Philosophy of MCN Lactation

• Family-centered Prolactin - produced in responsed to sucking

• Community-centered Oxytocin - release of milk (milk-letdown reflex)
• Evidence-based
Menstrual Cycle
2 purpose of sexual pleasure Follicular Phase
• To strengthen the couples relationship • 1st day of period
• To give them the ability to share with God in the creation of • Brain > FSH & LH > Blood > Ovaries > Stimulate 15-20 eggs
another human being > 1 dominant follicle remains > ↑ production of estrogen
• FSH & LH > ↑ production of estrogen
2 purpose of sexuality
• Unitive Ovulatory Phase (Ovulation)
• Pro-creative • Starts 14 days after FP
• 1 dominant follicle > ↑ production of LH > Egg > Ovary
Conception - fertilization of an egg by the spem in the • Fertilization process
fallopian
tubes. Luteal Phase
• Starts after OP
Ovulation • Empty follicle > corpus luteum > progesterone > prepares
FSH & LH > Ovaries > Ovum uterus for for fertilized egg
• If conception happens, the woman is now considered
Oogenesis pregnant
14 days after > Oocyte matures > released as Ovum • If conception does NOT happen, egg passes down the uterus
> uterus sheds > Menstruation begins
Fertilization
Ovum > Fimbriae > Fallopian Tube > 1 week > Uterus > Cycle of Human Sexual Response
Sperm pen > fertilized zygote > 2 weeks > embryo > uterine • Excitement - stimulation > parasympathetic nerves >
wall vasocongestion > ↑ HR & RR
• Plateau - reached just before orgasm > ↑ HR & RR
Menstruation • Orgasm - stimulation passes thru the plateau
Shedding begins at 28 days, can be short as 24 days, long as • Resolution - genitals return to unaroused state
36 days
Androgen - muscular dev’t G - # of pregnancy
Estrogen - female reproductive dev’t T - # of full term infants (37 - 42 weeks)
Thelarche - starts 1-2 years prior to menstruation P - # of preterm infants (Before 37 weeks)
A - # of miscarriage
Contraceptive Methods L - # of living children
Hormonal
• Birth Control Pills EDD
• Depo-provera - birth control shot/3 months • Jan - March: +9,+7
• Implants • Apr - Dec: -3, +7, +1

Barrier AOG using LMP

• Spermicides
• Condoms
• Diaphragm - latex barrier inside vagina during intercourse ​
• Cervical cap - latex barrier inside vagina before intercourse
• Intrauterine Device (ID) - T-shaped object inside uterus; must
be on period during insertion
• Sterilization - permanent cutting or tying of fallopian tube
(tubal ligation) or vas deferens (vasectomy)

Fertility Based Awareness

• Cervical Mucus Method/Billing Ovulation Method - wetness of
dryness of mucus
• Basal Body Temperature - fertile 2-3 days before ↑ temp.
• Basal Body Temperature - infertile 4th day of ↑ temp. > end

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• Sympto-Thermal Method - BOM + BBT

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• Standard Day Method - ​ ​- 1st day of period

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• Standard Day Method - ​ ​ - Period is < 26 days

⚪️
• Standard Day Method - ​ ​- Pregnancy is unlikely

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• Standard Day Method - ​ ​- Pregnancy is likely Fundal Height (McDonald’s Rule)
• Standard Day Method - ​ - Pregnancy is unlikely • from symphysis pubis > highest portion of the uterus
• Lactational Amenorrhea Method - use of breastfeeding
Estimating Fetal Growth - McDonald’s Rule
• AOG in Months = FH (cm) x 2/7 = ? months
• AOG in Weeks = FH (cm) x 8/7 = ? weeks
If fundal height is bigger than AOG - multiple pregnancy, LGA,
miscalculated EDD
If fundal height is lesser than AOG - pregnancy length
miscalculated, SGA, Anomaly dev’t
Estimating Fetal Length - Haaese’s Rule
Estimating Fetal Weight - Johnson’s Rule
Leopold’s Maneuver - identify fetal presentation, size & # of
fetus
• Fundal Grip - determine fetal part & presentation ↗ ↖
• Umbilical Grip - determine fetal back & position ↻ ↑ ↑
• Pawlick’s Grip - determine engagement & presenting part ↽
• Pelvic Grip - determine degree of flexion ↘ ↙
Presumptive Signs
Period Absent (Amenorrhea)
Really tired (Fatigue)
Enlarged Breast
Sore Breast
Urination increased
Movement of fetus in uterus (Quickening)
Emesis (vomiting) & nausea
Probable Signs
Positive pregnancy test
Returning of the fetus (External Ballotment)
Outline of fetus can be palpated
Braxton Hicks Contraction: false labor contractions
A softening of the cervix (Goodell’s Sign)
Bluish color of the vulva, cervix & vagina (Chadwick’s Sign)
Lower uterine segment (Hegar’s Sign)
Enlarged uterus Common diseases that causes congenital condition
Toxoplasmosis
Positive Signs Other infections (B. streptococcus, listeria, candida)
Fetal movement felt by doctor/nurse Rubella
Electronic Device detects fetal heart sound (Doppler) Cytomegalovirus
The delivery of the baby HSV
Ultrasound detects the fetus Everything else (STD, esp. Chlamydia, Gonorrhea)
See visible movements of the baby by the doctor/nurse Syphilis

Types of Pelvic 10 early signs of labor

• Gynecoid • Baby drops (lightening)
- round pelvic inlet, shallow pelvic activity & short ischial • Increased urge to urinate
spines • Passage of the mucus plug
- most suitable pelvic shape for childbirth • Cervix dilation
• Anthropoid • Thinning of the cervix (Effacement)
- oval shaped inlet, large anterior-posterior diameter, smaller • Back pain
transverse diameter • Contractions
- favors occiput-posterior position, but slows down progress • Burst of energy (nesting)
• Android • Urge to have bowel movement (Diarrhea)
- triangular/heart-shaped inlet, prominent ischial spines, • Water breaks
narrower transverse diameter
- Childbirth is more difficult, need to push harder Stages of Fetal Dev’t
• Platypelloid Pre-embryonic Stage
- kidney-shaped inlet, narrow anterior-posterior diameter • 1st week after conception
- Doesn’t allow engagement of head w/ease • XX - female, XY - Male

Infections in mothers Embryonic Stage

Chickenpox • Week 3 - Week 8
Hepatitis B,C,D, E • Implantation occurs
Enteroviruses
AIDS Fetal Stage
Parvovirus B19 (5th disease) • Week 8 - till birth
• Embryonic stage ends > Organogenesis begins
• 3 - 5 hours
• 4 - 7 cm cervix dilation
Placenta weighs 400-600g (1 lb). • Contractions for 45-60
Amniotic fluid ranges from 800-1200 mL seconds, w/3-5 minutes of
*Urine is acidic, pH of 5-5.5, AF is alkaline, pH of 7.2 rest.
Umbilical cord: 1 vein, 2 arteries
Transition Phase
• 30 mins - 2 hours
Common P’s in Labor • 8 - 10 cm cervix dilation
Passenger (Fetus) • Contractions for 60 - 90
• OA (Occiput-Anterior) - most common & easiest to deliver, all seconds, w/30 sec - 2 min
other positions are considered malposition rest
• OP (Occiput-Posterior) - painful, longer 2nd stage of labor
2nd stage • Use gravity at your
Passageway (Pelvis)
advantage.
• Gynecoid is the most suitable for childbirth
• Rest bw contractions
Power (Contractions)
Engagement
• duration of contraction: 4-5 times, each lasting 40-60
Descent
seconds for 10 minutes
Flexion
• intensity of contraction: strong week
Internal rotation
• 5-1-1 rule: contraction every 5 minutes, each lasting 1 minute
Extension
for 1 hour
External rotation
Psyche (Emotional condition of the woman)
Expulsion
• Provide support
3rd Stage • delivery of placenta
Stages of Labor
• 5 - 30 minutes

1st Stage Latent Phase Sign of Placental Separation

• 8 -12 hours • Cush of blood
• 3 cm cervix dilation • Cord lengthening
• Contraction for 30-45 • Uterus becomes globular
seconds, w/5-30 minutes of
rest • Uterus at the level of
Active Phase umbilicus or rising

*Brandt-Andrews Maneuver
4th Stage • 2-3 hours after birth
Vital signs
• every 15 mins for 1 hr
• every 30 mins for 1 hr
• hourly
• q4h until stable
Postpartum period • 6 weeks after delivery
Taking-In Phase
• 1-2 days after delivery
Taking Hold Phase
• 2 - 4 days after delivery
Letting Go Phase
• PD may set in
Fetal Heart Rate 120-160 beats/min (normal)
• > 160 beats / min = tachycardia (increase)
• < 110 beats / min = bradycardia (decrease)
• < 100 beats / min = severe bradycardia
Medical pain-relieving options for labor
Nitrous Oxide
• laughing gas
• thru face mask
• does not stop the pain, but relieves
Pethidine
• strong pain reliver
• IM/IV
Epidural Anesthesia
• most effective pain relief
• vaginal and c-section births
Non-medical pain-relieving options for labor
• Active Birth
• Massage & Heat
• Water immersion
• Relaxation/
• Aromatherapy
• Acupuncture
• TENS
• Sterile water injections
Discharge
Lochia Rubra
• First 3 day after birth
• dak red
Lochia Serosa
• 4 - 10 days
• pink - brownish
Lochia Alba
• 10 - 28 days
• colorless or white
• After 8 weeks (2 months), menstruation returns.
• If breastfeeding: 6 months (Lactational Amenorrhea)
• If not, 6-10 weeks
• After 3-4 weeks, sexual intercourse is allowable.
Things to remember for Postpartum Visit
• Early detection and management of complications
• Complication readiness
• Promoting health and preventing disease
• Woman-centered education and counseling

Summary for Newborn Care Practice

• Immediate & Thorough Drying
• Early skin-to-skin contact
• Properly timed cord clamping
• Non-separation of Newborn from Mother for Early
Breastfeeding

Check-Up
• Week 4 - Week 28: Once a month
• Week 28 - Week 36: Twice a month
• Week 36 - birth: Weekly
 INFORMATION FOR PARENTS 2022 Recommended Immunizations for Children 7–18 Years Old

Tdap Meningococcal MMR

HPV
Flu Tetanus, Measles, Chickenpox
Human Pneumococcal Dengue Hepatitis B Hepatitis A Polio
Influenza diphtheria, MenACWY MenB mumps, Varicella
papillomavirus
pertussis rubella

7-8 Years

9-10 Years ONLY

in
places
11-12 Years where
dengue
spreads
13-15 Years

16-18 Years

More Everyone 6 All 11- through All 11- through All 11- through Ages 10 years Ages 9-16 years
information: months and 12- year olds 12- year olds 12- year olds and older at who live in
older should should get one should get a should get increased risk dengue endemic
get a flu vaccine shot of Tdap. 2-shot series of one shot of should receive areas AND
every year if HPV vaccine. A meningococcal a serogroup B have laboratory
they do not have 3-shot series is conjugate meningococcal confirmation of
contraindications needed for those (MenACWY). A (MenB) vaccine. previous dengue
with weakened booster shot is Ages 16–18 years infection
immune systems recommended old who are not
and those who at age 16. at increased
start the series at risk may be
15 years or older. vaccinated with a
MenB vaccine.

COVID-19 vaccination is recommended for ages 5 years and older.

Talk to your child’s doctor or nurse about the vaccines recommended for their age.
These shaded boxes indicate when the vaccine is
recommended for all children unless your doctor tells
you that your child cannot safely receive the vaccine.
These shaded boxes indicate the vaccine is
recommended for children with certain health or
lifestyle conditions that put them at an increased risk for
serious diseases. See vaccine-specific recommendations
at www.cdc.gov/vaccines/hcp/acip-recs/.
These shaded boxes indicate the vaccine SHOULD
be given if a child is catching up on missed vaccines.
This shaded box indicates children not at increased risk
MAY get the vaccine if they wish after speaking to a
provider.
This shaded box indicates children not at increased risk
may get the vaccine if they wish after speaking to a
provider.
SIGNS & TEST
• Preterm Week 1 • Single heart tube develops

FETAL DEVT
before 37 weeks • Respiratory & Digestive tract develops
Week 2
• Full term • CNS & PNS develops

TES between 38 - 41 weeks

• Post term
42 weeks beyond
• Chadwick's Sign
Week 3

Week 4
• Brain growth

• Heartbeat begins
• Esophagus & Lungs buds
Week 5
• Presence of Kidney, Spinal Cord develops
• Arms & legs buds
Week 6

Goodell's Sign
Week 7

Embryoscopy
• Heart chamber develops
• Diaphragm is complete
Week 8 • Brain wave can be detected via EEG

Hegar's Sign
• Facial features is discernible
Week 9
• Arms & legs dev't, Ext. genitals forms

Week 10 • Heartbeat via Doppler

Week 11 • Electrocardiogram can be recorded; Fetal movement via Ultrasound

Chronic Villi Sampling

Week 12 • Heartbeat via Doppler; Urine, nail beds & tooth forms; sex is distinguished

Week 13

Week 14

Amniocentesis Week 15

Week 16 • Meconium is sticky in consistency; fetal heart sound is heard; Lanugo is formed
• Liver & pancreas are functioning; Sex can be determined via UTZ
Ultrasound

Week 17

Week 17
SIGNS & TEST

Amniocentesis
• Fetoscopy • Cordocentesis Week 18

Ultrasound

FETAL DEVT
Week 19

TES • Fundal Height • Quickening Week 20

Week 21
• Vernix caseosa begins to cover the skin
• Immunoglobulins across the placenta
• Meconium present in upper intestine

Week 22

Week 23

• Leopold's Maneuver Week 24 • Surfactant is formed

• Ears respond to sound; Eyes exhibit pupillary action

Glucose & Tolerance Test

Week 25 • Meconium present in rectum

• Non-Stress Test Week 26

Week 27

Week 28 • Lung aveoli is almost mature

• Body fats increase, Bones are complete
Week 29 • Head hair gets coarse & thicker; Brain is continuously active

Week 28

Week 30

Week 31

Week 32 • Sucking & swallowing reflexes matured

• Subcutaneous fats are deposited
• Cardiotocography Week 33 • Fetus responds to outside noise via movement
• Fingernails reaches the fingertips
• Contraction Stress Test Week 34
SIGNS & TEST
Week 35

FETAL DEVT
Engagement
Week 36 • GI tract secretes enzymes for carbohydrates, fats & proteins

TES Week 37

Week 38
• Skin is covered by soft, downy, hair (lanugo) and vernix caseosa

Week 39

Week 40 • Fetal kicks actively

• Fetal hemoglobin > Adult hemoglobin
Week 41 • Vernix is fully formed

Week 42

Week 43

Week 44

Week 45

Week 46

Week 47

Week 48

Week 49

Week 50