Care of Mother, Child & Adolescent (Lecture) - NCM107A

Module 4: Care of Mother The Mother & Teratogenic Maternal Infections

The Fetus During The Perinatal Period
● Malaria
- caused by Plasmodium protozoa
ANTEPARTUM
(bite of infected female
anopheles mosquito)
Effects of Teratogens on The Fetus
- maternal anemia, fetal loss,
premature delivery, intrauterine
Teratogen - is any factor, chemical or
growth retardation, and delivery
physical, that adversely affects the
of low birth-weight infants (<2500
fertilized ovum, embryo, or fetus.
g or <5.5 pounds), a risk factor
for death
Factors that influence amount of
damage of teratogens:

● Strength of the teratogen ● Herpes Simplex Virus

● Timing of the teratogen (Genital Herpes Infection)

● Affinity for specific tissue- there - Herpes 1 virus is the causative

are teratogens that cause agent of the common cold sore

specific damage like: - Herpes 2 virus- is generally the

- Lead cause of genital lesions.

- Mercury
- Thalidomide ● Rubella (German Measles)
- Tetracycline - the worst viral infection that
- Rubella virus causes extensive fetal damage.
The greatest risk to the embryo

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Care of Mother, Child & Adolescent (Lecture) - NCM107A

from this virus is during The newborn’s skin may be covered

organogenesis with large petechiae (i.e.,
- classic sequelae: hearing “blueberrymuffin” lesions).
impairment, cognitive and motor
challenges, cataracts, cardiac
● Syphilis - a spirochete
defects (most commonly patent
infection and STD
ductus arteriosus and pulmonary
- Effects to fetus: congenital
stenosis), restricted intrauterine
anomalies, extreme rhinitis
growth (i.e., small for gestational
(sniffles), and a characteristic
age), thrombocytopenic purpura,
syphilitic rash
and dental and facial clefts, such
as cleft lip and palate
● Toxoplasmosis - a pathogen
infection contracted by eating
● Cystomegalic Inclusion
undercooked meat; it is spread
Disease (CID)
through cat stool, and cat litter
cystomegalovirus
- a salivary gland disease,
transmitted by droplet infection Effects to Fetus:

effects to fetus: severe neurologic miscarriage / stillbirth / premature birth

challenges (e.g., hydrocephalus, or an abnormally low birth weight.
microcephaly, or spasticity) or with eye Health Instructions:
damage (e.g., optic atrophy or
- Should be cautioned to avoid
chorioretinitis), hearing impairment, or
undercooked meat
chronic liver disease.

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Care of Mother, Child & Adolescent (Lecture) - NCM107A

- Should be careful not to change a Infections that cause Illness at Birth

cat box or work in soil where cats
● are maternal infections not
defecates
harmful to the fetus during
- Taking a new cat is not wise but pregnancy but harmful if they
see to it that the cat is clean and are present at time of birth.

healthy
- Lyme - a multi system disease Gonorrhea
caused by bacteria carried by ● caused by bacteria Neisseria
Gonorrhoeae
ticks and transmitted through tick
● effects on the fetus:
bites miscarriages, premature birth
- Rashes spreading around the and low birth weight,
premature rupture of
bite
membranes, and
- Fever, chills, muscle pains, chorioamnionitis.
- Lyme arthritis
- Nerve and heart problems Candidiasis
● a monilial infection cause by
CANDIDA ALBICANS
● Other Viral Diseases
● effects in the fetus as a
(rubeola/measles, mumps, sequelae: prematurity or an
chicken pox, varicella, underlying infection

polio, influenza, viral

hepatitis, HIV) ● So, a baby born with CNS
damage or anomalies may
- may cause: fetal death, severe
have a TORCH Screen of
anemia and congenital heart
disease

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Care of Mother, Child & Adolescent (Lecture) - NCM107A

T - Toxoplasmosis ● Tranquilizers
● Vitamin A derivatives
O - Other viral infection
(including syphilis)
R - Rubella
C - Cytomegalovirus Teratogenicity of Alcohol

H - Herpes II ● Fetal alcohol syndrome

Teratogenicity of Cigarettes
● fetal growth restriction
Potential Teratogenicity of Vaccines ● Low birth weight
● a fetus may be at greater risk
● Live virus vaccines (measles,
for being stillborn
HPV, mumps, rubella, polio)
● after birth, may be at a
greater risk than others for
sudden infant death
Teratogenic Drugs
syndrome
● Thalidomide
● Cytotec drugs
● Analgesics (Aspirin, NSAID) Environmental Teratogens
● Antineoplastics
● Androgens ● impure air or water – fetal
● Anticonvulsants growth restriction
● Anticoagulants
● Antidiabetic
● Antithyroid
● Antibiotics Metal & Chemical hazards
● Antischizophrenic
● Anthelmintics Pesticides, Carbon Monoxide,
● Antivirals Mercury, Fluoride, Lead
● Caffeine
● Angiotensin - ingestion may cause mental
● Hypoglycemics
retardation and CNS damage to
● Nicotine
● Radiopharmaceuticals fetus
● Narcotics

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Care of Mother, Child & Adolescent (Lecture) - NCM107A

Toxic Waste (Dioxin)

- may cause fetal malformation Health Assessment During the

and leukemia later in life First Prenatal Visit:
Radiation

- produces a range of A. Demographic Data

malformations depending on the
stage of development of the
embryo or fetus and the strength
and length of exposure
address, telephone number, race/ethnic
group, religion, health insurance
B. Family profile

Hyperthermia and hypothermia identify support system, size of house,

her age & partner’s age, educational
- advise pregnant women not to
levels, occupation
use hot tubs, saunas, or tanning
beds during pregnancy
- effect of hypothermia is not well C. Family history
known - Inherited disease
- Congenital Anomalies
Teratogenic Maternal Stress: D. Past medical history
- anxiety and worry beyond the - Cardiac, kidney, STD’s, DM,
usual amount could produce Thyroid, Respiratory, Surgical
physiologic changes through their procedures, Injuries, Childhood
effects on the sympathetic Diseases, Allergies/ drug
division of the autonomic nervous sensitivities\
system.

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Care of Mother, Child & Adolescent (Lecture) - NCM107A

E. Social profile ○ G - # of pregnancies

Information of woman’s lifestyle ○ P- # of delivered full term

○ T – term pregnancy
● Exercise
○ P – preterm pregnancy
● Hobbies
○ A – abortion
● Smoking
○ L – living children
● Drinking habits
○ M – multiple pregnancies
● Medication history
● Recreational drugs
Tests for fetal growth and
development are commonly done for
F. Gynecologic history
a variety of reasons, including to:

○ Reproductive tract ● Predict the outcome of the

○ Breast problem pregnancy
● Manage the remaining weeks of
○ Menarche
the pregnancy
○ Menstrual cycle (interval, ● Plan for possible complications at
duration, amount, birth
● Plan for problems that may occur
discomfort)
in the newborn infant
○ Past surgery on ● Decide whether to continue the
reproductive tract pregnancy
● Find conditions that may affect
○ Reproductive planning
future pregnancies
method
○ Sexual history

G. Obstetric history

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Care of Mother, Child & Adolescent (Lecture) - NCM107A

Nursing responsibilities for these Fundal Heights:

assessment procedures include: ● at the symphysis pubis – 12
● verifying that a signed consent form
weeks
has been obtained as needed
● at the umbilicus – 20 weeks
● being certain the woman and her
support person are aware of what
● at xiphoid process – 36 weeks
the procedure will entail and any
potential risks
Mc Donald’s rule:
● preparing the woman physically and
psychologically, providing support ● lunar months:
during the procedure ○ fundal height(cm)
● assessing both fetal and maternal x 2/7
responses during and after the ○ ex: 14 cm x 2/7 = 4
procedure months
● providing any necessary follow-up ● weeks:
care, and managing equipment and
○ fundal height (cm)
specimens.
x 8/7
○ ex: 14 cm x 8/7 =
HEALTH HISTORY 16 weeks
- any pre pregnancy illnesses
Laboratory Tests
- drugs a woman takes
- nutritional intake 1. Blood grouping - to determine the
- personal habits blood type
- exposure to teratogens 2. Hgb/Hct - to detect anemia Hgb <
11 g/dl or Hct < 32% requires iron
- unintentional injuries or intimate
supplementation
partner violence
3. CBC - to detect infection or cell
abnormalities
4. Rh factor - for possible
PHYSICAL EXAMINATION
maternal-fetal blood incompatibility
● vital signs 5. VDRL or RPR (Rapid Plasma
● height & weight Reagin) - serologic test for syphilis
● pelvic measurement 6. Urinalysis
● Abdomen 7. Antibody titers for rubella &
Hepatitis B
8. HIV Screening

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Care of Mother, Child & Adolescent (Lecture) - NCM107A
9. Glucose Tolerance test
10. Tuberculosis Screening
11. Ultrasonography
● Schedule of Pre- visits up to 32
weeks - once/ 2 months
● 32- 36 weeks - 2x / months
● 36 weeks to delivery- once a
week
Leopold’s maneuver
- a systematic way of observation &
palpation to determine fetal position
Preparation:
1. Let the patient void.
2. Position the mother supine with
knees flexed
Steps:
1. Palpate what is lying in the
fundus. “Fundal Grip”
BREECH – round, hard, mobile
CEPHALIC – irregular, soft, non- mobile
2. Palpate fetal back in relation to
the right & the left. “Umbilical
Grip”
3. Locate the presenting part at
pelvic inlet & check for
engagement. “Pawlik’s Grip”
4. Palpate just above the inguinal
the relationship of the presenting
part to the pelvis. “Pelvic Grip”
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Assessing the fetal heart tones:
1. Fetal heart tones
- a very rapid, somewhat muffled
ticking sound
normal: 120-160 bpm
2. Uterine bruit / Souffle
● a soft murmur caused by the
passage of blood thru the uterine
vessels
● synchronous with maternal pulse
3. Funic Souffle
● hissing sound produced by
passage of blood thru the
umbilical arteries
● synchronous with FHB
VARIATIONS IN F H B
1. Early deceleration
- caused by fetal head compression
- Management: no intervention required
2. Late Deceleration
- caused by uteroplacental insufficiency
- delayed until 30-40 secs after the
onset of contraction.
Care of Mother, Child & Adolescent (Lecture) - NCM107A

- Management 1. Fetoscopy
change the woman’s position to left side 2. Pre-Implantation diagnosis

admin O2, IV
3. Variable Deceleration Genetic Counseling:

- caused by umbilical cord compression ● an educational process that

seeks to assist affected
- Management: change the woman’s individuals in getting an inherited
position to relieve pressure on the cord condition to understand the
nature of the genetic disorder,
Genetic Assessment & Counseling its transmission and the options
there might be for prevention and
● Genetics - the study of
or testing.
individual genes and their
impact on relatively rare
single gene disorders. Purpose of Genetic Counseling:
● Assessment: 1. Provide concrete, accurate
1. History information about the process
2. Physical Assessment of inheritance and inherited
A. Inspection of body areas disorders
3. Diagnostic Test: 2. Reassure people who are
A. Karyotyping concerned their child may
B. Maternal Serum screening - AFP inherit a particular disorder
that the disorder will not occur
4. Chorionic Villi sampling
3. Allow people who are affected
5. Amniocentesis by inherited disorders to make
6. Percutaneous Umbilical Blood informed choices about future
Sampling reproduction
4. Allow people to pursue
7. Fetal Imaging
potential interventions that
A. Computed tomography Scan may exist such as fetal
B. MRI surgery
C. UTZ

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Care of Mother, Child & Adolescent (Lecture) - NCM107A
5. Allow families to begin
preparation for a child with
special needs
Assessment of Fetal Well being &
Maturity
● FETAL HEART RATE
- heard and counted as early as
the 10th to 11th week of
pregnancy by the use of an
ultrasound Doppler technique
- Done routinely at every prenatal
visit past 10 weeks.
● DAILY FETAL MOVEMENT
COUNT (KICK COUNTS)
- occurs at approximately 18 to 20
weeks of pregnancy and peaks in
intensity at 28 to 38 weeks
● DAILY FETAL MOVEMENT
COUNT (KICK COUNTS)
- Lie in a left recumbent position
after a meal.
- Observe and record the number
of fetal movements (kicks) their
fetus makes until they have
counted 10 movements.
- Record the time (typically, this is
under an hour).
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- If an hour passes without 10
movements, they should walk
around a little and try to count
again.
- If 10 movements (kicks) cannot
be felt in a second 1-hour period,
they should telephone their
primary healthcare provider. The
fetus could be healthy but
sleeping during this time, so lack
of typical movements may not be
serious, but it is an indication for
further assessment
● AMNIOCENTESIS
- done during the 26th week of
gestation
- in amniocentesis, a hollow needle
is inserted through the mother's
abdomen into the uterus, and
amniotic fluid is drawn for
analysis
- early 1st trimester: to detect
congenital abnormalities
- 3rd trimester: determine fetal
lung maturity
a. Lecithin/Sphingomyelin (L/S) Ratio
- measures maturity of fetal lung
- the protein component of the
enzyme surfactant
Normal Ratio 2:1
b. Alpha-Feto Protein
Hannah Leal Rendaje Shariff BN1E
Care of Mother, Child & Adolescent (Lecture) - NCM107A

- major plasma of early fetus NON-REACTIVE:

- decrease after 13 weeks of - FHR does not increase to fetal
gestation activity
- with AFP: neural tube defect - Less than 3 responses in 20
c. Color of Amniotic fluid minute recording

POST AMNIOCENTESIS: ○ OXYTOCIN CHALLENGE

- Let the mother drink 2-4 glasses TEST (OCT) /
of water within 2 hours CONTRACTIONS
- Monitor vital signs STRESS TEST (CST)
- done for evaluation of the ability
of the fetus to withstand the
NON STRESS TEST (NST)
stress of uterine contractions
● used to evaluate FHR in
Indication:
response to fetal activity
● non stress because the fetus is - If the woman has a non reactive
not challenged or stressed by non stress test -
uterine contractions Procedure:
- Diluted IV Oxytocin is given via
Indications: infusion pump
- women with prolonged pregnancy
- diabetes Interpretation:
- hypertensive disorders - Negative:
- history of stillbirth ● 3 contractions in 10 min
● No Late Deceleration (Indicates
Interpretation: Placental Insufficiency)
REACTIVE: - Positive:
- FHR greater than 15bpm in ● presence of Late Deceleration in
response to fetal activity for 15 response to uterine contractions
seconds
- 5 responses in 20 minute ● ULTRASONOGRAPHY
recording
Uses:

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Care of Mother, Child & Adolescent (Lecture) - NCM107A
- Diagnose pregnancy as early as
6 weeks gestation.
- Confirm the presence, size, and
location of the placenta and
amniotic fluid.
- Establish a fetus is growing and
has no gross anomalies such as
hydrocephalus; anencephaly; or
spinal cord, heart, kidney, and
bladder concerns.
- Establish the sex if a penis is
revealed.
- Establish the presentation and
position of the fetus.
- Predict gestational age by
measurement of the biparietal
diameter of the head or
crown-to-rump measurement.
- Discover complications of
pregnancy
HEALTH EDUCATION
Objective of Health Education to
Pregnant Women and family
1. Use effectively the knowledge
gained in the discussion of
prenatal care.
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2. Identify health problems,
discomforts and needs of
pregnant mothers.
3. Enumerate the different
prenatal exercises.
4. Formulate the plan of action
in taking care of prepartum
clients
5. Discuss possible danger S/S
of pregnancy, during the
course of labor, delivery and
its nursing interventions.
6. Explain factors affecting the
normal process of labor and
delivery.
7. Show behaviors of concern,
compassion and competence
in the care of prepartum and
intrapartum mothers and
family
1. Weight gain
○ Normal weight
A. 2-5 lbs – 1st trimester
B. 1 lb/week – 2nd & 3rd trimester
C. Total Weight Gain: 25-35 lbs
D. Components of Weight Gain
- Fetus 7.5 lbs
- Placenta 1-1.5 lbs
- Amniotic Fluid 2 lbs
- Uterus 2.5 lbs
Hannah Leal Rendaje Shariff BN1E
Care of Mother, Child & Adolescent (Lecture) - NCM107A

- Breast tissue 3 lbs C. Pelvic tilt – for relief of backache

- Blood Volume 4 lbs Shoulder circling –
- Maternal stores 4-8 lbs for relief of
backache
2. Nutrition 5. Sexual Relations
- Calories – increase 300 Kcal/day ○ no restrictions
- CHON – 4 servings of meat ○ CI: vaginal
recommended or 60 g/day bleeding, ruptured
- Ca – 1200 mg/day membranes
- Folate – 0.4 mg/day ○ strong uterine
- Iron – 30 mg/day contraction after
orgasm

3. Rest
- encourage mother to sit down &
elevate the feet
Common Discomforts of
- 10 hours of sleep
- modified Sim’s
Pregnancy
4. Exercise
- amount & type of exercise
A. Breast Tenderness
depend on the physical condition
- often one of the first symptoms
of the woman & stage of
noticed in early pregnancy and
pregnancy
may be most noticeable on
A. Walking - most ideal exercise
exposure to cold air.
because it stimulates muscular
- Management: encourage a
activity of the entire body & does
woman to wear a bra with a wide
not result in fatigue or strain.
shoulder strap for support and to
B. Kegels exercise - aid in
dress warmly to avoid cold drafts
restoration of perineal muscles &
if cold increases symptoms.
prevent stress incontinence
C. Tailor sitting – for relief of
backache; stretches perineal B. Varicosities
muscles

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Care of Mother, Child & Adolescent (Lecture) - NCM107A
○ due to pressure of the
gravid uterus to the large
veins
Management:
○ Management:
- avoid constricting clothing
- avoid crossing legs at the knees
- frequent rest periods with legs
elevated
- wear support (elastic stockings}
- keep within the recommended
weight gain
- avoid prolong standing (change
position frequently if standing)
exercise
C. Nausea & Vomiting
- No definite cause has been
established for this symptom of
early pregnancy, but it may be
related to:
- sensitivity to the high level of
chorionic gonadotropin
hormone produced by the
trophoblast cells
- high estrogen or progesterone
levels
- lowered maternal blood sugar
caused by the needs of the
developing embryo
lack of pyridoxine
(vitamin B6)
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diminished gastric
motility
- traditional solution: to keep dry
crackers by their bedside and
eat a few before rising
- sucking on sour candies
- eat small but frequent meals
rather than large infrequent
ones.
- avoid greasy or highly
seasoned food.
- delay breakfast until nausea
passes (eat snacks before
bedtime)
- avoid sudden movements and
fatigue because these may
increase or cause nausea.
A. Fatigue
○ due to increased metabolic
requirements
○ Management:
- increasing the amount of rest and
sleep
- elevate the feet
B. Hemorrhoids
- due to smooth muscle relaxation
effect of progesterone
- Constipation
Hannah Leal Rendaje Shariff BN1E
Care of Mother, Child & Adolescent (Lecture) - NCM107A
- pressure of the gravid uterus
Management:
● hot sitz bath
● avoid constipation
● rest/ sleep in sim’s position
● avoid long standing or walking
● topical anesthetic agents as
prescribed
C. Leg cramps
- caused by imbalance of Ca &
phosphorus
Management:
● to relieve cramps, extend the
affected leg, keeping knees
straight, bend your foot toward
you /or ask someone to help you
flex your foot
● diet rich in calcium, phosphorous
● B- complex supplement.
D. Frequent urination
- due to pressure of the gravid
uterus on the bladder
Management:
● will be resolved without
intervention. However, you can
use Kegel’s exercise to lessen
the discomfort
● void every 2hrs/ or as necessary
15
● avoid caffeine
E. Backache
- caused by the enlarging uterus/
lordosis
Management:
● tailor sitting
● shoulder circling
● pelvic rock
● squat rather than bend when
lifting
F. Leukorrhea
● profuse whitish vaginal discharge
● cause: in response to high
estrogen level and the increased
blood supply to the vaginal
epithelium and cervix in
pregnancy
Management:
● daily bath or shower
● clean perineal area always (front
to back)
● wear perineal pads
● wear cotton underwear
G. Hypotension
- occurs when a woman lies on her
back and the uterus presses on
Hannah Leal Rendaje Shariff BN1E
Care of Mother, Child & Adolescent (Lecture) - NCM107A
the inferior vena cava, impairing
blood return to her heart
Management:
- a woman turns or is turned onto
her side
- rising slowly and avoiding
extended periods of standing
- advise pregnant women to
always rest or sleep on their side,
not their back (prevention)
-
G. Dyspnea
● difficulty of breathing
Management:
● elevate head of bed
● avoid having a full stomach
● avoid physical exertion
H. Ankle edema
● reduced blood circulation in lower
extremities
Management:
● avoid constricting clothing
● open, flat footwear
● elevate leg while resting
● avoid long standing or walking
I. Cravings
● are so common they are
considered a normal part of
adaptation to pregnancy.
16
● associated with Iron Deficiency
Anemia
Management:
● help plan an intake that includes
the food, at least in moderation,
to help her enjoy her pregnancy
without feeling guilty
● iron supplements
● small, frequent meals
Pica - cravings for nonfood substance
J. Palmar Erythema / Plantar
Pruritus
cause: increased estrogen levels
Management:
● explain that this type of itching in
early pregnancy is normal
● use of calamine lotion
K. Heart Palpitations
● cause: circulatory adjustments
necessary to accommodate her
increased blood supply.
Management:
● gradual, slow movements will
help prevent this from happening.
Hannah Leal Rendaje Shariff BN1E
Care of Mother, Child & Adolescent (Lecture) - NCM107A

Teaching Self-Care Needs During Discomforts of Pregnancy ( Middle to

Pregnancy late pregnancy)
1. Backache
1. Bathing 2. Headache
2. Breast Care 3. Dyspnea
3. Dental Care 4. Ankle edema
4. Perineal Hygiene
5. Dressing Substances and Drugs to Avoid:
6. Sexual activity
7. Exercise 1. Caffeine
8. Employment 2. Tobacco/ Cigarettes
9. Travel 3. Alcohol
10. Nutrition 4. Marijuana
5. Cocaine

Discomforts of Pregnancy: (First

Trimester) DANGER SIGNS OF PREGNANCY
A. vaginal spotting/bleeding
B. leaking of fluid from the
1. Breast tenderness vagina
2. Palmar Erythema/ Pruritus C. unusual abdominal cramps
3. Constipation - 1st trimester- ectopic pregnancy
4. Morning Sickness - 3rd trimester- abruptio placenta
5. Fatigue D. persistent headache, blurring
6. Leg cramps of vision
7. Supine Hypotension E. marked swelling of hands &
8. Varicosities feet
9. Hemorrhoids F. painful, burning urination
10. Heart palpitations discharge
11. Frequency of urination G. foul smelling vaginal
12. Leukorrhea discharge
H. chills & fever
I. persistent nausea & vomiting

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Care of Mother, Child & Adolescent (Lecture) - NCM107A

5. Do not withhold breath while

exercising.
Preparation for Labor and
6. Do not continue with exercise
Delivery if any danger signs of
pregnancy occurs.
Childbirth Education: 7. Never exercise to a point of
fatigue
Goals: To prepare the expectant 8. Never practice second stage
parents emotionally and physically for pushing
childbirth while promoting wellness
behavior that can be used by parents
and their families for life. Preparation for childbirth
1. childbirth exercise
2. reduce and manage pain 1. Childbirth exercise:
3. increase enjoyment and ○ Tailor sitting
satisfaction with childbirth ○ Squatting
exercise ○ Kegel’s exercise
4. birthing plan ○ Abdominal
contraction
○ Pelvic rocking
Exercise Guidelines for preparation
2. Pain management:
of Labor
● the 3 premise:
- discomforts during labor can be
1. Always rise from the floor minimized if the woman comes
slowly into labor well-informed.
2. To rise from the floor, roll over - discomforts during labor can be
to the side then push up minimized if the woman’s
3. When exercising the leg, abdomen is relaxed
never point the toes (extend - Pain perceptions can be altered
the heel) instead. by distraction techniques or by
4. Do not attempt exercises that Gate Control Theory of pain
hyper extend the lower back. perception.

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Care of Mother, Child & Adolescent (Lecture) - NCM107A
According to Gate Theory:
● Stimulus > peripheral nerve fiber
> cells of dorsal horns of spinal
cord > substantia gelatinosa (a
dense interfacing network of cells
in the spinal cord) creates a
sudden synapse > motor nerve >
impulse > spinal cord >
hypothalamus and cortex of the
brain (where the impulse is
interpreted as pain)
Gating Mechanism to control pain/
discomfort:
A. Cutaneous stimulation
B. Distraction
C. Reducing anxiety
D. Lamaze method
(Psychoprophylaxis) - a
combination of two words
which are: ‘’prophylaxis’’
and ‘’psyche’’; based on the
theory “Stimulus response
conditioning”
○ Cleansing breath - done to
begin all breathing
exercises
Purpose:
○ Conscious relaxation - this
is done by relaxing body
portions.
○ Consciously controlled
breathing - a woman uses
different rates in labor
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depending on the intensity
of contraction
○ Consciously controlled
breathing:
E. Level 1 or A - Low and rhythmic
chest breathing.
F. Level 2 or B - A shallow chest
breathing & lighter breathing than
level 1.
G. Level 3 or C - breathing is
shallower mostly at the sternum.
H. Level 4 or D - the woman uses a
‘’ pant blow’’ pattern of breathing.
I. Level 5 – is chest panting. A
continuous shallow panting.
A. Bradley method - (husband
coached) it is based on the
premise that childbirth is a
joyful and natural process.
B. Dick Read method - the
premise of this method
is that ‘’fear leads to tension
and that it leads to pain."
○ Whole body relaxation
exercise
○ Abdominal breathing
THE BIRTH SETTING
1. Birth Attendants/ Support
person
2. Birth Setting
○ Hospital
○ Birthing chair
Hannah Leal Rendaje Shariff BN1E
Care of Mother, Child & Adolescent (Lecture) - NCM107A
○ Home birth
○ Alternative Birthing
centers (ABC’s )
3. Activities during labor
4. Birth
5. Postpartum
Alternative Methods of Birth
THE LEBOYER METHOD
● the birthing room is darkened
(no sudden contrast in light)
● environment is pleasantly
warm
● soft music played; harsh
noises kept to a minimum
● infant is handled gently
● cord is cut late
● infant is placed immediately in
warm bath water
HYDROTHERAPY AND THE WATER
BIRTH
● women are encouraged to not
only labor in warm showers or
tubs but also to give birth in
spa tubs of warm water
● disadvantage: most women
expel feces from pushing in
the second stage of labor, the
20
water bath may become
contaminated.
● most women who choose
underwater birth, however,
enjoy the experience and are
pleased that they chose this
method
UNASSISTED BIRTHING
● unassisted birthing /
freebirthing / couples birth
● refers to women giving birth
without healthcare provider
supervision
● a woman learns pregnancy
care from reading books or
articles found on the Internet
and then arranges to have her
child birth at home
● “birth is such a natural
process that no medical
supervision is necessary”
● others choose it because they
have no health insurance and
so can’t afford either a
hospital or alternative birth
setting
● potentially dangerous
Hannah Leal Rendaje Shariff BN1E
Care of Mother, Child & Adolescent (Lecture) - NCM107A

Nursing Diagnosis ● Planning with couples for

1. Health seeking behaviors r/t labor and birth should be;
learning more about the birth ● Realistic
setting and newborn care ● Flexible
- Or if lack with support person,
this nursing dx may apply; Implementation

2. Ineffective coping r/t lack of 1. Provide a woman and her

support person. partner with information on
the benefits of birthing
3. Anxiety r/t absence of options.
significant others 2. Remain objective, examine
- For a couple unable to make a your own attitude, cultural
decision for a birth setting. influences and values related
to childbirth and explore how
these differ from those of your
4. Decisional conflict r/t lack of patients
information about advantages 3. Refer couples to a childbirth
and disadvantages of various preparation course
childbirth setting. 4. Review the arrangement a
- If there are older children in the woman needs.
family, the nursing diagnosis ○ Preparation for
might be; transportation
○ Preparation for
homebirth
5. Anxiety r/t sibling role in
○ Purchase supplies
pending birth event and
needed for
sibling ability to welcome a
childbirth
new family member.

Outcome Identification/ planning

21 Hannah Leal Rendaje Shariff BN1E

Care of Mother, Child & Adolescent (Lecture) - NCM107A

22 Hannah Leal Rendaje Shariff BN1E