A FAMILY CENTERED MATERNITY CARE STUDY

ON A CLIENT IN THE DISTRICT

WRITTEN BY

ANSAH JENNIFER

(672222004)

A FINAL Y EAR REGISTERD MIDWIFERY STUDENT OF THE

NURSING AND MIDWIFERY TRAINING COLLEGE, KORLE BU

KORLE-BU

AUGUST, 2023

i
 A FAMILY CENTERED MATERNITY CARE STUDY

ON A CLIENT IN THE DISTRICT

WRITTEN BY

ANSAH JENNIFER

(672222004)

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF GHANA IN

PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF A

LICENSE TO PRACTICE AS A REGISTERED MIDWIFE.

AUGUST, 2023

ii
 TABLE OF CONTENTS

TABLE OF CONTENTS i

PREFACE iv

ACKNOWLEDGEMENT v

INTRODUCTON vi

LITERATURE REVIEW viii

CHAPTER ONE 1

ASSESSMENT OF CLIENT / FAMILY 1

Personal and Social History 1

Family History 1

Menstrual History 1

Surgical History 2

Medical History 2

Lifestyle and Hobbies 2

Past Obstetric History 3

Present Obstetric History 4

CHAPTER TWO 6

REPORT ON ANTENATAL CARE 6

My First Contact with the Client 6

i
Why I Chose My Client 10

First Antenatal Home Visit 11

Subsequent Antenatal Home Visits 12

Subsequent Antenatal Clinic Visits 14

Nursing Care Plan for Antenatal 18

CHAPTER THREE 26

REPORT ON LABOUR AND DELIVERY 26

Initial Assessment and Admission into The Labour Ward 26

Management of First Stage of Labour 28

Management of the Second Stage of Labour 30

Immediate Care of the Baby 31

Management of the Third Stage of Labour 32

Examination of the Placenta 33

Management of the Fourth Stage Of Labour 33

Examination of the Baby 34

Labour Nursing Care Plan 37

CHAPTER FOUR 45

REPORT ON PUERPERIUM 45

Management In The Lying-In Ward 45

ii
Preparation For Discharge 46

Postnatal Home Visits 48

First Day Posnatal Home Visit 48

Second Day Postnatal Home Visit 50

Third Day Postnatal Home Visit 52

Fourth Postnatal Home Visit 53

Fifth Day Postnatal Home Visit 54

Sixth Postnatal Home Visit 55

Seventh Day Post Natal Home Visit 56

Sixth Week Postnatal Clinic Visit 57

Termination of Care and Continuity Of Care 59

Puerperium Nursing Care Plan 60

SUMMARY 67

CONCLUSION 68

BIBLIOGRAPHY 69

APPENDICES 70

SIGNATORIES 84

iii
 PREFACE

An expectant mother’s desire is to have a safe delivery and a healthy baby. This desire of an

expectant mother can be achieved by the concept of Family Centered Maternity Care.

According to International Childbirth Education Association (ICEA), a Family centered

maternity care is a process of offering good obstetric care to expectant mother and her baby.

The main focus and reason for this study is to build confidence of parents, support and

encourage them throughout pregnancy, labour and postpartum period and also promote health

and prevent diseases.

A Family Centered Maternity Care concept imploring the nursing process used to identify

problems and managed the pregnant woman effectively. In providing this nursing care,

physical, psychological, spiritual, social and the rehabilitative aspect of the client are

considered within the framework of her family and community in order to maintain and attain

the highest possible health outcome and wellbeing to reduce maternal and infant mortality

and morbidity

Family centered maternity care provides the student midwife with the knowledge to provide

holistic care to the expectant mother and her family on a thoughtful understanding of the

client as a unique being with specific problems and needs to go through pregnancy, labour

and puerperium successfully without any complications. This study therefore aims at making

childbearing safe, reduce maternal and infant mortality as well as identification and

prevention of complications. It helps the student midwife to adopt a scientific approach to

collect relevant data, analyze data, identify problems, diagnose, plan and implement nursing

care. It also serves as a learning experience as well as a course requirement for student

midwives for attainment of Registered Midwifery Certificate from the Nursing and

Midwifery Council of Ghana

iv
 ACKNOWLEDGEMENT

I wish to express my sincere gratitude to God Almighty for granting me the knowledge,

wisdom, understanding and strength to reach this far.

I am also grateful to the entire tutors of Nursing And Midwifery Training College, Korle,

forgetting the principal of the school, Mrs. Mercy Adzo Kporku for giving me the

opportunity to be trained as a midwife. Special thanks go to my supervisors Mrs. Baidoo

Gifty for her precious time, energy and corrections during the period of care and marking of

the care study.

My sincere appreciation goes to the midwife in charge, Mrs. Afia ,Achiaa Asante ward

in charge and staff of Mamprobi Hospital for their encouragement, help, suggestions and

supervision during the writing of this script.

My sincere gratitude goes to my client Madam R.D.O. and her family for their cooperation

and information which helped me a lot in the writing of this care study.

My heartfelt gratitude goes to my parents, Mr. and Mrs. Ansah, friends and siblings for their

support both spiritually and financially.

Lastly, I wish to acknowledge the authors and publishers whose various books were used as

references.

v
 INTRODUCTON

Safe delivery in women of childbearing age is ensured using modern approaches in

midwifery practice such as the Family Centered Maternity Care and the nursing process

approaches. These approaches are used to detect early and any deviations from normal during

pregnancy, labour and puerperium and the appropriate care rendered. The use of Family

Centered Maternity Care and the nursing process approaches again aims at reducing the

number of deaths associated with pregnancy, childbirth and puerperium as well as promoting

the health of women and their newborns.

To attain these objectives, clients’ specific problems especially the physical, psychological

and social needs are detected and promptly managed and treated appropriately with the client

and family involvement and participation in the rendering of care.

Nursing process is an organized approach to identification of patient’s nursing care problems

and the utilization of nursing actions that effectively alleviate, minimize or prevent the

problems from developing (Weller, 2019).

Family Centered Maternity Care is a process of offering good obstetric care to expectant

mother and her baby. The focus and reason are to build confidence of parents, support and

encourage them throughout pregnancy, labour and postpartum period and also promote health

and prevent diseases.

This process is usually beneficial to the student midwife as she adopts a scientific approach to

collect relevant data, identify problems, analyze, diagnose, plan and implement the nursing

care. The nursing process enabled me to collect relevant data from the client, her existing

record, family members, laboratory investigations and physical examinations.

vi
Patient care study renders individualized total patient care; family centered care leads to and

promote safe motherhood. The key component of reproductive health programs consisting of

good antenatal care, supervised delivery and postnatal care has become a global effort to curb

the high incidence of maternal mortality rate in Ghana.

For the purpose of confidentiality my patient would be referred to as Miss R.D.O., however,

the names of health professionals and individuals involved in the management of her would

be maintained.

This case study is on Madam R.D.O. gravida 2 para 1 alive who lives at Smart-start school

area and is a regular attendant at Mamprobi Hospital. I used the Family Centered Maternity

Care and the nursing process approaches to provide Madam R.D.O. with care that was

individualized, holistic, efficient and effective to meet her needs.

This study is divided into four (4) chapters as follows:

Chapter one (1) consists of client’s social history, habit of daily living, family, medical,

surgical, menstrual, past obstetric, present obstetric histories, and validation of data.

Chapter two (2) consists of the care rendered in the antenatal period. The chapter ends with a

care plan which outlines care given based on the nursing process.

Chapter three (3) is narrative of the care given during first, second, third and fourth stages of

labour. It ends with a care plan.

Chapter four (4) explains the care provided during puerperium. It consists of home visits to

the client and her family. It also explains client’s visit to the facility for postnatal care. It also

ends with a care plan.

vii
 LITERATURE REVIEW

Considering this narrative report, there is the need to look at the process, which the expectant

mother experiences in pregnancy, labour and puerperium. This chapter aims to describe

physiological changes and the application of family centered maternity care during

pregnancy, labour and puerperium.

According to Weller (2019), pregnancy is being with a child, the condition from conception

to the expulsion of the foetus. The average duration for a normal pregnancy is 280 days plus

or minus 14 days. (40weeks or 9months) counted from the first day of the last menstrual

period.

The period of pregnancy is divided into trimesters thus, into periods of weeks and each is

made of three months or twelve completed weeks (Ghana health service (GHS), 2016).

The first trimester is from the first twelve completed weeks. Amenorrhea, nausea and

vomiting, frequency of micturition, gradual enlargement of the uterus and breast changes are

peculiar within this phase.

The second trimester is from thirteen to twenty- six completed weeks. This period is

characterized by morning sickness, first fetal movement; fundal height is above the umbilicus

and fetal heart rate being heard on auscultation.

From twenty-seven to forty completed weeks is the third trimester. The fundus rises to the

level of the Xiphisternum around 36 week’s gestation and descends slightly later as the foetal

head engages (lightening). Lightening result in frequency of micturition as the head presses

on the bladder.

There are various physiological changes that occurs in a woman’s body that helps her to carry

the pregnancy, prepare her for labour and delivery. These changes explain the signs and

viii
symptoms of pregnancy and the many disturbances that clients may complain about and seek

medical advice. Some changes that occur during pregnancy are outlined below.

In the reproductive system, the uterus increases in size, weight and grows from a pear shape

and assumes a more globular form in anticipation of foetal growth. It also accommodates the

increasing amount of liquor and placenta tissues as pregnancy advances. The cervix increases

in width and becomes softer and purplish in colour due to increased blood supply. It also

remains firmly closed and filled with operculum to act as a barrier against ascending

infections and holds the content of the uterus. The vagina becomes vascular and bluish in

colour. There is increase in vaginal secretion (leucorrhoea) and pH of the vagina. The breasts

become tender. There is an increase in blood supply and an increase in size of the breasts.

Towards the end of pregnancy, breast milk is produced because of the hormone prolactin.

In the skeletal system, the hormones oestrogen, progesterone and relaxin cause relaxation of

the pelvic joints namely sacroiliac and sacrococcygeal joints. An increased concentration of

relaxin increases pelvic laxity and may be responsible for loosening pelvic ligament and

increasing instability causing some degree of discomfort for the woman. There is decreased

neuromuscular control and coordination, decreased abdominal strength, and increased spinal

lordosis. All these influences postural control and may be related to the increased risk of

falling. Because of the changes, many women experience waist pain and lower back pain

(Marshall & Raynor, 2014).

In the urinary system, systemic vasodilatation in the first trimester and an increase in blood

volume and cardiac output results in a massive vasodilatation of the renal circulation.

Dilatation of the renal pelvis and ureters with reduced peristalsis starts as early as 7 weeks of

gestation, peaks at between 22 and 26 weeks and by the third trimester is marked

approximately 90% of women (Marshall & Raynor, 2014). Dilated ureters with reduced

ix
peristalsis and obstruction by the enlarged uterus all contribute to urinary stasis leading to the

increased risk of urinary tract infection. Glucose excretion in urine increases due to increased

glomerular filtration rate. An increase in urinary output leads to frequency and urgency of

micturition in early pregnancy due to the enlarging uterus, which compresses the urinary

bladder and reduces its capacity. It occurs again towards the end of pregnancy when the

presenting part becomes engaged in the pelvis putting the bladder under pressure and the

enlarging uterus also compresses both ureters at the pelvic brim causing obstruction to urine

flow (Marshall & Raynor, 2014).

For changes in the nervous system, hormonal fluctuations occurring throughout pregnancy

may re-model the female brain, increasing the size of neurons in some regions and producing

structural changes in others. Oestrogen and progesterone readily enter the brain to act on the

nerve cells changing the balance between inhibition and stimulation. Other pregnancy

hormones such as relaxin, prolactin and lactogen also have an impact. Hormonal and

mechanical influences affect a pregnant woman’s sleep pattern. These includes nocturia,

nasal congestion, stress, anxiety, dyspnea as well as muscular aches and pains, leg cramps

(Marshall & Raynor, 2014).

In the gastro intestinal system, oestrogen and progesterone causes the gum to become

highly vascularized, oedematose, have less resistance to infection and are easily irritated.

Most women complain of heartburns which is due to the relaxing effects of progesterone on

the lower oesophageal sphincter. There is also a reduction of gastric and intestinal tone and

motility leading to constipation in pregnancy and sometimes in puerperium. Nausea and

vomiting which is associated with the increased amount of Human Chorionic Gonadotrophin

(HCG) hormone which begins between 4-8 weeks of gestational age and decreases by the

middle of the second trimester. There may be changes in the sense of taste and this could lead

x
to craving for foods and unnatural substances during pregnancy (Pica). There is also

excessive salivation (ptyalism) in early pregnancy.

Changes that occur in the cardiovascular system include an increase in cardiac output

(30%) which ensure blood flow to the brain and the coronary arteries is maintained, whilst

distribution to other organs is modified as pregnancy advances. These changes in the

cardiovascular system during pregnancy improve oxygenation and flow of nutrition to the

fetus. There is hemodilution as a result of an increase in the red blood cells of about 30% and

increase plasma volume. Due to this, the plasma dilutes the blood cells causing this condition

which could lead to physiological oedema and anaemia. Both chambers of the heart enlarge

and increase in size, which displace the diaphragm downwards causing the heart to shift to

the left and interiorly. In later pregnancy, the gravid uterus occludes the inferior vena cava,

this happens when the woman lies supine. This will predispose the woman to exhibit supine

hypotensive syndrome. In the first trimester, the blood pressure remains unchanged, and in

the second trimester, the blood pressure reaches its lowest level and gradually rises as term

approaches.

With the skin changes, as a result of melanocyte stimulating hormone, oestrogen and

progesterone, some women develop chloasma which is a deeper patchy coloring on the face.

There is dark coloring of linea alba to become linea nigra which extends from the umbilicus

to the pubis and also, the nipples and the areolas darken. As maternal size increases in early

pregnancy, stretching occurs in the collagen layer of the skin, thus the breasts, abdomen, and

thighs. This results in striae gravidarium. Fingernails grow more quickly during pregnancy.

In the endocrine system, the changes during pregnancy are responsible for the initiation and

maintenance of the pregnancy for growth and development. The Human Chorionic

Gonadotrophin (HCG) is produced by the placental trophoblastic cells and the pituitary

xi
gland. Its role is to prevent the corpus luteum from subsiding so that it can continue to

produce progesterone which in turn maintains the decidua. Relaxin is produced by the corpus

luteum which helps to inhibit the strength of uterine contractions in pregnancy. Human

Placental Lactogen is secreted to regulate maternal carbohydrate, lipid and protein

metabolism and fetal growth also aid in the growth and development of the breasts.

Oestrogen increases uterine blood flow and facilitates placental oxygenation and nutrition to

the foetus. Progesterone prevents the onset of uterine contractions (Marshall & Raynor,

2014).

With the respiratory system, the changes during pregnancy results in an overcompensation

to the respiratory demand. The driving force for the change is the stimulatory effect of

progesterone on the respiratory center, which lowers the threshold and increases sensitivity to

carbon dioxide. 75% of women with no underlying pre-existing respiratory disease

experience some dyspnea possibly due to an increased awareness of the physiological

hyperventilation. Hyperventilation can be extremely uncomfortable and may lead to dyspnea

and dizziness. From early pregnancy onwards, the overall shape of the chest alters, the lower

ribs flare outwards prior to any mechanical pressure from the growing uterus. The changes

that happen to the ribcage are thought to be mediated by the effect of progesterone, which

together with relaxin increases the ribcage elasticity by relaxing the ligament. Blood volume

expansion and vasodilation of pregnancy results in hyperemia and oedema of the upper

respiratory mucosa, which predispose the pregnant woman to nasal congestion, epistaxis and

even changes in voice.

Any deviation from normal during pregnancy can be detected through antenatal care.

Antenatal care is the care provided by midwives and obstetricians during pregnancy to ensure

that fetal and maternal health are satisfactory, to enable early detection and treatment of any

deviation from normal. Psycho-emotional preparation of the parents for labour and

xii
parenthood and health education on diet, personal hygiene, environmental hygiene, exclusive

breastfeeding, the use of insecticide treated net, birth preparedness and complication

readiness plan are also included.

Labour is described as the process by which the foetus, placenta and membranes are

expelled through the birth canal (Marshall & Raynor, 2014). (GHS, 2016) states that “Labour

is said to occur when there are regular, painful uterine contractions resulting in the

progressive cervical effacement and dilatation”. Labour begins when there are regular painful

contractions lasting at least 20 seconds (timed by a midwife/nurse) occurring at a frequency

of at least two contractions in every 10 minutes and with a cervical dilatation of at least 3cm.

There are four stages of labour, the first stage of labour begins with the dilation of the cervix

and is characterized by regular rhythmic contractions. It ends with effacement of the cervix

and full dilation of the cervix which is 10 centimeters. It takes 12 to 15 hours for the

primigravidae and 6 to 10 hours for the multigravida.

The first stage of labour is divided into latent, active and the transitional phases; the latent

phase starts from when cervical dilatation starts and ends when the cervix is 4 centimeters

dilated and the cervical canal shortens from 3 centimeters long to less than 0.5 centimeter

long.

The active phase starts when the cervix is 4 centimeters dilated and ends when it is fully

dilated (10 centimeters). First stage of labour is monitored on the partograph. The partograph

is a graphical representation of the events and progress of labour. It helps in early detection of

abnormalities. The transitional phase is the stage of labour when the cervix is from around 8

centimeters dilated until it is fully dilated (or until the expulsive contractions during second

stage are felt by the woman).

xiii
The second stage of labour marks the full dilatation of the cervix and complete expulsion of

the foetus. It lasts a few minutes to 1 hour.

The third stage of labour starts from the separation of the placenta till complete expulsion

of the placenta and membranes. It also involves the control of bleeding. It normally lasts

30minutes.

The fourth stage of labour starts from the first six hours after the expulsion of placenta and

membranes which also mark the beginning of puerperium. It involves close observations of

the mother and baby until their conditions are stable.

According to Oduro-Kwarteng (2015), puerperium is a period that starts immediately after

delivery of placenta up to 6-8 weeks. It begins from the fourth stage to 6 weeks after delivery.

The mother recovers from the strains and stresses of pregnancy, labour and delivery and other

physiological changes which occurred during pregnancy. During this period the mother is

prone to infections such as mastitis, puerperal sepsis and breast abscess whiles baby is prone

to pemphigus. Therefore, the mother is educated to prevent such complications from

occurring, by ensuring good personal and environmental hygiene.

Lactation is established and bonding is created between mother and baby through

breastfeeding and close contact. The care during puerperium also ensures physical and

psychological wellbeing and development of the baby. The postnatal pathway is divided into

three.

“Which covers the postnatal period. These are.

Immediate puerperium: this is the first 24hours after delivery.

Early puerperium: this lasts from the 2nd to 7th day after delivery.

xiv
Late puerperium: this is the 2nd week through to the 6th week after childbirth.

xv
 CHAPTER ONE

ASSESSMENT OF CLIENT / FAMILY

Introduction

This chapter gives the preview on various information about the client social, family,

medical, surgical, menstrual, past and present obstetrical histories as client lifestyle, hobbies

and her community in whole.

Personal and Social History

Madam R.D.O gravida 2 para 1 alive is a 23year old lady who comes from James

Town in the Greater Accra Region and stays at Banana-In. She is fair in complexion, weighs

55 kilograms and 165 centimeters in height at booking. Madam R.D.O is married to Mr. F.O

who is an accountant officer. She attends Redeemed Christian Church of God. Madam

R.D.O is a student at Pentecost University. Client had registered to the National Health

Insurance Scheme, and it is her source of finance for medical care. Client speaks and

understand Twi, Ga and English. Client next of kin is her son C.K.O

Family History

Madam R.D.O is the first born to Mr. K.O.M and Madam J.M. Her father is a retired teacher

and her mother is a seamstress. Among the six children are three females and three males. No

known histories of any chronic or hereditary diseases such as cancer, diabetes mellitus,

epilepsy, hypertension, sickle cell disease or mental illness in the family. She has twins in her

family but no congenital abnormality such as extra digits, cleft palate, cleft lip, spinal bifida in

the family.

1
Menstrual History

Madam R.D.O had her menarche at the age of fifteen (15) years which lasts for seven (7 days

with normal flow. Madam R.D.O. does not take any medication during her period but she

normally uses two (2) pads a day during her menses to promote personal hygiene. She has

never experienced dysmenorrhea in her life. Her last menstrual period was 16th January

2023 and her expected date was 4th October 2023.

Surgical History

Madam R.D.O, has never undergone any surgical procedure and has never been involved in

road traffic accident which could have affected her pelvis .She also added that she has neither

donated nor received blood transfusion.

Medical History

According to Madam R.D.O she has no known medical history of conditions such as anemia,

heart disease, respiratory disorders, epilepsy, and hypertension.

Lifestyle and Hobbies

Madam R.D.O normally wakes up around 5:00am, she prays and brushes her teeth with

toothbrush and toothpaste after which she sweeps her room and compound. She added that she

does not sweep the compound always because it is swept in turns. She then goes to throw her

rubbish away at the dump site which is 6 minutes’ walk away from her house. And her

husband helps her with fetching of water which is 4 minute’s walk away from their house, bath

their first son which is 2years of age and dress him. By 7:00am she had done her house chores

and prepare their breakfast after that she take her bath. Client takes her porridge with bread in

the morning, rice with tomato sauce in the after afternoon and banku with soup or hot pepper

with fried fish in the evening. She added that, since orders are not effective, she goes to her

workplace, she closes around 4.30pm. She then goes home to prepare their evening meal which

2
was mainly banku with okro soup since that is her favorite. Client said during her leisure time,

she rests on her bed or watch television. Client urinates frequently when she takes in enough

fluid and empties her bowel at least once a day.

Past Obstetric History

Pregnancy; Madam R.D.O gravida 2 para 1 alive and healthy went through all her pregnancy

successfully without any complications. She had her first pregnancy in the year 2021. She

said she took the two doses of Tetanus` diphtheria injection as well as K23 doses of

Sulphadoxine-Pyrimethamine (SP)) in her first pregnancy. She delivered her child at term.

She said during her pregnancy, she only experienced some minor disorders such as backache,

waist-pains, nausea and vomiting of which she reported to the clinic, and it was explained to

her that all these minor disorders are seen as a normal physiological change in pregnancy

which would resolve as pregnancy progressed. She has never suffered any pregnancy induced

conditions such as pregnancy induces hypertension, pre-eclampsia and gestational diabetes.

She visited the antenatal clinic for at least 6 times during her pregnancy. According to client

the interval between the first child and the current pregnancy is 4 years.

Labour: According to Madam R.D.O, her previous delivery took place at health center by

spontaneous vaginal delivery. Client first child was delivered at Mamprobi Hospital who was

a male and weighed 3.2kg at birth per records. The duration of labour for the first born did

not exceed 12 hours. Client said the placenta was delivered few minutes after the baby was

born, and the child was in good health after delivery. There was no complications such as

postpartum hemorrhage and breastfeeding was initiated at birth. Abnormalities such as cleft

palate, cleft lip, and extra digit were not detected at birth. Amount of blood loss was 200mls

in her previous delivery.

3
Puerperium; Madam R.D.O went through puerperium successfully without any

complications such puerperal infection and sepsis. She started breastfeeding her child after

delivery. Her child looked healthy and normal. Her child was fully immunized against the

childhood preventable diseases. She practiced exclusive breastfeeding for six months and

weaned after 1year 6months. Client also stated that her family supported her in taking care of

the baby and some of the household chores. She uses the natural family planning method thus

lactational amenorrhea method. She said her child was fully immunized against vaccine

preventable disease according to schedules. She did not experience problems like puerperal

sepsis and etc.

Present Obstetric History

Madam R.D.O G2P1 alive first visited the clinic on the on 27th February,2023, she was 8

weeks + 6days of gestation and symphysio-fundal height was non palpable. Client last

menstrual period was on the 16th of January, 2023 and her expected date delivery was

calculated as 4th October 2023 .Ultrasound scan gave her 3rd October 2023. Her vital signs

and laboratory investigations on that day were as follows.

Temperature - 36.8 degree celsius

Pulse - 80 bpm

Respiration - 23cpm

Blood pressure - 100/70mmHg

Weight - 79 kg

Height - 165cm

Lab Investigations

Haemoglobin - 12.2g\dl

Sickling - Negative

Blood Group - O

4
Rhesus factor - Positive

Urine for pregnancy test - Negative

Hepatitis B - Negative

VDRL - Non-Reactive

Protein in urine - Negative

Glucose in urine - Negative

G6PD - Negative

Urine albumin - Negative

Antibody screening for HIV - Non-Reactive

Stool test - Negative

On head to toe examination, there were no abnormalities detected. Education on danger signs

was given. She was educated on the need to attend Antenatal Clinic regularly. She was put on

the following drugs.

Tab Ferrous sulphate 200mg-1dly×30 days

Tab Folic acid 5mg 1dly×30 days

Tab Multivitamin 200mg 1dly×30 day

5
 CHAPTER TWO

REPORT ON ANTENATAL CARE

Introduction

This chapter comprises of the first interaction with client, the reason for which I chose her as

my client for my Family-Centered Maternity Care Study, laboratory investigations, Antenatal

(first and subsequent visits) home visits, her psychosocial environment, validation of data,

subsequent antenatal clinic visit and nursing care plan for antenatal.

My First Contact with the Client

My first interaction with my client, Madam Rose Kumah at Mamprobi Hospital during her

seventh antenatal clinic visit at 37weeks .. She was warmly welcomed, greeted, and made

comfortable by providing her with a seat. I introduced myself as a student midwife,

established an interactive atmosphere and ensured both auditory and visual privacy, stating

that all our conversations were going to be confidential.

On a quick inspection, Madam Rose Kumah. was neatly dressed, well composed and

generally looked healthy. I requested for her Maternal Health Record Book which she

willingly handed over to me. I paid particular attention to her previous histories which may

affect my care for her, her previous vaccination status, previous prenatal visits not forgetting

problems identified and tackled during her previous visits. I realized that she was a regular

6
attendant. Data was collected regarding her social, family, medical, surgical, menstrual, past

and present obstetric histories to ascertain the authenticity of what has already been

documented.

Her vital signs were checked and recorded as follows:

Temperature - 36.1 degree Celsius

Pulse - 80 beats per minutes

Respiration - 21 cycle per minutes

Blood Pressure - 128/90 Millimeters of Mercury

Weight - 82 Kilograms.

Other investigations includes:

HIV/AIDS - Non-reactive

Blood film for Malaria Parasites - Negative

Urine for routine examination - Negative.

The above results were compared to the previous records in the Maternal Health Record

Book. I explained to Madam Rose Kumah that she was going to be examined from head to

toe in order to detect any physical problems that may pose any risk to pregnancy under the

supervision of my preceptor. She was asked to urinate which she did. Afterwards, she was

assisted to undress. I helped her onto the examination bed and was encouraged to lie on her

left side to prevent supine hypotensive syndrome.

Privacy was provided with the aid of curtains. I washed my hands with soap under running

water and dried them thoroughly with a clean towel. Madam Rose Kumah was then

instructed to lie on her back with both arms lying by her side. Her general physical

appearance and emotional status were assessed. She looked healthy.

7
Starting from the head, her hair was twisted. It was clean. No Tinea capitis, dandruff, hair

loss, lice, or any other infection was detected. Her general facial expression was observed as

a guide to her physical and emotional state. Her face was not puffy. On inspection, her

conjunctiva looked pink, no jaundice was observed. No discharge was noticed from the eyes

or ears. Her hearing was balanced. Madam Rose Kumah’s mouth was moist, her teeth were

neat, pink tongue and no halitosis was sensed.

Her neck was palpated for abnormalities such as goiter, pain, restriction of movement,

enlarged thyroid gland, enlarged lymph nodes and distended neck veins but none was

detected. I observed her breathing pattern by closely looking at her chest. I sought consent

from her before examining her breasts. Her breasts were tender and enlarged which were

normal signs of pregnancy. Primary and secondary areolae were noticeable. Upon palpation,

no abnormal mass or enlarged axillary lymph nodes were noticed. Madam Rose Kumah was

advised to wear brassiere that will adequately support the weight of the breasts and taught

how to do self-breast examination.

On inspection, the upper extremities were of equal size and length. The palms and nail bed

looked pink. Madam Rose Kumah denied having any tingling sensations. Fingers were

examined for oedema by asking her to make a fist but on adhering, she said there was no

tightness on her fingers. The nails were examined for nail biting, cleanliness and cyanosis

but upon examination, nails were clean, not bitten and no cyanosis was observed. Capillary

refill was checked, and it was normal.

Madam Rose Kumah’s abdomen was inspected and no scar was found. Her abdomen was

globular, size corresponded with gestational age. Foetal movement was observed. No

abnormalities such as enlarged spleen, enlarged liver were detected. The fundus of the uterus

was palpated, and the symphysio-fundal height was 36 centimeters. A soft rounded mass was

8
palpated at the fundus indicating foetal buttocks. Lateral palpation indicated a longitudinal

lie. The right side felt rough and irregular indicating the foetal limbs. This suggested that the

foetal position was occipito-anterior position. Pelvic palpation revealed a hard mass which

was ballotable and indicated that it was the foetal head.

The presentation was cephalic and head descent was 5/5th above the pelvic brim. Foetal

heart found was audible and upon auscultation, it counted 149 beats per minutes, and it was

rhythmic.

The lower extremities were examined for equality of length, oedema, varicose veins, pains

and stiffness. But varicose veins where detected which client said it appears only when she’s

pregnant.Madam Rose Kumah back was examined for deformities of the spines such as

scoliosis and lordosis, but none was detected. Costo-vertebral angle tenderness and sacral

oedema were also checked which were all absent. Her skin was healthy, evenly dark with no

abnormalities such as rashes.

All findings of the examination based on the progress of pregnancy, state of health and that

of the foetus were communicated to her. She was taught how to get up from the bed (by

asking her to turn on her side, sit-up and get down to prevent dizziness which could lead to

fainting or sudden fall). She was helped to re-dress. I thanked her, washed my hands and

documented findings in the maternal health record book.

She complained of loss of appetite. She was given tablet Ferrous Sulphate 200mg once (1)

daily for thirty (30) days, Tablet Multivite 200mg once (1) daily for (30) days which will

help her eat well. She was educated on adequate nutrition, malaria prevention, birth

preparedness and complication readiness plan and was advised not to take any herbal

preparation or any self-prescribed drugs except her routine drugs. She was also educated on

the need to keep her genital area dry and clean and was advised to drink a lot of water at

9
 least eight (8) cups a day. She was told to arrange for transport, support person at home and

get items ready for delivery.

Madam Rose Kumah. was briefed on signs of labour which include strong rhythmic

contractions, presence of show (blood-stained mucoid discharge) and rupture of membranes.

She was advised to promptly report to the hospital as soon as she notices any of such signs.

She was educated on side effects of medication and was asked to report the following week

as her next visit to the clinic. I again educated her on nutrition, malaria prevention and

exclusive breastfeeding. After provision of the antenatal service, I asked madam Rose

Kumah to wait behind for a brief discussion, I introduce myself to her and made my

intentions known to her that I would like to use her as my client for the Family Centered

Maternity Care, she agreed willingly after I explained to her what family centered maternity

care entails. My preceptor was informed, after reviewing Madam Rose kumah maternal

records, she gave me the go ahead.

I took her contact number and the direction to her house, and I sought her consent to visit

her. I booked an appointment to visit her at home the next day in the evening. I also gave her

my contact number, thanked her, and bade her goodbye.

Why I Chose My Client

Madam Rose Kumah Gravida3 para 4 reported to the antenatal clinic on 12 th September 2024 .

Client complained she wanted to wait a while before she gives birth again , client want to space

child birt so. I took the opportunity to introduce myself as a student midwife from Nursing and

Midwifery Training College KorleBu who is on community midwifery practicals. I educated

her on some family planning options and the eligibility criteria. I soughted permission from her

if she share any other problems .

10
Midwife in charge was informed, and permission was granted. After going through the normal

antenatal process, she gave the direction to her house, her phone number was taken and she

was promised of a visit .

First Antenatal Home Visit

My first home visit to Madam Rose Kumah’s house was on 15th September 2024 l called

Madam Rose Kumah in the afternoon prior to remind her of my visit. On reaching Madam

Rose Kumah’s vicinity. . I got to the house at 4:00pm. They offered me a seat and water.

After pleasantries were exchanged, I told her my reason for coming, that is to inform her

mother and other members of her family about my intention to use her for my Family

Centered Maternity Care Study and to honor my appointment, to observe her environment, to

know how she and her family were faring and also to help solve problems that may be

identified.

My client lives in a compound house which is a two- bedroom self -contained apartment. It is

built with cement blocks, well plastered, roofed with aluminum roofing sheets, but not

painted. The room has windows and standing fan which aid in ventilation. The couple lives

with their children .I enquired about her bathroom and toilet facility which she showed me,

and they were neatly kept. There are other houses in the neighborhood and she had cordial

relationship with the inhabitants of the houses.

The main source of water is the pipe borne water which is used for all domestic purposes

such as drinking, cooking, and washing. Their main source of light is electricity but

occasionally uses torch light anytime there is black out. Madam Rose Kumah use a dustbin

lined with a black polythene bag for refuse which is covered with its lid, and she empties it at

the public refuse dump weekly. The couple was commended on keeping their environment

neat and they were encouraged to keep it up. I enquired of the loss of appetite she complained

11
of the previous day, she verbalized an improvement in diet, I asked of the whereabout of the

child, and she replied that she had gone out to play.

Madam Rose Kumah was counselled on exclusive breast feeding, anaemia prevention, family

planning, care of the baby and the importance of taking the prescribed medications. Madam

Rose Kumah was educated on dangers associated with malaria infection to both her and her

baby, some of which include low birth weight, still birth and the use of insecticide treated net.

According to her, she and the family had also arranged for transportation in case of

emergency.

Also, she was advised to use the insecticide treated net to prevent malaria and anaemia. She

was assisted to hang the insecticide treated net after the advice which she was grateful for. I

educated her on the care of the insecticide treated net, personal and environmental hygiene,

how to select food items and prepare them without destroying the nutrient and to eat foods

rich in iron, folate, and energy (fruits and vegetables, animal source foods, legumes, and

grains). Her layette was inspected, and everything had been bought according to the list she

was given at the Antenatal Clinic. She was reminded of her next visit which was on the 19 th

September 2024and she promised to honor it.

I probed further to know who would be supporting her after she delivers, and she told me her

sister and mother. I educated her on the need for a support person during puerperium aside

her husband since he also spends most of his day at work. I gave the family the opportunity

to ask questions of which they had none.I thanked her and left.

Subsequent Antenatal Home Visits

My next home visit was on the 20th of September On arrival I met Madam Rose Kumah and

her family at home. She was delighted to see me. I was welcomed warmly and offered a seat.

The husband was home, and he was happy to see me again that day. I thanked them and

12
asked of their health which they told me they were all in good health but that she was feeling

waist pain, headache, and she looked anxious as well. She was reassured; I explained to her

that waist pain and abdominal pain was a minor disorder of late pregnancy and that she was

in safe hands and will be well managed. Enquiry was made on her anxiety, and she said it

was because of the pain she was experiencing and that she didn’t know what the outcome

would be. She was reassured that she was in safe hands, and all will be done for her to go

through pregnancy, labour and puerperium safely. I educated Madam Rose Kumah and the

husband on family planning and exclusive breastfeeding. I further on told them the family

planning methods were at affordable prices and the need to practice after delivery. Madam

Rose Kumah. was advised to keep drugs out of reach of her child to prevent any home

accident.

She was advised on adequate nutrition, intake of green leafy vegetables and fruits personal

and environmental hygiene, malaria, and anaemia prevention. Emphasis was placed on the

intake of adequate fluid to prevent dehydration and risk of urinary tract infection due to

stasis of urine secondary to kinking of the ureters. She was encouraged to take her

hematinics as prescribed. I then made enquiries about her preparation towards labour and

delivery and they said they were set. The baby’s layette and items needed for confinement

were inspected once again and it was complete. The family appreciatesd my visit and

education. I bade them goodbye.

I visited my client, Madam Rose Kumah again on the 22 nd September 2024 around 3:00pm.

She was happy to see me. I met her and her children home. I enquired about her general

wellbeing and that of the family. I educated her on labour signs like painful rhythmic uterine

contractions, waist pain, blood stain mucous discharge from the vagina and severe lower

abdominal pain. Education was given to Madam Rose Kumah and the family on diet which

should contain all the essential nutrients.

13
Madam Rose Kumah was asked to take her prescribed drugs. I again reminded the family on

the need for emergency transportation and a support person during labour. We practiced deep

breathing exercise together and I counseled Madam Rose Kumah on the need to adhere to

information given. She exhibited adequate understanding on things explained to her by

recounting some of the signs of labor such as appearance of show, waist pain and painful

rhythmic uterine contractions. I bade her goodbye and reminded my client of the next

antenatal visit. However, she was to report earlier if she experienced any sudden change in

health.

Subsequent Antenatal Clinic Visits

Madam Rose Kumah visited the clinic again on the 19 th September 2024 I welcomed her and

offered her a seat. I enquired about her health and that of the family, which she said they were

doing well. I took her Maternal Health Record Book and read through it.

History was taken and she complained of pain in her lower abdomen. I reassured her and

explained to her that the lower abdominal pain was because of the stretching of the ligaments

and muscles of the uterus during late pregnancy which would be managed and that it was a

minor disorder in pregnancy. She was then counseled on rising slowly from the recumbent

position and avoiding strenuous exercises. Vital signs were checked and recorded as follows:

Temperature - 36.5 degree Celsius,

Pulse - 84 beats per minute,

Respiration - 20 breaths per minutes,

Blood pressure - 116/61millimeters in Mercury

Weight - 83kilogram.

Urine protein and glucose were found to be negative; haemoglobin level was 11.3g/dl. All

findings were normal. General physical examination and abdominal examination was done.

14
General appearance was okay. She looked a bit disturbed. The procedure for examination

was explained to allay fear and anxiety. She was asked to empty her bladder and taken to the

examination bed after she was assisted to undress. Privacy was provided; I washed my

hands thoroughly and dried them with a clean towel.

On abdominal inspection, abdomen was globular with no scar. Linea nigra was prominent

and foetal movement was present. Symphysio-fundal height on abdominal palpation was 36

centimeters, gestational age was 38 weeks plus 3 days. The foetal buttock was palpated at the

fundus. On lateral palpation, lie was longitudinal, the left side felt smooth indicating the

foetal back whiles the right side felt rough showing the limbs of the foetus and the foetal

position was left occipito-anterior position. Pelvic palpation revealed a hard mass denoting

the foetal head. The Presentation was cephalic and head descent was 5/5 above the pelvic

brim. Foetal heart sounds was counted to be 143 beats per minute with good rhythm. The

lower limbs were examined and no tenderness in the calf muscles was determined. No

deformity was identified upon examining the back. All findings were communicated to her

and documented in her maternal health record book.

She was again reminded about birth preparedness and complication readiness plan and to also

to report to the hospital when she notices any sign of labour or any danger sign such as

persistent frontal headaches, epigastric pain and blurred vision which could mean imminent

eclampsia. She was educated in nutrition, rest and sleep and personal hygiene. She was given

Albendazole 400mg to treat any worm infestation. She was rescheduled to report to the

antenatal clinic in a week time if she has not delivered by then. She was encouraged to ask

questions, but she said everything was well explained. I bade her farewell and she left.

On 27th September, 2024Madam Rose Kumah . reported to the antenatal clinic as scheduled.

She was welcomed and made comfortable by giving her a seat. She went through the routine

15
registration process. Enquiries were made about her health status and that of the family. They

were all fine. She looked healthier and cheerful compared to her previous visit. Vital signs

and investigations were checked and recorded as:

Temperature - 36.1 degree Celsius,

Pulse - 80 beats per minute,

Respiration - 21 cycles per minutes,

Blood Pressure - 110/70 millimeters of Mercury,

Weight - 83.2 kilograms

General physical examination and abdominal examination were done. She was neatly

dressed and looked relaxed. The procedure for examination was explained to her to allay

anxiety. She was asked to empty her bladder and taken to the examination couch. I

thoroughly washed my hands and dried them with a clean hand towel. Linea nigra was

prominent and foetal movement could be seen. Symphysio-fundal height was 38 centimeters

which was normal for gestational age 39 weeks plus 0 day. The foetal buttocks were

palpated at the fundus. Upon lateral palpation, the lie was longitudinal; the left side felt

smooth indicating the foetal back while the left side felt rough indicating the foetal limbs.

Foetal position was left occipito-anterior position. Pelvic palpation revealed hard mass,

which was an indication of the foetal head.

The presentation was cephalic and head descent was 5/5th above pelvic brim. Upon

auscultation, the foetal heart rate was 156 beats per minute with good rhythms. The lower

limbs were examined but no abnormality such as calf muscle tenderness was found. All

findings were communicated to her and recorded in her Maternal Health Record Book.

16
She was asked to continue the drugs she was given at the antenatal clinic previously thus

Tablet Ferrous Sulphate 200mg once (1) daily for thirty (30) days, Tablet Multivite 200mg

thrice (3) daily for (30) days. According to her, she has been taking her drugs according to

the prescription. She was taught breathing exercises to be used during labour, which is deep

cleansing breaths. She was advised on nutrition and exclusive breastfeeding. She was

advised to wear low fitting footwear and to avoid reaching out for items at a height but

rather seek assistance.

She complained of waist pains, frequency of micturition and inability to sleep. She was

reassured and I explained to her that the waist pain was because of the relaxation of the joint

ligaments by relaxin, progesterone and oestrogen. I also told her the frequency of micturition

was because of the foetal head pressing against the bladder. I also advised her to have

adequate rest and sleep, thus 2 hours sleep in the day and 8 hours at night. She was asked to

get the items for confinement ready including her health insurance and the antenatal health

record book. She was told to report to the antenatal clinic if she had not delivered in a week

time in the absence of question, she was seen off.

17
Nursing Care Plan for Antenatal

Problems Identified During Antenatal

1. Loss of appetite (19/09/24

2. Lower abdominal pain (19/09/24)

3. Frequency of micturition (19/09/24)

4. Waist pain (Acute pain) (19/09/24

5. Inadequate sleep (19/09/24)

Short Term Goal

1. Client’s appetite will improve within 24hours.

2. Client will experience reduction in the intensity of lower abdominal pain within 24

hours.

3. Client will develop effective coping mechanism for frequency of micturition within

24 hours.

4. Client will experience reduction in the intensity of the of the waist pain within 4hours.

5. Client will sleep or rest two hours during the day and 8 hours during the night within

48 hours.

Long Term Goal

Client will carry pregnancy to term with no complication to herself and the foetus.

18
 Antenatal Nursing Care Plan

Date/ Nursing Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Outcome Criteria Time
12/09/24 Altered Client’s appetite for 1. Reassure client. 1. Client was reassured that her 13/09/202 Goal fully A.J
@ nutrition food will improve condition will be managed. 4 met as
4:15pm (less than within 24 hours as 2.Assess severity of condition 2. Severity of condition was @ evidenced by
body evidenced by assessed by calculating the body 4:15pm client
requirement) 1. Client verbalizing she mass index verbalizing
related to has been able to eat at 3.Encourage client to eat 3. Client ate small quantities of improvement
loss of least two-thirds of food small quantities of food at food at short intervals. in appetite.
appetite. served. short intervals.
2. Midwife observing 4. Encourage client’s relatives 4. Client’s relatives served
patient eat at least two- to serve client’s food client’s food attractively.
thirds of food served attractively.
5. Encourage support person 5. Client’s support person
to prepare client’s favourite prepared client’s favourite meal
meal on request. on request.
6. Encourage client to take 6. Client took enough fruits.eg
enough fruits. pineapple.
7.Encourage client to take 7. Client took prescribed
prescribed haematinics haematinics.

19
 Antenatal Nursing Care Plan

Date/ Nursing Nursing Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Objective/ Time
Outcome
Criteria
15/09/23 Lower Client will 1.Reassure client. 1.Client was assured that condition will 16/09/23 Client A.J
@ abdominal experience a be managed. @ verbalized a
10:20am pain related to reduction in the 2. Assess the site and severity of 2.Site and severity of lower abdominal 10:20am reduction in
stretching of intensity of lower the lower abdominal pain. pain was assessed using the numerical the intensity
the ligaments abdominal pain pain severity score system. of lower
and muscles within 24 hours 3. Educate client to avoid sudden 3 . Client was educated to avoid sudden abdominal
of the uterus. as evidenced by jerky movements and avoid jerky movements and avoid strenuous pain.
client verbalizing strenuous exercise. exercise. Goal fully
some relieve of 4. Counsel client to rise slowly 4. Client was counseled to rise slowly met.
lower abdominal from recumbent position. from recumbent position.
pains 5. Advice client to void when she 5. Client voided when she felt the urge.
feels the urge.
6. Encourage family support with 6. The family supported client with
her household chores. household chores.

20
 Antenatal Nursing Care Plan

Date/ Nursing Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Outcome Time
Criteria
15/09/23 Frequency of Client will cope 1. Reassure client . 1. Client was assured that 16/09/2024 Client A.J
@ micturition with frequency of condition would be managed. @ expressed
related to the micturition 2. Assess frequency and dysuria 2. Frequency of dysuria of the 11:09am her ability
10:30am descent of the throughout of the client. client was assessed using a to cope
foetal head pregnancy as micturition time chart. with
exerting pressure evidenced by 3. Educate client to take 3. Client was educated to take frequency
on the bladder. 1. client verbalizing adequate fluid during the adequate fluid during the daytime of
being able to cope daytime and minimize fluid and minimize fluid intake in about micturition.
with frequency of intake in about 2 to 3 hours to 2 to 3 hours to bedtime.
micturition. bedtime. Goal fully
4. Educate client on the signs 4. Client was educated on the met.
and symptoms of urinary tract signs and symptoms of urinary
infection. tract infection such as burning
sensation and cloudy or bloody
urine.
5. Ask client to promptly report 5. Client was asked to promptly
to the hospital if she report to the hospital if she

21
 Date/ Nursing Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Outcome Time
Criteria
experiences any the signs of experiences any the signs of
urinary tract infections. urinary tract infections.
6. Advise client to put covered 6. Client was advised to put
bedpan by her bedside at night. covered bedpan by her bedside at
night to urinate whenever she
wants to.
7. Encourage client to maintain 7. Client was encouraged to
good perineal care. maintain good perineal care by
bathing regularly and washing the
perineum with water after each
visit to the washroom

Antenatal Nursing Care Plan

22
Date/ Nursing Nursing Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Objective / Time
Outcome Criteria
19/09/24 Acute pain Client will 1. Reassure client. 1. Client was assured by explaining 20/9/2024 Client A.J
@ (waist pain) experience to her the possible cause of her @ verbalized
11:10am related to reduction in the symptoms. 3:10pm reduction
relaxation of intensity of the 2.Assess severity of pain. 2. Client’s pain was assessed using in the
the pelvic waist pain within 4 the pain scale (2/10). intensity of
ligament by the hours as evidenced 3. Encourage client to avoid 3. Client avoided long standing and waist pain.
hormone by long standing and strenuous strenuous work. Goal fully
relaxin in client verbalizing work. met.
pregnancy. reduction in 4. Counsel client to wear low 4. Client was counseled to wear low
intensity of waist heeled shoes and flat foot heeled shoes and flat foot slippers
pain. slippers.
5. Educate client on the use 5. Client slept on a firm bed.
of firm bed.
6. Educate members of the 6. Members of the family helped
family to help client perform client perform household choice.
household choice.
7. Encourage client to have 7. Client was encouraged to have
enough rest. enough rest.

23
Date/ Nursing Nursing Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Objective / Time
Outcome Criteria
8. Serve prescribed analgesics 8. Tablet paracetamol 1000mg was
when necessary. served.

24
 Antenatal Nursing Care Plan

Date/ Time Nursing Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Diagnosis Outcome Criteria Time
19//09/2024 Inadequate Client should be able 1. Reassure client . 1. Client assured that condition will 20/09/24 Client A.J
@ sleep to sleep for at least 8 be managed. @ verbalized
10:30am related to hours at night and 2 2. Counsel client to rest 2. Client was made to rest during day 10:30am her ability
nocturnal hours in the day during day time. time at least 2 hours. to sleep or
frequency within 48 hours as 3.Counsel client on 3.Client was counseled on relaxation rest for
of evidenced by client relaxation techniques such technique such as meditation. eight hours
micturition verbalizing that she as meditation. at night
can sleep or rest for 4. Educate client to take 4.Client was educated to take and two
at least 8 hours at adequate fluid during the adequate fluid during the daytime hours in a
night and 2 hours daytime and minimize fluid and minimize fluid intake in about 2 day.
during the day intake in about 2 to 3 hours to 3hours to bedtime. Goal fully
without any to bed. met
interruption 5. Advise client to put 5. Client was advised to put covered
covered bedpan by her bedpan by her bedside at night to
bedside at night. urinate whenever she wants.
6. Advice the client to go to 6. Client was advised to go to bed
bed early. early.

25
 CHAPTER THREE

REPORT ON LABOUR AND DELIVERY

This chapter is about admission, history taking and initial assessment of the client in labour,

management at first stage, second stage, third stage and fourth stage of labour until baby is

delivered successfully and to take care of the mother and baby to make sure both are fine. It

also includes the short- term and long- term goals and nursing care plan during labour.

Initial Assessment and Admission into The Labour Ward

On 01/10/23, Madam R.D.O. G2P1 alive arrived at the labour ward at 5:25am in the

company of her mother and sister. They were welcomed and a comfortable atmosphere was

provided. Seats were offered to them. The Client’s facial expression indicated that she was in

pain. Her Maternal Health Record Book was reviewed for any complications in previous

childbirth and any current risk factors such as high blood pressure and protein in urine, but

everything was normal.

On observation, she looked anxious. Enquiry was made about her anxiety, and she said it was

due to the hospitalization. She was reassured of quality labour and that she was in safe hands

and would be given good care. I took labour history and Madam R.D.O. reported that she had

waist pains, thighs pain and painful rhythmic uterine contractions which started at 1:45am

and noticed blood-stained mucous discharge from the vagina at the same time. I enquired of

any danger signs such as severe headache, epigastric pain, vaginal bleeding, persistent

vomiting and blurred vision and she said there was none. Madam R.D.O. was sent to the

examination room at 5:27am and all procedures and purposes for all examinations were

explained to her. Her vital signs were checked and recorded as follows:

26
Temperature : 36.7 degree Celsius,

Pulse : 80beats per minute,

Respiration : 21cycle per minute

Blood pressure: 110/70 mmHg.

Madam R.D.O. was reassured that she was in safe hands and that her condition would be

managed. Madam R.D.O. was asked to empty her bladder to obtain accurate symphysio-

fundal height measurement and to prevent interaction of the procedure. A clean bed pan was

provided and about 150mls of urine was passed. Urine was tested for protein, glucose, and

acetone, but all three parameters read negative. She was assisted onto the examination couch

after privacy was ensured. A general head to toe examination revealed no abnormalities like

pallor or oedema.

On inspection, the abdomen was globular in shape with visible fetal movement with no scars.

On palpation symphysio-fundal height was 37centimeters. The lie was longitudinal,

presentation was cephalic, descent was 4/5th above pelvic brim and gestational age was 39

weeks plus 3 days. On auscultation, fetal heart rate was 143 beats per minute with normal

rhythm. Uterine contractions were 3 in 10 minutes, lasting 30 to 35 seconds each.

A tray was set for vaginal examination after the procedure was explained to her and her

consent was sought. I washed my hands with soap under running water, dried them with a

clean towel and put on my surgical gloves and draped her with sterile towel. She was asked

to flex her knees and open her thighs. Her vulva was inspected and there were no rashes,

oedema, vulva warts or varicose veins seen. Vulva was swabbed; vagina was examined at

5:40am. The vagina was easily distended, moist and warm with the cervix soft and elastic and

well applied to the presenting part. Os uteri was 4cm dilated. Membranes were intact and

there was no moulding. The Presentation was cephalic. The ischial spines were blunt, and the

27
sacrum was well curved. The position of the foetus was occipito-anterior. Sutures were easily

felt, and bones were separated. The vulva was swabbed, and a new perineal pad was applied

to the perineum. I removed the gloves, washed my hands, and dried them.

Progress of labour, maternal and foetal conditions was explained to her, and she was

reassured of the best care. The findings were communicated to her, and a dilation board was

used to explain the process of cervical dilatation in detail. Intravenous line was secured and

blood samples was taken to the laboratory for full blood count to determine her haemoglobin

level and also to determine her blood clotting time. She was encouraged to lie on her left side

to facilitate adequate supply of oxygen to the foetus, after being transferred into a

comfortable bed at the maternity ward. I washed my hands and recorded the findings into the

nurse’s notes and on the partograph (refer to Appendix IV A for partograph), and Maternal

Health Record Book. Madam R.D.O.’s relatives later arrived and were oriented to the ward

environs. Her relatives were instructed to get her a meal. Her name was registered in the

admission and discharge book and the daily ward state.

Management of First Stage of Labour

As labour progressed Madam R.D.O. was encouraged to urinate frequently, at least every 1-2

hours to help in the descent of the foetal head. The urine was measured and tested for protein

and glucose. Foetal heart rate, contractions and maternal pulse were checked every 30

minutes while vaginal examination, head descent, blood pressure and temperature were

checked every 4 hours. Uterine contractions became more intense and Madam R.D.O.

complained of waist pain and painful uterine contraction, she was encouraged to do deep

breathing exercises.

She was also allowed to assume any position she felt comfortable with and encouraged to

take more fluids. To ensure emotional and physical comfort, the fan was switched on and her

28
face was wiped with clean towel each time she sweats. I also did sacral massage and involved

her in conversation to take her mind off the pain.

At 9:40am, her vital signs were checked and recorded as;

Temperature : 37.3oC

Pulse : 82bpm

Respiration : 24cpm

Blood Pressure : 110/80mmHg

Urine was tested every 4 hours for protein, glucose and acetone, but all three parameters read

negative Urine was emptied and its volume was recorded. Client was reassured and

encouraged to breathe through her mouth. At 9:40am, 160mls of urine was passed. Vaginal

examination was repeated at 9:40am and cervix was 8 cm dilated and membranes were still

intact. descent was 1/5th above the pelvic brim, Moulding was + (bones are just touching

each other) and contractions were 4 in 10 minutes lasting 42 to 46 seconds, feotal heart rate

was 135 beats per minute (Refer to partograph on appendix IV). Observation and monitoring

continued till 11:02 am when membranes ruptured. Madam R.D.O. complained of having the

urge to bear down.

Liquor was clear. Vaginal examination was repeated to confirm full dilatation of the cervix.

Cervix was 10cm (no cervix was felt), descent was 0/5 th above the pelvic brim, moulding +

(bones are just touching each other) and contraction were 4 in 10 minutes lasting 45 to 50

seconds when I last checked at 10:40am, foetal heart rate was 132 beats per minute (Refer to

partograph on appendix IV). Madam R.D.O was informed that she was in the second stage of

labour. She was transferred to the delivery bed and was told what to expect (for example;

having the urge to defecate). I gave her sacral massage. Her mum was with her, and also gave

her some massage. Delivery trolley had already been set.

29
Management of the Second Stage of Labour

Delivery trolley and resuscitation tray were sent to the delivery room to receive the baby.

Madam R.D.O. was assisted in a lithotomy position. She was encouraged to continue the

breathing exercise. I quickly put on a rubber apron, goggles, face mask and boots. I washed

and dried my hands and put on sterile gloves. The upper thighs, vulva and perineum were

swabbed and she was draped with sterile towel with one under her buttocks and other on her

abdomen to deliver the baby unto it.

Vaginal examination was done by my supervisor to confirm full dilatation of the cervix. The

vulva was normal, vagina was moist and warm. Cervix was 10 cm dilated and descent was

0/5th above the pelvic brim. Moulding was +. Madam R.D.O. was reminded that the baby

was going to be delivered onto her abdomen and that she must support the baby with her two

hands. I encouraged her to continue with the deep breathing exercise and to bear down with

contractions and rest in between. A sanitary pad was placed at the anus to prevent faeces from

contaminating the baby’s face and delivery field. As the foetal head advanced with

contraction, flexion was maintained with the fingers placed on the head to prevent rapid

expulsion and to allow a smaller diameter to distend the perineum. The foetal head was

delivered by extension after crowning of the head.

The baby’s face was cleaned with sterile gauze followed by the eyes from the inner canthus

outward. I felt for cord around the neck which was absent. I waited for restitution and

external rotation of the head. The anterior shoulder was delivered by gentle downward

traction, with one hand on either side of the baby’s head. The posterior shoulder was

delivered gently by moving the baby’s head towards the mother’s abdomen and the rest of the

body was delivered by lateral flexion onto the mother’s abdomen.

30
At exactly 11:09am on 01/10/23, a live female infant was delivered. She cried immediately

after delivery. The baby was dried thoroughly with a towel. The wet towel was removed, and

the baby was placed skin to skin on mother’s abdomen and covered with a cloth.

Madam R.D.O was asked to hold the baby. The baby’s condition was assessed within one

minute using the Apgar score and it was 7/10. The baby’s cord was clamped with the artery

forceps and cut in-between within 3 minutes. The baby shown to Madam R.D.O. for sex

identification. She was congratulated.

Skin-to-Skin contact between mother and baby was initiated on the mother’s chest and

remained uninterrupted for one hour. An identification band bearing the mothers name, the

baby’s sex, date of birth and time of delivery was tagged to the left wrist of the baby. Baby’s

condition was assessed at 5 minutes using the Apgar score which was 9/10 (refer to Appendix

IV for APGAR SCORE chart).

Immediate Care of the Baby

As soon as the baby’s head was born, the mouth and the nose were cleaned with a sterile

swab to ensure clear airways. The baby’s face was wiped with dry gauze. The eyes were

cleaned from the inner canthus outwards using sterile gauze. Each eye was cleaned one at a

time with gauze. This was done to prevent the eyes from becoming infected with organisms,

present in the birth canal.

The time was noted, and it was 11:09am and the baby was put on the mother's chest to initiate

skin to skin. The baby was dried thoroughly with a towel. The wet towel was removed, and

the baby was placed skin to skin on mother’s abdomen and covered with a cloth. The baby's

cord was clamped with two artery forceps at 2 centimeters away from baby's abdomen and 3

centimeters from the first artery forceps and covered with a clean gauze before cutting to

separate the baby from mother.

31
Management of the Third Stage of Labour

The procedure of the third stage of labour was explained to Madam R.D.O. Her vulva was

swabbed. Soiled linens and the delivery sheet were changed and replaced with new ones. A

sterile receiver was placed against the perineum to receive the placenta. The uterus was

gently palpated to verify that there was an undiagnosed twin waiting to be born but there was

none. Oxytocin injection 10 International Units (IU) was given intramuscularly on the mid

anterolateral aspect of the thigh at 11:10am.

The cord was clamped close to the perineum using the artery forceps. The clamped cord was

held with one hand and the other hand placed just above the mother’s pubic bone with the

palm facing towards the umbilicus to gently push up the uterus to give a counter traction to

prevent retroversion of the uterus. The placenta and the membrane were completely expelled

at 11:14am on 01/10/23.

The uterus was massaged to contract and blood clots were expelled from the uterus. I asked

Madam R.D.O. concerning how to dispose the placenta. I gave her some options, that is, to

incinerate it (destroy completely by burning it into ashes completely), placenta could be

decontaminated and buried or the placenta would be put in a polythene bag and

decontaminated with a decontaminant, for example 0.5% Chlorine and then handed over to

her. She opted that the hospital disposed of it according to its protocol. Blood clots were

expelled to empty the uterus by massaging the uterus which would also aid in the contraction

of the uterus.

The perineum, vaginal walls and the cervix were examined for lacerations and tears but were

found to be intact. Madam R.D.O.’s soiled linens were removed. She was cleaned and a new

perineal pad was applied to the vulva and was made comfortable in a neatly laid post-delivery

bed at the labour ward. She was assisted to correctly attach the baby to her breast, encouraged

32
to breastfeed to enhance bonding between mother and baby and also help in building the

baby’s immunity. She was encouraged to urinate frequently at least every 1-2 hours to help

contract the uterus since full bladder can predispose her to post-partum haemorrhage. The

estimated blood loss was 150ml.

Instruments and other items used in conducting the delivery were decontaminated in 0.5%

Chlorine solution for ten minutes, gloves used, swabs and gauze used were discarded in the

bin designed for infectious waste according to the infection prevention guidelines. The

instruments were removed after ten (10) minutes, washed under running water rinsed and

sent to the autoclave to be sterilized for subsequent use. Sharps such as needles and syringes

were disposed into the safety box.

Examination of the Placenta

I inspected the cut end of the cord for the number of vessels. It was two arteries and one vein.

The placenta and its membranes were examined and the lobes on the maternal surface were

complete, no infarct or extra lobe was noticed, the foetal surface with the blood vessels

running deep into the maternal surface. The cord was centrally situated. I examined the foetal

surface for the arrangement of vessels and the blood vessels were seen to be radiating from

the cord. The length of the cord was 52cm. I held the maternal surface upwards in my palms

and inspected for any missing cotyledon but they were intact. No infarct was observed. The

membranes were complete and there were 20 lobes. The placenta was without an extra lobe.

Finally, the placenta was discarded into a bucket of decontaminant (0.5% Chlorine solution)

with a cover for final disposal.

Management of the Fourth Stage Of Labour

Madam R.D.O. and her baby girl were observed closely for the first six hours in the delivery

room before being transferred to the lying-in ward for further observation.

33
Their vital signs were checked and recorded every 15minutes for 2 hours and hourly for 4

hours on the post-delivery observation form. I examined the uterus, and found to be well

contracted, it measured 18cm. She was encouraged to pass urine to help the uterus to contract

and to control haemorrhage. She lodged no complaint. Lochia was dark red and draining

moderately. She was advised to change sanitary pad frequently when soiled to prevent

ascending infection to the genital tract. Immediate post-delivery vital signs were checked and

recorded as follows.

Mother

Blood pressure - 110/70mmhg

Pulse - 84bpm

Respiration - 23cpm

Temperature - 36.30C

The baby was also observed for heart rate, respiration, colour, cord bleeding, suckling, hourly

temperature, and general condition, which were normal. Breastfeeding was initiated within

the first thirty minutes of birth and mother was encouraged to breastfeed on demand.

Immediate vital signs of baby checked and recorded as

Temperature 36.80C

Respiration 42cpm

Apex heart rate 137bpm

Mother was served porridge and bread to replenish the energy spent in labour. She was left

undisturbed with her baby with minimal interruption to examine.

Examination of the Baby

After an hour of uninterrupted skin to skin between mother and baby, the baby was weighed

and the weight was 3.0 kilograms, injection of Vitamin K1 (1mg) was given intramuscularly

on the mid-anterolateral aspect of the thigh. The cord was dressed aseptically with
34
chlorhexidine 7.1% gel. No bleeding in the cord was noticed since it was well clamped.

Tetracycline 1% eye ointment was applied on each eye to prevent possible eye infections.

The baby was examined from head to toe in a well-lit environment to exclude any

abnormalities and birth injury in the presence of Madam R.D.O. I explained the procedure to

Madam R.D.O. and shut the windows and doors to keep the room warm. I washed and dried

my hands and put on examination gloves.

The baby was placed on an examination table at a comfortable working height and undressed.

The appearance was observed, breathing pattern and chest movement were also assessed and

they were all normal. The head was of normal size and the shape with no swelling, the

fontanelles were of normal size as anterior fontanelle and posterior fontanelle admitted two

fingers and one finger respectively. They were pulsating well.

The mouth was inspected for abnormalities like cleft lip, tongue tie and cleft palate but none

was found. The ears were placed normally, equal and had no discharges. The nose had no

discharges and was patent. The eyes were normally placed and had no discolouration.

Sneezing, sucking, and crying reflexes were present. The birth weight was 3.0 kg. The head

circumference measured 34cm. The Sub-occipito bregmatic diameter was 10cm and

biparietal diameter was 9.6cm. The full length of the baby was measured, and it was 50cm

(Refer to examination and post-delivery findings of the baby on appendix VIC).

The neck was examined for congenital goiter, swelling or rigidity but none detected. The

chest movement and breathing were normal. No mass was found in the breasts. The baby’s

limbs were examined for extra digits, clubbing or webbing but none was found, and they

were equal. Grasping and Moro reflexes were present. The abdomen was inspected, and the

size was normal. No masses enlarged spleen or liver was detected. The umbilical cord

contained three vessels: two arteries and one vein.

35
No abnormalities were found on the genital area. Anus and urethra were patent, as meconium

and urine had been passed. There were no swellings, dimple or spinal bifida on the spine. The

baby was given to the mother to breastfeed. Findings were communicated to Madam R.D.O. I

removed my gloves and disposed of items used. Client’s sister was counselled to assist in the

care of the baby and they were informed to prepare to be transferred to the lying-in ward.

36
Labour Nursing Care Plan

Problems Identified During Labour

1. Waist pain (Acute pain) (01/10/23)

2. Excessive sweating (01/10/23)

3. Risk for maternal exhaustion (01/10/23)

4. Anxiety (01/10/23)

5. Risk for perineal tear (potential problem) (01/10/23)

Short Term Goals

1. Client anxiety will cope with waist pain throughout labour.

2. Client will be comfortable within 30 minutes.

3. Client will cope with painful uterine contractions throughout labour.

4. Client’s anxiety will be allayed within an hour.

5. Client’s perineum will remain intact after delivery.

Long Term Goal

Client will go through labour normally without any complication to herself and the baby.

37
 Nursing Care Plan During Labour

Date/ Nursing Nursing Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Objective/ Time
Outcome
Criteria
01/10/23 Acute pain 1.Client will 1.Assess the severity of waist pain. 1.Severity of waist pain was assessed 01/10/23 Student A.J
@ (waist pain) cope with waist using the pain assessment scale. And she @ midwife
6:15am related to the pain throughout 2. Reassure the client that waist was 2/10. 11:35am observed
descent of labour as pain is a normal occurrence in 2. Client was assured about the fact that client being
the foetal evidenced by; labour and can be managed. the waist pain in labour was a normal calm.
head. a. Student 3. Encourage client to adopt a occurrence and can be managed. Goal fully
midwife comfortable position. 3. Client was made to adopt a left lateral met
observing client 4. Engage client in a conversation position.
being calm. to divert her attention from the 4. Client was engaged in a conversation
pain to divert her attention from the pain.
5.Teach and instruct client to do 5.Client was instructed to do deep
deep breathing exercise. breathing exercise that she was taught.
6.Encourage client to urinate 6.Client was encouraged to urinate
frequently to aid descent of the frequently to aid descent of the foetal
foetal head. head.

38
 Nursing Care Plan During Labour

Date/ Nursing Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Outcome Time
Criteria
01/10/23 Altered Client will obtain 1. Reassure client. 1.Client was assured that her comfort will 01/10/23 Client was A.J
@ body comfort within 30 be maintained. @ comfortable
6:40am comfort minutes as 2.Open nearby windows for 2.Nearby windows were opened for fresh 7:10am as evidenced
related to evidenced by client fresh air to circulate. air to circulate. by client
excessive verbalizing being. 3.Turn the fans on. 3.The fans were turned on to provide cool verbalizing it.
sweating. air for the client. Goal fully
4.Advise client to take in 4.Client was advised to take more fluids met
more fluid to prevent to prevent dehydration.
dehydration.
5. Clean client’s face and 5.Client’s face and body were cleaned
body with a clean towel. with a clean towel.
6. Assist client to take off 6. Client was assisted to take off her
her clothing and wear gown. clothing and a wear gown

39
 Nursing Care Plan During Labour
Date/ Nursing Nursing Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Objective/ Time
Outcome Criteria
01/10/23 Risk for Client will be able 1. Reassure client. 1. Client was assured that she will be 01/10/23 Goal fully A.J
@ maternal to cope with painful managed. @ met as
7:05am exhaustion uterine contraction 2. Communicate the progress 2. Progress of labour was 11:35am evidenced
related to throughout labour of labour to client. communicated to client. by
painful uterine as evidenced by 3. Encourage client to do deep 3. Client was encouraged to do deep
contractions. client verbalizing breathing exercises during breathing during contractions. 1. Student
the intensity of pain contractions. midwife
has reduced. 4. Allow client to adopt a 4. Client was allowed to assume an observed
comfortable position. upright position. client being
5. Encourage client to rest 5. Client was encouraged to rest in calm during
between contractions and between contractions and assume a contractions
assume a comfortable comfortable position.
position.
6. Engage client in 6. Client was engaged in conversation
conversation to divert her to divert her attention from pain.
attention from pain.

40
Date/ Nursing Nursing Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Objective/ Time
Outcome Criteria
7. Encourage client to 7. Client was encouraged to frequently
frequently empty the bladder empty the bladder at least every 1-2
to aid in the descent of the hours to aid in the descent of the foetal
foetal head. head.

41
 Nursing Care Plan During Labour
Date/ Nursing Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Outcome Criteria Time
01/10/23 Emotional Client will be 1.Reassure client on 1. Client was reassured that competent staffs 01/10/23 Goal fully A.J
@ disturbance relieved of anxiety competency of staff and best were around to help her with safe delivery. @ met
7:50am (Anxiety) within 1 Hour as of care for her 8:50am Student
related to the evidenced by student 2. Provide privacy to client. 2. Privacy was provided. midwife
birthing midwife observing 3. Explain all procedures to 3. Every procedure performed was explained observed
process and client presenting with client. to client. client
outcome of a relaxed facial 4. Orient client to the ward and 4. Client was oriented to the ward and being calm.
labour. expression. show her the equipment to be instrument for delivery was shown to her.
used.
5. Monitor labour, maternal 5. The client was monitored using the
and fetal condition using the partograph.
partograph.
6. Introduce client to mothers 6. Client was introduced to mothers who have
who have delivered had safe vaginal delivery.
successfully.
7. Document every procedure 7. All procedures performed on the client
performed. were documented.

Nursing Care Plan During Labour

42
Date/ Nursing Nursing Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Objective/ Time
Outcome
Criteria
01/10/23 Potential for Client will have 1. Reassure client. 1. Client was reassured that she will 01/10/23 Goal fully met as A.J
@ perineum an intact feel better after delivery. @ client
10:05am trauma related perineum after 2. Confirm full dilatation of cervix 2. Full dilatation of the cervix was 11:15am demonstrated
to normal delivery of the before allowing client to bear confirmed before client was allowed techniques to
physiological baby as down. to bear down to prevent cervical tear. minimize risks of
stretching of evidenced by 3. Encourage client to breathe 3. Client was encouraged to breathe infections and
the perineal student midwife through the mouth. through the mouth to prevent was free of
muscles visualizing maternal exhaustion. infections.
during labour. intact perineum. 4. Maintain good flexion of the 4. Good flexion of the head was
head during delivery. maintained during delivery to allow
the smallest diameter to distend the
perineum.
5. Encourage client to keep her 5. Client was encouraged to keep her
buttocks down during delivery buttocks down to prevent perineal
process. trauma.
6. Deliver head slowly in between 6. Head was delivered slowly
contractions. between contractions .

43
Date/ Nursing Nursing Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Objective/ Time
Outcome
Criteria
7. Restitution was allowed to take
7. Allow restitution to take place place before the body was delivered
before delivery of the body. unto the mother’s abdomen.

44
 CHAPTER FOUR

REPORT ON PUERPERIUM

This chapter talks about puerperium, after delivery how mother and baby were cared for. This

includes preparation for discharge, postnatal home visits. This was done to take care of

mother and baby and to check for any complication which may arise during early puerperium

and manage them accordingly.

Management In The Lying-In Ward

The care and observation of Madam R.D.O. and her baby continued in the lying-in ward. The

fundal height was measured, and the uterus was assessed for contraction, and it remained

contracted and firm. Lochia was inspected and found to be red and moderate. (Appendix V D

for immediate postdelivery findings on mother). The baby was examined again from head to

toe and no abnormalities such as jaundice and pallor were detected. The baby’s colour,

temperature and respiration were checked and recorded quarter hourly for 2 hours and hourly

for 4 hours.

Madam R.D.O. was advised to empty her bladder frequently to aid in involution of the uterus

and prevent bleeding. She was also taught how to fix the baby to breast when lying down and

when sitting. She was encouraged to practice exclusive breast feeding for the first six months

and educated to wash her hands before and after handling the baby and changing her pad

when it’s soaked. The need for early ambulation and postal exercises was emphasized to

client. The client was encouraged to have adequate rest and sleep to regain her strength and

also recover from strains and stresses of labour and delivery.

Madam R.D.O. complained of after pain which according to her becomes severe when the

baby is suckling. She also complained of tiredness. I reassured her that she would be

45
managed and explained to her that after pain is a minor disorder in puerperium that help in

the contraction of the uterus, and the tiredness was also due to the stress of labour.

She was given two tablets of paracetamol (1gram) to relieve her of the pain as ordered by the

In-Charge. She was served rice with tomato stew. Client was encouraged to report any

excessive bleeding, severe headache, dizzinesss, or any abnormal condition. After six hours

the baby was given her first bath and cord dressed with chlorhexidine 7.1% gel. The baby

was wrapped in a warm cloth and put to breast to suckle.

Madam R.D.O.’s temperature, pulse, respiration, and blood pressure were checked and

recorded. The uterus was well contracted and fundal height was checked and recorded.

Lochia was inspected for its amount, colour, odour and consistency and no abnormality

detected. Client was also advised to support her breast with firm brassieres with broad straps

to provide comfort and was reminded to have enough rest. All the findings were

communicated to her after which she had a warm bath. She was encouraged to practice them

at home and informed of possible discharge the next day.

Preparation For Discharge

On 02/10/23, Madam R.D.O. had a warm bath and took her breakfast. History was taken on

the client’s sleeping pattern and general condition and that of the baby. According to her they

were doing well except that she had inadequate sleep at night and complained of constipation

due to pain anticipated during bowel movement. She was reassured and counseled on the

need to take in enough fruits, vegetables, and water. General examination was done and no

abnormalities, such as jaundice and pallor were detected. Colostrum was present in the

breasts. Fundal height was assessed for signs of involution. Lochia was inspected and it was

red and moderate (Refer to Appendix VIII for report on mother). Her vital signs were taken

as follows: Temperature36.7degree celcius, Pulse- 89 beat per minute, Respiration- 20 cycle

per minute, BP- 108/66mmHg.

46
The baby was examined from head to toe and no abnormality such as jaundice and pallor was

detected. The baby was topped and tailed, and the cord dressed with chlorhexidine gel. Baby

was given Bacilli Calmette Guerin (BCG) 0.05mls and two (2) drops of Oral Polio ‘O’

immunization and appointment for the next visit of the immunizations communicated to her.

(Refer to Appendix IIC for pharmacology of drugs used in puerperium for baby).

At 11:37am Madam R.D.O. and relatives were informed of her discharge after she was

reviewed by the doctor that morning. Preparations were made towards the departure. The

client and her support persons were educated on the care of the baby as well as the mother.

Madam R.D.O was advised to change her perineal pad frequently, wash her hands before and

after breastfeeding the baby and after visiting the toilet and changing the pad. She was

educated on the importance of adequate nutrition including fruits and vegetables to prevent

constipation and to enhance good health. The importance of adequate rest and sleep were

emphasized to promote physical and emotional stability. The client was also encouraged to

sleep under insecticide-treated mosquito net with the new born baby to prevent malaria. She

was counselled on care of the breasts, the need for exclusive breastfeeding, and observation

of the lochia for its amount, colour and offensive odour were made known to her.

On the care of the baby, Madam R.D.O. was advised not to apply unsterile substances such as

Shea butter, broken bottles, and herbs on the cord as it may lead to infection. Application of

hot water to the head, giving of enema was discouraged. She was urged to top and tail the

baby until the cord was off. She was counselled on frequent changing of baby’s diapers when

wet or soiled to keep the baby dry and warm and apply Vaseline to the buttocks. Madam

R.D.O. was counselled on exclusive breastfeeding and proper fixing of the baby to the breast

(latching) to prevent breast engorgement and sore nipple. She was reminded of the

importance of breaking wind after each feed. Madam R.D.O. was encouraged to send the

47
baby to the clinic for immunization against childhood preventable diseases. Madam R.D.O.

was reminded to register the baby at Birth and Death Registry. The support person was

advised to help the client in the care of the baby so that she can have adequate rest especially

during the day.

Finally, she was advised to report any abnormal condition or sickness such as vomiting, cord

bleeding and high temperature. Prescribed analgesic (paracetamol 1gram) was given to her,

and she was told to take it when necessary. She said she has some routine drugs which were

given to her during pregnancy in the house. She was told to continue taking them. Madam

R.D.O and the family were advised to pierce baby’s ear at the hospital, which they did before

leaving for the house. I informed them about the postnatal home visits, puerperal care and the

activities that would be carried out during my subsequent visits to the house for continuity of

care. Her bill was settled, and we left the ward at 12:00 pm together with the mother and her

sister. I escorted them to the house after which I took my leave with a promise of coming in

the evening to visit.

Postnatal Home Visits

Mother and baby were visited twice daily, morning and evening for the first three days and

once daily on the subsequent days.

First Day Posnatal Home Visit (02/10/23)

I visited Madam R.D.O, her baby, and the family in the evening around 5:00pm. I was

warmly welcomed by the whole family. I enquired about their health, and they said they were

all fine.

History of sleeping, feeding patterns, micturition and bowel movement were taken from

mother. History of baby’s health taken from mother revealed that baby was suckling and

sleeping well, passing urine and moving her bowels normally.

48
The Baby

I explained the procedure to mother and examined baby. The Baby was examined from head

to toe and no abnormality was detected, skin was pink, eye, nose and ears clean and clear

cord was normal with no bleeding or infection. The baby was top and tailed and cord dressed

with chlorhexidine 7.1% gel and exposed to dry. The baby was then dressed in clean clothes

and handed over to the mother.

Mother

Examination of the mother was done from head to toe. The uterus was palpated, and fundal

height was measured to see whether involution was taking place. Her temperature, blood

pressure, respiration and pulse were checked and recorded. Lochia was inspected and was

rubra (Refer Appendix VIIA for report on mother). The breasts were lactating well.

I reminded her again on how to fix the baby to breast and taught various ways of holding the

baby such as the side lying, cradle and cross cradle holds. She was encouraged to continue

breastfeeding exclusively; break wind after feeding and to bath baby with anti-septic solution

and avoid heating the child with excess clothing’s to prevent heat rashes.

I thanked her and informed her that I will visit the following morning.

Mother Baby

Temperature 37.00C Temperature 36.50C

Pulse 80bpm Respiration 41cpm

Respiration 20cpm Apex heart rate 136bpm

Blood pressure 110/70mmHg Stool meconium

Fundal height 17cm

49
Second Day Postnatal Home Visit (03/10/23)

I visited Madam R.D.O and her family on the second day post-delivery in the morning. I

received a warm welcome and was offered a seat. I asked about their health, and Madam

R.D.O confirmed they were fine history was taken on both mother and baby.

Baby

I then continued by explaining the procedure to Madam R.D.O that I will be examining baby.

I performed head to toe examination on the baby and no abnormality was detected. The baby

looked healthy. The baby was bathed using the top and tail method, cord dressed with

chlorhexidine 7.1% gel and allowed to dry. Baby dressed and made comfortable in bed, all

findings communicated to mother and documented.

Mother

I explained the procedure to Madam R.D.O and examined her from head to toe, uterus

palpated and fundal height measured and recorded. The colour, odour, and amount of lochia

was normal. I helped Madam R.D.O up, washed my hands and communicated all findings to

her and documented all findings.

Mother and baby’s vital signs were checked and recorded:

Mother Baby

Temperature 36.60C Temperature 36.5 0C

Pulse 84bpm Apex heart rate 134bpm

Respiration 21cpm Respiration 50cpm

Blood pressure 110/70mmHg Stool meconium

Fundal height 16cm

I told her I will be visiting in the evening at 4:30pm. I thanked left to the house.

50
Evening

I visited Madam R.D.O again in the evening to check on their health. Baby was sleeping

when I came so I enquired from her if baby was bathed using top and tail and she said yes. I

asked about their health, and she said they were all fine.

Baby

The procedure was explained to mother to examine the baby. The baby was examined from

head to toe but no abnormalities was detected on examination. The baby’s temperature, heart

beat, and respiration were checked and recorded.

Mother

Head to toe examination done on mother after explanation of procedure. The breast

examination was done with no abnormalities, lochia was inspected, and it was normal with

no odour. We had a conversation on how to keep herself prevent infection, like changing pads

regularly when soiled. I entreated her to wash her hands regularly, after visiting the

washroom, before breastfeeding the baby, and after changing linens or diapers. She was

taught postnatal exercise such as Kegel exercise, abdominal and leg exercise and was

supervised to do it on each visit. It was explained to her that the exercises would help to

strengthen the pelvic floor muscles and facilitate the uterus to return into its pre-gravid state.

I asked if she had any complaints to which she said no. Mother and baby’s vital signs were

checked and recorded.

Mother Baby

Temperature 36.9- degree Celsius Temperature 36.4degree Celsius

Pulse 81bpm Apex heartbeat 136bpm

Respiration 22cpm Respiration 45cpm

51
Blood pressure 100/60mmHg Stool greenish yellow

Fundal height 16cm

Third Day Postnatal Home Visit (04/10/23)

I visited Madam R.D.O, the following day at 8:00am. We exchanged greetings and I was

offered a seat. History was taken on mother and baby.

Baby

I explained the procedure to madam R.D.O and examined baby from head to toe with no

abnormality detected. I top and tailed baby and dressed cord aseptically. During the top and

tail I realized baby had heat rash. I assessed the severity of the heat rash on the body and

reassured mother. She was counselled to wear light cotton clothing for the baby and maintain

adequate ventilation in the room.

Mother

Head to toe examination was also done on mother, breast examination done, abdomen

palpated for involution and fundal height checked and recorded, lochia inspected for colour,

odour and amount. She was encouraged to practice exclusive breastfeeding. She moves

bowel and urinates well. She complained of acute pain (after pain) especially during

breastfeeding of baby. The client was reassured that the condition would be managed. It was

explained to her that the lower abdominal pains were because of contracting of the uterus

back to its pre gravid state. She was educated in exclusive breastfeeding, rest and sleep,

adequate nutrition and family planning. Her mother and sister were advised to assist her in

carrying out her daily chores and care for the baby.

Mother Baby

Temperature 36.5- degree Celsius Temperature 36.4 degree Celsius

52
Pulse 81bpm Apex heart rate 138bpm

Respiration 22cpm Respiration 49cpm

Blood pressure 120/80mmHg Stool greenish yellow

Fundal height 15cm Weight 2.7kg

I visited again in the evening at 5.00pm and both mother and baby were doing well. We

exchanged greetings and I was offered a seat.

Baby

I performed a physical examination on baby. Bathed baby and dressed baby, baby’s vital

signs were checked and recorded.

Mother

Mother was examined from head to toe, breast was examined for engorgement. I enquired if

she was doing the exercises, I taught her, and she said yes. I encouraged her to do it in order

to help get back to her pre pregnant state.

Vital signs were checked and recorded as

Mother Baby

Temperature 36.8degree Celsius Temperature 36.5 degree Celsius

Pulse 70bpm Apex heart rate 140bpm

Respiration 19cpm Respiration 42cpm

Blood pressure 110/65mmHg Stool greenish yellow

I thanked her and told her I will visit the following day and bid her goodbye.

53
Fourth Postnatal Home Visits (05/10/23)

Madam R.D.O. was visited the following day at 5:00pm. I was warmly welcomed and offered

a seat. I informed her about the purpose of the visit. I took history on both mother and baby.

Baby

On examination of the baby, I realized that baby’s abdomen was distended, I assessed baby

and expelled air from the abdomen by breaking wind and the mother was taught how to break

wind after breastfeeding baby. The baby was top and tailed and cord dressed aseptically with

chlorhexidine 7.1% gel. Baby stool changed from meconium to yellowish.

Mother

Mother was examined, she complained of sleeping disturbances due to cry of baby, so told

her it is as a result of baby been hungry or baby’s diaper been wet. Lochia was light and

colour was serosa.

Mother and baby’s vital signs were checked and recorded as:

Mother Baby

Temperature 37.20C Temperature 36.50C

Pulse 83 bpm Apex heart rate 143bpm
Respiration 22cpm Respiration 40cpm

Blood pressure 100/70mmHg Stool greenish yellow

Fundal height 14cm

I thanked her and told her I will visit her the next day in the morning

Fifth Day Postnatal Home Visit (06/10/23)

On the fifth day, I visited Madam R.D.O in the evening around 6.00pm. History was taken for

both mother and baby and recorded. I realized both mother and Baby were fine.

54
Baby

I explained the routine examination to her and after the assessment, the baby was bathed, and

cord dressed aseptically. The baby was re assessed for distention but abdomen was no longer

distended.

Mother

Madam R.D.O was examined, lochia was scanty and pink in colour. Mother complained of

tiredness due to increased responsibility, I advised her to have enough rest and sleep, and to

sleep when baby is also asleep. I encouraged her to continue the postnatal exercises. Vital

signs were checked and recorded as follows:

Mother Baby

Temperature 36.8-0C Temperature 36.30C

Pulse 82 bpm Apex heart rate 140bpm

Respiration 18cpm Respiration 40cpm

Blood pressure 118/74mmHg Stool greenish yellow

Fundal height 13cm Weight 3.1Kg

Sixth Postnatal Home Visit (07/10/23)

On the sixth day postnatal, I visited madam R.D.O in the evening at 5:00pm. I enquired about

their health after greeting them and they were all fine and looking healthy.

Baby

I performed physical examination on the baby. The baby was bathed and I realized cord was

off but wound was not healed, chlorhexidine 7.1% gel was applied to the wound.

Mother

55
Madam R.D.O. was also examined from head to toe, lochia was observed to be scanty and

pink in colour but not offensive. Mother lodged no complaint. I encouraged her to continue

the exclusive breastfeeding of the baby. Vital signs were checked and recorded as:

Mother Baby

Temperature 36.50C Temperature 36.40C

Pulse 62bpm Apex heart rate 138bpm

Respiration 20cpm Respiration 41cpm

Blood pressure 110/70mmHg Stool yellow

Fundal height 12cm

I thanked mother and told her I will be coming the next day in the evening.

Seventh Day Post Natal Home Visit (08/10/23)

I met Madam R.D.O, her husband and mother in the evening at 4:30pm. Client and family

were happy to see me, and they all were looking healthy. She looked fit and had no complaint

after history taking.

Baby

I examined the baby from head to toe and no abnormality was detected. The baby’s skin was

pink and baby was active. Vital signs were checked and recorded.

Mother

Mother was also examined, and she was doing well. Lochia was very scanty and pink. She

expressed her sincere gratitude for taking care of her and the baby.

56
Education on exclusive breastfeeding, nutrition, personal and environmental hygiene, and

care of the baby was also repeated. She was advised to thoroughly wash her hands before and

after attending to the baby. In order to prevent skin infections such as Pemphigus

Neonatorum and heat rashes, Madam R.D.O. and her mother were advised to bath baby with

antiseptic solution like savlon, wash baby’s items separately and mop skin folds thoroughly

after bathing baby. She was told to allow complete emptying of breast at a feed before fixing

baby to the second breast to prevent breast engorgement.

Madam R.D.O. was counseled on family planning and informed to visit the family planning

unit after six weeks to discuss with the service provider a wide range of available methods

and choose a suitable method. She was also informed of the end of my home visits on the 7 th

day and about the termination of my care. I advised her to register her baby and remind her 6

weeks postnatal visit on the 10/11/23 which I will be handing her over.

I informed the family that it was my last postnatal visit but would visit occasionally to check

on the family so far as I was in the town. Her husband, mother and sister were all thanked

and congratulated for their support and encouraged to continue supporting the mother and the

children.

Vital signs were checked and recorded as:

Mother Baby

Temperature 36.80C Temperature 36.2 0C

Pulse 84bpm Apex heart rate 140bpm

Respiration 20cpm Respiration 51cpm

Blood pressure 110/70mmHg Stool greenish yellow

57
Sixth Week Postnatal Clinic Visit (10/11/23)

On 10/11/23, Madam R.D.O. and the baby reported to the postnatal clinic looking healthy

and cheerful. They were warmly welcomed and provided a seat. We exchanged , pleasantries

and I took a brief history on her health and that of the baby and according to her they were

both doing well.

The procedure for examination was explained to her. The baby’s temperature was checked,

and it read 36.6oC which is normal, respiration was 40 cycle per minutes and apex heartbeat

was 149bpm. The baby was undressed, and a head-to-toe examination was conducted in the

presence of his mother under the supervision of my preceptor. The anterior fontanel admitted

two fingers; the eyes were examined for discharge or discoloration but looked white and

clear. The cord stump had healed. The baby was active and had normal reflexes. The baby

was weighed, and her weight was 3.6kg, head circumference was 35 cm and full length-51

cm. Baby was redressed and wrapped in a cot sheet to keep warmth.

Madam R.D.O.’s temperature, pulse, respiration, and blood pressure were checked and

recorded as temperature: 36.7oC, pulse: 78bpm, respiration: 20cpm and blood pressure was

110/70 mmHg. Her weight was 76 kilograms. She was asked to empty her bladder and a

urine specimen was taken and tested for protein and glucose and the result was negative. She

was then examined from head to toe and no abnormality such as jaundice and pallor was

detected. The breasts were firm, full and lactating well and fundal height measured 8

centimeters. Lochia was Alba, scanty and odourless. The perineal area was clean without any

evidence of infections. The limbs were inspected and palpated to detect abnormalities like

rashes and oedema, but none was detected. Laboratory investigations were carried out on the

urine and blood and no protein, acetone or glucose was found in the urine. Her haemoglobin

level was 11.4g/dl which was normal. All the findings were communicated to her. I stressed

the importance of good nutrition, rest and sleep and the need to continue with the postnatal

58
exercises to strengthen her pelvic and abdominal muscles. Advice was given on family

planning and care of the baby. Client was advised to attend the child welfare clinic as

scheduled for the growth of the baby to be monitored and for the baby to receive the

necessary immunizations. Madam R.D.O. was congratulated for taking good care of herself

and the baby and encouraged to keep it up.

Termination of Care and Continuity Of Care

She was handed over to the midwife in-charge who will in turn hand her over to the

community health nurses for continuity of care during my six weeks period absence. I

thanked her for her cooperation and extended my greetings to her family after which I saw

her off.

59
Puerperium Nursing Care Plan

Problems Identified During Puerperium

1. Acute pain (after pain) (03/10/23)

2. Tiredness (04/10/23)

3. Interrupted sleep (05/10/23)

4. Distended abdomen (Baby) (06/10/23)

5. Body pains (07/10/23)

Short Term Goals

1. Client will experience some relieve of after pain within 2 hours

2. Client will be relieved of tiredness within 48 hours.

3. Client will rest/sleep for at least 2 hours in the day and 6 hours at night within 48

hours.

4. Baby’s distended abdomen will subside within 30 minutes.

5. Client will be relieved of body pains within 48 hours

Long Term Goals

Mother and baby will go through puerperium without any complications.

60
 Nursing Care Plan for Puerperium

Date/ Nursing Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Outcome Time
Criteria
03/10/23 Acute pain Client will 1. Reassure the client. 1.Client was reassured that pain will be 03/10/23 Client A.J
@ (After pain) experience some relieved. @ expressed
4:15pm related to relief of after pain 2. Assess severity of pain. 2. Severity of pain was assessed, and it 6:15pm some relieve
contraction of within 2 hours as was mild using the numerical pain scale. of
the uterine evidenced by client 3. Explain the cause of the pain 3. The cause of the pain was explained after pain
muscles. verbalizing some to the client. to the client. Goal fully
relieve of after pain. 4. Encourage client to breast 4. Client breast feed baby on demand. met
feed baby on demand.
5. Encourage client to empty 5.Client emptied her bladder frequently.
her bladder frequently.
6. Encourage early ambulation. 6. Client was encouraged to ambulate
early.
7.Encourage client to rest and 7.Client was advised to rest and sleep
sleep and educate her on its and was educated on its importance.
importance.
8.Encourage client to apply 8.Client was encouraged to apply warm
warm compress. Example warm towel to the lower abdomen to relieve

61
Date/ Nursing Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Outcome Time
Criteria
towel. pain.
9.Serve prescribed analgesics 9.Tablet paracetamol 1000mg served
when necessary

Nursing Care Plan For Puerperium

Date/ Nursing Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
62
Time Diagnosis Outcome Time
Criteria
04/10/23 Fatigue Client will 1. Reassure client . 1. Client was assured that condition can 06/10/23 Client A.J
@ (Tiredness) experience relief of be managed. @ verbalized,
4:40pm related to tiredness within 48 2.Assess severity of condition 2.Severity of condition was assessed 4:40pm Relief of
stress of hours as evidenced 3.Examine client from head to toe 3.Client was examined from head to tiredness.
labour by client verbalizing toe Goal fully
relief from tiredness. 4. Assess client’s daily activities. 4. Client’s daily activities such as house met.
chorse were assessed.
5.Educate client on the 5.Client was educated on the
importance of rest and sleep importance of rest and sleep to reduce
the fatigue related
6. Encourage client to rest/sleep 6. Client slept at least 2 hours in the day
at least 2 hours in the day and 8 and 8 hours in the night.
hours in the night.
7. Encourage relatives to support 7. Client’s relatives supported client and
client and assist in the care of the assisted her in the care of the baby and
baby and house chores. house chores.

Nursing Care Plan For Puerperium

Date/ Nursing Nursing Objective / Nursing Orders Nursing Intervention Date/ Time Evaluation Sign

63
Time Diagnosis Outcome
Criteria
05/10/23 Sleep pattern Client will be able to 1 Reassure client . 1. Client was assured that she will 05/10/23 Goal fully A.J
@ Disturbance sleep at least 6 to 8 be able to sleep during the night. @ met. Client
8:00am related to cry hours during the 2 Educate client to feed baby 2 Client was educated to feed baby 4:00pm verbalized
of the baby. night as evidenced well before she sleeps. well before she sleeps. that she is
by, 3. Educate client to 3. Client was educated to able to sleep
client verbalizing encourage her husband to encourage her husband to assist in well and her
that assist in the baby’s care at the baby’s care at night. husband
She is able to sleep night. 4. Client limited visitors observed she
well, and her 4. Educate client to limit during sleeping hours. had a sound
husband also visitors during sleeping hours. sleep.
observed that she 5. Family created conducive
had a sound sleep. 5. Counsel family to create environment for sleep.
conducive environment for
sleep. 6. Client’s husband helped
6. Advise relatives to help with the care of the baby and
with the care of the baby and household chores.
household chores.

64
 Nursing Care Plan For Puerperium

Date/ Nursing Nursing Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Objective/ Time
Outcome Criteria
06/10/23 Distended Baby’s distended 1. Assess baby’s condition. 1. Baby’s condition was assessed by 06/10/23 Student A.J
@ abdomen abdomen will doing a physical exam. @ midwife
8:02am (baby) related subside within 30 2. Reassure mother that baby’s 2. Baby’s mother was reassured 8:32am observed
to improper minutes as condition will be managed. that condition would be managed baby with a
attachment of evidenced by by adhering to instructions and reduced
baby to breast student midwife advice given abdominal
during observing baby 3. Educate mother on proper 3. Mother was educated on proper girth.
breastfeeding having a reduced positioning and attachment of positioning and attachment of baby
abdominal girth. baby to breast. to breast. Goal fully
4. Supervise mother during 4. Mother was supervised during met.
breastfeeding. breastfeeding.
5. Teach mother how to break 5. Mother was taught how to break
wind after breastfeeding. wind after breastfeeding.
6. Advise mother to put baby in 6. Mother was advised to put baby
lateral position when sleeping. in a lateral position when sleeping.
Nursing Care Plan For Puerperium

65
Date/ Nursing Nursing Objective / Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Outcome Criteria Time
7/10/23 Altered Client will be 1. Reassure client . 1.Client was reassured that pain will be 09/10/23 Client A.J
@ body relived from body managed. @ verbalized
4:30pm comfort pains within 48 2.Assess the severity of body 2.Severity of body pain was assessed 4:30pm that she was
(Body hours as evidenced pains (1 out of 10). relieved of
pains) by client 3.Explain the condition to client. 3.Condition was explained to client. body pains.
related to verbalizing being 4.Encourage client to rest for 2 4.Client was encouraged to rest 2 hours Goal fully
stress and relieved of body hours in the day and sleep at during the day and at least 6-8 hours at met.
strain of pains least 6-8 hours at night. night.
labour 5.Educate client to eat nutritious 5.Educate was educated on nutritious
meal. diet.
6.Encourage client and support 6.Client and support person were
person to restrict encouraged to restrict visitors.
visitors
7.Advice relatives to help with 7.Client’s husband and relatives
house hold chores helped with house hold chores.

66
 SUMMARY

The birth of a new baby is an important event in the lives of every family. To be able to

achieve such an important life event, an expectant mother deserves to go through normal

pregnancy, labour and puerperium by being attended to by a skillful midwife and a

supporting family. This care study was on Madam R.D.O. 23years old, gravida 2 para 1 alive,

whom I met at Mamprobi Hospital. Madam R.D.O. was the client I chose to provide her with

information that will help her improve her haemoglobin level and to help her manage minor

disorders that she will experience also to provide her with appropriate care during pregnancy,

labour and seven (7) days of puerperium. She made her first antenatal visit on 27/02/23 and

she attended the antenatal clinic regularly till she went into labour. Most of the examinations

carried out on her revealed no abnormalities. Pregnancy progressed well until 39weeks plus

one day when she delivered a live healthy baby girl on 01/10/23 at 11:09am. Baby’s weight at

birth was 3.0kg. Findings of examinations carried out on baby were normal. She experienced

a normal puerperium and breastfed exclusively.

A family- centered maternity care concept with the nursing process was used to identify

Madam R.D.O.’s problems and she was provided with care that was individualistic, holistic,

efficient and effective to meet her needs. She was supported by the husband and relatives

during pregnancy, labour and her mother assisted in the care of mother and baby during

puerperium. Upon discharge, Madam R.D.O. was educated in the care of the baby and herself

as well. Seven (7) days postnatal visits were made for continuity of care. On the 2 nd to 8th of

October, 2023, mother and baby were visited once daily.

Madam R.D.O. and her baby made their Sixth week postnatal visit on 10/11/23. They were

healthy and cheerful. Both mother and baby were examined, and no abnormalities were

detected. I handed them over to the community health nurse for continuity of care.

67
 CONCLUSION

Family-Centered Maternity care study has given me a broad knowledge about good

interpersonal patient care involving the family as well. This experience has helped me in

educating and assisting my client in solving problems relating to pregnancy, labour and

puerperium. It also helped me to manage efficiently any expectant mother who will be

entrusted to my care. Again, I wish all expectant mothers will experience this family centered

care to help reduce maternal and infant mortality and morbidity in the country. It has offered

me the opportunity to put what I have learnt in the classroom and on the field into practice.

68
 BIBLIOGRAPHY

Marshall, J, R. M. (2014). Myles Textbook for Midwives (16th ed.). Edinburgh: Churchill

Livingstone: Elsevier.

Oduro-Kwarteng V. (2015). Obstetrics for Nurses and Midwives (3rd ed). Kumasi: Robee

Printing Press

Weller, B. F. (2019). Bailliere's Nurses Dictionary for Nurses and Health Care Workers (27th

ed.). London: Churchill Livingstone: Elsevier.

Ghana Health Service. (2016). National Safe Motherhood Service Protocol. Accra: O'Mens

Investment.

International Childbirth Education Association (n.d). About. Retrieved May 27, 2021, from

International Childbirth Education Association: http//icea.org/about/

Client Maternity and Child Health Record Book, Mamprobi Hospital. Hospital number:

401/22.

69
 APPENDIX

COMPLETE DIAGNOSTIC INVESTIGATION

Date Specimen Investigation Normal Finding Remarks
Value

27/02/23 Urine Sugar protein Negative Negative Normal

Haemoglobin level Negative Negative Normal
Blood Sickling 12.2g/dl 12.9g/dl Normal
Grouping Negative Negative Normal
Rhesus factor A, B, AB, O O Normal
HIV/AIDS Positive/negative Positive Normal
Hepatitis Negative Negative Normal
VDRL Negative Negative Non- Normal
G6PD Negative reactive Normal
Normal Normal Normal

17/07/23 Urine Sugar protein Negative Negative Normal

Haemoglobin level Negative Negative Normal
Blood 12.2g/dl 12.6g/dl Normal
16/08/23 Urine Sugar protein Negative Negative Normal
Haemoglobin level Negative Negative Normal
Blood 12.9g/dl 12.2g/dl Normal

70
 Complete Diagnostic Investigation

Date Investigation Normal Value Finding Remarks

29/08/23 Sugar protein Negative Negative Normal

Haemoglobin level Negative Negative Normal
12.5g/dl 12.5g/dl Normal

20/09/23 Sugar protein Negative Negative Normal

Haemoglobin level Negative Negative Normal
12.3g/dl 12.3g/dl Normal

71
 APPENDIX

PHARMACOLOGICAL DRUGS FOR MOTHER

Name of Classification Dosage Route Action Uses Actual Side Effect Side Effect
Drug Effect Experienced
Tablet folic acid Vitamin 5mg daily Oral Helps in the formation Maturation of red blood Nausea and vomiting None
preparation of normal blood cells cells

Tablet Vitamin 200mg twice daily Oral Increases appetite and Increased appetite Gastrointestinal None
Multivitamin preparation helps in the formation irritation
of red blood cell

Tablet ferrous Iron 200mg daily for Oral Helps in the formation Formation of red blood Abdominal None
sulphate preparation 30days of red blood cells cells discomfort, diarrhea
dark stool
Tablet Sulphadoxin Anti-malaria 3 tablets start from Oral Prevention of malaria Prevent malaria in Itching, vomiting, None
epyrimethamine and 16 weeks pregnancy nausea
prophylaxis (quickening) and
subsequent doses at 4
weeks interval till
birth.

72
 Pharmacological Drugs For Mother Cont’

Name Of Classification Dosage Route Action & Uses Actual Side Effect Side Effect
Drug Effect Experienced
Tetanus toxoid Anti-tetanus 0.5miligram Subcutaneous Helps in the Prevention of tetanus Slight fever and None
injection prevention of tetanus chills

Oxytocin Oxytocic drug 10units Intramuscular Increase uterine Increase contractions Hypotension and None
contraction and control hyper stimulation
of bleeding.
Vitamin A Group A vitamin 200000unit once Oral Growth and Growth development, Vomiting None
supplement daily development proper prevent infection and
sight blindness

Tablet Analgesic 500mg Oral Helps to reduce Relieve pain Liver damage with None
paracetamol increased body prolong use
temperature and pain

73
 Pharmacological Drugs For Baby

NAME OF CLASSIFICATION DOSAGE ROUTE ACTION USES ACTUAL SIDE EFFECT SIDE EFFECT
DRUG EFFECT EXPERIENCED
Vitamin K Group K vitamins 1milliliter Intramuscular Production of No bleeding Hypersensitive rea None
prothrombin that aids ction
in clotting
Chloramphenicol Antibiotics 2 drops Instillation To prevent eye Infection of the eye was None None
eye drop infection prevented

Oral Antigen vaccine 2 drops Orally Gives immunity Baby is under Diarrhea, fever None
Poliomyelitis against poliomyelitis observation
Injection Bacillus Antigen vaccine 0.05 ml Intradermal Production and Baby is under Blister formation Blister was
Calmette Guerin prevention of observation and slight fever formed
tuberculosis

74
 Pharmacological Drugs For Baby

Name Of Classification Dosage Route Action/ Actual Side Effect Side Effect
Drug Uses Effect Experienced
Pneumococcal Antigen 0.5 milligram Intramuscular Vaccinates neonates Pneumonia prevention Redness at the None observed
ly against pneumonia side of injection
and fever
5 in 1 vaccine Antigen 0.5 milligram Intramuscular Vaccinates neonates Prevention of childhood Low grade fever None observed
(Pentavalent) ly against diphtheria, preventable diseases
pertussis (whooping
cough), tetanus,
hepatitis
B, haemophilusinfluen
za type B
Rota virus Antigen 1.5 milligrams (2 Orally Prevention of Gastroenteritis None None observed
drops) gastroenteritis prevention

75
 APPENDIX

ANTENATAL CHART

Date Weight Blood Urine Gestat Fundal Present Descent Foetal Complai Treatment Name And
(Kg) Pressure Protein Ional Height - Ation Heart ns Signature
(Mmhg) Sugar Age (Cm) Rate
27/02/23 60 110/80 Negative 8week+ 6 non- Variable EP No Tablet (Multivite, folic
days palpable complain acid, ferrous sulphate,
Sulphadoxine
Pyrimethamine)
13/03/23 60.5 110/70 Negative 10week Non variable - EP No Tablet (Multivite, folic
s+6 days palpable complain acid, ferrous sulphate,
Sulphadoxine
Pyrimethamine)
11/04/23 58 100/70 Negative 15week 16cm variable - EP No Tablet (Multivite, folic
s complain acid, ferrous sulphate,
Sulphadoxine
Pyrimethamine)

76
 ANTENATAL CHART CONT’
Date Weight Blood pressure Urine Gestational Fundal height Presentatio Descent Foetal Complains Treatment Name and
(kg) (mmHg) Protein Sug age (cm) n heart rate signature
ar

22/05/23 61 100/60 Negative 20weeks 20cm variable - 138 No Tablet (Multivite,

complain folic acid, ferrous
sulphate,
Sulphadoxine
Pyrimethamine)
19/06/23 62 100/70 Negative 24 weeks+ 24 Cephalic 5/5th 128beat per Sleep Tablet (Multivite,
1days minute disturbance folic acid, ferrous
sulphate,
Paracetamol,
Sulphadoxine
Pyrimethamine
17/07/23 60 100/60 Negative 28+6days 26 Cephalic 5/5th 133 beat Frequent Tablet (Multivite,
per minute micturition folic acid, ferrous
sulphate)
Sulphadoxine
Pyrimethamine

77
 ANTENATAL CHART CONT’

Date Weight Blood Urine Gestationa Fundal Presentation Descent Foetal Complains Treatment
(Kg) Pressure Protein l Age Height Heart
(Mmhg) Sugar (Cm) Rate
18/08/23 66 100/70 Negative 33weeks+ 33 Cephalic 5/5th 137 beat per Constipation Tablet (Multivite,
4day minute folic acid ferrous
sulphate.
29/08/23 65 110/70 Negative 35weeks+ 34 Cephalic 5/5th 143 beat per Waist pain Tablet (Multivite,
1days minute Complain folic acid and
ferrous sulphate.
20/09/23 64 100/60 Negative 38weeks+ 36 Cephalic 5/5th 140 beat per Lower Tablet (Multivite,
minute abdominal pains folic acid and
ferrous sulphate.

29/09/23 64 100|70 Negative 39weeks+ 38 Cephalic 5|5th 144 beat per Backache Tablet (Multivite,
1day minute folic acid and
ferrous sulphate.

78
 APPENDIX

OBSERVERD DURATION OF LABOUR

LABOUR DURATION

First stage 5 hours 25 minutes

Second stage 7 minutes

Third stage 5minutes

TOTAL 5 hours 37 minutes

79
 APPENDIX

APGAR SCORE CHART

CONDITION 1ST MINUTE 5TH MINUTES

Appearance 1 2

Pulse 2 2

Grimace 1 1

Activity 1 2

Respiration 2 2

Total Score 7/10 9/10

80
 APPENDIX

EXAMINATION OF PLACENTA AND MEMBRANES

Lobes 20 Complete

Membranes Complete

Length of Cord 52 centimeters

Cord Insertion Centrally

Vessels One vein and two arteries

Condition Healthy

81
 APPENDIX

IMMEDIATE POST DELIVERY FINDINGS ON MOTHER

Uterus Well Contracted

Lochia (colour) Rubra (red)

Amount of lochia Moderate

Perineum Intact

Fundal height 18cm

Blood loss 150mls

Blood Pressure 110/70mmHg

Pulse 84bpm

Respiration 23bpm

Temperature 36.30C

Condition Satisfactory

82
 APPENDIX

EXAMINATION AND POST DELIVERY FINDINGS ON BABY

Sex Female

Birth weight 3.0kg

APGAR Score 7/10, 9/10

Head circumference 34 centimeters

Chest circumference 32 centimeters

Biparietal 9.6 centimeters

Sub occipitobregmatic 10 centimeters

Full length 50 centimeters

Birth Injuries None

Congenital abnormalities None detected externally

Meconium Passed

Urine Passed

General Condition Satisfactory

83
 SIGNATORIES

NAME OF STUDENT: JENNIFER ANSAH

SIGNATURE: ……………………………………………

DATE: …………………………………………

NAME OF SUPERVISOR: GIFTY BAIDOO

RANK ………………………………………….

SIGNATURE: ………………………………………………

DATE: ………………………………………………

NAME OF PRINCIPAL: MS MERCY ADZO KPORKU

RANK …………………………………………….

SIGNATURE: ………………………………………………...

DATE: …………………………………………………

84