Lesson

Components of Health History

Intravenous

1. Demographic data (name, age, address, gender, marital status, educational level, occupation,
Oxytocin
religion and health insurance information)

2. Chief concern: is the reason why a woman visits the health care setting. This is related to
Admini
the fact that she is or thinks she is pregnant.

3. Present health history

4. Past health history: woman’s past medical history including diseases that may cause potential
difficulty during pregnancy (e.g. heart disease, hypertension, diabetes, kidney disease, thyroid
disease, urinary tract infection, varicosities, tuberculosis, asthma, STIs including Hepatitis B and C,
herpes and HIV, childhood diseases and immunizations)
5. Family health history: illnesses that occur among woman’s relatives (hereditary diseases like
cardiovascular and renal disease, blood disorders cognitive impairment and congenital anomalies
or diseases inherited genetically)
6. Gynecologic history:
A. Menstrual history: age of menarche, length of menstrual cycle, duration and amount of
menstrual flow, any accompanying discomforts and menstrual pain.
∙ Menarche: is the first menstrual period
∙ Menopause: cessation of menstrual cycles
∙ Amenorrhea: absence of menstruation
∙ Dysmenorrhea: painful menstruation
∙ Menorrhagia: abnormally heavy menstrual flows
∙ Metrorrhagia: bleeding between menstrual periods
∙ Oligomenorrhea: scanty or very light menstruation
B. Perineal and Breast Self-Examination
∙ Perineal self-examination: inspecting the external genitalia monthly for
signs of infection or lesions
∙ Breast self-examination: monthly self-care routine
C. Past surgery: involves previous surgery on the reproductive tract which may influence the ability
of a woman to conceive and give birth
D. Reproductive planning
E. Sexual history
**Note: Abdominal examination is included
7. Obstetric history: includes previous pregnancy (when? type of delivery? outcome of birth?),
previous miscarriage or therapeutic abortions.
Classifying pregnancy status (OB Score)
GTPAL or GTPALM: provides information on woman’s history of pregnancy
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G: the number of times a woman has been pregnant, including the present pregnancy (Gravida
status)
P: the number of children over the age of viability that a woman has previously delivered (Para
status)
T: the number of full-term infants born at 37 weeks or after
P: the number of preterm infants born before 37 weeks
A: the number of spontaneous miscarriage or abortion
L: the number of living children
Definition of terms related to pregnancy:

Term

Definition

Para

Number of pregnancies that have reached viability, regardless of whether the infants were born
alive.

Gravida

Woman who is or has been pregnant.

Primigravida

Woman who is pregnant for the first time.

Primipara

Woman who has given birth to one child past age of viability.

Multigravida

Woman who has been pregnant previously.

Multipara

Woman who has carried two or more pregnancies to viability.

Nulligravida

Woman who has never been and is not currently pregnant.

Viability

The ability of the fetus to survive in extra-uterine condition (20 weeks gestation)
∙ Age of fetus ≥ 20-24 weeks
∙ Weighs at least 500g
∙ Length ≥ 18cm

Term pregnancy

A pregnancy of 38 – 42 weeks

Preterm pregnancy

It occurs before the end of 37 weeks of gestation

Postterm pregnancy (Postmature or

postdate)
Datism

A pregnancy that exceeds from 42 weeks

Abortion

is the medical term for any interruption of pregnancy before a fetus is viable

Miscarriage

Early: Termination of pregnancy before 16th week

Late: Termination of pregnancy between 16th -24th weeks

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Naegele’s is a method used for calculating the estimated Expected Date of Delivery/Expected Date
of Confinement (EDD/EDC) based on Last Menstrual Period (LMP)
8. Psychosocial aspect- social support system
9. Laboratory result (CBC, Blood group and RH Factor, HCG, urinalysis, ultrasound) 10. Current
medication or treatment
11. Functional health history/History of daily activity: information regarding woman’s current
nutrition, elimination, sleep, activity or exercise, personal habits, lifestyle, recreation, and
interpersonal interactions
12. Physical examination
A. Assessment of Body Systems
B. Height/Weight and Vital Signs:
Calculation of Body Mass Index:
BMI (Body Mass Index) = (weight per kg) / (Height per meter) ²

TOTAL WEIGHT GAIN DURING PREGNANCY (Body Mass Index – BMI)

*Institute of medicine (IOM) and National Research Council (NRC), 2009
(weight per kg/Height per meter2)

Range of Total Weight Gain (lb) Single Fetus

Underweight: BMI is less than 18.5

28-40

Normal weight: BMI is 18.5 to 24.9

25-25

Overweight: BMI is 25 to 29.9

15-25

Obese: BMI is 30 or more

11-20

Note:
Weight gain during 1st trimester: 0.8kg (1.5 lbs) per month ; 0.4 kg (1 lb) per week during the last
two trimesters (minimum weight gain 4.5 lbs, 12 lbs and 12 lbs for the trimester)
Normal weight gain during pregnancy is 11.3-15.8 kg (25 – 35 lbs)
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Lesson 2
EDC (Expected Dated of Confinement)
Example: Mrs Vila visits
her physician today
because of uncomfortable
feelings like morning
discomfort and body malaise.
The Nurse took vital signs and
asked her some question:
Nurse: When was your last
menstrual period?
Mrs Vila: April 11, 2021.
Compute for the EDC.
Example: A patient was rushed in the emergency
room complaining of minimal vaginal bleeding and
she stated that she is pregnant. As interviewed her
LMP is January 6, 2021. Compute for the EDC.
Example: LMP- August 14, 2021 LMP- March 27, 2021
LMP- December 25, 2020
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Lesson
3
Abdominal examination
General Guidelines: ∙ Empty bladder
AOG Age of Gestation Computation

∙ Measure fundal height (measure growth of fetus)

∙ Provide privacy
∙ Use inspection and palpation
∙ Documentation
Inspection:
Inspect the woman’s abdomen for its shape. This can indicate fetal size and lie, the amount of
amniotic fluid and sometimes fetal movement may be noticed. Obvious scars will be seen and this
information may be significant

Gestational age

Fundal height

40 weeks

1-2 finger widths below subcostal arch

(Normally, due to settling of the fetus into the midpelvis, known as Lightening)

36 weeks

Usually touches the xiphoid process

32 weeks

Between umbilicus and xiphoid process

28 weeks

3 finger widths above umbilicus

24 weeks

Just above the level of umbilicus

20 or 22 weeks
At the level of umbilicus

16 weeks

Between symphysis pubis and umbilicus

12 weeks

Just above the symphysis pubis

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Bartholomew’s Rule
Estimating Gestational Age from Fundal Height Measurement
Description:
Fundal height is measured in centimeters from the pubic symphysis to the top most portion of the
uterus
Purpose: To determine if the baby is growing normally at each stage of the pregnancy. Normally,
the height of the uterus will match the gestational age
How to measure fundal height
∙ Place a tape measure on the mother’s abdomen, holding the 0 (zero) part of the measuring tape at the top of
the pubic bone
∙ Follow the curve of her abdomen, and hold the tape measure at the top of her uterus (Fundus feels like firm,
circular or rounded regular)
∙ Write down the number of centimeters (cm) from the top of the pubic bone to the top of the uterus.
McDonald’s Rule:
Fundal height (cm) X 8/7 = AOG in weeks
Fundal height (cm) X 2/7 = AOG in months
Manual computation Age of Gestation- LMP: January 8, 2021
Clinic visit: September 6, 2021
Jan 23
Feb 28
Mar 31
Apr 30
May 31
Jun 30
Jul 31
Aug 31
Sep 7
181 days
181/ 7= 25.85(calculator)
181/7= 25 weeks and 7 days ( manual division)
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Lesson
4
Breast examination
General Guidelines:
∙ Perform hand hygiene
Breast Care

∙ Prepare necessary supplies/ materials needed.

∙ Explain the procedure to the client.
∙ Provide optimal privacy
∙ Use inspection and palpation
∙ The patient should be undressed from her waist up with arms at her sides. ∙ Maintain a warm and relaxing
environment, with good lighting
∙ Documentation
General Appearance:
1. Inspect for the breasts, areolas and nipples.
Breasts:
Assess for the
⮚ Size and symmetry
⮚ Characteristics of the skin (color, thickening, peau d’orange, edema,
superficial venous pattern of the breasts)
⮚ Presence of dimpling, nipple or skin puckering
Observe the breasts while woman’s hands are over her head and presses her hands on her hips.
Normally, the breasts hang evenly.
Breast asymmetry involves having a breast with a different shape or size than the other. Screening
of breast cancer or mammogram may indicate asymmetrical size or density of the breast.
(Note: it is common to have a slight asymmetry in size; usually the left breast is slightly smaller than
the right breast)
Areolas
∙ Observe the size, shape, symmetry, color and lesions
Nipples
∙ Note the symmetry, size, shape, appearance and direction to which the nipples point (protruded, flat or
inverted), presence of any rashes or sores and nipple discharge or bleeding
2. Palpate for the breasts.
Assist the client in supine position
Rationale: This position will flatten the breast tissue and displace it medially Put pillow under the side
of the breasts to be palpated and raise her arm over her head.
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Palpate the entire breast using the first three finger pads, in a gentle circular motion. Note for any
masses or lumps (location, size, shape, consistency, tenderness and mobility) or presence of
tenderness, swelling, and increase in warmth
Note: Patterns of palpation can be vertical strip, spokes-on-a-wheel or concentric circles.
Gently squeeze the nipple. Check for any induration or subareolar mass. Using the thumb and
forefinger, gently depress the nipple tissue into the wall behind the areola. Note for any discharge
Note: Milky discharge may be due to hypothyroidism, prolactinoma, drugs. Bloody discharge may
be due to papilloma, Paget’s disease
3. Inspect and palpate for the axillae
Inspect the skin for rashes and any signs of infection.
The patient’s forearm is rested across the examiner’s forearm.
(An alternative is to ask the patient to rest their hand on the examiner’s shoulder) Rationale: The
patient’s muscles are loose and relaxed
4. Palpate for the left axilla using your right hand and reaching your fingers high into the axilla.
Anterior (posterior surface of anterior axillary fold)
Medial (on the chest wall)
Lateral (against the humerus)
Posterior (anterior surface of posterior axillary fold)
Note for the texture: smooth without edema
5. Palpate for the right axilla using your left hand and reaching your fingers high into the axilla.
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Lesson
5
Leopold’s Maneuver
Abdominal Assessment

Leopold’s Maneuvers are a systematic method of observation and palpation to determine fetal
position, presentation, lie and attitude. The maneuvers are important because they help determine
the position and presentation of the fetus, which in conjunction with correct assessment of the
shape of the maternal pelvis can indicate whether the delivery is going to be complicated, or whether
a Cesarean section is necessary.
Keen observation of abdomen should give data about:
1. Longest diameter in appearance (longest diameter (axis) is the length of the fetus) 2. Location of
apparent fetal movement (the location of the activity most likely reflects the position of the feet)
PREPARATION
1. CARDINAL RULE: instruct woman to empty bladder first. This will promote comfort and allows
for more productive palpation because fetal contour will not be obscured by a distended bladder.
2. Place woman in dorsal recumbent position, supine knee flexed to relax abdominal muscles.
Place a small pillow under the head for comfort.
3. Drape properly to maintain privacy.
4. Explain procedures to gain patient’s cooperation
5. Warm hands first by rubbing them together before placing them over the woman’s abdomen to
aid comfort. Cold hands may stimulate uterine contractions. 6. Use the palm for palpation, not
fingers.
7. During the first three maneuvers, stand facing the patients. For the last maneuver, stand
facing the patient’s feet
FIRST MANEUVER:
Fundal Grip: what fetal pole or part occupies the fundus?
¬ Palpation of the fundal area to determine which fetal part is in the uterine fundus ¬ To determine
the presenting part of presentation (part of the fetus lying over the
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inlet)
Procedures
1. Nurse stand at the side of the bed, facing the patient
2. Using both hands, feel for the fetal par lying in the fundus
Findings
The nurse-midwife should ascertain what is lying at the fundus by feeling the upper abdomen
(fundus) with tips of both hands. generally, she will find there is a mass, which will either be the
head or the buttocks (breech) of the fetus. The nurse-midwife must decide which pole of the fetus; it
is by observing three points:
∙ Relative consistency- the head is harder/firmer than the breech
∙ Shape- if the head, it will be round and hard, and the transverse groove of the neck may be felt. The breech
has no groove and usually feels more angular. ∙ Mobility- the head will move independently of the trunk; but
the breech
moves only in conjunction with the body.
If the nurse-midwife feels the head, the fetus is in breech presentation; if the nurse-midwife feels
the buttocks, it means the fetus is in vertex presentation.
SECOND MANEUVER: Umbilical Grip: Which side is the fetal back?
To locate/identify the fetal back in relation to the right and left sides of the mother To determine the
fetal position (the relationship of the presenting part to one of the quadrants of the mother’s pelvis)
Procedures
1. The nurse-midwife places the palmar surfaces of both hands on either side of the abdomen 2.
With left palm stationary on the left side of the abdomen to steady the uterus, the right palpates the
right side of the uterus on a circular motion from top to lower segment of the uterus applying gentle
but deep pressure to palpate the fetal outline and small fetal parts 3. The nurse-midwife the reverses
her hands
Findings
Small fetal parts (knee and elbows) feel nodular with numerous angular nodulations. Fetal back feels
smooth, hard, like a resistant surface
THIRD MANEUVER: Pawlik’s Grip: What fetal part lies above the pelvic inlet?
¬ Determine if the presenting part has entered the pelvis (engagement of presenting part)
¬ To find the head at the pelvis and to determine the mobility of the presenting part
Procedures
1. The nurse-midwife stands at the side of the bed, facing the patient
2. It should be conducted by gently grasping the lower portion of the abdomen, just above the
symphysis pubis, between the thumb and the two fingers of one hand and then pressing together
slightly and make gentle movements from side to side
Findings
If the presenting part moves, round, ballotable and easily displaces it is not yet engaged. If the
presenting part not movable felts as relatively fixed, knoblike part, it is engaged. If it is firm, it must
be the head. If soft, it could be breech
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FOURTH MANEUVER: Pelvic Grip: Which side is the cephalic prominence?
Cephalic prominence is a part of the fetal head that prevents the deep descent with one hand
To determines the degree of fetal head flexion or extension
To determine the attitude or habitus (degree of flexion of the fetal body, head and extremities, or
the relationship of fetal parts to each other)
To determine the fetal descent
Should only be done if fetus is in cephalic presentation. Information about the infant’s
anteroposterior position may also be gained from this final maneuver
Procedures
1. The nurse-midwife faces the feet of the patient
2. Place one hand each on either side of the lower pole of the uterus
3. Palpate the fetal head by pressing downward about 2 inches above the inguinal ligament 4. Use
both hands
Findings
If descended deeply, only a small portion of the fetal head will be palpated. If cephalic prominence
or brow or the baby is on the same side of the small fetal parts, the head is flexed.
If the cephalic prominence is on the same side of the fetal back, the head is extended.
Things needed:
Tape measure
Blanket (to provide privacy)
Stethoscope
Clipboard (documentation

Leopold’s Maneuver

Rationale

Preparation
1. Explain the procedure and instruct the mother to void to empty her bladder.

To relieve the patient’s anxiety and enhance cooperation. To promote comfort and allows for more
productive palpation because fetal contour will not be obscured by distended bladder.

2. Wash your hands using warm water. Drape properly.

To aid comfort and cold hands may stimulate uterine contraction. To provide privacy.

3. Position the client in a dorsal

recumbent position, supine with knees slightly flexed.

To relax abdominal muscles

Procedure
First maneuver: (Fundal grip)
1. Stand at the foot part of the client, facing her and place hands above the abdomen just below the
xyphoid
process.
2. Gently move your hands downward and Page33 palpate the superior
surface of the fundus

To determine whether the fetal head or breech. When palpating, a head feels firmer than a breech.
A head is round and hard; the breech is less well defined. A head moves independently of the body;
the breech moves only in conjunction with the body.

Second maneuver: (Umbilical grip)

1. Face the client, hold the left-hand stationary of the uterus while you palpate with the right hand
on the opposite side

To determine the location of the fetal back. One hand will feel a smooth, hard, resistant surface (the
back), while on the opposite side, a number of

Page 13 of 49

of the uterus from top to bottom. Repeat palpation using the opposite side.

angular nodulations (the knees and elbows of the fetus) will be felt.

Third maneuver: (Pawlik’s grip)

1. Gently grasp the lower portion of the abdomen just above the symphysis pubis between the
thumb and fingers and try to press the thumb and
fingers together.
2. Determine any movement and whether the part feels firm or soft.

To determine if the presenting part has entered the pelvis (engagement of presenting part)
If the presenting part moves, round, ballotable and easily displaces it is not yet engaged. If the
presenting part not movable felts as relatively fixed, knoblike part, it is engaged.
If it is firm, it must be the head. If soft, it could be breech.

Fourth maneuver: (Pelvic grip)

1. Place fingers on both sides of the uterus approximately 2 inches about the inguinal pressing
downwards and inward in the direction of the birth canal.
2. Allow the fingers to be carried downward to determine the fetal
attitude and degree of fetal extension into the pelvis.

To determines the degree of fetal head flexion or extension.

To determine the attitude or habitus (degree of flexion of the fetal body, head and extremities, or
the relationship of fetal parts to each other).
To determine the fetal descent

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Lesson 6
Fetal Heart Tone Monitoring

FETAL HEART TONE MONITORING

Fetal Heart Tone/Rate
∙ Fetal well-being or fetal health is best measured by evaluating fetal heart tones (FHT). ∙ A normal fetal heart
tone (FHT) usually ranges from 120 to 160 beats per minute (bpm) in
 the in utero period. Mild bradycardia is considered to be 100 to 119 BPM (beats per minute).
Marked bradycardia is considered as 99 or fewer BPM. Marked tachycardia is considered to be 180
BPM or higher. This is only a guide; some authorities will use different parameters for diagnosis; be
familiar with what is used at your facility to diagnose these conditions.
∙ This method of testing fetal well-being can be used commencing with the 18th to 20th
week of pregnancy. A fetoscope is used for counting the rate. In some cases, ultrasonic equipment
may be used to detect fetal heart tones, as early as the 10th week of gestation. However, most
nurses will use the standard fetoscope for heart tones.
When to check FHT
∙ Typically, FHT drops somewhat with the onset of uterine contraction but recovers promptly as the
contraction ends. Changes in FHT that are most likely to be ominous always are detectable immediately after
a contraction. It is therefore imperative to auscultate FHT immediately after a contraction.
∙ Fetal distress is suspected if FHT immediately after a contraction is repeatedly below 120/minute and fetal
distress very likely exists if FHT is less than 100/minute even though there is recovery to a normal rate before
the next contraction.
Frequency of FHT Auscultation
∙ Normal labor, first stage: at least every 30 minutes, immediately after a contraction.
∙ High-risk pregnancy/labor: every 15 minutes in an acceptable alternative to continuous electronic
monitoring.
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Procedure

Rationale

1.To use the Doppler:

∙ Place the ultrasonic gel on the diaphragm ∙ The diaphragm should be warmed prior to the using the Doppler
.∙ Place the Doppler diaphragm on the woman’s abdomen halfway between the umbilicus and symphysis
pubis and in the midline. Listen carefully for the sound of the heartbeat.

Gel is use to maintain contact with the maternal abdomen and enhances conduction of sound.
You are most likely to hear the FHR in this area.

2.Check the woman’s pulse against the fetal sounds you

hear. If the rates are the same, reposition the Doppler
and try again.

If the rates are the same, you are probably hearing the maternal pulse and not FHR.

3. If the rates are not similar, count the FHR for 1 full
minute.

Note that the FHR has a double rhythm and only one sound is counted.

4. If you do not locate the FHR, move the Doppler laterally.

5. Auscultate the FHR between, during, and for 30 to 60 seconds following a uterine contraction
(UC).

This detects abnormal heart rate.

1. Frequency recommendations:
∙ Low risk women: Every 30 minutes
during the first stage, and every 15
minutes in the second stage.
∙ High risk women: Every 15 minutes
during the first stage, and every 5
minutes in the second stage.

This evaluation provides the opportunity to assess the fetal status and response to labor.

7. Documentation

Document that the procedure was explained to the woman and that she verbalized
understanding. The location of the FHR, FHR baseline, changes in FHR that occur with
contractions, and presence of accelerations or decelerations should be included. Other
characteristics should include variability, maternal position, type of device used, uterine activity,
maternal pulse, and nursing
interventions that were performed.

8. To use fetoscope
∙ The bell should be warmed prior to
using the fetoscope.

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9. Place the fetoscope earpieces in your ears and the device support against your forehead; use
the handpiece to position the bell of the fetoscope on the mother’s abdomen.

10. Place the diaphragm halfway between the umbilicus and symphysis and in the midline.

You are most likely hear the FHR in this area.

11. Without touching the fetoscope, listen carefully to the

FHR.
12. Frequency recommendations:
∙ Low risk women: Every 30 minutes during the first stage, and every 15 minutes in the second stage.
∙ High risk women: Every 15 minutes during the first stage, and every 5 minutes in the second stage.

This evaluation provides the opportunity to assess the fetal status and response to labor.

13. Documentation

Document that the procedure was explained to the woman and that she verbalized
understanding. The location of the FHR, FHR baseline, changes in FHR that occur with
contractions, and presence of accelerations or decelerations should be included. Other
characteristics should include variability, maternal position, type of device used, uterine activity,
maternal pulse, and nursing
interventions that were performed

14. To use Stethoscope

∙ Explain the procedure to the mother.

Tell the mother that you will check the fetus by listening to its heartbeat. Explain that frequent check
of the FHT is routine.

15. Perform the Leopold’s maneuvers.

To detect the area of fetal back – best site for locating the FHT.

16. With the bell of the stethoscope placed over the area of fetal back, count FHT for 1 whole
minute.

17. Observe care in holding the stethoscope over the mother’s abdomen.

Keep fingers odd bell. Make sure that friction noises from the fingers or abdominal surface do not
distort the sounds.

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18. Differentiate FHT from other sounds:

∙ FHT: distinct in sound, resembling the ticking of a watch
placed under a pillow; rapid with rate of 120- 160/minute.
∙ Maternal soufflé: from uterine arteries pulsation;
described as soft, blowing with “sh” sound the rate
which resembles that of maternal pulse. ∙ Funic Souffle or cord whistle: soft, whistling sound
occurring at the same rate as the FHT. ∙ Maternal peristalsis may also be heard because a woman
in labor is usually hungry.

To check if it is really FHT and not maternal soufflé, carefully listen to the FHT using a well
functioning stethoscope and at the same check the maternal pulse.
The identification of maternal soufflé does not guarantee fetal life.
The identification of funic soufflé indicates fetal life.

19. Encourage the mother and father (if present during labor) to listen, too to the FHT.

To promote bonding between the fetus and the father, allow him to listen to the FHT.

20. Record accordingly.

21. Report abnormalities of FHT.

a. Late Decelerations: FHT decreases where the range of drop maybe within normal and the
decelerations occur after the onset of contraction (usually after acme) and persists beyond
completion of contraction. This is an ominous sign of fetal hypoxia caused by uteroplacental
insufficiency.
b. Variable Deceleration: FHT decreases at any point during or between contractions where the
range of drop in FHT is large and extends below normal. This is another ominous sign of umbilical
cord compression. ϖ For both late decelerations and variable decelerations, the healthcare
provider should act fast: repose the mother to her left side, give oxygen and summon the physician

Lesson 17
Newborn Care
ESSENTIAL NEWBORN CARE
The ENC Protocol is a step-by-step guide for health workers and medical practitioners issued by the
Department of Health for implementation under AO 2009-0025 dated December 1, 2009.
OBJECTIVES OF ENC
Aims to ensure health workers have the skills and knowledge to provide appropriate care at the
most vulnerable period in a baby’s life. (WHO, Essential Newborn Care, 2010)
DEFINITION OF TERMS
1. Attachment - is the mode of contact between the baby's mouth and the mother's breast during the
act of breastfeeding
.
2. Kangaroo Mother Care - a universally available and biologically sound method of care for all
newborns, but in particular for premature babies, with three components:
a) skintoskin contact,
b) exclusive breastfeeding and
c) support to the mother-infant
3. Newborn Resuscitation - a series of actions taken to establish normal breathing in a newborn
with depressed vital signs

4. Positioning - means how the mother holds her baby to ensure proper attachment to each other. 5.
Positive pressure ventilation - is the most important aspect of newborn resuscitation for ensuring
adequate ventilation of the lungs, oxygenation of vital organs such as heart and brain, and initiation
of spontaneous breathing.
Pregnancy, Childbirth, Postpartum and Newborn Care (PCPNC): A Guide for Essential practice in
Philippine setting - an Essential Care Practice Guideline adapted from the World Health
Organization by the Department of Health. It provides evidence based recommendations to guide
healthcare professionals in the management of women during pregnancy, childbirth and
postpartum, post-abortion, and newborns during their first week of life
6. Skin-to-skin contact - is placing the naked newborn prone on the mother's bare chest. It is
considered a critical component for successful breastfeeding initiation.
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7. Small baby - a newborn weighing from between 1,500 g to 2,499 g
8. Vernix Caseosa – Protective barrier to E. coli and Group B Strep
ESSENTIAL IMMEDIATE NEWBORN CARE PRACTICES
1. Time Band: AT PERINEAL BULGING – prepare for delivery
a. Check the temperature of the delivery room (25-28oC), free of air drafts
b. Notify the appropriate staff
c. Arrange the needed supplies in linear fashion: 2 CLEAN DRY TOWELS
CORD TIES
SYRINGES & NEEDLES
CORD CLAMPS
RESUSCITATION EQUIPTMENT
TETRACYCLINE
OINTMENT
RAZOR BLADE
d. Check resuscitation equipment
e. Wash hands with clean water and soap
f. Double glove just before the delivery
2. Time Band: IMMEDIATE THOROUGH DRYING - Within 1-30 seconds
a. Call out the time of birth
b. Dry the newborn thoroughly for at least 30 seconds
c. Wipe the eyes, face, head, front and back, arms and legs
d. Remove the wet cloth
e. Do a quick check for breathing and while drying
f. NOTES: during the 1st second
Do not ventilate unless the baby is floppy/limp and not breathing
Do not suction unless the mouth/nose are blocked with secretions and other materials
3. Time Band: CORD CARE - 1-3mins
a. Remove the first set of gloves
b. After the umbilical pulsation have stopped, clamp the cord using a sterile plastic clamp or tie at 2
cm
from the umbilical base
c. Clamp again at 5 cm from the base
d. Cut the cord to the plastic clamp
e. Notes:
Do not milk the cord towards the baby
After the 1st clamp, you may strip the cord of blood before applying the 2nd clamp
Cut the cord close to the plastic clamp so that there is no need for a second trim
Do not apply any substance unto the cord
4.Time Band: UNANG YAKAP / BREASTFEEDING - within 90 mins – is conducted to ensure early
breastfeeding initiation and roaming-in. The earlier the baby breastfeeds, the lesser the risk of
death.
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a. Leave the newborn in skin-to-skin contact

b. Observe for feeding cues, including tonguing, licking and rooting
c. Point these out to the mother and encourage her to nudge the newborn towards the breast
NON-IMMEDIATE INTERVENTIONS
These interventions are usually given within 6 hours after birth, and should never be made to
compete with the time-bound interventions.
1. Give Vitamin K prophylaxis
- Inject a single dose of Vitamin K 1 mg 1M (if parents decline intramuscular injections, offer oral
vitamin
K as a 2nd line).
2. Inject Hepatitis and BCG vaccinations
-Inject hepatitis B vaccine IM and BCG intradermal
3. Examine the newborn. Check for birth injuries, malformations or defects
-Weigh the newborn and record.
-Look for possible birth injury and/or malformations.
-Refer for special treatment and/or evaluation if available.
-If the newborn has feeding difficulties because of the injury/malformation, help the mother to
breastfeed. If not successful, teach her alternative feeding methods.
3. Cord Care
-Wash hands.
-Fold diaper below stump. Keep cord stump loosely covered with clean clothes. -If stump is soiled,
wash it with clean water and soap. Dry it thoroughly with clean cloth.
-Explain to the mother that she should seek care if the umbilicus is red or draining pus.
-Teach the mother to treat local umbilical infection three times a day:
Early Washing
-hinders crawling reflex
-can lead to hypothermia, infection, coagulation, defect, acidosis, delayed fetal to NB circulatory
adjustment, hyaline membrane disease, brain hemorrhage
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Lesson 18
APGAR Scoring
APGAR Scoring
Assessment of the newborn immediately starts the moment he or she is delivered, and there are a
lot of standard assessments used to evaluate them rapidly.
The Apgar scoring is done during the first 1 minute and 5 minutes of life. The heart rate, respiratory
rate, muscle tone, reflex irritability, and the color are evaluated in an infant. Apgar score is the
baseline for all future observations.
• Each parameter can have the highest score of two and the lowest is 0.
• The scores of the five parameters are added to determine the status of the infant. • Apgar scoring
• 0-3 points: the baby is serious danger and need immediate resuscitation. • 4-6 points: the baby’s
condition is guarded and may need more extensive clearing of the airway and supplementary
oxygen.
• 7-10 points: are considered good and in the best possible health.
The physical assessment includes an exam of the following physical characteristics: • Skin texture.
Skin may be sticky, smooth, or peeling.
• Lanugo. This is the soft downy hair on a baby's body. It's absent in premature babies. It's present
in full-term babies, but not in babies born late.
• Plantar creases. These are the creases on the soles of the feet. They range from absent to
covering the entire foot.
• Breast. The thickness and size of the breast tissue and the areola (the darkened area around each
nipple) are assessed.
• Eyes and ears. Eyelids are checked to see if they are open or fused shut (more likely in a
premature baby). The amount of cartilage and stiffness of the ear tissue are also noted.
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• Male genitals. The presence of testes and the look of the scrotum, from smooth to wrinkled, is
verified.
• Female genitals. The appearance and size of the clitoris and the labia are noted.
Ballard score is commonly used to determine gestational age
• Scores are given for 6 physical and 6 nerve and muscle development (neuromuscular) signs of
maturity. The scores for each may range from -1 to 5.
• The scores are added together to determine the baby’s gestational age. The total score may range
from -10 to 50.
• Premature babies have low scores. Babies born late have high scores. • The neuromuscular
assessment includes an exam of the following:
• Posture. How the baby holds his or her arms and legs.
• Square window. How far the baby's hands can be flexed toward the wrist. • Arm recoil. How well
the baby's arms spring back to a flexed position. • Popliteal angle. How well the baby's knees bend
and straighten.
• Scarf sign. How far the elbows can be moved across the baby's chest. • Heel to ear. How close the
baby's feet can be moved to the ears.