To A Beautiful Mom

MATERNAL
HEALTH
NURSING

OBJECTIVES
Recognize common terminology related to the
postpartum and newborn areas in maternal
health nursing
Demonstrate the proper technique of
massaging the fundus and explain why this is
done
List seven newborn primitive reflexes and
demonstrate each one
Describe 3 interventions to prevent
hypoglycemia in the newborn
Define the 5 Rights of medication
administration

Beautiful Mom
Terminology To
toA
Know!
EDC Estimated date of confinement
EDD Estimated date of delivery
Amniocentesis Transabdominal puncture of the amniotic sac to obtain
a sample of amniotic fluid that contains fetal cells and
biochemical substances for lab examinations
Gravida A woman who has been pregnant regardless of the duration
or outcome of the pregnancy
Para A woman who has given birth after a pregnancy of at least 20
weeks gestation also designates the number of pregnancies
that end after at least 20 weeks (twins and triplets are
considered 1 birth when calculating parity)
Fundus Part of the uterus that is farthest from the cervix top of the
uterus

Terminology to Know! (cont.)

Stillbirth Birth of a dead child
PROM Premature Rupture of Membranes spontaneous rupture of
membranes before the onset of labor
ROM Rupture of membranes
Placenta abruption/abruptio Premature separation of normally
implanted placenta
Placenta previa Abnormal implantation of the placenta in the lower
uterus at or near the cervical os
HCG Human chorionic gonadotropin (secreted by the placenta and
present in maternal blood and urine after conception)

Terminology to Know! (cont.)

Surfactant Combination of lipoproteins produced by the lungs of the
mature fetus to reduce surface tension in the alveoli which
promotes lung expansion after birth
Lanugo Fine, soft hair that cover the fetus
Fontanel - Space at the intersection of sutures connecting fetal or
infant skull bones

Terminology to Know! (cont.)

Molding Shaping of the fetal head during movement throughout the
birth canal

Fetal lie Relationship of the long axis of the fetus to the long axis of
the mother

Terminology to Know! (cont.)

Primipara A woman who is pregnant for the first time
Primigravida a woman (after a pregnancy of 20 weeks) who has
given birth
Multipara A woman who has given birth after two or more
pregnancies of at least 20 weeks/a woman who has been
pretnat more than once
Nulligravida A woman who has never been pregnant
Nullipara A woman who has not completed a pregnancy to at least
20 weeks gestation

Terminology to Know! (cont.)

APGAR Scoring Method of rapid evaluation of the infants
cardiorespiratory adaptation after birth. The infant is scored at
1 minute and 5 minutes in each of five areas.
A = Appearance
P = Pulse
G = Grimace(reflex irritability)
A = Activity
R = Respiration

Scoring
8-10 Normal
5-7 Mild Depression stimulation needed
3-4 Moderate Depression Oxygen and/or insertion of stomach tube
to decompress stomach
0-2 Severe Depression Life support needed

Terminology to Know! (cont.)

Presentation - 3 fixed fetal reference points
1. Occiput back of head presentation
2. Mentum chin presentation

3. Breech/Footling Breach Fetal buttocks or foot presentation

Terminology to Know! (cont.)

Vernix Caseosa Thick white sustance that protects the skin of the
fetus

Meconium First stool excreted by the newborn which consists of

vernix, skin cells, hair, cells from intestinal tact, bile and other
intestinal secretions. Greenish black, thick, sticky and tarlike
Mongolian spots Bruise like marks on newborns with darker skin
tones.

Terminology to Know! (cont.)

Effacement The shortening and thinning of the cervix
Contraction Physiological effect of the birth process; coordinated,
involuntary and intermittent. Each contraction consists of
three phases:
-Increment begins in the fundus and spreads
throughout the uterus
-Peak/Acme time when contraction is the most
intense
-Decrement decreasing intensity as uterus relaxes
Lightening Decent of the fetus toward the pelvic inlet before labor
Bloody Show Mixture of cervical mucus and blood from ruptured
capillaries in the cervix; precedes labor and increases with
cervical dilation

Terminology to Know! (cont.)

Braxton Hicks Contractions Irregular mild uterine contractions that
occur throughout pregnancy becoming stronger during the
last trimester
Crowning Appearance of the fetal scalp or presenting part at the
vaginal opening
Station Measurement of fetal decent
in relation to the ischial spines
of maternal pelvis

Terminology to Know! (cont.)

Leopolds Maneuvers Used to determine presentation and position of
the fetus and aid in location of fetal heart sounds

Terminology to Know! (cont.)

Engorgement Temporary swelling and fullness of breasts that peaks
at 72-96 hours after birth when the production of milk begins
to increase
Antepartum The time during pregnancy before the onset of labor
Intrapartum Time of labor and childbirth
Postpartum The first 6 weeks after childbirth
Gestation Period of fetal development from conception to birth
Term a birth that occurs between the 38th and 42nd weeks of
gestation

Terminology to Know! (cont.)

Preterm/premature labor Onset of labor after the 20th week and
before the beginning of the 38th week of gestation
Postterm labor a birth that occurs after 42 weeks of gestation
Decelerations classified as early, late, and variable
Early not associated with fetal compromise - caused by
compression of fetal head which increases intracranial pressure
causing the vagus nerve to slow the heart rate

http://www.childbirths.com/cypress/fetalmonitoringetc.htm

Terminology to Know! (cont.)

Late Reflects possibility of impaired placental exchange
(uteroplacental insufficiency)

Variable Reflects umbilical cord compression

http://www.childbirths.com/cypress/fetalmonitoringetc.htm

To A Beautiful Mom

POSTPARTUM

POSTPARTUM ASSESSMENT
FUNDUS LOCATION
The fundus should be at the midline, feel hard and round 1-2
finger breadths below the umbilicus
If the fundus is displaced, have the patient void as
most likely the full bladder is to blame.
If the fundus is soft (boggy) it is important to massage
the fundus until firm.
A soft fundus is also referred to as Uterine Atony (a
lack of muscle tone). This is the cause of early
Postpartum Hemorrhage.
Technique for massage: The non-dominant hand supports and anchors
the lower uterine segment, the dominant hand massages the top part
of the fundus.

POSTPARTUM ASSESSMENT

(Cont.)

HOW TO MASSAGE THE FUNDUS

POSTPARTUM ASSESSMENT

(Cont.)

Assessment of Perineum
Should be pink and no signs of bruising
May be edematous apply ice for comfort and promotion of
vasoconstriction
Assess episiotomy and document
REEDA Acronym
R Redness
E Edema
E Ecchymosis
D Discharge
A Approximation

(edges of wound should be close)

POSTPARTUM ASSESSMENT

(Cont.)

LOCHIA
Scant Blood only on tissue when wiped or
less than 1 inch stain on peripad
Light - Less than 4 inch stain on peripad
Moderate Less than a 6 inch stain on peripad
Heavy - Saturated peripad within 1 hour
Heavy bleeding could be from lacerations, uterine atony or post partum
hemorrhage

POSTPARTUM ASSESSMENT

(Cont.)

POSTPARTUM HEMORRHAGE
PREDISPOSING FACTORS
v
v
v
v
v
v
v
v
v

Multiple gestation
Large infant
Multiparity (5 or more)
Prolonged labor
Use of forceps or vacuum extractor
Cesarean birth
Manual removal of the placenta
Uterine inversion
Placenta previa, placenta accreta or low
implantation

POSTPARTUM ASSESSMENT

(Cont.)

Assess:
Lung sounds, heart sounds and pedal
pulses
Check lower extremities for redness,
swelling, and warmth
Check Homans sign

POSTPARTUM ASSESSMENT

(Cont.)

VITAL SIGNS:
Pulse may be slightly decreased from labor
Pulse > 100 could indicate postpartum hemorrhage
Blood Pressure
May be elevated secondary to pain
If > 140/90 may indicate preeclampsia
If decreased may indicate hypovolemia from
excessive bleeding (postpartum hemorrhage)
Temperature If greater than 100.4, could indicate early
postpartum infection

POSTPARTUM ASSESSMENT

(Cont.)

BREASTFEEDING
BENEFITS
FOR THE INFANT

FOR THE MOTHER

Decreased allergies
Immunologic properties
Decreased incidence of:
Diabetes
Cancer
SIDS
Nutritional needs met
Easily digested
Protein fat and carbs in correct
proportion
No improper dilution issues
Not likely to be contaminated
Less likely to result in overfeeding

Oxytocin released enhanced

involution
Decreased loss of blood menses
delayed
Mother rests during feedings
Reduction of stress hormone levels
Mother more likely to eat properly
Skin-to-skin contact enhances
bonding
Convenient
Economical
Infant less likely to be ill
Risk reduction of some cancers

POSTPARTUM ASSESSMENT

(Cont.)

POSTPARTUM DISCHARGE TEACHING

Uterine massage
Lochia
Involution
Episiotomy care
Care of abdominal incision
Breast care
Bowel/Urinary function
Nutrition
Rest/Exercise
Sexual activity
Contraception
Medications
Emotional responses
Infant care

To A Beautiful Mom

THE
NEWBORN

THE HEALTHY NEWBORN

90% of newborns make a smooth transition to extra uterine
life
10% may need help

WARMTH IS IMPERATIVE get them in the warmer, dry them

off and remove wet linen keep head in a sniffing position
(optimum position of opening the airway)

THE HEALTHY NEWBORN (cont.)

INFANT RADIANT WARMER
On/Off
Switch
Digital temperature display
Skin/Manual switch