Belinda

INDEX NUMBER: NMTCTPRM210061
A FAMILY CENTERED MATERNITY CARE STUDY
ON
J.A
WRITTEN BY
BELINDA OBENG
(STUDENT MIDWIFE)
NURSING AND MIDWIFERY TRAINING COLLEGE
TWIFO PRASO
NOVEMBER 2022.
Table of Contents
PREFACE
ACKNOWLEDGEMENT
INTRODUCTION
Why I Chose My Client ix

LITERATURE REVIEW
CHAPTER 1
ASSESSMENT OF CLIENT AND FAMILY
Personal and social history 1

Daily activities of client 2
Family, medical and socioeconomic history 2
Medical History 3
Surgical History 3
Menstrual History 4
Past Obstetric History 4
Present Obstetric History 6
Summary of antenatal clinic visit (second to fifth visit) 8
CHAPTER II
ANTENATAL CARE
First contact with client 11

First antenatal home visit 18
Client’s subsequent visit to the clinic 19
Subsequent home visit 22
NURSING CARE PLAN DURING ANTENATAL
TABLE ONE: CARE PLAN DURING ANTENATAL
CHAPTER III
INTRAPARTAL CARE
i
Admission, history taking and initial assessment of client in labour 32
Management of first stage of labor 34
Interpretation of partograph 36
Management of the second stage of labor 37
Immediate care of the baby 38
Active management of the third stage of labor 39
Management of fourth stage of labour 41
Summary of labour notes 46
NURSING CARE PLAN DURING LABOUR
TABLE TWO: NURSING CARE PLAN DURING LABOUR
CHAPTER IV
MANAGEMENT OF PUERPERIUM
Subsequent care of the baby 54

Baby’s first bath and cord dressing 54
First Day of Puerperium 55
First day postnatal home visit 58
Second day postnatal home visit 59
Third day Postnatal Home Visit 60
First day postnatal clinic visit 61
Fourth day postnatal home visit 63
Fifth Day Postnatal Home Visit 64
Sixth Day Postnatal Home Visit 65
Second postnatal clinic visit 66
Seventh Day Postnatal Home Visit 68
TERMINATION OF CARE
NURSING CARE PLAN DURING PUERPERIUM
TABLE THREE: CARE DURING PUERPERIUM
SUMMARY AND CONCLUSION
BIBLIOGRAPHY
ii
APPENDIX VII: PHARMACOLOGY OF DRUGS
SIGNATORIES
iii
PREFACE
A family centered maternity care study is one of the curriculum offered in
diploma midwifery which uses systematic approach in caring for the pregnant
woman and her family as well as the society. It is usually conducted during the
domiciliary vacation practicum for second year student midwives in their
second semester. It requires knowledge acquired during lectures, clinical
observations and others in order to conduct it.
The motive of this study is to equip the student midwife in the profession in
terms of the management of clients and their family regardless of the
background in the periods of pregnancy, labour and puerperium with the idea
of ensuring individualized and focused care.
The study will help the student midwife to acquire skills and experience in
handling client by making clinical decisions, initiating care and evaluating her
actions. It will also help her to conduct deliveries and care for her client for the
first seven day in the postpartum period.
The family centered maternity care study contributes to the requirements
needed for awarding the student midwife of the professional certificate in
midwifery by the nursing and midwifery council of Ghana.
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ACKNOWLEDGEMENT
A special and most sincere gratitude goes to the Almighty God for the love,
understanding, strength and wisdom granted unto me that enabled me to
complete this study successful. My profound gratitude also goes to Helen Gifty
Dwamenah Amoah (Mrs.), the principal of this noble institution, Nursing and
Midwifery Training College, Mampong Ashanti for her spiritual guidance and
support.
Again I wish my heartfelt gratitude to my able supervisor, Shirley Akanzire
Ayinkopa (Mrs.) for her spiritual, physical and psychological guidance,
patience and ever welcoming support throughout this study. And to the entire
tutorial staff of Nursing and Midwifery Training College, Mampong Ashanti, I
say may God bless you all in all your endeavors for your dedication towards
the success of this study.
If this study is a success, it is due to my client, Miss C.B and her family for
their cooperation and the adherence during the study. She provided me with the
information I needed for the study. She never stopped adhering to the
education given to her.
I also thank the staff members of Kona Health Center for their support during
the study. A great thanks also goes to the midwife in-charge, Esther Morrison
(Mrs.) and the entire midwives (Kona maternity wing) for their assistance.
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Again, my gratitude goes to all ever reliable authors and publishers whose
work I had various references to this study. To you all, I wholeheartedly say
thank you.
Finally, I salute my parents, siblings and my well-wishers for their support
during this study, May God richly bless you all.
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INTRODUCTION
The family centered maternity care study is conducted by the student midwife
to render an individualized, consent and a focused care to her client and the
family as well as the society at large. The purpose of this study is to provide
quality care to expectant mother and her family during the periods of
pregnancy, labour and puerperium in order to reduce maternal and child
morbidity and mortality and to help the student midwife to connect theory to
practical.
This study is about Miss C.B. a twenty year old client, who is gravida three
para one alive (G2P1A) and her family. The study commenced on the 27th
October, 2021 when I met Miss C.B at thirty-six weeks(36weeks) for her six
antenatal visit at Kona maternity wing. I introduced myself to her and made
my intentions known to her which she willingly agreed to be my client. I
nursed her from that day through the period of pregnancy, labour and to the
seventh (7th) day of puerperium, 2nd December, 2021.
The study is made up of four chapters;
The first chapter is about client’s profile which enabled me to care for her
throughout antenatal and it is made up of her personal history, daily activities,
social history, family history, medical history, surgical history, past obstetric
history, present obstetric history and the summary of her antenatal clinic visits
before I met her.
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The second chapter entails the antenatal period of my client and all the care
provided to her during the home and antenatal visits.
The third chapter also entails the initial assessment of labour, admission,
management of the first, second, third and fourth stages of labour.
The fourth stage deals with the management of client and her baby in the first
seven days of puerperium. It also contains the termination of care, conclusions,
pharmacology of drugs administered during the study, bibliography,
appendices and signatories.
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Why I Chose My Client
On 27th October, 2021, I met Miss C.B during one of her antenatal clinic visits
when she was waiting for her turn to be cared for. I approached her and
introduced myself as a student midwife from Nursing and Midwifery training
college, Mampong-Ashanti. I requested for her antenatal book so that I may
glance through which she gladly did. In her antenatal book after glancing
through, I realized she came for booking at twenty-four (24) weeks gestation
and so I used the opportunity to educate her on the importance of early first
trimester antenatal booking. I also made my intensions known to her as the
client I will like to care for during this late pregnancy, through labour to the
seventh day post-partum with the involvement of her family but will hand over
to the community health nurse. She agreed and was willing to cooperate with
me throughout the study and I thanked her.
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LITERATURE REVIEW
Pregnancy
Pregnancy is the period from conception to delivery of baby. The normal
duration is 280 days (40weeks or 9months and 7days). It is counted from the
first day of the last normal menstrual period to delivery or 265 days from
conception to delivery (Tiran, 2012).
Labour
According to Marshall and Raynor (2014), labour is the process by which the
foetus, placenta and its’ membrane are expelled through the birth canal. It
consists of four stages viz; the first stage, second stage, third stage and fourth
stage.
Puerperium
According to Campana (2021, may 14th), puerperium is the period of 6 to 8
weeks following delivery during which the anatomical and physiological
changes of pregnancy regress.
COVID19
According to Cennimo, D.J etal (2021, June, 25th), COVID19 is an acronym of
Coronavirus 2019 by WHO and it is defined as an illness caused by novel
coronavirus now severe acute respiratory syndrome coronavirus 2 (SARS-
CoV-2) with common signs of coughing, fatigue and fever.
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CHAPTER 1
ASSESSMENT OF CLIENT AND FAMILY
According to Ead (2019, September, 16th), assessment is the act of gathering
key information in order to determine the direction of care and judging how
client is responding to treatment.
This chapter deals with the information about client personal and social
history, family history, medical history, surgical history, menstrual history,
past obstetric history and present obstetric history.
Personal and social history
Miss C.B is a native of Kona in the Sekyere South district who lives in a house
situated at an area called Seade. She is twenty (20) years old who is fair in
complexion, measures 158cm tall in height and weighs 55kg. She speaks
Ghanaian language (Twi). She is a Christian and attends church at Shalom
chapel in Kona. She is educated to the Junior High School level and now an
apprentice hairdresser and a trader. According to her, she and the partner, A.I
who is twenty-four [24] years and a kente weaver are not married traditionally
but both stay together and he is responsible for their son and the unborn baby
and he is the support person.
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Daily activities of client
Miss C.B wakes up at 6:00 am after saying a word of prayer to her maker. She
washes her face and perform household chores. She washes her teeth and
empty the bladder before she takes her bath then later her son after she has
woken him up around 7:00am. According to her, sometimes after dressing up
the son, the partner takes him to the lorry station where the school bus will
come for him around 7:30am. At 3:30pm, the school bus drops the child at
where she works. She closes from work at 4:30pm, rest for about one hour
before she prepares food for dinner. Her favourite food is yam and palava
sauce.
According to her, her son sleeps around 7:00pm whilst she watches television
and goes to bed at 8:30pm after having her bath. She said, she does her
washing on Saturdays, goes to church on Sundays and she neither smoke nor
drink alcohol.
Family, medical and socioeconomic history
Miss C.B is the only child of her parents who are both alive. Both parents are
farmers and they reside in Kona in the Sekyere south district which is their
hometown.
According to Miss C.B, none of her family members suffer from hereditary
conditions such as hypertension, sickle cell disease, Diabetes mellitus,
epilepsy, heart disease or any mental illness such puerperal psychosis or
puerperal depression and no history of multiple gestation. She also said that,
2
there is no known infectious diseases like Human Immunodeficiency Virus
(HIV) but the family usually suffer from systematic diseases such as malaria,
headache of which none of her family has died out of that. She added that,
majority of her family members belong to blood group O with rhesus positive
and there is no known allergies in her family.
Medical History
Miss C.B belongs to blood group O with rhesus positive. According to Miss
C.B, she has no medical conditions like hypertension, heart disease, diabetes
mellitus, epilepsy, human Immunodeficiency virus, sickle cell disease as well
as respiratory diseases such as tuberculosis, asthma nor any mental illness. She
added that she had never been transfused before and neither does she has
history of allegiance to food such as beans, groundnut or drugs such as
penicillin nor or any routine medications except with the IFA given during
antenatal. She also said, she has never been hospitalized due to illness except
when she was in labour but the health facility at Kona on out - patient
department (OPD) basis when suffering from minor ailments.
Surgical History
According to my client, she has never undergone any surgical procedure such
as laparotomy, laparoscopy neither has she undergone any kind of
gynaecological procedures such as salpingectomy, vaginal or uterine prolapse
as well as fertility treatment nor sustained injury to the pelvis that could affect
childbearing.
3
Menstrual History
Miss C.B had her menarche at the age of twelve (12) years in the year 2014.
She has a normal and a regular 28days menstrual cycle with a moderate flow
which last for at least five days. According to her, she experiences
dysmenorrhea in the month she eats lots of sugary foods but resolves on its
own. She used condoms as contraceptives before conceiving and resumed her
menses six months after the delivery of her son. The expected date of delivery
is on 1st December, 2012 according to her first scan result dated 4th August,
2021 and base on that, her first day of her last menstrual period was calculated
as 24th February, 2021 since she could not remember it.
Past Obstetric History
Pregnancy
Miss C.B is gravida two para one [G2P1A]. Her first pregnancy was in the year
2018 to 2019. According to her, she carried the pregnancy to 37weeks of
gestation without any complications. She attended antenatal clinic at Kona
Health Center (maternity wing) after she missed her monthly period.
According to clients’ previous maternal and child record book, she attended
seven subsequent visits before giving birth, she took one dose of Sulfadoxine
pyrimethamine and did not take again as a result of reaction formation, two
tetanus Diphtheria injections under close observation and a dose of 400mg of
Abendazole to prevent worm infestation. She had no ill-health during
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pregnancy but experienced some minor disorders like nausea and vomiting and
headache.
Labour
According to Miss C.B, she had spontaneous vaginal delivery (SVD) at Kona
Health Center (maternity wing) after sixteen (16) hours when she reported to
the facility with complaints of lower abdominal and contractions. According to
client’s previous labour records in her antenatal book, she delivered a bouncing
baby boy of weight 3.5kg at 9:20am with Apgar score of 8/10 for the first
minute and 9/10 for the fifth minute and delivered placenta at 9:30 am when
she was 37 weeks gestation whereas the amount of estimated blood loss after
delivery was 200mls. She neither had complications nor did she sustained a
tear after birth. She said baby was breastfed within the first thirty minutes and
he [baby] had no ill health after examination.
Puerperium
According to Miss C.B, she was discharged after 24hours of delivery. Her
baby was immunized against tuberculosis and Poliomyelitis with Bacillus
Calmelle Guerin (B.C.G) and Polio O vaccines respectively by the community
health nurses as well as 1mg of vitamin K1 to prevent bleeding. She
experienced no complications during puerperium such as breast engorgement,
urinary tract infections (UTI), mastitis. She had a normal flow of lochia for ten
days and completely breastfed exclusively for the first six months before the
initiation of complementary feed and weaned the baby for one and half years.
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She said she used condoms as a birth control method and discontinued about a
month after they decided to have another pregnancy. Throughout this period,
she was supported by the partner’s mother and the partner himself.
Present Obstetric History
Miss C.B, gravida two para one alive (G2P1A) attended her first antenatal clinic
on the 4th August, 2021 at Kona Health Center (maternity wing) when she was
twenty-four (24) weeks. 17th February, 2021 was the first day of her last
menstrual period and the expected date of delivery was 24th November, 2021.
Client’s history was taken which included the personal, social, family, medical,
surgical and obstetric histories were taken and findings were recorded
accurately. Clinical data gathered on the client indicated that she was in a good
health condition. And these were the findings;
Vitals signs were recorded as;
Temperature 36.5oC
Pulse 70bpm
Respiration 20cpm
Blood pressure 92/60mmHg
Weight 55kg
Height 158cm
Laboratory investigations revealed;
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Haemoglobin 11.0g/dl
Blood group O
Rhesus typing Positive
Hepatitis B surface antigen Negative
Sickling Negative
Glucose-6 phosphate dehydrogenase (G6PD) defect No defect
Venereal Disease Research (VRDL/Syphilis) Negative
Human Immunodeficiency Virus Negative
Blood film for malaria parasite Negative
Other Investigations
Ultrasound scan revealed;
Estimated gestational age 24weeks plus zero
days
Placenta location Posterior
Liquor volume Adequate
Number of fetuses One
Fetal heart rate Present
Estimated fetal weight 730g
Fetal lie longitudinal

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Presentation Cephalic
Fetal sex Male
Expected date of delivery 24th November, 2021
Urine routine examination(R/E) revealed a positive pregnancy test and no
protein and sugar. Miss C.B was examined from head to toe and no
abnormalities were detected. During abdominal, fetal lie was assessed upon
palpating and revealed longitudinal, symphysio-fundal height was 23cm, fetal
heart rate was 138bpm. Client lodged no complaints. Routine drugs like tablet
folic acid and tablet iron were served for one month and 400mg of
metronidazole. Injection against tetanus Diphtheria was administered as her
first dose since she defaulted with the previous schedule. She was educated on
how to use the mother and child health record(MCH) book, purpose of
antenatal care, diet and nutrition, prevention of mother to child
transmission(PMTCT), malaria prevention and an insecticide mosquito treated
net provided for her.
Summary of antenatal clinic visit (second to fifth visit)
On 1st September, 2021, client attended the clinic for her second (2nd) antenatal
visit at a gestational age of 28 weeks. During abdominal examination,
Symphysio-fundal height was 27cm and presentation was cephalic upon
palpating and fetal heart rate after auscultation was 138bpm. Urine routine
examination (R/E) revealed negative protein and sugar. She took her first dose
of Sulfadoxine pyrimethamine on close observation, second injection against
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Tetanus Diphtheria was administered and the routine drugs which is Iron and
Folic Acid were served. She was counselled on danger signs in pregnancy,
pregnancy induced hypertension and birth preparedness and complication
readiness. (Refer to appendix IIC) for the counselling done. Vital signs of Miss
C.B were recorded as;
Temperature 36.2oC
Pulse 81bpm
Weight 56kg
On 15th September, 2021, she visited her third (3rd) antenatal clinic at 30 weeks
of gestation. Abdominal examination was conducted on client and it revealed
as symphysio-fundal height (SFH) as 28cm and presentation as cephalic upon
palpating and foetal heart rate was present upon auscultation. Urine was tested
for protein and sugar and were negative. Routine drugs were served to client
(Refer to appendix IIA) for client’s antenatal records.
On 29th September, 2021, she had her fourth (4th) antenatal clinic at 32weeks
of gestation. During abdominal examination, symphysio-fundal height was
30cm and fetal presentation as cephalic upon palpating. Fetal heart rate was
present upon auscultation. Urine routine examination (R/E) revealed negative
protein and sugar. She took her second dose of Sulfadoxine pyrimethamine and
routine IFA served as capsule Iron III 1dly x 30 and Folic Acid 5mg 1dly x 30.
She complained of insomnia and constipation. Laboratory investigations and
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ultrasound scanning were conducted. (Refer to appendix I) for results. Her vital
signs were recorded as follows;
Temperature 36.3oC
Pulse 79bpm
Weight 58kg
She had her fifth (5th) antenatal visit on 13th October, 2021 at 34weeks
gestation. Client weighed 58kg and her blood pressure was 86/60mmHg.
During abdominal examination, symphysio-fundal height was 32 cm and
presentation as cephalic on palpation. There was foetal heartbeat on
auscultation. She had no complains and was scheduled for the next two weeks
as indicated in appendix IIA which is antenatal records.
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CHAPTER II
ANTENATAL CARE
First contact with client
On 27th October, 2021, I met Miss C.B neatly dressed and composed at the
maternity wing of Kona Health Center during her sixth (6th) visit to the
antenatal clinic at thirty-six (36th) weeks gestation. I requested for her antenatal
book so that I may glance through which she gladly did. In her antenatal book
after glancing through, I realized she came for booking at twenty-four (24)
weeks gestation and was educated on the routine activities during ANC
booking to create awareness, importance of blood sample taken during booking
such as helping to know the blood group, rhesus typing, G6PD status and
others serve as a baseline for care, importance of vital signs as it serve as
baseline for reference, reasons for ultrasound scanning as to rule out ectopic
pregnancy and any abnormalities, and on the importance of the routine drugs
such as preventing spinal bifida, anemia, activation of enzymes and
carbohydrate metabolism. I introduced myself as a student midwife from
Mampong Nursing and Midwifery training college and made my intentions
known to her as to care in this current late third trimester and then hand her to
the public health nurses. She agreed to cooperate and was thanked. During the
interaction, barrier in nursing and COVID-19 protocols such as wearing of
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nose mask and social distancing were ensured. Clients’ vital signs were
recorded as;
Temperature 36.3oC
Pulse 82bpm
Respiration 20cpm
Weight 59kg
Laboratory Investigations
Haemoglobin level 11.4g/dl
Repeated Human Immunodeficiency Virus Negative
Urine routine examination NAD
Ultrasound scan revealed;
Gestational age 36weeks plus 0day
Expected date of delivery 24yh November, 2021
Placenta location Posterior
Liquor volume Adequate
Presentation Cephalic
Fetal heart rate Present
Estimated fetal weight 2.9kg

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Fetal lie Longitudinal
13
Physical examination
Client was asked to void the bladder after procedure explained to her. Privacy
was provided, a tray was set for physical examination and client made
comfortable on the couch. I washed hands, dried them and stood at the right
side of woman. On examination, the hair looked heat, face was bright, and eyes
were in symmetry and had a clear sclera and pink conjunctiva. Ears and nose
were neat and patent respectively. Lips were smooth and soft. She was
engaged in a conservation in order to examine the mouth upon assessing, was
odourless, clean and teeth were clean and whitish in colour. The gum and
tongue were pink in appearance. Her neck was easily rotated from side to side
and had no enlarged lymph nodes and thyroid gland as well as distended neck
veins.
The breast were normal with the size and shape. It had a pigmented areolar
with Montgomery’s tubercle and a prominent nipple at its center. The left
breast was a little bigger than the right breast. The distal breast was palpated
from the axillary tail of Spence with the distal hand placed under the head in
the circular motion to check for mass lump but none was found. The same
procedure was done for the proximal breast. I gently squeezed the areolar and
it discharged a clean yellowish fluid was wiped with a clean cotton. Client was
thought how to do self-breast examination at home after delivery and five to
six (5-6) days after menstruation and report any abnormalities. Upper limbs
were examined and they were symmetry and had no deformities. The palms
were pink and clean with palmar creases. She was asked of tingling and
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tightness of the fingers on making a fist (carpel tunnel syndrome) which she
said none was present.
On abdominal examination, I exposed abdomen only and warmed my hands by
rubbing them together. Client had an oval abdominal shape with presence of
straiegravidarum, linea nigra and fetal movement upon inspection. I located the
upper border of the symphysis pubis and measured the symphysio-fundal
height by placing the zero mark of the tape measure on the upper border of the
symphysis pubis while extending the tape along the contour of the abdomen
36weeks. I palpated the fundus by placing palms on either side of the fundus
and curving them around the top of the fundus which upon palpating, it
occupied a soft irregular mass (buttocks) during fundal palpation. I then placed
my palms on both sides of the uterus midway between symphysis pubis and
fundus, stabilized the right side of the abdomen with the left palm and palpated
in a rotary manner the left side of the abdomen with the right palm and a
smooth curve was palpated and it indicated back of foetus. The same
procedure was repeated for the right side of the abdomen with just a change in
hands and the limbs was felt. During pelvic palpation I stood facing client’s
feet and asked her to slightly bend her knees and to slowly breathe out. I
placed my palms just below the umbilicus with fingers directed towards the
symphysis pubis and thumbs almost meeting. After palpating, a hard round
mass was felt at the lower pole of the uterus indicating cephalic presentation. I
then located the anterior shoulder and placed two fingers there with the left
hand, the border of the symphysis pubis with the right hand and placed the
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right ulnar just above the symphysis pubis and the fingers and it
accommodated five fingers which indicated a descent of 5/5th above the pelvic
brim. She was then asked to extend her knees for auscultation. During this
period, a warm fetal stethoscope was placed at where the back was located and
my ear placed against it, I listened to the heart beat while comparing with the
maternal pulse and counted for one minute. The heart rate after counting was
140bpm with a good regular rhythm.
During vulva examination, hands were washed and a sterile glove worn. Client
was asked to flex the knees and open them. On inspection, the labia majora,
labia minora and the perineum were clean and odourless with a well shaved
pubic hair.
She was assisted to a lateral position for the back to be examined. On
examination, I ran my middle and index fingers through her spine and had a
normal curvature.
Her lower extremities were equal in size and length. The toe nails were pink in
colour and was trimmed. Legs were dorsiflexed with no varicose veins, pain or
edema. Client was thanked for cooperation. She was then assisted from the
couch, helped with dressing up and offered her a seat. I washed my hands,
informed the client about the findings, educated her of personal hygiene and
documented findings. All the procedures were supervised by the midwife in-
charge. During history taking, client complained of lower abdominal pain and
backache. She was reassured of competent care to allay fear and anxiety,
physiology behind condition was explained to her as the result of descent of
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foetal head, she was also encouraged to wear low heel shoes, to support the
back with a pillow to relieve pressure on the lower abdomen, to take in more
fibers to prevent constipation and prescribed analgesic such as paracetamol 1g
was served to relieve pain for lower abdominal pain. And for backache, she
was reassured that condition was temporal to allay anxiety, physiology behind
backache was explained to client that it was due to the effect of relaxin and
progesterone on the sacroiliac joints. Also, she was encouraged to avoid long
standings to ease pain and education on correct posture such as using a pillow
at the back, foot support and armrest whilst in sitting position. Again, she was
encouraged to avoid heavy lifting to prevent pain aggravation. Client was
educated on signs of labour and progress of delivery, and was reminded of
nutrition in pregnancy and birth preparedness and complication readiness.
Tablet Paracetamol 1g tds for 5days was served to relieve pain and routine
drugs that is Iron III capsules 200mg tds for 7days and tablet folic Acid 5mg
for daily for 7 days were served to client to prevent anaemia.
I informed my intentions of visiting her at home and she agreed. She gave me
the address of the house and I took her mobile contact and a date, 30th October,
2021 was finalized for the home visit. She was reminded of the next antenatal
visit which was on 3rd November, 2021 and later bid a goodbye.
On 28th October, 2021, I called client to enquire about the problems of lower
abdominal pain and backache and she said she was relieved of the pains.
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First antenatal home visit
Psychosocial environment
On 30th October, 2021, I visited client in her house with the motive to check on
how she was faring and to check on how she relates with her family. On arrival
at 12:20pm, she and her partner with their son was in the house and I greeted
them. I was warmly welcomed by client and partner and a seat was offered.
Client introduced me to her partner and their son. I enquired about their health
and they said they were doing well. Miss C.B has a very good relationship with
the partner, her son as well as the co- tenants in the house after I enquired
about how she relates with them. According to her, she attends closely related
ceremonies such as weddings, funerals and graduation which she ensures the
COVID-19 protocols.
Physical environment
Miss C.B lives in a compound house, roofed with aluminium roofing sheets
and windows covered with sliding windows. She gets her source of water from
a drilled borehole in her neighborhood which is a few steps away from the
house and stores it in a well cleaned covered barrel. She shares kitchen and
bathroom with the tenants (3) which according to her, they assign themselves
daily basis in cleaning the kitchen whilst bathroom is weekly basis. She uses
charcoal according to her for cooking. She keeps the refuse in a covered
dustbin and disposes it at the public refuse dump which is about some few
steps away from the house. Drainage system was good and all gutters that is
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from the bathroom and surroundings were neatly cleaned. I congratulated her
for keeping her surroundings hygienic.
Whilst in the room, she had a well ventilated and lighted system. The room
was clean, spacious and floor covered with carpet. I requested to check her
items for delivery which she brought them and everything was intact and
arranged in a bag. She was reminded on the signs of labor, birth preparedness
and complication readiness, malaria prevention, danger signs in pregnancy and
was advised to put the things at a place where it could be easily seen which she
did whilst I was there. Partner was also encouraged to assist client in doing her
chores to reduce her stress. Routine drugs were checked if she was taking them
and it was confirmed she took them as they were supposed to be taken. Client
was reminded of the next visit and I thanked them for their cooperation.
Client’s subsequent visit to the clinic
Miss C.B visited the antenatal clinic on the 3rd November, 2021 for 7th visit.
She was welcomed and a seat offered to her. I ascertained about her health and
that of her family which she responded, they were doing well. Her vital signs
were checked and recorded accurately as;
Temperature 36. 1oC
Pulse 83bpm
Respiration 19cpm
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Weight 59kg
On abdominal examination, procedure was explained to her that she was going
to be assessed in order to know her well-being and the fetus as well. Hands
were washed with soap under running water, wiped with a clean towel and
then warmed by rubbing them. During abdominal inspection, the shape was
globular, linea nigra, striae gravidarum and fetal movements were present. On
fundal palpation the buttocks occupied the upper pole of the uterus.
Symphysio-fundal height measured 36cm, gestational age was 38 weeks and
lie being longitudinal. On lateral palpation, the fetal back was felt at the right
side of the mother’s abdomen and limbs at the left part of the abdomen.
Position was left occipito-anterior and presentation was cephalic on pelvic
palpation. Descent of the head was five fifth (5/5th) above the pelvic brim. On
auscultation, the fetal heart rate was 140bpm (beat per minute) with good
volume and regular rhythm. Urine test for protein and sugar were all negative.
Madam C.B was showed to the labor ward and the lying-in ward in order to
help her familiarize with the things there and to help relieve fear and anxiety.
On 10th November, 2021, client had her eighth (8th) antenatal clinic at 38 weeks
of gestation. Abdominal examination was conducted on client and it revealed
as symphysio-fundal height (SFH) as 36cm and presentation as cephalic upon
palpating and foetal heart rate was present upon auscultation. Urine was tested
for protein and sugar and were negative. Routine drugs were served to client
(Refer to appendix IIA) for client’s antenatal records. Client complained of
increased vaginal discharge. She was reassured to allay fear. She was also
20
encouraged to wash vulva with plain water without douching, to bath at least
twice a day, to use panty liners and to avoid wearing tight under wears. The
following day at 9:00am, I called client check on her health and the problem
with leucorrhea and she said she was coping with it.
17th November was client’s 9th antenatal clinic visit at 39 weeks of gestation.
During abdominal examination, symphysio-fundal height was 37cm and fetal
presentation as cephalic upon palpating. Fetal heart rate was 145bpm with a
regular rhythm upon auscultation. Urine routine examination (R/E) revealed
negative protein and sugar. Routine IFA were served to client. She was
educated on immunization schedule for baby (Refer to appendix IIC). Her vital
signs were recorded as follows;
Temperature 36.3oC
Pulse 78bpm
Weight 62kg
On 24th November, 2021, client attended the clinic for her tenth (10th) antenatal
visit at a gestational age of 40 weeks. During abdominal examination,
Symphysio-fundal height was 38cm and presentation was cephalic upon
palpating and fetal heart rate after auscultation was 143bpm. Urine routine
examination (R/E) revealed negative protein and sugar. She took her fourth
dose of Sulfadoxine pyrimethamine on close observation and the routine drugs
which is Iron and Folic Acid were served. She was counselled on neonatal care
21
and danger signs in newborn (Refer to appendix IIC) for the counselling done.
Vital signs of Miss C.B were recorded as;
Temperature 36.2oC
Pulse 82bpm
Weight 62kg
Subsequent home visit
On 6th November, 2021, I visited Miss C.B again in her house at 9.00 am to
find out how she and her family were doing. I was warmly welcomed by client
and her partner and a seat was offered to me. I quickly did some observations
and noticed the environment was in good condition as the other time and
recommended her for that.
At 9:30am, I asked her if there were any problem and she said she was having
sleepless nights and frequent micturition. For the problem with sleepless night,
client was reassured to allay fear and anxiety, she was encouraged to reduce
fluid intake at night to ensure sufficient sleep, she was also encouraged to have
warm bath before going to bed to promote sleep. Again, she encouraged to
ensure calm environment before going to bed and lastly, partner was
encouraged to give client massage to induce sleep whilst with the problem of
frequent micturition, she was reassured to allay fear and anxiety, she was also
encouraged to urinate whenever she feels the urge, to wear cotton under wear,
wash under wears frequently to prevent infections and lastly, bath at least twice
22
daily to prevent potential infections and ensure body comfort. She was
reminded of the signs of labor such as the painful regular rhythmic
contractions and discharging of show. She was also educated on breastfeeding
and importance of postnatal care. I thanked the client and her partner for their
cooperation and asked permission to leave and left. The following day at
10:30am, I called client to enquire about her health and she said she was able
to have enough sleep and was coping with the frequent micturition.
23
NURSING CARE PLAN DURING ANTENATAL
A nursing care plan is a documentation of care administered to client which
involves all the relevant information about client diagnosis, the goals of
treatment, specific nursing orders including what observation are needed and
what actions must be performed and a plan for evaluation (Papandera, 2018,
January, 8th)
Actual Problem Identified
1. On the 27th October, 2021 at 9:00am, client has insufficient knowledge
on early booking.
2. On the 27th October, 2021 at 10:30am client complained of lower
abdominal pain
3. On the 27th October, 2021 at 10:35am client complained of backache
4. On the 6th November, 2021 at 8:30am client complained of having
sleepless nights
5. On the 6th November, 2021 at 9:00am client complained of frequent
micturition.
6. On the 10th November, 2021 at 9:30am client complained of
leucorrchea.
Short Term Objectives
1. Client will be abreast with gain much information on the importance of
early booking.
2. Client will be relieved of lower abdominal pain within 24 hours.
24
3. Client will be relieved of backache within 24 hours.
4. Client will have sufficient sleep at night within 24 hours
5. Client will cope with frequency of micturition throughout pregnancy
6. Client will cope with leucorrhoea throughout pregnancy
25
TABLE ONE: CARE PLAN DURING ANTENATAL
DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTIONS DATE EVALUATION

AND DIAGNOSIS OBJECTIVE AND
TIME TIME
27/10/21 Lack of Client will 1. Reassure client of 1. Client was reassured of competent care 27/10/21 Goal fully met
at knowledge gain competent care. to allay fear and anxiety. at as evidenced by
9:00am on early information 2. Educate client on the 2. Client was educated on the routine 9:30am client verbalized
booking on the routine activities during activities during ANC booking to she was not
related to importance of antenatal clinic (ANC) create awareness. going to repeat
insufficient early booking booking. it in her next
information within 3. Educate client on the 3. Importance of blood sample taken pregnancy.
30minutes importance of blood during booking such as helping to
evidenced by sample taken for know the blood group, rhesus typing,
client giving investigation during G6PD status and others serve as a
feedback on booking. baseline for care were educated to
some of the client.
importance of 4. Educate client on the 4. Importance of vital signs as it serve as
early booking. importance of the vital baseline for reference was educated to
signs taken during client.
booking.
5. Educate client on the 5. Reasons for ultrasound scanning as to
reasons for taking rule out ectopic pregnancy and any
ultrasound scanning abnormalities were educated to client.
during booking.
6. Educate client on the 6. Education on the importance of the
routine drugs (IFA) routine drugs such as preventing spinal
served during booking. bifida, anemia, activation of enzymes
and carbohydrate metabolism.
26
DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE EVALUATION
AND DIAGNOSIS OBJECTIVES/ AND
TIME OUTCOME TIME
CRITERIA
27/10/2 Lower Client will be 1. Reassure client to allay 1. Client was reassured of competent 28/10/2 Goal fully met
1 abdominal relieved of fear and anxiety. care to allay fear and anxiety. 1 as evidence by
at pain related lower 2. Explain the physiology 2. Physiology behind condition was at client verbalized
10:30am to descent of abdominal pain behind the condition. explained to her as the result of 10:30am a relief of pain.
foetal head. within 24 hours descent of foetal head.
as evidenced by 3. Encourage client to wear 3. Client was encouraged to wear low
client low heel shoes. heel shoes.
verbalizing a 4. Encourage client to 4. Client was encouraged to support the
relief of pain. support the back with back with a pillow to relieve pressure
pillow when in the on the lower abdomen.
sitting position.
5. Encourage client to take 5. Client was encourage to take in more
in more fibers. fibers to prevent constipation.
6. Serve prescribed 6. Prescribed analgesic such as tablet

analgesia such as tablet Paracetamol 1g tds x 5days was
Paracetamol 1g tds x served to relieve pain.
5days.
27
AND DIAGNOSIS OBJECTIVES AND
TIME TIME
27/10/21 Backache Client will be 1. Reassure client that 1. Client was reassured that condition 30/10/21 Goal fully met as
At related to relieved of condition is temporal. was temporal to allay fear and at evidence by
10:30am relaxation of backache within anxiety. 10:30am client verbalized
the sacroiliac 24 hours as 2. Explain the physiology 2. Physiology behind condition was a relief of pain.
joints by the evidenced by behind the condition to explained to client that it was due to
action of client client. effect of relaxin and progesterone on
progesterone verbalizing a the sacroiliac joints.
and relaxin relief of pain. 3. Encourage client to avoid 3. Client was encouraged to avoid long
hormones. long standings. standings to ease pain.
4. Teach client on correct 4. Client was taught on correct posture

posture such as using a pillow at the back,
foot support and armrest whilst in
the sitting position.
5. Encourage client to avoid 5. Client was encouraged to avoid
heavy lifting. heavy lifting to prevent pain
aggravation.
28
DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTIONS DTE EVALUATION
TIME TIME
6/11/21 Insomnia Client will be 1. Reassure client. 1. Client was reassured to allay fear 7/11/21 Goal fully met
at related to able to have and anxiety. at as evidenced by
10:30a frequent sufficient 2. Encourage client to reduce 2. Client was encouraged to reduce 10:30am client verbalized
m micturition. sleep at night fluid intake at night. fluid intake at night to ensure that she had
within 24 sufficient sleep. enough sleep.
hours as 3. Encourage client to have a 3. Client was encouraged to have a
evidenced by warm bath before going to warm bath before going to bed to
client bed. promote sleep.
verbalizing 4. Encourage client to ensure 4. Client was encouraged to ensure
she has calm environment before calm environment before going to
enough sleep. going to bed. bed.
5. Encourage partner to 5. Client’s partner to massage client to
massage. induce sleep.
29
TIME TIME
6/11/21 Frequent Client will be 1. Reassure client. 1. Client was reassured to allay fear 7/11/ 21 Goal fully met as
At micturition able to cope and anxiety. At evidence by
11:00am related to with frequent 2. Encourage client to 2. Client was encouraged to urinate 10:30am client verbalized
pressure on micturition after urinate whenever she whenever she feels the urge to she could cope
the bladder termination of feels the urge. prevent retention of urine. with frequent
by the gravid pregnancy. 3. Encourage client to wear 3. Client was encouraged to wear micturition.
uterus. cotton under wears. cotton under wears.
4. Encourage client to wash 4. Client was encouraged to wash
under wears frequently. under wears frequently to prevent
infections.
5. Encourage client to bath 5. Client was encourage to bath at least
at least twice daily. twice daily to body comfort.
30
TIME OUTCOME TIME
CRITERIA
10/11/2 Leucorrhoea Client will be 1. Provide emotional support 1. Client was provided with 11/11/2 Goal fully met as
1 related to able to cope with to client. emotional support to allay fear. 1 evidence by
At increased mucus leucorrhoea till 2. Encourage client to wash 2. Client was encourage to wash At client verbalized
9:30am production by termination of vulva with plain water vulva with plain water without 9:00am she was coping
endocervical pregnancy as without douching. douching. with
glands. evidenced by 3. Encourage client to bath 3. Client was encourage to bath at leucorrhoea.
client at least twice a day. least twice a day.
verbalizing she 4. Encourage client to use 4. Client was encourage to use
feels panty liners. panty liners.
comfortable and 5. Encourage client to avoid 5. Client was encouraged to avoid
can cope with it. wearing tight under wear. wearing tight under wear.
31
CHAPTER III
INTRAPARTAL CARE
Intrapatal care is the care provided for a woman during labour or parturition
(Tiran, 2012).
Admission, history taking and initial assessment of client in labour
On the 25th November, 2021 at 12:10am, Miss C.B reported to the ward with
her partner after she called me and said she was experiencing painful
contractions with a blood stained mucus seen. She was welcomed and a seat
offered to her and the partner directed to sit at the lounge. Her maternal and
child health (MCH) record book was collected and glanced through and she
was 40 weeks plus 1 day. Laboratory investigation revealed haemoglobin level
at 36 weeks as 11.4g/dl, negative HIV and hepatitis B statuses. History was
taken concerning signs of labor and danger signs. According to her, she had
lower abdominal and waist pains around 9:07pm with blood-stained mucoid
(show) coming from the vagina without any discharge of liquor amni. The last
meal she took was rice ball with groundnut soup, took no medications before
coming and could feel the movements of the foetus. Her expected date of
delivery was recalculated to confirm date. She was then admitted to the ward.
Client’s vital signs were recorded as;
Temperature 36.0oc
32
Pulse 95bpm
Respiration 23cpm
Blood pressure 116/90mmHg.
Examination of client
At 12:20am, client was asked to void after procedure explained to her and a
tray was set for the examination. She was assisted to lie on the couch
comfortably so that she was not lying completely supine and privacy provided.
On abdominal examination, there were foetal movements and no scars on
inspection. Symphysio-fundal height was 43cm, the fundus occupied a soft
irregular mass (buttocks), 3/5th descent and cephalic presentation on palpation.
Foetal heart rate upon auscultation was 143bpm.
I sat on a chair at the right side of client’s bed, warmed palms and placed the
right palm on the fundus to check contractions. Contractions were timed for
10minutes and duration for each contraction in seconds. I started counting
when the fundus hardens and ends when it softens. Palm was sustained on the
fundus until the end of the 10minutes where client experienced 4 contractions
in 10 minutes lasting 35 seconds and was recorded on the partogragh
(Appendix III).
On vagina examination, client was helped to get into a lithotomy position,
hands were washed and sterile glove put on. Soiled pad was removed and
discarded with the left hand. Client was then asked to separate legs. On
33
inspections, there was no scars or inflammation or any offensive discharge. A
swab soaked with savlon was picked with the right hand and dropped into the
left hand and labia majora, labia minora and the vestibule were wiped from
anterior to posterior using one swab per stroke. I gently inserted the right
middle finger into the vagina but firmly pressing downwards, the index finger
was also inserted. In the vagina, the middle and index finger was separated to
check if vagina can stretch and it could. The vagina was warm and cervix was
soft. I then located the cervical os and on examination, the os dilated 7cm with
cervix 80 percent effaced. Refer to partogragh in (Appendix III). Findings were
communicated to client to allay anxiety. She was then provided with a bed and
reassured of competent and safe care. She was also advised to either adopt a
left lateral position or walk around.
Management of first stage of labor
First stage of labor is the period where cervical effacement and dilatation
occur, contractions fundally dominate and there is polarity between the upper
and lower uterine segment until cervix is fully dilated (Tiran, 2021).
During this period, client was monitored using partograph and strict aseptic
techniques were ensured. At 12:10am, client complained of lower abdominal
pain. She was reassured to allay fear and anxiety, physiology behind lower
abdominal pain in labour was explained to client, she was encouraged to do
deep breathing exercise during uterine contraction and was allowed to adopt a
comfortable position. Her partner was encouraged to give sacral massage
during contractions to relief pain.
34
At 12:50am, before client was seen re-applying perineal pad that fell on the
floor and due to that, she was educated on the effects of re-application of pad
that has fallen on the floor, she was encouraged to change perineal pad when
soiled or fallen off to prevent infections. She was also encouraged to wash
hands before and after touching perineal pad. Again, she was educated on
correct application of perineal pad and strict aseptic techniques were ensured to
prevent infections.
At 1: 20am, client was anxious and would not even drink water offered to her
as evidenced by client paced to and forth in the room. Client was reassured of
competent care to allay anxiety, progress of labour was explained to client to
allay anxiety, every procedures performed was explained to client and was
engaged in a conversation to divert anxiety. Also, she was encouraged to ask
questions. Again, she was educated on the need of hydration in labour, she was
also encouraged to take in more fluids for good hydration, urine output was
checked and recorded and prescribed intravenous normal saline 500mls was set
up to prevent dehydration.
At 2:20am, I observed that during contractions, client was bearing down. She
was reassured to allay anxiety. She was also educated on the effects of
premature bearing down such as rapid expulsion of products of conception.
Again, full dilatation was confirmed before client was allowed to bear down,
she was encouraged to stop bearing down after foetal crowns and flexion was
maintained on foetal head for the smallest diameter to distend the perineum.
35
Interpretation of partograph
At 12:20am, client progress of labour was monitored on the partograph and
recorded. Vaginal examination revealed 7cm dilatation of the cervical os,
descent was 3/5th above the pelvic brim and amniotic fluid was intact. Fetal
heart rate was 143bpm contractions were 4 in 10 minutes lasting for
35seconds, maternal pulse was 95bpm, blood pressure was 116/90mmHg,
temperature was 36.00C, urine tested for protein and acetone were negative,
volume of urine was 80mls.
At 12:50am, after assessment, maternal pulse was 98bpm, uterine contractions
were 4 contractions in 10 minutes lasting for 40 seconds and fetal heart rate
was 144bpm. Findings were communicated to client and was reassured.
At 1: 20am on assessment, maternal pulse was 96bpm, uterine contractions
were 4 in 10 minutes lasting for 40 seconds and fetal heart rate as 145bpm.
500mls of intravenous infusion was set up.
At 1:50am, client was again assessed for progress of labour. On assessment,
foetal heart rate was 145bpm on auscultation, maternal pulse was 98bpm and
contractions were 4 contractions in 10minutes lasting for more than 40seconds
At 2:20am, client’s pulse and temperature were 95bpm and 36.20C
respectively, foetal heart rate was 143bpm and contractions were 4
contractions in 10minutes lasting for more than 40seconds. Urine tested
negative protein and acetone and volume was 60mls.
36
At 2:50am, membranes ruptured and that is why vagina examination was
done. On assessment, cervical dilation was 10cm, descent was 0/5th above the
pelvic brim, amniotic fluid was clear and moulding revealed as bones in
apposition. Contractions were 5 in 10 minutes lasting for more than 40
seconds, foetal heart rate was 145bpm and maternal pulse was 95bpm.
Management of the second stage of labor
The second stage of labor commence when there is full cervical dilatation until
the expulsion of the fetus completely from the uterus (Tiran, 2012).
Client was sent to the second stage room and assisted on the delivery couch in
a lithotomy position which she preferred after explaining that she was in the
second stage of labor. The delivery couch was covered with a rubber
mackintosh and a delivery mat and warmth provided in the room. I wore a
mackintosh apron and boots whilst nose mask was already worn, washed my
hands with soap under running water, wiped with clean towel and wore sterile
gloves. My assistant covered client’s abdomen with a cot sheet. Client was told
to hold the baby when delivered unto her abdomen and to bear down with
contractions and rest between contractions.
I maintained flexion of the fetal head using the index finger, the thumb finger
and a pad to allow the biparietal diameter of 9.5cm to distend the perineum and
to prevent injury to the pelvic floor muscles until the head crowned. After
crowning of the fetal head, I checked for cord around neck but there was none
and cleaned baby’s face with a sterile gauze. Client was asked to stop bearing
37
down for restitution to take place. I waited for restitution to end. After
restitution, anterior shoulder was delivered with a little push by the mother and
downward traction and posterior shoulder also with a little push from the
mother and upward traction was delivered. The rest of the body was then
delivered by lateral flexion unto the mother’s abdomen at 3:00am and she was
congratulated.
Immediate care of the baby
After delivery of the baby, with a gentle rubbing, immediately dried the baby
thoroughly, the body, upper limbs, legs and the head and later suctioned the
mouth followed by the nose to stimulate breathing and to prevent hypothermia.
I showed baby to mother and asked her for the sex of the baby which she
answered as male. I kept the baby warm by positioning him skin-to-skin on
mother’s abdomen near her breast for about one hour, covered both with clean,
warm, dry cloth and covered baby’s head with a head cap. I assessed the Apgar
score for the first minute and was recorded as 8/10 and then the fifth minutes
which was 9/10. During the one hour skin-to-skin, I checked baby’s
temperature every fifteen (15) minutes by using thermometer. I assisted mother
to initiate breastfeeding within the first thirty (30) minutes of delivery and
taught her signs that indicated baby wanted to feed and these were baby either
crying, bringing tongue down and forward, opening mouth or making licking
movements. Throughout this care, strict infection prevention was observed to
prevent infection.
38
Active management of the third stage of labor
Third stage of labor is a period which involves the separation and complete
expulsion of placenta and membranes and controlling of haemorrhage (Tiran,
2012).
During this stage, procedure was explained to client to gain her cooperation.
During the procedure, I palpated client’s abdomen to be sure there was no
other fetus in utero. After confirmation, I asked my assistant to administer 10
international units (IU) of oxytocin intramuscularly on the left thigh of client
within one minute of delivery. I waited for cessation of pulsation in the cord,
removed the first gloves and then clamped the cord at two ends with a cord
clamp and an artery forceps. The space between the clamps were covered with
a sterile gauze and cut with a sterile scissor. I then placed a sterile receiver
against the perineum to collect blood and receive placenta. The clamp on the
cord connected to the placenta was reapplied nearer to the vulva, placed my
hand on client’s abdomen and waited for the uterus to contract strongly. As the
uterus contracts, I placed one hand above the symphysis pubis with palms
facing the umbilicus exerting pressure in an upward direction and the other
hand grasping cord whilst applying a steady downward and backward traction
to expel the placenta. After delivery of placenta, the time was noted as 3:10am.
It was examined and revealed as complete membranes with cord situated at the
center of the placenta. After examination, I placed it in the receiver,
decontaminated, showed it to client and relative and disposes off appropriately.
I then examined the perineum and was intact. I cleaned the perineum, applied a
39
fresh clean perineal pad and thanked her for the cooperation. After one hour of
delivery, I assisted client off the couch into a comfortable bed in the lying-in
room.
Examination of the placenta

The placenta was examined immediately after delivery. It was examined to be
sure no part or fragment of it or membrane was retained. I placed the placenta
in my palms with the maternal surface uppermost and inspected for
completeness, infarction and calcification and it was intact, no infarctions or
calcifications present. The foetal surface was also examined for insertion of the
cord and radiation of blood vessels from the cord insertion and it viewed that
cord was inserted at the center of the placenta and blood vessels radiated from
the cord insertion of the cord and radiation of the blood vessels from the cord
insertion and it viewed that cord was inserted at the center of the placenta and
blood vessels radiated from the cord insertion towards the edge of the placenta
which disappeared deep into the placenta tissue before it got to the edge. The
umbilical cord was with no knot and hard two arteries and a vein. I then held
the placenta by the cord allowing the membrane to hang and hole through
which baby was delivered, was been identified and I spread my hands inside
the hole to inspect for completeness and it was complete. The amnion was
them separated from the chorion up to the umbilical cord to inspect the chorion
and was viewed as being completed. The placenta was discarded appropriately
after decontamination.
40
Examination of the genital tract
The genital tract (perineum) was examined for tears, lacerations and
hematoma. During procedure, client was reassured and procedure explained as
well as privacy provided. After explanation of procedure, I massaged the
uterus for it to contract. I then asked my assistant to direct a light on the
perineum to aid visualization. I cleaned the perineum with a weak antiseptic
solution (diluted savlon). After cleaning I wrapped a sterile gauze around my
fingers and gently parted the vaginal walls to inspect the anterior, posterior and
lateral walls if there was tears and no tears were sustained. The perineum was
the cleaned and a clean fresh pad applied. Client was educated on personal
hygiene relating to the perineum and was thanked.
Management of fourth stage of labour
Care of the mother

Immediately after delivery of the placenta and its membranes, client’s uterus
was palpated to expel clot. After being well contracted, she was cleaned
anteroposteriorly and symphysio-fundal height measured and recorded as
17cm. the perineum assessed for tears and lacerations as well as hematoma but
none was present. Vital signs were checked and recorded accurately as;
Temperature 36.20C
Pulse 82bpm
Respiration 20cpm
41
Client was assisted in putting baby to breast within the first thirty (30) minutes
postpartum. During this stage of labour, vital signs, perineum (for the flow of
lochia) and the state of uterus were checked and recorded every fifteen (15)
minutes for the first hour, thirty (30) for the next two hours and hourly for the
next three hours. Throughout this period, the flow of lochia was moderate and
vital signs was in the following range;
Temperature 36.20C – 36.70C
Pulse 78bpm -84bpm
Respiration 19cpm -22cpm
Blood pressure 100/60mmHg -120/70mmHg. (Refer appendix IVA).
Client complained of lower abdominal pain and was encouraged to void
frequently and eat light meals. She was also encouraged to rest and sleep after
environment made conducive for resting and to ambulate early to ensure
drainage of lochia involution of the uterus. Again, she was educated on the
importance of personal hygiene and the signs she should report for immediate
attention. The following post-delivery drugs were served;
Capsule Amoxicillin 500mg tds x 7
Tablet Metronidazole 400mg tds x 7
Tablet Folic Acid 5mg daily x 30
Tablet Fersolate 200mg tds x 14
Tablet Paracetamol 1000mg tds x 7
42
Tablet multivite 200mg tds x 30
Essential care of the baby

Baby was maintained skin-to-skin for an hour after delivery with breastfeeding
initiated within the first thirty minutes. He was provided with warmth and head
covered with a cap to prevent hypothermia. Vital signs were checked and
recorded as;
Temperature 37.00 C
Heart beat 140bpm
Respiratory rate 32cpm
Vital signs (respiratory rate and heart beat) were checked every fifteen minutes
for an hour, thirty minutes for the next two hours and hourly for the next three
hours whilst temperature was checked hourly and they ranged between the
following;
Temperature 36.50 C- 37.20 C
Heart beat 126bpm- 144bpm
Respiratory rate 30cpm- 40cpm
Baby was observed for breathing, colour of skin, cord appearance, suckling
and movements and it revealed that breathing was normal, skin was pink,
presence of suckling, active movements and cord was healthy with no
bleeding. Chloramphenicol eye drop was administered to baby’s eye to prevent
eye infections, cord cleaned with chlorhexidine gel and left to air dry to
43
prevent cord infections and 1.0ml of vitamin K1 administered intramuscularly
at the mid anterolateral thigh to prevent bleeding.
Examination of baby
Examination of the baby was done to identify any abnormalities. Before
examination of the body, a tray was set for the examination, procedure
explained to mother and consent asked, room windows were closed to provide
warmth and privacy provided. During procedure, I washed my hands, dried
with clean towel and wore a pre-warmed gloves. Baby was placed on a flat
firm padded surface covered with a pre-warmed cot sheet under a bright light.
Baby was examined from head to toe and no abnormalities detected. The
sutures and frontanelles were normal and pulsating. The anterior frontanelle
admitted two (2) fingertips whereas the posterior admitted a fingertip. Eyes
were well situated in symmetry with no signs of jaundice. Nose was clean.
Ears were well situated and was and was in line with the eye. Mouth had an
intact palate, no false teeth and there was presence of rooting reflex. Neck was
normal and could be turned around. Breathing pattern was normal as evidenced
by a good rhythm of the upward and downward movement of the chest. Upper
limbs were in symmetry, intact fingers, presence of palmar creases and gasping
reflex. Cord was healthy, had two arteries and a vein with no bleeding. The
genitalia had labia majora covering the labia minora. Hymen was perforate,
urinary orifice patent as baby urinated. Baby passed dark green meconium and
there were no rashes on the buttocks. The lower limbs were in symmetry. The
legs (particularly with the knees) were flexed to check for fractures but were
44
none. Baby was turned back to be examined, I palpated from the cervical
region down to the sacral region to check for abnormalities such as spinal
bifida but none was detected. Moro reflex was also present. Baby’s weight was
taken and he was weighed 3.8kg, head circumference was 32cm, chest
circumference was 30cm and full length was 49cm. He was cleaned and a new
diaper put on after he passed meconium. Baby was dressed up, provided with
warmth and handed over to the mother. Outcome of examination was
communicated to mother and documented.
45
Summary of labour notes
Date of delivery 25/11/21
Time of delivery 3:00am
Mode of delivery Spontaneous vaginal delivery
Time of delivery of placenta and membranes 3:10am
Time of oxytocin injection 3:01am
Estimated blood loss (EBL) 200mls
Duration of labour
Stages of labour Commence End Duration
First stage 9:07pm 2:50am 5 hours 43 minutes
Second stage 2:50am 3:00am 10 minutes
Third stage 3:00am 3:10am 10 minutes
Total duration 9:07am 3:10am 6 hours 3 minutes
Condition of Mother after Delivery
Condition of the mother Satisfactory
Condition of perineum Intact
Condition of cervix Intact
Fundal height 17cm
Blood pressure 100/60 mmHg
Pulse rate 82bpm
46
Respiration 20cpm
Temperature 36.2OC
Estimated blood loss 200mls
Condition of Baby after Delivery
Condition of Baby satisfactory
Sex Male
Birth weight 3.8kg
Baby length 49cm
Head circumference 32cm
Apgar score 8/10, 9/10
Urine Passed
Meconium Passed
Abnormalities Nil
Condition of the Placenta and Cord
Placenta and Membranes Intact
Condition of Placenta Healthy and normal
Placental lobes Complete
Cord vessels one vein, two arteries
Cord Length 46cm
Cord insertion Centrally situated
Maternal surface Dark red in colour
Fetal surface Grayish blue
47
NURSING CARE PLAN DURING LABOUR
Actual Problem Identified
1. On 25th November, 2021 at 12:10am client complained of lower
abdominal pain.
2. On 25th November, 2021 at 12:50am client was at risk of infection
(application of perineal pad that had fell off).
3. On 25th November, 2021 at 1:20am client was at risk of dehydration.
4. On 25th November, 2021 at 1:20am client was anxious.
5. On 25th November, 2021 at 2:20am client was at risk of trauma.
Short term objectives
1. Client will be able to cope with lower abdominal pain.
2. Client will be free from infections throughout labour.
3. Client will have fluid balance throughout labour.
4. Client will be able to overcome anxiety within thirty minutes.
5. Client will have intact perineum after delivery of baby.
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TABLE TWO: NURSING CARE PLAN DURING LABOUR
TIME OUTCOME TIME
CRITERIA
25/11/21 Lower Client will be 1. Reassure client. 1. Client was reassured to allay fear 25/11/21 Goals fully met
At abdominal able to cope with and anxiety. At as evidenced by
12:20am pains related lower abdominal 2. Explain the physiology 2. Physiology behind lower abdominal 12:50am client verbalized
to painful throughout of lower abdominal pain pain in labour was explained to that she was
uterine labour as in labour to client. client. coping with lower
contraction. evidenced by 3. Encourage client to do 3. Client was encouraged to do deep abdominal pains
client verbalizing deep breathing exercise breathing exercise during uterine
she can cope during contractions. contraction.
with lower 4. Allow client to adopt a 4. Client was allowed to adopt a
abdominal pain. comfortable position. comfortable position.
5. Encourage client’s 5. Client’s partner was encouraged to
partner to give sacral give sacral massage during
massage during contractions to relief pain.
contractions.
49
TIME TIME
25/11/21 Risk for Client will be free 1. Educate client on the effects of 1. Client was educated on the effects of 25/11/21 Goal fully met as
At infection from infection reapplying pad that has fallen on reapplying pad that has fallen on the At evidenced by
12:50am related to re- throughout labour the floor. floor to create awareness. client not
9:20am
application of as evidenced by 2. Encourage client to apply fresh 2. Client was encouraged to change contacting
perineal pad client showing no perineal pad when soiled or fallen perineal pad when soiled or fallen off to infection
that fell on the signs of infection off. prevent infection. throughout
floor. by the end of the 3. Encourage client to wash hands 3. Client was encouraged to wash hands labour.
period of labour. before and after touching perineal before and after touching perineal pad.
pad.
4. Educate client on correct 4. Client was educated on correct
application and removal of application and removal of perineal pad.
perineal pad.
5. Ensure strict aseptic techniques 5. Strict aseptic techniques were ensured
during procedures. to prevent infections.
50
TIME TIME
25/11/2 Risk for Client’s fluid 1. Reassure client. 1. Client reassured to allay fear and anxiety 25/11/21 Goal fully met
1 dehydration balance will be and to gain her cooperation. At as evidenced by
At related to refusal maintained 2. Educate client on the need of 2. Client was educated on the need of 9:20am client fluid
1:20am to take in fluids. throughout hydration in labour. hydration in labour. balance being
labour as 3. Encourage client to take in 3. Client was encouraged to take in more maintained after
evidenced by more fluids for good hydration. fluids for good hydration. the end of fourth
client showing 4. Check client’s urine output. 4. Client’s urine output was checked and stage.
no signs of recorded.
dehydration. 5. Administer prescribed 5. Prescribed intravenous fluid infusion
intravenous fluid infusion (500mls of normal saline) was administered
(500mls of normal saline). to hydrate client.
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TIME TIME
52
25/11/21 Anxiety Client’s anxiety 1. Reassure client competent care. 1. Client was reassured of competent 25/11/21 Goal fully met as
At related to will be to care to allay anxiety. At evidenced by
1:20am unknown overcome within 2. Explain the progress of labour. 2. Progress of labour was explained to 1:50am client remaining
outcome of thirty (30) client to allay anxiety. calm and
labour. minutes as 3. Explain to client every procedure 3. Every procedure to be performed confident
evidenced by to be performed on her. was explained to client. throughout
client showing 4. Stay with client and engage her in 4. Client was engaged in a labour.
relaxed facial conversation. conversation to divert anxiety.
expression. 5. Encourage client to ask questions 5. Client was encouraged to ask
and answer them correctly. questions whilst correct answers were
provided.
53
TIME TIME
25/11/2 Risk for Client will have 1. Reassure client. 1. Client was reassured to allay 25/11/2 Goal fully met
1 perineal an intact anxiety. 1 as evidenced by
at trauma perineum after 2. Educate client on effect of 2. Client was educated on the effect At client having
2:20am related to the delivery of premature bearing down. of premature bearing down such as 3:10am intact perineum.
premature the baby as 3. Confirm full dilation before rapid expulsion of products of
bearing. evidenced by client is allowed to bear down. conception.
client having an 4. Encourage client not to push 3. Full dilation was confirmed before
intact perineum but pant after head has client was allowed to bear down.
after crowned. 4. Client was encouraged not to push
examination. 5. Maintain flexion of fetal head but to pant after head crowned.
during delivery to allow the
54
smallest diameter to distend 5. Flexion was maintained on fetal
the perineum. head for the smallest diameter to
distend the perineal.
55
CHAPTER IV
MANAGEMENT OF PUERPERIUM
Puerperium is a six to eight(6-8) weeks period following childbirth during which uterus and
other organs and structures return to non-pregnant state(Tiran, 2012).
This chapter consists of subsequent care of the baby, baby's first bath and cord dressing, first
day of puerperium and clients’ preparation for discharge, first day postnatal home visit,
second day postnatal home visit, third day postnatal home visit, fourth day postnatal home
visit, fifth day postnatal home visit, sixth day postnatal home visit and seventh day postnatal
clinic and home visit, termination of care, nursing care plan during puerperium, summary and
conclusion, bibliography, appendices, pharmacology of drugs administered and signatories.
Subsequent care of the baby

After the six hours of the third stage, baby was monitored and vital signs checked every four
hours. He was monitored for skin colour, reflexes, suckling and patency of the urethral and
anal openings. His vital signs during this period ranged between the following;
Temperature 36.2oC - 37.2oC
Heart beat 133bpm – 140bpm
Respiration 35cpm – 40cpm.
Mother was advised to report any unusual findings such as high body temperature, fast
respiration or poor suckling for immediate action to be taken.
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Baby’s first bath and cord dressing
Procedure was explained to the mother and permission was granted. She was asked if she
wanted to observe whilst I bath the baby and she said yes. Baby was put in a safe place on a
firm flat surface and items to be used were assembled on a trolley for the bath and cord
dressing. Windows and door were shut to provide warmth and water was mixed and tested
with the elbow for its temperature. I wore plastic apron, washed my hands with soap under
running water and dried with a clean towel. I wore examination gloves, undressed baby and
wrapped him with a clean cot sheet. Baby’s face and eyes were cleaned gently with a damp
towel and a cotton wool swab soaked in clean water respectively. I supported the nape of
baby’s neck with my palm and plugged the ears with my thumb and the index finger to
prevent water from entering the ear. Baby’s head was washed with a soapy sponge, rinsed
and dried with a clean towel. The rest of the body; the neck, arms, front trunk, front feet and
back down to the feet were cleaned with soapy sponge particularly paying more attention to
the skin folds. Baby’s body was then immersed in the warm water with his head resting on
my arm above the water and was rinsed thoroughly. After rinsing of baby, he was placed on a
flat surface covered with a clean cot sheet and a small towel was used to dry him where much
attention was also given to the skin folds. I smeared baby with baby`s oil and dressed him.
Examination gloves were removed, washed hands, dried them and put on sterile gloves. I
exposed the cord and inspected for looseness and bleeding but there was none. It was then
cleaned with chlorhexidine gel from the stump to the base and was exposed to be air dried
and findings communicated to the mother. I then wrapped baby in a dry clean cot sheet to
provide warmth. Client was educated on how to dress the cord. She was also encouraged to
dress the cord with only chlorhexidine provided and to top and tail till cord is off. Client was
thanked for her cooperation. Basin used for the bath and surface for examination were
cleaned. Gallipots used in the cord dressing was decontaminated, washed and sterilized to be
ready for use. I then washed hands and dried them after which findings were documented.
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First Day of Puerperium
Care of the Mother
The first day of puerperium was 26th November, 2021. I enquired about client’s health and
she complained of severe lower abdominal pains. She was reassured to allay fear and anxiety.
Physiology of lower abdominal pain was explained to her. She was also encouraged to
continue breastfeeding and to apply warm compress to lower abdomen. 1g of paracetamol
was administered to relieve pain. Her vital signs were checked and recorded as;
Temperature 36.3°C
Pulse 82bpm
Respiration 20cpm
Weight 57kg
She was examined for pallor and jaundice but none was there. She was also examined to rule
out sore nipple, pain, engorgement or tenderness during breast examination but it turned out
to be normal and well lactating. Abdomen was normal with no distension and symphysio-
fundal height measured 19cm. Lower limbs had no edema, perineum was intact and lochia
was non offensive with a normal flow. After examination, she was encouraged to empty the
bladder frequently to aid in involution of the uterus and to change perineal pads frequently to
prevent infections.
Care of the Baby
Baby was examined from head to toe and no abnormalities such as extra digits were detected.
He was active, no discharging eyes and passed meconium and urine which indicated patent
anal and urethral orifices with clean cord. He weighed 3.8kg, head circumference was 32cm
and full length was 49cm. His vital signs were checked and recorded as;
Temperature 36.50C
58
Apex beat 124bpm
Respiration 39cpm.
Injection Bacillus Calmette-Guerin (BCG) 0.05mls was given intradermally on baby’s right
upper outer deltoid muscle to protect him from tuberculosis, two (2) drops of oral polio `O`
was administered to baby against poliomyelitis and baby was handed to mother. Client was
counselled to apply nothing on the injected site and not to breastfeed within thirty minutes
after the administration of polio O vaccine. Mother was counselled on the rest of the
immunizations scheduled at the child welfare clinic (CWC).
Preparation of Client and Relative for Discharge
On 26th November, 2021 at 8:00am, client and relative were informed about discharge. They
were educated on continuity of care. Her relatives were asked to settle the bills after it had
been worked out which they did. Discharge papers were duly signed by the Midwife on duty.
Client’s relative was directed to the dispensary for drugs which he did. I educated client and
her relative on the drug regimen and helped client to pack her belongings. Client in the
presence of her mother-in-law was reminded to visit on the third and seventh day postpartum
which were 28th November and 2nd December, 2021 respectively but to report any abnormal
changes in the body such as rise in temperature, profuse bleeding from the vagina in herself
and decreased suckling reflexes or breathing difficulties in the baby even before the
scheduled time. She was counselled to top and tail baby and dress cord daily with
chlorhexidine until it is off. She was also counselled not to apply any medications on the
baby’s sutures and fontanelles and should frequently change baby’s diapers or napkin
whenever soiled to prevent sore buttocks and other heat rashes. She was encouraged to take a
balanced diet, to maintain good personal hygiene, to have adequate rest and sleep and to sleep
with the baby under an insecticide treated net to prevent malaria. She was also encouraged to
exclusively breastfeed, to take her drugs on time, eat enough fruits, vegetables and fluids to
59
prevent constipation. She was reminded of postnatal exercise to strengthen pelvic floor
muscle. I informed client about the postnatal home visits to create awareness and cooperation
and then bid them a good bye after education, discarded the linen which she was sleeping on,
decontaminated the bed and then washed my hands. Medications served were
Capsule Amoxicillin 500mg tds for 7 days
Tablet Metronidazole 400mg tds for 7 days
Tablet Paracetamol 1g tds for 5 days
Tablet Fersolate 200mg 1 daily x 30days
Tablet Folic Acid 5mg daily for 30 days
Tablet Multivite 200mg tds for 30 days
First day postnatal home visit
I visited on the 26th November, 2021 at 4:00pm. The aim of the visit was to find out how the
family was coping with the newborn baby, to ensure good cord care and to manage any minor
disorder if present. On arrival, I greet the family and a seat was offered to me. I enquired
about client’s and baby’s health as well as her relatives and she responded they were all doing
well. Mother and baby were examined after procedure explained to client. On examination,
both mother and baby had no abnormalities. Mother passed urine and had bowel movement.
Breast milk was yellowish white (colostrum) and lochia on assessment was non offensive
moderate bright red (rubra). Baby also passed urine and dark green meconium. The following
were their vital signs.
Mother Evening
Temperature 36.4°C
Respiration 20cpm
Pulse 82bpm
60
Baby Evening
Temperature 36.7°C
Apex heart beat 130bpm
Respiration 38cpm
Second day postnatal home visit
The second day postnatal home visit was on the 27th, November, 2021.this was to find out
how family was coping with the newborn baby, to enquire about mother and baby’s health
and to evaluate previous complain( lower abdominal pain). And they were visited both
morning and evening. On arrival to the house, I was warmly welcomed by client and her
family. I enquired about their health and how they were coping with the baby which they
responded as being good and were happy with the presence of the baby.
Care of the mother
I sought permission to examine client if there were any abnormalities which she granted. She
was examined after procedure explained to her and it revealed a well lactating breast with no
engorgement or pain, fundal height measured 18cm and lochia was moderate with no
offensive odour. I enquired about bowel movement and emptying of the bladder which she
said she could empty both bowel and bladder with no pain but had frequent bladder
emptying. Client was reassured and physiology behind condition explained to her to allay
anxiety. She was encouraged to continue with the emptying whenever she feels the urge in
order to aid involution, to reduce fluid intake when going to bed and to wear cotton under
wears to prevent infection. She was also asked of her previous problem with the lower
abdominal pain and she replied pain being subsided. Vital signs checked for both morning
and evening are as follow;
Morning Evening
Temperature 36.3°C 36.4°C
61
Pulse 84bpm 82bpm
Respiration 20cpm 20cpm
Blood pressure 120/68mmHg 110/70mmHg
Care of the Baby
Baby was examined from head to toe both morning and evening ensuring warmth. I washed
and dried my hands and began with the examination in the presence of the family. On
assessment, umbilicus was clean with no bleeding, presence of reflexes and no rashes on the
skin. He passed meconium and urine which indicated patent anal and urethral orifices and
weighed 3.8kg. Vital signs checked and recorded are as follows
Vital signs Morning Evening
Apex beat 140bpm 138bpm
Third day Postnatal Home Visit
On 28th November. 2021, I had my third (3rd) postnatal home visit and it was done both
morning and evening at 8:00am and 4:30pm respectively.
Care of the mother
During history taking, client complained of backache during breastfeeding and she was
reassured to allay fear and anxiety. Physiology behind condition was explained to create
awareness and was educated on correct positioning of the baby to breast. She was also
encouraged to support the back with a pillow and foot with a chair respectively during
breastfeeding and to apply warm compress to relieve pain. She was also asked of her previous
problem with the frequent micturition which she said she was relieved from that. A thorough
head to toe examination was performed on client and no abnormality was detected. Breast
62
was well lactating, symphysio-fundal height was 16cm with well contracted uterus and lochia
was a non-offensive moderate pale brown (serosa) flow. Vital signs for both morning and
evening are as follows;
Morning Evening
Pulse 82bpm 84bpm
Care of the baby
I examined baby from head to toe and no abnormality was detected both morning and
evening. He passed stool during examination and it was yellowish brown in colour. He was
topped and tailed and cord dressed with chlorhexidine gel from the tip to the base. Baby was
dressed neatly and given to mother to be breastfed and on inspection, suckling and
swallowing reflex were present. He weighed 3.75kg and his vital signs for both morning and
evening were as follows;
Morning Evening
Apex heart beat 136bpm 134bpm
First day postnatal clinic visit
Client had her first postnatal clinic visit on the 29th November, 2021. She looked cheerful and
was welcomed and a seat offered. I ascertained for any problem or resumption of menses
63
from client but she had no complains and had not resumed menstruation. Her weight was
taken and she weighed 58kg. Vital signs taken were;
Temperature 36.10C
Pulse 90bpm
Respiration 22cpm
Blood pressure 110/60mmHg.
Physical examination was done on client after procedure explained to her. On assessment,
breast was heavy and well lactating. Symphysio-fundal height measured 15cm and uterus was
well contracted. Perineum was clean and lochia was moderate.
Care of the baby
Baby was examined from head to toe. On assessment, eyes were clear, nostril was clean, no
false teeth and there was presence of reflexes. Abdomen was round, cord was clean and baby
passed meconium which indicated patency of the orifice. Vital signs checked were recorded
as;
Temperature 36.40C
Respiration 40cpm
Findings were documented after communicated to mother and was thanked for her
cooperation. She was educated on malaria prevention and encouraged to continue with the
exclusive breastfeeding. I then introduced client to the community health nurse at the
64
reproductive child health (RCH) unit that I was going to hand her over on the seventh day
after termination of care for continuity of care. I reminded client of the evening home visit
and was bid a good bye.
Fourth day postnatal home visit
Client and family were visited in the evening at 4:00pm. During client had no complaints and
she experienced no more backache during breastfeeding. She was examined from head to toe
after consent seeked and no abnormality was detected. Vital signs checked are as follows;
Mother
Temperature 36.00C
Pulse 92bpm
Respiration 23cpm
Care of the baby
I examined baby from head to toe and no abnormality was detected. He passed meconium
and its colour was yellowish brown. He was given to client’s mother-in-law to be topped and
tailed after examination. In my presence, baby was topped and tailed and cord dressed using
chlorhexidine gel. He was then dressed exposing the umbilicus and wrapped in a clean cot
sheet to provide warmth. Vital signs checked are as follows;
Temperature 36.70C
65
Respiration 39cpm
Fifth Day Postnatal Home Visit
Care of the mother
30th November, 2021 was client’s fifth postnatal home visit which happened to be both
morning and evening. During these periods of visit, head to toe examination was carried on
client with her consent. I washed my hands before and after procedure and findings were
made known to client that no abnormalities were detected. Uterus was well contracted and
symphysio-fundal height was 14 centimeters. Lochia was moderate, pink (serosa) and non-
offensive. She had no complaints and vital signs checked were the following;
Morning Evening
Pulse 84bpm 88bpm
Care of the Baby
Baby was examined from head to toe. Before examination, baby was seen to have passed
stool for a long time therefore, mother was educated on the causes of rashes on the buttocks.
She was also encouraged to use cotton diapers and napkins on baby, change baby’s diaper
immediately he empty his bowel and to wash soiled napkins and dry under sun. After
examination, no abnormality was detected. Baby’s stool was observed and was still yellowish
brown. He was topped and tailed and the cord dressed with methylated spirit and cotton wool
swabs. Baby was then given to mother for breastfeeding and on feeding, suckling and
swallowing reflexes were present.
66
Morning Evening
Temperature 36.5°C 36.4oC
Sixth Day Postnatal Home Visit
Care of the mother
I visited client and her family on the 1st December, 2021 both morning and evening. I warmly
welcomed by them as they already knew about the visit. I sought client’s permission to
examine her which she granted. On examination, no abnormalities were detected. Breast was
well lactating and symphysio-fundal height as 13cm. During history taking, client
complained of sleepless. She was reassured to allay fear, to rest when baby is put to bed, to
reduce fluid intake when going to bed and to take a warm bath before going to bed to prevent
interruptions during sleeping. Mother-in-law was also encouraged to limit visiting to ensure
client’s rest and sleep.
Morning Evening
Pulse 90bpm 92bpm
Care of the baby
Baby was examined thoroughly from head to toe with no abnormalities detected. He passed
stool and urine. Cord was off on examination therefore, he was bathed using sponge, soap
67
and tepid water. Baby was dressed and wrapped in a cot sheet to provide warmth after the
bath. He was given to be breastfed and he suckled well. His vital signs are as follows;
Morning Evening
Temperature 37.10C 37.00C
Second postnatal clinic visit
On the seventh day, 2nd December, 2021, client and baby in the company of her mother-in-
law visited the clinic as scheduled. Both mother and baby looked cheerful. They were
welcomed and a seat was offered to them. I enquired about their health and they said they
were feeling well. I asked client of resumption of menses and if she was breastfeeding
exclusively and she said no and yes respectively. Client as well as baby’s vital signs were
taking and they recorded as follows;
Mother
Temperature 36.1oC
Pulse 86bpm
Respiration 22cpm
Weight 56kg
Baby
Temperature 36.5oC
Respiration 40cpm
Weight 4.1kg
68
A urine specimen bottle was given to her and midstream urine was requested to check for
protein and glucose which the results showed negative. Blood sample was taken for
estimation of haemoglobin level and the result was 12.5g/dl. Results of investigation were
communicated to client.
Client and baby were taken to the examination room to be examined. All windows and door
were closed and privacy provided. With permission from mother, baby was taken, undressed
and wrapped in a clean cot sheet and was put on a flat surface in the presence of the mother.
Procedure was explained to Miss C.B, my hands were washed and dried. On examination,
baby had no rushes or bruises on the skin, fontanelle and sutures were examined for any
bulging fontanelle or widening sutures but there were none. The eyes, nose and ears were
examined and no abnormalities were detected. There were presence of breast tissues, areolar
and nipple. The abdomen was soft, not distended, and the umbilical cord was completely
healed. The extremities and the back were also examined and there were no abnormalities.
Mother confirmed baby had bowel movement twice with a yellowish colour, urinated thrice
and breastfeeds well. Baby was dressed, wrapped and given to client’s mother-in-law in order
to attend to client.
I attended to client for the examination as procedure was explained to her. With an emptied
bladder, she was assisted unto the examination couch, privacy provided and hands washed
and dried.
On inspection, client’s hair was neat, nicely permed and tied with a clean ribbon. The eyes,
nose and ears were clean without any discharges. She was engaged in conversation for mouth
to be inspected and it was clean with no offensive odour. I palpated the breast and it was
heavy, soft and lactating well with healthy nipples. The upper and lower extremities were
without edema.
69
On abdominal palpation, fundus was well contracted and symphysio-fundal height measured
12cm. The lochia was non-offensive, scanty and pink in colour. She was assisted into a prone
position for her to be examined and was normal. I thanked client for her cooperation and
helped her out of the examination couch and dressing up.
Client was encouraged to maintain good personal and environmental hygiene in caring for
herself and the baby and to continue with postnatal exercise. She was again educated on
nutrition, rest and sleep. Client lodged no complains when she was asked if she is having any
problem. She also asked of her previous problem and she said she could sleep well. Mother
was encouraged to register baby at the birth and dead registration office.
She was also taken to the family planning unit for counselling and was finally handed over to
the midwife-in-charge for continuity of care. All findings on both baby and mother were
communicated to her. I finally expressed my heartfelt gratitude and thanked client and the
entire family for their support and co-operation throughout my care study. I then saw them
off and bid them goodbye.
Seventh Day Postnatal Home Visit
On 2nd December, 2021 at 4:30pm, the community health nurse and I visited client in the
house. I asked of their health and client verbalized they had no problem. With client’s
permission, physical examination was performed and no abnormality was detected. Client
said she had moved her bowel twice and passed urine thrice. Uterus well contracted and
colour of lochia was pink (serosa) with a decreased amount of flow and odourless on
inspection of the perineal pad (Refer to appendix VA). Baby was also examined from head to
toe and no abnormalities were recorded. Client was educated on the importance of child
welfare clinic, exclusive breastfeeding for first six months. She and baby were handed over to
the community health nurse for continuity of care and I thanked her and the family for their
warm reception during the study. Both mother and baby’s vital signs are as follows;
70
Mother Evening
Temperature 36.5°C
Respiration 20cpm
Pulse 84bpm
Baby Evening
Temperature 36.8°C
Respiration 38cpm
71
TERMINATION OF CARE
Termination of care is the period where the interactions between the midwife and client
comes to a terminus. The care commenced on the 27th October, 2021 which was the first
contact with client and ended on the 2nd December, 2021 which was my last home visit and
the seventh day postpartum. On the 28th November, 2021 during the client’s first postnatal
visit, she was introduced to the community health nurse and as informed earlier to client
during the first contact at the antenatal clinic that she was going to be handed over to the
community health nurse on the seventh day postnatal, client was handed over to the
community health nurse for continuity of care. Client was reminded of the exclusive
breastfeeding which she chose as her family planning method. She was also reminded of the
postnatal clinic visits schedules, baby’s birth registration at the birth and death registration
office and baby’s circumcision at the facility. Client together with her family showed how
they appreciated the care offered to them and promised to cooperate with the community
health nurse. I thanked client and her family and sought permission to leave.
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NURSING CARE PLAN DURING PUERPERIUM
Actual problems
1. On 26th November, 2021 at 7:30am client complained of lower abdominal pains.
2. On 27th November, 2021 at 8:30am client complained of frequent micturition.
3. On 28th November, 2021 at 4:30pm client complained of backache
4. On 30th November, 2021 at 4:00pm baby was at risk of rashes
5. On 1st December, 2021 at 8:00am client complained of sleeplessness
Short Term Objectives
1. Client will be relieved of lower abdominal pains within 24 hours
2. Client will be relieved from frequent micturition within 24 hours
3. Client will be relieved of backache within 24 hours
4. Baby will be free from nappy rash and sore buttocks throughout care
5. Client will be able to have enough sleep within 24 hours
Long Term Objective
Mother and baby will go through the puerperal period without any complications.
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TABLE THREE: CARE DURING PUERPERIUM
DATE AND NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE EVALUATION
TIME DIAGNOSIS OBJECTIVE AND
TIME
74
26 /11/21 Lower Client will be 1. Reassure client to allay fear and 1. Client was reassured to allay fear and 27/11/21 Goal fully met as
at abdominal relieved of lower anxiety anxiety at evidenced by
7:30am pain related to abdominal pain 2. Explain the physiology of lower 2. Physiology of lower abdominal pain 9:00am client verbalized
physiological within 24hours as abdominal pain to her. was explained to her. a relief of pain.
changes after evidenced by 3. Encourage clients to continue 3. Client was encouraged to continue
birth. client verbalizing with breastfeeding. breastfeeding.
a relief of pain. 4. Encourage clients to apply warm 4 .Client was encouraged to apply warm
compressors to the lower compressors to lower abdomen.
abdomen. 5. 1g of paracetamol was served to client
5. Serve 1g of paracetamol to client relieve pain.
to relieve pain.
TIME TIME
75
27/11/21 Frequent Client will be 1. Provide client with emotional 1. Client was provided with 28/11/21 Goal fully met
at micturition relieved from support. emotional support to allay fear at as evidenced by
8:30am related to frequent and anxiety. 10:00am client verbalized
redraw of micturition 2. Explain the physiology behind 2. Physiology behind condition was relief from
oestrogen and within 24 condition. explained to client. frequent
progesterone. hours as 3. Encourage client to continue 3. Client was encouraged to continue micturition.
evidenced by empty the bladder whenever empty the bladder whenever she
client she feels the urge to. felt the urge to.
verbalizing she 4. Encourage client to reduce 4. Client was encouraged to reduce
has been fluid intake when going to bed. fluid intake when going to bed.
relieved of 5. Encourage client to wear 5. Client was encouraged to wear
frequent cotton under wears. cotton under wears to prevent
micturition. infection
76
TIME TIME
28/11/21 Backache Client will be 1. Reassure client to allay fear and 1. Client was reassured to allay fear 29/11/21 Goal fully met as
at related to poor relieved of anxiety. and anxiety. at evidenced by
4:30pm posture during backache within 2. Explain physiology behind 2. Physiology behind condition was 5:00pm client verbalized
breastfeeding. 24hours as condition to client. explained to client to create she no more
evidenced by awareness. experience
client 3. Teach client on correct 3. Client was taught on correct backache.
verbalizing a positioning of baby to breast. positioning of baby to breast.
relieved of pain. 4. Encourage client to support her 4. Client was encouraged to support
back with pillow and foot with her back with pillow and foot with
chair when breastfeeding. chair during breastfeeding.
5. Encourage client to apply warm 5. Client was encouraged to apply
compress to relieve pain. warm compress to relieve pain.
77
TIME TIME
30/11/21 Risk for nappy Baby will be 1. Reassure client that baby will be 1. Client was reassured that baby will be free from 2/12/21 Goal fully met
at rash on free from nappy free from nappy rash and sore nappy rash and sore buttocks. as baby was free
at
4:00pm buttocks rash on buttocks buttocks. from nappy rash
related to throughout care 2. Explain causes of nappy rash on 2. Causes of nappy rash was explained to client that it and sore
9:30am
prolong skin as evidenced by buttocks to client. was due to infrequent change of napkins and diapers. buttocks
contact with midwife 3. Client was encouraged to change baby’s soiled throughout
soiled diapers. observing baby 3. Encourage client to immediately napkins immediately he soils himself to prevent puerperium.
skin free from change baby’s soiled napkins. potential rashes.
rash. 4. Client was encouraged to apply baby oil or powder
4. Encourage client to apply baby oil on baby’s buttocks before applying the napkin or
or powder on baby’s buttocks diaper.
before applying the napkin or
diaper. 5. Client was encouraged to wash napkins properly
5. Encourage client to wash napkins and dry them in sun to prevent invasion of
properly and dry them in sun. microorganisms.
6. Encourage client to use cotton 6. Client was encouraged to use cotton napkins to
napkins. help in absorbing and to prevent heat.
78
TIME TIME
1/12/ 21 Sleeplessness Client will be 1. Reassure client to gain her 1. Client was reassured to gain her 2/12 /21 Goal fully met
at related to baby’s able to have cooperation and to allay fear. cooperation and to allay fear. at as evidenced by
8:00am demands at enough sleep 2. Encourage client to take a rest 2. Client was encouraged to take a rest 10:30am client verbalized
night. within 24 hours whenever she puts the baby to whenever she puts the baby to sleep. that she had
as evidenced by sleep. enough rest and
client verbalizing 3. Encourage client’s family to limit 3. Client’s family was encouraged to sleep.
she had enough visitors. limit visitors to ensure enough rest
rest and sleep. 4. Encourage client to have a warm during day time.
bath before going to bed. 4. Client was advised to have a warm
5. Encourage client reduce fluid bath before going to bed.
intake when going to bed. 5. Clients was reduce fluid intake when
going to bed.
79
SUMMARY AND CONCLUSION
This script is a family centered maternity care provided to Miss C.B, a 20 years old gravida
two (2) para one (1) alive. She is a native of Kona a suburb of Kumasi in the Ashanti region
and lives in there.
She started her first antenatal clinic visit on the 04th August, 2021 at twenty-four (24) weeks
gestation. I met her at the antenatal clinic for the first time on the 27 th October, 2021 at Kona
maternity wing when she was 36weeks of gestation. Physical examinations including
laboratory investigations were carried out and no abnormalities were detected. Although she
went through the pregnancy with some minor disorders but she was successfully managed.
Her labour and delivery were managed carefully without any complications and she delivered
an alive male infant of weight 3.8kg on the 25th November, 2021 at 3:00am. Apgar score for
the first (1st) and fifth (5th) minutes were 8/10 and 9/10 respectively.
Her Puerperium was noneventful as she implemented all health education given her during
the antenatal and postnatal period which helped to prevent complications. Mother and baby
were finally handed over to the community health nurses for continuity of care.
Caring for Miss C.B and her family has gave me more insight in midwifery and I am
confident that it is going to enable me give comprehensive individualized care to any
expectant mother and her family who may come under my care in the near future.
80
BIBLIOGRAPHY
Campana, A. (2021, May,14th). The puerperium puerperal sepsis. Retrieved from:
www.gfmer.ch.
Cennimo, D.J etal. (2021 June, 25th). What is COVID 19? Retrieved from:
www.medscape.com
Ead, H. (2019 September, 16th). Application of the nursing process in a complex care
environment. Retrieved from: www.cna-aiic.ca.com
Marshall, J. & Raynor, M. (2014). Myles Textbook for midwives. 16th Ed. China: Elsevier Ltd.
Papandrea, D. (2018, January, 8th). Nursing care plans: what you need to know. Retrieved
from: www.nurse.org.
Tiran, D. (2012). Baillere’s midwives dictionary. 12th Ed. London: Educational Director
Expentancy Ltd.
81
APPENDIX VII: PHARMACOLOGY OF DRUGS
DRUG CLASSIFICATION DOSAGE ROUTE ACTION AND USES SIDE EFFECTS EFFECT ON
NAME OF DRUG OF CLIENT
DRUG
Tablet Folic Vitamin preparation 5mg daily 1. Treatment of iron deficiency anaemia. Constipation 1. Hemoglobin
Acid with a haematenic X 30 days Oral 2. Reduce the risk of neural tube defects Nausea level
and vitamin B in the fetus. Increased.
complex 3. Help in the formation and maturation 2. No reaction
of red blood cells. observed
Tablet Iron preparation 200mg 1. Help in the formation of red blood Gastro intestinal upset and 1. Hemoglobin
Fersolate 3times Oral cells. black tarry stools. level increased.
daily for 2. Supplement the iron requirement of Nausea 2. Colored stool.
30days the body.
3. Used in the treatment of iron
82
deficiency anaemia
DRUG
Capsule Antibiotics 500mg Oral 1 Treatment and prevention of infection. Nausea and vomiting, IT prevented
Amoxicillin 3times 2 Acts against wide range of gram Anorexia and abdominal pains infection and
daily for negative or positive organisms. promoted wound
7days healing.
Tablet Antibacterial 400mg Oral Treatment and prevention of infection Dark urine, unpleasant taste in Dark urine
Metronidazole preparation 3times the mouth and furring of noticed.
daily for tongue. Gastro intestinal upset. Furred tongue
7days Central nervous system effect. noticed
Tablet Analgesic and 500mg Oral 1. Reduce body temperature. Prolonged usage may damage None observed
Paracetamol antipyretics 3times 2. Alleviate pain the liver
daily for
5days
83
DRUG
Tablet Antimalaria 3 tablet Oral Intermittent treatment for malaria in Vomiting No reaction and
Sulfadoxine prophylaxis after 16 pregnancy Seizures and Diarrhea client was
Pyrimethamine weeks prevented from
(SP) then malaria
monthly x
5 doses
Injection Vaccine Intramuscular 1. Stimulate the formation of antibiotic Slight rise in temperature. None observed
Tetanol Toxoid 0.5ml or against tetanus organism. Inflammation of the site of
Subcutaneous 2. Given to prevent mother from injection, pain and tenderness
transferring the immunity to the fetus
Tablet Dewormer 400mg Oral Prevents worm infestation. Nausea, vomiting and fever. None
Albendazole
84
DRUG
Injection Oxytocin drug 5-10 units Intramuscular 1. Stimulate uterine contraction, controls 1. Uterine contraction ruptured 10 units given in
Oxytocin bleeding. if overdose is given. active
2. Stimulate lactation. 2. It may cause fetal distress. management of
3. Used for induction and augmentation 3. Nausea and vomiting. third stage labour.
of labour No reaction
observed
Injection Anti-hemorrhagic 0.5-1mg Intramuscular 1 Helps in the clotting of blood. Flashes in the face. No reaction
vitamin K1 vitamin Helps prevent hemorrhagic disease of the Sweating and cyanosis observed
new born.
Chlorhexidine Antiseptic 10mg Topical Prevents and reduces umbilical cord None None
digluconate gel once daily infections
85
DRUG
Injection 0.5ml Intradermal on Stimulates the production of antibodies 1. Rise in temperature. 1. Pain observed
Bacillus Vaccine the right against tuberculosis 2. Pain and tenderness. 2. There was a
Calmette shoulder 3. Inflammation at the site of rise in
Guerin injection. temperature.
3. Inflammation
observed at the
injection site.
Polio O Vaccine 2 drops Oral Stimulate the production of antibodies Gastrointestinal upset None Observed
vaccine against poliomyelitis Diarrhea
Tablet Vitamin preparation 200mg 1. For improvement of appetite Nausea and vomiting None observed
Multivite 3times Oral 2. Helps in the formation of bone tissue
daily for and red blood cell.
30 days
86
SIGNATORIES
NAME OF CANDIDATE JUDITH ADJEI MENSAH
SIGNATURE ……………………………………...
DATE ………………………………………
SUPERVISOR SHIRLEY AYINPOKA AKANZIRE (MS)
SIGNATURE …………………………………………….
DATE …………………………………………….
THE PRINCIPAL HELLEN GIFTY DWAMENA AMOAH (MRS)
RANK ………………………………………………….
SIGNATURE ………………………………………………......
DATE …………………………………………………..
………………………
(COLLEGE STAMP)
87

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INDEX NUMBER: NMTCTPRM210061

A FAMILY CENTERED MATERNITY CARE STUDY

NURSING AND MIDWIFERY TRAINING COLLEGE

Why I Chose My Client ix

ASSESSMENT OF CLIENT AND FAMILY

Personal and social history 1

First contact with client 11

TABLE ONE: CARE PLAN DURING ANTENATAL

TABLE TWO: NURSING CARE PLAN DURING LABOUR

Subsequent care of the baby 54

NURSING CARE PLAN DURING PUERPERIUM

TABLE THREE: CARE DURING PUERPERIUM

SUMMARY AND CONCLUSION

A family centered maternity care study is one of the curriculum offered in

domiciliary vacation practicum for second year student midwives in their

second semester. It requires knowledge acquired during lectures, clinical

observations and others in order to conduct it.

terms of the management of clients and their family regardless of the

of ensuring individualized and focused care.

first seven day in the postpartum period.

The family centered maternity care study contributes to the requirements

needed for awarding the student midwife of the professional certificate in

midwifery by the nursing and midwifery council of Ghana.

understanding, strength and wisdom granted unto me that enabled me to

Again I wish my heartfelt gratitude to my able supervisor, Shirley Akanzire

Ayinkopa (Mrs.) for her spiritual, physical and psychological guidance,

tutorial staff of Nursing and Midwifery Training College, Mampong Ashanti, I

the success of this study.

education given to her.

Finally, I salute my parents, siblings and my well-wishers for their support

during this study, May God richly bless you all.

pregnancy, labour and puerperium in order to reduce maternal and child

my intentions known to her which she willingly agreed to be my client. I

seventh (7th) day of puerperium, 2nd December, 2021.

The study is made up of four chapters;

throughout antenatal and it is made up of her personal history, daily activities,

before I met her.

provided to her during the home and antenatal visits.

management of the first, second, third and fourth stages of labour.

seven days of puerperium. It also contains the termination of care, conclusions,

pharmacology of drugs administered during the study, bibliography,

appendices and signatories.

introduced myself as a student midwife from Nursing and Midwifery training

college, Mampong-Ashanti. I requested for her antenatal book so that I may

trimester antenatal booking. I also made my intensions known to her as the

me throughout the study and I thanked her.

Pregnancy is the period from conception to delivery of baby. The normal

conception to delivery (Tiran, 2012).

According to Campana (2021, may 14th), puerperium is the period of 6 to 8

weeks following delivery during which the anatomical and physiological

changes of pregnancy regress.

According to Cennimo, D.J etal (2021, June, 25th), COVID19 is an acronym of

Coronavirus 2019 by WHO and it is defined as an illness caused by novel

coronavirus now severe acute respiratory syndrome coronavirus 2 (SARS-

CoV-2) with common signs of coughing, fatigue and fever.

ASSESSMENT OF CLIENT AND FAMILY

According to Ead (2019, September, 16th), assessment is the act of gathering

client is responding to treatment.

history, family history, medical history, surgical history, menstrual history,

past obstetric history and present obstetric history.

Personal and social history

Ghanaian language (Twi). She is a Christian and attends church at Shalom

and he is the support person.