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TRANSCRIPT
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One-week Certificate Course on Natural Birthing
(For UG, PG Nurses)
CHOITHRAM COLLEGE OF NURSING
SWA – Choithram’s Natural Birthing Centre
Dr. Usha Ukande
PRINCIPAL
Choithram College of Nursing
Convenor – SWA-Choithram’s Natural Birthing
Centre
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PREFACE
Women are designed to give birth naturally and with the benefit of medical and midwifery
supervision to ensure everything is progressing as it should; only a few women will require
medical intervention.
Natural childbirth is both the manifestation and enhancement of woman’s strength and it is
the safest and gentlest choice for mother and child.
During natural childbirth, mother remains alert and mobile. Standing up and walking enhances
the downward descend of the baby by gravity. Pain and discomfort of the birthing process is
reduced with the help of application of alternative therapies such as acupressure, music,
massage, hydrotherapy and by keeping her hydrated and maintaining her energy with oral
fluids and light food nourishment.
As both mother and baby remain alert, therefore the baby can be placed skin to skin
immediately after birth and the baby takes its first breast feed immediately (as the sucking
reflex is maximum at this time). This serves many purposes such as baby gets warmth direct
from the mother (avoiding hypothermia), gets nutrition (avoiding hypoglycaemia) and mother
baby bonding is established. Mother too has the advantage of immediate skin to skin contact
i.e. her third stage is hastened that results in early separation and delivery of placenta and less
post-partum haemorrhage.
For ensuring healthy post-natal period and proper care of the baby, the mother is taught
“mother craft”. She is also taught post-natal exercises and advised upon right diet and healthy
life style.
Continuum of care is assured throughout the pregnancy, childbirth and thereafter through the
post-natal period.
This module is prepared with the vision to facilitate the learner in helping women for making
their body prepared for natural birth with less or no medical interventions, with the help of
evidence based alternative therapies.
- Dr Usha Ukande
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INDEX
S. No
CONTENTS
Page No.
1 ICM competencies 1-7
2 SOMI- Society of Midwives India 8-10
3 MMC- Midwifery model of care 11
4 Introduction: SWA- Choithram’s Natural Birthing Centre
12-13
5 Pre-Conception Care and preparedness 14-16
6 WHO Recommendations of Antenatal Care 17
7 WHO Recommendations on Intrapartum Care 18
8 WHO Recommendations on Postnatal Care 19-21
9 International Mother Baby Childbirth Initiative 22-24
10 Compassion in hospital care staff 25-30
11 Meditation, yoga-asanas exercises & therapies during pregnancy & birthing
31-38
12 Respectful Maternity Care (WRA) 39-40
13 CTG 41-42
14 Let us Sum up 43-54
15 Evaluation & Certification 55-57
16 References for Further readings 58
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INTERNATIONAL
CONFEDERATION OF MIDWIVES
ICM competencies
The international confederation of midwives (ICM) is a federation of midwifery associations
representing countries across the globe. The ICM works closely with the world health
organization, all united nations agencies, and governments in support of safe motherhood and
primary health care strategies for the world’s families. ICM takes the leadership role in
development of the definition of the midwife, and the delineation of the midwifery scope of
practice (the essential competencies).
Key Midwifery Concepts
• Partnership with women to promote self-care and the health of mothers, infants, and
families.
• Respect for human dignity and for women as persons with full human rights;
• Advocacy for women so that their voices are heard and their health care choices are
respected.
• Cultural sensitivity, including working with women and health care providers to
overcome those cultural practices that harm women and babies.
• A focus on health promotion and disease prevention that views pregnancy as a normal
life event.
• Advocacy for normal physiologic labour and birth to enhance best outcomes for
mothers and infants.
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COMPETENCY 1
Midwives have the requisite knowledge and skills from obstetrics, neonatology, the social
sciences, public health and ethics that form the basis of high quality, culturally relevant,
appropriate care for women, new born, and childbearing families.
Knowledge
1. Methods of infection prevention and control, appropriate to the service being provided
2. The midwife has the knowledge and/or understanding of principles of research,
evidenced based practice, critical interpretation of professional literature, and the
interpretation of vital statistics and research findings
3. The concept of alarm (preparedness), resources for referral to higher health facility
levels, communication and transport [emergency care] mechanisms
4. The legal and regulatory framework governing reproductive health for women of all
ages, including laws, policies, protocols and professional guidelines
5. Human rights and their effects on health of individuals (includes issues such as
domestic partner violence and female genital mutilation [cutting])
6. Advocacy and empowerment strategies for women
7. Local culture and beliefs (including religious beliefs, gender roles)
8. Traditional and modern health practices (beneficial and harmful)
Skills and/or Abilities
1. Engage in health education discussions with and for women and their families
2. Use appropriate communication and listening skills across all domains of competency
3. Record and interpret relevant findings for services provided across all domains of
competency, including what was done and what needs follow-up
4. Take a leadership role in the practice arena based on professional beliefs and values
Professional Behaviours
1. The midwife is responsible and accountable for clinical decisions and actions
2. The midwife acts consistently in accordance with professional ethics, values and human
rights
3. The midwife acts consistently in accordance with standards of practice
4. The midwife maintains/updates knowledge and skills, in order to remain current in
practice
5. The midwife behaves in a courteous, non-judgmental, non-discriminatory, and
culturally appropriate manner with all clients
6. The midwife is respectful of individuals and of their culture and customs, regardless of
status, ethnic origin or religious belief
7. The midwife maintains the confidentiality of all information shared by the woman;
communicates essential information between/among other health providers or family
members only with explicit permission from the woman and compelling need
8. The midwife works collaboratively (teamwork) with other health workers to improve
the delivery of services to women and families
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COMPETENCY 2
COMPETENCY 3
Midwives provide high quality, culturally sensitive health education and services to all in
the community in order to promote healthy family life, planned pregnancies and positive
parenting.
Knowledge 1. Cultural norms and practices surrounding sexuality, sexual practices, marriage and
childbearing
2. Components of a health history, family history and relevant genetic history
3. Physical examination content and investigative laboratory studies that evaluate
potential for a healthy pregnancy
Skills and/or Abilities
1. Take a comprehensive health and obstetric, gynaecologic and reproductive health
history
2. Perform a physical examination, including clinical breast examination, focused on the
presenting condition of the woman
3. Order and/or perform and interpret common laboratory tests ( Hematocrit, urinalysis
dipstick for proteinuria)
Midwives provide high quality antenatal care to maximize health during pregnancy and
that includes early detection and treatment or referral of selected complications.
Knowledge
1. Signs and symptoms of pregnancy
2. Examinations and tests for confirmation of pregnancy
3. Implications of deviation from expected fundal growth patterns, including intrauterine
growth retardation/restriction, oligo- and polyhydramnios, multiple foetuses
4. Fetal risk factors requiring transfer of women to higher levels of care prior to labour
and birth
5. Normal psychological changes in pregnancy, indicators of psychosocial stress, and
impact of pregnancy on the woman and the family
6. 6. Safe, locally available non-pharmacological substances for the relief of common
discomforts of pregnancy
7. 7. How to determine foetal well-being during pregnancy including foetal heart rate and
activity patterns
8. 8. Health education needs in pregnancy (e.G., Information about relief of common
discomforts, hygiene, sexuality, work inside and outside the home)
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COMPETENCY 4
9. Basic principles of pharmacokinetics of drugs prescribed, dispensed or furnished to
women during pregnancy
10. Effects of prescribed medications, street drugs, traditional medicines, and over-the-
counter drugs on pregnancy and the foetus
11. Signs, symptoms and indications for referral of selected complications and conditions
of pregnancy that affect either mother or foetus (e.G., Asthma, HIV infection, diabetes,
cardiac conditions, malpresentations/abnormal lie, placental disorders, pre-term labour,
post-dates pregnancy)
12. The physiology of lactation and methods to prepare women for breastfeeding
Skills and/or Abilities
1. Take an initial and ongoing history each antenatal visit
2. Perform a physical examination and explain findings to the woman
3. Take and assess maternal vital signs including temperature, blood pressure, pulse
4. Assess maternal nutrition and its relationship to foetal growth; give appropriate advice
on nutritional requirements of pregnancy and how to achieve them
5. Perform a complete abdominal assessment including measuring fundal height, lie,
position, and presentation
6. Evaluate foetal growth, placental location, and amniotic fluid volume, using ultrasound
visualization and measurement (if equipment is available for use)
7. Listen to the foetal heart rate; palpate uterus for foetal activity and interpret findings
8. Monitor foetal heart rate with doppler (if available)
9. Perform a pelvic examination, including sizing the uterus, if indicated and when
appropriate during the course of pregnancy
10. Perform clinical pelvimetry [evaluation of bony pelvis] to determine the adequacy of
the bony structures
11. Calculate the estimated date of birth
12. Provide health education to adolescents, women and families about normal pregnancy
progression, danger signs and symptoms, and when and how to contact the midwife
13. Teach and/or demonstrate measures to decrease common discomforts of pregnancy
14. Provide guidance and basic preparation for labour, birth and parenting
15. Prescribe, dispense, furnish or administer (however authorized to do so in the
jurisdiction of practice) selected, life-saving drugs (eg, Antibiotics, anticonvulsants,
antimalarials, antihypertensives, antiretrovirals) to women in need because of a
presenting condition
16. Identify deviations from normal during the course of pregnancy and initiate the referral
process for conditions that require higher levels of intervention
Midwives provide high quality, culturally sensitive care during labour, conduct a clean and
safe birth and handle selected emergency situations to maximize the health of women and their
new-borns.
KNOWLEDGE
1. Physiology of first, second and third stages of labour
2. Anatomy of foetal skull, critical diameters and landmarks
3. Psychological and cultural aspects of labour and birth
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COMPETENCY 5
4. Indicators of the latent phase and the onset of active labour
5. Indications for stimulation of the onset of labour, and augmentation of uterine
contractility
6. Normal progression of labour
7. How to use the partograph (i.e Complete the record; interpret information to determine
timely and appropriate labour management)
8. Measures to assess foetal well-being in labour
9. Measures to assess maternal well-being in labour
10. Process of foetal passage [descent] through the pelvis during labour and birth;
mechanisms of labour in various foetal presentations and positions
11. Comfort measures in first and second stages of labour (e.G., Family
presence/assistance, positioning for labour and birth, hydration, emotional support,
non-pharmacological methods of pain relief)
12. Signs and symptoms of complications in labour (e.g. Bleeding, labour arrest,
malpresentation, eclampsia, maternal distress, foetal distress, infection, prolapsed cord)
Skills and/or Abilities
1. Take a specific history and maternal vital signs in labour
2. Perform a focused physical examination in labour
3. Perform a complete abdominal assessment for foetal position and descent
4. Time and assess the effectiveness of uterine contractions
5. Perform a complete and accurate pelvic examination for dilatation, effacement, descent,
presenting part, position, status of membranes, and adequacy of pelvis for birth of baby
vaginally
6. Monitor progress of labour using the partograph or similar tool for recording
7. Provide physical and psychological support for woman and family and promote normal
birth
8. Facilitate the presence of a support person during labour and birth
9. Provide adequate hydration, nutrition and non-pharmacological comfort measures
during labour and birth
10. Stimulate or augment uterine contractility, using non-pharmacologic agents
11. Manage a cord around the baby’s neck at birth
12. Support expectant (physiologic) management of the 3rd stage of labour
13. Inspect the placenta and membranes for completeness
14. Perform fundal massage to stimulate postpartum uterine contraction and uterine tone
15. Provide a safe environment for mother and infant to promote attachment (bonding)
16. Estimate and record maternal blood loss
17. Inspect the vagina and cervix for lacerations
Midwives provide comprehensive, high quality, culturally sensitive postpartum care for
women.
Knowledge
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COMPETENCY 6
1. Physical and emotional changes that occur following childbirth, including the normal
process of involution
2. Physiology and process of lactation and common variations including engorgement,
lack of a milk supply, etc
3. The importance of early breastfeeding for mother and child
4. Maternal nutrition, rest, activity and physiological needs (e.g Bowel and bladder) in the
immediate postpartum period
5. Principles of parent-infant bonding and attachment (e.g. How to promote positive
relationships)
6. Principles of interpersonal communication with and support for women and/or their
families who are bereaved (maternal death, stillbirth, pregnancy loss, neonatal death,
congenital abnormalities)
7. Methods of family planning appropriate for use in the immediate postpartum period
(e.g., Lam, progestin-only ocs)
8. Perform a focused physical examination of the mother
9. Initiate and support early breastfeeding (within the first hour)
Midwives provide high quality, comprehensive care for the essentially healthy infant
from birth to two months of age.
Knowledge
1. Elements of assessment of the immediate and subsequent condition of new-born
(including APGAR scoring system, or other method of assessment of breathing and
heart rate)
2. Principles of new-born adaptation to extrauterine life (e.g, Physiologic changes that
occur in pulmonary and cardiac systems)
3. Basic needs of new-born: established breathing, warmth, nutrition, attachment
(bonding)
4. Advantages of various methods of new-born warming, including skin-to-skin contact
(kangaroo mother care)
5. Characteristics of healthy new-born (appearance and behaviours)
6. Selected variations in the normal new-born (e.g., Caput, moulding, Mongolian spots)
7. Immunization needs, risks and benefits from infancy through young childhood
8. Traditional or cultural practices related to the new-born
9. Principles of infant nutrition, feeding cues, and infant feeding options for babies
(including those born to HIV positive mothers)
10. Signs, symptoms and indications for referral or transfer for selected new-born
complications (e.g., Jaundice, haematoma, adverse moulding of the foetal skull,
cerebral irritation, non-accidental injuries, haemangioma, hypoglycaemia,
hypothermia, dehydration, infection, congenital syphilis
Skills and/or Abilities
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COMPETENCY 7
1. Provide immediate care to the new-born, including drying, warming, ensuring that
breathing is established, cord clamping and cutting when pulsation ceases
2. Assess the immediate condition of the new-born (e.g., Apgar scoring or other
assessment method of breathing and heart rate)
3. Promote and maintain normal new-born body temperature through covering (e.g.,
Blanket, cap), environmental control, and promotion of skin-to-skin contact
4. Provide routine care of the new born, in accord with local guidelines and protocols (e.g.,
Identification, eye care, screening tests, administration of vitamin k, birth registration)
5. Position infant to initiate breast feeding within one hour after birth and support
exclusive breastfeeding
6. Educate parents about normal growth and development of the infant and young child,
and how to provide for day-to-day needs of the normal child
7. Assist parents to access community resources available to the family
Midwives provide a range of individualised, culturally sensitive abortion-related care
services for women requiring or experiencing pregnancy termination or loss that are
congruent with applicable laws and regulations and in accord with national protocols.
Methods of teaching/learning: - Power Point Presentation
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SOCIETY OF MIDWIVES INDIA
(SOMI)
SOCIETY OF MIDWIVES, INDIA
SOMI was born out of urgency to address the Indian women’s needs and rights related
to child birth within the context f a vacuum in specific midwifery service providers.
In 1997 a small group at the academy for
Nursing studies led by Dr. Prakasamma, played a crucial role in spearheading the
coming together of an interested group of nurses.
SOMI was officially launched by the year 2000 & registered in November 2000 at
Hyderabad.
Mission & Objectives
Our mission is to strengthen midwifery and enable midwives to achieve safe
motherhood.
We believe that every woman is entitled to receive care from midwives during her
pregnancy, childbirth and during postnatal period.
We believe that a midwife’s place is with the women.
We advocate for safe, skilled and sensitive care to women, their babies and their
families.
How we work
SOMI has 5600 members across 20 states of India. Currently has 17 chapters and 21
units with headquarter in Hyderabad, India.
SOMI operates through executive body and staff based at Hyderabad.
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President- Dr. Bandana Das
Vice- President- Dr. Sudha Reddy
Secretary- Lt. Col. Mrs. Manomani Venkat
Our Activities
Conferences
Campaigns & Advocacy
Capacity Building Workshop
SOMI Indore Chapter
Society of Midwives, Indore chapter came into existence on 5th May 2005. Its inauguration
was done at Choithram College of Nursing with 14 newly formed members.
Choithram college of nursing opened a new chapter in the history of Indore, The society
of midwives, India, Indore chapter. The inauguration was at Choithram hospital and
research centre on international day of midwives, 5th may 2005.
Dr. Usha Ukande, Principal, CCON and organizing secretary of ‘the society of
midwives, India, Indore Chapter gave brief introduction of the society. In her address,
she dealt with the origin, the achievements, activities and contribution of the society.
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Activities under SOMI
International, National and State Conference and Workshops
Workshops
Skill enhancement
Health camps
Bi-annual SOMI meetings
Day’s celebration
Women’s day
Safe motherhood day
International midwives’ day
Breast feeding week
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MIDWIFERY MODEL OF CARE
Midwifery Model of Care
Midwives Model of Care Is Woman-Centered
The Midwives Model of Care is a fundamentally different approach to pregnancy and
childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-
on care before, during, and after birth. Midwives are health care professionals
specializing in pregnancy and childbirth who develop a trusting relationship with their
clients, which results in confident, supported labor and birth by midwives who are
trained -to provide comprehensive prenatal care and education, guide labor and birth,
address complications, and care for newborns. The Midwives Model of Care is based
on the fact that pregnancy and birth are normal life events
Model of Care Includes:
Monitoring the physical, psychological and social well-being of the mother throughout
the childbearing cycle
Providing the mother with individualized education, counseling, and prenatal care,
continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions and replacing with best practices
Here are six care practices based on the Midwifery Model of Care that these birthing
centers advocate...
* Labour begins on its own
* Freedom of movement throughout labour
* Continuous labour support
* No routine interventions
* Spontaneous pushing in upright or gravity-neutral position
* No separation of mother and baby after birth with unlimited opportunities for
breastfeeding
Identifying and referring women who require obstetrical attention.
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INTRODUCTION TO CHOITHRAM’S
NATURAL BIRTHING CENTRE
SWA- Choithram’s Natural Birthing Centre
Inaugurated on 14th sept 2016 with the goal to return birth to natural birth by empowering
women and family through pre- conception care, pregnancy education classes, parenting
courses and midwifery support. It is running successfully with 82 natural births till now. It is
presently working with the same goal
Concept
Giving the power of birthing back to the woman and the midwife
At Choithram’s “SWA” the woman is given the right to choose her birthing process through
safe, sensitive & skilled care. The team believes in woman’s strength and capability to birth
her baby without unnecessary intervention.
Philosophy
“We believe that women have the right to make choice to have a spontaneous, safe and
supported birth.”
AIM
Our goal will be to provide professional, individualized care to meet the needs of women and
their families through Midwifery Model of Care in a ‘home like’ environment, emphasizing
upon minimal medical intervention
The center is set up for women with uncomplicated pregnancies who are expecting a Natural
birth. Women who choose the birth Centre are more likely to have a normal birth.
• Birth Centre is staffed with experienced team of midwives.
• Midwives support the women throughout their pregnancy and birth.
• They are vigilant enough to recognize if further medical support is needed
• Birth Centre encourage family member to be with the woman in birth Centre to
support her during this special time. We want her to celebrate birth with those who are
close to her.
• Woman’s birthing partner can also stay with her during her first stage and even during
birthing and after the baby is born.
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SWA is recommended for those who:
• Have an uncomplicated pregnancy
• Are in 37-42 weeks into your pregnancy
• Are not anemic
• Have healthy pregnancy
• Have no associated medical conditions.
• Baby has developed normally and is head down
SWA offer Range of Therapies that will ease out from discomfort during first stage (SWA
Bundle)
1. Meditation & Breathing exercises
2. Hydrotherapy
3. Use of birthing ball
4. Selected Acupressure
5. Abdominal effleurage/ Back Massage
6. Specific Yoga Asanas
7. Keeping the woman hydrated enough by giving her fluids and light food
8. Garbh sanskar music
9. Encourage Walking
10. STS & initiation of breast feeding
A responsive health system which focuses on respect for pregnant and birthing women, their
autonomy and choice, confidentiality, quality of care and communication creates an
enabling environment for advancing their well-being. The veil of silence has been broken.
The need for compassionate maternity care that is founded in respect and dignity is now
starkly evident. Professional bodies are already working in “Empowering Women &
Empowering Midwives.Governments need to revise and reframe their policies and allocate
more resources for this cause.
Methods of teaching/learning: - Power Point Presentation
Activity: - ROLE PLAY
Scenario- you are a midwife, a mother with 37 weeks of gestation, mild labour
pain approaches you, how will you counsel the mother?
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PRE-CONCEPTION CARE
AND PREPAREDNESS
SUPRAJA- Creating Conscious Births
Souls are always born into different bodies. They are born throughout many different lifetimes
and may be matched up with the same parents or different ones. Who we are planning to be
with is determined when we are at the “source,” which is the time before we were conceived.
We may not remember the actual decision-making process, but we definitely choose the people
we are meant to be with before birth.
We may get paired with people who help guide us along the way. If you are with a specific
person right now, you might decide to reverse your roles when you get back to the source.
Soul chooses the time and date of birth, as well as the location soul will be born in and whose
family. This happens way before souls are even conceived. Our whole lives are predetermined
from before conception. You may scoff because you don’t remember this happening, but it all
happens while you are in your spirit form. You won’t remember them when you get to this
planet, but those decisions are prominent and your life will be guided by them.
However, this doesn’t mean that soul won’t have free will when it get to this time and place.
Soul can always make any changes that are necessary for life to continue on the right path. We
cannot always design our own destiny and fate, but we can certainly give it a nudge in the
direction we want. Our soul contracts are really just a deal we have made with ourselves when
we were at the source. They are there so that we will continually grow towards a higher state
of awareness and consciousness.
When you have the feeling of meeting the right person, this means part of your soul contract is
likely being fulfilled. It can be quite confusing at first, especially when you don’t realize the
way things work. However, it will start to make much more sense as you experience it over
and over again.
This world can be a very mysterious and amazing place. Everything happens for a reason, even
if you don’t know what that reason is at the moment. Take great comfort in knowing that you
are absolutely carrying out the plans and actions that your spirit wanted before you were born.
Take the time to grow as a person. Learn everything that you can to make your spirit proud.
Search for your soul family while loving the one you have. Remember, you will be back again
someday to experience it all anew.
Sambhuti- The Birth
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Dhyaan Baby
1) Garbh Sankalp- when couples plan for pregnancy all movements are coordinated and
harmonious
a. Pratyana
b. Panchakarma
c. Agnihotra
d. Go puja
e. Brahmacharya
f. Mauna
A. Pratyana-Prayatna means adding more awareness to yatna , being more conscious
about conception to bring conscious population in the world.
B. Panchkarma –Cleansing one’s body before conception, cleansing of emotions, mind
& Soul. It can be done through detoxification, taking nutritious food, avoiding alcohol
and other addictions. Start this procedure before thinking of conception at least 3 months
before.
C. Agnihotram-It is the process of evoking the five purities for one purpose. This will
make the body filled with Ananda means full of light and delight.
D. Go puja- The word GO- means Cow, Light, Earth or expansion. Cow worship must be
performed by the couples, they must go, visit or serve the place where cows are kept,
cow aura contains “Dhanjayay Prana” this Pranay gas helps to push the sperm to get
inside the ova.
E. Brahmacharya
After conception, couple should treat each other as dev and devi, following
brahmacharya as a divine soul is residing in the woman’s womb.
F. Mauna
Man should practice “Mauna” once in a week in order to channelize his energy the
idea of mauna is to drop negative thoughts and talk, drop all actions at all level ,
meditate, remain in silence ,free from chios
Methods of teaching/learning: - Power Point Presentation, Videos
Activity: - An eligible couple comes to you after 8 months of marriage. Now they want
to conceive. How will you prepare them to conceive naturally?
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WHO Recommendations of Antenatal Care
WHO RECOMMENDATIONS
OF ANTENATAL CARE
Pregnancy is a normal physiological process & any intervention offered should have
known benefits & be acceptable to the pregnant women.
Aims of Antenatal Care
Monitoring the progress of pregnancy with minimum interference
Guidance to the expectant mother
Early detection of any deviation from normal
Institution of corrective measures wherever possible
Preparation of the mother for labour & delivery
Prenatal Care
The ideal initial prenatal care visit occurs before conception with a pre-conceptive visit. A pre-
conceptive visit allows modification of behavioural choices, medication, and optimizing
medical concerns before conception.
Nutritional Interventions
Dietary interventions
Iron and folic acid supplements
Calcium supplements
Restricting caffeine, alcohol, tobacco intake
Maternal Assessment
Anaemia
Tobacco use
Substance use
Gestational diabetes mellitus
Foetal Assessment
Daily fetal movement counting
Symphysis-fundal height measurement
Ultrasound scan
Preventive Measures
Tetanus toxoid vaccination
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WHO Recommendations on Intrapartum Care
Interventions for Common Physiological Symptoms
Nausea and vomiting
Heartburn
Leg cramps
Low back and pelvic pain
Constipation
Varicose veins and edema
Woman want a positive childbirth experience that fulfils or exceeds their prior personal
and socio-cultural beliefs and expectations. This includes giving birth to a healthy baby
in a clinically and psychologically safe environment with continuity of practical and
emotional; support from birth companion and kind, technically competent clinical staff.
Most women want a physiological labor and birth, and to have a sense of personal
achievement and control through involvement in decision making, even when medical
interventions ae needed or wanted.
Care Throughout Labour and Birth
Respectful maternity care
Effective communication
Companionship during labour and childbirth
Continuity of care
First Stage of Labour
Definitions of the latent and active first stages of labour
Duration of the first stage of labour
Routine assessment of foetal wellbeing on labour admission
Relaxation techniques for pain management
Oral food and fluid
Maternal mobility and position
Second Stage of Labour
Definitions and duration of second stage of labour
Birth position
Method of pushing
Techniques for preventing perineal trauma
Third Stage of Labour
Prophylactic uterotonics
Delayed umbilical cord clamping
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WHO Recommendations on Postnatal Care
Controlled cord traction
Care of the New-born
Skin to skin contact
Breastfeeding
Vitamin k administration
Delayed bathing
Care of Women After Birth
Uterine tonus assessment
Routine postpartum maternal assessment
Postnatal discharge following uncomplicated vaginal birth
Recommendation 1: Timing of discharge from a health facility after birth
After an uncomplicated vaginal birth in a health facility, healthy mothers and new-borns should
receive care in the facility for at least 24 hours after birth.
Recommendation 2: Number and timing of postnatal contacts
At least three additional postnatal contacts are recommended for all mothers and new-borns,
on day 3 (48–72 hours), between days 7–14 after birth, and six weeks after birth.
Recommendation 3: Home visits for postnatal care
Home visits in the first week after birth are recommended for care of the mother and new-born.
Recommendation 4: Assessment of the baby
The following signs should be assessed during each postnatal care contact and the new-born
should be referred for further evaluation if any of the signs is present: stopped feeding well,
history of convulsions, fast breathing (breathing rate ≥60 per minute), severe chest in-drawing,
no spontaneous movement, fever (temperature ≥37.5 °C), low body temperature (temperature
Recommendation 5: Exclusive breastfeeding
All babies should be exclusively breastfed from birth until 6 months of age. Mothers should be
counselled and provided support for exclusive breastfeeding at each postnatal contact.
Recommendation 6: Cord care
Clean, dry cord care is recommended for new-borns born in health facilities and at home in
low neonatal mortality settings. Use of chlorhexidine in these situations may be considered
only to replace application of a harmful traditional substance, such as cow dung, to the cord
stump.
Recommendation 7: Other postnatal care for the new-born
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• Bathing should be delayed until 24 hours after birth. If this is not possible due to cultural
reasons, bathing should be delayed for at least six hours.
• Appropriate clothing of the baby for ambient temperature is recommended.
• This means one to two layers of clothes more than adults, and use of hats/caps.
• The mother and baby should not be separated and should stay in the same room 24
hours a day.
• Communication and play with the newborn should be encouraged.
• Immunization should be promoted as per existing WHO guidelines.
• Preterm and low-birth-weight babies should be identified immediately after birth and
should be provided special care as per existing WHO guidelines.
Recommendation 8: Assessment of the mother
First 24 hours after birth
All postpartum women should have regular assessment of vaginal bleeding, uterine contraction,
fundal height, temperature and heart rate (pulse) routinely during the first 24 hours starting
from the first hour after birth.
Blood pressure should be measured shortly after birth. If normal, the second blood pressure
measurement should be taken within six hours.
Urine void should be documented within six hours.
Beyond 24 hours after birth:
At each subsequent postnatal contact, enquiries should continue to be made about general well-
being and assessments made regarding the following: micturition and urinary incontinence,
bowel function, healing of any perineal wound, headache, fatigue, back pain, perineal pain and
perineal hygiene, breast pain, uterine tenderness and lochia.
Breastfeeding progress should be assessed at each postnatal contact.
Recommendation 9: Counselling
• All women should be given information about the physiological process of recovery
after birth, and that some health problems are common, with advice to report any health
concerns to a health care professional
• Women should be counselled on nutrition.
• Women should be counselled on hygiene, especially handwashing.
• Women should be counselled on birth spacing and family planning.
• All women should be encouraged to mobilize as soon as appropriate following the birth
Recommendation 10: Iron and Folic Acid Supplementation
Iron and folic acid supplementation should be provided for at least three months.
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Recommendation 11: Prophylactic Antibiotics
The use of antibiotics among women with a vaginal delivery and a third or fourth degree
perineal tear is recommended for prevention of wound complications.
Recommendation 12: Psychosocial Support
• Psychosocial support by a trained person is recommended for the prevention of
postpartum depression among women at high risk of developing this condition.
• A woman who has lost her baby should receive additional supportive care.
Methods of teaching/learning: - Power Point Presentation, videos of positive birthing,
Modules of WHO guidelines
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INTERNATIONAL MOTHER BABY
CHILD BIRTH INITIATIVE (IMBCI)
International Mother Baby Childbirth Initiative
The International Mother Baby Childbirth Initiative (IMBCI) is a unique human-rights and
evidence-based initiative, based on the midwifery model of care. The IMBCI Ten Steps is
based on the results of a survey of birth and breastfeeding organizations in 163 countries and
on input from IMBCO's Technical Advisory Group (TAG), international representatives, and
birth experts all over the world who participated in its construction. IMBCO’s TAG was
comprised of representatives from twenty international agencies including WHO, UNICEF,
UNFPA, JHEIPGO, Save the Children and The White Ribbon Alliance for Safe Motherhood.
Mother-Baby Friendly practices as laid out in the Ten Steps are evidence-based practice
recommendations constructed from the results of the best available research held to gold
standards. They give practice recommendations on the safety, effectiveness of the use of tests,
treatments and interventions. They place an emphasis on maternal experience and are designed
to guide maternity care decisions.
An optimal Mother Baby maternity service has written policies, implemented in education and
practice, requiring that its health care providers:
Treat every woman with respect and dignity, fully informing and involving her in
decision making about care for herself and her baby in language that she understands
and providing her the right to informed consent and refusal.
Possess and routinely apply midwifery knowledge and skills that optimize the normal
physiology of pregnancy, labour, birth and breastfeeding.
STEP 1
STEP 2
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Inform the mother of the benefits of continuous support during labor and birth and
affirm her right to receive such support from companions of her choice, such as fathers,
partners, family members, doulas, or others.
Provide drug-free comfort and pain-relief methods during labor, explaining their benefits
for facilitating normal birth and avoiding unnecessary harm.
Provide specific evidence-based practices proven to be beneficial in supporting the
normal physiology of labor, birth, and the postpartum period.
Avoid potentially harmful procedures and practices that have no scientific support for
routine or frequent use in normal labor and birth.
Implement measures that enhance wellness and prevent illness, emergencies and death of
the mother and/or baby.
Provide access to evidence-based skilled emergency treatment for life-threatening
complications. Ensure that all maternal and newborn health providers have adequate
and ongoing training in emergency skills for appropriate and timely treatment of mothers
and their new borns.
STEP 3
STEP 4
STEP 5
STEP 6
STEP 7
STEP 8
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Provide a continuum of collaborative care with all relevant health care providers,
institutions, and organizations.
Strive to achieve the WHO/UNICEF Baby-friendly Hospital Initiative with the 10 Steps
to Successful Breastfeeding.
STEP 9
STEP 10
Methods of teaching/learning: - Power Point Presentation, Interactive Discussion
Activity: - Demonstrate the pain relief methods during labour
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COMPASSION MODEL OF CARE
FOR MIDWIVES
What They Think It Is, What Gets in Its Way, And How to Enhance It
COMPASSION-is how care is given through relationships based on empathy, respect and
dignity – it can also be described as intelligent kindness and is central to how people perceive
their care.
Building a Model of Compassion
Dr. Senga steel and Dr. Michael Clift (Researchers, Whittington health trust board, London)
conducted a study on their hospital staff in order to assess the understanding of staff regarding
compassionate care, the obstacles interrupting for compassionate care and the ways to promote
compassionate care among staff.
What they did?
Visible leadership Programme (VLP)
Team of senior nurses and midwives met the staff nurses and briefly discussed the presenting
issues of the day before the ordination of scheduled audit of clinical areas in the hospital
In the survey they also asked nurses two questions:
1)What does compassion mean to you?
2) Give an example of when you were involved in a compassionate interaction?
Results
218 nurses answered the compassion question
2 researchers conducted inductive thematic analysis of the data set for a four-month
period.
Themes were constructed that reflected the view of the nurses
constructed a two-part model that described the concept and behaviors of compassion
Then summarized the skills, obstacles and cultivators of compassion
The compassion Model
Visual model of collated themes, both large and small, in response to two questions, producing
a model of the concept of compassion and behaviours.
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The bigger the bubble the more frontline health care staff described that theme. Paler
bubbles represent smaller themes that were similar enough to sit within the larger
themes found
Findings
It seemed clear that compassion involved the generation of feeling as described by words such
as caring and empathy. In terms of how this was done communication and helping were the
most common words
Some staff felt compassion should be given to all patients, all the time- “being constant”
Some staff felt it was more about seeing when a patient is in distress and acting with
compassion at that moment. – ‘acting at the right time’.
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The Model: Concept – 1
The Model: Behaviors – 2
The compassionate care models
On reviewing the models, it was observed the process primarily taking place during compassion was
communication.
It begins with observation and then communication takes place involving listening and helping.
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Obstacles to Compassion
The obstacles to compassion
Several themes of the model aims to establish, what the obstacle to compassion were in
terms of showing compassion to patients, and to their colleagues.
‘Technical Rationality’ relates to the prioritization of technical work and language over care.
The presence of technology such as machines and measuring instruments acted as a barrier
between nurse and patient.
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‘Judgemental Thinking’ refers to situations staff described where they would have less
compassion for a patient whose lifestyle choices they disagreed with.
Example: caring for an alcoholic patient with liver damage. Judgements about behaviour
and whether a person deserves compassion were a clear obstacle to creating the initial feeling
of compassion towards patient suffering.
‘Environment’ refers to the staff support network available in clinical areas which is reflected
as support, respect and good working relation with the team members. It involves physical as
well as social environment.
‘Conflicting priorities’ when working with temporary staff, they were not allowed to do as
much, so the staff nurses would have to add that task to their own workload. Correcting the
mistakes causes conflicts. Consequently, resulting in communication issues.
‘Feelings’ difficult to feel’ compassion because patients had withdrawn due to repeated
interactions with staff that had lacked compassion because of various obstacles.
‘Personal characteristics’ some staff felt that other staff simply did’nt have it, that they were
not naturally compassionate people. They have less knowledge regarding perception of human
behaviour.
True compassion involves listening, making ourselves available and being able to do
something about what we hear. That does not fit in a highly structured fragmented and
standardized service.
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SKILLS OF COMPASSION
Conclusion
Compassion is fundamental to patient care and the need for compassion in practice is as
strong as it has ever been. Nurses, midwives and care staff are in a powerful and influential
position to improve the experience of patients, the quality of care and health outcomes across
the range of health and care sectors.
Methods of teaching/learning: - Power Point Presentation
Activity: - you are a midwife and a mother came with mild labour pain. Converse with
that mother in labour pain using the compassion skills?
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MEDITATION, YOGA-ASANAS
EXERCISES & THERAPIES DURING
PREGNANCY & BIRTHING
MEDITATION, YOGA-ASANAS EXERCISES & THERAPIES DURING
PREGNANCY & BIRTHING
Pranayama
Pranayama is the formal practice of controlling the breath, which is the source of our Prana,
or vital life force.
Anulom-Vilom
• Helps to cure mental problems like Depression, Anxiety, Tension in the period of
pregnancy.
• Most beneficial for breathing related problems like Asthma, maintains B.P etc.
• Improve the working of lungs.
Brahmari
It works on calming the nerves and soothes them especially around the brain and forehead.
The humming sound vibrations have a natural calming effect.
Hamstring Stretching Exercise
• Stretching regularly helps to lengthen muscles to permanently enhance flexibility
• Stretching regularly helps to lubricate your joints so that they move smoothly and
without pain
• Stretching regularly gives you a greater freedom of movement
Palm Tree Pose
• Tadasana gives a good stretch to the arms, chest, abdomen, spine and the legs.
• It creates a sense of physical and mental balance. This sense of balance can be enhanced
if one practices the same with closed eyes.
• Women during early stages of pregnancy can be benefited due to the gentle stretch of
the abdomen.
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Trikonasana
• Helps in Stretches hips, back muscles, chest and shoulders.
• Stretches the spine.
• Give Strength to the thighs, calves and buttocks.
• It also stimulates the nervous system and alleviates nervous depression, strengthens the
pelvic area and tones the reproductive organs.
Warrior Pose
• The standing pose strengthens the muscles of the legs, arms, shoulders, and back, while
stretching the calves, upper body, and groin area.
• Practice Warrior after warming up your body, during the higher intensity portion of
your yoga workout.
Cat –Camel Pose
• Encourages mobility in a stiff spine
• Strengthens the lower back
• Helps lessen lower back pain
• Helps decrease hip pain
• Strengthens the abdominals
• Helps encourage baby to move into ideal birth position
• Helps with round ligament pain
• Strengthens shoulders
Pelvic Rotation
• Toning your tummy, giving a flatter look
• Tightens your pelvic floor muscles
• Organs in the pelvis sit in the right place
• Makes the muscles in your buttocks work more
• Makes the muscles in the sides of your legs work more
• Your back curves are in a neutral position – not too saggy
• Aligns the rest of the body on top of your pelvis – mid and upper back, head and neck
• Your lungs are used more effectively
Goddess Pose
Goddess pose is a prenatal yoga pose designed to strengthen thighs and legs for bearing
down and delivery. Practice this pose during every trimester of pregnancy to prepare for
childbirth and connect with your baby.
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Butterfly Pose
• Titli Asana is Best exercise for relaxing and stretching the thighs.
• Titli Asana helps to open up the hips and thighs and improves flexibility.
• Titli Asana is a nice stretch for relieving stress and tiredness.
Pranayam Anilom-Vilom
Brahmari Hamstring Stretching
Palm tree pose
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Trikonasana warrior pose
Cat-camel pose
Hip rotation Goddess pose
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Butterfly pose
Acupressure Therapy to Relive Pain and Enhance Cervical Dilatation
We offer Range of Therapies that will ease out from discomfort during first stage (SWA
Bundle)
1. Meditation & Breathing exercises
2. Hydrotherapy
3. Use of birthing ball
4. Selected Acupressure
5. Abdominal effleurage/ Back Massage
6. Specific Yoga Asanas
7. Keeping the woman hydrated enough by giving her fluids and light food
8. Garbh Sanskaar music
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9. Encourage Walking
10. STS & initiation of breast feeding
Meditation
• Helps mother throughout pregnancy & especially at birth to relieve stress and anxiety.
• Also gives her quality sleep.
Walking with Birth Companion
Walking and upright positions in the first stage of labour reduces the duration of labour,
the risk of caesarean birth, the need for epidural , and does not seem to be associated with
increased intervention or negative effects on mothers' and babies' wellbeing.
Squatting
• It encourages and strengthens the intensity of contractions, while relieving back
pressure.
• It may also reduce the need for episiotomy, as it actually helps relax and stretch the
pelvic floor muscle.
• Squatting should be practiced during pregnancy to help strengthen your legs
for squatting during birth.
Back Massage
• It is natural pain relief, massage can be helpful – especially during the first stages of
labor.
• They lift your mood and help to ease the pain of contractions.
• Massage during labor also has been known to reduce anxiety, making expectant moms
feel more at ease and able to cope better.
Grabh Sanskar
Garbh sanskar are not only to educate unborn child but also helps in active birth, better at
breastfeeding and bond with parents better for the mother-to-be for the momentous event
of childbirth.
Birthing Ball Exercises
• Helps to reduce back pain & make it easier for woman to move around.
• It can also help ease labor pain, reduce the pain of contractions.
• Shorten the first stage of labour.
• Help woman to adopt different upright positions.
Perineal Massage
• It increases the elasticity of the perineum.
• It improves the perineum's blood flow and ability to stretch more easily and less
painfully during the birth of the baby.
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• Tears in the perineum are less likely and the woman less likely to need an episiotomy.
Nipple Stimulation
• Nipple stimulation is used to naturally induce labor, speed up pre-labor and help the
uterus contract back down after the birth.
• Nipple stimulation can also be used during labor to strengthen contractions.
• Nipple stimulation may be advised for laboring women who find that their contractions
have slowed or stopped.
Hydrotherapy
Physiological and psychological benefits include:
• Ease of movement with greater mobility due to buoyancy.
• Relaxation during and between contractions.
Hydration
• Labor is considered to be a demanding exercise, during labor.
• It is necessary to stay hydrated during labor, so woman should be allowed to take fluids
orally like juices, tea, water.
Deep Breathing Exercise
• Pranayama is the formal practice of controlling the breath, which is the source of our
Prana, or vital life force.
• Helps to cure mental problems like Depression, Anxiety, Tension in the period of
pregnancy.
• Most beneficial for breathing related problems like it maintains B.P .
• Improve the working of lungs.
Li 4
Helps to reduce pain perception and cervical dilatation as well
Sp6
Helps to reduce pain perception and cervical dilatation as well
Methods of teaching/learning: - Power Point Presentation, Demonstration
Activity: - Demonstrate all the antenatal exercises according to trimester?
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RESPECTFUL MATERNITY
CARE
RESPECTFUL MATERNITY CARE FOR HEALTHCARE WORKERS: Tackling
Disrespect & Abuse During Facility-Based Childbirth
Respectful Maternity care refers to care organized for and provided to all women in a manner
that maintains their dignity, privacy and confidentiality, ensures freedom from harm and
mistreatment, and enables informed choice and continuous support during labour and
childbirth – is recommended.
Categories of Disrespect and Abuse
• Physical Abuse
• Non-Dignified Care
• Non-Consented Care
• Non-Confidential Care
• Discrimination
• Abandonment or Withholding of Care
• Detention in Facilities
Category of Disrespect and Abuse i Corresponding Right
1. Physical abuse Freedom from harm and ill treatment
2. Non-consented care Right to information, informed consent and
refusal, and respect for choices and preferences,
including companionship during maternity care
3. Non-confidential care Confidentiality, privacy
4. Non-dignified care (including verbal
abuse)
Dignity, respect
5. Discrimination based on specific
attributes
Equality, freedom from discrimination, equitable
care
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6. Abandonment or denial of care Right to timely healthcare and to the highest
attainable level of health
7. Detention in facilities Liberty, autonomy, self-determination, and
freedom from coercion
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CARDIOTOPOGRAPHY
CTG is a technical means of recording the foetal heartbeat and the uterine contractions during
pregnancy. The machine used to perform the monitoring is called a cardiotocograph, more
commonly known as an electronic foetal monitor (EFM).
Normal CTG
• The FHR classified by four features
• baseline rate,
• baseline variability,
• accelerations
• decelerations
Uterine contractions
• Frequency-The CTG normally records the frequency of the contractions via a
pressure transducer applied to the maternal abdomen
• strength can be measured but requires the insertion of a pressure catheter into
the uterine cavity. This is no longer common practice
Baseline
The FHR in between periodic changes is called the baseline FHR.
• The normal baseline FHR varies between 100-160 bpm.
• A baseline FHR of 161-180 bpm is non-reassuring.
• A baseline FHR of <100 or >180 bpm is classified as an abnormal feature.
• A stable baseline fetal heart rate between 90 and 99 beats/minute with normal baseline
variability (having confirmed that this is not the maternal heart rate) may be a normal
variation.
Baseline variability
• This is the difference between the upper and lower limits of the baseline heart rate over
a short period of time, for example, over one minute.
• Variability between 5 and 25 bpm is considered ‘reassuring’. Reduced variability of <5
bpm can be physiological during periods of fetal sleep.
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• Variability of <5 bpm is considered a non-reassuring feature if it lasts between 30 to 90
minutes.
• A variability of <5 bpm for more than 90 minutes is an abnormal feature.
Accelerations
• An acceleration is a transient increase in FHR of at least 15 bpm above the baseline
which lasts for at least 15 seconds (in the term fetus).
• The presence of accelerations is a reassuring feature and indicates fetal wellbeing.
• Accelerations are an essential feature of a non-labouring CTG
• In labour the fetus may preserve energy by reducing its movements. Therefore, the
absence of accelerations in labour is common and is of no known clinical significance.
Decelerations
• Decelerations are defined as a fall from the baseline rate of at least 15 bpm, lasting for
at least 15 seconds.
• Decelerations are classified as early, late and variable according to their timing with
respect to contractions. The duration, depth and recovery time are also important in
characterising them.
• Early decelerations have been associated with head compression in labour.
• Late decelerations are more indicative of fetal hypoxia.
• Variable decelerations are commonly seen with cord compression.
Hints to Optimize CTG use for Intrapartum Monitoring
• Normal baseline variability & accelerations indicate fetus in good health & ensure fetal
well-being for about three hours.
• Periodic reduced variability may indicate fetal sleep pattern but if lasts for more than
30 minutes or associated with decelerations even if shallow; should be considered
suspicious
• It is important to remember that CTG cannot predict acute hypoxia so regular
monitoring is important despite reassuring admission CTG .
• Along with abnormal trace if there is associated complicating factor like thick
meconium, IUGR or amnionitis fetal hypoxia develops faster.
• In preterm infant hypoxia worsens other complications like HMD, ICH, so early action
should be taken with non-assuring CTG
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LET’S SUM UP
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46
TRIMESTER WISE GIDELINES
DURING PREGANANCY
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INTRODUCTION: Perineal trauma is a common experience in women giving vaginal birth.
So among the preventive measures, antenatal perineal massage and warm compress is an effective and
feasible strategy which is simple, inexpensive, and apparently harmless. Women are commonly
experiencing perineal trauma during their first delivery. And it is predicted that more than 85% of
women who deliver vaginally will have perineal trauma and 60-70% of these needs surgical repair
(Wong L.K., 2011)
OBJECTIVES OF THE STUDY 1. To assess the effectiveness of perineal massage on the rate of episiotomy and degree of perineal
tear among primigravida women.
HYPOTHESES H1: There is significant difference in the rate of episiotomy and degree of perineal tear after Perineal
Massage and Warm Perineal Compresses at the level of p < 0.05.
ASSUMPTIONS
Application of Perineal Massage and Perineal Warm Compresses in the first and second stage of labour
will significantly reduce perineal trauma.
DESIGN: : Randomised control trial
SETTING : Govind Vallabh Pant & Kasturba Gram Hospital, Indore
SAMPLING TECHNIQUE : Randomised Sampling Technique
SAMPLE : Primigravida mothers
SAMPLE SIZE : 30 samples
TOOL : Tear Assessment Checklist
Conclusion :This study leads to the conclusion that application of some of the preventive techniques
like Perineal Massage and Warm Perineal Compresses during antenatal and Intranatal period of a
primigravida women is highly beneficial for improving the strength and elasticity of the perineum and
hence reduces the rate of perineal tear and need of routine episiotomy during 2nd stage of labour.
Thus, the midwives should adopt these techniques as a routine practice for the promotion of normal
vaginal delivery without any perineal trauma. Diagram 1: On comparison of perineal massage group(g1), warm perineal compresses group(g2)and control
group(g3)
Effectiveness of Perineal Massage versus Warm Perineal Compresses on the
rate of episiotomy & degree of perineal tear
Researcher: Ms Athira Ashok
Guide: Prof. Varsha Hariharan
MEAN
SD
0
5
PERINEALMASSAGE
GROUP(G1)
WARM PERINEALCOMPRESSESGROUP(G2)
CONTROLGROUP(G3)
MEAN
SD
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INTRODUCTION
There are many alternative therapies which can be used for progress of labour without using
medicalization such as acupressure, hydrotherapy etc. Nipple stimulation is one of the
alternative method for progress of cervical dilatation during first stage of labour .
OBJECTIVES
To assess the progress in cervical dilatation among primi gravida woman after giving nipple
stimulation during 1st stage of labor in experimental group.
METHODOLOGY
Research design: Quazi-experimental design
Research setting: Christian mission hospital
Sample size: 30
Sampling technique: purposive sampling
HYPOTHESIS
H1: There is a significant difference on cervical dilatation among primi gravida woman of
experimental group as compared to control group at the level ( P≤0.05).
FINDINGS
Assessment of cervical dilatation first observation after giving a nipple stimulation
CONCLUSION
Nipple stimulation found to be very effective in dilatation of cervix and reduces the rate of
induction of labour without any medication.
LET’S SEE OUR PROGRESS
0
5
10
15
0-3 CM 4-7 CM >7 CM
Chart Title
EXPERIMENTAL CONTROL
“An Experimental study to evaluate the effectiveness of nipple stimulation on
cervical dilatation during first stage of labour among primi gravida woman in
selected Hospitals of Indore in the year 2016-17.”
Researcher: Ratna Parmar, Mrs Prachi Awasthi
56
1. Enlist few therapies and three acupressure points used during first stage
of labour for reducing pain perception?
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2. Enlist few yogasanas and exercises that can be advised in 2nd trimester?
YOGASANAS EXCERCISES
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3. Write 5 points of evidence Based Care & WHO Recommended Standards
In Midwifery Care?
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4. Which acupressure point would you use to reduce nausea and vomiting?
……………………………………………………………………………
5. What is the best position that a mother should adopt during active stage
of labour and why?
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6. Write \few points of International Mother Baby Childbirth Organization?
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7. Enlist the 7 competencies of International Confederation of Midwives
(ICM)?
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8. Enumerate the four parameters seen in CTG?
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9. Enlist few universal rights of child bearing women?
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10. Interpret this CTG
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