NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL

FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
Stages of Labor
● Contractions grow stronger, lasting 40
to 60 seconds and occurs
The First Stage (Stage of Cervical Dilatation) approximately every 3 to 5 minutes.
➔ which begins with the initiation of true ● This phase averages 3 hours in
labor contractions and ends when the nullipara and 2 hours in multipara.
cervix is fully dilated. ● Show ( increased vaginal secretions)
and perhaps spontaneous rupture of
The Second Stage (Delivery of the Baby) the membranes may occur.
➔ extending from the time of full dilatation ● Encourage women to be active
until the infant is born. participants in labor by keeping active
and assuming whatever position is most
The Third Stage (Placental Stage) comfortable for them except flat on their
➔ lasting from the time the infant is born back.
until after the delivery of the placenta. ● This phase can be difficult for a woman
because contractions grow so much
Fourth Stage stronger and last so much longer than
they did in the latent phase.
➔ first 1 to 4 hours after birth of the
placenta is sometimes termed the
"fourth stage" to emphasize the Transition Phase
importance of close maternal ● Contractions reach their peak on
observation needed at this time. intensity occurring every 2 to 3 minutes
with a duration of 60 to 70 seconds.
● A maximum cervical dilatation of 8 to 10
THE FIRST STAGE (TAKES ABOUT 12 cm.
HOURS TO COMPLETE) ● If it has not previously occurred, show
The Latent Phase will occur as the last of the mucus plug
● Begins at the onset of regularly from the cervix is released.
perceived uterine contractions and ends ● Duration = from the beginning of one
when rapid cervical dilatation begins. contraction to the end of the same
● Contractions are mild and short, lasting ● contraction.
20 to 40 seconds. ● Interval = from the end of one
● Cervical Effacement occurs. contraction to the beginning of the other
● Cervix dilates from 0 to about 3 cm. contraction.
● The phase averages 6 hours in ● Frequency = from the beginning of one
nullipara and 4.5 hours in multipara. contraction to the beginning of the other
● Cause only minimal discomfort and can contraction.
be managed by controlled breathing.
● Encourage to continue to walk about
and make preparations for birth.

Active Phase
● Cervical dilatation occurs more rapidly
increasing from 4 to 7 cm at a rate of
about I cm per hour in nulliparas and 2
cm per hour in multiparas.

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
no longer exerted on her stomach as
the fetus descends into the pelvis.
● She pushes with such force that she
perspires and the blood vessels in her
● neck become distended.
● The fetus begins descent and as fetal
head touches the internal perineum to
begin internal rotation, her perineum
begins to bulge and appear tense.
● The anus may become everted, and
stool may be expelled.
● As the fetal head pushes against the
vaginal introitus, this opens and the
● If the membranes have not previously
fetal scalp appears at the opening to
ruptured they will usually rupture at full
the vagina and enlarges from the size
dilatation (10 cm).
of a dime, to a quarter, then a half
● Both full dilatation (10 cm) and
dollar. This is termed Crowning.
complete cervical effacement
● As she concentrates on pushing, she
(obliteration of the cervix) have
may become unaware of the
occurred.
conversation in the room.
● A woman may experience intense
● Pain may disappear as all of her energy
discomfort that is strong, it may
and thoughts are directed toward giving
accompanied by nausea and vomiting.
birth.
● She may also experience a feeling of
● As the fetal head is pushed out of the
loss of control, anxiety, panic and/or
birth canal, it extends then rotates to
irritability.
bring the shoulders into the best line
● A few minutes before, she may have
with the pelvis.
enjoyed having her forehead wiped with
● The body of the baby is then born.
a cool cloth or her back rubbed.
● Her focus turns entirely inward to the
task of birthing her baby. THE THIRD STAGE
● A new sensation, the irresistible urge to ● The Placental Stage begins with the
push usually begins. birth of the infant and ends with the
delivery of the placenta.
THE SECOND STAGE ● Two phases are involved: Placental
● separation and Placental Expulsion
● Is the time span from full dilatation and
● After the birth of the infant, the uterus
cervical effacement to birth of the infant.
● can be palpated as a firm round mass
● This stage takes about 1 hour.
just below the level of the umbilicus.
● A woman typically feels contractions
● After a few minutes of rest, uterine
change from the characteristic
contractions begin again, and the organ
crescendo-decrescendo pattern to an
assumes a discoid shape.
uncontrollable urge to push or bear
● It retains this new shape until the
down with each contractions as if to
placenta has separated, approximately
move her bowels.
5 minutes after the birth of the infant.
● She may experience momentary
nausea or vomiting because pressure is

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
The Placenta has Loosened and is Ready to uterine fundus by the primary health
Deliver when: care provider (Crede maneuver).
1. There is lengthening of the umbilical ● Pressure should never be applied to a
cord. uterus in a noncontracted state,
2. A sudden gush of vaginal blood occurs. because doing so could cause the
3. The placenta is visible at the vaginal uterus to evert (turn inside out)
opening. accompanied by massive hemorrhage.
4. The uterus contracts and feels firm ● It needs to be inspected after delivery to
again. be certain it is intact and part of it was
not retained (which could prevent the
uterus from fully contracting and lead to
SCHULTZE PRESENTATION postpartal hemorrhage).
● If the placenta separates first at its
center and lastly at its edges, it tends to
The Care of a Woman during the
fold on itself like an umbrella and

First Stage of Labor

presents at the vaginal opening with the
fetal surface evident.
● Approximately 80% of placentas
PROMOTE VOIDING AND PROVIDE
separate and present in this way.
BLADDER CARE
● Appearing shiny and glistening from the
fetal membranes. ● A full bladder or bowel can impede fetal
● descent, so encourage a woman to void
as possible, at least every 2 to 4 hours
DUNCAN PRESENTATION ● during labor.
● The placenta separates first at its ● You can assess for a full bladder by
edges, it slides along the uterine percussion (an empty bladder sounds
surface and presents at the vagina with dull; a full one sound resonant).
the maternal surface evident. ● If a woman cannot void and the bladder
● It looks raw. red, irregular, with the becomes distended, she may need to
ridges or cotyledons that separate be catheterized.
blood collection spaces evident.
● This stage takes a total of about 15
Essential Intrapartum and
minutes.

Newborn Care Practice

● Because bleeding occurs as the
placenta separates, before the uterus
contracts sufficiently to seal maternal ● The EINC practices are evidenced-
capillaries, there is a blood loss of based standards for safe and quality
about 300 to 500ml, not a greater care of birthing mothers and their
amount in relation to the extra blood newborns.
volume that was formed during ● In December 2009, the Secretary of the
pregnancy. DOH Francisco Duque signed the AO
2009-0025, which mandates
implementation of the EINC Protocol in
PLACENTAL EXPULSION
both public and private hospitals.
● Once separation has ocurred, the ● Millennium Development Goal (MDG)
placenta delivers eicher by the natural our Commitment by 2015.
bearing down effort of the mother or by ● MDG 4 = Reduce child mortality
gentle pressure on the contracted ● MDG 5 = Improve Maternal Health
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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
Antenatal Care: 3. Properly timed Cord Clamping and
1. Have at least 4 antenal visits with a skilled Cutting.
health provider.
➔ To detect diseases which may
complicate pregnancy.
➔ To educate women on danger and
emergency signs and symptoms.
➔ To prepare the woman and her family
for childbirth.
4. Unang Yakap (First Embrace) of the
mother and her newborn for early
Recommended Practices during Labor
breastfeeding initiation.
● Admit when the parturient is already in
● Active Labor
● Continuous maternal support, by a
companion of her choice, during labor
and delivery
● Mobility during labor
● Position of choice during labor and
delivery
● Episiotomy will not be done, unless
necessary Unnecessary Interventions Eliminated:
● Active Management of the Third Stage
● Enemas and perineal shavings
of labor(AMSL)
● Fluid and food intake restrictions
● Monitoring the progress of labor with
● Routine insertion of Intravenous fluids
use of Partograph
● Fundal pressure to facilitate second
stage of labor
Recommended EINC Practices for
NEWBORN Care: Unnecessary Interventions in Newborn Care
1. Immediate and thorough drying of ● Routine Suctioning
the newborn. ● Early bathing
● Routine separation from the mother
● Foot printing
● Application of various substances to the
cord
● Giving prelacteals or artificial infant milk
formula or other breastmilk substitutes

Prior to Woman's Transfer to the Delivery Room

● Ensure that mother is in her position of
2. Early Skin to skin contact between
choice while in labor
mother and the newborn.
● Asks mother if she wishes to eat/drink
or void
● Communicate with the mother-informed
her of the progress of labor, give
reassurance and encouragement

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
Woman Already in the Delivery 1-3 Minutes
Room(Preparing for Delivery) ● Remove the wet cloth.
● Check temperature in the DR area to be ● Place baby in skin-to-skin contact on
25-28 Celsius; eliminate airdraft the mother's abdomen or chest.
● Asks woman if she is comfortable in the ● Cover baby with dry cloth and the
semi-upright position baby's head with a bonnet.
● Ensure the woman's privacy ● Exclude a 2nd baby by pałlpating the
● Removed all jewelries then wash hands abdomen in preparation for giving
thoroughly observing the WHO Oxytocin.
1-2-3-4-5 procedure ● Used wet cloth to wipe the soiled
● Prepare a clear, clean newborn gloves.
resuscitation area. Checked the ● Give IM oxytocin within one minute of
equipment if clean, functional and within baby's birth. Dispose wet cloth properly.
easy reach ● Remove first set of gloves and
● Arrange materials/supplies in a linear decontaminate them properly ( in 0.5%
sequence:Gloves, dry linen, bonnet, Chlorine solution for at least 10
Oxytocin injection, plastic clamp, minutes.
instrument clamp, scissors, 2 kidney ● Palpate the umbilical cord to check for
basins pulsations.
● After pulsations stopped, clamp cord
using the plastic clamp or cord tie 2 cm
from the base.
● Place the instrument clamp 5 cm from
the base.
● Cut near plastic cord clamp (not
● Clean the perineum with antiseptic midway).
solution ● Perform the remaining steps of the
● Wash hands and put on 2 pairs of delivery of placenta.
sterile gloves aseptically ( if same ● Wait for strong uterine contractions then
worker handles perineum and cord) apply controlled cord traction and
counter traction on the uterus,
continuing until the placenta is
ATT THE TIME OF DELIVERY delivered.
● Encourage women to push as desired
● Drape the clean, dry linen over the
● mother's abdomen or arms in
preparation for drying the baby
● Apply perineal support and do not
control the delivery of the head
● Call out time of birth and sex of baby
● Inform the mother of outcome

First 30 Seconds
● Thoroughly dry the baby for at least 30
seconds, starting from the face and
head, going down to the trunk and
extremities while performing a quick
check for breathing.
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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
● Massage the uterus until firm. ● Advise OPTIONAL/DELAYED bathing
● Inspect the lower vagina and perineum of baby.
for lacerations/tears and repair ● Advise breastfeeding per demand.
lacerations/tears, as necessary. ● In the first hour: check baby's breathing
● Examine the placenta for completeness and color, and check mother's vital
and abnormalities. signs and massage uterus every 15
● Clean the mother; flush perineum and minutes.
apply perineal pad/napkin/cloth. ● In the second hour: check mother -
● Check the baby's color and breathing, baby dyad every 30 minutes to one
check if the mother is comfortable, hour.
check if uterus contracts. ● Complete all records.
● Dispose the placenta in a leak-proof
container or plastic bag. Recommended Post Partum Care
● Decontaminate (soaked in o.5% ● Routinely inspect the birth canal for
chlorine solution) instruments before laceration
cleaning; Decontaminate 2nd pair of ● Inspect the placenta and membranes
gloves before disposal for 10 minutes. for completeness
● Advise mother to maintain skin-to-skin ● Early resumption of breastfeeding the
contact. Baby should be positioned in uterus
prone on mother's chest/in between the
breasts with head turned to one side. Partograph
● Graphical tool that represents progress
15-90 Minutes After The Delivery of the of labor
Baby
● Advise the mother to observe for
feeding cues.
● Support mother, instruct her on
positioning and attachment.
● Wait for FULL BREASTFEED to be
completed.
FEEDING CUES

Early Cues Mid Cues Late Cues

Stirring, Hand in Agitated

turning head, mouth Body
resting Movements
Stretching or Components of the Partograph:
Smacking or Squirming Turning Red
➔ Part 1 = Progress of Labor
licking lips
Increasing Crying ➔ Part 2 = Assessment of Maternal
Opening and Movement Condition
closing ➔ Part 3 = Assessment of Fetal Condition
mouth ➔ Part 4 = Outcome of Labor
● After a complete breastfeed, administer
eye ointment (first), thorough physical
examination, inject Vit. K, Hepatitis B
and BCG injection.

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
Post Partum Period
Note:
➔ Fundus of the uterus is palpable
● Is the period beginning immediately through the abdominal wall halfway
after the birth of a child and extending between the umbilicus and the
for about six weeks. symphysis pubis (Approx. 2cm below
● It is the time after birth, a time in which the umbilicus) within a few minutes after
the mother’s body, including hormone birth.
levels and uterus size, returns to a ➔ One hour later it will rise at the level
non-pregnant state. of the umbilicus and will stay in that
level for 24 hours: fundus descends
approximately 1 cm per day: by the
POSTPARTUM MATERNAL PHYSICAL
10th day the fundus should no longer
EXAMINATION
be palpated.
Summary: BUBBLE HE ➔ Mapalpate between umbilicus and
B - Bowel function symphysis pubis, 2nd day 2cm
U - Uterine fundus below the umbilicus.
B - Bladder function
B - Breast Descent of Uterine Fundus
L - Lochia ● Usual progression of uterine descent
E - Episiotomy into pelvis at about 1cm/day.
H - Homan’s sign ● Immediately after delivery, fundus
E - Emotion typically at umbilicus or just below it.
● By 10 days postpartum, uterus should
Breast not be abdominally palpable.
● Inspect for redness and engorgement. ● If the fundus is deviated to the left or to
● Palpate breasts to determine if they are the right or elevated above level of
soft or filling warm, engorged or tender. umbilicus always rule out DISTENDED
● Check nipples for pressure sores, BLADDER, and cause the patient’s flow
cracks, or fissures. to be heavier. (The fundus should be in
● Evaluate whether nipples are everted, midline; if it is on the left or right side
flat or inverted. meaning distended bladder).
● Engorgement usually occurs 2-3 days ● Bladder distention may displace the
postpartum, warm shower before uterus, leading to a boggy uterus and
nursing may help alleviate the problem. increase risk for atony.
● Always encourage mother to empty her
Uterine Fundus bladder.
● It should be firm, if not, massage prior
to palpation and assess for any blood Normal findings: normal size and shape,
discharges during massage. (if mobile regular, firm, in the midline, below the
pagpalpate may mass meaning ga umbilicus and non-tender.
contract pa).
● Assess its location and the degree of Abnormal findings: immobile, irregular, soft,
uterine contraction, any tenderness or tender, deviated away from the midline or above
pain should be noted. the umbilicus after 24 hours.
● Patients might feel occasional
contractions, sometimes called
afterpains, during the first few days
after delivery. These contractions-
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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
which often resemble menstrual cramps
FOUR MAIN CAUSES OF POSTPARTAL
- prevent excessive bleeding by
HEMORRHAGE
compressing the blood vessels in the
uterus. 1. Uterine Atony = or relaxation of the uterus
(fails to contracts, not firm uterus, vaginal
bleeding).
LOCHIA ● Is the most frequent cause of postpartal
● vaginal loss following birth. hemorrhage.
● The uterus must remain in a contracted
Lochia Rubra state after birth to allow the open
➔ dark red discharge. vessels at the placental site to seal
➔ 1-3 days (sign of shock -HR and RR increases
and BP decreases).
Lochia Serosa ● Vaginal bleeding is copious and the
➔ pink or brownish serosanginous client may exhibit symptoms of shock
discharge ● Subinvolution = incomplete return of the
➔ 4-7 days/may last up to 10 days uterus to its prepregnant size and
shape.
Lochia Alba ● Involution = complete return of the
➔ creamy or yellowish discharge (white) uterus to its prepregnant size and
➔ 7-10 days or up shape.
● At 4 to 6 weeks, uterus is still enlarged
and soft.
● Lochia discharge is still present.
Nursing Care of a Woman and Family ● May result from a small retained
placental fragment, a mild endometritis
Experiencing a Postpartal (inflammation in the endometrium), or a
myoma is interfering with complete
Complication contraction.

POSTPARTAL HEMORRHAGE Therapeutic Management:

● Any blood loss from the uterus greater ➔ Methergine (for contraction of the
than 500 ml in a 24-hour period uterus) tablet 0.2 mg QID to improve
(NSVD), if through CS greater than uterine tone and complete involution.
1000 ml. ➔ If uterus is tender to palpate, suggests
● Early hemorrhage - occur within the endometritis, and Oral Antibiotic may be
first 24 hours. prescribed.
● Late Hemorrhage - any time after the
first 24 hours during the remaining days Perineal Hematomas
of the 6-week puerperium. ● Is a collection of blood in the
subcutaneous layer of tissue of the
perineum (perineum- phase between
vagina and anus).
● The overlying skin as a rule, is intact
with no noticeable trauma.
● Such blood collections may be caused
by injury of the blood vessels in the
perineum during birth.
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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
● Most likely to occur after a rapid B. Vaginal Laceration = easier to assess
spontaneous birth and in women who than cervical laceration.
have perineal varicosities. ● Vagina may be packed to
● Reports severe pain in the perineal maintain pressure on the
area or a feeling of pressure between suture line.
legs (culture and sensitivity test- if there ● Document packing, removed
is infection). after 24 to 48 hours or before
discharge.
Therapeutic Management: C. Perineal Laceration = lacerations of
➔ Analgesic the perineum may occur when a woman
➔ Apply ice pack (covered with a towel to is placed in Lithotomy position for birth,
prevent thermal injury to the skin) may because this position increases
prevent further bleeding. pressure in the perineum.
➔ If hematoma is large in size, have the
site incised and the bleeding vessel Classification of Perineal Laceration:
ligated under local anesthesia. ➔ First degree = vaginal mucous
membrane and the skin of the perineum
2. Lacerations to the fourchette.
● Small lacerations or tears of the birth ➔ Second Degree = vagina, perineal
canal are common and may be skin, fascia levator ani muscle, and the
considered normal. perineal body.
● Large lacerations are complications. ➔ Third Degree = entire perineum, and
● They occur most commonly in: difficult reaches the external sphincter of the
or precipitate birth, primigravidas, birth rectum.
of a large infant (9lbs), use of ➔ Fourth Degree = entire perineum,
Lithotomy position and use of rectal sphincter, and some of the
instruments (semi-sitting position to mucous membrane of the rectum.
give birth).
● After birth, anytime a uterus feels firm Perineal lacerations are sutured and treated
but bleeding persists, suspect a as an episiotomy repair
laceration.
3. Retained Placental Fragments
Three Types of Lacerations: ● Placenta does not deliver completely;
A. Cervical Laceration = usually found on fragments of it separate and are left
the sides of the cervix, near the behind.
branches of the uterine artery ● Every placenta should be inspected
● Bright red vaginal bleeding, carefully to see that it is complete.
immediately after the delivery ● The uterus cannot contract with the
of the placenta. fragment in place.

Therapeutic Management: repair of the Therapeutic Management:

cervical laceration ➔ removal of the placental fragments to
stop bleeding, usually Dilatation and
Curettage is performed.

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
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Transcribe Notes by: Kerstine Anne P. Andrade
4. Disseminated Intravascular Coagulation ● A benign temperature elevation may
● Is a deficiency in clotting ability caused occur in 1st postpartal day particularly if
by a vascular injury. the women is not drinking enough fluid.

The Profile of a Newborn

Puerperal Infection
● of the reproductive tract

APGAR SCORING
Conditions that Increase a Risk for
Postpartal Infection: ● At 1 minute and 5 minutes after birth,
● Rupture of the membranes (more than newborns are observed and rated
24 hours, bacteria may invade the according to an Apgar Score.
uterus) Infection placental fragments ● It is an assessment scale used as a
retained within the uterus (tissue standard for newborn evaluation.
necrosis serves as an excellent bed for
bacterial growth). 1. Heart Rate
● Postpartal hemorrhage (the women’s ➢ Auscultating a newborn heart with a
general condition is weakened). stethoscope is the best way to
● Preexisting Anemia (the body’s defense determine heart rate.
against infection is lowered).
● Prolonged and difficult labor. 2. Respiratory Effort
● Internal fetal heart monitoring. ➢ Respirations are counted by observing
● Local vaginal infection chest movements.
● Uterus explored after birth for a retained ➢ A mature newborn cries and aerates
placenta. the lungs spontaneously at about 30
● A puerperal infection is serious, seconds after birth.
although it usually starts with local
infection, but can involve the 3. Muscle Tone
peritoneum (peritonitis) or circulatory ➢ Term newborns hold their extremities
system(septicemia). tightly flexed, simulating their
intrauterine position.
Therapeutic Management: ➢ Muscle tone is tested by observing their
● Use of appropriate antibiotic after resistance to any effort to extend their
culture and sensitivity test. extremities.
● Client’s temperature should be lower
than 38 C excluding the first 24 hours. 4. Reflex Irritability
● All articles’ instruments introduced One of the two possible cues used to evaluate
should be sterile. reflex irritability are:
● Proper perineal care from front to back. ➢ Response to having the soles of the
● Handwashing to prevent cross feet slapped.
contamination. ➢ Response to a suction catheter in the
● IV Antibiotics such as Ampicillin, nostrils.
Gentamycin, and third generation
Cephalosporin Cefixime (Suprax), take 5. Color
full course to prevent infection from ➢ All infants appear cyanotic at the
recurring. moment of birth.
➢ They grow pink with or shortly after the
first breath.

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
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Transcribe Notes by: Kerstine Anne P. Andrade
➢ Acrocyanosis (cyanosis of the hands ● During the first few days after birth, a
and feet) is so common in the newborns newborn loses 5% to 10% of birth
that a score of 1 in this category is weight (6 to 10 oz).
normal. ● This weight loss occurs because a
newborn is no longer under the
influence of salt and fluid retaining
APGAR SCORING CHART
maternal hormones.
0 1 2 ● This causes diuresis to begin to remove
a part of the infant’s high fluid load: in
Heart Rate Absent Slow (below, 100 addition, the newborn voids and passes
100 beats/min stool.
beats/min)

Respiratory Absent Slow, Good, Length

Effort irregular, strong ● A newborn’s length at birth in relation to
weakery cry weight is a second important
determinant used to confirm that a
Muscle Faccid Some Well flexed newborn is healthy.
Tone flexion of ● The average birth length of a mature
extremities female newborn is 49 cm (19.2 in).
● For mature males, the average birth
Reflex No Grimace Cough or
Irritability Response sneeze length is 50 cm (19.6 in).

Head Circumference
Color Blue, Pale Body pink, Normal ● Head circumference is measured with a
Ext. Blue skin
color tape measure drawn across the center
of the forehead and then around the
most prominent portion of the posterior
head (the occiput).
Total Score
● In a mature newborn, the head
● Score of <4 indicates serious danger of
circumference is usually 34 to 35
respiratory and cardiovascular failure,
cm (13.5 to 14 in).
needs resuscitation.
● Score of 4-6 indicates a guarded
Chest Circumference
condition, newborn may need clearing
of the airway and supplementary ● Chest circumference is measured at the
oxygen. level of the nipples.
● Score of 7-10 indicates the infant is ● The chest circumference in a term
adjusting well to the extrauterine life. newborn is about 2 cm less than the
head circumference.
Vital Statistics
Temperature
● Weight
● As long as newborns are breathing well, ● The temperature of newborns is about
they are weighed nude and without a 99 F (37.2 C) at birth because they
blanket soon after birth have been confined in their mother’s
● Following this initial weight. An infant is warm and supportive uterus.
weighed nude once a day, at ● Temperature will fall almost immediately
approximately the same time every day, to 0 below normal because of heat loss,
during a hospital stay the temperature of birthing rooms (21 to

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
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Transcribe Notes by: Kerstine Anne P. Andrade
22 C) and the infant’s immature ● At the same time increased blood flow
temperature regulating mechanism. to the left side of the heart causes the
foramen ovale(the opening between the
Pulse right and left atria) to close because of
● The heart rate of a fetus in utero the pressure against the lip of the
averages 110 to 160 beats/min. structure(permanent closure does not
● Immediately after birth, as the newborn occur for weeks).
struggles to initiate respirations, the ● With the remaining fetal circulatory
heart rate may be as rapid as 180 structures (umbilical vein, two umbilical
beats/min. arteries, and ductus venosus) no longer
● Within 1 hour after birth, as the receiving blood from the placenta, the
newborn settles down to sleep, the blood within them clots and closes
heart rate stabilizes to an average of them, and the vessels atrophy over the
120 to 140 beats/min. next few weeks.

Respiration Blood Coagulation

● The respiratory rate of the newborn in ● Vitamin K synthesized through the
the first few minutes of life may be as action on intestinal flora in the clotting
high as 90 beats/min. sequence.
● As respiratory activity is established ● Because a newborn’s intestine is sterile
and maintained over the next hour, this at birth unless membranes have
rate will settle to an average of 30 to 60 ruptured more than 24 hours, it will take
breaths/min. about 24 hours for flora to accumulate
and for ongoing Vitamin K to be
Blood Pressure synthesized.
● The BP of a newborn is approximately ● This causes most newborns can be
80/46 mmHg at birth. predicted to have this diminished blood
● By the 10 th day, it rises to about coagulation ability.
100/50 mmHg and remains at that level ● Vitamin K (Aquamephyton) is usually
for the infant year. administered intramuscularly into the
lateral anterior thigh, the preferred site
Cardiovascular System for all injections in newborns,
● Changes in the cardiovascular system immediately after birth (Vastus
are necessary after birth because now Lateralis).
the lungs are responsible for ● Stools = the first stools of the newborn
oxygenating blood that was formerly are usually passed within 24 hours after
oxygenated by the placenta. birth.
● As soon as the umbilical cord is ● It consists of meconium, a sticky,
clamped, which stimulates the neonate tarlike, blackish-green, odorless
to take in oxygen through the lungs, material formed from the mucous,
fetal cardiovascular shunts begin to vernix, lanugo, hormones and
close. carbohydrates that accumulated in the
● With the first breath, blood pressure bowel during intrauterine life.
decreases in the pulmonary artery. As ● About the second day or third day of
this pressure decreases, the ductus life, newborn stool changes in color and
arteriosus, the fetal shunt between the consistency termed Transitional stool,
pulmonary artery begins to close. bowel contents appear both loose and
green.
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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
● Urinary System = the average Desquamation
newborn voids within 24 hours after ● within 24 hours after birth, the skin of
birth. most newborns begins to dry on the
palm and soles of the feet and results in
The Appearance of a Newborn
areas of
peeling similar to sunburn.
The Skin
● General inspection of a newborn’s skin Milia
includes color, any birthmarks and ● sebaceous glands in a newborn are
general appearance. immature, one pinpoint white papule (a
plugged or unopened sebaceous gland)
The Color is usually found on a cheek or across
● Acrocyanosis is a normal finding the bridge of the nose and disappear by
through the first 24 to 48 hours after 2 to 4 weeks of age as the sebaceous
birth. gland mature and the plugged ones
● Most term newborns have a ruddier drain.
complexion for their first month.
Erythema Toxicum
Hyperbilirubinemia - is caused by ● some degree of rash is present in most
accumulation of excess bilirubin in the blood. term newborns.
● In the average newborn, the skin and ● I begin with small papules increases in
sclera of the eyes begin to be severity to become erythematous by the
noticeably yellow on the 2nd or 3 rd day 2 nd day and then disappears by the
of life as a result of breakdown of RBC third day.
(Physiologic Jaundice).
Skin Turgor
Birthmarks ● grasp a fold of the skin between your
● Hemangiomas are vascular tumors of thumb and fingers and evaluate if it
the skin. feels elastic. When released the skin
● Mongolian spots are collection of should fall back to form a smooth
pigment cells (melanocytes) that appear surface.
as slate-gray patches across the
sacrum or buttocks and possibly on the Fontanelles
legs and arms of the newborn. ● Significant membrane-covered spaces
called the fontanelles are found at the
Vernix Caseosa junction of the main suture lines.
● is the white, cream cheese-like ● The anterior fontanelle (Bregma) lies
substance that serves as a skin at the frontal junction of the coronal and
lubricant in utero. sagittal sutures.
● The anterior fontanelle has four
Lanugo sides, or a diamond shaped. Its
● is the fine, downy hair that covers a anteroposterior diameter measures
term newborn’s shoulders, back, upper approximately 3 to 4 cm, its transverse
arms, and possibly on the forehead and diameter is 2 to 3 cm.
ears. ● It closes and can no longer be felt when
the infant reaches 12 to 18 months of
age.

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
● The Posterior Fontanelle lies at the
Present at birth Not usually present
rear of the skull at the junction of at birth
lambdoidal and sagittal sutures.
● It is triangular-shaped. It is smaller Poorly defined Usually due to
than the anterior fontanelle, measuring borders traumatic birth
only 2 cm across its widest part
● Because of its small size, it closes May include Increases in size
when an infant is about 2 months age. ecchymosis over 1st day of life

Disappears within Takes months to

Structure of the Fetal Skull
48 hrs resolve
● The Cranium, the uppermost portion of
the skull, is composed of 8 bones. The
four superior bones- the frontal (two The Neuromuscular System
fused bones), the two parietals, and the
occipital- are the bones important in ● The newborn demonstrates
childbirth. neuromuscular function by moving their
● The bones of the skull join together at extremities, attempting to control head
suture lines. movement, exhibiting a strong cry, and
● The Suture lines are important in birth demonstrating newborn reflexes.
because, as membranous interspaces,
they allow the cranial bones to move I. The Blink Reflex
and overlap. ➔ A blink reflex in newborn serves the
same purpose as it does in an adult - to
The Suture lines protect the eye from any object coming
● are important in birth because, as near it by rapid eyelid closure.
membranous interspaces, they allow ➔ It may be elicited by shining a strong
the cranial bones to move and overlap. light such as flashlight or otoscope light
● The Sagittal suture joins the two into the eye.
parietal bones at the top of the skull.
● The Lambdoid suture is the line of II. The Rooting Reflex
juncture between the ccipital bone and ➔ If a newborn’s check is brushed or
the two parietal bones. stroked near the corner of the mouth,
● The Coronal suture is the line of the infant will turn the head in that
juncture between the frontal bones and direction.
the two parietal bones. ➔ This reflex helps the newborn find food

III. The Sucking Reflex

Caput Cephalohematoma
➔ When a newborn’s lips are touched, the
succedaneum
baby makes a sucking motion.
Soft tissue edema Collection of blood ➔ Like the rooting reflex, this reflex also
between the helps the newborn find food as when
periostium and the the newborn’s lips touch the mother’s
skull breast or a bottle, the baby sucks and
take in food.
Edema extends Swelling does not ➔ This sucking reflex begins to diminish at
across suture lines cross suture
about 6 months of age. It disappears
lines
immediately if it is never stimulated.

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
IV. The Swallowing Reflex ➔ The newborn makes a few quick lifting
➔ The swallowing reflex in a newborn is motions, as if to step onto the table.
the same as in the adult. ➔ Elicited by: Bringing the anterior
➔ Food that reaches the posterior portion aspect of tibia against edge of table.
of the tongue is automatically ➔ Response: Lifts leg on the table
swallowed. ➔ Appear at birth and disappear at 6
➔ Gag, cough and sneeze reflexes are weeks.
also present in newborns to
➔ maintain a clear airway in the event that IX. The Plantar Grasp Reflex
normal swallowing does not keep the ➔ When an object touches the sole of the
pharynx free of obstructing the mucous. newborn’s foot at the base of the toes,
the toes grasp in the same manner as
V. The Extrusion Reflex the fingers.
➔ In order to prevent the swallowing of ➔ This reflex disappears at about 8 to 9
inedible substances, a newborn months of age in
extrudes any substance that is placed ➔ preparation for walking. However, it
on the anterior portion of the tongue. may be present during sleep for a
➔ If newborns are offered solid food longer period of time.
before this reflex fade at 4 months, it
seems as if they are spitting out any X. The Tonic Neck Reflex
type of food. ➔ When newborns lie on their backs, their
➔ Newborns grasp on object placed in heads usually turn to one side or the
their palm by quickly closing their other.
fingers on it. ➔ The arm and leg on the side toward
➔ Mature newborns grasp so strongly. which the head turns extend, and the
➔ This reflex disappears at about 6 weeks opposite arm and leg contract.
to 3 months of age; after ➔ This posture is most evident in the arms
➔ it fades a baby begins to grasp but should not be totally absent in the
meaningfully. legs.

VII. The Step (Walk)-In-Place Reflex XI. The Babinski Reflex

➔ Newborns who are held in vertical ➔ When the sole of a newborn’s foot is
position. stroked in an inverted ”J” curve from the
➔ With their feet touching a hard surface heel upward, a newborn fan the toes
will take a few quick, alternating steps. (positive Babinski sign).
➔ This step disappears by 3 months of ➔ The reflex remains positive (toes fan)
age so that by 4 months, babies can until at least 3 months of age, when it is
bear a good position of their weight supplanted by the down turning or adult
unhindered by this reflex. flexion response.

VIII. The Placing Reflex XII. The Magnet Reflex

➔ The Placing reflex is similar to the ➔ If pressure is applied to the soles of the
step-in-place reflex, except it is elicited feet of a newborn lying in a supine
by touching the anterior surface of the position, he or she pushes back against
lower part of a newborn’s leg against a the pressure.
hard surface such as the edge of the ➔ This and the two following reflexes are
bassinet or table. tests of spinal cord integrity.

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
XIII. The Crossed Extension Reflex
➔ When a newborn is lying supine, if one
Growth and Development
leg is extended and the sole of that foot ● Growth and development ------ are
is irritated by being rubbed with a sharp assessed by both observation and
object, such as thumbnail, the infant specific testing.
raises the other leg and extends it as if
trying to push away the hand irritating Growth (quantitative change)
the first leg. ➢ Defined as an increase in physical size,
➔ One leg is held in extension and the head typically measured as height,
sole is rubbed. weight and circumference, measure
➔ Response: Other leg at first flex and and plot height and weight on a
adduct and then extend with fanning of standard growth chart for children at all
the toes. well – child care visits.
➔ Disappears by 8 months.
Development (qualitative change)
XIV. The Trunk Incurvation Reflex ➢ Refers to the progression toward
➔ When a newborn lies in a prone maturity in mental, physical, and social
position and is touched along the markers of normal development.
paravertebral area on the back by a Observe what specific activities the
probing finger, the newborn flexes the child can accomplish to establish
trunk and swings the pelvis toward the whether developmental milestone
touch. (major markers of normal development)
are achieved.
XV. The Landau Reflex
➔ When a newborn is supported in a
FACTORS INFLUENCING GROWTH AND
prone position by a hand, the newborn
DEVELOPMENT
should demonstrate some muscle tone.
➔ A baby may not be able to lift the head ➔ Genetic and environmental influences
or arch the back in this position (as will are primary factors in determining if a
be possible at 3 months of age), but child will be able to reach his or her
neither should the infant sag into an genetic potential
inverted “U” position. ➔ Temperament typical way a child
➔ The latter response indicates extremely reacts to situation –genetic influences.
poor muscle tone, the cause of which (Whether a child receives good nutrition
needs to be investigated. , beginning with being breastfed ).

XVI. The Deep Tendon Reflex Psychosexual development

➔ Both a patellar and a biceps reflex are ➢ refers to developing instincts or sensual
intact in a newborn. pleasure (Freudian theory)
➔ A Biceps reflex is a test for spinal
nerves C5 and C6. Psychosocial development
➔ A Patellar reflex is a test for spinal ➢ refers to stages of personality
nerves L2 through 14. development (Erikson’s theory)

Moral development
➢ Is the ability to know right from wrong
(Kohlberg’s theory)

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
Cognitive development ● Infant practice over and over taking a
➢ Refers to ability to learn or understand first step before they accomplish this
from experience securely.
➢ to acquire and retain knowledge,
➢ to respond to a new situation and
FACTORS INFLUENCING GROWTH AND
➢ to solve problems DEVELOPMENT

Piaget’s theory of cognitive development A. Genetic

➢ It is measured by intelligence tests and - the study of heredity and how
by observing children’s ability to qualities and characteristics
function effectively in different are passed on from one
environment. generation to another by
means of genes.
B. Environmental Influences
PRINCIPLES OF GROWTH AND - are primary factors in
DEVELOPMENT determining if a child will be
● Growth and development are able to reach his or her genetic
continuous processes from conception potential.
until death.
● Growth and development proceed in an Genetics
orderly sequence. ➢ From the moment of conception when a
● Growth in height occurs in only one sperm and ovum fuse, the basic genetic
sequence from smaller to larger. makeup of an individual is cast.
● Development also proceeds in a ➢ Inheritance determines characteristics
predictable order. such as learning style.
● Children pass through the predictable ➢ A child may also inherit a genetic
stages at different rate. abnormality, which could result in
● All body system do not develop at the disability or illness at birth or later in life
same rate. and so prevent optimal growth.
● Development is cephalocaudal.
● Cephalo is a Greek word meaning – Temperament
‘’ Head” Caudal means - “tail” ➢ Temperament is the usual reaction
● Development proceeds from proximal to pattern of an individual or an
distal body parts. individual’s characteristic manner or
● Development proceeds from gross to thinking, behaving or reacting to stimuli
refined skills. in the environment.
● There is an optimum time for initiation ➢ Cognitive or moral development,
of experiences or learning. temperament is not developed in stages
● Children cannot learn tasks until their but in an inborn characteristic set at
nervous system is mature enough to birth.
allow that particular learning. ➢ Children are not all alike.
● Neonatal reflexes must be lost before
development can proceed. Gender
● An infant cannot grasp with skill until ➢ On average, girls are born lighter( by an
their nervous system is mature. ounce or two) and shorter(by an inch or
● A great deal of skill and behavior is two) than boys. Boys are tend to keep
learned by practice. this height and weight advantage until
prepuberty, at which time girls surge
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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
ahead as they begin puberty growth
BASIC DIVISION OF CHILDHOOD
spurt 6 mos. To 1 year earlier than
boys. By the end of puberty (14 to 16 Stage Age Period
years), boys again tend to be taller and
heavier than girls. Neonate First 28 days of life

Health Infant 1 month – 1 year

➢ A child who inherits a genetically
transmitted disease may not grow as Toddler 1 – 3 years
rapidly or develop as fully as a healthy
Preschooler 3 – 5 years
child depending on the type of illness
and the therapy or care available for the School age child 6 – 12 years
disease.
Adolescent 13 – 17 years
Intelligence
➢ Children with high intelligence do not Late adolescent 18 – 21 years
generally grow faster physically than
other children, but they do tend to Sociocultural theories
advance faster in skills. ➢ Are those that stress the importance of
environment on growth and
Environment development.
➢ Although children cannot grow taller
than their genetically programmed Learning theory
height potential allows, their ➢ Suggest children are like blank pages
➢ Adult height can be considerably less that can be shaped by learning.
than their genetic potential if their ➢ learning skills are the key to achieve
environment hinders their growth. success in life.
(Family’s low economic status).
Epigenetic theories
THEORIES OF CHILD DEVELOPMENT ➢ Stress that genes are the true basis for
growth and development.
A theory is a systematic statement of principles
that provide a framework for explaining a
phenomenon. Developmental theories are THEORIST THEORY
theories that provide road maps for explaining
human development. Sigmund Freud Psychoanalytic

Erik Erikson’s Psychosocial

Developmental tasks
development
➢ are a skill or a growth responsibility
arising at a particular time in an Piaget’s Cognitive
individual’s life, the achievement of development
which will provide a foundation for the
accomplishment of future tasks. It is not Kohlberg’s Moral Development
so much chronologic age as the
completion of the task that defines
whether a child has passed from one
developmental stage of childhood to
another.
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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
SIGMUND FREUD (1856-1939) - ERIK ERIKSON (1902- 1996) --relational
Psychosexual ● Was trained in psychoanalytic theory
● An Austrian neurologist and the founder but later develop his own theory of
of psychoanalysis, offered the first psychosocial development, a theory
theory of personality development. The that stresses the importance of culture
theory based on the observation of and society in the development of the
mentally disturbed adults, described personality (Erikson 1993).
adult behaviour as being the result of ● A person’s social view of self is very
instinctual drives of a primarily sexual important than instinctual drives in
nature (libido). determining behaviour, allows for more
● He described child development as optimistic view of the possibilities for
being a series of psychosexual stages human growth. Erikson looked at
in which a child’s sexual gratification actions that lead to mental health.
becomes focused on a particular body ● He describes eight developmental
part at each stage. stages covering the entire life span.
● The theory is also criticized as being
gender biased because females are
STAGES OF CHILDHOOD
viewed in a less favorable light than DEVELOPMENTAL TASK
males.
● Gender bias has the potential to Infant Trust versus Child learn to
perpetuate gender inequality, which mistrust love and be
doesn’t provide a level playing field for loved
women.
Toddler Autonomy Child learns
PYSCHOSEXUAL STAGE versus to be
shame independent
Infant Oral stage: Child explore and make
the world by using mouth decision for
self
Toddler Anal stage: Child learn to
control the urination and Preschooler Initiative Child learns
defecation versus guilt to do things
basic
Preschooler Phallic stage: Child learn problem
sexual identity through Solving and
awareness of genital area that doing
things is
School age Latent stage: Child’s desirable
personality development
appears to be active or School age Industry Child learns
dominant. versus how to do
inferiority things well.
Adolescent Genital stage: Adolescent
develop sexual maturity and Adolescent Identity Adolescence,
learns to established versus role learn who
satisfactory relationship confusion they are
with others. what kind of
person they
will be

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
PIAGET’S Development Cognitive (1896- KOHLBERG’S Theory of moral
1980) – Behaviorism Development (1927 – 1987)
● A Swiss psychologist, introduced ● A German psychologist, Kolhbeg’s
concepts of cognitive development, or (1984).
the way the children learn and think. ● Studied the reasoning ability of boys
● Piaget defined four stages of cognitive and based on Piaget’s development
development, within the stages of stages, develop a theory on the way the
growth, then finer units or schemas. To children gain knowledge of right and
progress from one period to the next, wrong or moral reasoning.
children reorganize their thinking ● Recognizing moral reasoning also help
processes. determine whether children can be
● Comprehensive theory about the depended on to carry out self- care
nature and development of human activities such as administering their
intelligence. own medicine or whether children have
● Simple to complex. internalized standards of conduct so
they do nor cheat when away from
external control.
STAGES OF COGNITIVE DEVELOPMENT
● Children must be able to think
Age Span Sensorymotor abstractly ( be able to conceptualize an
idea without a concrete picture),
1 month Neonatal reflex
KOHLBERG’S STAGES OF MORAL
1- 4 months Primary circular
DEVELOPMENT
reaction

4- 8 months Secondary circular Preconventional (Level I)

reaction
Age in Stages Description
8- 12 months Coordination of year
secondary
2- 3 1 Punishment/obedie
12- 18 months Tertiary circular nce or
reaction (heteronymous
morality).
18- 24 months Invention of new
means through Child does right
mental coordination because
a parent tells him
2 – 7 years Preoperational to avoid
thought punishment.

7 - years Concrete operational 4–7 2 Individualism.

thought Carries out actions
to satisfy own
12 years Formal operational needs rather than
thought society. will do
something for other
if that person does
something for him
or for her.

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NCM 107 LECTURE I MATERNAL & CHILD HEALTH NURSING I FIRST SEMESTER I FINAL
FINAL COVERAGE
Transcribe Notes by: Kerstine Anne P. Andrade
Conventional (Level II)

Age in Stages Description

year

7- 10 3 Orientation to inter
personal relations of
mutuality.

Child follows rules

because of a need to
be a good person in
own eyes or others.

10 – 12 4 Maintenance of social
order, fixed rules, and
authority. Child finds
following rules
satisfying.

Follow of authority
figures as well as
parents in an effort
to keep the system
working. Child often
asks what the rules are
and if something is
right.

Post Conventional ( Level III)

Age in Stages Description

year

Older 5 Social contract,

than 12 utilitarian law making
perspectives.

Follows standard of
society for the good of
all people.

10 – 12 6 Universal ethical
principle orientation.

Follows internalized
standard of conduct.
right.

21