ANGELES UNIVERSITY FOUNDATION

Angeles City
College of Nursing

CARE OF MOTHER, CHILD, ADOLESCENT (WELL CLIENTS) – NCM 0107

First Semester, A.Y. 2021 – 2022

Module 4: Care of the Mother and the Fetus during the Perinatal Period
(Intrapartal Care – Part 1)

Labor and delivery is the culmination of the childbearing cycle and is an intense
period during which the products of conception are expelled from the uterus. It calls for
all the psychologic and physical coping methods that a woman has available to her. No
matter how much childbirth preparation she has had, nor how many times she has
already gone through the experience, the woman will require nursing care that is
efficient and family focused, because childbirth marks the beginning of a new family
structure.

Nursing interventions to make labor safe, comfortable, and effective are vital.
Any support person should be treated with respect and should be included in all phases
of the process, whenever possible. Labor and delivery are enormous emotional and
physiologic accomplishments for a woman and her support person, and interventions
that make the experience more positive and memorable for them will mean a lot to
future family interactions.

Module Learning Outcomes

Upon completion of this module, the student should be able to:
1. Assess mother, child, adolescent with the use of specific methods and tools to
address existing health needs.
2. Formulate nursing diagnosis/es focusing on health promotion and disease
prevention related to mother, child, and adolescent’s health.
3. Implement safe and quality interventions addressing health needs affecting women
from pregnancy to postpartum and children from perinatal to adolescent stage.
4. Conduct individual/group health education activities based on the priority learning
needs of mother, child, adolescent.
5. Evaluate with the client the health outcomes of nurse-client working relationship.
6. Institute appropriate corrective actions to prevent or minimize harm arising from
adverse effects.
ASSESSMENT: PRETEST
Test I. Multiple Choice. Choose the best answer
1. Labor pains is perceived more quickly if anxiety is present.
A. True
B. False

2. This component of labor refers to the fetal position:

A. Psyche
B. Passageway
C. Passenger
D. Power

3. The suture which joins the occipital bone and two parietal bones:
A. Frontal
B. Sagittal
C. Coronal
D. Lambdoid

4. This refers to the intersections of the cranial sutures:

A. Mentum
B. Fontanelle
C. Molding
D. Attitude

5. When the fetus presents the smallest anteroposterior diameter because it puts the
whole body into an ovoid shape, occupying the smallest space as possible, the fetal
attitude is:
A. Poor
B. Moderate
C. Good
D. Excellent

6. When the fetal presenting part is at the level of the ischial spine, the station is:
A. 0
B. -1
C. +2
D. +3

7. Which of the following is the most common type of fetal presentation?

A. Military
B. Brow
C. Face
D. Vertex
 8. All of the following are methods that can determine fetal position, presentation, and
lie, EXCEPT:
A. Abdominal x-ray
B. Auscultation of fetal heart tones
C. Leopold’s maneuver
D. Sonography

9. One of the premonitory signs of labor onset is slight decrease in maternal weight 1
or 2 days before the onset of labor.
A. True
B. False

10. In the mechanisms of labor, which of the following will follow after fetal descent?
A. Internal rotation
B. Flexion
C. Extension
D. External rotation

FEEDBACK ON THE PRETEST

1. A 6. A
2. C 7. D
3. D 8. A
4. B 9. A
5. C 10. B
Note: If your score is 7 or higher, your understanding of the Care of the Mother and the
Fetus during the Perinatal Period (Intrapartal Care – Part 1) is satisfactory; you may
proceed in reading this module to further enhance your knowledge.

If your score is lower than 7, you may proceed in studying this module and
approach the instructor for assistance in understanding the contents of the
module.
At the end of reading and studying this module, kindly accomplish the
post-test in order to evaluate your understanding of the Care of the
Mother and the Fetus during the Perinatal Period (Intrapartal Care – Part
1).

Methods to Manage Pain in Childbirth

A. Gate Control Mechanisms – involves halting the impulse at the level of the spinal
cord so the impulse is never perceived at the brain level as a pain.

3 Techniques:
a. Cutaneous stimulation
b. Distraction
 c. Reduction of anxiety

B. Bradley Method (Partner-coached) Method

- Pregnancy is a joyful natural process and stresses importance of the husband
- Pain is reduced by: abdominal breathing, walking during labor

C. Psychosexual Method
- Stresses that pregnancy, labor and birth and the early newborn period are
important points in woman’s life cycle
- The program involved conscious relaxation and levels of progressive
breathing encourages the woman “to flow with” rather than struggle against
contractions of labor.

D. Grantly Dick-Read Method

- Fear leads to tension and tension leads to pain
- Achieves relaxation and reduced pain in labor by using abdominal breathing
during contractions

E. Lamaze Method
- Based on stimulus-response conditioning,
6 Major Concepts of Lamaze:
1. Labor should begin on its own, not induced.
2. Woman should walk, move around, and change position.
3. Woman should bring loved one, friend for continuous support.
4. Interventions that are not medically necessary should be avoided.
5. Women should be allowed to give birth in other positions.
6. Mother and baby should be kept together after birth.

The learner will watch videos some methods to manage pain in

childbirth
https://www.youtube.com/watch?v=bJ8wAgxdYqA - Elowyn's
Birth Story // The Bradley Method // Natural Hospital Birth
https://www.youtube.com/watch?v=TSuRnhfB2qA – Lamaze
classes
https://www.youtube.com/watch?v=_3n9_FJ14NI – LAMAZE
HEALTHY BIRTH – What you NEED to Know!

Types of Birth Setting

Besides how to prepare for labor, choosing a birth setting is another important decision
that a couple needs to make during pregnancy (Alliman & Phillippi, 2016).

1. Hospital Birth (labor-birth-recovery postpartum rooms or labor-birth-recovery)

 2. Alternative Birthing Center – wellness-oriented childbirth facilities designed to
remove childbirth from the acute care hospital setting while providing enough
medical resources for emergency care should complication of labor and birth
arises.
3. Home Birth – it allows for family integrity, puts responsibility on the woman to
prepare the house and take care of her infant after birth.
4. Children attending birth

Alternative Methods of Birth

1. Leboyer – from a warm, fluid-filled intrauterine environment to a noisy, air-filled

brightly lit birth room creates a major shock.
- The birthing room is darkened so there is no sudden contrast in light, keep
room pleasantly warm, soft music is played, infant handled gently, cord is cut
late, place in a warm-water bath.
2. Hydrotherapy and Water Birth
- Reclining or sitting in warm water labor can be soothing, feeling of weightless
and relaxation can reduce discomforts
- Disadvantages: water contaminated with mother’s fecal material, aspiration,
maternal chilling

Activity 1. Concept Mastery Alert.

The students will write their answer on the discussion board. They will answer the
question “Who are the best candidates for birthing homes?”

THEORIES OF LABOR ONSET

Labor normally begins when a fetus is sufficiently mature to cope with

extrauterine life yet not too large to cause mechanical difficulties in delivery. However,
the trigger that converts the random, painless Braxton Hicks contractions into strong,
coordinated, productive labor contractions is unknown. A number of theories have been
proposed to explain why labor begins. These include:

1. Uterine Stretch Theory. Any hollow body organ when stretched to capacity will
necessarily contract and empty because of pressure on nerve endings and
increased irritability of the uterine musculature.

2. Oxytocin Theory. Oxytocin is an effective stimulant of uterine contractions in late

pregnancy and is commonly used to induce or augment labor.

3. Progesterone Deprivation Theory. Progesterone is believed to inhibit uterine

motility. The onset of labor in humans might result from withdrawal of
progesterone at a time of relative estrogen dominance.

4. Prostaglandin Theory. The relative progesterone deprivation and estrogen

predominance set off production of cortical steroids which act on lipid precursors to
release arachidonic acid, and in turn, increase the synthesis of prostaglandins.
Prostaglandins, like oxytocin are known to stimulate uterine contractions.

5. Theory of Aging Placenta. The decrease of nutrients and blood supply in the aging
placenta causes uterine contractions.

6. Activity 2. Practice Test.

A 10-item multiple choice quiz will be given through the poll

results of myCLASS Bigbluebutton or through google meet.

COMPONENTS OF LABOR

A successful labor depends on three integrated concepts:

1. Passageway. This refers to the route the fetus must travel from the uterus through
the cervix and vagina to the external perineum; because these organs are
contained inside the pelvis, the fetus must also pass between the pelvic ring.

2. Passenger. If the fetus is of appropriate size and in an advantageous position and

presentation.
3. Power. This is supplied by the fundus of the uterus and implemented by uterine
contractions, a process that causes cervical dilatation and the expulsion of the
fetus from the uterus.

4. Psyche. The woman’s psyche is preserved so afterward labor can be viewed as a

positive experience.

8. Activity 3. Question and answer on the discussion board.

Mechanisms of Labor

Passage of a fetus through the birth canal involves a number of different position
changes to keep the smallest diameter of the fetal head always presenting to the
smallest diameter of the birth canal. These position changes are termed as the Cardinal
movements.

The learner will watch a video on the cardinal movements of labor

https://www.youtube.com/watch?v=odHEQNGph2Y – Cardinal
movements
https://www.youtube.com/watch?v=ybWQCkElMiI – Cardinal
movements of labor

1. Descent/flexion
2. Internal rotation
3. Extension begins
4. External rotation
5. Extension complete
6. Expulsion
Activity 4. Practice Test

A 10-item multiple choice quiz will be given through the poll results
of the myCLASS Bigbluebutton or through google meet.

PREMONITORY SIGNS OF LABOR

1. Lightening. This is the descent/settling of the presenting part into the pelvic inlet
which happens 10-14 days before labor in primigravida and 1 day before labor in
a multipara. And when the largest diameter of the presenting part passes the
pelvic inlet, the head is said to be "engaged." However, lightening is heralded by
the following signs:

a. Relief of dyspnea
b. Relief of abdominal tightness
c. Increased frequency of voiding
d. Increased amount of vaginal discharge
e. Increased lordosis as the fetus enters the pelvis and falls further forward
f. Increased varicosities
g. Shooting pains down the legs because of pressure on the sciatic nerve

2. Increased Braxton Hicks's contractions in the last week or days before labor.

These are false labor contractions, painless, irregular, abdominal and

relieved by walking, and are also known as practice contractions.

3. A sudden burst of maternal energy/activity because of hormone epinephrine. This

is meant to prepare the body for the “labor” ahead.

4. Slight decrease is maternal weight. Loss of weight is about 2-3 lbs. One to two
days before the onset of labor because of the decrease in progesterone level and
probably loss of appetite.

5. Softening /”ripening” of the cervix.

SIGNS OF TRUE LABOR

The more women know about true labor signs, the better, because they will be
able to recognize them. True labor is said to occur when the following signs are
observed:
1. Uterine Contractions. The surest sign that labor has begun is the initiation of
effective, productive, involuntary uterine contractions.

There are 3 phases of uterine contractions:

a. Increment / Crescendo – intensity of the contraction increases.

b. Apex / Acme – the height or peak of the contraction.
c. Decrement / Decrescendo – intensity of the contraction decreases.

Characteristics of Contractions:

1. Frequency of contraction – this is timed from the beginning of one

contraction to the beginning of the next.
2. Duration of contraction – this is time from moment the uterus first begins
to tighten until it relaxes again.
3. Intensity of contraction – it may be mild moderate or strong at its acme.

a. Mild contraction – the uterine muscle becomes somewhat tense, but

can be indented with gentle pressure.
b. Moderate contraction – the uterus becomes moderately firm and a
firmer pressure is needed to indent.
c. Strong contraction – the uterus becomes so firm that it has the feel of
wood like hardness, and at the height of the contraction, the uterus
cannot be indented when pressure is applied by the examiner’s finger.

2. Uterine Changes. As labor contractions progress, the uterus is gradually

differentiated into two distinct portions. These are distinguished by a ridge formed in
the inner uterine surface, the physiologic retraction ring.

Upper uterine segment – this portion becomes thicker and active, preparing it to
exert the strength necessary to expel the fetus during the expulsion phase.
Lower uterine segment – this portion becomes thin walled, supple, and passive so
that the fetus can pushed cut of the uterus easily.
Contour of the uterus changes from a round ovoid to a structure markedly elongated
in a vertical diameter than horizontally. This serves to straighten the body of the
fetus and place it in better alignment to the cervix and pelvis.

1. Cervical changes. There are 2 changes that occur in the cervix.

Effacement. This is the shortening and thinning of the cervical canal to paper-thin
edges to primiparas, effacement is accomplished before dilatation begins while
with multiparas, dilatation may proceed before effacement is complete.
Dilatation. This refers to the enlargement of the cervical canal from an opening a
few millimeters wide to one large enough (approximately 10 cm.) to permit
passage of the fetus.
 Dilatation occurs for two reasons. First, uterine contractions gradually increase
the diameter of the cervical canal lumen by pulling the cervix up over the
presenting part of the fetus. Second, the fluid-filled membranes press against
the cervix.

4. Show. This is the blood-tinged mucus discharged from the vagina because of
pressure of the descending fetal part on the cervical capillaries, causing their
rupture. Capillary blood mixes mucus when operculum is released.

Rupture of the membranes of bag of waters. This is a sudden gush or a scanty slow
seeping of amniotic fluid from the vagina. The color of the amniotic fluid should
always be noted. At term, this is clear, almost colorless and contains white specks
of vernix caseosa. Green staining means it has been contaminated with meconium,
a sign of fetal distress. Yellow staining may mean blood incompatibility while pink
staining may indicate bleeding.

Once membranes have rupture, labor is inevitable, meaning to say that uterine
contractions will occur within next 24 hours. The initial nursing action is for
patients with ruptured membranes are:

1. Notify physician.
2. Lie patient to bed to ensure that the fetus is not impinging on the cord.
3. Check the fetal heart rate to determine for fetal distress.
4. If the patient claims she can feel a loop of the cord coming out of her
vagina (umbilical cord prolapse), lower the head of the bed
(Trendelenburg position) in order to release pressure on the cord. Also
apply sterile saline-saturated gauze to prevent drying of the cord, if
needed.

If labor does not occur spontaneously at the end of 24 hours after

membrane rupture, it will be induced, provided the woman is estimated to
be at term.

Activity 5. Critical Thinking

The student will answer the question “What will you do if a

woman in labor tells “I’m feeling as if I’m losing a grasp on
things?” Do you consider this as a normal reaction during
labor or not and why? The answers will be posted in the
discussion board.
ASSESSMENT: PRETEST
Test I. Multiple Choice. Choose the best answer
1. Labor pains is perceived more quickly if anxiety is present.
A. True
B. False

2. This component of labor refers to the fetal position:

A. Psyche
B. Passageway
C. Passenger
D. Power

3. The suture which joins the occipital bone and two parietal bones:
A. Frontal
B. Sagittal
C. Coronal
D. Lambdoid

4. This refers to the intersections of the cranial sutures:

A. Mentum
B. Fontanelle
C. Molding
D. Attitude

5. When the fetus presents the smallest anteroposterior diameter because it puts
the whole body into an ovoid shape, occupying the smallest space as possible,
the fetal attitude is:
A. Poor
B. Moderate
C. Good
D. Excellent

6. When the fetal presenting part is at the level of the ischial spine, the station is:
A. 0
B. -1
C. +2
D. +3

7. Which of the following is the most common type of fetal presentation?

A. Military
B. Brow
C. Face
D. Vertex
 8. All of the following are methods that can determine fetal position, presentation,
and lie, EXCEPT:
A. Abdominal x-ray
B. Auscultation of fetal heart tones
C. Leopold’s maneuver
D. Sonography

9. One of the premonitory signs of labor onset is slight decrease in maternal weight
1 or 2 days before the onset of labor.
A. True
B. False

10. In the mechanisms of labor, which of the following will follow after fetal descent?
A. Internal rotation
B. Flexion
C. Extension
D. External rotation

FEEDBACK ON THE POSTTEST

1. A 6. A
2. C 7. D
3. D 8. A
4. B 9. A
5. C 10. B
Note: If your score is 7 or higher, your understanding of the Care of the Mother and the
Fetus during the Perinatal Period (Intrapartal Care – Part 1) is satisfactory; you may
proceed in reading this module to further enhance your knowledge.

If your score is lower than 7, you may proceed in studying this module and
approach the instructor for assistance in understanding the contents of the
module.

Prepared by:

Jennie C. Junio, RN, MAN

NCM 0107 Instructor

Peer Evaluator/s:

Dr. Angela Angeles – Gonzales

NCM 0107 Instructor
Reviewed by:

Debbie Q. Ramirez, RN, Ph.D.

Assistant Dean

Approved by:

Zenaida S. Fernandez, RN, Ph.D.

Dean