Module No.

The three delays

The three Delays: Barriers in accessing health care on time

1st delay- Delay in deciding to
seek medical care
- Failure to recognize danger
signs
- Lack of money
-Unplanned/
unwanted pregnancy
- Lack of companion in going to
health facility
- No person to take care of
children/home
- Fear of being not treated
properly in health facility
2nd delay: Delay in identifying and
reaching the appropriate facility
-Distance from a woman’s home to
health facility/provider
-Lack of/poor condition of roads
- Lack of emergency transportation
-Lack of awareness of existing
services
-Lack of community support
3rd delay :Delay in receiving
appropriate and adequate care at
the health facility
- Lack of health care providers
- Shortage of supplies
- Lack of equipment
-Lack of competence of health
providers
-Weak referral system

- Philippine midwifery practice is guided by the Midwifery Act of 1992 (RA 7392)
- The RA 10354 which is the “Responsible Parenting and Reproductive Health Act of 2012”, when implemented,
will repeal the RA 7392” Philippine Midwifery Act of 1992”

Module No. 4
- Puerperium- 6 weeks postpartum.
- Rubin's Postpartum Phase
1. Taking-in - 1st 2-3 days- Focused on her own needs for sleep, rest & dependent on others
2. Taking-hold phase/Transition Phase-3rd day-2 weeks. Focused on her ability to control body function
and ability to assume the mothering role
3. Letting-go phase- The mother realizes that the infant is a separate individual & not a part of herself

CAUSES OF POSTPARTUM HEMORRHAGE

5 T’S
TONE UTERINE ATONY
TISSUE RETAINED TISSUES/CLOTS
TRAUMA LACERATIONS/HEMATOMA
THROMBIN CLOTTING DISORDERS
TRACTION UTERINE INVERSION
3 MAIN COMPONENTS:
ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR

1. INJECTION OF OXYTOCIN after delivery of the baby

2. CONTROLLED CORD TRACTION to deliver the placenta
3. MASSAGE OF UTERUS to keep it contracted after delivery of placenta

Module No. 5
 SIGNS OF TRUE LABOR
1. Uterine contractions
2. Show
3. Ruptured membranes

COMPONENTS OF LABOR
1. PASSAGE –PELVIS
2. PASSENGER-THE FETUS
3. POWERS – UTERINE FACTORS
4. THE WOMAN’S PSYCE –PERSON
5. POSITION
3 stages of labor
1. Cervical stage-Form the true labor pain up to the full effacement and dilatation of the cervix
2. Expulsive stage or fetal stage- From the full effacement and dilatation of the cervix to
the delivery of the baby
3. Placental stage-From the delivery of the baby to the delivery of the placenta

DYSTOCIA/Difficult labor -Characterized by abnormally slow progress of labor. Abnormal labor

A. COMPLETE- The fetus has thigh tightly flexed on the abdomen, both the buttocks & the
tighly flexed feet present to the cervix. Attitude: Good (full) flexion

B. FRANK – Attitude is moderate because the hips are flexed but the knees are extended to
rest on the chest. The buttocks alone present to the cervix. Attitude: Moderate

C. INCOMPLETE-FOOTLING- Neither THE THIGHS nor LOWER LEGS flexed.

Attitude: Poor flexion single- one foot presents
Double-footling- both feet presents

FACE PRESENTATION-The head is hyperextended.

BROW PRESENTATION-The rarest presentation
SINCIPUT- moderately flexed
TRANSVERSE LIE- The fetus is lying horizontally in the pelvis so than
the long axis is perpendicular to that of the mother. “ stuck
shoulder”

Remember:
 ROA or LOA- fetus deliver fastest
  ROP or LOP – labor is extended

TYPES OF PELVIS
1. android – The male pelvis. The AP diameter is wider than its transverse diameter
2. anthropoid – The ape like pelvis, its inlet is oval shaped with AP diameter wider than transverse diameter.
- Deepest type of pelvis
- Narrow transverse and wide AP does not conform to the head of the body

3. platypelloid – The flat pelvis. Its transverse diameter is wider that its AP diameter
- The rarest type of pelvis.

4. gynecoid – The normal female type pelvis

- most ideal of childbirth

Module No. 7

3 GENERAL METHODS OF BREECH DELIVERY

1. SPONTANEOUS BREECH DELIVERY 2. PARTIAL BREECH EXTRACTION 3. TOTAL BREECH EXTRACTION

– The infant is expelled entirely -The infant is delivered -The entire body of the infant is
spontaneously without any traction spontaneously as far as the extracted by the obstetrician
or manipulation other than support UMBILICUS, but the remainder
of the infant. of the body is extracted.

CARDINAL RULE: Do not APPLIED fundal pressure:

AVOID 4 Ps
1. PUSH
2. PULL
3. PANIC
4. PIVOT

A common treatment algorithm is ALARMER

- A- sk for help. This involves requesting the help of an obstetrician, anesthesia and pediatrics
for subsequent resuscitation of the infant.
- L- eg hyperflexion (McRoberts' maneuver)
- A- nterior shoulder disimpaction (suprapubic pressure)
- R- otation of the posterior shoulder(Woodscrew maneuver)
- M- anual delivery of posterior arm
- E- pisiotomy
- R -oll over on all fours

Rubin maneuver- push the fetal shoulder towards the chest

SIGN OF SHOULDER DYSTOCIA-Turtle sign”
ADOPE
A=Age
D=Diabetes (including prediabetes)
 O=Obesity
P=Prior large infant and prostatism
E=Excessive weight gain

BE CALM Be Calm mnemonic:

B: Breathe, do not push. Encourage the woman to breathe or even pant in order not to push.
E: Elevate the legs into a McRoberts’ position.
C: Call for help.
A: Apply suprapubic pressure (NOT fundal pressure).
L: Enlarge the vaginal opening with an episiotomy when additional hand room is needed.
M: Maneuvers (e.g., McRoberts’, Rubin, or Woods)

Module No. 8

FP PROGRAM METHODS
Modern methods
 Permanent methods
1. Female sterilization/Bilateral Tubal Ligation
2. Male sterilization/Vasectomy

Module No. 9 (Topic 1 and 2)

BASAL BODY TEMPERATURE (BBT) - is based on a woman’s resting body

temperature.
THE COVER LINE – determining the thermal shift.
Sperm can live up to 72 hours in a woman's body
Ovum can be fertilized up to 24 hours after ovulation

HOW THEY WORK

Consist of 32 beads
RED(1) –(Day 1)- represents the first
day of menstruation Brown (6) –
(Day 1-7)-First 7 days of the cycle –
NOT FERTILE WHITE (12) –(Day 8-
19) FERTILE WINDOW
BROWN – REST OF THE BEADS - INFERTILE

BLACK TUBE-THIS TUBE DOES NOT

REPRESENT A DAY OF THE CYCLE.
IT HAS AN ARROW THAT SHOWS
WHICH DIRECTION TO MOVE THE
RING
- The day a woman starts her period
she puts the rubber ring on the red
bead.

LACTATIONAL AMENORRHEA METHOD (LAM) - introductory postpartum method

based on physiological infertility experienced by breastfeeding women.
3criteria:
  she is amenorrheic
 she is fully or nearly fully breastfeeding her infant
 her infant is less than six (6) months old

Module No. 10

Low-dose COCs
1. One type has 28 pills in a packet, with 21
"active" pills containing hormones and seven
"inactive or reminder" pills of a different
color. The reminder pills do not contain
hormones.
2. Another type of pills contain only the 21 "active/hormone containing” tablets.

Monophasic pills -provide the same amount of estrogen and progesterone in every hormonal pill.

Biphasic pills- have the first 10 pills with one dosage and the next 11 pills having another level of
estrogen and progestin.

Triphasic pills -have the first seven pills or so with one dosage, the next seven pills have another
dosage and the last seven pills with yet another dosage.

Warning Signs
J - Jaundice
A - Abdominal pain (severe)
C - Chest pain
H - Headaches (severe)
E - Eye problems such as brief loss of vision, seeing flashes of light or zigzag lines
S - Severe leg pains

COP (combined oral pills)

- Trust pills
- Lady pills
CIP (combined injectable pills)
- PROTECT (HEALTH CENTER)
- DAPHNEE (28 DAYS)
PROGESTINE SUB DERMAL “3YEARS”
POP (PROGESTIRONE ONLY PILLS)
- FOR BREAST FEEDING ONLY
- NO MENSTRATION
- 3HRS YOU MISSED HAVE A CHANCE TO BE PREGNANT
POI (PROGESTERONE INJECTABLE ORAL)
DEPOLYSTINE
- RED TOP
- 1ML/ 150mg
- LYDAVEL “ PRIVATE”
YELLOW TOP SAME ML AS DEPOLYSTINE

HORMONAL METHOD
LOW DOSE COC
FOC METHOD
 POI METHOD
COMBINED INJECTABLE

1. If a woman misses one or two active COC pill in any

day of the first three weeks or starts a pack a day late
1. Take missed pill 1. Take the scheduled 3. Continue taking one pill at a
as soon as she pill at the usual time time until pack is finished. No
remembers back-up is necessary

2. If a woman misses three or more active COC pills in the first two weeks or starts a
pack two or more days late
1. Take the last missed 2. Take the pill 3. Abstain from sex or 4. Continue taking the
pill as soon as she scheduled for the day use back up method pill until pack is
remembers at the regular time for the next 7 days finished

3. If a woman misses three or more active pills on the third week

1. Take the last missed 2. Continue taking the 3. Discard inactive pills. 4. Abstain from sex or
pill as soon as she remaining active pills Immediately start a new use back up method for 7
remembers until consumed pack and continue taking days
the pill until the pack is
finished

4. If a woman misses any non-hormonal pill (any of the last seven pills in a 28-pill pack)

1. Discard the missed non-hormonal pill(s) 2. Start a new pack as usual and keep taking
COCs one each day

MODULE 11

IUD or what we call TCu380A, effective for 12 years.

WARNING SIGNS OF IUD

PAINS:
- Period late
- Abdominal pain
- Infection
- Not feeling well
- Strings missing or longer

Bilateral tubal ligation (BTL)- is known as female sterilization

Module No. 12

Condoms - Offer dual protection from STI, HIV, and also prevent pregnancy.
SPERMICIDES:
FOAM OR CREAM – Anytime less than 1 hr before sex
TABLETS,SUPPOSITORIES, FILM – Less than 1 hr but more than 10 mins before
sex You can insert any spermicide up to 1 hour before sex.
Do not douche for at least 6 hours after sex.

DIAPHRAGM
Inserts with spermicidal before sex
For ach actional act of intercourse – use applicator to insert additional spermicide. She does not remove the
diaphragm.
Leaves the diaphragm in place at least 6 hours after the man's last
ejaculation Do not leave the diaphragm in more than 24 hours

CERVICAL CAP
Insert the cervical cap with spermicidal before sex.
She does not NEED ADDITIONAL spermicides for additional acts of intercourse that occur within 48 hours after
insertion
The woman leaves the CAP in for at least 6 hours after the man's last
ejaculation DO NOT LEAVE the cap for more than 48 hours