to be more productive economically

7. Sustainable Development Goal 7: AFFORDABLE AND CLEAN ENERGY

 "Ensure access to affordable, reliable, sustainable and modern energy for all."
 Targets for 2030 include access to affordable and reliable energy while
increasing the share of renewable energy in the global energy mix.

8. Sustainable Development Goal 8: DECENT WORK AND ECONOMIC GROWTH

 "Promote sustained, inclusive and sustainable economic growth, full and
productive employment and decent work for all."
 The target for 2020 is to reduce youth unemployment and operationalize a
global strategy for youth employment.
 The target is to establish policies for sustainable tourism that will create jobs.

9. Sustainable Development Goal 9: INDUSTRY, INNOVATION AND

INFRASTRUCTURE
 "Build resilient infrastructure, promote inclusive and sustainable
industrialization, and foster innovation".

10. Sustainable Development Goal 10: REDUCED INEQUALITIES

 Reduce income inequality within and among countries."

11. Sustainable Development Goal 11: SUSTAINABLE CITIES AND

COMMUNITIES
 "Make cities and human settlements inclusive, safe, resilient, and
sustainable.“
 Ensure access to safe and affordable housing

12. Sustainable Development Goal 12: RESPONSIBLE CONSUMPTION AND

PRODUCTION
 “Ensure sustainable consumption and production patterns."
 Using eco-friendly production methods and reducing the amount of waste.

13. Sustainable Development Goal 13: CLIMATE ACTION

 "Take urgent action to combat climate change and its impacts by regulating
emissions and promoting developments in renewable energy."

14. Sustainable Development Goal 14: LIFE BELOW WATER

  "Conserve and sustainably use the oceans, seas and marine resources for
sustainable development.

15. Sustainable Development Goal 15: LIFE ON LAND

 "Protect, restore and promote sustainable use of terrestrial ecosystems,
sustainably manage forests, combat desertification, and halt and reverse
land degradation and halt biodiversity loss."
 Preserving biodiversity of forest, desert, and mountain eco-systems

16. Sustainable Development Goal 16: PEACE, JUSTICE AND STRONG

INSTITUTIONS
 "Promote peaceful and inclusive societies for sustainable development,
provide access to justice for all and build effective, accountable and inclusive
institutions at all levels."
 Reducing violent crime, sex trafficking, forced labor, and child abuse are clear
global goals
 Targets universal legal identity and birth registration, ensuring the right to a
name and nationality, civil rights, recognition before the law, and access to
justice and social service.

17. Sustainable Development Goal 17: PARTNESHIPS FOR THE GOALS

 "Strengthen the means of implementation and revitalize the global partnership
for sustainable development.“
 Assure that countries and organizations cooperate instead of compete

EVIDENCE-BASED PRACTICE is a problem solving approach to the delivery of

health care that integrates the best evidence from studies and patient care data with
clinician expertise and patient preferences and values. (Fineout-Overholt E, 2010)

WHY IS EBP IMPORTANT FOR NURSING PRACTICE?

 It results in better patient outcomes g
 It contributes to the science of nursing
 It keeps practice current and relevant
 It increases confidence in decision-making
 Policies and procedures are current and include the latest research
 Integration of EBP into nursing practice is essential for highquality patient care
and achievement of recognition programs

FORMULATE THE BURNING CLINICAL PICOT QUESTION

P – patient or population e.g. age, gender, ethnicity, certain disorders
I – intervention or issue of interest e.g. exposure to a disease, risk behavior,
prognostic factor
C – comparison intervention or group e.g. placebo or no disease group
O - outcome e.g. risk of disease, accuracy of diagnosis, rate of occurrence of
adverse outcome
T- time frame – the time it takes for an intervention to achieve outcome

FORMULATE THE BURNING CLINICAL PICOT QUESTION

 Example of PICOT question
‒ In adult patients with total hip replacements (Population), how effective is pain
medication (Intervention) compared to aerobic stretching (Comparison) in
controlling post operative pain (Outcome) during the perioperative and
recovery time (Time)?
 1.2 REPRODUCTIVE AND SEXUAL HEALTH
FRAMEWORK FOR MATERNAL & CHILD HEATH NURSING CARE
 Maternal and child health nursing can be visualized within a framework in which
nurses, using nursing process, nursing theory, and evidence-based practice,
care for families during childbearing and childbearing years through four phases
of health care:
1. Nursing Process
2. Nursing Theory
3. Evidence-Based Practice
4. Nursing Research

NURSING PROCESS
 A scientific form of problem solving
 Serves as the basis for assessing, making a nursing diagnosis, planning,
implementing and evaluating care

NURSING THEORY
 Using a theoretical basis help appreciate the significant effect of a child’s illness
or
 the introduction of a new member of the family.
‒ Ramona Mercer: ROLE ATTAINMENT THEORY
 The Maternal Role Attainment Theory was developed to serve as a
framework for nurses to provide appropriate health care interventions for
nontraditional mothers in order for them to develop a strong maternal
identity. This helps develop the mother-child relationship as the infant
grows.
‒ Cheryl Tatano Beck: POSTPARTUM DEPRESSION THEORY
 Concepts or stages:
1. Encountering terror (anxiety attacks, obsessive thinking)
2. Dying of self (“unrealness”, isolation, contemplating selfdestruction)
3. Struggling to survive (prying for relief, seeking solace)
4. Regaining control (making transitions, attaining recovery)

REPRODUCTIVE DEVELOPMENT
 Reproductive development begins at the moment of conception and continues
through life.

INTRAUTERINE DEVELOPMENT
 SEX assigned at birth is generally determined at the moment of conception by
chromosome information, which is supplied by the sperm that joins with the
ovum to create the new life.
 GONAD –is a body organ that produces sex cells (Ovary in females; testis in
males)
 When ovaries form, all of the oocytes (cells that will develop into eggs
throughout the woman’s mature years) are already present (Edmonds,2012).

PUBERTAL DEVELOPMENT
 PUBERTY is the stage of life at which secondary sex changes begin.
 In most girls, these changes are stimulated when the hypothalamus synthesizes
and releases gonadotropin-releasing hormone (GnRH), which then triggers the
anterior pituitary to release FOLLICLE-STIMULATING HORMONE (FSH) and
LUTEINIZING HORMONE (LH).
 FSH and LH are termed GONADOTROPIN (gonad = “ovary”; tropin = “growth”)
hormones not only because they begin the production of androgen and estrogen,
which in turn initiate secondary sex characteristics, but also because they
 continue to cause the production of eggs and influence menstrual cycles
throughout women’s lives (Eggers, Ohnesorg, & Sinclair, 2014).

ROLE OF ANDROGEN:
 When triggered at puberty by FSH, ovarian follicles in females begin to excrete a
high level of the hormone estrogen. This hormone is actually not one substance
but three compounds:
1. Estrone (E1)
2. Estradiol (E2)
3. Estriol (E3)
 The increase in estrogen levels in the female at puberty influences the
development of the uterus, fallopian tubes, and vagina; typically female fat
distribution, and hair patterns; breast development; and an end to growth
because it closes the epiphysis of long bones. The beginning of breast
development is termed as THELARCHE

SECONDARY SEX CHARACTERISTICS:

 Adolescent sexual development has been categorized into stages (Tanner,1990).
There is a wide variation in the time required for adolescents to move through
these developmental stages, however, then sequential order is fairly constant.
 The average age of menarche (the first menstrual period) occurs is 12.5 years. It
may occur as early as 9 years or as late as 17, however, and still be within a
normal age range. Irregular menstrual periods are the rule rather than the
exception for the first year.(Mc. Evoy et.al, 2004). Menstrual periods do not
become regular until ovulation consistently occurs with them (menstruation is not
dependent on ovulation) and this does not tend to happen until 1 to 2 years after
menarche. This is one reason why estrogen-based oral contraceptives are not
commonly recommended until a girl’s menstrual period have become stabilized
or are ovulatory (to prevent administration of a compound to halt ovulation before
it is firmly established).
 Production of spermatozoa does not begin in intrauterine life as does the
production of ova, nor are spermatozoa produced in a cyclic pattern as are ova,
rather, they are produced in a continuous process. Sperm production continues
from puberty throughout the male’s life span, in contrast, the production of ova
stops at menopause.

In girls, pubertal changes typically occur in the following order:

1. Growth spurt
2. Increase in the transverse diameter of the pelvis
3. Breast development
4. Growth of pubic hair
5. Onset of menstruation
6. Growth of axillary hair
7. Vaginal secretions

Secondary sex characteristics of boys usually occur in the following order:

1. Increase in weight
2. Growth of testes
3. Growth of face, axillary and pubic hair
4. Voice changes
5. Penile growth
6. Increase in weight
7. Spermatogenesis (production of sperm)
ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

MALE AND FEMALE REPRODUCTIVE POTENTIALS:

 Woman’s reproductive lifespan begins after menarche and terminates with
menopause; typically a span of 35 to 40 years.
 A large store of germ cells present at birth decreases by puberty to 300,000. A
woman releases no more than 500 ova during ovulation throughout her lifetime.
 Reproductive activity in the male begins with sperm production at the onset of
puberty and is continuous throughout his lifetime.
 New sperm is generated every 74 days and the capacity to reproduce is
associated with sexual excitement, penile erection and ejaculation.

A. MALE REPRODUCTIVE SYSTEM

 External Structures
1. PENIS
‒ Organ for copulation.
‒ Composed of three cylindrical masses of erectile tissue in the penis
shaft : two termed the corpus cavernosa and the third termed the
corpus spongiosum.
‒ Penile erection is stimulated by parasympathetic nerve innervations.
‒ Glans – bulging, sensitive ridge of tissue at the distal end of the organ.
‒ Prepuce – a retractable casing of skin that protects the nerve-sensitive
glans at birth.
2. SCROTUM
‒ Rugated, skin-covered, muscular pouch suspended from the perineum.
‒ Support the testes and help regulate the temperature of the sperm.
3. TESTES
‒ 2 ovoid glands, 2 to 3 cm wide, that lie in the scrotum.
‒ Each testis is encased by a protective white fibrous capsule and is
composed of a number of lobules, each lobule containing interstitial
cells (Leydig’s cells) and a seminiferous tubule.
‒ Seminiferous tubules produce spermatozoa.
‒ Leydig’s cells are responsible for production of the male hormone
testosterone.
 Internal Structures
1. EPIDIDYMIS
‒ Tightly-coiled, very narrow tube, approximately 20 feet long.
‒ Responsible for conducting sperm from the testes to the vas deferens
‒ Storage of sperm for at least 12 to 20 days. (total of 64 days to reach
maturity)
‒ Aspermia – absence of sperm.
‒ Oligospermia – fewer than 20 million sperm per milliliter.
2. VAS DEFERENS (Ductus deferens)
‒ Site of complete sperm maturity.
3. SEMINAL VESICLES
‒ Secrete viscous portion of the semen.
‒ Sperm become increasingly motile with this added fluid, because it
surrounds them with nutrients and a more favorable ph.
4. EJACULATORY DUCT
‒ Passageway for sperm and semen.

5. PROSTATE GLAND
‒ Secretes alkaline fluid added to the semen.
6. BULBOURETHRAL GLANDS (Cowper’s Gland)
 ‒ Like the prostate gland and seminal vesicles, they secrete an alkaline
fluid that counteract the acid secretion of the urethra and ensure the
safe passage of spermatozoa.
7. URETHRA
‒ Connects internal structures to the external environment
 ACCESSORY GLANDS
1. Seminal vesicles
2. Prostate Gland
3. Bulbourethral and urethral glands
 SEMEN or SPERM PRODUCTION
‒ Semen is a thick, whitish fluid which contains spermatozoa and fructose-
rich mutrients.
‒ At puberty, hypothalamus, stimulates pituitary to produce FSH and LH,
to manufacture sperm and to stimulate testosterone responsible for
secondary sex characteristics.
‒ Spermatogenesis occurs continually after puberty; spermatozoa are
released from the seminiferous tubules. It is a heat – sensitive process
which takes about 75 days.

B. FEMALE REPRODUCTIVE SYSTEM

 External Structures:
1. MONS PUBIS or MONS VENERIS
‒ Pad of adipose tissue located over the symphysis pubis covered by
course, curly hair that protects the junction of the pubic bone from
trauma.
2. LABIA MAJORA
‒ Two folds of adipose tissue covered by loose connective tissue and
epithelium positioned lateral to the labia minora.
‒ Covered by pubic hair and serves as protection for the external
genitalia and the distal urethra and vagina.
3. LABIA MINORA
‒ Two hairless folds of connective tissue posterior to the mons veneris
that is abundant with sebaceous glands which add lubrication to the
vaginal canal.
4. VESTIBULE
‒ Flattened smooth surface inside the labia where the opening of the
urethra and the vagina both arise.
5. CLITORIS
‒ Small rounded erectile tissue at the forward junction of the labia
minora that is
‒ sensitive to touch and temperature and the center of sexual arousal
and orgasm.
6. URETHRAL MEATUS
‒ Located just below the clitoris; an opening for urine elimination.
7. SKENE’S GLANDS or PARAURETHRAL GLANDS
‒ Located just lateral to the urethral meatus that lubricates the external
genitalia during coitus.
8. VAGINAL INTROITUS
‒ Below the urethral meatus; an opening for the vaginal canal.
9. BARTHOLIN’S GLANDS or VULVOVAGINAL GLANDS
‒ Located just lateral to the vaginal opening on both sides which open
into the distal vagina.
‒ Secretions from this glands helps to lubricate the external genitalia
during coitus.
10. FOURCHETTE
 ‒ Ridge of tissue formed by the posterior joining of the two labia minora
and labia majora.
‒ This is the structure that is sometimes cut during childbirith to enlarge
the vaginal opening.
11. PERINEAL BODY
‒ Posterior to the fourchette which is a muscular area that easily
stretches during childbirth.
12. HYMEN
‒ Tough elastic semi-circle of tissue that covers the opening to the
vagina in childhood.
 Internal Structures
1. OVARIES
‒ Grayish white structure, the size and shape of almonds, located close
to and on both sides of the uterus in the lower abdomen.
‒ Its function is to produce, mature and discharge ova; to produce
estrogen and progesterone and to initiate and regulate menstrual
cycles.
‒ These are also important in the maintenance of secondary sexual
characteristics.
2. FALLOPIAN TUBES
‒ Arise from each of the upper corner of the uterine body and extends
outward and backward approximately 10 cm in length and functions
to convey the ovum from the ovaries to the uterus and provide
fertilization of the ovum and sperm.
3. UTERUS
‒ Hollow, muscular, pear-shaped organ, located in the lower pelvis,
posterior to the bladder and anterior to the rectum.
‒ It is the site of implantation and nourishes and protects the growing
fetus.
4. VAGINA
‒ Hollow musculomembranous canal located posterior to the bladder
and anterior to the rectum, which extends from the cervix of the
uterus to the external vulva.
‒ It acts as the organ of copulation and conveys sperm to the cervix.
5. PELVIS
‒ A bony ring with three parts ( Ilium, ischium, and pubis) and four
bones ( two innominate bones, sacrum and coccyx)
‒ Serves to support and protect the reproductive and other pelvic
organs.
‒ Types of pelvis: Gynecoid, Android, Anthropoid, Platypelloid.
6. BREAST
 Internal breast structures:
1. Glandular tissue (parenchyma)
‒ Acinar cells produce milk
2. Lactiferous ducts or sinuses
‒ Transport milk to the nipple
3. Adipose and fibrous tissues
 External breast structures
1. Nipple
‒ Transmits sensations to the posterior pituitary gland to release
Oxytocin
2. Areola
‒ Pigmented area surrounding the nipple area
3. Montgomery’s tubercles
‒ Sebaceous glands that provide lubrication to the nipple area.
CERVICAL CHANGES:
 The mucus of the uterine cervix, as well as the uterine body, changes each
month during the menstrual cycle. Education regarding cervical mucus changes
can help women plan coitus to coincide with ovulation, so as to increase their
chances of pregnancy, or avoid coitus at the time of ovulation, to prevent
pregnancy.
1. FERN TEST. When high levels of estrogen are present in the body, as
they are just before ovulation, the cervical mucus forms fernlike patterns
when it is placed on a glass slide and allow to dry. The patterns are
caused by the crystallization of sodium chloride on mucus fibers
(arborization or ferning)
2. SPINNBARKEIT TEST. At the height of estrogen secretion, the cervical
mucus not only becomes thin and watery, but it also can be stretched into
long strands. Performing this test at the midpoint of the menstrual cycle is
another way to demonstrate that high levels of estrogen are being
produced and, by implication, that ovulation is about to occur.

SEXUALITY
 Encompasses a complex of emotions, attitudes, preferences and behaviours
related to expression of sexual health.
 Each person is born a sexual being , and his or her gender identity and gender
role behaviour evolve from and usually conform to the societal expectations
within that person’s culture.
 SEX is a dynamic aspect of life, intertwined with biologic and psychosocial
components that cannot be separated.
 BIOLOGIC GENDER is used to denote a person’s chromosomal sex : male (XY)
or female (XX).
 GENDER IDENTITY or SEXUAL IDENTITY means a person’s inner sense of
being male and female.
 GENDER ROLE is the male or female behaviour a person exhibits; maybe
culturally influenced.
 Developmental task of sexual identity:
1. Gender identity – masculinity and feminity
2. Sex role standards – attitudes and attributes to differentiate roles
3. Sexual partner preference
 RESPONSIBLE SEXUALITY involves commitment to a relationship, responsible
reproductive health care, and decisions on childbearing.

DEVELOPMENT OF GENDER IDENTITY

 Whether gender identity arises from primarily a biologic or a psychosocial focus
is controversial. The amount of testosterone secreted in utero (a process termed
sex typing) may affect this characteristic. How appealing parents or other adult
role models portray their gender roles may also influence how a child envisions
himself or herself.
 Gender role is also culturally influenced. In Western society, women have in the
past been viewed as kind and nurturing, with sole responsibility for childbearing
and homemaking. Men were viewed as financial providers for the family. Gender
roles today are more interchangeable than they were once were: women pursue
all kinds of jobs and career without loss of femininity, and men participate (some
as primary homemakers) in childbearing and household duties without loss of
masculinity.
 An individual’s sense of gender identity develops throughout an entire lifespan,
but the stage is set by expectations even before a child is born.
 A. INFANCY
‒ Gender identity is established early in life (Fulchiero-Gordon, 2005)
‒ From the day of birth, female and male babies are treated differently by
their parents.
‒ People generally bring girls dainty rattles and dresses with ruffles; they
are treated more gently by parents and held and rocked more than male
babies.
‒ People tend to buy boys bigger rattles and sports-related jogging suits.
B. PRESCHOOL PERIOD
‒ Children can distinguish between males and females as early as 2 years
of age. By
‒ age 3 to 4 years, they can say what sex they are, and they have
absorbed cultural
‒ expectations of that sex role.
‒ Often, boys will play rough-and-tumble games with other boys, and girls
will play more quietly with each other, although the two frequently mix at
this age.
‒ Sex role modelling is reinforced through behaviour toward and
expectations of the child, as well as from such things as the color and
décor of the child’s room and the child’s clothing.
‒ Social contacts between the child and significant adults contribute to
sexual identification and should be encouraged in this developmental
period.
C. SCHOOL-AGE CHILD
‒ Early school-age children typically spend play time imitating adult roles
as a way of learning gender roles.
‒ They form a strong impressions of what a female or male role should be.
D. ADOLESCENT
‒ At puberty, as the adolescent begins the process of establishing, a
sense of identity,
‒ the problem of final gender role identification surfaces again.
‒ Most early adolescents maintains strong ties to their gender group, boys
with boys and girls with girls.
E. YOUNG ADULT
‒ When young adult move away from home to attend college or establish
their own home, they choose the way they will express their sexuality
along with other life patterns.
‒ Many adults marry with a commitment to one sexual partners.
‒ Others establish relationships (cohabitation) that are less binding in
concern and support.

HUMAN SEXUAL RESPONSE

 Sexuality has always been a part of human life, but it is only in the past few
decades that it has been studied scientifically by experts in the fields of sex
research. One common finding of researchers has been that feelings and
attitudes about sex vary widely; the sexual experience is unique to every
individual, but sexual physiology (i.e how the body responds to sexual arousal)
has common features (Sadock, 2005).
SEXUAL RESPONSE CYCLE
1. EXCITEMENT
‒ Occurs with physical and psychological stimulation (i.e. sight, sound, emotion,
or thought) that causes parasympathetic nerve stimulation.
‒ This leads to arterial dilation and venous constriction in the genital area.
‒ The resulting increased blood supply leads to vasocongestion and increasing
muscular tension.
‒ In women, this vasocongestion causes the clitoris to increase in size and
mucoid fluid to appear on vaginal walls as lubrication.
‒ The vagina widens in diameter and increases in length.
‒ The nipples become erect.
‒ In men, penile erection occurs, as well as scrotal thickening and elevation of
the testes.
‒ In both sexes, there is an increase in heart and respiratory rate and blood
pressure.
2. PLATEAU
‒ Is reached just before the orgasm.
‒ In women, the clitoris is drawn forward and retracts under the clitoral prepuce;
the lower part of the vagina becomes extremely congested and there is
increased nipple elevation.
‒ In men, the vasocongestion leads to distention of the penis.
‒ Heart rate increases to 100 to 175 beats per minute and respiratory rate is
approximately 40 breathes per minute.
3. ORGASM
‒ Occurs when stimulations proceeds through the plateau stage to a point at
which the body suddenly discharges accumulated sexual tension.
‒ The shortest stage in sexual cycle.
‒ Usually experienced as intense pleasure affecting the whole body, not just the
pelvic area.
‒ It is also a highly personal experience: description of orgasms vary greatly
from person to person.
4. RESOLUTION
‒ Period during which the external and internal genital organs return to an
unaroused state.
‒ The resolution period usually takes 30 minutes for both men and women.

TYPES OF SEXUAL ORIENTATION

 Sexual gratification is experienced in number of ways. What is considered
normal varies greatly among cultures, although general components of accepted
sexual activity are that privacy, consent, lack of force are included. Most
individual value systems are closely aligned to the cultural norm.
1. HETEROSEXUALITY
‒ One who finds sexual fulfilment with a member of the opposite sex.
‒ Because interest in the opposite sex and sexual relationships may begin
as early as the beginning of puberty, health care providers needs to
provide information on safer sex practices and planning for their use to
children as young as 10 to 12 years of age for the knowledge to be most
helpful.
2. HOMOSEXUALITY
‒ One who finds sexual fulfilment with a member of his or her own sex.
‒ Gay – homosexual man
‒ Lesbian – homosexual woman
‒ Additional terms used are: “men who have sex with men” and women
who have sex
‒ with women”.
 3. BISEXUALITY
‒ People are bisexual if they achieve sexual satisfaction from both
homosexual and
‒ heterosexual relationships.
4. TRANS-SEXUALITY
‒ Or transgender person is an individual who, although of one biologic
gender, feels as if he or she should be of the opposite gender.

TYPES OF SEXUAL EXPRESSION

A. CELIBACY
‒ Abstinence from sexual activity.
‒ It is the avowed state of certain religious orders
‒ It is also a way of life for many adults and one that is becoming fashionable
among a growing number of young adults.
B. MASTURBATION
‒ Is self-stimulation for erotic pleasure;
‒ It can also be a mutually enjoyable activity for sexual partners.
‒ It offerssexual release, which may be interpreted by the person as overall
tension or anxiety relief. Masters et al.
C. EROTIC STIMULATION
‒ Is the use of visual materials such as magazines or photographs for sexual
arousal.
D. FETISHISM
‒ Sexual arousal resulting from the use of certain objects or situations.
‒ Leather, rubber, shoes and feet are frequently perceived to have erotic
qualities.
E. TRANSVESTISM
‒ Transvestite is an individual who dresses to take on the role of the opposite
sex.
‒ Can be heterosexual, homosexual, or bisexual.
F. VOYEURISM
‒ Obtaining sexual arousal by looking at other person’s body.
G. SADOMASOCHISM
‒ Involves inflicting pain (sadism) or receiving pain ( masochism) to achieve
sexual
‒ satisfaction.
‒ It is a practice generally considered to be within the limits of normal sexual
‒ expression as long as pain involved is minimal and the experience is
satisfying to both sexual partners.

THE INFLUENCE OF THE MENSTRUAL CYCLE ON SEXUAL RESPONSE

 During the second half of the menstrual cycle—the luteal phase—there is
increased fluid retention and vasocongestion in the woman’s lower pelvis.
Because some vasocongestion is already present at the beginning of the
excitement stage of the sexual response, women appear to reach the plateau
stage more quickly and achieve orgasm more readily during this time. Women
also may be more interested in initiating sexual relations during this time.

SEXUAL HARASSMENT AND VIOLENCE:

 Sexual harassment is unwanted, repeated sexual advances, remarks, or
behaviour toward another that: Is offensive to the recipient and Interferes with
job performance.
 It can involve actions as obvious as a job supervisor demanding sexual favors to
a job superior sending sexist jokes by e-mail to a person he or she supervises.
 2 types:
 1. Quid pro quo (an equal exchange), in which an employer ask for something in
return for sexual favors, such as a hiring or promotion preference.
2. Hostile work environment, in which an employer creates an environment in
which an employee fells uncomfortable and exploited.

1.3 RESPONSIBLE PARENTHOOD

 A responsible parenthood is simply defined as the “will” and ability of parents to
respect and do the needs and aspirations of the family and children. It is the
ability of a parent to detect the need, happiness and desire of the children and
helping them to become responsible and reasonable children.

QUALITIES OF RESPONSIBLE PARENTHOOD:

1. Marriage to the right partner
2. Ability to provide
3. Adoption of peaceful strategies
4. Emotional adjustment ability
5. Adoption of Family Planning, sound knowledge of childbearing and rearing.

FAMILY PLANNING:
 Kinds of Contraceptive Techniques:
‒ Natural Methods
‒ Hormonal Methods
‒ Barrier Methods
‒ Intrauterine Device
‒ Permanent Methods

A. NATURAL METHODS
 Natural Family Planning Method is based on sexual abstinence at the time of
ovulation to prevent conception. As the name implies, are those that involve
no introduction of chemical or foreign material into the body.
 ADVANTAGES:
‒ Safe and has no side effects
‒ Inexpensive
‒ Acceptable to religious affiliations that do not accept artificial methods of
contraception.
‒ Helpful for planning pregnancy and avoiding pregnancy
‒ Promotes communication about family planning and contraception
between couples.
 FERTILITY AWARENESS METHODS
‒ Rely on detecting when a woman is capable of impregnation (fertile) and
using periods of abstinence or contraceptive use during that time.
 CALENDAR (RHYTHM) METHOD
‒ Requires the couple to abstain from coitus on the days of a menstrual
cycle when the woman is most likely to conceive (3 to 4 days before until
3 to 4 days after ovulation)
‒ To calculate “safe days”, she subtracts 18 from the shortest cycle
documented. This number represents her first fertile day. She subtracts
11 from her longest cycle. This represents her last fertile day.
‒ To avoid pregnancy, she would avoid coitus or use contraceptives
during fertile period.
 BASAL BODY TEMPERATURE (BBT)
‒ Requires a predictable menstrual cycle to predict the occurrence of
ovulation.
 ‒ Basis is that just before ovulation, woman,s BBT falls about half a
degree and at the time of ovulation her BBT rises a full degree because
of the influence of progesterone.
‒ To use this method, the woman takes her temperature each morning
immediately after waking, before any activity. Ovulation occurs as soon
as she notices a dip followed by an increase in temperature.
 CERVICAL MUCUS METHOD (BILLINGS METHOD)
‒ Before ovulation, the cervical mucus is thick and does not stretch when
pulled between thumb and finger (spinnbarkeit).
‒ With ovulation, cervical mucus is copious, thin, watery, and transparent.
It feels slippery, stretches 1 inch and is accompanied by breast
tenderness.
 SYMPTOTHERMAL METHOD
‒ Combines the cervical mucus changes and BBT methods. Woman
watches her temperature daily and analyzes her cervical mucus at the
same time.
‒ Couples abstain for about 3 to 4 days.
 LACTATION AMENORRHEA METHOD
‒ There appears to have some form of natural suppression of ovulation as
long as the woman is breastfeeding and after 6 months of breastfeeding
a woman should be advised to use another form of contraception.
 COITUS INTERRUPTUS (WITHDRAWAL)
‒ The man withdraws at the moment of ejaculation and spermatozoa are
emitted outside the vagina.
‒ This method offers little protection against conception because the man
can have ejaculation before withdrawal is complete.

B. BARRIER METHODS
 Works by placement of chemical or other barrier between the cervix and
advancing sperm so that it cannot enter the uterus or fallopian tube and
fertilize the ovum.
 VAGINALLY-INSERTED SPERMICIDAL PRODUCTS
‒ These agents cause the death of the spermatozoa before they enter the
cervix.
‒ Major advantage is that: it lacks the side effects of hormonal products.
‒ Contraindicated in women with acute cervicitis, because it may further
irritate the cervix
 DIAPHRAGM
‒ Circular rubber disk placed over the cervix prior to intercourse that forms
a barricade against the entrance of the spermatozoa.
‒ Woman must return for second fitting because the cervix changes with
pregnancy, miscarriage, cervical surgery (Dilatation and curettage) or
therapeutic abortion and weight gain/loss of 15 lbs.
‒ Should be kept in placed for at least 6 hours after coitus, because
spermatozoa remain viable in the vagina for that duration, should not
exceed 24 hours.
 CERVICAL CAPS
‒ Made of soft rubber and shaped like a thimble that fits snugly over the
uterine cervix but can remain in place longer than the diaphragms
should not exceed 48 hours to prevent cervical irritation.
‒ They are contraindicated in clients with abnormally short or long cervix.
Previous abnormal pap smear, history of TSS (Toxic shock syndrome),
allergy to latex, history of PID (pelvic inflammatory disease), cervicitis or
papilloma virus infection and with history of cervical cancer.
  CONDOMS
‒ Latex rubber or synthetic sheath placed over the erect penis before
coitus. Latex condoms have the potential of preventing the spread of
STD.
 INTRAUTERINE DEVICE (IUD)
‒ Mechanism of action is not fully understood but newer information
suggests that it interferes with fertilization. The loop is inserted during
menses to ensure that she is not pregnant at the time of insertion.
‒ Teach woman to check for the string periodically and to have an annual
pelvic exam must be done.
‒ Amenorrhea and spotting are common side effects.
‒ In case pregnancy occurs, IUD should be removed. An IUD left in uterus
during pregnancy increases the risk of abortion and infection.
‒ The IUD are replaced:
 Copper-T = every 4 years
 Copper-T 380 = every 8 years
 Progestasert = every year
 Saf T coil and Lippes loop = until menopause if there are no problems
‒ IUD is checked by physician once a month after insertion then after 6
months and yearly.
IUD Danger Signals:
P – Period late or missed period
A- Abdominal pain (severe), pain with intercourse
I – Infection; increased temperature, fever and chills
N – Noticeable vaginal discharge: foul smelling
S – String length shorter or longer or missing; spotting, bleeding, clots, heavy periods

C. HORMONAL METHOD
 ORAL CONTRACEPTIVE PILLS
‒ Prevent ovulation
‒ Consist of hormonal agents: estrogen and progesterone.
‒ They come in two type of packets:
 21 day pill has a rest day of 7 days and a woman starts a new
packet after 7 days of the last pill.
 28 day pill, the woman takes the pill continuously for 28 days.
However the last 7 pills do not contain hormone and is either
composed of iron supplement or lactose.
 Side effects: bloating, nausea and weight gain
 Adverse effect: leg cramps, headache, abdominal pain
 Should not be given to women who smoke or with coagulation
problem.
 If one dose is missed, take it as soon as remembered or take two
the following day; if two doses were missed, double the dose for
two days then resume regular dose; if 3 or more doses were
missed, stop the pills and start a new pack after withdrawal
bleeding occurs.
 ESTROGEN PATCH
‒ Applied to the trunk, chest and extremity.
‒ Effective for three weeks after which a new patch is applied.
 DEPO-PROVERA
‒ Medroxyprogesterone or DMPA
‒ IM injections given every 12 weeks.
‒ Exert their contraceptive effect by inhibiting ovulation, altering cervical
mucus and preventing endometrial growth.
 ‒ Can be given 5 days postpartum if not breastfeeding; if breastfeeding
given 6 weeks postpartum.
‒ Adverse effects: irregular bleeding, headache, weight gain, depression.
 NORPLANT (Subcutaneous implant)
‒ Are made up of synthetic progesterone (levonorgestrel)
‒ Timed release dosage of progesterone
‒ Inserted surgically into the subcutaneous tissue simultaneously with
menses.
‒ Effective for 5 years
‒ Decrease in menstruation
‒ Adverse effects: irregular bleeding, headache, weight gain, depression.
 MORNING AFTER PILL (RU 486)
‒ Can be used up to 8 weeks gestation
‒ Not 100% effective and teratogenic
‒ Consent taken for elective abortion if not effective.

Serious Complications of birth control pills:

A – Abdominal pain may indicate liver or gallbladder problems
C – Chest pain/ shortness of breath indicates pulmonary embolus
H – headache (sudden/persistent) indicates hypertension
E – Eye problems (vascular accident)
S – Severe leg pain (thromboembolism)

D. SURGICAL METHOD
 VASECTOMY (Male)
‒ A small incision is made on each side of the scrotum. The vas deferens
at that point is then cut and tied, cauterized, or plugged, blocking the
passage of spermatozoa.
‒ Sperm no longer enters the vas deferens.
‒ Use additional birth control method for 6 weeks or after 20 ejaculations
‒ Does not alter performance.
 TUBAL LIGATION (Female)
‒ The fallopian tubes are ligated, occluded by cautery, crushing, clamping,
or blocking and thereby preventing passage of both sperm and ova.
‒ Has 99.5% effectiveness rate.
‒ Permanent procedure but ovulation and menstruation continues
‒ Sexual activity may resume as soon as incision is healed.
‒ Adverse effect; gas/bloating, bleeding (rare)