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M.S RAMAIAH INSISTUTE OF NURSING EDUCATION AND
RESEARCH
CASE PRESENTATION ON preparation
for labour
SUBMITTED TO
MRS.DIVYA RAGHAVAN
LECTURER,
DEPT OF OBG NURSING,
M.S.R.I.N.E.R
SUBMITTED BY
MRS.LIMA MATHEWS
1STYR MSC NURSING
M.S.R.I.N.E.R
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SUBMITTED ON :19/02/2011
INTRODUCTION
As a part of my speciality clinical posting, at M.S.Ramaiah Hospital ,I Mrs.Lima Mathews ,Iyr M.Sc
Nursing student has selected Mrs.Namitha for my antenatal case study,whose P! is "# w$s .She i
a primigra%idae mother !& Po Lo Ao
BASELINE DATA
Name ' Mrs. Namitha.
Age ' (" yrs
Marital status ' Married
)ard ' Semi special ward
Nationality ' Indian
Religion ' Hindu
*ducation ' SSL+
ccupation ' Home ma$er
Address A$e$atta,Na%eli post
+N Halli
-um$ur
Admission date ' /#/(0&0
1stetrical score ' !& Po Lo Ao +onsulted 1y ' 2r. 3ma de%i
LMP ' &/&(/(00# 2ate of care started ' /#/(0&0
*.2.+ ' 4/#/(0&0 2ate of care ended ' &&/#/(0&0
!estational age ' "5 wee$s
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2iagnosis ' "5 wee$s with cephalic presentation ,primigra%idae
CHIEF COMPLAINT
Mrs.Namitha came to the hospital for safe confinement with the complaint of 1ac$ pain and
a1dominal pain
OBSTETRICAL HISTORY
PAST OBSTETRICAL HISTORY
PRIMI!RA6I2A
PRESENT OBSTETRICAL HISTORY
1sT!"#$s$!
Patient concei%ed spontaneously after & year of married life. Pregnancy was confirmed aft
urine pregnancy test after &/( month of amenorrhea. Regular antenatal chec$up was done. 7lood an
urine in%estigations were done. Her H1 was &(.4 gm8. 3rine e9aminations are normal. 3ltrasoun
scan was done normal findings. No history of %omiting or 1leeding per %agina.7p&(/40 mmof H
wt: ;$g
2%&T!"#$s$!
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MEDICAL HISTORY
PAST MEDICAL HISTORY
Mrs.Namitha is not ha%ing any history of medical illness li$e hypertension, dia1etes, tu1erculosis,
epilepsy, thyroid disorders etc
PRESENT MEDICAL HISTORY
Mrs. Namitha is ha%ing history of amenorrhea .No other medical illness li$e hypertension ,dia1tes
,epilepsy is present .Not suffering from anyother communica1le and noncommunica1le disease.
SURGICAL HISTORY
PRESENT AND PAST SURGICAL HISTORY
She has not undergone any surgeries
FAMILY HISTORY
Mrs. Namitha 1elongs to a nuclear family. No history of dia1etes mellitus, hypertensio
epilepsy, 1lood disorders and any other communica1le diseases. No history of congenital anomaly an
twinning in the family.
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FAMILY GENOGRAM
0 @RS 5: @RS :4 @RS :;
(EY
>emale Male patient
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PERSONAL HISTORY
Mrs. Namitha 1elongs to a middle class family. Her hus1and is the 1read winner of th
family. -hey li%e in their own house. -heir house got all facilities li$e water supply, electricit
drainage system etc
2ietary pattern appetite is good
-a$ing mi9ed diet
*limination pattern 1owel and 1ladder ha1its are regular
Rest and sleep regular
*9ercise no specific e9ercise pattern
Personal hygiene maintains good personal hygiene
+ultural history doesnt ha%e any cultural 1elief that would affect her health
ccupational history house wife
MENSTRUAL HISTORY
Age of menarchy &;yrs
Regular (4 days cycle with ;: days of 1leeding
No dysmenorrhea
MARITAL HISTORY
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married life ( yrs
Arranged marriage
Ha%ing good relationship with hus1and
Non consanguineous marriage
Ha%e not used any contracepti%e methods
PARTNER)S HISTORY
Name Mr.Suresh
Age (4 yrs
*ducation P3+
ccupation B *lectrician
!enetic disorder no history of genetic disorders
Health pro1lem no significant health pro1lem
Ha1its no 1ad ha1its
7lood group ?%e
Attitude positi%e attitude towards pregnancy
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PHYSICAL E*AMINATION .
.GENERAL APPEARANCE
Height ' &54cm
)eight ' 50 $g
7ody 1uilt ' moderate
rientation ' oriented to time, place and person.
Sensorium ' conscious.
Le%el of acti%ity ' Restricted
VITAL SIGNS
-emperature ' #4.5C>
Pulse ' 4;1t/mt
Respiration ' (;1reath/mt
7lood pressure ' &(0/40 mm of Hg
HEAD TO FOOT ASSESSMENT
S(IN
+olour ' >air
-e9ture ' Smooth
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-emperature ' )arm And 2ry
Lesions ' A1sent
>oul dour ' A1sent
*dema ' A1sent
HAIR
+olour ' 7lac$
-e9ture ' Smooth
2istri1ution ' *Dually 2istri1uted
Infection ' A1sent
NAIL
Shape ' Normal
+olor ' Pale
Infection ' A1sent
HEAD AND FACE
SiEe ' Normal
Shape ' Normal
>acial Appearance' Normal
Sinuses ' Normal.
EYES
*ye1rows ' *Dually distri1uted
*yelashes ' Normal
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*yelids ' 7ilaterally Symmetrical
Sclera ' +lear And )hite
Pupil ' Pupils eDual and reacting to light
6ision ' Normal
+on=uncti%a ' Pale
E+!
Alignment ' Normal
+ondition f S$in ' Normal
+olor ' Normal
*9ternal Pinna ' No Lesion, And Infection
2ischarge ' No 2ischarge
Hearing ' Normal
)e1er test ' Air conduction is more than 1one conduction.FnormalG
Rinne test ' Air conduction is more than 1one conductionFnormalG
NOSE
SiEe ' Normal
Shape ' Normal
Symmetry ' Symmetric
Nasal Septum ' No 2e%iated Nasal Septum
Nostrils ' No +rust, Infection,
2ischarge ' A1sent
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MOUTH THROAT
+olour ' pin$
Lesion ' a1sent
Symmetry ' eDual
Lips ' dry, pin$ in colour
-eeth ' 1rown, no loosening, and decayed teeth
Mucus mem1ranes' normal and dry
-ongue ' not coated and dry
dour ' a1sent
3%ula ' midline position
ral mucosa and gums' normal
Hard and soft palate ' normal and pin$
NEC(
-onsils ' Normal
-hyroid gland ' Normal
Range of motion ' Normal
CHEST
Inspection ' no lesion, discoloration, 1ilateral chest e9pansion
Palpation ' no mass, no tenderness,
Percussion ' resonance sound heard, eDual air entry
Auscultation ' S& S(, sounds heard
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A9illa and cla%icular nodes' not enlarged
BREAST
I%s-$"%
SiEe ' 7oth are symmetrical
Primary aerola ' Present
Monotogomery tu1ercle ' present
Nipple ' erect
No pain ,redness ,tenderness
Palpation
Palpation done 1y circular method
)arm to touch
No lymphnode enlargement
No pain, redness, tenderness
ABDOMEN
Inspection ' Shape is %oid
+ontour is con%e9
3m1ilicus is flat
>lan$s are full
7ladder is emptied
Striae gra%ida and Linea nigra present
Palpation ' >etal mass present
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Auscultation ' >etal Heart sound present
BAC(
7ody cur%e ' normal
Lesions ' a1sent
GENITALIA
2ischarges ' A1sent
7owel Pattern ' Reduced
7ladder Pattern ' Normal
E!$#""$s
No edema or 26-
OBSTETRICAL E*AMINATION
I%s-$"%
SiEe ' Appro9imate to the period of gestation
Shape ' o%oid
+ontour ' +on%e9, s$in elastic
3m1licus ' >lat
>lan$s ' >ull
>oetal mo%ement ' %isi1le fetal mo%ement present
+ondition of 1ladder ' *mptied
S$in changes ' Linea Nigra and striae gra%idarium present
P+-+"%
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A1dominal girth#0 cm
>undal height"4 in cm
"( in wee$s
>undal palpation Soft irregular mass suggesti%e of fetal 1uttoc$s
Lateral palpation
Right side ' Small irregular $no1 li$e structure suggesti%e of fetal lim1
Left side ' +ontinuous smooth well cur%ed structure suggesti%e of spine
Pel%ic palpation
At Pel%is ' Hard glo1ular non 1allota11le mass suggesti%e of fetal head,
+on%erging hand indicate head is not engaged
ccipital pole ' palpa1le
Syncipital pole ' not palpa1le
+on%erging/ di%erging ' con%erging
2escend of the head ' :/:th
*ngaged ' not *ngaged
Pel%ic grip
SiEe ' normal
>le9ion ' >le9ed
+om1ine grip
At fundus ' 7road soft irregular mass suggesti%e of fetal 1uttoc$s
At pel%is ' Hard glo1ular non 1allota1le mass suggesti%e of fetal head
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A3s3+"%
>etal heart sound ' &;; 1/mt
Rhythm ' Regular
F"%&"%4s
!estational age ' "5 wee$s
Lie ' Longitudinal
Presentation ' +ephalic presentation
Position ' LA
Attitude ' >le9ion
2escend ' :/: th R L
*ngaged ' not *ngaged
>HS ' &;; 1/mt
Regular
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INVESTIGATION
SL % I%5$s"4+"% P+"$%)s 5+3$ N!#+ 5+3$ I#-!$ss"%
1. U!"%$ !3"%$ $s
+olour @ellow @ellow Normal
a Appearance +lear +lear, haEy Normal
1 pH 5.: ;.5 B 4 Normal
c specific gra%ity &.0& &.0&5 B &.0(( Normal
2.
a
C6$#"+ $+#"%+"% 7
3!"%$
Protein??
Negati%e P!$"%3!"+
1 !lucose Negati%e Negati%e Normal
c etone Negati%e Negati%e Normal
d 7ile salt Negati%e Negati%e Normal
e 7ile pigment Negati%e Negati%e Normal
f 3ro1ilinogen 0 .( 0." & Normal
g 7lood Negati%e Negati%etrace
Normal
h Nitrates
Negati%e Negati%e Normal
'
a
M"!s-"
$+#"%+"%
*pithelial cells & B (/hpf ccasionallyfew/hpf
Normal
1 Pus cells & B (/hpf 0 B ;/hpf Normal
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c R7+s Nil Male o B
"/hpf>emale 0
:/hpf
Normal
d Mucous strands A1sent A1sent Normal
e +rystals Nil A1sent Normal
f +asts Nil A1sent Normal
8
a
Serum glucose
Random 1lood sugar 4; mg/dl 0 B &;0mg/dl
Normal
1 3rine sugar &5 mg/dl &: B ;:
mg/dl
Normal
c +reatinine 0.4"mg/dl 0.55 B &.0#mg/dl
Normal
d 3ric acid ".5 mg/dl (.: B 5 mg/dl Normal
a
Serum electrolytes
Serum sodium &" mmol/L &": B &;:
mmol/L
Normal
1 Serum potassium (.# mmol/L ;." mmol/L Normal
c Serum chloride # mmol/L #4 B
&0mmol/L
Normal
a
Haematology
Haemoglo1in &(."gm/dl &&.: B&;.:gm/dl
Normal
1 R7+ count ;."million/cmm ".4 B ;.4millions/cumm
Normal
c Pac$ed cell %olume "48 "0 B ;58 Normal
d M+6 ##fl 40 B &00 fl Normal
e
M+H "0 pg ( B "5 pg Normalf M+H+ "5gm/dl "( B ":gm/
dl
Normal
g )7+ count 4.#thousand/cmm ; B
&&thousand/cmm
Normal
h Poly morph 48 ;0 B :8 Infection
i Lymphocyte "08 (0 B ;:8 Normal
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= *osinophil ;8 0 B 58 Normal
$ 7asophil 08 0 B &8 Normal
l Platelet "(thousand/cumm &:0 B;:0thousand/cm
m
Normal
a
C"%4 -!7"$
7leeding time ".( minutes Normal (5minutes
1 +lotting time 5 minutes Normal 4&: minutes
c Acti%ated partial
throm1o plastine
"(.0# sec Normal "o;0 sec
ULTRA SOUND
Single intrauterine li%e foetus with cephalic presentation of ": wee$s of gestation. >oetal growth is
normal
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PREPARATION OF WOMEN FOR A!OUR
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INTRODUCTION
+hild1irth is one of the most mar%ellous and memora1le segment in a womans life. It does not real
matter if the child is the first, second or the third one. *ach e9perience is uniDue and calls for
cele1ration. ne of the most 1eautiful time period during a womens life is the pregnancy perio
7ecause her life will 1e satisfied 1y gi%ing 1irth to her 1a1y. >or that she will 1e ready to suffer all th
pains with full happiness.
LABOUR
Series of e%ents that ta$e place in the genital organs in an effort to e9pel the %ia1le products of
conceptions out of the wom1 through the %agina into the outer world is called la1our . Normally it
occurs 1etween "4 wee$s ;( wee$s .if it is occurring 1efore ", it is called as preterm and if it is
occurring after ;( it is called post term. Parturient is a patient in la1our .Parturition is the process of
gi%ing 1irth.
CHANGES OCURRING IN THE BODY DURING CHILD BIRTH
C6+%4$s "% +%+#"+ s!33!$
-he 1ones and muscles of the -$5"spro%ide support for the growing uterus and 1a1y, and
pro%ide a passage through which your 1a1y emerges during 1irth.
-he 3$!3s surrounds the 1a1y, growing as the 1a1y grows.
-he $!5"is actually a part of the uterus, 1ut made up of
different tissue. 2uring pregnancy, the cer%i9 is thic$ and
closed. As you approach the time of 1irth, your contractions
draw the cer%i9 up into the 1ody of the uterus, and it 1ecomes
thinner Fcalled effacementG and opens Fcalled dilationG. )hen
the cer%i9 is fully dilated Fa1out ten centimetersG, contractions
help the 1a1y 1egin to mo%e from the uterus into the %agina.
-he 5+4"%+leads from the cer%i9 to the outside of your 1ody. -he inside of your %agina has
many folds, called rugae, which unfold as the 1a1y passes through
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WHAT HAPPENS IN BODY BEFORE LABOUR BEGINS
7ody prepares for child1irth throughout your pregnancy, 1ut in the last few wee$s, it does some fina
preparation.
H!#%$s ;!< s7$% 6$ "4+#$%s =$;$$% 6$ =%$s "% -$5"s, which gi%es your
pel%is additional room for 1irth. 2uring this time, mother might feel a shift in her sense of
1alance, =oints might feel looser, and might feel sore and achy.
O6$! 6!#%$s =$4"% s7$% $!5", which is the nec$ of the uterus. -hroughout most o
pregnancy, mothers cer%i9 is closed, holding the 1a1y inside mothers uterus. Much of the
wor$ of la1or is in opening the cer%i9 to the passage of mothers 1a1y. Howe%er, mothers
cer%i9 may 1egin to soften, thin, and open e%en 1efore la1or 1egins. -his %aries from woman
to woman, and from pregnancy to pregnancy. Some women may ha%e closed cer%i9es until
la1or starts. thers may ha%e prela1or contractions that dilate their cer%i9 to three or four
centimetersG 1efore la1or 1egins.
E%4+4$#$%.2escending of the fetus towards the lower a1domen .>or first time mothers,
this may ta$e place up to a few wee$s 1efore the 1irth. >or some second or su1seDuenttime
mothers, engagement may not occur until after la1or 1egins.
M6$! #+> $-$!"$%$ 6$ -+ss+4$ 7 s!"%4>, -$!6+-s =&"%4$& #33s.-his
Jmucous plugJ has 1een in place inside the cer%i9 during pregnancy, and as the cer%i9 1egin
to soften and open, this mucous loosens and may 1egin to pass from the %agina. Some women
may notice this increased mucous passage for a few days For e%en wee$sG 1efore la1or 1egins
others may not notice it at all.
T6$ =!$+
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Second stageBstarts from the full dilatation till the e9pulsion of the foetus.It has got two phases.
2uration is ( hours in primi and "0 min in multi.
aGpropulsi%e phasestarts from full dilatation to the descent of the presenting part to the pel%ic floor
1Ge9pulsi%e phase Bfrom the maternal 1earing down effort till the deli%ery of the foetus
Third stageBfrom the e9pulsion of the fetus till the e9pulsion of the placenta .duration is &: min in
1oth multi and primi
FACTORS INFLUENCING THE PROGRESSION OF LABOUR
+hild1irth professionals often refer to the following factors influencing la1or progression as the J>ou
PsJ of la1or'
P+ss$%4$!F 1a1yG
P+ss+4$ Fthe pel%ic 1ones, cer%i9 and %agina, and the muscles in pel%isG
P;$! F contractionsG
Ps>6$ F emotionsG
FACTORS THAT EASE LABOUR
La1our is a gradual phase that gains momentum with each contraction. A %ariety of factors could
trigger la1our and e%ery womanKs e9perience is uniDue. Since a normal, hasslefree deli%ery is what
any woman would prefer here are a few factors that would facilitate a safe and easy la1our.
B!$+6"%4 R"46
7reathing techniDues play an important role in la1our and child1irth. Most antenatal and la1our
preparation classes train e9pectant mothers in the right form of 1reathing, which encourages focus an
concentration during la1our. -hough there are many types of 1reathing e9ercises, 1ut there are no
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particular rules a1out how you ought to 1reathe. Most women find that adopting a particular 1reathin
pattern helps them control la1our pain during deli%ery. -he emphasis is on lengthening the out1reath
following it till the %ery end.
S+>"%4 A"5$
It has 1een pro%en that women who are fit ha%e safer and more positi%e 1irth outcomes. Acti%ity
encourages circulation and the production of natural hormones. It also enhances energy le%els and
strengthens muscle tone in preparation for child1irth. *9ercising regularly is more 1eneficial than
e9ercising randomly as it 1uilds strength and stamina and reduces the possi1ility of in=ury.
P"+$s
Pilates is a 1ody conditioning discipline that focuses on the 1reath to achie%e impro%ed fle9i1ility an
strength for the whole 1ody. Pilates help impro%e posture and aid 1ody control and stress managemen
It strengthens the pel%ic floor muscles in preparation for child1irth and also focuses on the
a1dominals, 1ac$ and 1uttoc$s. Pilates can 1e practised from the 1eginning of the second trimester.
And 1ecause it is a nonaero1ic, noimpact system, the 1asic e9ercises are ideal during pregnancy an
child1irth as they are gentle and slow.
Y4+
@oga is a safe, effecti%e and rela9ing form of e9ercise during pregnancy. It relie%es stress and an9ietencourages hormonal 1alance, increases stamina and calms the mind. Many women consider yoga a
most empowering way to prepare for la1our and child1irth. @oga also helps lower 1lood pressure, aid
effecti%e digestion, strengthens the pel%ic floor muscles and reduces constipation.
A$!%+$ T6$!+->
In recent times, there is an emphasis on %arious alternate therapies that could ease the pain and traum
of la1our. Refle9ology, massages, meditation, aromatherapy, acupressure, acupuncture or shiatsu,
which in%ol%e stimulation of pressure points along the 1ody are popular among e9pectant mothers.
is 1elie%ed that water therapy helps the uterus to contract more effecti%ely, while asmine in
aromatherapy is noted for preparing the uterine muscles for la1our. Refle9ology the techniDue of
massaging pressure points on the feet has 1een pro%en to help induce la1our and num1 pain.
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G$"%4 P6>s"+
-uning in to 1ody is %ital during the final stages of your pregnancy, as gi%ing 1irth is a natural
physical tas$. Studies ha%e found that se9ual intercourse during the last few wee$s of pregnancy can
help soften the cer%i9 in preparation for la1our. -he prostaglandins found in semen, helps soften the
connecti%e tissue of the cer%i9 and increase o9ytocin production in the muscle cells of the wom1 in
preparation for la1our. As synthetic prostaglandin gel is often used to soften the cer%i9 and wom1 to
induce la1our, medical professionals nowadays recommend se9 during the last few wee$s of
pregnancy.
P$!"%$+ #+ss+4$ massaging the area of tissue 1etween the anus and the %agina during the last fe
months of pregnancy, is considered to 1e helpful in minimising possi1le tearing or the need for
episotomy. 7reast and nipple stimulation ha%e 1een pro%en to induce strong uterine contractionNipple stimulation has 1een 1eneficial
PREPARATION
+@ W6+ "s =$ -+
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G"%46#$ 37"
-here will 1e need clothes to go home in, so mother has to pic$ a comforta1le outfit that wont creas
easily and will allow you to 1reastfeed. A fa%ourite maternity dress with a front opening would 1e
great.
N$;=!% Ess$%"+s
Pac$ a few new1orn sleep suits mitts, 1ootees, 1i1s, a 1lan$et, new1orn nappies and cotton wool for
those first changes.
N3!s"%4 %"46;$+!
-his is a must. >eeding tops ha%e a crosso%er front, detacha1le strap or front opening so mother can
comforta1ly and discreetly 1reastfeed your 1a1y.
C+#$!+
Howe%er e9hausted and sweaty you feel, you will 1e glowing after gi%ing 1irth. -he first time mothe
holds your child is an e%ent to capture for $eeps, so ma$e sure the 1attery is fully charged.
D!$ss"%4 4;%/+!&"4+%
3seful co%erup for early la1our.
T6$ +$s "ss3$ 7 P3="+"%s Inorder to fill the days of pregnancy
H$+&=+%&eep your hair 1ac$ during la1our.
D"s-s+=$
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M+$!%"> -+&s
-he hospital will pro%ide with some, 1ut mother has to get ready with necessary one
B"!6 -+%
Should ta$e a copy of 1irth plan B itll help to get the 1irth they want.
TENS #+6"%$
In foreign countries we are ha%ing this as a complementary therapy .+an ease early la1our pains 1y
sending an electric charge through pads on the s$in.
S"--$!s +%& s
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It is gaining more importance as the women will 1e getting free from all types of tensions and worrie
along with the 1elo%ed mem1ers
W+$! B"!6
Mother cant insist on gi%ing 1irth in water 1ecause we need a midwife e9perienced in water .In
foreign hospitals we can use this option successfully
I%&3"%
According to NI+* guidelines, if your pregnancy goes 1eyond ;& wee$s you mother isa offered
induction . If mothers 1eing pressured into induction, which in%ol%es 1eing gi%en drugs to trigger
la1our,mother has to as$ these Duestions
BB what are the 7enefits of doing this
RB )hat would 1e the Ris$s if we do this
AB )hat are the Alternati%es we could try first F)hether a mother can go home and try ta$ing a
long wal$G
IB )hat is my Instinct telling me F2o I really want this 1a1y out now or am I ner%ous a1out
induction and would I prefer to let it happen naturallyG
NB )hat if we do Nothing for the ne9t day/wee$ +an I come in daily for monitoring to $eep a chec
on the 1a1y
E$"5$ C+$s+!$+%
Research has found that many of the women who as$ for a caesarean do so 1ecause of fears a1out
la1our or 1ecause they%e had a traumatic la1our pre%iously. Howe%er, all women should 1e offered
counselling and support 1y a midwife to help o%ercome her fears, 1ut if it cant 1e o%ercome, a repor
from a psychologist or counsellor may help when the o1stetrician is ma$ing the decision.
D!"-
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WRITING A BIRTH PLAN
-he most important thing to remem1er a1out a 1irthing plan is that these are preferences. ne mus
remain open and fle9i1le if e%ents stray from chosen path. 3ltimately, you want a healthy 1a1y an
mom and if that means ma$ing some tough choices, then so 1e it. No regrets
Here is an e9ample for 7irth plan
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SETTINGS FOR BIRTH
As hospital deli%ery may not 1e your only option. Many women now deli%er at a 1irthing center, 1worldwide, the most widely used setting is a home1irth.
PATIENT PREPARATION
P6>s"+ -!$-+!+"%
Sha%ing or clipping of the %ul%a is done.
-he %ul%a and perineum are washed with soap and water
-he women should ta$e shower
+ontinous encouragement and emotional support
N3!""%+ -!$-+!+"%
Patient is maintained in N.P. and ice pieces can 1e gi%en if necessary
B;$ -!$-+!+"%
*nema has to 1e gi%en on the early morning of the deli%ery
POSITIONS USED IN ACTIVE LABOUR
S+%&"%4 ! $+%"%4 7!;+!& ;6"$ s3--!$& => >3! -+!%$! ! + -"$$ 7 73!%"3!$
-his position pro%ides support 1ut it also allows to ta$e ad%antage of gra%ity. Lean 1ody
weight into each contraction. -his position may relie%e 1ac$ache. It also allows partner to gi
you a massage.
(%$$"%4 ;"6 >3! 3--$! =&> !$s"%4 +4+"%s + 6+"! ! >3! -+!%$!s +--his position ta$es the weight off spine and is a good position for pel%ic tilts, which can
relie%e 1ac$aches. Many women also find it is a restful position.
O% + 73!s
-his also ta$es the weight off spine and allows you to tilt your pel%is to relie%e 1ac$aches. It
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can help encourage the 1a1y to rotate from a posterior position. )aggling your hips may help
the 1a1y mo%e.
S""%4 +s!"&$ + 6+"! 7+"%4 6$ =+"%4 % >3! s"&$
-his is a restful and rela9ing position that ta$es the pressure off your 1ac$ For your
hemorrhoids if you ha%e anyG, and it allows your partner to gi%e you a massage. @our nurse or
midwife will encourage the use of this position if your 1lood pressure is ele%ated. It is also a
practical position if you are ha%ing an epidural.
A ="!6"%4 =+or1irthing stoolcan 1e used to support different positions, to help $eep a
woman upright, and to speed the 1irth along. A 1irthing stool can also 1e used in the later
stages.
Late in acti%e la1our and during transitioning,changing your position can enhance the 1a1y
passage downward through the 1irth canal. @ou may want to try these positions'
S3+"%4
-his position widens pel%is to the ma9imum and ta$es ad%antage of gra%ity, to mo%e the 1a1
through the 1irth canal. Pushing in this position is easier for some women, 1ut others find
tiring and uncomforta1le. It is not recommended if the 1a1y is coming Duic$ly.
http://www.womenshealthmatters.ca/centres/pregnancy/glossary/index.html#birthingbhttp://www.womenshealthmatters.ca/centres/pregnancy/glossary/index.html#birthingshttp://www.womenshealthmatters.ca/centres/pregnancy/childbirth/stages.html#transitionhttp://www.womenshealthmatters.ca/centres/pregnancy/childbirth/stages.html#transitionhttp://www.womenshealthmatters.ca/centres/pregnancy/glossary/index.html#birthingbhttp://www.womenshealthmatters.ca/centres/pregnancy/glossary/index.html#birthingshttp://www.womenshealthmatters.ca/centres/pregnancy/childbirth/stages.html#transition8/14/2019 antenatal preparation.doc
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S$#"s""%4 ;"6 >3! +"=%$ 7+ +4+"%s 6$ =$&
-his is a restful position that allows you to lay 1ac$ 1etween contractions. It ma$es %aginal
e9aminations or the use of a fetal monitor easy.
L>"%4 % >3! s"&$
-his is a restful position that lets you rela9 1etween pushes. It ta$es the pressure off 1ac$ an
allows an epidural to 1e used. -his position can slow down a rapid 1irth.
COMMON INTERVENTIONS DONE DURING LABOUR
-hese are the most common inter%entions used during la1our to help you deli%er your 1a1y.
Episiotomy
An episiotomy is a cut made in the perineum Fthe s$in and muscle 1etween the %agina and anusG. It
used to enlarge the %aginal opening and ma$e the 1irth of the 1a1y easier if the perineum is n
stretching. Local anesthetic can 1e used and the cut will 1e stitched up after the 1irth. It should he
within se%en to &0 days.*pisiotomies used to 1e performed routinely howe%er, se%eral studies show
that with normal 1irths, women who did not ha%e episiotomies generally fared 1etter than women wh
had one.
-he procedure ma$es it more li$ely that a woman will ha%e a larger tear that e9tends into the rectum
that her tear will ta$e longer to heal, and that she will ha%e pain in the wee$s and months following t
1irth. -here are times when an episiotomy is needed B for e9ample, if the 1a1y is in distress B 1ut the
is no e%idence to show that routine episiotomies 1enefit women or their 1a1ies.
Most doctors no longer perform episiotomies routinely 1ut a few still do. Midwi%es can perfor
episiotomies 1ut are far less li$ely to do so than doctors.
Electronic Fetal Monitoring
-his is a machine used to record the 1a1yKs heart1eat and the freDuency of the motherKs contractio
during la1our. *lectrodes that record the 1a1yKs heart1eat can 1e put on the motherKs 1elly with a 1
Fe9ternal monitoringG or can 1e placed onto the 1a1yKs scalp, through the motherKs %agina Fintern
monitoringG.
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*lectronic fetal monitoring is not used routinely 1ut it may 1e used to chec$ the 1a1yKs health durin
the 1irth. )hen internal monitoring is done, your water must 1e 1ro$en if this has not already occurr
naturally. -he monitor will 1e attached to your 1a1yKs head with a scalp clip. Support people may ne
to ma$e an e9tra effort to focus on the mother rather than the machine.
Some women feel that electronic fetal monitoring interferes with the natural 1irthing process, whi
others, especially women who may ha%e had complications with pre%ious 1irths, find it reassuring
$now that the 1a1ys heart1eat is 1eing monitored. 2iscuss the pros and cons with your care pro%ider
Forceps and Vacuum Etraction
-hese instruments are designed to guide the 1a1y out of the %agina, when the woman canKt push her
1a1y out completely. -hese methods may 1e used if' you are e9hausted
the position or siEe of the 1a1y ma$es the 1irth difficult
there is fetal distress
you are ha%ing difficulty pushing due to medication
If forceps or a %acuum e9tractor is used, mother will 1e gi%en a local anesthetic and an episiotomy w
often 1e done.7oth procedures can cause temporary changes in 1a1yKs appearance 1ut these will
disappear with time. >orceps may lea%e mar$s on the side of the 1a1yKs face and a %acuum e9tractor
may cause temporary swelling on the top of the 1a1yKs head.
!nduction"Augmentation
-hese inter%entions may or may not use drugs to start FinduceG or speed up FaugmentG la1our. -hey a
used when a more rapid child1irth is needed to protect the health of the mother or the 1a1y, or wh
mother had significantly past your due date.
A fetal heart monitor is often used during an induced la1our to ensure that all is well. -he mo
common ways of inducing la1our are'
artificial rupture of mem1ranes FARMG
prostaglandin gel
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o9ytocin
A!"7""+ !3-3!$ 7 #$#=!+%$s
In the hopes of starting la1our, caregi%er may 1rea$ the 1ag of amniotic fluid surrounding the 1a1y.
-his may 1e done with a long thin plastic hoo$ called an amniohoo$. -his procedure can increase the
ris$ of infection of the fetal mem1ranes and amniotic fluid.
P!s+4+%&"% 4$ ! >"%
7oth prostaglandin and o9ytocin are hormones. Prostaglandin gel can 1e used when the cer%i9 is less
than three centimeters dilated. It is applied to the 1ac$ of the %agina where it softens and JripensJ the
cer%i9, to help it dilate. It is a milder way to induce la1our and may 1e done on an outpatient 1asis,
depending on the hospital. 9ytocin may cause intense contractions and usually ma$es the 1irthproceed rapidly. It is gi%en through an intra%enous line after the woman is in the 1irth room.
#esarean Section
A cesarean section is a surgical procedure used to deli%er a 1a1y. A cesarean section For +sectionG is
surgical operation where the 1a1y or 1a1ies are 1orn through an incision in the uterus. -oday one o
of e%ery four or fi%e women in +anada gi%es 1irth 1y +section. +anadas +section rate has increase
dramatically o%er the past four decades.
-he most common reasons for a cesarean are'
dystocia Fa slow or difficult la1ourG
1reech 1irth Fwhen the 1a1y has not turned into a headdown position 1ut is in a position to 1
1orn 1ottom first or feet firstG
multiple pregnancy Fparticularly if there are more than twins, although many women do deli%
multiples %aginallyG
placenta pre%ia B a pregnancy complication that can cause 1leeding 1efore or during deli%ery
PSYCHOLOGICAL PREPARATION FOR LABOUR
7irth partner, or partners can pro%ide support in the following ways'
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Physical support they can help $eep you comforta1le, 1ring your drin$s and snac$s, and help
you to mo%e around.
*motional support simply ha%ing someone there for you is really important. Reassurance an
words of encouragement will also help.
Ad%ocacy you may not feel li$e answering Duestions so ha%ing someone there to e9plain yo
%iews can 1e really helpful.
MEDICATION
>or some women, these techniDues are enough other women choose to com1ine them with
medications to reduce the amount of drug they use. If choose to a%oid or delay medication, it is wise
to in%estigate the medications you might choose -here are two main drug options for pain relief' narcotic drugs, such as morphine, gi%en early in la1our
an epidural
Narcotics
2rugs, such as meperidine F2emerolQG or morphine, can 1e gi%en during early la1our, if the 1irth
not e9pected within four hours. -hese drugs relie%e pain, although pain relief may 1e less comple
than the relief achie%ed with an epidu
Epidural
An epidural uses local anesthetic Fa medication that num1s the area and causes loss of feelingG. -h
medication is in=ected into the lower 1ac$, to num1 the ner%es to the uterus and 1irth canal. A sm
dose of a morphineli$e drug is often included to reduce the amount of freeEing reDuired.
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pre%ent wear and tear on your =oints Fwhich 1ecome loosened during pregnancy due to normal
hormonal changesG 1y acti%ating the lu1ricating fluid in your =oints
help you sleep 1etter 1y relie%ing the stress and an9iety that might ma$e you restless at night
loo$ 1etter.
*9ercise increases the 1lood flow to your s$in, gi%ing you a healthy glow.
COMPARISON OF BOO( PICTURE WITHPATIENT PICTURE
BOO( PICTURE PATIENT PICTURE
PREPARATION
PAC(ING TO HOSPITAL
!oinghome outfit
New1orn *ssentials
Nursing nightwear
+amera
2ressing gown
-he latest issue of Pu1lications
2isposa1le $nic$ers and 7reast pads
Head1and
She was prepared with the cloths neededfor the hospital stay
New1orn dresses and clothes were also
ta$en
She had ta$en certain health magaEines to
occupy her leisure
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Maternity pads
7irth plan
-*NS machine
Slippers and soc$s
IPod
Snac$s
-oiletries
BIRTH OPTIONS
Home 1irth
)ater 7irth
Induction
*lecti%e +aesarean
2rip
*pidural
+aesarean
PHYSICAL PREPARATION
Sha%ing or clipping of the %ul%a is done.
-he %ul%a and perineum are washed with
soap and water
Maternity pads were carried to the hospitals
Slippers and soc$s were carried to the
hospitals
Snac$s was ta$en
Soap and other necessary toiletries wasta$en
She got admitted for the institutional
deli%ery
+lient got prepared physically for the
la1our .
Her %ul%al hairs were sha%ed
She too$ the showwer
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-he women should ta$e shower
+ontinous encouragement and emotional
support
NUTRITIONAL PREPARATION
Patient is maintained in N.P. and ice
pieces can 1e gi%en if necessary
BOWEL PREPARATION
*nema has to 1e gi%en on the early
morning of the deli%ery
POSITIONS USED IN ACTIVE
LABOUR
Standing or leaning forward while
supported 1y your partner or a piece of
furniture
neeling with your upper 1ody resting
against a chair or your partnerKs lap
n Jall foursJ
Sitting astride a chair facing the 1ac$
Sitting on a toilet leaning forward into
your partner
P!--$& 3- "% =$&
Lying on your side
SDuatting
Semisitting with your tail1one flat
against the 1ed
Lying on your side
COMMON INTERVENTIONS DONE
DURING LABOUR
She was under N.P. 1efore deli%ery
*nema was administered in the early
morning
She had ta$en a lithotomy position for the
la1our
She had undergone a right mediolateral
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*pisiotomy
*lectronic >etal Monitoring
>orceps and 6acuum *9traction
Induction/Augmentation
A!"7""+ !3-3!$ 7 #$#=!+%$s
P!s+4+%&"% 4$ ! >"%
PSYCHOLOGICAL PREPARATION
FOR LABOUR
episiotomy
Assessment of the uterine contractions
were monitored .>etal heart rate was
monitored using electronic fetal
monitoring
ARM was done
9ytocin drip was started
She was psychologically prepared for the
la1our
APPLICATION OF THEORYPEPLAUS INTERPERSONAL THEORY
Hildegard peplau 1egan her nursing career in "& .He first pu1lished the model in :( in
interpersonal relations in nursing .He 1ased her model on psycho dynamic nursing .In his model the
phases of interpersonal relationship reflects occurrence in personal interaction .-he four phases are
orientation,identification ,e9ploitation and resolution. 2uring this phases the nurse assumes so many
roles such as teacher, resource counseller,leader,e9pert and surrogate.
>3R PHAS*S B-H*@ AR*
rientation
Identification
*9ploration
Resolution
ORIENTATION Mrs. Namitha is a antenatal women and she
became oriented the situation and hospital seting and the
services rovide in the hos ital
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NURSING DIAGNOSIS
Impaired tissue perfusion related to preclampsia secondary to arteriolar %asospasm as e%idenced
1y edema on legs
Ris$ for in=ury related to signs of pre eclampsia
>ear and an9iety related to Pre eclampsia and its effect on the fetus
2i%ersional acti%ity deficit related to imposed 1ed rest as e%idenced 1y %er1al response
IDENTIFICATION
Mrs.Namitha , a client I found during my posting ,an antenatal
mother
E"POITATIONI gave health education about the breast
feeding and the excercises and she is willing to accept me
as a health worker
RESOUTION Mrs.Namitha is willing to go for follow up
continue a healthy life and happily we ended up our thera
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HEALTH EDUCATION
DIET:
Ad%ised the mother to ta$e nutritious and easily digesta1le food li$e green leafy %egeta1l
,fruits etc.
Ad%ised her to ta$e iron rich,protein rich food
Ad%ised the mother to ta$e plenty of fluidF&0&: glsses of waterG
E*ERCISE
Ad%ised the patient to do mild e9ercise and acti%ities
*9plained a1out acti%e and passi%e e9ercise
Ad%ised mother a1out antenatal e9ercise li$e pel%ic floor and a1dominal e9ercise
-aught a1out the 1reathing e9ercise to 1e practised throygh the intranatal period
Ad%ise to a%oid the strenuous acti%ities li$e lifting hea%y o1=ects
PERSONAL HYGIENE
Ad%ised the importance of oral hygiene
Ad%ised the patient a1out oral hygiene and also a1out to ta$e regular 7ath
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*ducate a1out perineal hygiene
-aughtr a1out the 1reast care needed
MEDICATION
Ad%ised client to ta$e medication at correct time ,dose and route as prescri1ed 1y doctor
CARE OF BREAST
Ad%ised to $eep the 1reast clean, taught a1out 1reast self e9amination
7reast should 1e cleaned with lu$e warm water and dry it properly
FOLLOW UP
I ad%ised the patient to ta$e medication regularly as per physician order and as$ed the patient
come for follow up.
FETAL MOVEMENT COUNT
)omen is ad%ised to and taught to monitor fetal mo%ements and fetal heart sounds
Ad%ised to chec$ the mo%ements at least " times a dayFmorning ,noon,and e%eningG.
RECTAL MOVEMENT CARE
*ncouraged to include plenty of fruits and green leafy %egeta1les in the diet
-aught the importance of roughage rich diet
A%ised ti increase the fluid inta$e
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CONCLUSION
Mrs.Namitha (" yr old lady admitted on/#/(0&0 with the complaint of mild pedal edema an
headache. !eneral condition of the patient is good. I pro%ided all care to the patient .Now h
condition is impro%ed to some e9tent. 2uring these days she was %ery cooperati%e and followed m
instruction regarding diet and e9ercise
BIBLIOGRAPHY
Adele pilliteri O Maternal And +hild Health Nursing. : th edition. 3nited States f America
Lippincott )illiams and )il$ins ' (00. 5"0.
7o1a$ B ensen. O *ssentials f Paternity Nursing. " rd edition. Mos1ys pu1lications. 3nit
States f America' #&. :;:50.
2utta. 2.+. O -e9t 7oo$ f 1stetrics. 5thedition. +alcutta' New +entral 7oo$ Agency' (00
&;:&:"
Mos1ys 2rug +onsult for NursesT. "rdedition. *%ol%e pu1lications. (005. "#, ;5&
Myles. O-e9t1oo$ for Midwi%es. &:thedition. London' +hurchill Li%ingstone *lse%ier' (004. 5:
55&.
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