UNIVERSITY OF THE EAST

RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER

# 64 Barangay Doña Imelda Aurora Boulevard Quezon City 1113
Telephone No. 713-33-09 ; 715-08-61 local 289

COLLEGE OF NURSING

Name: Embile, Aleeyah Jasmine U. Date: 2020

Year/Section/Group Number: Year 2 / C Grade: _________

Activity No. 1 Care of Mother during Intrapartum Period

Learning Outcome: The student will be able to demonstrate accountability and responsibility or safe
nursing practice during maternal child nursing care.

Instructions:

Answer what is being ask in the scenarios provided. 5 pts each number.

1. During childbirth education classes, couples often seek advice about how to care for their
new baby and support their children through the sibling adjustment process. Describe the response
you would give to the concerns expressed by the following couples.

A. Anna and Rich express concern that their new baby will “cry all the time” just like their first
baby. “When she cried, we did everything – we fed her, changed her diaper, rocked her – but nothing
seemed to work. Our friends told us to be careful or we would spoil her if we went to her every time she
cried.” Discuss why babies cry and the influence of parental emotions on baby. What should a nurse
teach the mother on how to interact with a newborn and what techniques should be employed.

Mommy Anna, Daddy Rich, all infants cry more during the first three months of life than during any
other time. There is no standard definition for "excessive" crying, although it is normal for infants to
cry for up to two hours per day. Infants without colic cry, although generally less frequently and for a
shorter time than infants with colic-is more than excessive "normal" crying, at least in some infants.
Also, according to Sarah A. Keim, PhD, a pediatric expert at Nationwide Children’s Hospital in
Columbus, Stressed parents are less responsive to their infants' cues, and that less-sensitive caregiving
is stressful to babies. If you are worried about spoiling your baby, I’ll tell you right now, you can't
spoil your baby with too much attention. I’ll be teaching you some techniques on how to soothe your
baby:

 First, make sure your baby doesn't have a Fever. In a baby, a fever is a  temperature of
100.4°F (38°C). Call the doctor right away if your baby does have a fever.
 Make sure your baby isn't hungry and has a clean diaper.
 Rock or walk with the baby.
 Sing or talk to your baby.
  Offer the baby a pacifier.
 Take the baby for a ride in a stroller.
 Hold your baby close against your body and take calm, slow breaths.
 Give the baby a warm bath.
 Pat or rub the baby's back.
 Place your baby across your lap on his or her belly and rub your baby's back.
 Put your baby in a swing or vibrating seat. The motion may be soothing.
 Put your baby in an infant car seat in the back of the car and go for a ride. Often, the vibration
and movement of the car are calming.
 Play music — some babies respond to sound as well as movement.

Some babies need less stimulation. Babies 2 months and younger may do well swaddled, lying on
their back in the crib with the lights very dim or dark. Make sure the swaddle isn't too tight. Stop
swaddling when the baby is starting to be able to roll over.

B. Anita and Joe are pregnant for the second time. They are excited about the pregnancy but are
unsure of how to prepare their 4-year-old daughter for the new baby and the changes it will necessitate
in her life. Anita says, “We didn’t have to worry about this when we had our first baby” Discuss sibling
preparation and how it will affect the family.

Mommy Anita, Daddy Joe, your daughter is now in Preschool age. This means that at this age, your
child is still very attached to you and does not yet understand how to share you with others. Your
child also may be very sensitive to change and may feel threatened by the idea of a new family
member. Here are some suggestions that may help ease your preschooler into being a big sister.

 Wait a while before telling your preschooler about the baby. Explain it to your child when
you start purchasing nursery furniture or baby clothes or when she begins to inquire about the
growing "stomach" of Mommy Anita. Picture books for preschoolers can be of great help.
There are some hospitals that has sibling classes in which they will educate your soon to be
big sister about the new member of the family. Try telling your child before he hears to
someone else about the new baby.
 Involve your preschooler in planning for the baby. This would decrease her jealousy. Let her
go shop for baby products with you. Show photographs of herself when she was still a baby.
If you are going to use some of her old baby things, let her play with them a bit before you
get them ready for the new baby. Buy your child a doll so he can take care of "her" baby.
 Be honest. Explain that the baby is going to be cute and cuddly but will also fuss and cry and
take your time and attention. Also, make sure your older child understands it might be a while
before she's able to play with the new one. Reassure your daughter that after the baby is born
you will love her still just as much as you do now.
 Time major changes in your child's routine. If you can, finish toilet training or switching from
a crib to a bed before the baby arrives. If not possible, put them off until after the baby is
settled in at home. Otherwise, your child may feel overwhelmed by trying to learn new things
on top of all the changes caused by the new baby.
 Expect your child to regress a little. This is normal and is your older child's way of making
sure she still has your love and attention. Instead of telling her to act her age, let her have the
attention she needs. Praise her when she acts more grown-up.
 Prepare your child. She may be confused when you leave for the hospital. Explain that you
will be back with the new baby in a few days.
 Set aside special time for your older child. Read, play games, listen to music, or simply talk
together. Show her that you love her and want to do things with her still even after having a
 new baby. Also, make her feel a part of things by having her cuddle next to you when you
feed the baby.
 Have your older child spend time with daddy Joe. A new baby presents a great opportunity
for fathers to spend time alone with older children.
 Ask family and friends to spend a little time with your older child when they come to see the
new baby. This will help her feel special and not left out of all the excitement. They might
also give her a small gift when they bring gifts for the baby.

2. Tony and Andrea are considering the possibility of giving birth to their second baby at
home. They have been receiving prenatal care from a certified nurse-midwife who has experience
with home birth. Their 5-year-old son and both sets of grandparents want to be present for the
birth.

A. Discuss the decision-making process that Tony and Andrea should follow to ensure that they
make an informed decision that is right for them and their family.

The decision-making process involves discovering internal motivators for deciding to have a
home birth, a period of gathering information and taking control of the decision to give birth at
home. They should read resources and studies and be able to List down Pros and cons of giving
birth at home and at the hospital. They should also ask for advices to their Ob-gynecologist on the
possible consequences and positive outcomes if they are going to push for home birthing.

B. Tony and Andrea decided that home birth is an ideal choice for them. Outline the preparation
measures you would recommend to Tony and Andrea to ensure a safe and positive experience for
everyone.

There is a lot of controversy over who should be eligible to give birth at home. Many countries
have standardized “lists” of what makes a woman a good candidate for a home birth. Mommy
Andrea might be a candidate for a home birth if she meets these guidelines:

 Her pregnancy has been low-risk. That means she had no evidence of hypertension, diabetes
or other chronic medical conditions. She also hasn’t developed any pregnancy complications,
like gestational diabetes or preeclampsia, and not at risk of preterm birth.
 She should have no history of a previous C-section, because there’s a low risk of uterine
rupture with VBAC (vaginal delivery after C-section) — making it safer to deliver in a
hospital or birthing center in case of complications. If she had complications in her previous
pregnancy, she might be more likely to have complications this time around, making a
hospital or birthing center her safest option.
 Home birth will be attended by a physician or certified nurse-midwife. If they opt for a
midwife, a consulting physician should be on call, preferably one who has seen her during her
pregnancy and has previously worked with the midwife.
 Have a transportation available and live close to a hospital. This way if an unexpected
emergency arises and she needs an advanced medical assistance to protect her life or her
baby’s.
 She’s only carrying one baby.
 Her delivery is perfectly timed. That means she goes into labor between 37 and 41 weeks.
Any earlier or later, they should head to the hospital, as preterm babies born before 37 weeks
often need at least a few days’ stay in a hospital’s neonatal intensive care unit (NICU), and
late arrivals — usually larger, with a wider head circumference — more often need to be
delivered by cesarean section to make a safe arrival.
  The baby is properly positioned for a vaginal delivery. That is, head down. Breech require
extra assistance during birth and possibly require C-section to protect the baby and the
mother's life.

3. Nancy, a pregnant woman (3-2-0-0-2) at 26 weeks of gestation, asks the nurse about midwives.
She says, “My friend had a nurse-midwife, and she said that she was amazing. My first two birth
experiences were difficult – my husband and I really needed someone to help us. do you think a
nurse- midwife could be that person?”

A. Explain the role of the nurse-midwife so that Nancy will have the information she will need to
make an informed decision.

Various roles and responsibilities of a nurse-midwife:

1. Care giver: provides high quality antenatal and postnatal care to maximize the women’s health
during and after pregnancy, detect problems early and manage or refer for any complications.

2. Coordinator: coordinates care for all women. Coordinator ensures holistic, voluntary and social
services for pregnant women when appropriate so that every women’s birth experience regardless
of risk factor.

3. Leader: The role of leader is to plan, provide and review a women’s care, with her input and
agreement, from the initial antenatal assessment through to the postnatal period. Their leading
role reduces admission to hospital and results in significantly less intervention during birth.

4. Communicator: Understand that effectiveness of communication. It helps to develop trust

relationship with pregnant women and family members. The nurse-midwife has to communicate
effectively with pregnant women and family members as well as others so that they can share
their all problems.

5. Manager: Manager is a great role for a nurse-midwife. They manage all the circumstances
where appropriate and can recognize and refer women to obstetricians and other specialists in a
timely when necessary.

6. Educator: Nurse-midwives provide high quality, culturally sensitive health education in order
to promote healthy, helpful family life and positive parenting.

7. Counselor: Nurse-Midwives provide information and counsel pregnant women on prenatal

self-care including nutrition, hygiene, breastfeeding and danger sings in pregnancy and childbirth.

8. Family planner: They also counsel people as a family planner. They provide all information
about all kind of family planning methods and help couple to take decision.

9. Adviser: Nurse-Midwives give advices on development of birth plan and promote the concept
of birth preparedness. They also give advice during complicated situation so that it will help them
to take decision.

10. Record keeper: Record keeping is an integral part of nurse-midwifery practice. It helps
making continuity of care easier and enabling identify problem in early stage.
 11. Supervisor: Supervising and assisting mothers during antenatal period, monitoring the
condition of the condition of the fetus and using their knowledge to identify early signs of
complication

B. Nancy decides to try a nurse-midwife for her upcoming labor. Identify what you would tell Nancy
about finding a nurse-midwife.

Here are some qualifications that a nurse-midwife should possess:

 A registered nurse (RN) or advanced practice registered nurse (APRN) license: There is no
APRN in the Philippines yet. Unlike Registered midwives (RMs), Registered nurse-midwives
come from a background in nursing.
 A graduate-level education in nurse-midwifery: RNMs must possess a graduate-level degree
in nurse-midwifery. The most widely recognized graduate degree for nurse-midwives is the
Master of Science in Nursing (MSN),
 National certification as a registered nurse-midwife: Nurse-midwives must pass a national
certification examination and earn national certification as a registered nurse-midwife

C. Specify questions that Nancy should ask when she is making a choice about the nurse-midwife
she will hire for her labor.

Questions for a midwife

Introduction questions:

o How many births do you attend per month?

o How many clients required C-sections, episiotomies, suturing?
o What types of interventions do you use?
o What complications and emergencies have you seen and how were they handled? (i.e.
post maturity, prolonged labor, fetal distress, breech, bleeding)
o What complications/emergencies have you or can you handle?
o What percentage of clients have cesareans in your practice?
o What is your mortality rate?
o Do you have any apprentices? Who else may be at the birth?
o Who is your midwife backup if you are unavailable?
o What is her experience?
o Do you have a consult physician?

Prenatal questions:

o What is your schedule for prenatal care visits?

o What is included in prenatal care?  (Should include lab work, urine checks, blood
pressure, fetal heart tones)
o What nutrition counseling do you provide?
o What are your feelings about birth preparation classes?
o Do you visit the home at any time before the birth?
o What do you consider high risk?

Labor and Birth questions:

 o When do you want to be called once labor has begun?
o What emergency equipment do you provide?
o How do you view the father’s role?
o What is your role during labor? birth?
o What measures do you suggest for pain relief?
o How often do you monitor the baby in labor?
o What is fetal distress in your opinion?
o What do you consider prolonged labor/birth pushing?
o Do you have preferences for labor/ birth positions?
o How do you feel about water birth?  Have you attended any?
o What measures do you take to prevent tearing?

After delivery questions:

o Do you check for tears? (vaginal, urethral, rectal)

o Do you have local anesthetic & suturing equipment for this repair to be done without
going to the hospital?
o How do you prevent/treat excessive postpartum bleeding?
o How do you handle the baby immediately after birth?
o How long do you stay after the birth?  What do you check at this time?
o What is your schedule for follow-up care?
o Do you do the newborn screening tests?
o What is your philosophy regarding circumcision?
o How is the filing of the birth certificate handled?
o Do you routinely give me a copy of all my records after the birth?

Financial questions:

o How much do you charge for your services?

o What services are not included in this fee?
o When do you want the full fee paid?
o Do you do insurance billing?

Submission Details:

Output Requirement: Student will show his/her therapeutic response to each situation that is provided
above. Submit output through Canvas.
File Format: Font: Times New Roman, Word or PDF, Size is 8.5x 11 (letter)

Document Template: Written in a word format in a portrait orientation.