COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

ROTATION 2
Labor Room and Delivery room

SPECIFIC LEARNING OUTCOMES

At the end of 2 weeks, the student nurses will be able to:
OVERVIEW
 Gain knowledge on specific concepts related to normal pregnancy.
 Describe the labor and delivery process.
 Identify significant laboratory and diagnostic test necessary for labouring women.
 Discuss the physical and physiologic process of labor and delivery.
 Formulate nursing diagnoses related to the needs of the labouring and birthing mother
as well as the newborn.
 Describe how you would conduct a rapid assessment of a woman in labour.
 Describe the features of woman — friendly care during labour and delivery.
 Describe the steps in history taking of a woman in the first stage of a normal labour.
  Explain how you would palpate the abdomen of a woman in labour to assess the size,
lie and presentation of the baby.

 Manifest the right attitude in providing quality care to a pregnant client.

Labor and Delivery Room Rotation involves training in the care of women who are in labor and
about to give birth. In this rotation you will be taught to apply the concepts you have learned in maternal
and child nursing. Basically, it includes assessment and monitoring of a woman’s in labor and about to give
birth well-being and her baby.
The labor room also called the labor, delivery, and recovery room (LDR) is the most versatile
place at the hospital. Once you are placed in a room, this is the room that you will use for your labor and
birth, in addition to the initial hours of recovery. The LDR is designed for all kinds of births. LDR can be
used for women choosing to go unmedicated or those who wish to have an epidural. These rooms can also
handle minor emergencies and procedures including forceps and vacuum deliveries.
In the first study session in this Module, you learned how to tell if true labour has begun, about the
four stages of labour, and the movements the baby makes as it descends through the birth canal. In
this study session, you will learn how to assess the condition of a woman who is already in labour, the
condition of the fetus, and how it is positioned in her uterus. We also want you to pay attention to giving
‘woman-friendly care’ which respects her beliefs and rights.

Labour will already have begun in almost all cases when you are called to a woman’s home or
when she arrives at your Health Post. One of the most critical assessments you have to make in Labour
and Delivery Care is at the time when you first attend a labour. Rapid early assessment is required so that
you can decide on the care needed for the labouring mother, in case immediate referral or emergency
measures are required. If all is well, you need to take the woman’s history in detail and conduct a physical
examination in order identify the stage of labour that she has reached, and discover any information from
her history that may affect the progress or outcome of her labour. This study session builds on the
assessment and history-taking skills you developed during your study of the Prenatal Care Module.

When face to face classes resume student nurses will be assigned to go on duty in the labor and
delivery room area of Negros Oriental Provincial Hospital. The rotation will be for 2 weeks wherein students
are expected to assist in the care for labouring and delivery women. The responsibilities include assisting

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
labouring and clients who are to deliver in and out of the area, gathering obstetrical data, labor watching,
plotting the partograph, taking vital signs, performing leopold’s maneuver, taking and recording fetal heart
rate, measuring fundal height, assisting the physician or midwife in assisting and handling delivery and
performing initial care of the newborn.

DISCUSSION: Labor Room and Delivery Room

Childbirth, also known as labour or delivery, is the ending of pregnancy where one or
more babies leaves the uterus by passing through the vagina or by Caesarean section.[7] 
The most common way of childbirth is a vaginal delivery.[6] It involves three stages of labour:
the shortening and opening of the cervix during the first stage, descent and birth of the baby during the
second stage, and the delivery of the placenta during the third stage.[14][15] The first stage begins with
crampy abdominal or back pain that lasts around half a minute and occurs every 10 to 30 minutes. [14] The
pain becomes stronger and closer together over time. [15] The second stage ends when the infant is fully
expelled. In the third stage, the delivery of the placenta, delayed clamping of the umbilical cord is generally
recommended.[16] As of 2014, all major health organisations advise that immediately following vaginal birth,
or as soon as the mother is alert and responsive after a Caesarean section, that the infant be placed on the
mother's chest, termed skin-to-skin contact, delaying routine procedures for at least one to two hours or
until the baby has had its first breastfeeding. [17][18][19]

Most of the concepts related to

pregnancy is included in your
MCN lecture. You will be
assigned to certain topics later
on for your wardclass activity.
This is to review and gain better
understanding on certain
concepts you’ve learned https://www.freepik.com/free-photo/asian-
healthcare-female-
posing_12752034.htm#page=1&query=nu
rse&position=2

In Fundamentals of Nursing, you have already learned how to take the vital signs
properly. You may continue to practice at home to master it because it is a basic skill
you need when you go on duty. In addition to the assessment of the labouring and
delivering woman, it is necessary to determine the fundal height, age of gestation, fetal
position, , labor watching, plotting the partograph, fetal heart rate (FHT), assessment of
well-being and gestational assessment of newborn. Let us discuss how these are done.

A. ESTIMATING THE EXPECTED DATE OF DELIVERY/CONFINEMENT/BIRTH (EDD/EDC/EDB)

There are several formula/methods considered for calculating EDD/EDC/EDB but we will be
focusing on Naegele’s Rule.

NAEGELE’S RULE
• Estimates the expected date of delivery
Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
• It is based on the woman’s 1 st day of the last menstrual period (LMP)
• The result is approximately 280 days from the start of LMP (40weeks)

Rule’s Assumptions: CALCULATION

* Regular 28-day cycle
* Accurate recall of If LMP is April to December If LMP is January to March
LMP
FORMULA: Subtract 3 months FORMULA: Add 9 months
* 30 days in a month
Add 7 days Add 7 days
* Conception occurs
Add 1 year
on the 14th day of
cycle
FOR EXAMPLE: FOR EXAMPLE:
LMP is May 5, 2020 LMP is February 12, 2020
Subtract (-) 3 months = February 5, Add (+) 9 months = November 12,
2020 2020
Add (+) 7 days = February 12, 2020 Add (+) 7 days = November 19,
2020
Add (+) 1 year = February 12, 2021

EDD: February 12, 2021

EDD: November 19, 2020

B. ESTIMATING FETAL GROWTH IN WEEKS

As the fetus grows, the uterus expands to accommodate its size. Although not evidence grounded,
typical fundal measurements are:
• Over the symphysis pubis at 12weeks
• At the umbilicus at 20weeks
• At the xiphoid process at 36weeks

McDONALD’s RULE
• Although not thoroughly reliable, it is still used for fundal height measurement as an easy
method of determining midpregnancy growth.
• Measure in centimeters from the notch of the symphysis pubis to over the top of the uterine
fundus as a woman lies supine.
• It may equal to the week of gestation between the 20 th and 31st weeks of pregnancy.
• It becomes inaccurate during the 3 rd trimester of pregnancy because the fetus is growing more
in weight than in height during this time.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

C. Rapid evaluation of a woman in labour

On first seeing a woman who is already in labour, your immediate task is to make a rapid assessment of
whether there is any cause for concern. Does she need an urgent referral for emergency care, or is her
labour progressing normally at this stage?

What you must do for a rapid assessment

Things you need to have

 Her Prenatal Care Card (if she has been in your care previously); if she has come to you for the first
time and she is already in labour, start a new health record for her
 Partograph for recording the progress of labour (you will learn how to use the partograph.
 Sterile gloves
 Fetoscope to listen to the baby’s heart beat
 Thermometer to take the mother’s temperature
 Watch or other timer to help you measure the fetal heart rate, the mother’s pulse rate and labor
contractions.
 Blood pressure measuring cuff with stethoscope
 Swabs (3-4 balls of gauze soaked with antiseptic solution to clean the perineum before doing a
vaginal examination. You can prepare warm water and soap if you have no antiseptic solution.

 Never use alcohol to swab the genital area!

Sometimes a woman may come to you already in the second stage of labour. In this case, take her
to the delivery room immediately and make her as comfortable as possible. If you are seeing her at home,
select an appropriate place and make it as clean and safe as you can in the available time. It is important to
prepare in advance the equipment you will need for attending a delivery and keep it packed and ready at all
times in case you are called to a woman who is close to giving birth.

Check her vital signs

 Blood pressure: normal values range between 90/60 mmHg to below 140/90 mmHg.
 Maternal pulse rate: normal range is 80-100 beats/minute, but should not be greater than 110
beats/minute in a woman in labour.
 Temperature: average 37oC; if it is between 37.5-38.4oC the woman has a low grade fever; if it is
38.5oC or above, she has a high grade fever.
If one or more of these vital signs is outside of the normal range, you should refer her immediately (Figure
1). If the values deviate a long way outside the normal range refer her after you have begun an infusion of
intravenous (IV) fluids.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Figure 1.

Look at and listen to the woman

 Did someone carry her to the hospital or birthing center?
 Is there blood on her clothing or on the floor beneath her?
 Is she grunting, moaning, or bearing down?

Figure 2 If the woman is losing a lot of blood, she needs urgent help.
Ask her, or someone who is with her, whether she has now or has recently had:

 Vaginal bleeding
 Severe headache/blurred vision
 Convulsions or loss of consciousness
 Difficulty breathing
 Fever
 Severe abdominal pain
 Premature leakage of amniotic fluid (waters breaking early).
If the woman currently has any of these symptoms, immediately:

 Shout for help

 Stay calm and focus on the woman
 Stay with her — do not leave her alone
 Take immediate action to give the necessary pre-referral treatments and refer her urgently to the
nearest hospital or health centre.
Management of complicated labours is covered in detail of this Module, including referral procedures and
what to do on the journey to the health facility.

2. History-taking in labour

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
The best way to learn about a woman’s history is to ask her, but you must do this sensitively. At
first, she may not be comfortable talking with you. Try to help her feel comfortable by listening carefully,
answering her questions, keeping what she tells you private, and treating her with respect.

2.1. Recording socio-demographic data

If you have looked after the mother during her prenatal care check-ups, you will already know this
information. If this is the first time you have seen her, record her name and her age: this is particularly
important if she is a very young first-time mother, below 18 years of age.

Also record her height if possible, or estimate it; this will help you to evaluate whether she is ‘small’
for the size of the baby, which may mean that she could have problems giving birth if the baby’s head
cannot fit through her small pelvis.

Next ask her address, religion, occupation (if she is in employment), and record it in the
appropriate space in the chart.

Write down what is her main presenting symptom (her complaint), which in this case is usually labour pain
(contractions), and a bearing-down sensation if she is already in second stage of labour.

2..2  History of past and present pregnancy

Ask about the number of previous pregnancies and births (if any) the woman has had, and about
the current pregnancy. Gestational age is the number of weeks the fetus has been in the uterus; the
average number of weeks at full term is 40, calculated from the date when the woman’s last normal
menstrual period (LNMP) began.

Gravidity and parity status

Gravidity is the total number of previous pregnancies, regardless of the outcome, including spontaneous
miscarriage or abortion before 28 weeks of gestation.

 Gravida 1 or primigravida: first pregnancy

 Gravida 2: second pregnancy, etc.
 Multigravida: pregnant two or more times (number not specified)
Parity is the number of babies delivered either alive or dead after 28 weeks of gestation.

For women who can’t tell you the exact number of gestational weeks, any delivery they think was after
about 7 months (30 weeks) counts in the parity number.

 Nullipara or Para 0: no pregnancy reached 28 weeks

 Primipara or Para 1: one birth after 28 weeks
 Para 2: two births after 28 weeks
 Multipara: two or more births after 28 weeks (number not specified)
 Grand multipara: five or more births after 28 weeks.
 A woman comes to your hospital or birthing clinic in labour at full term. She tells you that she has previously
given birth to two live babies (both at the gestational age of 40 weeks), and one dead baby (stillbirth) at 32
weeks. She also had a spontaneous miscarriage at 26 weeks. Record the gravidity and parity of this
woman.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
Your answer?

Estimating the expected date of delivery

You should also ask when was the first day of her last normal menstrual period (LNMP). This will
help you to calculate the expected date of delivery (EDD) and the gestational age of the fetus. Calculating
the EDD and gestational age will help you to identify whether the labour is preterm, term or post-term.
Often women do not recall their LNMP; in such cases it is useful to ask her when she first felt her baby’s
movement inside her (quickening or fetal kick). This occurs at approximately 18-20 weeks in primigravida
mothers and 16-18 weeks in multigravidas.

3. Physical examination in labour

When you physically examine a woman in labour, your focus will be on her abdomen, vagina and cervix,
so remember to:

 Maintain her privacy

 Examine her comprehensively (head to toe)
 Look for signs of anaemia (paleness inside the eyelids, pale fingernails and gums)
 Look for yellowish discoloration of the eyes (jaundice), which indicates liver disease.
3.1  Inspection of the abdomen

In order to memorise what aspects to inspect on the abdomen of a woman in labour, you can take the initial
‘S’ letters of the three points to look out for: size, shape and scars.

 Size: Is the abdomen too big or too small for the gestational age of the fetus? If it is too small, the
baby may not have developed properly; if it is too big, the woman may have twins, or a condition
called polyhydramnios (too much amniotic fluid). If the abdomen is either too big or too small, refer
the mother to a health facility.
 Shape: Does the abdomen have an oval shape (like an egg — a little bit wider at the top of the uterus
and narrower at the lower segment)? At near to full term, or in labour, this shape usually indicates
that the baby is presenting ‘head-down’. If it is round like a ball, it may indicate an abnormal
presentation.
 Scar: Observe if she has a scar from an operation in the lower abdomen, from a previous caesarean
delivery; the scar will usually be just above her pubic bone; if she has had surgery on her uterus
previously, refer her to the nearest health facility. Scarring of the uterus puts her at risk of uterine
rupture during the current delivery.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Figure 3  Previous caesarean surgery increases the risk during the next labour.
4. Palpation of the abdomen
Palpation means feeling the abdomen with your hands in specific positions, or moving them in
particular ways, using certain levels of pressure. Ask the mother to lie down on her back and bend her legs
at the knees, with her feet flat on the bed. You need to be able to move around her: sometimes you will be
palpating her abdomen while standing at her feet and looking up her body towards her head; sometimes
you will be standing behind her and facing her feet; and sometimes you will stand beside her.

 Can you recall the purposes of abdominal palpation in a woman in labour? (They are the same as during
the pregnancy; see Pretenatal Care Module.

Review on Leopold’s manoeuvres

There are four palpations of the abdomen, which are commonly referred to by midwives and doctors
as Leopold’s manoeuvres. You need to do them in the correct sequence.

First Leopold’s manoeuvre: fundal palpation

Figure 4  Fundal palpation — the first manoeuvre.

Second Leopold’s manoeuvre: lateral palpation

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Figure 5  Lateral palpation–the second manoeuvre.

Third Leopold’s manoeuvre: deep pelvic palpation

The third manoeuvre helps to confirm your earlier findings about the fetal presentation—is it cephalic or
breech?

 What is cephalic presentation?

Your answer?

Figure 6  Deep pelvic palpation–the third manoeuvre helps to determine the presenting part.

Fourth Leopold’s manoeuvre: Pawlick's grip

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Figure 7  Pawlick’s grip — the fourth manoeuvre helps to determine whether the presenting part has
engaged. (Source: WHO, 2008, as in Figure 2.4)
5. Measuring fetal heart rate

Use a fetoscope or stethoscope to listen to the fetal heart rate immediately after a contraction. Listening to
sounds inside the abdomen is called auscultation. Count the number of fetal heartbeats for a full minute at
least once every 30 minutes during the active phase first stage of labour and every 5 minutes during the
second stage. If there are fetal heart rate abnormalities (less than 120 or more than 160 beats per minute,
sustained for 10 minutes), suspect fetal distress and refer urgently to a health facility, unless the labour is
progressing fast and the baby is about to be born.

6. Measuring contractions

To assess the frequency and duration of contractions, put your hand over the mother’s abdomen,
around the fundus. You will sense the abdomen starting to tighten and become hard. The mother may
make ‘pain’ sounds with the contraction. Count the frequency, i.e. number of contractions in 10 minutes,
and the duration. You will learn how to record these measurements, the mother’s vital signs and your
measurements of the fetal heart rate on a chart called a partograph.

7.  Vaginal examination (look at the patient’s chart)

The functions of a vaginal examination are to:

 Determine if true labour has begun and the stage it has reached, based on measuring the dilatation of
the cervix
 Assess the progress of labour in terms of the rate of increase in cervical dilatation and the descent of
the fetus down the birth canal
 Identify the fetal presentation and position
 Detect any moulding of the fetal skull bones (the extent to which they overlap under pressure from the
birth canal)
 Assess the size of the mother’s pelvis and its adequacy for the passage of the fetus
 Check the colour of the amniotic fluid.
In this study session, we will not focus on vaginal examination as this will be assessed by the physician
and midwife: assessing the stage of labour by measuring the dilatation of the cervix.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
Cervical dilatation is the increase in diameter of the cervical opening, estimated in centimeters. Dilatation
happens after the cervix has effaced (the 3 cm length of the cervix has been drawn up into the uterus.

8. Labor watching and plotting the partograph

Partograph: A tool to help in the management of labor. Guides birth attendant to identify women whose
labor is delayed and therefore decide appropriate action.

Please open this link address for how to plot the partograph.

https://drive.google.com/open?id=1nlM3jUv_zkg63G_YNEtn7RzjTeEq_PFu&authuser=0

https://drive.google.com/open?id=1VXvFb2ToVA1egWXLpGzmZOOF-HhFwljc&authuser=0

9. Assessment of well-being and Gestational age of newborn

The Apgar score is a standard neonatal health assessment score that is generally given to babies at one
minute and three minutes after birth. The score is based on various assessment components that are
designed to measure a newborn's overall health.

What Is the Purpose of Getting an Apgar Score?

The main purpose of the Apgar score is to help doctors determine whether the infant requires medical
intervention or assistance. This page will explain the Apgar assessment test and its scoring system to help
you better understand how the Apgar score is determined and what it really means.

What Is the Apgar Score?

The Apgar Score is a type of widely utilized neonatal assessment test given to newborns shortly after birth.
This test measures how healthy a baby is based off numerous factors, including the baby's appearance,
heart rate, reflexes, and other criteria. The goal of the test is to help prevent infant mortality and to
determine if immediate medical care is needed.

When Is the Apgar Test Administered?

Again, the test is usually administered at two separate time intervals after birth. The first Apgar test is
administered at the 1-minute mark after birth. The results of this test are known as the 1-minute Apgar
score. The second test is done 5 minutes after birth and is known as the 5-minute Apgar score. So you
typically get a 5-minute Apgar score and a -minute score. If there are concerns about a baby's health and
there is a low Apgar score, the test may be given multiple times. In rare or critical cases, the test may be
repeated until 10 minutes after birth. You see this more with a preterm birth, an infant that needs
resuscitation, and other children at greater risk for neonatal mortality.

What Does "Apgar" Stand for?

Apgar is an acronym that stands for:

 Appearance
 Pulse
 Grimace response
 Activity
 Respiration

For each category, the newborn baby is ranked from 0-2, with 2 being the highest score. After ranking, the
sum of each criteria is added up to determine an overall score between 1 and 10. It is normal for a baby to
get a lower score than 10, and does not automatically mean your baby is going to encounter complications.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
Appearance
The doctor will examine the physical appearance of the child, focusing on the skin color of the hands and
feet.

 Score of 0: the newborn's body is completely pale or blue in color, no area has become flushed
pink
 Score of 1: the body of the newborn has become pink, but the hands and feet remain blue
 Score of 2: the entire body is flushed pink, no area is left discolored or blue
Pulse
The doctor will use a stethoscope to measure the newborn baby's heart rate. This is generally considered
the most important part of the Apgar Score.

 Score of 0: the newborn has no pulse and the heart is not actively beating, immediate and urgent
care is required to generate pulse
 Score of 1: newborn has consistent pulse, but is beating less than 100 beats per minute
 Score of 2: newborn's pulse is stable and maintains over 100 beats per minute
Grimace
The grimace part of the Apgar Score is also known as reflex irritability, which measures a baby's response
to stimulation. This part of the test could include the doctor giving the newborn a slight pinch.

 Score of 0: no response to physical stimulation, reflexes are considered floppy and weak
 Score of 1: newborn responds to physical stimulation, but only when that stimulation is aggressive
or forceful
 Score of 2: newborn has normal reflexes to physical stimulation, and the child may respond by
coughing, sneezing, or crying
Activity
The activity score measures a newborn's muscle tone and physical activity of the child. The doctor will
extend the arms and legs and watch the newborn flex and move their muscles in response.

 Score of 0: no activity of the arms and legs, newborn does not attempt to move or flex muscles
when stimulated
 Score of 1: gives slight movement of arms and legs, but lacks full movement
 Score of 2: actively moves both arms and legs and muscles provide resistance to being
overextended
Respiration
The respiration score measures the newborn's breathing effort after birth.

 Score of 0: newborn is not breathing at all, immediate medical attention is needed to stimulate
respiratory system
 Score of 1: newborn is breathing but the breathing is slow, weak, or shallow. The baby is not able
to or struggles to cry.
 Score of 2: newborn is taking strong breaths at a regular pace, provides a strong cry after delivery

What Does an Apgar Score Mean?

The final Apgar score is calculated by added up the scores for each of the 5 components of the test. The
highest possible total score is 15 and the lowest is 0. Any score higher than 7 is generally considered to be
a sign of good health. Many babies get a total score lower than 10 for basically harmless reasons, such as
parts of the body taking a longer time to gain color.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

If a baby has a low score, it does not necessarily mean they will not grow into a healthy child, but could
indicate that they need additional neonatal care. Some babies that have an increased risk of getting a lower
score, which include premature babies, C-section deliveries, and babies that had a complicated or
traumatic labor and delivery.

GESTATIONAL AGE

Gestational age and growth parameters help identify the risk of neonatal pathology. Gestational age is
the primary determinant of organ maturity.

Gestational age is loosely defined as the number of weeks between the first day of the mother's last
normal menstrual period and the day of delivery. More accurately, the gestational age is the difference
between 14 days before the date of conception and the day of delivery. Gestational age is not the actual
embryologic age of the fetus, but it is the universal standard among obstetricians and neonatologists for
discussing fetal maturation.
Estimations of gestational age can be based on
 Date of conception

 First day of the last menstrual period and cycle length

 Fetal ultrasonography

 Physical parameters after birth (eg, using the Ballard score)

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
Newborn physical examination findings also allow clinicians to estimate gestational age using
the new Ballard score. The Ballard score is based on the neonate's physical and neuromuscular
maturity and can be used up to 4 days after birth (in practice, the Ballard score is usually used in
the first 24 hours). The neuromuscular components are more consistent over time because the
physical components mature quickly after birth. However, the neuromuscular components can be
affected by illness and drugs (eg, magnesium sulfate given during labor). Because the Ballard
score is accurate only within plus or minus 2 weeks, it should be used to assign gestational age
only when there is no reliable obstetrical information about the estimated date of confinement or
there is a major discrepancy between the obstetrically defined gestational age and the findings on
physical examination.

Assessment of gestational age—new Ballard score

Scores from neuromuscular and physical
domains are added to obtain total score.
(Adapted from Ballard JL, Khoury JC, Wedig
K, et al: New Ballard score, expanded to
include extremely premature infants. The
Journal of Pediatrics 119(3):417–423, 1991;
used with permission of the CV Mosby
Company.)

Based on gestational age, neonates are classified as

 Premature: < 34 weeks gestation

 Late pre-term: 34 to < 37 weeks
 Early term: 37 0/7 weeks through 38 6/7 weeks

 Full term: 39 0/7 weeks through 40 6/7 weeks

 Late term: 41 0/7 weeks through 41 6/7 weeks

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
 Postterm: 42 0/7 weeks and beyond

 Postmature: > 42 weeks

In this Labor Room and Delivery Rotation module, you have learned that:

1. Prepare your equipment for attending a labour and delivery in advance, so you are ready to go
immediately if called.
2. Make a rapid evaluation of the labouring woman’s vital signs (blood pressure, pulse rate and
temperature).
3. Follow the principles of woman-friendly care by respecting her beliefs, wishes and rights, and
empowering her and her chosen caregivers to support the labour and delivery.
4. Ask about and record the woman’s name, age, address, gravidity and parity, last menstrual
period, when she first felt the fetus move, and how long since the first contraction.
5. Use abdominal palpation using the four Leopold’s manoeuvres to determine the fetal
presentation and position, and the extent of engagement of the presenting part.
6. Look at the patient’s chart for the internal examination findings of the woman in labour to
assess cervical dilatation, fetal presentation and descent, the condition of the fetal skull, and
signs of vaginal infection, scarring or swelling.
7. Perform labor watching and plot the partograph to determine the contractions’ duration,
frequency,and intensity.

To help you understand the procedure better, watch the youtube video links
provided for labor watching and plotting of partograph. Please watch and listen to
each video carefully because there are details in one video which may not be in
another. Every video shows important information beneficial for you.
VIDEO LINKS:
http://www.slideshare.net/fathi1957/partograph-103750056?from_m_app=android

LEARNING ACTIVITIES/EXERCISES
INSTRUCTIONS: Please follow instructions carefully and accomplish each task HONESTLY. Please refrain
from copying requirements of others or the work of students ahead of you. You will only truly learn if you do
it yourself.
Self-Assessment Questions

https://classroom.google.com/c/MjIxMjc3MjIzNzM1/a/MjMwMDIxNzYzMDUz/details

Instructions: For those answers that used numbers, please answer in this manner:
e.g. May 16, 2020
38 2/3 weeks
G1T1P0A0L1
I value honesty if you want to learn please rely on your own ability. Remember this is a course that has
a board exam .

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
The name and photo associated with your Google account will be recorded when you upload files and
submit this form.

1. Pamela, a G1P0 had her first prenatal visit last November 13, 2020. Her LNMP was May 16, 2020.
Based on her LNMP, what is the EDC of Pamela.
Your answer
2. Astean, a 28 year old is currently 36 weeks pregnant. Last 2016, she lost her child at 8 weeks and
another last 2018 at 10 weeks. She has a 10 year old twins who were born at 34 weeks gestation, a 5
year old who was born at 37 weeks gestation. What is her GTPAL?
Your answer?

ACTIVITY/EXERCISE A

WARDCLASS WRITTEN OUTPUT. Wardclasses are done at the beginning of each rotation, in this case
labor room and delivery rotation. Its aim is to prepare you on the basic concepts related to the labor room
and delivery area. You will be assigned to different relevant topics and is required to submit a syllabus that
shows your objectives, topic outline, and plan of how are you going to present your topic as well as
evaluation measures for your learners. Once your syllabus is approved, you have to submit a resource unit
containing the detailed content of what you are going to discuss. You may submit it before your scheduled
presentation. Please be guided with the criteria on how your syllabus and resource unit will be rated based
on the rubrics for written outputs which can be found on the feedback portion of this module. This should
be accomplished during the first week of rotation (please refer to rotation plan schedule).
Here is the format for your syllabus and resource unit:
Bondpaper size - long
Font - either calibri, arial narrow, or courier new; size - 11 or 12
Page 1: Cover Page with the Title of your assigned topic, submitted by: your name, submitted to: CIs
name (indicate whether RN, RM, MN, MSN, MAN, MPH, PhD, & others)
Page 2: NORSU Vision, Mission, Goals, Corporate Values
Page 3: CNPAHS Vision, Mission, Goals, Objectives
Page 4: BSN 2 Goals and Objectives
Page 5:
TOPIC Title of assigned topic
PLACEMENT 1st Semester SY 2020-2021
PARTICIPANTS BSN II Section B, Prenatal Group1
TOPIC DESCRIPTION A brief description of your topic in 2-3
sentences
GENERAL One general statement which is specific,
OBJECTIVES measurable, attainable, realistic, time-
bounded (SMART). It should include
knowledge, skills, attitude (KSA) that you want
your learners to possess at the end of your

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
discussion; focus on your topic not N203 in
general.

Page 6:

CONTENT SPECIFIC TIME TEACHING - EVALUATI

OBJECTIVE ALLOTMEN LEARNING ON
S T ACTIVITIES

*columns with many entries should be provided a wider space; time

frame should only be 30mins-1 hour

Last Page: References in APA format; categorize to print and non-print. An example is shown
below:

ACTIVITY/EXERCISE B

WARDCLASS PRESENTATION. During the first week of the rotation, you are also expected to present
your report to the class. Since we could not meet face to face, you may make a video of your presentation
of your wardclass topics utilizing the activities stated in your syllabus. Be creative and resourceful enough
in utilizing materials available at home to present your topics comprehensively. You may send the recorded
video by google classroom or upload it in youtube and provide us the link. You may also share it with your
classmates by email.
Review the criteria indicated in the rubrics for wardclass presentation for you to be guided on how to
prepare your presentation. It is included in the feedback portion of this module.
NOTE: Failure to submit the said video presentation would mean an INC in your grade which you need to
comply once face to face classes resumes.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Section A.
WARDCLASS ASSIGNMENTS (Section A)
TOPIC GROUP 1 GROUP 2 GROUP 3
1. Theories of Labor DIOSMA, Mary AGUILAR, Precious NAKAHARA, Ken
2. Preliminary Signs of Genieve Gem OLBES, Aldrin
Labor EBROLE, Mary ALCALA, Mariaden A. OMAQUE, Careen
3. Characteristics of Janelle ANO-OS, Hazel P. Joy
ELNASIN, Nina ANTIASON, Britney E. PALMA, Janine Faith
True vs. False Labor
Nathaniel DIAGO, Shaira B. PALOMAR, Zandra
4. Components of
EMPEYNADO, Sheen Janine
Labor (do not include
ENTROSO, Cristel
Mechanisms of Labor)
Keith

1.Stages of Labor (pls ESTANDARTE, Kaye BAGAPORO, Jhon RENGQUIJO,

include Mechanisms of Alayna Romel O. Kimberly Pearl
Labor under 2nd Stage of ESTRADA, Ranie Ann BANONG-BEIRA, ROSALIA, Raye
Labor) GAHISAN, Candace Sophia Hope SANCHEZ, Jerica
2.Maternal and Fetal Merl BONGON, Princess Jel Gaye
Responses to Labor GULFAN, Phergel B. SANTAMARIA, Maria
3.Danger Signs of Labor BRIONES, Jae Astrid Luz Fatima
S.

1.Experience of Pain During ISO, Florida CIRUNAY, Jeyza C. SARONO, Allyza Joy
Labor LAURETE, Mary DECON, Lezil A. SIWA, Nicole Andre
 Etiology of Pain Queen DELA CRUZ, Roselle TUBAT, Rea
 Physiology of Pain LICOS, Jarah Thresha S. YABO, Necklame
2.Comfort and Pain Relief MARABULAS, Maria DENGAL, Aimen H.
Measures Rhona Pearl
 Pharmacologic and Non-
pharmacologic Pain
Mgts.

Section B.

WARDCLASS ASSIGNMENTS

TOPIC GROUP 1 GROUP 2 GROUP 3

Signs of labor and differentiate CAL, Poleigh AGIR, Rica VELEZ, Ruxandra
between false and true labor Shane M. L.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
Components of labor and CONJUICO, ALAPAP, Nazzar VALENCIA,
mechanisms of labor Christina Ericka A. Rachel E.

Stages of labor CORPUS, Prince ALVAREZ, Shena ULLA, Stephanie

Christian M. Glenn B.
Maternal and fetal responses and DE ASIS, Maria ANTIQUINA, TSAI, Ya-Hsin L.
assessment during labor Estrella B. Marriette

Electronic monitoring and care of DULAY, Kimberly APOYA, Fregen SIGLOS, Jannelle
the woman during the first stage Joy B. H.
of labor.
Care of the woman during the ENLAGADA, ARIOLA, Mark Dan SIENES, Chrisdale
second and third stage of labor Cherry B. Nerisse T.

Care of the woman during the ENRERA, Maria BALASABAS, SALAC, Jannie
fourth stage of labor and etiology Camela Q. Juvylyn Dei A.
of pain during labor and birth.

Comfort and pain relief measures GUNCE, Jiarl BALINTON, Aimie QUINTAO, Hanna
during labor Jimboy E. Regine
(complementary,alternative and
pharmacologic measures).
Psychologic and physiologic ISABELO, Raizah BANDAJON, Jade PARTOSA, Japeth
changes durIng postpartum Mae B. Marie John B.
period.

Profile and appearance of the LADION, Shiela BAYAWA, Kriza Shin ORTIZ, Alexis
normal newborn. Mae G. Leigh G.

Assessment for well-being and LOOC, Maria BOILES, Carla Mae NERI, Obet Andro
gestational age of a newborn. Obdulla D. D.

Care of the newborn at birth MANABIT, Princess BONSOBRE, Shannen MISSION, Mary
Kate V. Dale Mae S.
Nutritional needs of the newborn. MANIANGLUNG, BUGTAY, Katty Misiross MATULA, Joan
April Mae K. Kate L.

 You may search the internet for your topics but make sure that your source is reliable. It will be
preferable, however, if you use a Maternal and Child Health Nursing book by Adele Pillitteri. You
may still use internet sources for additional references. Please follow the APA format in citing your
references.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

ACTIVITY/EXERCISE C

HYPOTHETICAL CASE STUDY.

The current pandemic results to our inability to go on actual duty in the labor room and delivery rotation
area. With the rise in Covid-19 cases, it will be risky for each of you to be rotated and exposed at the
hospital to assess, and take care of a woman who is in labor and about to deliver. In order for you to better
understand the changes experienced by a labouring and about to give birth women, you will be given a
hypothetical case study to work on.
The following should be included:
1. Health History (demographic profile, past health history, family history (genogram), menstrual history,
obstetric history, etc.)
2. Physical Assessment (Head-to-toe)
3. Plotting of Partograph
4. Nursing Care Plan (with 3 priority nursing diagnosis); it should be inidividualized/based on client needs
and not just copy pasted from any source

FORMAT: For Health History and Physical Assessment follow the format you’ve learned in Health
Assessment class. For the nursing care plan, follow he table below.

ASSESSMENT NURSING OBJECTIVES INTERVENTION RATIONALE EVALUATION

DIAGNOSIS OF CARE
Priority # 1 Should be
Subjective stated in a Independent Based on the
Follow the
Cues specific, set criteria in
North
measurable, your
American
attainable, objectives.
Nursing
realistic, &
Diagnosis Dependent
timebounded
Association
(SMART)
(NANDA) in
Objective manner.
stating your
Cues
Dx with the Collaborative
direct With
physiologic clear/specific
cause of the set of criteria.
condition as
related
factor.
Priority # 2 Should be
Subjective stated in a

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
Cues Follow the specific, Independent Based on the
North measurable, set criteria in
American attainable, your
Nursing realistic, & objectives.
Diagnosis timebounded Dependent
Association (SMART)
Objective (NANDA) in manner.
Cues stating your
Dx with the
With Collaborative
direct
physiologic clear/specific
cause of the set of criteria.
condition as
related
factor.
Priority # 3 Should be
Subjective stated in a Independent Based on the
Follow the
Cues specific, set criteria in
North
measurable, your
American
attainable, objectives.
Nursing
realistic, &
Diagnosis Dependent
timebounded
Association
(SMART)
(NANDA) in
Objective manner.
stating your
Cues
Dx with the Collaborative
direct With
physiologic clear/specific
cause of the set of criteria.
condition as
related
factor.

**You may submit your hypothetical case study on the second week of labor room and delivery rotation. All
assessment data should be in a long size bondpaper, font size 11 or 12 either, calibri, arial narrow, or
courier new. Take note that the hypothetical case study comprises 40% of your clinical grade. Failure to
submit one may result to an INC mark. Please be guided on the rubrics for rating hypothetical cases.

PRACTICE TASK/ASSESSMENT
Plotting of the partograph.

Recording and plotting the partograph. Mrs. X was admitted in LRDR at 2PM. Upon abdominal
palpation the contraction were 3 in 10 minutes, each lasting 20 seconds. The FHT was 130/min. The IE
was 2 cm dilated, membranes were intact. Her blood pressure was 110/70 mmhg; her pulse was 76/min;
temperature 36.6 degrees celsius. At 6pm, the IE was 5 cm dilated; uterine contractions 3 in 10 minutes,
each lasting 50 seconds. The FHT was 140/min; membranes ruptured, clear. Blood pressure of 105/70
mmhg; pulse 80/min, temperature 37 degrees celsius. At 10 pm,the IE was 8 cm dilated; uterine

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
contractions 4 in 10 minutes, each lasting 60 seconds. The FHT was 140/min. Blood pressure of 105/70
mmhg; pulse 80/min, temperature 37 degrees celsius. Upload your partograph image.
10 points

Add file

Hypothetical Case Study: Section A

Patient Profile:
Name of Patient: Mrs. X
Husband’s name Mr. X
Age: 27
Religion: R. Catholic
Occupation: Housewife
Address: Sibulan, Negros Oriental
Date of Admission: November 15, 2020
Obstetrical Score: G1P0A0L0
LNMP: February 8, 2020
A. Chief Complaints:
- Amenorrhea from 9 months
- Having labor pains since 4 am
- Back ache
B. Patient’s Medical History
a. History of present illness:
- Patient was admitted on November 15, 2020 at 8 am, with complaints of pain in lower abdomen
since 4 am.
b. History of past illness:
- No history of hypertension, diabetes mellitus, cardiovascular diseases, coronary artery disease and
tuberculosis
- No surgical history
c. Family History:
- No history of genetically disorder and heredofamilial diseases
C. Personal History:
- Patient eats meat and vegetables. No history of drug allergies and drug addiction. No use of any
type of substances of abuse like smoking, drug abuse and alcohol.
D. Functional History:
- Sleep pattern and appetite is normal. Sedentary lifestyle
E. Menstrual History:
-Menstrual cycle is regular of 4-5 days with moderate flow. No intermenstrual bleeding and no coital
bleeding,

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
F. Obstettical History: G1P0A0L0

Assessment of Patient on Admission

General:
Body built: moderate
Weight: 56 kg.
Vital signs:
Temperature: 37.4 degrees C
Pulse: 94 bpm
Respiration: 24 cpm
BP: 124/80 mmhg
Hydration- Adequate
Anenia: none
Pallor: none
Heart: No abnormality detected
Lungs: No abnormality detected
Liver: No abnormality detected
Examination:
Abdominal:
On inspection fundal height: At level of xiphoid process of sternum
On Ausultation: FHT: 148/min
On palpation through GRIP:
Fundal grip: softer consistency
Lateral grip: in left lateral grip felt like a continuous hard flat surface
Pelvic Grip: Round part felt it means presenting part is head
Pawlik’s GRIP: Head is fixed
Uterine contraction: 2 contraction/ 10 min, duration > 20 seconds
Vaginal Examination
Vulva: Normal
Vagina: Normal
Cervix: 2 cm dilatation
Effacement: 30%
Membranes: Intact
Presenting Part: Head

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
Pelvis Seems adequate
Laboratory Tests:
Test Result Normal Value
1. Sodium 139 mEq/lit 135-145 mEq/lit
2. Potassium 3.9 mEq/lit 3.5-5.5 mEq/lit
3. CBC
-RBC 5.12 m/cu mm 4.3-6.3 m/cu mm
- WBC 8,000/ cu mm 4.5-11,000/cu mm
-Hemoglobin 8.9 mg/dl 12-14 mg/dl
-Hematocrit 36.4 % 40-50 %
-Platelet Count 150,000/mcl 150,000- 400,000/mcl
-Blood Type O(+)
4. Blood Glucose 90 mg/dl 80-120 mg/dl
5. Serum Cholesterol 242 mg/dl 120-250 mg/dl
-LDL 167 mg/dl <155
-HDL 33 mg/dl <35
6. SGOT 219 U/L 0-40 U/L
SGPT 67 U/L 5-36 U/L
7. URINALYSIS
Albumin (-) (-)
Sugar (-) (-)
RBC (-) (-)
WBC (-) (-)

Medical Intervention:
- D5LR with 10 units oxytocin hooked
- Nubaine given
Nursing Intervention:
- Straight catheterization
- Labor watching done
- Medications given

Progress of Labor:
- At 10 AM, Mrs. X on abdominal examination the contraction 3 in 10 minutes, each lasting at 50
seconds. The descent head was 3/5 above the brim, 4 cm dilated. FHT is 140/min. Membranes
ruptured , clear, no molding. BP 105/70 mmhg; pulse rate 80/min, temperature 37 degrees C.
respiratory rate 20 cpm
- At 1 pm, 6 cm dilated, contractions were moderate, 3 in 10 min, duration 60 seconds. VS remained
the same.
- At 7 pm, IE was done and showed 8 cm dilated cervix, Contractions at 4 in 10 minutes, 70 seconds
duration, intensity moderate, +2 station 90 % effaced with meconium stained amniotic fluid. Vs: BP:
110/70 mmhg; PR: 92 bpm, T: 37.5 degrees C; FHT: 140 bpm.
- At 9 pm, IE was done and showed 10 cm dilated cervix, +3 station, 100 % effaced. Contractions 5
in 10 mins, duration 90 secondsPerineal prep done, The doctor did a midline episiotomy. At 9:30
pm, Mrs. X, gave birth to a 3100 gms baby boy in LOA position. At 9:33, placenta was expelled
showing shultze placenta. The baby was given initial care and crede’s prophylaxis to the eyes and
given Vitamin K and Hep B IM at vastus lateralis left and right. Placed identifying bracelet and left

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
at abdomen’s mother for skin to skin contact. VS of baby within normal limits, no gurgling lung
sounds. No abnormalities noted.
Instructions:
1. Compute the AOG AND EDC
2. Record and plot the partograph (attached an image file of your recording and plotting on the
partograph form).
3. Make an NCP for first stage of labor active phase

Hypothetical Case Study: Section A

CASE STUDY #1: LABOR AND DELIVERY SITUATION: Mrs. M. is a 27-y/o gravida 3, para 2, who was
admitted at term at 6:30 p.m. She stated that she had been having contractions at 7 to 10 minute intervals
since 4 p.m. They lasted 30 seconds. She also stated that she had been having "a lot of false labor" and
hoped that this was "the real thing". Her membranes were intact. Mrs. M.'s temperature, pulse and
respirations were normal and her blood pressure was 124/80. The fetal heart tones were 134 and regular.
The nurse examined Mrs. M. and found that the baby's head was at +1 station, and the cervix was 4 cm.
dilated and 80 percent effaced. She reported her findings to the doctor and he ordered Demerol 50 mg.
with Phenergan 25 mg. to be given intravenously when needed.
1. Do you think Mrs. M. is in false labor? Give reasons for your answer.
2. As Mrs. M. was getting into bed, her membranes ruptured. What is the first thing that you would do after
this occurs? Why?
3. After her membranes ruptured, her contractions began coming every 4 minutes and lasted 45 to 55
seconds. They were moderately strong. Why is it important for Mrs. M. to relax during her contractions?
How can you help her to relax?
4. When do you think Mrs. M. should be given the medication ordered by the doctor? What safety
measures should be taken at the time the medication is given? What observations should be made after it
is given? Why? What observations would you report to the doctor?
5. How would you know that Mrs. M. has entered the transition phase? 6. A vaginal exam revealed that
Mrs. M. is complete and +2. What should be the nursing interventions at this time?

TEACHER INTERVENTION

If you have any concerns/ clarifications regarding this module or the task assigned to you, you may reach
me by email [email protected] and [email protected] or call or text at this number:
09952525618. If using facebook messenger is more convenient for you to communicate, please do not
hesitate to send a message in the group that has been created for N203- A and B.

If there are instructions which are unclear to you, do not hesitate to ask for clarifications to avoid mistakes
in accomplishing your requirements.

FEEDBACK

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
Feedback on all activities will be given as soon as requirements are reviewed individually. Each
requirement are graded based on the following rubrics below.

ACTIVITY A RUBRICS

ACTIVITY B RUBRICS

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

ACTIVITY C RUBRICS

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021
 COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES
NOTE: After assessment of each requirement, it will be rated accordingly. But, if there is a need for you to
make improvements, it will be sent back to you for revision. Feedback will be given individually or through
group conferences which will be scheduled based on the availability of the majority.

REFERENCES:
References:
Pillitteri, A. (2010). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family.
(6th ed.). Philadelphia: Lippincott Williams and Wilkins.
Pillitteri, A. (n.d). Electronic Monitoring. Fetal Heart Rate and Uterine Contractions Record. Maternal &
Child Health Nursing, 6(1), 377-380. Quezon City, Philippines: C&E Publishing, Inc.
Pillitteri, A. (n.d). Nursing Care of a Family During Labor and Birth. Maternal & Child Health Nursing , 6(1),
357-359. Quezon City, Philippines: C&E Publishing, Inc.

Prepared by: R.M. Abellanosa & C. Villalon, 1st Semester, S.Y. 2020-2021