Maternal and Child Nursing

Care of the Mother and the Newborn

I. Care of the Mother
Care of the Ante partum Mother

• History Taking
– The history taking can be about obstetrical,
medical and family history.
*Observe and ask also general questions about:
- how well the baby is doing
- whether the new mother has any problems or
questions about breastfeeding or her own health
- the general mood of the new mother and how
the mother interacts with the baby
• Taking Vital Signs:
FHT (Fetal Heart Tones)
-The fetal heart should be audible by 20
weeks with standard fetascope
-If you cannot hear it within the following
week, use a Doppler or refer for a
sonogram.
-Normal fetal heart tone (FHT) range is 120 to
160 beats per minute (BPM), but younger
babies are considered normal up to 170
BPM.
-The heart rate is generally higher at the
beginning of pregnancy, slowing ten to
fifteen points as the baby grows.
TPR (Temperature , Pulse Rate, Respiratory Rate)
• Temperature
• slight elevation not abnormal in first 24 hours
• due to exertion of labor and dehydration
• temperature greater than 37.8 Celsius beyond 24 hours may indicate
infection
• accompanying foul smelling lochia - infection
• Pulse
•  slight bradycardia- decrease workload of heart - okay
• mild tachycardia - blood loss, pain, excitement , physical exertion- okay
• Persistent tachycardia - abnormal - excessive blood loss, or hemorrhage
• significant changes report immediately
• Respiratory Rate
• no abnormal breath sounds should be present
• slightly elevated with exertion, excitement or pain
• tachypnea, abnormal breath sounds, breathlessness, chest pain , anxiety
due to dyspnea - indicate - pulmonary edema or pulmonary emboli
• report abnormal findings immediately
Blood Pressure

• should remain near normal levels

• slight elevation - exertion, excitement or oxytocic
medications
• consistent or sudden elevation with headache , visual
disturbances - PIH
• orthostatic hypotension - changes in intraabdominal
pressure
Weight of mother
• It depend on the patient but it should be within
the range of the patient’s normal weight before
pregnancy.
• Breastfeeding can burn an extra 500-600 calories a
day.
• According to THE BREASTFEEDING ANSWER BOOK,
"Breastfeeding mothers tend to lose more weight
when their babies are three to six months old than
formula-feeding mothers who consume fewer
calories.
Pelvic Exam
• Vaginal bleeding is usually mostly resolved by six
weeks, although you may have some spotting for a few
weeks more. A pelvic examination allows your
practitioner to see how well your uterus has returned
to its prepregnancy size, to see that the cervix is
closed--a sign that there are not any retained placental
fragments, which can cause bleeding and infection--
and to see how well any episiotomy or laceration has
healed. You will be questioned about loss of urine and
your pelvic support will be noted on your examination.
You will be asked about constipation and might be
checked for hemorrhoids.
Internal exam
•   Inspect your perineum and do a speculum and
internal exam. During the speculum exam the
patient will be check to make sure any bruises,
scratches, or tears to cervix or vagina are
healing properly and the doctor may do a Pap
smear. During the internal exam, your uterus
and ovaries will be felt, and check vaginal
muscle tone.
Leopold’s Maneuver
– Leopold’s Maneuver is preferably performed after 24
weeks gestation when fetal outline can be already
palpated.
Preparation:
• Instruct woman to empty her bladder first.
• Place woman in dorsal recumbent position, supine
with knees flexed to relax abdominal muscles.
Place a small pillow under the head for comfort.
• Drape properly to maintain privacy.
• Explain procedure to the patient.
• Warms hands by rubbing together. (Cold hands can
stimulate uterine contractions).
• Use the palm for palpation not the fingers.
First Maneuver or Fundal Grip

Purpose: To determine fetal part lying in the fundus. To determine

presentation.
Procedure: Using both hands, feel for the fetal part lying in the fundus.
Findings: Head is more firm, hard and round that moves independently
of the body.
Breech is less well defined that moves only in conjunction with the
body.
Second Maneuver or Umbilical Grip
Purpose: To identify location of fetal back.To determine position.
Procedure: One hand is used to steady the uterus on one side of the
abdomen while the other hand moves slightly on a circular motion from
top to the lower segment of the uterus to feel for the fetal back and
small fetal parts. Use gentle but deep pressure.
Findings: Fetal back is smooth, hard, and resistant surface
Knees and elbows of fetus feel with a number of angular nodulation.
Third Maneuver or Pawlik’s Grip
Purpose: To determine engagement of presenting part.
Procedure: Using thumb and finger, grasp the lower portion of the abdomen
above symphisis pubis, press in slightly and make gentle movements from
side to side.
Findings: The presenting part is not engaged if it is not movable. It is not yet
engaged if it is still movable.
Fourth Maneuver or Pelvic Grip
Purpose: To determine the degree of flexion of fetal head. To determine
attitude or habitus.
Procedure: Facing foot part of the woman, palpate fetal head pressing
downward about 2 inches above the inguinal ligament.
Use both hands.
Findings: Good attitude – if brow correspond to the side (2nd maneuver) that
contained the elbows and knees.
Poor attitude – if examining fingers will meet an obstruction on the same
side as fetal back (hyperextended head) Also palpates infant’s
anteroposterior position. If brow is very easily palpated, fetus is at
posterior position (occiput pointing towards woman’s back)
Determine EDC
• Naegele’s Rule
*A German physician named Franz Carl Naegele [1777-1851] was
the first person to scientifically study and write about estimating
due dates. 
  *Naegele's rule states that the due date can be found by taking the
first day of a woman's last menstrual period, subtracting three
months, adding one week and adjusting the year if necessary.
*For example, if a woman's last menstrual period was April 14th,
2002 then her due date by Naegele's rule would be January 21st,
2003, i.e.:
April 14, 2002
- 3 months + 7 days + 1
-----------------------------------
= January 21, 2003
• Subtracting 3 months from April gives you January in the above
example.  Adding 7 days to the 14th gives you the 21st.  Since you
can't go backwards in time to deliver before your last menstrual
period, you have to adjust the year by adding one to 2002 to get
2003. 
Mc Donald’s Rule
Fundal height, or McDonald's Rule, is a measure of the size of
the uterus to assess fetal growth and development. It is measured from
the top of the pubic bone to the top of the uterus in centimeters and it
should match your baby's gestational age, within one to three
centimeters; for example, a measure of 22 centimeters should be seen
on a 19 to 25 weeks pregnant woman. This measurement, as you might
suspect, should increase as your pregnancy continues toward a due date.
How It Is Used:
The fundal height is diagnostic tool held over from the days before
ultrasound, but it is still useful in large clinics where a patient may not
get the same doctor twice in a row for her prenatal visits.
Fundal height is very useful in the larger clinics, because many different
doctors will see a patient before her due date. Because there needs to be
at least some objective frame of reference among the different doctors,
the fundal height measurement can still be helpful.
Health Teachings on mothers about:
• Diet
– Eat Grains, Vegetables, Fruits, Milk, Meat and Beans

• Elimination

• Clothing
– At all times and under all circumstances the pregnant
woman's clothing should be comfortable, suitable for the
occasion, artistic, and practical. And to be therefore beautifully
clothed is to be as inconspicuous as is possible. Toward the
end of pregnancy often the feet swell, in which instance larger
shoes should be worn in connection with the bandaging of the
ankles and legs.
• Physical Hygiene

• Activities
– Two main concepts must be understood and utilized to quickly, safely, and
effectively strengthen and flatten your abdominal wall after pregnancy.
– First, a critical component for restoring your abs and the development of core
strength is learning to control the shape of your abdominal wall during exercise.
To do this, you need to train your abs to pull back in toward your spine during
exertion. The quickest and safest way to develop a flat abdominal wall after
pregnancy is to perform special postpartum exercises that specifically develop this
essential skill.
– Second, dynamic stability is the other key component of postpartum
reconditioning and exercise after pregnancy. This term may sound like a
contradiction. However, it refers to the ability to maintain proper position during
exercise. Because you have both loose joints and weakened abs after pregnancy,
it is particularly easy for the weight and force of your limbs to pull your pelvis,
spine, or shoulder girdle out of good alignment. When your bones are out of
proper positioning, muscle functioning is impaired, which greatly reduces the
effectiveness of exercise. After pregnancy, you must learn to recognize and
eliminate undesired movement during exercise. Dynamic stability is an essential
skill that enables you to develop core strength, promotes healthy spinal function,
and prevents injury.

• Rest and Sleep

• Attitude

• Pregnancy Physiologic

• Changes