FAMILY CASE STUDY INTRODUCTION Pregnancy, the state of carrying a developing embryo or fetus within the female body.

This condition can be indicated by positive results on an overthe-counter urine test, and confirmed through a blood test, ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy lasts for about nine months, measured from the date of the woman's last menstrual period (LMP). It is conventionally divided into three trimesters, each roughly three months long. When gestation has completed, it goes through a process called delivery, where the developed fetus is expelled from the mothers womb. There are two options of delivery: Cesarean section and NSVD or normal spontaneous vaginal delivery. A cesarean section is a surgical incision through the mothers abdomen and uterus to deliver one or more fetuses. NSVD or normal spontaneous vaginal delivery is the delivery of the baby through vaginal route. It can also be called NSD or normal spontaneous delivery, or SVD or spontaneous vaginal delivery, where the mother delivers the baby with effort and force exertion. Normal labor is defined as the gradual subjugation and dilatation of the uterine cervix as a result of rhythmic uterine contractions leading to the expulsion of the products of conception: the delivery of the fetus, membranes, umbilical cord, and placenta. Laboring cannot that be easy; thereby implicating that there are processes and stages to be undertaken to achieve spontaneous delivery. Through which, Obstetrics have divided labor into four (4) stages thereby explaining this continuous process. STAGE 1: It is usually the longest part of labor. It begins with regular uterine contractions and ends with complete cervical dilatation at10 centimeters. This stage is broken down into three (3) phases: the

Early phase,
where the contractions are usually very light and maybeapproximately 20 minutes or more apart from the beginning, gradually becoming closer, possibly up to five minutes apart; the

Active phase
,where contractions are generally four or five times apart, and may last up to 60 seconds long. Cervix dilates with 4-7 cm and initiates a more rapiddilatation. It is known that to get through active labor, mobility andrelax ations are done to increase contractions; and the

Transition phase
,where it is definitely known as the shortest phase but the hardest,contractio ns maybe two or three times apart, lasting up to a minute and a half, about approximately 8-10 cm of cervical dilatation. Some women will shake and may vomit during this stage, and this is regarded as normal. Most of the time, women would find a comfortable position to acquire complete dilatation. STAGE II : This stage lasts for three or more hours. However, the length of this stage depends upon the mothers position (e.g.; upright position yields faster delivery). Once the cervix has completely dilated, the second stage had begun. This stage ends with the expulsion of the fetus. STAGE III : This stage focuses on the expulsion of the placenta from the mother. Placenta exclusion is much easier than the delivery of the baby because it includes no bones, and this is during this stage that the baby is placed on top of the mothers womb. STAGE IV : No more expulsions of conception products for this stage as this is generally accepted as POST PARTUM juncture. This phase is from the

placental delivery to full recovery of the mother. Labor and delivery of the fetus entails physiological effects both on the mother and the fetus. In the cardiovascular system, the mothers cardiac output increases because of the increase in the needed amount of blood in the uterine area. Blood pressure may also rise due to the effort exerted by the mother in order expel the fetus. There could also be a development of leukocytes or a sharp increase in the number of circulating white blood cells possibly as a result of stress and heavyexerti on. Increased respiratory may also occur. This happens as aresponse to the increase in blood supply in order to increase also the oxygen intake. Braxton Hicks contractions, or also known as false labor or Practice contractions . Braxton Hicks are sporadic uterine contractions that actually start at about 6 weeks, although one will not feel them that early. Most women start feeling them during the second or third trimester of pregnancy. True labor is felt in the upper and mid abdomen and leads to the cervical changes that define true labor. With delivery imminent, the mother is usually placed supine withher knees bent (ie, the dorsal lithotomy position). An episiotomy (anincisi on continuous with the vaginal introitus) may be performed at this time. Episiotomy may ease delivery of the fetal head and allow some control over what may otherwise be an uncontrolled perineal laceration. However, many providers no longer perform routine episiotomy, since it may increase the risk of rectal injury and are larger than the spontaneous laceration. The labor and birth process is always accompanied by pain. Severaloptions for pain control are available, ranging from intramuscular orin travenous doses of narcotics, such as Meperidine (Demerol), to generalanesthesia. Regional nerve blocks, such as a pudendal block or locali nfiltration of the perineal area can also be used. Further options include epidural blocks and spinal anesthetics

OBJECTIVES The significance of this study is for us Midwifery 2nd year student to apply the principles and concept we had learned in MW 102 Normal OB with the following objectives: To be able to review the concept and theories of Normal OB the maternal and child nursing. To be able to describe the development,psysiology and nursing care of the client who has undergone normal spontaneous vaginal delivery and episiotomy procedure. To be able to design a nursing care plan for the patient for the patient who has undergone NSVD and episiotomy procedure. To be able to provide information and health teaching to the patient of post -partum period. To be able to establish a good working relationship with the patient and hospital staff.

Anatomy of female reproductive system External

Our overview of the reproductive system begins at the external genital area or vulva which runs from the public area downward to the rectum. Two folds of fatty, freshly tissue surround the entrance to the vagina and the urinary opening: the labia majora or outer folds, and the labia minora or the inner folds, located under labia majora. The clitoris, is a relatively short organ (less than one inch long), shielded by hood of flesh. When stimulated sexually, the clitoris can become erect like a mans penis. The hymen, a thin membrane protecting the entrance of the vagina, stretches when you insert tampon or have intercourse.

INTERNAL

THE VAGINA The vagina is a muscular,ridged shealth connecting the external genitals to uterus,where the embryo grows into the fetus during pregnancy. In the reproductive process, the vagina functions as a two way street, accepting the penis and sperm during intercourse and roughly nine months later,serving as the avenue of birth through which the new baby enters the world. THE CERVIX The cervix is the lower end of the womb (uterus). It is at the top of the vagina. It is about 1 inch long. The cervical canal passes through the cervix. It allows blood from a menstrual period and a baby (fetus) to pass from the womb into the vagina.

UTERUS an organ in female mammals for containing and usually for nourishing the young during development prior to birth that consists of a greatly modified and enlarged section of an oviduct (as in rodents and marsupials) or of the two oviducts united (as in the higher primates including humans), that has thick walls consisting of an outer serous layer, a very thick middle layer of smooth muscle, and an inner mucous layer containing numerous glands, and that during pregnancy undergoes great increase in size and change in the condition of its wallscalled also womb; see cervix 2a, corpus uteri, endometrium, fundus c, myometrium, perimetrium. OVIDUCTS The fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus. On maturity of an ovum, the follicles and the ovarys wall rupture, allowing the ovum to escape and enter the fallpian tube. there it travels toward the uterus,pushed along by movements of cilia on the inner lining of the tubes.This trip takes hours or days. If the ovum is fertilized while in the fallopian tube,then it normally implants in the endometrium when it reaches the uterus,which signals the beginning of pregnancy. OVARIES The ovaries are the place inside the female body where ova o eggs are produced. The process by whichj the ovum is releasd is called ovulation.The speed of ovulation is periodic and the impacts directly to the lenght of a menstrual cycle. After ovulation,the ovum is captured by the oviduct,where it travelled down the oviduct to the uterus,occasionally being fertilised on its way by an incoming sperm, leading to pregnancy and the eventual birth of a new human being.

The Fallopian tubes are often called the oviducts and they have small hairs to help the egg cell travel.

Uterine Full Term

Mechanism of Labor

ACKNOWLEDGEMENT The materialization of this case study wouldnt be possiblewithout the aid of the following folks: To the Almighty Father for the strength given in realizing andfulfilling the duties and the study; to beloved parents who have alwaysbeen supportive all throughout the start of the duty until the end, the toilsand efforts; to dear comrades and colleagues who have been extendingall out help during the rough scenarios, specially to Miss Sheila MarieAdorador for aiding me in realizing the case study; and to my groupmatesfor the overwhelming support, help and camaraderie, for bein gcooperative and indulging, that helped me augment my learning andsomeho w sharpened my skills. To our ever lenient but strict clinical instructor, Mr. PaulRitchie Pelos, for simplifying what used to be incomprehensible, tricky andcomplicated concepts, for assisting us in the various procedures we have performed and for being kind to us despite our immaturity