NURSING AND MIDWIFERY TRAINING COLLEGE, SEKONDI

FAMILY CENTERED MATERNITY CARE STUDY DURING

PREGNANCY ,LABOUR AND PUERPERIUM

ON

MADAM I.E

BY

6922190038

A STUDENT MIDWIFE IN PARTIAL FULFILMENT FOR THE AWARD OF

DIPLOMA REGISTERED MIDWIFERY

JUNE 2022

PREFACE

Family Centered Maternity Care Study is a systematic approach in rendering comprehensive

nursing care to a pregnant woman and her family throughout pregnancy, labour, and
puerperium. It aims at helping the family to accept the pregnancy and the coming of a new
member into the family and to help the expectant mother to stay healthy and have a healthy
baby.

This involves the use of the nursing process which is a scientific approach to data collection,
data analysis, planning, implementation, and evaluation of nursing care rendered by the
midwife.
This care study allows the student midwife to use the knowledge and skills acquired in her
midwifery training to successfully nurse a client throughout pregnancy, labour, and
puerperium.

This care study is also designed to help the student midwife develop practical skills in
midwifery and help put into practice the theoretical knowledge acquired in her three-year
training.

It offers the student an opportunity to give individualized and quality obstetric care to meet
the physiological, psychological, social, spiritual, and rehabilitative needs of a client based
on the nursing process.

The experience and knowledge acquired during this study will enable me to give the best
care in my midwifery practice irrespective of where I find myself and this will as well help
reduce maternal and infant morbidity and mortality.

It builds teamwork among staff and good interpersonal relationships between the midwife
and clients. In giving holistic care to my client, confidentiality should be kept. This care
study is also compiled into a document in partial fulfillment for the award of a diploma in
midwifery by the Nursing and Midwifery Council for Ghana after training. In view of this,
my client would be known as Madam I.E. throughout the narrative report.

ACKNOWLEDGEMENT

My greatest thanks goes to the Almighty God for granting me wisdom, guidance,
knowledge and understanding in making this care study a success.

I would also like to thank the Principal Mr. Abdul Karim Boakye Yiadom (Alhaji) and the
entire tutors of the Nursing and Midwifery Training College, Sekondi who also gave me the
opportunity to study in the school. My sincere gratitude goes to my Supervisor, Sister Anti
Kwakye for her guidance and corrections made in making this script meaningfully complete
and also for her time and support throughout the writing of this care study.

My sincere appreciation goes to Madam I.E who willingly allowed me to use her for this
study and many thanks to her husband and her mother in-law for their support.

A special thanks goes to the Staff of Essikadoi Government Hospital, especially Sister

Sarah, the maternity ward in-charge and all the staff for their help given and the education
they elicited throughout the period of my clinical experience. I say may the Almighty God
bless you.

Special appreciation goes to my family members especially, my father Mr George Ayensu

and Mrs. Grace Ayensu my mother for their financial support and encouragement
throughout my education.

I am very grateful to the authors and publishers of all the books I used as references in the
success of this may the Good Lord bless you all.

TABLE OF CONTENTS

CONTENTS

PREFACE

ACKNOWLEDGEMENT

TABLE OF CONTENT

INTRODUCTION

LITERATURE REVIEW

WHY I CHOOSE MY CLIENTS

CHAPTER ONE
ASSESSMENT OF CLIENT AND FAMILY

Social History

Family History

Medical History

Surgical History

Menstrual history

Past Obstetric History

Present Obstetric History

Family’s medical and socio-economic History

CHAPTER TWO

ANTENATAL CARE

First Contact with Client

First Antenatal Home Visit

Subsequent Visit to the Clinic

Subsequent Home Visit

Antenatal Nursing Care Plan

 CHAPTER THREE

INTRAPARTAL CARE

ADMISSION AND MANAGEMENT OF LABOUR

Management of First Stage of Labour

Management of Second Stage of Labour

Immediate care of the baby at birth

Management of the Third Stage of Labour

Management of the Fourth Stage of Labour

Labour Notes

Nursing Care Plan on Labour

CHAPTER FOUR

POSTNATAL CARE

MANAGEMENT DURING PUERPERIUM

Care of the Mother during Puerperium

Subsequent Care of the Baby During Puerperium;

Examination of the Baby

Baby’s First Bath and Cord Dressing

First Day Post natal and Discharge

First Day Post natal Home Visit

Second And Third Day Postnatal Home Visit

Fourth To Sixth Day Postnatal Home Visit

Seventh Day Postnatal Home Visit

First Post Natal Review Visit

Nursing Care Plan on Puerperium

SUMMARY AND CONCLUSION

BIBLIOGRAPHY

APPENDICES

SIGNATORIES

INTRODUCTION

Family Centered maternity care is a systematic approach used in nursing and caring for an
expectant mother and her family. It is based on rendering holistic individualized client
centered care to the expectant mother and her family are involved in this care throughout
pregnancy, labour and puerperium.

This care started on the 17th January 2022 when Madam I.E visited the Essikado Hospital
for her scheduled antenatal visit. She was nicely and neatly dressed with a nice hair style.
Madam I. E. came to the health facility early in the morning. I observed her when she was
sitting down and she looks very tired and unwell. After her registration I approached her,
introduced myself to her as a student midwife from NMTC, SEKONDI, I then asked of her
problem and she said, she is having backache and she feels dizzy as well. I reassure her that
she will be fine by the time she finish receiving care for the day and she was a bit relieve. I
collected her antenatal record book, looked through and realized that she had a good
obstetric history and also met the criteria for the care study.

I choose Madam I.E as my client because she met the criteria for the client centered
maternity care study, I chose her for the care study because she was co-operative and was
interested in learning from me. Also I wanted to take the opportunity to assist in managing
the problems she complained about.

I then informed client about my intention to take her for my client centered maternity care
study and nurse her for the rest of the period of pregnancy, during labour and deliver and
one week after delivery. She then accepted and promised to give me all the necessary
information I will require from her.

Madam I.E was a 32 year old woman, gravida 4 para 3 all alive and a hairdresser who was a
regular attendant at antenatal clinic. She was 36weeks plus 6days of gestation, had good
past and present obstetrical history, and has had previous delivery and gone through
puerperium safely without any complication. Client’s condition at the beginning and end of
our interaction was good. Both mother and baby stayed healthy throughout the period of
pregnancy, labour and puerperium. This report is presented in four chapters.

The first chapter talks about client’s profile/social history, habit of daily living/hobbies, past
medical, surgical, menstrual, past obstetric and present obstetric histories as well as family
medical and socioeconomic history, then client’s home environment.

The second chapter entails first contact with client: first antenatal home visit to the client,
subsequent antenatal clinic visits, subsequent home visits to the client.
The third chapter is about the intrapartal care which includes admission and management of
first stage, second, immediate care of the baby at birth, third stage of labour, and fourth
stages of labour. It also includes summary of labour notes, duration of labour, condition of
mother after birth, sex of baby, condition of baby at birth, examination of the placenta and
its membranes.

The fourth chapter is about management during the puerperium which includes narrative of
care during fourth stage of labour, subsequent care of baby during puerperium, examination
of the baby, baby’s first bath, first day post-delivery, post-delivery home visits, 1st
postnatal review visit.

nursing care plan was used in the management of client’s and baby`s

problems from pregnancy, labour and delivery through to puerperium.

LITERATURE REVIEW

Pregnancy is also known as gravidity or gestation is the time during which one or more
offspring develops inside a woman. Pregnancy can occur by sexual intercourse or assisted
reproductive technology.

It usually last around forty (40) weeks from the last menstrual period and ends in child birth
(Wylie and Linda, 2005). Hammond (1996) explained that during pregnancy, lots of
physiological and physical changes takes place under the influence of hormones.
Physiological changes occur in the reproductive system which involves the changes in the
myometrium, perimetrium, uterine size from the first few weeks to 36 weeks.

Also physiological changes occur in the cardiovascular system, the immune system,
respiratory system, urinary system, gastrointestinal system, musculoskeletal system and
maternal weight. Some of these hormonal changes result in minor disorders such as morning
sickness, heartburns, constipation, abdominal pain and varicose veins.

There is also an increase in pigmentation of the skin such as chloasma. In the urinary
system, the mother experiences frequency of micturition due to the effect of progesterone
relaxing the detrusor muscle.

According to Fraser and Cooper (2003), pregnancy is divided into three trimesters. The first
trimester is from conception until 12 weeks of gestation. This phase is associated with
changes such as breast tenderness and feeling nausea. The second trimester is from 13 to 25
weeks during which the woman’s body begins to grow. The third trimester is from 25 weeks
to 40 weeks, a period when the fetus continue to grow and become mature for delivery.

Antenatal care : is a planned examination, observation and guidance given to the pregnant
woman from conception till the time of labour. According to Fraser and Cooper (2003),
antenatal care follows a traditional pattern consisting of monthly visits until 28 weeks
gestation, two weekly visits until 36 weeks and weekly visits until the birth of the baby.
Some of the goals of antenatal care are to reduce maternal and prenatal mortality and
morbidity rate and to improve the physical and mental health of women and children. For
comprehensive care, the woman needs to attend antenatal clinic and focus antenatal is the
ideal. Focus antenatal care is cheaper, better, faster and evidence-based approach to
antenatal care .This care was developed with the package which includes counseling,
examination and tests that serve immediate purpose and have been proven health benefit.
Education during pregnancy includes health education on personal and environmental
hygiene, exercise, rest and sleep, danger signs during pregnancy and birth preparedness and
complication readiness plan (Cooper 2003).

Labour : is the process by which the product of conception that is the fetus, liquor amnii,
placenta and membranes are expelled from the uterus after the 28th week of gestation
through the birth canal (Kirkman 2003).
According to Barbara Weller (1996), labour is the process by which the uterus empties its
content after 28th weeks of pregnancy. She further explained that normal labour starts at
term and its spontaneous and the foetus present by vertex. The mother delivers by naturally
unaided effort, the period does not exceed 18 hours, and no complication arises. Certain
contributing factors such as hormonal theory, mechanical theory and nervous theory have
been pondered about the onset of labour (Fraser 2003).

According to Balliere’s Nurses’ dictionary, labour has four stages. Tiran (1997) says the
first stage starts from the onset of regular painful uterine contractions and retractions to full
dilatation of the cervical os. First stage last for 11 hours and 6 hours 30 minutes in
primigravida and multigravida respectively. The second stage starts from full dilatation of
the cervical os to complete expulsion of the foetus. It last for 45 minutes and 15 minutes in
primigravida and multigravida respectively. The third stage marks the complete expulsion of
the placenta and membranes. This stage lasts for 15 minutes in both multigravida and
primigravida. The woman in labour is monitored on the partograph. The partograph is a
graphical record of the progress of labour, particularly the dilatation of the cervical os.
Progress can be assessed from the visual pattern of cervical dilatation and descent of
presenting part in conjunction with the record of maternal wellbeing. When normal progress
does not occur, action such as augmentation with oxytocic drugs can be given (Tiran 1997).
The foetal heart rate, maternal pulse and contractions are monitored every 30 minutes,
vagina examination done 4 hourly, blood pressure and temperature are monitored 2 hourly
and urine examination is done 4 hourly and plotted on the partograph to monitor progress of
labour. The fourth stage is the first six hours post-delivery (Copper and Fraiser
2009).During this stage, the baby and mother are closely are closely monitored and
observed to rule out postpartum complications such as hemorrhage and cord bleeding.

puerperium is defined as the time from the delivery of the placenta through the first weeks
after the delivery where uterus returns to its non-gravid state. Puerperal changes begin
almost immediately by a drop in the levels of oestrogen and progesterone produced by the
placenta during pregnancy. The uterus shrinks back to its normal size and resumes its pre-
gravid position by the sixth week. During this process called involution, the excess muscle
mass of the pregnant uterus is reduced, the lining of the uterus (endometrium) is re-
established, usually by third week. While the uterus returns to its normal position, the breast
begins lactation. Colostrums, a high-protein form of milk is produced by the second day
after the birth and is gradually converted to normal breast milk which has less protein and
more fat by middle of the second week (Britannica, 2005). According to Veralls (2001),
puerperium is the period of 6-8 weeks following childbirth, during which time the genital
organs return to their pre-pregnant state, lactation should be established and the new born
infant should be accepted in the family. The uterus which developed over 40 weeks period
during pregnancy has now a much shorter time in which to make regressive changes.

These changes are described as involution. Immediately following the third stage of labour,
the fundus of the uterus is found about halfway between the symphysis pubis and umbilicus.
Within the next 24 hours, the lower uterine segment regains its tone and pushes up the
fundus to the level of the umbilicus. If the uterus is palpated on each successive day, it is
found to be a finger-breath lowers the abdomen at each examination. By the 10th day of
puerperium, it can no longer be palpated abdominally because ante version and ante flexion
are almost complete.

WHY I CHOOSE MY CLIENT

On the 17th of January 2022 I met madam I.E during seventh antenatal visit.After going
through her maternal health record book ,I realized she was 36weeks plus 6 days gestation
and fall under the criteria for the family centered maternity care study . I therefore introduce
myself as a student midwife from Sekondi Nursing and Midwifery Training College and
made my intention of using her as my client for the care study by taking care of her
throughout the latter part of pregnancy,labour and the first seven days of puerperium after
which she will be handed over to either a public health or community health nurse for
continuity of care which she agreed.
 CHEAPER ONE

ASSESSMENT OF CLIENT/ FAMILY

This chapter gives detailed information about the client, her family, and community
characteristic, and it includes client Social history, habit of daily living/hobbies, past
medical history, surgical history, past obstetrics history

Client Social History

Madam I E is a 32 years old pregnant woman. She comes from Komenda and staying at
parisquare, a suburb in Sekondi Takoradi in the Western Region of Ghana. She is 160cm
tall, fair in complexion. She does not smoke nor drink alcohol. She had her formal education
up to secondary school level. She speaks Fante and works as a hairdresser which is where
she gets her source of income of about. GHC700 monthly. Client is a Christian who
fellowships with the church of Pentecost at Parisquare.

She has been happily married to Mr. E E who works with Ghana Ports and Authority and
blessed with three children two girls and a boy the first child is S E who is 8years old , the
second child is E E who is 6years old and the third child is V E who is also 3 years old.
They attends the community school. Client’s next of kin is her husband Mr. E E

Madam I E wakes up by 5:30am. The first thing she does is brushing her teeth and doing her
morning devotion. She then prepares breakfast for the children and prepares them for
school. They go to school by their School bus. She continues with her house chores when
her children are gone before she also prepare to go to work. There are varieties of food
which they take as breakfast but they normally take tea and porridge with bread as breakfast
around 6:30am. During late afternoon, she sometimes picks up her children from school and
rest before preparing supper for the family. She normally takes rice and stew or yam with
garden eggs stew for lunch although there are varieties of food they take at lunch, and takes
in fufu and light soup or banku with okra soup as super. She likes banku with pepper and
fish. She likes taking meat pie with sobolo as her snacks. She likes watching Ghanaian
movies during her leisure time and playing of ludu.

She baths twice daily and empties her bowel once or sometimes twice daily. She urinates
when she feels the urge to do so about four to five times depending on the weather and the
amount of water she takes. During the weekend thus Saturdays, she wakes up early and does
general cleaning of the home, washes dirty clothes and prepares her dishes for the weekend
with the help of her husband. After the days duties she sits with her family to enjoy some
family time together in a form of watching movies or sometimes chat together whiles they
enjoy some fresh air outside.

On Sunday, they go for early church service and return home by 11:00am to prepare lunch
which is usually fufu with soup or banku with pepper and fish and they take their supper at
around 5:30pm which is usually rice and stew or jollof rice. They watch television and
resume to bed at 8:30pm. Her hobby is watching movies.

Family History

Madam I.E said she is the first child of three children born by her parents, Mr and Mrs A.
According to her there is no hereditary history of any medical condition like hypertension,
heart disease, diabetes, jaundices, asthma and sickle cell disease.They do not suffer from
Epilepsy and Mental illness. She said the family occasionally suffer from ailment like
headache fever and abdominal upset and whenever they feels sick, They visit the hospital
for treatment. They have no known allergies to food or drugs and no history of STIs,
including syphilis and HIV. The other siblings are working and do not depend on madam
I.E.
 PAST AND PRESENT MEDICAL HISTORY

According to made I.E she does not suffer from any medical conditions like
hypertension,heart disease, sickle cell, diabetes mellitus, epilepsy, and respiratory diseases
like tuberculosis, chronic cough, asthma and some infections like HIV . Client belong to
blood group A Rhesus positive.she said she occasionally suffer from minor ailments such as
headache fever , malaria and she normally visit the hospital for treatment .She added that
she has no allergies to drugs nor food .

Surgical History

According to Madam I E she has never undergone any surgical operation being it major or
minor such as caesarean section (CS), myomectomy, laparotomy or had any injury which
requires surgical intervention on her pelvis. Also she has not received any blood transfusion
before.

Menstrual History

Madam I E had her menarche at the age of fifteen (15) years; she has 28days menstrual
cycle and bleeds moderately for three to six days. The problem she normally faces during
menstruation is abdominal cramps at the first day of her menstruation. According to her, she
has never used any contraceptive before. She could not remember her last normal menstrual
period but expected date of delivery (EDD) by scan was 8th February 2022

Past Obstetric History

Madam I.E gravida 4, para 3 all alive carried her previous pregnancies to term without any
complications such as placenta previa, placenta abruption, preeclampsia, eclampsia,
antepartum haemorrhage she has no abortion or still birth. According to her antenatal
booklet under her past obstetric history, first pregnancy was in 2013, which she delivered a
male infant on 17th November with weight 3.2kg and second pregnancy was in 2016, which
she delivered on 11 February with weight 2.8kg and third pregnancy was 2018which she
delivered on 28 November with weight 2 8kg. . She was a regular attendant to the clinic ,
she received all doses of sulphadoxine pyrimethamine as prescribed during her pregnancies;
she has received all the life time shots of tetanus immunization as well as dose of
Albendazole to help prevent worm infection . According to client she had all her deliveries
at hospital with gestational age of 40 weeks she added that she had spontaneous vaginal
deliveries with no episiotomy, she confirmed that her second stage of labour took about 20
minutes. The third stage was managed by active management and it took less than 15
minutes, she said she did not lose a lot of blood or was transfused with blood Madam I.E
said, all babies cried effectively immediately after birth. All babies were completely
immunized against all the childhood preventable disease and their condition at the time of
interaction was good.

According to my client, she was discharged 24 hours after delivery she went through
puerperium without any complications such as breastfeeding problems, puerperal sepsis,
postpartum haemorrhage etc she had a normal lochia flow for 10 days and it was moderate .
For all deliveries, she resumed her normal menstruation after eight months and breastfed
exclusively for six months. She weaned them off breast milk at the age of two years. She
never practiced any artificial family planning but decided to go with the natural way of
preventing pregnancy. She had support from her husband as well as her family and some
relatives.

Present Obstetric History

According to Madam I.E she visited the antenatal clinic on the 13th

September 2021 for the first time at Essikado Hospital . She said she does not recall the date
yof her last menstrual period and her expected date of delivery (EDD) was on the 8th

February 2022according to her scan.

She felt her fetal movement on the 5th month of pregnancy and the first dose of
sulphadoxine pyrimethamine was given on the 13th September, 2021 (18th weeks plus
2days), second dose was on the 11th October, 2021(22weeks plus 6 days), and the third
dose on the 8th November, 2021(26th weeks plus 6 days), and the fourth dose was given on
20th December 2021 (33 weeks ) and the Fifth dose was given on 17th January 2022 (36
weeks plus 6 days ) they were given under the direct observational therapy. On her visit to
the clinic after registration, her vital signs were checked and recorded as follows:

Temperature 36.2 degree Celsius

Pulse98 beats per minute

Blood pressure 110/60 millimeters per mercury

Weight65kg

Height 160cm

Laboratory investigations were recorded as follows;

Blood group A Rhesus factor positive

Glucose 6 Phosphate Deficiency No defect

Haemoglobin level 10.0g/dl

Venereal Disease Research Laboratory (VDRL)/Syphilis: Negative

HIV status Negative

Urine No protein

BF for MPs No MPs seen

Hepatitis B Non-reactive
According to her antenatal booklet, head to toe examination was conducted and revealed no
abnormalities, abdominal examination revealed no scars, as well as striae gravidarum and
client was in her second trimester according to her maternal record book. She complained of
headache Madam I E was reassurebreast.Physiology of pregnancy was explained to her. She
was encouraged to avoid doing strenuous exercise.

Client was given the following routine drugs and was encouraged to take them as
prescribed;

Tablet Folic Acid - 5mg daily × 30days

Tablet feMylesàQ sulphate - 30mg 1 daily × 30days

Tablet Multivitamin - 5mg 3 times daily × 30days

Madam I E was asked to report; to the clinic regularly as per scheduled by her date of next
visit for care. However, in case of any ill health such as vaginal bleeding, excessive
vomiting, excessive abdominal pain, swelling of the feet and face and severe headaches, she
was advised to report before the scheduled date. She has had health education on topics such
as danger sign in pregnancy, rest and sleep, nutrition, used of insecticide treated bed nuts,
breastfeeding and breast care, birth preparedness and complication readiness. She was
schedule for four weekly visits of which she complied and attended clinic regularly and was
taking through all the routine care, including assessment, physical examinations and
education as well as she did various routine laboratory investigations and ultrasound scan.
And her records also confirmed she reported to the hospital when she felt any abnormalities.

CHAPTER TWO
 ANTENATAL CARE

This chapter deals with the care to the client and gives information about my first contact
with client, first antenatal home visit, subsequent visit to the clinic, subsequent home visit to
the client’s home and managing of the problems identified using the nursing care plan.

First Contact with Client

I first came into contact with Madam I E at the antenatal clinic of the Essikado Hospital in
the Western Region on 17th January, 2022, at 9:10am when she came for her routine visit at
36 weeks +6days gestation. It was her seven visits to the clinic. I met Madam I. E at the
entrance to the hospital and she looked very tired and complained of backache. I assumed
because she walked from the junction to the hospital that has caused the tiredness, but
during the health talk on the use of the mosquito net to prevent malaria she still looked tired
and quiet. After the talk, I went for her antenatal record book and checked whether she meet
the criteria for the family centered maternity care study and told the midwife in -charge
about me using her as my client and she told me to take her vital signs, weight and do a
urine test. These were the results;

Temperature 36.40 C

Pulse rate 80 beat per minute.

Respiration 24 count per minute.

Blood pressure 110/60millimetre per mercury.

Weight 70 kilograms.

Urine tested for glucose albumin and protein Trace /Negative

Gestational age. 36weeks plus 6days

FHR. 146

SFH. 37cm
I introduced myself to the client as a student midwife from NMTC Sekondi; I established
rapport with her and assured her of confidentiality. Procedures for assessment and care
were explained to her. On history taking, Madam I E complained of backache. I reassured
her and sought permission to do general examination from head to toe.

She emptied her bladder while I provided privacy. I then assisted her to undress and assisted
her to lie on the couch for the head to toe examination under supervision of the midwife in-
charge. I washed my hands with soap under running water and dried them with a clean dry
towel. On examination, she had a neat hair and tie together with a beautiful band. Her face
was clean with no puffiness, sclera was white and conjunctiva looked pink. There was no
discharge from her nose and ears. Her mouth was inspected. The teeth were white and clean,
tongue not coated, no gum bleeding or dental caries or offensive odour from her mouth.
There was no distended neck vein or enlarged lymph nodes on palpation of neck.

On breast inspection, nipples were centrally situated and erect; areola was darkened with
prominent areola. On palpation, there was no lump or axillary swelling or abnormal/blood
stained discharges from her breast, there was no discolouration or redness of the breast skin.
I taught her how to perform breast self-examination when she resumes menses after birth
and advised her to report whenever she detects any abnormalities such as a lump, a huge
axillary swelling or blood stained discharges in the breast.

Her upper limbs were equal in size and length. Finger nails were kept clean, short and neat,
no pallor of the palm and nail beds.

On abdominal examination, inspection showed the abdomen was globular in shape, linear
nigra, striae gravidarum were present but there was no scar and edema on the abdomen. On
fundal palpation, symphysiofundal height measured 37cm and gestational age was 36
weeks + 6days. The lie was longitudinal, with fetal limbs palpated on the right side and back
at the left side of the mother’s abdomen upon lateral palpation, presentation was cephalic on
pelvic palpation, position was left occipito anterior, and descent of the fetal head was 5/5 th
above the pelvic brim. On auscultation, the fetal heart rate was 146bpm with good volume
and regular rhythm. There lower limbs were equal in length but there was no ankle oedema,
pain in the calf muscles or varicosities and pallor . Client back was examined and no
abnormality detected.

Permission was sought to inspect the vulva. On vulva inspection, the underwear’s were
clean and pubic hair was shaved with no vulva warts, varicosities, sores or offensive
discharges seen.

After examination, I helped her to get out of bed and assisted her to dress. I thanked her and
explained the findings to her. I washed my hands under running water and dried. I recorded
the findings in her antenatal record booklet. She was given the last dose of the Sulphadoxine
Pyrimethamine under direct observational therapy. She was put on the following
medications.

Tablet folic acid 5mg daily x 7days

Tablet Multivitamin 5mg 1 daily x 7days

Tablet ferrous sulphate 200mg 2 daily x 7days

I encouraged her to take her treatment for her to recover soon. She was advised to eat well
balanced diet prepared from locally available food such as kontomire, agushie, beans and
dried fish. She was also advised to take in more fluids and fruits, sleep under treated bed
nets and reduce strenuous activities at home. I told the client about my intention to use her
for my care study to continue the care and management for the rest of her period of
pregnancy, labour, puerperium. I went on to explain to her that as part of the three year
training, I have to take a client and care for her throughout pregnancy, labour and
puerperium which involves collecting data from her, visiting her at home, delivering her and
caring for her one week after delivery. She was pleased and agreed to be my client and I
thanked her.

I scheduled an appointment to visit her. She gave me her telephone number, the location and
direction to her house. I thanked her and saw her off outside the hospital.
 FIRST ANTENATAL HOME VISIT

I visited Madam I.E on 22nd January, 2022 at 9am. I was able to get there through the
directions she gave me. The aim of the visit was to know the client’s home environment in
order to know if there is any condition present that may endanger the health of my client. I
was warmly welcomed by her husband and her children in the house with her.

Madam I.E lives in a self-contained House with a well arranged big hall at Parisquare
adjacent the main road. The house was built with blocks, plastered and roofed with
aluminum sheet which was painted yellow in the outside and cream inside the rooms. The
room has four windows and a door for the hall and same for the bedroom and that allows for
good ventilation in the rooms. Both the hall and bedroom were well arranged with a well-
furnished kitchen, bathroom and toilet. She dumped her refuse in a plastic dustbin with a
well-fitting lid and disposed it off every morning at a refuse dump site. According to client
their waste water is drained by a small gutter at the back of the house which looks neat.
They use electricity as a source of light and her source of water is from the community pipe
borne water which is not far from the house. Her husband and children helps with her daily
chores and cleaning when they are around. Madam I.E has a good interpersonal
relationship with her neighbors .She is clam ,kind , friendly and hardworking they come
together on Saturday to clean the compound ,She participates in social activities in the
community .client is emotionally and psychologically stable and she is happy and prepare
to receive the new member into their family.

There was also stagnant water in small hole just beside the house which is likely to breed
mosquitoes so I encourage her husband and children to drain the water and fill the hole with
stone to prevent breeding mosquitoes. However, her surroundings were neat with good
drainage system. I congratulated them on how they had kept their house tidy and
encouraged them to keep it up. I asked about the previous complains and she said she was
fine and coping with it. I asked of any complaints and she said she was not able to move her
bowel regularly. I educated her on the need to take in adequate water of about 6-8glasses of
water daily, eat more fruits and vegetables and other foods which contains enough fibers to
prevent constipation. She was educated on taking balanced or adequate diet. I also explain to
her the importance of antenatal clinic and to follow every treatment given to her in the
clinic.

I asked her to bring her items for delivery for inspection and everything was well packed in
a bag with the maternal record book and national health insurance scheme.

I took the layette out of the bag and rechecked to make sure she had everything in the bag. I
then inspect her national health insurance card and her maternal record book. I reminded her
of the expected date of delivery. I told her that she needs one person to take care of the
children in the house when labour sets in and one who will accompany her to the hospital. I
told her to arrange for a car which will take her to the hospital any time labour sets in and
that she should arrange with two drivers so that if incase one fails, she can call the other and
to also look for a blood donor when the need arise for blood transfusion. She was
encouraged to put some money aside in case of any emergency though she has the national
health insurance card. She was educated on the importance of using treated bed nets to
prevent malaria which will lead to anemia in severe cases. I also encouraged her to maintain
her good personal hygiene especially her under wears, the need to wash and dry them under
sun frequently.

The discussion was lively so they requested that I visit them again and I promised to do that.
I reminded her of the next visit to the clinic. I thanked them for their co-operation and
dedicated time and left, promising to see her at the clinic.

My second visit to Madam I.E house was on 29th January, 2022 at 10:30 am. I was warmly
welcomed. I asked of their health and they said they were doing well. I went to find out how
she and the family were faring and to find out her final preparations and arrangement for
birth. I also inspected if they have trained the stagnant water as I directed the last time I
visited and they had done exactly as was directed and she had a new cupboard where she
had arranged her kitchen items neatly. I thanked them for reinforcing all that they were
educated to do.
She was feeling well and coping and the family was doing fine. Client looked cheerful and
healthy. We discussed about her final preparation towards labour and delivery since she can
deliver anytime from then and everything was set. Her layette was set and well arranged,
blood donors were ready, plans for transportation had been made and client had put many
things in place and in order. Her husband was available to take her to the hospital during
labour and her sister will also be taking care of their home and the children in her absence.

She again complained of waist pains, frequent micturition and insomnia. I reassured her and
explained that they were due to physiological changes in pregnancy. I explained to her that
the waist pain is cause by growing fetus stretching the abdominal muscles and putting
pressure on the pelvic organ. I educated her to avoid bending down for longer hours when
performing household choices like washing but rather sit down to reduce pain. Again the
frequent of micturition was explained to her as the descent of the fetal head pressing on the
urinary bladder and was encouraged to ensure complete emptying of bladder when she feel
the urge. About the Insomnia, client was encouraged to adopt a comfortable position when
sleeping and also encourage her to sleep on a firm mattress.

She was encouraged to take her routine drugs, to eat well balanced diet and to have adequate
rest and sleep. I educated her on signs of true labour and encouraged her to report to the
clinic if she experienced them and I told her to call me on phone when labour sets in and I
will be available at the labour ward waiting for her arrival, also she is supposed to report for
antenatal care as scheduled until labour sets in. I thanked her and left.

SUBSEQUENT ANTENATAL VISIT TO THE CLINIC

Madam I.E reported again to the antenatal clinic three times after my first contact with her.
That was on the 24th January, 2022 and 31st January, 2022 with gestational age 37weeks
+6days and 38weeks +6days respectively. On each occasions of these visits, she was taken
through the usual routine examination including physical examinations and recorded as
follows;

24/1/2022

Temperature 36.7oC

Pulse 84 bpm

Respiration 24cpm

Blood pressure 100/60mmHg

Weight 70 kilograms

Urine testing for sugar and protein were neg/neg

31/01/2022

Temperature 37.5degree Celsius

Pulse 86beat per minutes

Respiration 22 count per minute

Blood pressure 110/60mmHg

Weight 77kilograms

Urine testing for sugar and protein were trace/negative.

07/02/22

Temperature 36.4 degree Celsius

Pulse 88 beat per minute

Respiration 24 count per minute

Blood pressure 100/70 mmHg

Weight 70kilograms

Urine testing for sugar and protein were neg/neg

Aft er explaining the procedure for physical examination, privacy was ensured as well as
client emptied her bladder, hand washing was done and dried. She was helped to undress
and assisted unto the couch. She was physically examined and no abnormalities were
detected. On abdominal palpation, the symphysio fundal height was 36cm and 36cm
respectively with cephalic presentation and descent remained 5/5th above the pelvic brim on
both visit .The gestational age was 37 weeks +6days and 38weeks +6days respectively.
The foetal heart rates were recorded as 152beat per minutes and 146 beat per minutes with
regular rhythm and good volume on auscultation. Findings were explained to her and
recorded in her maternal record booklet during each visit. She was served with routine
drugs. She was advised to get her items for delivery ready and report to the clinic
immediately labour start.

She was served with the following routine drugs during each visit;

Tablet folic acid 5mg daily x 7days

Tablet ferrous sulphate 200mg daily x7 days

Tablet multivitamin 5mg daily x 7days.

NURSING CARE PLAN ON ANTENATAL CARE

Problems Identified.

Backache

Constipation
Insomnia.

waist pain

Frequency of micturition

SHORT TERM OBJECTIVE

1. Client’s backache will subside within 48hours.

2. Client will move bowel freely at least once a day within 48 hours.

3. Client will have adequate sleep at least 6 hours at night and two hours in the day.

4. Client waist pains will be relieved within 48 hours.

5. Client will cope with frequency of micturition throughout pregnancy.

LONG TERM OBJECTIVES

Madam I.E. will carry pregnancy to term successfully without any complications to herself
and her baby.
 TABLE 1: NURSING CARE PLAN ON ANTENATAL CARE

Date/ Nursing Objective Nursing orders Nursing intervention Date EVALUATION sign
time Diagnosis /outcome /time
criteria
17/01/22 Backache Client 1.Reassure client 1. client was reassured 19/01/22 Goal fully met RA
@ related to backache will 2.Explain to client the that she is in @
as client
hormone subside within causes of backache competent hands and 11am
10
verbalizing that
relaxin 48 hours as 3. Encourage client to that backache will
causing evidenced by maintain a proper subside backache has
relaxation client posture when 2. I explained to my
subside and
of the verbalizng that working ,sitting ,or client that backache
student
pelvic pain has sleeping was caused by
ligament subsided 4.teach client good hormone relaxing midwife
body mechanics causing relaxation of
observing client
5. Encourage client to pelvic ligament and it
having a
wear low heeled shoes could be as a result of
and slippers poor posture cheerful facial
3. client maintained a
expression
good posture by
sleeping on a firm
 matress ,sitting
comfortably and
resting her back on a
soft pillows and
walking straight
4. client was taught
squatting techniques
when picking objects
from the floor
5. client was seen
wearing low heeled
shoes and slippers

TABLE 1: NURSING CARE PLAN ON ANTENATAL CARE

Date/ Nursing Objective Nursing Orders Nursing Interventions Date/ Evaluation Sign
Time Diagnosis Outcome Time
Criteria
24/01/22 Constipation Client will 1. Reassure client . 1.Client was reassured 26/01/22 Goal fully met as client R.A
@ related to move bowel 2.Explain the physiology that she will be able to @ verbalized she was able to
ll:00am decrease freely at least of constipation in move her bowel freely 5:05pm. move her bowel freely at
motility of the once a day pregnancy to client. 2.Physiology of least once daily.
digestive tract within 48hours 3.Educate client to drink at constipation in
as a result of as evidenced by least 6-8 cup of water daily pregnancy was
effect of client and other fluids as well explained to client that,
progesterone verbalizing that 4. Educate client to take in it is due to decrease
in pregnancy. she was able to more fiber foods such as motility of the digestive
empty her fruits, vegetables and tract as a result of effect
bowel. whole grains of progesterone.
5. Encourage client to do 3. Client drinks at least
mild exercise like walking 6 cups of water daily
and sweeping and takes fluids like
Encourage client to fruit juice and soups.
respond to the urge to 4. Client was educated
defecate. to take in more fibrous
foods such as orange ,
pineapple and she
started eating lots of
fruits and more
vegetables that are in
 season
5. Client was
encouraged to do mild
exercise like walking
sweeping with long
broom.
6. Client visits the toilet
whenever she feels the
urge.

TABLE 1: NURSING CARE PLAN ON ANTENATAL CARE

Date/ Nursing Objective Nursing Orders Nursing Interventions Date/ Time Evaluation Sign
Time Diagnosis Outcome
Criteria
29/01/22 Disturbed Client will 1. Reassure client 1. Client was reassured that she will be 30/01/22 Goal fully R.A
sleeping have adequate 2. Encourage client to sleep met as client
@ pattern sleep at least 6 on a firm matress fine and her condition will be managed. @ verbalized she
10:30am. (insomnia) hours during 3.Encourage client to sleep in 2. Client was encouraged to sleep on a firm 4:30pm. was able to
related to the night and 2 a well-ventilated room and comfortable mattress. sleep at least
excessive hours in a day 4. Encourage client to take a 3. Client was encouraged to sleep in a 6hours in the
fetal within 24 hours warm bath before bed time well-ventilated room which she practiced night and
movements as evidenced 5.Encourage client to have by opening her windows to allow fresh air 2hours during
in the night. by client enough sleep during the day into the room during the day and by fan at the day.
verbalizing that when she is not doing night
she was able to anything. 4. Client takes a warm bath before she
sleep soundly. 6. Client should try to sleep goes to bed
and get up at the same time 5. Client sleeps 2 hours in the day during
everyday her leisure times

6. Client adopted a routine of sleeping and

waking up at a particular time.

TABLE 1: NURSING CARE PLAN ON ANTENATAL CARE

Date/ Nursing Objective Nursing Orders Nursing Interventions Date/ Evaluation Sing
Time Diagnosis Outcome Criteria Time
29/01/22 Waist pains Client will be 1.Reassure client. 1. Client was reassured that waist pain will 31/01/22 Goal fully R.A
@ related to relieved of waist 2 .Educate client to avoid subside. @ met as
10:30am growing pain within 48 bending down for longer 2. Client was educated to avoid bending 4:30pm client
uterus putting hours as evidenced hours when performing down for longer hours when performing verbalized
pressure on by client household chores household chores like washing but rather that waist
the pelvic verbalizing that 3.Encourage client to avoid mount a table at the level of her waist to pain has
muscles. she was relieved of prolong standing. avoid pain. been
pain. 4 .Educate client to wear 3. Client was encouraged to avoid prolong relieved.
low heeled shoes, flat standing but sit and rest the back on soft
sandals and slippers. pillows.
5. Educate client to have 4, Client was educated to wear low heeled
adequate rest and sleep at shoes, flat sandals and slippers.
least 2hours in a day and 5. Client was educated to have adequate rest
6hours in the night. and sleep at least 2hours in the day and
6. Serve client with 6hours in the night.
prescribed analgesics when 6. Client was served with paracetamol tablet
necessary. 1000mg PRN
 TABLE 1: NURSING CARE PLAN ON ANTENATAL CARE

Date/ Nursing Objective Nursing Orders Nursing Interventions Date/ Evaluation Sign
Time Diagnosis Outcome Time
Criteria
29/01/22 Alteration in Client will 1.Reassure client to alley 1.Condition was explained to client that it’s a 31/01/22 Goal was R.A
@ urinary cope with anxiety normal physiology that occurs in late pregnancy. @ fully met as
10:30pm elimination frequency of 2. Explain the cause of 2.Cause of frequency of micturition in late 10:00am client
(frequency micturition frequency of micturition to pregnancy was explained to client as the effect of verbalized
of throughout client descent of fetal head pressing on the urinary she was able
micturition) late 3.Client should lean forward bladder. to cope with
related to pregnancy as when urinating to ensure 3.Client practiced leaning forward when urinating frequency of
the descent evidenced by complete emptying of the and bladder was completely emptied. micturition.
of the fetal client bladder. 4.Client was encouraged to avoided beverages and
head verbalizing 4. Encourage client to avoid caffeine foods to help reduce frequent urination.
pressing on that she is beverages and foods that 5. Urine test was done to rule out signs of urinary
the urinary coping with contains caffeine since they tract infections.
bladder in condition cause excessive urination 6.Client was educated to avoid keeping urine for
late 5. Do urine test to rule out long period but respond to urge to urinate
pregnancy. signs urinary tract infection. immediately.
6.Educate client to avoid
keeping urine for long
period but respond to the
urge to urinate.
 CHAPTER THREE

INTRAPARTAL CARE

This chapter gives information on admission and management of the stages of labour,
examination of the placenta and membranes, summary of labour notes, condition of the baby
at birth, condition of the mother after delivery, condition of placenta and its membranes and
nursing care plan on labour.

ADMISSION AND MANAGEMENT OF LABOUR

MANAGEMENT OF FIRST STAGE OF LABOUR

Madam I.E reported at the Essikado hospital on the 8th February 2022 at 11:30 pm
accompanied by her husband and mother with the history of labour pains. They were
welcomed and offered seat. Client’s antenatal card was taken and glanced through to check
the obstetric history and to confirm the expected date of delivery. According to client, labour
pain started around 9:00pm on 8th February, 2022 and show was noticed at that same time
but no bleeding was noticed. Madam I.E was taken to the labour ward for examination. She
looked anxious so she was reassured that everything will be fine. I then asked whether she
had eaten and she said she ate rice and egg stew around 7:00pm. She was asked to empty her
bladder into a pale before lying on the couch. The volume of the urine was 200mls and the
result of protein and acetone test were negative; blood sample was taken for further
laboratory investigation. I washed my hands with soap, rinsed under running water and dried
with a clean towel. The vital signs were checked and recorded as follows;

Temperature 36.0 degree Celsius

Pulse 86 beats per minute

Respiration 22cycles per minute

Blood pressure 120/70 millimetres per mercury

The procedures for physical examination from head to toe including abdominal palpation and
vaginal examination were also explained to her. She was assisted to undress and to lie
comfortably on the examination couch. General examination from head to toe was conducted
and upon examination, there was no oedema on the face, the conjunctiva was pink. There
were no abnormal discharges from the nose and ears. There was no distended neck vein or
enlarged lymph nodes on palpation of the neck. On breast inspection, nipples were centrally
situated and erect, areola was darkened. On breast palpation, there was no abnormal lump,
axillary swelling or discharges from the breast. There was no pain in the calf of the leg or
varicosities.

On abdominal inspection, the shape was ovoid. The symphysis fundal height was 36cm,
maturity 40 weeks. On fundal palpation, the buttock was felt at the fundus and the lie was
longitudinal. Lateral palpation revealed the back of the fetus at the left side and the limbs at
the right side of the mother’s abdomen. On pelvic palpation, the presentation was cephalic
and head descent was 4/5th above the symphysis pubis, position was left occipito anterior. On
auscultation, fetal heart rate was 140beats per minute with very good volume and regular
rhythm. Contractions were occurring 3 in 10 minutes lasting 28 seconds, respectively.

The procedure for vaginal examination was also explained to her and was helped into the
dorsal position with knees flexed and was draped. I then washed my hands and rinsed under
running water and dried, wore sterile gloves and I was assisted by my In-charge to inspects
the vulva for oedema, warts, scars of previous deliveries, offensive discharge. None of these
abnormalities were detected. I swabbed vulva with antiseptic solution and performed vagina
examination. The vagina felt warm and moist, the cervix soft and thin and was 4cm dilated
with membranes intact. There was no moulding. My findings were also confirmed by the
midwife in-charge. The client was then cleaned and a new clean pad was applied to the vulva.

Findings about the progress of labour were communicated to client such as the dilatation of
the cervix was communicated to her using the dilatation board for her to understand the
process of cervical dilatation process. She was reassured that she is in safe hands since she
was still anxious. Intravenous fluid normal saline 500ml was administered to hydrate her.
She complained of severe lower abdominal pain. All findings were then recorded in the
labour sheet and on the partograph. Client was made comfortable in a well laid bed at the first
stage monitoring room.
Client was advised to empty her bladder very often in order to aid in the descent of the fetal
head as full bladder prevents dilatation and descent of the fetal head.

After recording the initial findings on the partograph, I continued with the monitoring of the
first stage, by checking blood pressure, temperature cervical dilatation, descent of the fetal
head, state of liquor and moulding which were recorded every 4 hours. Maternal pulse
contraction and fetal heart rate were monitored every 30 minutes and urine checked every 2
hourly. All these were recorded on the partograph

I encouraged her to lie on her left side to aid in circulation to the placental site or even walk
around and also encouraged her to do deep breathing exercise during contractions to prevent
premature bearing down, she was encouraged that when pain subsides a bit she could join the
other clients to watch television on the ward. At 12:30pm client pulse was 88bpm .
Contractions were 3 in 10 minutes lasting for 30 seconds, fetal heart rate was 140bpm . At
1:00am to 2:00am pulse was 82bpm to 90bpm contraction were 3 in 10 minutes lasting for 35
second ,fetal heart rate was 140bpm to 136bpm. At 2:00am to 3:00am Pulse was 86bpm to
80 bpm, Contractions were 3 in 10 minutes lasting for 40 seconds ,fetal heart rate 138 to 140
bpm. At 3:00am to 4:00am pulse was 80bpm to 90 bpm contractions were 4 in 10 minutes
lasting for 45 seconds , fetal heart rate was 140bpm to 142 bpm .

At 4:00am client was due for the next assessment and vaginal examination so I explained to
her and took her to the examination room, I then examined her to know the progress of labour
I realize that her perineal pad was soaked I educated her to change her pad frequently to avoid
infection, I also educate her to washed her hands before and after changing her perineal pad.
Cervical dilatation was 8cm, descent was 2/5th membranes were intact and contraction
occurring 4 in 10 minutes lasting for 45seconds, Fetal heart rate 140. She was asked to empty
her bladder into a pale. The urine volume was 100mls and the result of protein and acetone
were negative. All findings were communicated to her and recorded on the partograph. I saw
client sweating profusely and she complained of tiredness. She was encouraged to drink more
fluids, I opened nearby windows, switch on fans. I encouraged her to urinate when she feels
the urge. I noticed she was pushing prematurely so I then advised her not to push since she
was not fully dilated and told her the complications of pushing before full dilatation. She was
given sacral massage during contractions to reduce pain and was encouraged to continue with
the deep breathing exercise. Vital signs were checked and recorded as follows;

Temperature 37.0 degree Celsius

Pulse 80 beats per minute

Respiration 24 cycles per minute

Blood pressure 120/70 milimetres per mercury

Membranes ruptured spontaneous at 5:00am and liquor was clear the delivery trolley was
set and the delivery room was prepared vaginal examination was done to exclude cord
prolapse and client was 10cm dilated moulding was one plus and descent was 0/5th above the
symphysis pubis. The result was plotted on the partograph. Client was informed she was due
to deliver and was sent to the second stage room where a trolley containing sterile items for
delivery had been set client temperature ,pulse, fetal heart rate and the contractions was
checked and recorded

MANAGEMENT OF THE SECOND STAGE OF LABOUR

Madam I.E. was then assisted unto the couch in the dorsal position with the knees flexed at
5:05 am. A clean delivery sheet was placed under her buttocks as well as a clean cotsheet was
placed on her abdomen. The delivery trolley was pulled closer to the delivery area. I wore my
mackintosh apron and boot, washed my hands with soap and rinsed under running water and
dried them. I wore my sterile gloves and I explained to her that her baby will be delivered
unto her abdomen so she hold baby firmly to prevent falling. Cervical dilatation was
confirmed by the midwife in-charge and a pad was applied at the perineum to prevent faecal
matter from coming into contact with the vulva and the baby’s face in case there will be any.

Client was asked to push with contractions and rest in between, taking deep breaths to prevent
exhaustion. As the baby’s head advanced with contraction, flexion was maintained to allow a
smallest diameter of the fetal head to distend the vulva until the head crowned. She was asked
to stop pushing and pant to prevent perineal tear and lacerations. The sinciput, face and chin
swept the perineum. I cleaned the face, mouth and nose with sterile gauze. I then felt for cord
around neck and there was none. I allowed for restitution and external rotation of the head
indicating internal rotation of the shoulder. I held the head between my palms on each of the
baby’s ears and a gentle downward traction toward the perineum was done to deliver the
anterior shoulder and lifted the baby up towards the mother’s abdomen to deliver the
posterior shoulder. The rest of the body was delivered by lateral flexion and placed on the
mother’s abdomen.

At 5:15am on the 9th of February, 2022, an alive female infant was delivered who cried soon
after birth. The baby was dried off liquor with the sheet on the mother’s abdomen. The
umbilical cord was clamped 5cm away from the baby abdomen and the second sterile forceps
was used to clamp the umbilical cord 3cm away from the first clamp. A sterile scissors was
used to cut in between the clamps to separate baby from the mother. The end of the cord
attached to the placenta was placed in a receiver near the client’s perineum to receive the
placenta and any blood loss from the vagina. The baby was shown to mother for identification
of sex, baby was wrapped in a warm dried sheet and mother was asked to hold the baby
whiles the baby was on her abdomen to initiate skin to skin contact with her.

IMMEDIATE CARE OF THE BABY AT BIRTH

The immediate care of the baby begins when the head is delivered. The face was wiped with
clean gauze and both eyes were cleaned with sterile cotton wool swab from inner contour
outwards. It was done to prevent infections of the eyes. The mouth and nose were suctioned
with bulb syringe to ensure patent airway. The baby was put on the mother’s abdomen and
the cord was clamped and cut, separating the mother and the baby. The baby’s cord was
clamped and secured with a plastic cord. Baby was quickly dried up from head to toe to
enhance stimulation. Baby was weighed and the weight was 3.1kg .All wet clothing used to
receive baby was removed and clean dry sheet was used to wrap baby to keep baby warm.
Identification band was put on baby’s wrist with mother’s name, sex, date and time of
delivery, weight of baby written on it. Apgar score was assessed and in the first minute it was
8/10 and in five minutes it was 9/10. Injection vitamin K 1ml was given intramuscularly on
the thigh. The baby was a female.

MANAGEMENT OF THIRD STAGE OF LABOUR

Madam I.E was informed she was in the third stage and her cooperation is needed .The
mother’s abdomen was palpated to confirm that, there was no second or more foetus.
Injection Oxytocin 10 international units was given intramuscularly at the left thigh within 1
minute after birth to enhance contraction and to stop bleeding. Procedure was explained to my
client and made sure the bladder was empty. A receiver was placed in between the woman’s
thighs to receive the placenta and blood loss. An artery forceps was used to clamp the cord
close to the perineum. The next contraction was assessed at the fundus and the placenta was
delivered by controlled cord traction.

This was achieved by placing my left hand on the lower abdomen in the supra pubic area with
my palm facing the abdomen and at the same time held the forceps horizontally with the
right hand in between my fingers and applied gentle downward and outward traction. I
maintained counter pressure with the left hand in the supra pubic area whilst applying gentle
traction to the cord until placenta was visible at the vulva. Both hands were then used to
receive the placenta and in twisting action and a gentle downward movement was used to
bring the membranes out. The placenta and its membranes were placed in kidney dish.

Placenta and its membranes were completely expelled at 5:20am. The uterus was massaged to
expel retro placental clots and to help uterus to contract well and become firm. The perineum
and genital tract was inspected and there was no tear. The amount of blood loss per vagina
was estimated to be 200mls. Client was cleaned up and a new sanitary pad placed at the
vulva. She was congratulated for safe delivery and encouraged to empty the bladder
frequently to prevent postpartum haemorrhage. She was also advised to change the sanitary
pad when soiled to prevent infection. A quick examination was done on the placenta.

The placenta was held up by the cord to allow membranes to hang and the hole through which
the baby was delivered was identified. The cord had three blood vessels running through it
and they were two arteries and one big vein and the insertion of the umbilical cord was
centrally situated.

Both maternal and fetal surfaces were identified the amnion was peeled from the chorion
right up to the umbilical cord and this allowed the chorion to be fully viewed. The fetal
surface was bluish-grey in colour and it was smooth, had a shiny appearance with branches of
umbilical vein and arteries visible.

The maternal surface had complete lobes of 20 which were separated by sulci. After the
examination, the placenta was then discarded into a pit. The delivery instruments were put
into 0.5% chlorine solution for 10minutes. They were then cleaned and sterilized for reuse.
The delivery room was also cleaned with 0.5% chlorine solution. I washed my hands with
soap, rinsed under running water and dried.

MANAGEMENT OF THE FOURTH STAGE OF LABOUR

The fourth stage is the period that consists of the first six hours after delivery of all products
of conception and observation of mother and baby. Mother and baby were transported to the
lying-in ward and made comfortable in bed. Baby’s colour was pink and the cord was not
bleeding. Her condition was good as well as the mother. They were both observed for the first
six hours after delivery. The mother’s vital signs, lochia, and the general condition were
observed ¼ (15 minutes) hourly for one hour, ½ (30 minutes) hourly for two hours and one
hourly for three hours. Mother’s uterus was palpated ¼ hourly for two hours, ½ hourly for
two hours and one hourly for two hours. The baby’s heart rate, respiratory rate, colour,
temperature, umbilical cord, suckling and swallowing reflexes and the general condition were
also monitored quarter hourly for one hour, half hourly for the next two hours, and hourly for
the next three hours.

All information was recorded on the post-delivery observational chart for mother and baby.
Client was advised to empty her bladder frequently to prevent postpartum hemorrhage and to
massage the uterus frequently to aid in involution of the uterus. Her uterus measured 18cm
above the symphysis pubis and was well contracted. Her perineal pad was constantly
monitored for the amount of lochia, colour and smell. The amount was moderate with bright
red color and not offensive. Immediate breastfeeding was initiated in order for the uterus to
contract well for involution to take place. The mother’s baseline vital signs checked and
recorded as follows;

Temperature 36.5 degree Celsius

Respiration 20 cycles per minute

Pulse 68 beat per minute

Blood pressure 110/70mmHg

Baby’s baseline vital signs recorded as:

Temperature 36.6 degrees celcius

Apex heart beat 138 beats per minute

Respiration 40 cycles per minute

Skin colour Pink

All the subsequent observations done on client and baby were recorded on the post-delivery
observation chart.

Client was advised to report any abnormal bleeding, bulgy uterus, severe abdominal pain,
urinary incontinence, and bleeding of the baby’s cord for prompt action to be taken. She was
encouraged to change her perineal pad frequently when soiled and to wash her hands before
breastfeeding the baby and after changing her perineal pad to reduce the risk of infection. She
was served with some milo beverage with biscuit and later at around 10am, her mother served
her fufu and light soup from home to satisfy her hunger and regain her energy after delivery. I
explained to the mother that after six hours when the baby’s condition become stable, the
baby will be examined and have her first bath and she agreed to it.

SUMMARY OF LABOUR NOTES

According to client labour pains started at 9pm on 8th of February, 2022 and she reported to
the facility at 11:30 pm . She reported to the ward with 4cm cervical dilatation and was
monitored throughout the first stage of labour and delivered a live female neonate on the 9th
February 2022 at 5: 15am who cried soon after delivery with an Apgar score of 8/10 and 9/10
for the first minute and the next five minutes respectively, birth weight 3.1kg, estimated blood
loss of 200mls. Placenta and its membranes were also delivered by control cord traction at
5:20am. Condition of both mother and baby was satisfactory.

DURATION OF OBSERVABLE LABOUR

STAGE TIME DURATION

First 12:00am-5 :00am 5 hours

Second 5:00am-5:15am 15minutes

Third 5:15am-5:20am 5minutes
Total duration 5 hours 20minutes

CONDITION OF BABY AT BIRTH

Sex - Female

Weight - 3.1kg

Apgar score - 8/10, 9/10

Full length - 45cm

Head circumference - 32cm

Chest circumference - 36cm

Waist circumference - 35cm

Abnormalities - None detected

General condition - Satisfactory

 APGAR SCORE

SIGNS FIRST MINUTE FIVE MINUTE

Appearance 2 2
Pulse 2 2
Grimace 1 1
Activity 1 2
Respiration 2 2
Total 8/10 9/10

CONDITION OF MOTHER

Perineum - intact

Blood loss - 200mls

Temperature - 36.4℃

Pulse - 76 beats per minute

Respiration - 24 cycles per minute

Blood pressure - 120/70mmHg

Uterus - 18cm (Contracted)

General condition - Satisfactory

CONDITION OF PLACENTA AND ITS MEMBRANES

Length of cord - 40cm

Diameter - 22cm
Weight of placenta - 500g

Placenta lobes and membrane - intact

Vessels - two arteries, one big vein

Cord insertion - centrally

Maternal surface - dark red

Fetal surface - bluish grey

NURSING CARE PLAN ON LABOUR AND DELIVERY

Problems Identified

Lower abdominal pain

Client was anxious

Fatigue

POTENTIAL PROBLEM

Risk for genital infection

Risk for cervical tear

SHORT TERM OBJECTIVES

Client will cope with lower abdominal pain throughout labour

Client will be relieved of anxiety within 2hours in labour

Client will go through labour without signs of tid when necessary.genital infection

Client will go through normal labour with minimal fatique and maintain her energy.

Client will go through labour without cervical tear.

 Long Term Objectives

Client will go through labour successful and delivery without any complication to her and the
baby.
TABLE 2: NURSING CARE PLAN ON LABOUR FOR MADAM I.E

Date/time Nursing Objective Nursing Nursing Date/ Evaluation Sign

Diagnosis Outcome Orders Interventions Time
Criteria
09/02/22 Lower Client will be 1.Reassure 1.Client was 10/02/22 Goal fully met RA
@ abdominal able to cope with client reassured that @ as client said
11;50pm pain related to lower abdominal 2.Educate client everything will be 5:30am she
persistent and pain throughout on physiology fine. understands
progressive labour as of lower 2.Client was educated the cause of
contractions evidenced by abdominal pain that the physiology of pain and she
of the uterine student midwife 3.Encourage lower abdominal pain can cope with
muscles. observing that client to empty was as a result of it
client was calm. the bladder pregnancy hormones
And client frequently to oxytocin causing
verbalizing her reduce lower uterine contractions
ability to cope abdominal to aid in labour
with the pain pains. 3.Client was
throughout 4. Engage client encouraged to empty
labour in a the bladder frequently
conversation to to reduce lower
take her mind abdominal pain. And
of the pain aid in the descent of
the fetus.
5. Give sacral 4.Client was engaged
massage to in conversations to
client during take her mind of the
the pain. pain
6. Encourage 5.Client was given a
client to do sacral massage during
deep breathing contractions to relieve
exercise help to her of pain.
reduce pain 6.Client was
encouraged to do
deep breathing
exercised to help
reduce the pain
TABLE 2: NURSING CARE PLAN ON LABOUR FOR MADAM I.E

Date/ Nursing Objective Nursing Orders Nursing Date/ Evaluation Sign

Time Diagnosis Outcome Interventions Time
Criteria
09/02/22 Anxiety Client will be 1.Reassure Client. 1. Client was 9/02/22 Goal fully RA
@ 2:30 related to relieved of 2.Explain all findings to reassured that @ met as
am unknown anxiety within 2 client after examination, everything will be 4:20am student
outcome of hours as including progress of alright and she is in midwife
labour evidenced by labour the hands of observed
student midwife 3. Introduce her to other competent midwives client
observing that clients who have gone 2, All findings were showed
client is calm through labour explained to client relaxed
and cooperating successfully. after every facial
with care 4. Attend to client needs examination. expression
to reduce anxiety. and client
5. Spend time with client 3. Client was said she is
 and allow client to ask introduced to clients no more
questions about labour who have gone anxious and
through labour she
successfully. cooperated
4. Client needs was with labour
attended to. process

5. client was allowed

to ask question and
All questions asked by
client were answered.

TABLE 2: NURSING CARE PLAN ON LABOUR FOR MADAM I.E

Date/Time Nursing Objective Outcome Nursing Orders Nursing Interventions Date/ Evaluation
Diagnosis Criteria Time

09/02/22 Risk for Client will go through 1. Educate client to change 1. Client was educated to changed pad 9/02/22 Goal fully RA
@6:00am genital labour without signs pad frequently when frequently when soiled and apply new @ met as client
infection of infection of the soiled. ones. 7:30am showed no
related to genitals as evidence 2. Advice client to wash 2. Client was advice to wash hands signs of
poor by student midwife hands with soap under with soap under running water after genital
perineal observing that client running water after changing of pad to prevent infection infection.
hygiene. maintains good changing of pad. 3. Client was thought how to remove
perineal hygiene and 3. Tell client to remove perineal pad from anterior posterior
client showing no pad form anterior posterior that is from the vulva to the anus.
sign of infections that is from the vulva to 4. Urine test was done every two
the anus. hours during labour.
4. Do urine test to rule out 5. Signs of infection were observed
infections but there was no signs of infection
5. Observe for signs of
infection
TABLE 2: NURSING CARE PLAN ON LABOUR FOR MADAM I.E

Date Nursing Objective Nursing Orders Nursing Interventions Date/ EVALUATION Sign
/Time Diagnosis Outcome Time
Criteria
9/02/22 Activity Client will be able 1. Reassure Client 1. Client was reassured 9/02/22 Goal fully met RA
@ 6:00am intolerance to cope 2. Encourage client that she will be fine. @ as client went
(Fatigue) throughout to do deep breathing 2. Client was 7:10am through normal
related to labour and exercise. encouraged to do deep labour with
stress of maintain her 3. Encourage client breathing exercise. minimal fatigue
labour energy throughout to avoid excessive 3. Client was encourage
labour as screaming during to breathe through the
evidenced by contraction mouth when there is
client vebalising 4. Serve nourishing contraction instead of
the she has been fluid that contains screaming
relieved of stress glucose. 4. Client requested for
5. Encourage client malt drink which was
to rest in between served her.
contractions. 5. Client was
encouraged to rest in
 between contractions.

TABLE 2: NURSING CARE PLAN ON LABOUR FOR MADAM I.E

Date/Time Nursing Objective Nursing Orders Nursing Date/Time EVALUATION Sign

Diagnosis Outcome Interventions
Criteria
09/02/22 Risk for Client will go 1.Use cervical 1. The process of 9/02/22 Goal fully R.A
@6:00am cervical tear through dilatation board to cervical dilatation was @ met as student
related to successful labour demonstrate to explained to client 7:30am midwife
client bearing without cervical client the process using the dilatation observed
down tear as evidenced of cervical board. client had no
prematurely by student dilation 2. Progress of labour cervical tears
midwife 2. Explain the was explained to after birth.
observing an progress of labour client.
intact cervix to client. 3. Client was taught
after birth. 3. Teach client deep breathing
deep breathing exercises and was
exercises and encouraged to
encourage her to practice during
practice during contractions
contractions 4. Client was given
4. Give sacral sacral massage which
massage to help helped to soothing her
reduce pain and pain and the urge to
the urge to bear bear down.
down 5. Client was
5. Inform client informed that
about the effect of premature bearing
premature bearing down could put her at
down. risk of cervical tears.
6. Encourage Client was
client to bear encouraged to bear
down with down with contraction
contractions and and rest in between
rest in between them during labour.
during delivery.
 CHAPTER FOUR

POSTNATAL CARE

This chapter is about the care of the mother and baby during puerperium, subsequent care of the baby including examination of baby, baby’s first
bath and cord dressing, first post-delivery and discharge, post-delivery home visits, first post natal review visit, nursing care plan on problems
identified.

MANAGEMENT DURING THE PUERPERIUM

DAY OF DELIVERY

Client and baby were transferred to the lying-in-ward for a close monitoring for a period of six hours and the post-delivery observation was done
quarterly for one hour and half hourly for 2hours and hourly for 3hours and recorded on the post-delivery observation chat. The environment
was kept clean, well ventilated by opening nearby windows and both client and baby made comfortable in bed and observations continued. Her
temperature, pulse, respirations and blood pressure were checked immediately after delivery and recorded on the post-delivery observation chart
and they are as follows;

Temperature 36.5degree Celsius to 36.6 degree celsius

Pulse 78 beat per minute to 76 beat per minute

Respiration 20cycles per minute to 22 cycles per minute

Blood pressure 110/70milimeter of mercury to 120/80 Milimeter 0f mercury

Uterus was well contracted on palpation, fundal height measured 18centimeters, and lochia was bright red in colour with moderate flow and not
offensive. I advised Madam I.E to void frequently to aid in involution and prevent post-partum haemorrhage and taught her how to massage the
uterus to prevent bleeding at least every 15 minutes. She took her bath and was advised to practice good personal hygiene, thus to change perinea
pads frequently when soiled to prevent infection and in removing the pad, it should be anterior posteriorly. This was to prevent transfer of
infections from the anus to the vulva. I also advised her to wash her hands with soap under running water after removing the pad, after visiting
the toilet and before feeding the baby. She was also encouraged to continue breastfeeding the baby and break the wind after feeding the baby to
prevent abdominal distension. I helped her to position and fix baby to breast.

I told Madam I.E. to call me immediately she noticed any of these danger signs; bleeding more than normal or bleeding heavily, severe lower
abdominal pain, fever, inability to void or anything else that may concern her. She was also advised to report if the baby’s cord bleeds or if she
observes any change in baby’s colour or if baby has an abnormal cry or difficulty in breathing.

The baby’s general condition was good throughout the night .Client said, the baby passed urine 4 times throughout the night and emptied her
towel twice which was dark green in colour .The baby’s signs were checked and recorded as

Temperature 36.00c to 36.6c0

Respiration 34cpm to 46cpm

Apex heart rate ranged from 130 bpm to 140 bpm.

The baby was kept warm .

 SUBSEQUENT CARE OF THE BABY DURING PUERPERIUM

Examination of the Baby

I obtained permission from client to examine her baby after the six hours observation. The procedure for examination from head to toe was
explained to the mother and I carried out the examination in her presence. I wore a rubber apron, washed and dried my hands and put on a pair of
examination gloves. I quickly assessed the colour of the baby under a good source of light and it was pink. Baby was put on a covered flat
surface and only the part of the body to be examined is exposed at a time. The general condition of the baby was satisfactory. The circumference
of the head measured was 32cm and fontanelles were soft and flat but not bulging with the bregma pulsating, the head had no caput
succedaneum or cephal haematoma or any congenital abscess. She had a fine silky hair. Her eyes were clear with no abnormal discoloration or
jaundice; there was no cleft lip or palate and no false teeth in the mouth. Suckling, rooting and swallowing reflexes were present. The ears and
nose were normally situated with no discharge or deformity. There was no swelling of lymph node or rigidity or abnormal tumour of the neck.
The breasts nipples were centrally situated; no hard mass was felt in the breast upon palpation as well as abnormal discharges from the breast.

The chest and abdomen moved simultaneously during respiration. The abdomen was soft and rounded. The umbilical cord had two arteries and a
vein with no bleeding. The upper limbs were equal in length and size with no extra /missing digits or webbing.

The labia minora and majora were formed and the urethral and anal orifices were also patent as baby passed meconium and urinated after
delivery. The lower limbs were in equal size and length and there was no webbing of the toes, no extra or missing toe. The spine was well curved
with no abnormality such as spinal bifida. Baby’s full length was 48centimetres. Madam I.E. was informed of the findings made on the baby
after the examination and was given back the baby to continue breastfeeding. I thanked client and recorded my findings . .All items used for the
examination were decontaminated and cleaned .
 Baby’s First Bath and cord dressing

After the 6 hours had elapsed, the baby was prepared for her first bath. Mother was informed about the baby’s bath. The procedure was
explained and permission was obtained. Baby’s bathing Items such as baby’s dress, cot sheets, baby’s soap, baby’s sponge, towel, baby oil,
diaper were collected from mother and assembled. A sterile tray for cord dressing was set. The bath was prepared and baby was collected from
the mother. The water for the baby’s bath was mixed and tested with my elbow to check if the temperature was suitable for bathing the baby. I
washed my hands with soap under running water, dried and wore my examination gloves. I removed her from the soiled cot sheet and wrapped
her in a new clean and dried one. I swabbed baby’s eye with sterile cotton wool swabs from the inner canthus outward and cleaned the face with
wet towel. The nape of the neck was supported with one hand and ears plugged with my thumb and middle fingers to prevent water from
entering them. Hair was washed in a circular motion with a sponge and soap, rinsed it out with water and dried her with a clean dry towel and a
cap was used to cover the baby’s head to prevent heat loss. The rest of the body, thus the arms, chest, trunk, lower extremities and back were
exposed and washed with special attention to the skin folds. The back was turned with my palm supporting the chest and the baby’s body was on
the skin and quickly dressed to prevent heat loss. I washed my hands with soap and water, dried and wore a pair of sterile gloves.

The umbilical cord was dressed aseptically with Chlorhexidine and exposed to air dry. Baby was handed over to the mother wrapped in a warm
cot sheet to continue breastfeeding. All instrument used for cord dressing were decontaminated in 0.5% chlorine solution after 10 minutes, and
gloves and cotton discarded. The instruments were washed, rinsed, dried them and autoclaved to be reused

First Day Post Delivery and Discharge

On the day of discharge, which was 10/02/22, Madam I.E woke up in the morning at 6am. I exchanged greetings with her and enquired about her
sleeping pattern and she said she slept well. I encouraged her to take her bath and took her breakfast , her vital signs was checked and
recorded

Temperature 36.4degree Celsius

Pulse,78 beat per minute

Respiration 20 count per minute

Blood pressure 120/70milimeter per mercury.

She was told to empty her bladder, urine tested for protein and sugar and they were negative. Her general condition was good. The conjunctiva
was pink and the face was not puffy, mouth, teeth and tongue were clean, the lips were moist with no cracks or pallor. The eyes were also clear
with no abnormal discharges or pallor. The breast was palpated for abnormal lump or growth which was absent, there was no abnormal or
bloody discharge from the nipple and the size of the nipple was normal. Colostrum was expressed. The upper extremities were examined and no
deviations from the normal were detected, nail bed was squeezes for capillary refill, there no pallor of the nail beds. was

The uterus was firm and well contracted, fundal height was 17centimeters above the symphysis pubis. The amount of the lochia was moderate
with no offensive odour no blood clot and the colour was rubra. There was no sign of swelling on the perineal or oedema of the vulva.

There was neither oedema on the lower extremities when palpated and no tenderness of the calf muscles when dorsiflexed. The curvature of the
spine was normal and there was no oedema at the sacral region. She was advised to be checking and changing the perineal pad frequently.
Madam I.E. said she has emptied her bladder three times and moved her bowel once.
Baby was doing well and was looking healthy. Her vital signs were checked and recorded as follows

Temperature 36.3 degrees Celsius

Apex heart beat 136 beats per minute

Respiration 40 counts per minute

I explained the procedure for examination of the baby to Madam I.E and proceeded with it. On examination of the baby was pink in color, the
fontanelles were soft with the bregma pulsating, it admitted two finger and was not bulging or sunken in, also the posterior fontanelle admitted
one finger, sutures were in apposition, and the conjunctiva was pink, with clear sclera. There were no abnormal discharges from the eye, ears and
nose. Respiratory movements were observed on the chest and no deviations were detected, and there was no bleeding from the cord, the cord
was clear and firmly clumped. Baby was bathed and cord dressed aseptically with chlorhexidine. Mother confirmed baby had passed meconium
two times and urinated three times.

Client and baby were discharged on ward rounds. I informed her and she invited her husband and mother over to join us while I give them the
discharge education

She was told to continue with the exclusive breastfeeding, and feed baby solely on breast milk and not add food or water, also she was to feed
the baby on demand; day and night and when breastfeeding she should empty one breast completely before the other to prevent breast
engorgement and she should break the wind to prevent distended abdomen. She was assisted to correctly fix and attach baby well to the breast.
Education on kegel exercise was given to help strengthen the pelvic muscles. Education on taking nutritional diet to heal worn out tissues, rest
and sleep to help her recover from the stress and strain of labour, drinking more water and nourishing fluids, personal and environmental hygiene
including changing soiled pad often, bathing twice daily, washing hands and washing under clothing and drying in the sun were given. Her
husband and sister were requested to assist with care of baby and house chores so she can get enough rest and sleep.

She was educated on the need of caring for the newborn. Emphasis was made on the care of the baby’s cord . She was educated to use
Chlorhexidine to clean it and report any abnormalities such as offensive odour from the cord, bleeding and high temperature of baby
immediately to the facility. She was educated not to apply any herb on the cord to prevent infection. Again, she was advised not to apply hot
water on the fontanelles of the baby’s head and she should be changing the baby’s napkin or diapers when soiled. I also educated her not to
expose the baby to extreme cold or hot weather and both baby and mother must sleep under well treated insecticide mosquito net.

I again educated Madam I.E. on some minor disorders that may arises during puerperium such as severe backache, puerperal pyrexia, breast
engorgement and sores or cracks on the nipple.

The baby was finally immunized with BCG (Bacillus Calmette Guerin) 0.05mls which was administered intradermal at the right upper arm and
two drops of polio O vaccine given orally to the baby respectively. Mother was educated not to put anything nor rub the site of injection. Mother
was also given 2 capsules of vitamin A, one was taken immediately and the other taken same time the next day. I reminded her that I will be
visiting her daily in the next seven days at home to care for her and the baby, twice for the first three days and daily from fourth day to seventh
day and also her first postnatal review visit at the clinic. She was given a laboratory request for heamoglobin level and Bf for malaria parasites
assessment to be brought on her first postnatal review. Her hospital bills were covered by the NHIS.

Drugs prescribed for Madam I.E. were; Tablet paracetamol 1000mg when necessary for 5days, syrup iron III polymaltose 10 mls daily for 10
days, and Amoxicillin capsule 500mg tds for 7 days which were collected and given the direction on how to take them and encouraged to take
them as prescribed. I finally discharged her in the admission and discharged book.

I helped her pack her things and congratulated her and her family members for their co-operation and promised to visit them in the evening and
then saw them off from the ward at around 12:30pm.

FIRST DAY POST DELIVERY HOME VISIT

At 4:30pm in the evening I visited madam I.E and was warmly welcomed by the house hold. I enquired about their health and they were all fine.
She was taking her bath and baby was asleep. She was happy seeing me when she returned from the bath room. I asked of her health and she said
she was fine. The need and procedure for general examination was explained to her and she accepted. I washed my hands with soap under
running water and dried them. I conducted head to toe examination for both mother and baby.

Mother’s vital signs were checked and recorded as;

Temperature ,36.20C
Pulse,79bpm,

Respiration 20cpm

Blood Pressure 120 /70mmHg

Madam I E. said she had taken banku with okro stew. I asked her to empty her bladder and she said she emptied it when taking her bath On
physical examination, there was no sign of pallor of the eyes, the face was clean with no puffiness, no enlargement of the neck or pain.
Colostrum was expressed from the breast and no pain or abnormal discharge from it. Her uterus was well contracted and the fundal height was
17cm above the symphysis pubis. Lochia was red (rubra) in color, moderate in flow and not offensive. Palms and nail beds of upper extremities
had no pallor and the foot and toes also had no pallor and no pain in the calf muscles. She told me she had passed stool one time and urine four
times.

Mother complained of after pains. I reassured and explained to her that the after pains was as a result of involution of the uterus that is causing
contractions of the uterine muscles. She was encouraged to continue to breastfeed her baby, drink a lot of water, urinate frequently when she
feels the urge and continue taking her routine drugs including the prescribe analgesics.

Baby’s vital signs were checked and recorded as

Temperature 36.30C

Apex heart beat 135bpm ,

Respiration 37cpm
On physical examination baby’s skin looked pink, there was no sign of difficulty in breathing and chest was moving with good respiration, the
eyes were clear with no jaundice or pallor, mouth was clean with no coated tongue and lips were moist, suckling reflex was present and baby
suckled well at the breast. The abdomen was round and soft with no protrusion and cord was clean with no bleeding or foul smell. The upper
and lower extremities, the waist and hip could move freely on examination. Baby was topped and tailed and cord was dressed aseptically with
Chlorhexidine. Client told me baby had passed urine three times and stools two times. I reminded her not to put anything on baby’s cord. I also
reminded her on exclusive breastfeeding and to change diapers when soiled. I thanked them and left the house.

SECOND TO THIRD DAY POST DELIVERY HOME VISIT

My second to third day postnatal home visits were on 11/02/2022 and 12/02/22 ,I visited Madam I E twice every day 8:00am in the morning and
5 :30 pm in the evening . I met client and her husband, after exchanging greetings with them I enquired about their health and they were all
looking good. I was offered a seat. COVID 19 Protocals were observed , I washed my hands with soap and water and wore my nose mask .
Client said the after pains had subsided. I explained to client the need for repeated physical examination and asked her to empty her bladder.

She was helped to lie down comfortably in bed and head to toe examination was conducted after washing my hands with soap and water. Her
general condition was good.

On physical examination, there was no sign of pallor of the eyes, the face was clean with no puffiness, no enlargement of the neck or pain.
Colostrum was expressed from the breast and no pain or abnormal discharge from it. Her uterus was well contracted and the fundal height was
16 cm to 15cm on 11/02/22 and 12 /02/22 respectively above the symphysis pubis. Lochia was red (rubra) in color, moderate in flow and not
offensive. Palms and nail beds of upper extremities had no pallor and the foot and toes also had no pallor and no pain in the calf muscles. She
told me she had passed stool one time and urinated three times.

Her vital signs were recorded as

Temperature ranged between 36 .0 degree Celsius and 36.6 degree Celsius

Pulse 85 bpm to 78bpm

Respiration 20cpm and 22cpm

Blood pressure 110/70mmHg to 110/80mmHg

I emphasized on the need to continue with the kegel exercise, since it will help her regain the tone of her pelvic muscle. I also talked about good
nutrition, taking of more water and nourishing fluids as well as get adequate rest and sleep especially when baby is asleep.

BABY

On physical examination baby’s skin looked pink, there was no sign of difficulty in breathing and chest was moving with good respiration, the
eyes were clear with no jaundice or pallor, mouth was clean with no coated tongue and lips were moist, suckling reflex was present and baby
suckled well at the breast. The abdomen was round and soft with no protrusion and cord was clean with no bleeding or foul smell. The upper
and lower extremities, the waist and hip could move freely on examination. Baby was topped and tailed and cord was dressed aseptically with
Chlorhexidine. Client told me baby had passed urine three times and

stools three times. Her vital signs were checked and recorded as follows
Temperature 36.2degree Celsius to 36.3 degrees Celsius

Respiration 36 count per minute to 35 counts per minute

Apex heart beat 135 beat per minute to 136 beat per minute

The baby's weight on the third day 12/02/22 was checked and recorded as 3.0kg.

After the examination, I handed baby over to the mother to be breastfed because she was crying and seemed hungry. I observed that baby was
not fixed correctly to breast so baby stopped feeding within a short while about 5minutes and was not willing to take the breast again. Madam I
E was informed that baby came off the breast because she was not fixed correctly. I then taught her again how to fix and position baby correctly
to breast and told her that she is likely to develop cracked nipples and breast engorgement if the baby is not fixed and positioned rightly to
breast. She was also advised to wear well-fitting brassiere to support the breast, to feed baby on demand and to allow baby to empty one breast
before giving the other breast. I encouraged her to continue with the kegel exercise, since it will help her regain the tone of her pelvic muscle. I
also talked about good nutrition, taking of more water and nourishing fluids as well as get adequate rest and sleep especially when baby is
asleep.

FOURTH TO SIXTH DAY POST DELIVERY HOME VISIT

Madam I.E and family were visited on the 13th 14th and 15th of February,2022 once daily in the morning. I was welcomed and offered a
seat after exchanging greetings with them. I asked of their health and she complained of not being able to sleep at night because baby wakes up
to suckle at short intervals on the fourth day. She was advised to sleep whiles the baby is asleep. She was also advised to empty one breast
during breastfeeding and ensures baby is satisfied. She was encouraged to break the wind after each feed. Permission was sought to conduct
head to toe examination on both mother and baby.

On the fifth day 14th February 2022 Baby’s weight was checked and recorded as 3.1kg Mother was congratulated for her good work done for
keeping the baby in good health and to continue breastfeeding her on demand to gain more weight

On examination the fontanels were normal with no bulging or sunken and pulsation well. The conjunctiva was pink. The cord was clean and
tried with no bleeding. He passed greenish-yellow stool three times and urinated four times. Baby was feeding and growing very healthy.

Baby’s vital signs was checked and recorded as

Temperature 36.6 degree Celsius to 36. 4 degree Celsius

Respiration 36 count per minute to 39 counts per minute

Apex heart beat 138bpm to 132bpm

She was topped and tailed, cord was dressed aseptically and baby was made comfortable in bed. She was also encouraged to keep baby’s cord
dry.

Mother

She was encouraged to empty her bladder and head to toe examination was conducted on her. Her general condition was good. Her breast was
lactating well and nipples were intact. There was no oedema at the upper extremities and nail bed was pink. The lochia was serosa with
moderate flow. She said she has emptied her bladder Three and moved her bowel once was neither oedema nor tenderness at lower extremities.
Her vital signs were checked and recorded as follows.

Temperature 36.7degree Celsius to 36.2 degree Celsius

Pulse, 80beats per minute to 78 beats per minute

Respiration 20 count per minute to 21 counts per minute

Blood pressure 120/80 millimeters per mercury to 110/70millimetres per mercury .

The fundal height was 14cm,13cm,12cm on 13th ,14th,15th respectively. There was no pain at the calf or oedema at the back .the lochia was
still flowing but this time colour has changed from rubra to serosa and was brownish pink in colour and it had no odour .

She was advised to change her perineal pad when soiled and to wash her hands before and after changing the pad. Client told me she had passed
urine three times and moved her bowel once.

SEVENTH DAY POST NATAL HOME VISIT

I visited Madam I.E and her family around 8:30am on 16th February 2022. She and the family as well as the baby were doing fine. I asked of the
previous complains and she said she is relieved of it. I asked permission to examine baby. COVID 19 Protocals were observed , I washed my
hands with soap and water and observed social distance

Baby was examined from head to toe and upon examination, the skin colour was pink, and the hair looked dark and shiny. There were regular
chest movements. Personal hygiene was maintained. The baby was bathed and the cord cleaned with Chlorhexidine . Mother confirmed baby
had moved her bowel three time and urinated five times. The vital signs were checked and recorded as follows,

Temperature 36.5

degree Celsius

Respiration 38cycles per minutes

pulse 128beats per minutes

Baby's weight 3.2kg .The mother was congratulated and encouraged to continue breastfeeding her baby to help maintain and improve the
baby's weight.

I washed and dried my hands and carried out physical examination on Madam I.E. General appearance was good. Her eyes looked healthy and
conjunctiva was pink. The abdomen was palpated and the uterus was well contracted and firm with fundal height measuring 11cm. Lactation
was well established lochia flow was moderate and odourless. The colour of the lochia was Alba . She said she had moved her bowel once and
emptied her bladder two times. Findings were communicated to her. Her vital signs were checked and recorded as
Temperature 36.0 degree Celsius

Pulse 80 beats per minutes

Respiration, 20counts per minutes

Blood pressure 110/70millimter per mercury.

I informed client and family that my care has ended and I will meet the client and baby at the postnatal clinic the next day and hand them over to
the midwife in- charge. I thanked client and her family for giving me such an opportunity and for their understanding and cooperation
throughout the care. I reminded her of her first post-natal review visit to the facility which was the following day that is 17 th February 2022.
asked permission to leave and left.

FIRST POST NATAL REVIEW VISIT

Madam I.E reported to the postnatal clinic on 17th of February 2022 together with her baby and sister at 9:00am. I welcomed them and offered
them seat after exchanging greetings. Both mother and baby were observed to be healthy and doing very well. I asked of her headache and she
said she is relieved. The midwife in-charge gave me the permission to continue my care. All procedures to be performed on both client and baby
were explained to her and she agreed. Baby’s weight was checked and recorded as 3. 3kilogram and vital signs was also checked and recorded as

Temperature 36.5degree Celsius,

IApex Heart Beat 134beat per minute

Respiration 36 count per minute.

I washed my hands under running water and dried them with a clean dried towel and conducted head to toe examination.

On examination, baby’s skin colour was pink, her hair was was dark and silky, anterior fontanelle was soft and pulsating and has no abnormal
bulging, it admitted two fingers while the posterior admitted one finger. The eyes were clear, conjunctiva was pink in colour with no abnormal
discharge, redness, pallor or jaundice, nose was observed to be patent without discharges and the neck had no swelling. Baby’s breathing pattern
was regular.

The upper extremities were equal in length without extra/missing digits or webbing. Baby’s abdomen was round and soft with no hardness or
protrusion, the cord was off and stump was clean, dry and healing well. The lower extremities were equal in length without extra/missing digit
and webbed toes. Anus and urethra were patent. I enquired from mother about baby’s feeding and she said baby was feeding well. Client said
baby had passed urine three times and stool two times and the colour of the stool was yellow. Baby was wrapped in a warm cot sheet and she
was given to client’s sister to carry her while I examine mother.

Mother

I sought client permission and was asked to pass urine and midstream urine was collected and tested for protein and glucose and it was negative
for both. I provided privacy and assisted her to undress and helped her to lie on the bed. I washed and dried my hands, and conducted head to toe
examination. I examined the head, the scalp was cleaned and hair neatly styled. The face was without puffiness. Eyes were examined for
redness, abnormal discharges and conjunctiva for pallor and jaundice but none of these were detected. The mouth and gum were pink, the teeth
and tongue were clean and the lips were moist with no dryness and cracks. There was no swelling on the neck or enlarged lymph nodes. Her
breast was Lactating without any sign of cracked or sore nipple. Her upper extremities were equal in length the fingers nails were short and neat
and no pallor of the nail beds. On abdominal palpation, the uterus was involuting rapidly and fundus was 10cm palpable above the pelvic brim.
The lower limbs were equal in length, had no oedema or varicose veins and no tenderness of the calf. Client was encouraged to lie in a lateral
position with the back facing me, I passed my two fingers along the spinal column but no abnormalities were detected. I sought for her consent
to inspect her vulva and washed my hands, dried them and wore a sterile glove. The pubic hair was neatly shaved, vulva was clean with no
offensive discharge or profuse bleeding. Vulva pad was inspected for the amount of flow, colour, and consistency of lochia, it was Alba,
moderate and not offensive. Client was helped to dress up and assisted off the examination bed. I washed and dried my hands and communicated
all findings to Madam I.E She said she had passed one stool and urinated thrice. Client vital signs were checked and recorded as follows:

Temperature 36.3degree Celsius,

Pulse 80beats per minute,

Blood pressure 110/70milimeters of mercury,

Respiration 22 count per minute and weight

Weight 69kilograms

Client was reminded and encouraged to continue practicing breastfeeding and to feed baby on demand, and break wind after breastfeeding.

Laboratory investigation was done and blood film for malaria parasite confirmed no Mps and blood haemoglobin level estimation was 10.8g/dl,
urine for acetone and protein were negative. Client was educated to maintain her personal hygiene. She was also educated on family planning
and she promised to practice it.
Client was advised to register her baby at the Birth and Death Registry. She was educated to eat more fruits such as pawpaw, mango and
pineapple and also to take in more fluids. I asked client about her sleeping pattern and she said she was able to sleep well as well as the baby.
Client also said that the after pains had worn off. I reminded client that she will come for six weeks postnatal care before she will be handed over
finally to the public heath team of nurses for child welfare clinic where the will continue with baby immunization and weighing. They were
handed over to the midwife in-charge. I expressed my sincere gratitude to client and her mother and saw them off.

NURSING CARE PLAN ON PUERPERIUM

Problems identified

After pains

Sleeping pattern disturbance(insomnia)

Headache

Backache

POTENTIAL PROBLEMS

Risk for cord infection

SHORT TERM OBJECTIVES

Client will cope with after pain within 72 hours

Client's sleeping pattern will be restored within 48

Client will be relieved of headache within 24 hours

Client will be relieved of backache within 72 hours

Baby's cord will fall off without infection within 5 days

LONG TERM OBJECTIVES

Mother will have a normal puerperium and breastfeed baby successfully throughout puerperium

NURSING CARE PLAN ON PUERPERIUM FOR MADAM I.E

Date/Time Nursing Objective/Outcome Nursing Orders Nursing Date/Time Evaluation Signs
Diagnosis Criteria Interventions
10/02/22 After pains Client will be relieved 1.Reassure client 1. Client was 13/02/22 Goal fully R.A
@ related to of after pain within 72 2.Explain to client the cause reassured that @ met as client
6:30 involution of hours as evidenced by of the after pain condition is 6:30pm verbalized
the uterus client verbalizing that 3.Encourage client to temporal and it can she has been
she is relieved of pain continue breastfeeding on be managed relieved of
and midwife observing demand despite the pain 2. I explained to after pain
client having a cheerful 4.Encourage client to empty client that after pain and midwife
facial expression when her bladder frequently is caused by observing
breastfeeding on 5.Assess flow of lochia to contraction of the client having
demand. rule out infection uterine muscles to a cheerful
6. Serve prescribe allow the uterus to facial
analgesics to relieve pain go back to it non expression
pregnancy state when
3. Client was breastfeeding
encouraged to
continue exclusive
breastfeeding on
demand
4. Client was
encouraged to empty
her bladder
frequently to help
relieve her of the
pain.
5. Lochia was
assessed for colour,
consistency, smell
and amount of flow
which were normal
without signs of
infection
6. Tablet
paracetamol 1000mg
was served PRN
 TABLE 3: NURSING CARE PLAN ON PUERPERIUM FOR MADAM I.E

TABLE 3: NURSING CARE PLAN ON PUERPERIUM FOR MADAM I.E

Date/Time NURSING OBJECTIVE/OUTCOME NURSING Orders NURSING Date/time Evaluation Sign

Diagnosis CRITERIA Interventions
13/02/22 Sleeping Client will have enough 1. Reassure client 1.Client was 15/02/22 Goal fully met R. A
@ 9:am pattern rest and sleep within 48 2. Explain the reassured @ 9:30 as client
interrupted hours as evidenced by importance of rest encouraged and verbalized that
related to client verbalizing that she sleep the client given emotional she had
baby waking get adequate rest during during postnatal support enough sleep
up to feed at the day and at night period to feed 2. I explained to and rest
frequent 3. Educate client to my client the throughout
interval in the feed baby well with importance of rest puerperium
night breastmilk, break the and sleep that it and midwife
wind after each feed will help her observing
before putting her to regain her client having a
bed strength and cheerful facial
4. Encourage mother energy she lost expression.
to change baby's during pregnancy
diaper and apply and child birth
fresh dry ones before 3. Client was
bed time educated in how
5. Encourage mother to feed baby well
to sleep wherever with breast milk
baby is sleeping ,break the wind
during the day after each feed
6. Encouraged before putting
client's husband to her to bed
assist with care of the especially at night
baby at night 4 . Client was
encouraged to
change baby's
diapers and apply
fresh dry ones
before bed time to
promote comfort
and long hours of
sleep
5 . I encouraged
my client to sleep
wherever baby is
sleeping during
the day
6. Client's
husband was
encouraged to
assist client with
care of the baby
at night so that
 client can have
enough sleep

TABLE 3: NURSING CARE PLAN ON PUERPERIUM FOR MADAM I.E

Date/Time NURSING OBJECTIVE/ NURSING Orders NURSING Date/Time Evaluation Sign

Diagnosis Outcome Criteria Interventions
14/02/22 Alteration in Client will be relieved 1.Rassure client 1. Client was 15/02/22 Goal fully R. A
@ 8:30 am body comfort of headache within reassigned that @ 9:30 am met as
2.Encourage client to avoid
(headache) 24hours as evidenced by pain will be evidenced by
doing strenuous activities.
related to client verbalizing pain is relieved client
stress during relieved. 3.Encourage client to have 2. Client was verbalizing the
Puerperium enough rest during the day educated to avoid she is relieved
when baby sleeps. strenuous of pain

4.Check vital signs activities and

especially BP to rule out encouraged to do

any rise in the BP. fewer activities at

6. Serve prescribed home
analgesics 3. Client had
enough rest
during the day
when baby sleeps
4. Vital signs
including BP
were checked
but they were
within range
6. Prescribed
tablet
paracetamol
1000mg tid × 5
days was served
Date/Time NURSING OBJECTIVE/Outcome NURSING Orders NURSING Date/Time Evaluation Signs
Diagnosis Criteria Interventions
12/02/22 Backache Client will be relieved 1.reassure client 1. Client was 15/02/22 @ Goal was fully R.A
@ 8:00 related to poor of backache within 72 2. Encourage client to reassured that 9 :30am met as client
posture during hours as evidenced by assume correct posture backache cam be said backache
breastfeeding client demonstrating during breastfeeding managed is relieved and
correct posture for 3. Educated client the 2. Client was she assumed a
breast feeding various positions such as encouraged to good posture
verbalizing absence of sitting with her back assume correct during
backache supported and lying posture during breastfeeding
down when breastfeeding
breastfeeding 3.Education on
4. Advice client to wear various positions
low foot wear to reduce such as sitting with
stress on the back her back supported
5. Encourage client to and lying down
sleep on a firm matress when breastfeeding
to reduce backache 4. Client was
advised to wear low
heeled foot wears
to reduce stress on
the back
5. Client was
encouraged to sleep
on a firm matress
to reduce the
backache
Date/Time NURSING OBJECTIVE/Outcome NURSING Orders NURSING Date/Time Evaluation Sign
Diagnosis Criteria Interventions
11/02/22 Risk for cord Baby's cord will fall 1. Reassure client 1. Client and 16/2/22 Goal fully R.A
@ 6:30 pm infection without infection 2. Educated client and family family members @ 6:30pm met as
related to poor within 5 days as members not to cover the cord were reassured client kept
cord care evidenced by midwife with the baby's diapers that cord infection baby's cord
observing proper cord 3 Encouraged client and family can be prevented clean and
care and cord healing on infection prevention 2Client and family dry and
by dry gangrene measures. members were cord
4. Advice client and family told not to cover healed by
members not to apply anything the cord with the dry
on the cord such as herbs or baby's diapers gangrene
cream on the cord 3 .Client aand
5. Educate client on signs of family members
cord infection. were encouraged
to wash their
hands with soap
and water before
touching the
umbilical cord
4. Client and
family members
were advised not
to apply anything
such as herbs or
cream on the
cord.
5. Client and
family members
were educated on
signs of cord
infection such as
redness and
offensive odour.
 SUMMARY AND CONCLUSION

This family centered maternity care study was on Madam I.E. a 32years old gravid 4 Para 3
all alive. She was a regular antenatal attendant at Essikado Hospital. I chose her when her
pregnancy was 36 weeks +6days old. My first contact with her was on 17th January 2022. It
was her Seventh antenatal visit to the hospital. All general examination and laboratory
investigations carried on her during pregnancy, labour and puerperium revealed no sign of
abnormality. Madam I.E. was offered individualized client centered care throughout the rest
of the period of her pregnancy, labour and puerperium.

Client came into labour on 8th February, 2022 at 11:30pm. She went through labour
successfully and delivered a baby girl at 5:15am who weighed 3.1 kilogram with Apgar score
8/10 and 9/10 at 1st and 5th minute respectively. During puerperium, I took care of the client
through home visit for one week. During pregnancy, labour and puerperium, client presented
with certain health problems which were managed using the nursing care plan.

The care study on Madam I.E and the family provided me the opportunity to adopt scientific
approach in the collection of relevant data and how to analyze and utilize them. Writing this
care study gave me insight on how to identify needs of client, help solve their problems and
treat clients as individuals with unique characteristics through pregnancy, labour and
puerperium.

In conclusion, the family centered maternity care study has been a challenge but
useful and educative. The care study has given me the opportunity to put into
practice the knowledge acquired in the classroom. I therefore recommend that the
family centered maternity care study should be put into practice in our day to day
obstetric care to every woman to help reduce maternal and infant mortality rates.

BIBLIOGRAPHY
Client’s Antenatal card, Registration Number of 882/21 Essikado hospital.

Fraser, D.M & Cooper, M.A (2009). Myles textbook for Midwives (15thed). China:

Churchill Livingstone Elsevier Limited.

Fraser, D.M & Cooper, M.A (2003). Myles textbook for Midwives (Africa ed). China:

Churchill Livingstone Elsevier Limited.

Ghana Health Service (2008). National Save Motherhood Protocol Ministry of Health. Accra
Ghana: Yemen’s Press Ltd.

Korah, B.S & Philip J. (1996). B.I. Churchill’s Handbook of Midwifery (1sted). New Delhi:

B.I. Churchill Livingstone Pvt Ltd.

M.O.H, JHPIEGO & USAID, (2000). Reproductive Health Classroom and Clinical Activities
Guide For Training Midwives. A Supplement To The Midwifery Curriculum.

Accra Ghana: JHPIEGO press Ltd.

Ojo, O.A. & Briggs E.B. (1982). A Textbook for Midwives in the Tropics (2nded). From
London: Butler and Tanner Ltd.

Tanya A.M (2003). Oxford Mini Dictionary For Nurses (5thed). New York :L.E.G.O.S.p.A
Ltd.

Tiran D. (1997). Clinical Pharmacology for Nurses, London Oval Road: Harcourt Brace and
Company Ltd.

Tiran D. & Sweet B (1997). A Text Book for Midwives (12thed). London: Bailliere Tindal
Ltd.

Tiran D. (2008).Baillieres Midwives Dictionary (11th ed). London Oval road: Bailliere
Tindal Ltd.

Verrals, S. (1993). Anatomy And Physiology Applied to Obstetrics, (3rded). Singapore:

Longman Pitman Publishing Ltd.
WHO, Maternal and New Born Health/ Save motherhood Unit. Care in normal birth: a
practical guide. http://www.who.Int/maternal-child-adolescent/documents/who-frh-msm-
9624/en/.

Client’s Antenatal Card Number 228/20/Enchi).

 APPENDIX III

LABORATORY INVESTIGATIONS FOR MADAM I.E

DATE SPECIME EXAMINATION RESULTS NORMAL REMARKS

N
10/09/21 Blood Hemoglobin Level 10.4g/dl 10-16g/dl Moderate
10/09/21 Blood Blood group A A,B,O and AB Normal
10/09/21 Blood Rhesus factor Positive Positive Normal
10/09/21 Blood Sickling Negative Normal Normal
10/09/21 Blood BF for Mps No Mp’s No malaria parasite Normal
should be seen
HBs Ag Negative Normal Normal
No defect No defect Normal

Glucose-6 phosphates
dehydrogenase

13/09/21 Blood VDRL Test Non-reactive Non-reactive Normal

13/09/21 Blood HIV/AIDS Non-reactive Non-reactive Normal
13/09/21 Urine Protein Negative Negative Normal
Glucose Negative
Acetone Negative
Appearance Clear
Colour Straw
PH 6.0
Bilirubin Negative

DATE SPECIMEN EXAMINATION RESULTS NORMAL REMARKS

22/11/21 Stool Examination No ova seen No ova should be seen Normal
22/11/21 Blood BF No mp’s seen No malaria parasite Normal
should be seen
Haemoglobin level 10.1g/dl Normal range from 28
weeks gestation is
 10-14g/dl
20/12/2021 Blood BF No mp’s seen No malaria parasite Normal
should be seen.
Haemoglobin 9.8g/dl Normal range from 28 Moderate
weeks gestation is
10-14g/dl

20/12/21 Urine Protein Negative Negative Normal

Sugar Negative Negative
Acetone Negative Negative

17/01/2022 Blood Blood Film for Malaria No parasite seen No malaria parasite Normal
Parasites should be seen.
Haemoglobin level 9 .3g/dl Normal range from 28 Normal
weeks gestation is
10-14g/dl
DATE SAMPLE EXAMINATTION RESULTS NORMAL REMARKS
VALUES

17/02/2022 Blood Haemoglobin level 9.3g/dl 12.0g/dl-16.0g/dl Normal

Blood Blood Film for No malaria parasite No malaria parasite Normal

17/02/2022 malaria parasite seen should be seen
17/02/2022 Urine Protein Negative Negative Normal
Glucose
Acetone

Appendix IV

Ultrasound scan
Date 17th January 2022 Investigation Results
Fetal Heart Activities Present
Fetal Number One
Presentation Cephalic
Lie Longitudinal
Placenta Posterior
Liquor Volume Adequate
Fetal Abnormality None
Estimated Gestational age 36weeks plus 6days
Expected Date of Delivery 08/02/22
 APPENDIX VIII

PHARMACOLOGY OF DRUGS USED DURING ANTENATAL

Date Drug name Dosage Route of Classification Mode of action Side effect
administration
11/10/21 Tablet I gram tds daily for five Oral Analgesic It reduces pain Prolong use or overdose may cause liver and kidney d
paracetamol days Antipyretic and high body
temperature.
22/11/21 Tablet Folic 5mg daily for 14 days oral Haematenics Prevent anaemia, Diarrhoea, nausea and vomiting
Acid helps in the
formation of red
blood cells .It
prevent neural
tube defects and
increase appetite.
17/01/22 Tablet 5mg tid for 14 days Oral Haematenics Increase appetite. Nausea, Vomiting and dark stool .
multivitamin Helps in
formation of red
blood cell
PHARMACOLOGY OF DRUGS USED DURING ANTENATAL
Date Drug name Dosage Route of Classification Mode of action Side effect
administration
17/01/22 Tablet ferrous 30mg daily times Oral Haematinics For development and Nausea and vomit
sulphate 14 days production of red epigastric pain. B
blood cell. and constipation
13/09/21 Sulphadoxide- 525mg monthly Oral Antimalaria Prevent client from Loss of appetite, N
11/10/21 perimethamine getting malaria. Vomiting
08/11/21
20/12/21
17/01/22
APPENDIX X PHARMACOLOGY OF DRUGS IN LABOUR

DATE DRUGS NAME Dosage Route of Classification Mode of action Side effect Effect on client
administration
09/02/22 Oxytocin 10unit intramuscular Uterotonic Stimulate Uterus
Agent uterine muscles contracted well
to produce and no
effective bleeding
contraction to occurs.
prevent
haemorrhage
Injection 1ml Intramuscular Anticoagulant promotes Blister Protect baby
Vitamin k hepatic formation at from bleeding
formation of the site of
active injection
prothrombin
 for adequate
blood clotting.

APPENDIX XI

Duration of Labour
STAGES TIME DURATION
First 12:00am --5:00am 5hours
Second 5:00--5:15 15 minute
Third 5:15--5:20 5 minutes
Total 5hours 20minute

APPENDIX XII CONDITION OF THE PLACENTA AND MEMBRANE

Placenta and Membrane Completely Expelled
Length of Cord 40cm
Weight 500
Diameter of placenta 22cm
Cord Insertion Centrally
Umbilical Blood Vessels Two Arteries and A Vein
Maternal Surface Dark Red
Fetal Surface Bluish Red

APPENDIX XIII CONDITION OF BABY AT BIRTH

Sex Female
Weight 3.1kg
Apgar Score 8/10. 9/10
Full length 45cm
Head Circumference 32cm
Chest Circumference 36cm
 Abnormalities None Detected
General Condition Satisfactory

APPENDIX XIV APGAR SCORE

Signs First minutes Five minutes

Appearance 2 2
Pulse 2 2
Grimace 1 1
Activities 1 2
Respiration 2 2
Total 8/10 9/10

APPENDIX XIX PHARMACOLOGY OF DRUGS USED During puerperium

Date Drug name Dosage Rout of classification Mode of action Side effect
 administration

09/02/2022 Chlorhexidine 2-5ml External/ Tropical Antiseptic for Quick drying inhibits Burning sensation
dressing cord multiplication of
bacteria
Bacillus Calmate 0.05ml Intradermal. Right Arm Vaccine Alive attenuated Abscess formation o
Guerin vaccine that produces lymphatic glands,
active immunity against swelling at injection
tuberculosis by forming site.
antibodies.
Polio Vaccine OPV0 2 Drops Oral Vaccine It produces antibodies
against polio organism
thus building immunity
against poliomyelitis.
Capsule Amoxycillin 500mg tid Oral Antibiotic Antibiotic active Anorexia and Vomit
times 7days against wide range of
gram positive organism

Capsule
Vitamin A 200mg Oral Vitamin Skin rashes
It helps to reduce iron enlargement of live
deficiency and when taken in large
prevent night dose
blindness
SIGNATORIES

NAME OF STUDENT

SIGNATURE

DATE

NAME OF SUPERVISOR:

SIGNATURE:

DATE:

NAME OF PRINCIPAL:

SIGNATURE

DATE