PRACTICAL – 7

ANTENATAL CLINIC
Antenatal Care:

Antenatal care is the care of the women during pregnancy that is soon
after conception and continue throughout the pregnancy.

Objectives:

1) Promote protect and maintain the health of the mother during pregnancy.
2) Detect high risk cases and give them special attention.
3) Remove anxiety and treat associated with delivery.
4) Reduce maternal and infant mortality and morbidity.
5) Teach mother elements of child care, nutrition personal hygiene and
environmental sanitation.
6) Sensitize the mother to the need for family planning.
7) Support and encourage family’s healthy psychological adjustment to child
bearing.
8) Build up a trusting relationship between the family and their care givers.
9) Ensure that the women reach the end of her pregnancy physically and
emotionally prepared for her delivery.

Programme of health care services:

Antenatal Visits:

Advice to come for regular check ups, if any difficult in attending clinic at
least give minimum of 4 visits.

1st visit before the 3rd months

2nd visit during the 6th months
3rd visit during 8th months
4th visit during 9th months
preventive services for mothers:
a) The first visit irrespective of when it occurs should include the following
components.
  Health history
 Physical examination (weight, height, BP)
 Laboratory examination
1. Complete urine analysis
2. Stool examination
3. Complete blood count including Hb%
4. Serological examination
5. Blood grouping and Rh determination
6. Chest X – ray if necessary
7. Pap test (if facilities exist)
8. Gonorrhoea test (culture if needed)
b) On subsequent visit:
1. Physical examination
2. Laboratory test (urine and Hb%)
3. Iron and folic acid supplementation and medication if
needed
4. Immunization against tetanus
5. Health education on nutrition, family planning antenatal
care
6. Delivery
7. Home visiting
8. Referral services
Risk Approach:
Identify high-risk cases like,
1. Elderly primi (30 years and above)
2. Short stature (140 cms and below)
3. Mal presentations like breech, transverse lie etc.
4. Antepartum haemorrhage, threatened abortion
5. Pre eclampsia and eclampsia
6. Anaemia
7. Twins, hydramnios
8. Previous still birth, intra uterine death, manual removal of placenta
 9. Elderly grant multiparas
10. Prolonged pregnancy (14 days – after – EDD)
11. History of previous caesarean or institutional delivery
12. Pregnancy associated with general diseases like cardiovascular, renal
disease

Maintenance of Records:
Antenatal record is prepared at the first examination. A link is maintained
between antenatal record postnatal record and underfive record.

Productive services for mothers:

a) The first visit irrespective of when it occurs should include the following
components.
 Health history
 Physical examination (weight, height, BP)

Laboratory Examination:
1) Complete urine analysis
 Stools examination
 Complete blood count, including Hb%
 Serological examination
 Blood grouping and Rh determination
 Chest X – ray if necessary
 Pap test (if facilities exist)
 Gonorrhoea test (culture if needed)

b) Subsequent visit
1) Physical examination
2) Laboratory tests urine and Hb%
 Iron and folic acid supplementation and medication if needed
 Immunization against tetanus
 Health education on nutrition, family planning
 Home visiting
 Referral services
Equipments:
1) Weighing machine
2) Height scale
3) Inch tape
4) B.P. Apparatus
5) T.P.R. Tray
6) Foetus scope
7) Sterile gloves
8) Articles for urine testing
 Test tubes
 Test tube holders
 Benedict solution
 Acetic acid
 Dropper
 Kidney tray
 Paper bag
 Test tube stand
 Match box
 Spirit lamp
 Litmus paper
 Specimen bottles
9) Vaccine carrier with injection T.T. Vials
10)Disposable syringes
11) Kidney tray and paper bag
Physical setup:
Standards According to LUFWC
 Reception and registration  Reception and registration
counter counter

 General examination room  General examination room

cubicles o No cubicles
o Treatment room
 Treatment room
  Laboratory  No laboratory facilities

 Family planning extension  Family planning extension

counter to identify the eligible counter to identify the eligible
couples couples

The total number of antenatal mothers visited where 12, 24/02/06 to

25/02/06.

We have done home visit for antenatal mother and provided the
domiciliary midwifery care.
 PRACTICAL – 7

POSTNATAL CARE - 03
Activity:

Plan and visit a postnatal mother at home using a public health bag and
provide necessary care both to the mother and the newborn.

Area: Urban community, Corporation Hospital, Gavipuram, Guttahalli, Bangalore.

Baseline Data:
Name : Mrs. Komala
Age : 23
Sex : Female
Religion : Hindu
IP No : 11245
Husband Name : Mr. Suresh
Occupation : Cooli
Address : R.K. Layout, Gavipuram, Guttahalli, Bangalore
Diagnosis : Postnatal Mother
Date of Admission : 03/02/06
Date of Delivery : 03/02/06
Date of Discharge : 06/02/06

Introduction:

The postnatal period or puerperium is the period of adjustment after

pregnancy when the anatomic and physiological changes of pregnancy are
reversed and body returns to the normal non – pregnancy state. The return of
the reproductive organs to the non – pregnant state is called the process of
involution. The reproductive organs return to virtually the normal state by 6
weeks after delivery and a majority of non lactating women resume menstrual
cycles at this time or soon there after. Usually puerperium begins as soon as the
placenta (third stage of labour) is expelled and extends up to the period of six
weeks.
Objectives of the Puerperium or Postnatal Care:

1. To prevent complications of the puerperium

2. To provide care for the rapid restoration of the mother to optimum health
3. To check adequate of breast feeding
4. To provide family planning services
5. To provide basic health education to the mother / fly
Postnatal period has been divided into three phases:

1. Immediate puerperium – the first 24 hours after parturition

2. Early puerperium – extends until the first week of past parturition
3. Remote puerperium – includes the period of time required for involution of
the genital organs

Physiology or Puerperium:

1. Involution of generation organs

2. Involution of the uterus
3. The Lochia. Lochia is the term given to the discharge from the uterus
during puerperium
It has an alkaline reaction. The odour is unpleasant.

The types of Lochia are,

1. Lochia rubra – red 1 – 4 days

2. Lochia Serosa – pink 5 – 9 days (brownish)
3. Lochia alba – white 10 – 15 days

Lactation is initiated:

The act of sucking also stimulate the production and the flow of milk
probably by some – neuro – hormonal reflex mechanism which activates the
anterior pituitary to produce lactotropin and the posterior lobe to produced
oxytocin. Since colostrums is very essential for the protection of the newborn
and to initiate lactation. It is advised to put the baby to breast for sucking
immediately after birth.

General Clinical Aspects:

1. Normal blood volume is considerably increased

 2. The pelvic floor
3. Bladder – urethra and ureters
4. The cardio – vascular system
5. The kidneys
6. Pulse, temperature and respiration

Postnatal visit:
Equipment required for post – natal care:

1. Nursing bag
2. Family folders containing individual cards
3. Health education material and
4. Extra equipment as needed eg: immunization

Procedure:

1. Place the bag on a plastic sheet on a clean surface and washing hands
well and open the bag

 Remove the articles from the bag and placed them on the clean
surface

 Enquired regarding the condition of mother, child nutrition, after pains,

sleep, lochial discharge, urine and motion checked her temperature,
pulse and respiration

Breast Care:
Definition:
To establish normal lactation care of the breast should be emphasized
during the pre – natal period.

During Postnatal Period:

1. Cleansed the nipples before and after feeding

2. Asked the mother to feed the child when ever the child demand
3. Advised the mother to prevent sore nipples which may lead to breast
abscess

Equipment:

1. Sterile cotton swabs in a bowl

 2. Bowl of boiled cool water
3. Kidney tray
4. Soap and water
Procedure:
Breasts should be washed well daily with soap and water using a soft
clean cloth.

Immediately before and after nursing, the nipples should be cleaned with
boiled water and dried with swabs.

Breasts must be supported by means of binder of good brassiere.

Care of the mother during postnatal period:

 To assess the condition of the mother and her baby and confirm than the
puerperium in progressing normally.

 To encourage breast-feeding and ensure than the baby is receiving

sufficient nourishments.

 To give postnatal care which include the treatment of minor post partum
health problems of the mother and baby.

 To teach mother how to care for herself and her baby to regular check up,
family planning, nutrition and immunization.

Postnatal Care:

1. Assess the mother from head to toes

2. Check the vital signs
3. Measuring the uterus to find out the involution of the uterus taken place
4. Perineal care of mother had episiotomy wound
5. Observe the colour of lochia (vaginal discharge)
6. If primi mother breast care
7. Encourage the mother to feed the child
8. Ask the mother any pain in the legs or chest
9. Any difficulty or frequency of urination
10. Getting sufficient rest and sleep
11. About the diet
 12. Personal hygiene
13. Need for physical activity or postnatal exercise
14. Postnatal check up after 6 weeks
15. Find out regular bowel movement and voided

CONCLUSION:

Mrs. Komala undergone for abdominal tubectomy after 2 nd child. She

delivered a girl baby on 03/02/06. I have visited her on 07/02/06. She herself
had breast care and perineal care. Gave care in suture area. Checked the vital
signs and health education given about personal hygiene and normal diet. Left
the house at 12.30 pm. Informed her next visit.
Postnatal Care Study:

Name of the Hospital : Corporation Hospital

Gavipuram, Guttahalli

Name of the Mother : Mrs. Komala

Age : 23 years

Religion : Hindu

I.P. No. : 11245 Gravida 2 Parity 2

Husband Name : Suresh

Age : 30 years

Occupation : Cooli

Address : R.K. Layout, Gavipuram, Guttahalli,

Bangalore.

Date of Admission : 03/02/06 at 8 am

Date of Delivery : 03/02/06 at 10 am

Date of Discharge : 06/02/06

Previous History of Delivery:

1. Number of pregnancy – 2
2. Date of delivery – 20/02/04
3. Baby born – Full term
4. Condition of baby at birth – Alive
5. Nature of labour – Vaginal
6. Nature of ANC – Normal
7. Nature of puerperium – Normal
8. Lactation – Good
9. Duration of breast feeding – Demand feeding
 10. Weaning – 4 months
11. Adoption of family planning – Had tubectomy
12. Presently condition of sibling – Good and healthy

Present Pregnancy:

Antenatal – LMP 27/04/05

EDD – 03/02/06
No. of antenatal visits – Five
Inj. Tetanus Toxoid – Had 2 doses

Special Examination:

HB – 12 gms
Blood for VDRL – Non reactive
Blood group – B +ve

Mode of Delivery:

Normal vaginal
No episiotomy
Condition of mother – Good and healthy
Condition of Baby – Good and healthy
Weight of the Baby – 3 kgs
Height – 52 cms

Postnatal Care:
Admitted to postnatal ward on 03/02/06 at 12 Noon
Uterus – Contracted well
General condition of mother – Good
Vaginal bleeding – Normal

Daily Care and Treatment to Mother:

5th day
Uterus fundal height – 6 cms
Lochia serosa pink in colour normal no odour
Breasts – Normal
Diets – Normal
Valval toilet – Regular
General condition – Good
Sutures – Nil
Postnatal exercises – Doing
Feeding – Yes
Special complaints - Nil

Daily care and Treatment to the Baby:

5th day:

Cord – fallon
Eyes – Clean
Feeding – Sucking well
Bladder – Normal
Weight – 28 kgs

Health teaching given on 07/02/06:

To the Mother: Caring for Baby:

1. Perineal Care 1. Feeding technique

2. Breast Care 2. Weaning
3. Postnatal exercise 3. Immunization
4. Personal hygiene 4. Well – baby clinic
5. Diet 5. Bath
6. Family Planning 6. Care of cord
7. Care of eyes

Advice on discharge:

1. Personal hygiene
2. Diet
3. Weight lifting
4. Follow up
 5. Family planning
Newborn Care Neonatal Period:
Base – Line Data:
Name - Baby of Komala
Age - 5 days
Sex - Female
Date of birth - 03/02/06 at 10 am
Mother name - Komala
Father name - Suresh
Diagnosis - Neonatal
Weight - 3 kg
Height - 52 cms
Head circumference - 35 cms
Chest circumference - 32 cms
Rectom - Patent

Immediate Care of Newborn:

1. Clear airway
2. Established respiration
3. Warmth
4. Protection from haemorrhage
5. Protection from infection
6. Identification and observation of the health problems / needs
7. Nourishment and fluids
8. Love – parent child attachment
9. Rest
Neonatal period first 7 days early neonatal period than after 7 th days to 28
days called late neonatal period.

Neonatal Care:
1. Establishment and maintenance of cardio respiratory functions.
2. Maintenance of body temperature.
3. Avoidance of infection
 4. Establishment of satisfactory feeding regimen and
5. Early detection and treatment of congenital and acquired disorders
especially infections.

Immediate Care:
Clearing the airway:

To help establish breathing the airways should be cleared of mucus and

other secretions. Positioning the baby with his head low may help in the
drainage of secretions. This process can be assisted by gentle suction to
remove mucus and amniotic fluid.

Apgar Score:

The Apgar score is taken at one minute and again at 5 minutes after birth.
Apgar scoring of a newborn infant especially low birth weight babies. It requires
immediate and careful observation of the hart rate, respiration, muscle tone,
reflex response and colour of the infant. Each sign is given a score of 0, 1 or 2.
It provides an immediate estimate of the physical condition of the baby. A perfect
score should be 9 or 10. 0 – 3 indicates that the baby is severely depressed and
4 – 6 moderately depressed. A score below 5 needs prompt action. Infants with
low Apgar scores at 5 minutes of age are subject to a high risk of complications
and death during the neonatal period.

Care of the Cord:

In the case of the normal infant the umbilical cord should be cut and tied
when it has stopped pulsating. To prevent tetanus of the newborn by using
properly sterilized instruments and cord ties. The cord should be kept as dry as
possible. It dries and shrivels up and separates by aseptic necrosis in 5 – 6
days.

Care of the Eyes:

Before the eyes are open the lid margins of the newborn should be
cleaned with sterile wet swabs one for each eye from inner to outer side. Any
discharge from the eye of an infant immediately reported to the doctor for the
treatment.

Care of the Skin:

Clean the skin or wipe the maconium and blood clots and keep the baby
warm. After 3rd day first bathing can given to the baby. Because the vernix are
good for the baby skin it will prevent infection of the skin.
Maintenance of body temperature:

The normal body temperature of a newborn is between 36.5 to 37.5 Oc. A

newborn baby is projected out of warm womb of the mother into an environment,
which may be 10 to 20Oc. cooler especially in winter months in India.

A newborn has little thermal control and can lose body heat quickly,
immediately after birth, most of the heat loss occurs through evaporation of the
amniotic fluid from the body of the wet child. It is important that immediately after
birth the child is quickly dried with a clean cloth and wrapped in warm cloth and
given to the mother for skin-to-skin contact and breast-feeding.

Breast Feeding:

Breast feeding should be initiated with in an hour of birth. It helps to

establish feeding and a close mother child relationship known as bonding.

The first milk which is called colostrums is the most suitable food for the
baby during this early period because it contains a high concentration of protein
and other nutrient the body needs. It is also rich in anti – infective factors which
protect the baby against respiratory infections and diarrhoeal diseases.

Neonatal Examination:
a) First Examination:

Preferably in the delivery room

 The baby has not suffered injuries during birth process
 To detect malformations and need urgent treatment
 To assess maturity

Find out the abnormalities:

 Cyanosis of the lips and skin
 Any difficulty in breathing
 Imperforated anus
 Persistent vomiting
 Signs of cerebral irritation such as twitching convulsions neck rigidity,
bulging of anterior fontanel
 Temperature instability

Second Examination:
 Preferably by a paediatrician with in 24 hours after birth.
  It is a detailed systematic examination from head to foot, conducted in
good light.

1. The body size

2. Body temperature
3. Skin
4. Cardio – respiratory activities
5. Neuro – behavioral activity
6. Head and face
7. Abdomen
8. Limbs and joints
9. Spine
10. External genitalia
Measuring the Baby: (Anthropometric measurements)

1. Birth weight should be taken with in the first hour of life.

The normal birth weight in India women 27 kg to 2.9 kg.

Length (Height):

Length can be taken most accurately with a measuring board

(infantometer) with a fixed head piece on which the infant lies supine with its legs
fully extended and the feet flexed at right angles to the lower legs. Two people
are needed to hold the baby correctly. The normal height of the baby 48 – 50
cms.

Head Circumference:
The purpose of taking

 To assess the baby’s size against known standards for the population
 To compare the size with estimated period of gestation
 To provide a base line against which subsequent progress can be
measured

CONCLUSION:

Baby of Komala was 7 day newborn. There is no cord. So cleaned the

umbilical with spirit cotton and dried the area. The condition of the baby is good.
Baby sucks well. No health problems. After given the health talk about breast
feeding to the mother left the house at 12 noon.