Midwifery and Obstetrical Nursing Placement : Third Year ‘Time : Theory - 90 hours Practical - 180 hours Course Description : This course is designed for students to appreciate the concepts and principles of midwifery and obstetrical nursing. It helps them to acquire knowledge and skills in rendering nursing care to normal and high risk pregnant women during antenatal, natal and post natal periods in hospitals and community settings. It also helps to develop skills in managing normal & high risk neonates & participate in family welfare programme Time | Learning Unit__| (Hrs) | Objective Content and Teaching Learning Activities r 3 * Recognis | Introduction to midwifery and obstetrical Nursing ethe # Introduction to concepts of midwifery and trends & obstetrical Nursing issues in | Trends in midwifery and obstetrical nursing midwifer © Historical perspectives and current trends yand © Legal and ethical aspects obstetric > Pre-conception care and preparing for parenthood al © Role of nurse in midwifery and obstetrical care nursing © National policy and legislation in relation to maternal health & welfare © Maternal, morbidity, mortality and fertility rates © Perinatal, morbidity and mortality rates Teaching Learning Activities + Lecture discussion + Explain using Charts and graphs in ¥ * Describe | Review of anatomy & physiology of female the reproductive system and foctal development anatomy * Female pelvis- general description of the bones & joints, ligaments, planes of the pelvis diameters of physiolo the true pelvis, important landmarks, variations in gy of pelvis shape female + Female organs of reproduction - external reproduc genetalia, internal genital organs and their -tive anatomical relations, musculature ~ blood supply, system nerves, lymphatics, pelvic cellular tissue, pelvic peritoneum * Physiology of menstrual cycle ¢ Human sexualityFoetal development Conception co Review of fertilization, implantation (embedding, of the ovum), development of the embryo & placenta at term functions, abnormalities, the foetal sac, amniotic fluid, the umbilical chord, © Foetal circulation, foetal skull, bones, sutures and measurements * Review of Genetics ° Teaching Learning Activities © Lecture discussion * Review with Charts and models i Assessment and management of pregnancy (ante- natal) Normal pregnancy Physiological changes during pregnancy Reproductive system Cardio yaseular system Respiratory system Urinary system Gastero intestinal system Metabolic changes Skeletal changes Skin changes Endocrine system Psychological changes Discom forts of pregnancy Diagnosis of pregnancy Signs Differential diagnosis Confirmatory tests ‘Ante-natal care Objectives ‘Assessment ~ History and physical examination ~ Antenatal Examination ~ Signs of previous child- Soo0000008 ooe000800 birth 9. Relationship of foctus to uterus and pelvis : Lie, Atutude, Presentation, Position © Per vaginal examination * Screening & assessment for high risk: Risk approach© History and Physical Examination Modalities of diagnosts, Invasive & Non- Invasive, ultrasonics, cardiotomo-graphy , NST, cst al preparation 1 counseling Antenatal exercises Diet Substance use Education for chile-birth Husband and families Preparation for sate-confinement Prevention from radiation Psycho-social and cultural aspeets of pregnancy Adjustment to pregnancy Unwed mother ingle parent Teenage pregnut Sexual violenes Adoption ®ooa00*coc0s000* Teaching Learning Activities Lecture Discussion Demonst-ration Case diseussion/ presentation Health talk Practice session ‘Counseling session Supervised Clinical practice Assessment of skills with checklist Assessment of patient management problems Iv Describe the physiolo gyand stages of labour Deseribe the manage ~ ment of women during inntra- ‘Assessment and management of intra-natal period * Physiology ef labour, mechanism of labour © Management of labour © First stage ~ Signs and symptoms of onset of labour, normal & abnormal Duration Preparation of Labour room Woman Assessment & observation of woment in labour ; partogram — maternal and foetal monitoring = Active management of labour, eaeInduction of labour = Pain relief and comfort in labour + Second stage ‘© Signs and symptoms; normal & abnormal 9 Duration Conduct of delivery ; principles and techniques 2 Episiotomy (only if required) Receiving the new born ~ Neonatal resuscttation , initial steps and subsequent resuscitation ~ Care of umbilical cord - Immediate assessment including, sereening for congenital anomalies - Identification - Bonding + Initiate feeding + Screening and transport-tation of the neonate * Third stage © Signs and symptoms; normal & abnormal ce Duration © Method of placental expulsion © Management; Principles and techniques © Examination of the placenta © Examination of perineum * Maintaining records and reports * Fourth Stage Teaching Learning Activities + Lecture Discussion Demonst-ration Case discussion/ presentation Simulated pracuce Supervised Clinical practice Assessment of skills with checklist Assessment of patient management problems Deseribe the physiolo ay of puerperi um Describe the Assesment and management of women during post natal period Normal puerperium, Physiology Duration © Postnatal assessment and management ‘© Promoting physical and emotional well- being © Lactation management © Immunizationmanage © Family dynamics affer child-birth ment of © Family welfare services: methods, counselling ‘women © Follow-up during © Records and reports post- natal | Teaching Learning Activites period Lecture Discussion © Demonstra-tion © Health talk © Practice session ‘© Supervised Clinical practice © Assessment of patient management problems > t of skills with checklist Assessment and management of normal neonates © Normal Neonate © Physiological adaptation, © Initial & Daily assessment © Essential newbom care: Thermal control, © Breast feeding, prevention of infections VI 6 . * Immunization women * Minor disorders of newborn and its management with high] Levels of Neonatal eare (level I, 1, & Hl) tisk * Atprimary, secondary and tertary levels Preanane | Maintenance of Reports and Records Teaching Learning Activities © Lecture Discussion © Demonst-ration © Practice Session © Supervised Clinical practice vi | | = Denile TER ey the Screening and assessment Identifi- © Ultrasonies, cardiotomo-graphy, NST. cation CST, non-invasive & invasive, and © Newer modalities of diagnosis manage~ © High-risk approach ment of * Levels of care; primary, secondary & tertiary women levels with high © Disorders of pregnaney risk ‘© Hyper-emesis gravidarum, bleeding in early pregnane pregnancy, abortion, ectopic y y © Pregnaney, vesicular mole, © Ante-partum haemorrage «Uterine abnormality and displacement© Diseases complicating pregnancy ‘9 Medical and surgtcal conditions 2 Infections, RTUSTD), UTI, HIV, TORCH 9 Gynaecological diseases complicating pregnancy Pregnaney induced hypertension & diabetes, ‘Toxemia of pregnancy, hydramnios, 9 Rh incompatibility co Mental disorders Adolescent pregnancy, Elderly primi and grand multipara Multiple pregnancy Abnormalities of placenta & cord Intra-uterine growth-retarda-tion Nursing management of mothers with high-risk pregnancy © Maintenance of Records and Report wees Teaching Learning Activities © Lecture Discussion * Demonstrate using video films, sean reports, photo graph etc * Case discussion’ presentation © Health talk * Practice Session ‘* Supervised Clinical practice * Assessment of skills with checklist ‘¢ Assessment of skills with cheeklist Vu 10 © Describe ‘manage- ment of abnormal labour © And obstetric al emergencies Abnormal Labour — assessment and management © Disorders in labour © CPD and contracted pelvis © Malpositions and malpresentations © Premature labour, disorders of uterine actions- precipitate labour, prolonged labour © Complications of third stage: injuries to birth canal * Obstetrical procedures and operations, © Presentation and prolapse of cord, Vasa pracvia, amniotic fluid embolism, rupture of uterus, shoulder dystocia, obstretical shock * Obstetrical procedures and operations, ‘9 Induction of labour, forceps, vacuum version, manual removal af placenta, caesarean section, destructive operations Nursing management of women undergoingObstetri-cal operations & procedures Teaching Learning Activities Lecture Discussion Demonstration Case discussion/ presentation Practice Session Supervised Clinical practice Assessment of skills with checklist Assessment of patient management problems ix 4 Describe | Abnormalities during Posinatal Periods manage- # Assessment and management of women with ment of postnatal complications post © Puerperial infections, breast engorgement natal & infections, UTI, thrombos Embolic complica disorders, post-partum haemorrage, tions Eclampsia & subinvelution © Psychological complications ~ Post partum Blues - Post partum Depression = Post partum Psychosis 0 Identify | Assessment and management of High risk newborn the high * Admission of neonates in the neonatal intensive isk care units- protocols neonates | «Nursing management of andtheir | - Low birth weight babies tursing | ~ Infections manage | = Respiratory problems ment = haemolytic disorders = Birth injuries = Malformations © Monitoring of high risk neonates © Feeding of high risk neonates © Organisation & management of neonatal intensive care units * Infection control in neonatal intensive care units # Maintenance of reports and records XI 4 Describe | Pharmaco-therapeutics in obstetrics indicatio | Indication, dosage, action, contra indication & n side effects of drugs dosage, * Effect of drugs on pregnancy, labour & action, puerperium, side © Nursing responsibilities in the administration of effects drug in Obstetrics — oxytocins, antihy-pertensives.and nurses respons bilities nm the adminstr a-tion of drugs used for mothers diuretics, toco-lytic agents, anti-convulsants; # Analgesics and anesthesies in obstetries ¢ Effects of maternal medica-tion on foetus & neonate ‘Teaching Learning Activities Lecture discussion = Drug book Drug presentation XU 10 ‘Apprecia te the importan ce of family welfare program me Deseribe the methods of contrace ption & role of nurse in family welfare program me smily Welfare Programme + Population trends and problems in India * Concepts, aims, importance & history of family welfare programme + National Population: dynamics, policy & education © National family welfare programme; RCH, ICDS, MCH Safe motherhood © Organization & administration at national, state, district, block and village levels * Methods of contraception; spacing, temporary & permanent, Emergency contraception Infertility and sts management Counseling for family welfare Latest research in contraception Maintenance of vital statisties Role of national, international & voluntary organizations Role of'a nurse in family welfare programme Training/Supervision/Collabo-ration with other functionaries in community like ANMs, LHVs, Anganwadi workers, TEAS (Traditional birth altendant- Dai) ‘Teaching Learning Activities Lecture Diseussion Demonstration Practice session Assessment of skills with checklist Assessment of field visits and project reportsMidwifery and Obstet: Placement: Third Year & Fourth Year ‘Time: Practical - 180 hours each in Third year & Fourth Year Clinical Training - 240 hours ‘al Nursing — Practical Area Objectives Skills Assignments | Assessment ‘Methods Antenata | 2 |e Assessment | Antenatal history [* “Conduct |e Verification {clinic of pregnant taking Anteriatal of findings opp women © Physical © Examination | — of Antenatal examination 530 examination © Recording of © Health talk 8 Weight & BP =I © Completion © Hb & Urine © Case book ‘of casebook testing for sugar recordings recordings and albumin Antenatal examination- abdomen and breast Immunization Assessment of risk status © Teaching antenatal mothers © Maintenance of Antenatal records ibour Tle Assess © Assessmentof —f* *Conduct |e Assessment room avomen in women in labour normal of elinical Ow. labour © Pervaginal performance © Carry out ‘examinations & 20 vwith rating per-vaginal interpretation + * Pervaginal scale examinations | ¢ Monitoring & examination |* Assessment = Conduct caring of woman s-5 ofeach skill normal in labour © * Perform & | with deliveries Maintenance of suture the checklists © Perform partograph epi + Completion episioto © Conduct normal siotomies-5 of case book & suture it delivery © Resuscitate recordings © Resuscitaten |e Newbom newborns-5 ewborns assessment & © * Assist © Assist with immediate care with Caesarean | Resuscitation of CaesareanSections, MTP and other surgical procedures newborns Assessment of risk status of newbom. «© Episiotomy & suturing * Maintenance of labour & birth records # Arrange for & assist with, Caesarean section and care for ‘woman & baby during Caesarean * Arrange for and assist with MTP sestions2 © * Witness abnormal deliveries-5 © Assist with MTP & other surgical procedure 1 © Case book recordings and other surgical procedures ‘Post © Providmg [© Examinationand | © * Give care ‘Assessment natal nursing care assess-ment of to Post natal of clinical ward to postnatal | mother and baby mothers -20 | performance mother & Identification of © Health talks Assessment, baby deviations 1 ofeach skill * Counsel & |e Care of postnatal Case study with teach mother | mother and baby Case pre- checklists & family for | «Perineal care sentation -1 Completion parenthood |e Lactation © Case book of case book ‘management recordings recording * Breast feeding Evaluation © Baby bath of case study © Immunization, © ait resentation * reg g Postnatal Co beaks, ‘o Mother education craft sessions © Post natal care & © Exerois es © Immun ization Newborn © Provide + Newborn © Casestudy- [© Assessment nursery nursing care | assessment 1 of climeal tonewbam | * Admission of. © Observation performance‘at risk neonates Feeding of at risk neonates Katori spoon, paladi, tube feeding, total parenteral nutrition ‘Thermal management of neonates-kangaroo mother care, care of baby in incubator Monttoring and care of neonates Administering medications: Intravenois therapy Assisting with diagnostic procedure Assisting with exchange transfusion Care of baby on ventilator Phototherapy Infeetion control protocols in the mursery Teaching & counselling of parents Maintenance of neonatal records study -1 ‘Assessment of each skill swith checklists: Evaluation ofand ‘observation study Family Planning lime Rot tion trom post natal ward | wk Counsel for and provide family welfire services Counselling technique Insertion of LUD Teaching on use of family planning methods Amrange for & Assist with family “UD insertion -5 ‘Observation exercise on ment ofeach skill with checklists Evaluation ofand observation studyPlanning recording & operations reporting - 1 * Maintenance of records and reports * Essential Requirements for registration as midwife * Antenatal examination 30 * Conducting normal deliveries in hospital/home/health centre 2 Vaginal examination 5 Episiotomy and suturing s Neonatal resuscitation $ Assist with Caesarean Section 2 Witness/ Assist abnormal deliveries 5 * Postnatal cases nursed in hospital/home/ 20 health centre * Insertion of 1UD 5 Note; All casebooks must be certified by teacher on completion of essential requirements Clinical Training Obstetrical Nursing Clinical Training Duration - 5 weeks Duration Assessment Area’ | (inweeks)!| —_ Obiertive She Assignment Methods Labour 2 + Provide | © Integra] + Complet |» Assess ward compre ted ion of clinical ' ensive Practic other performane Neonatal care to e essential e.with intensive mothers require rating scale care unit/ 2 and ments © Completion NICU rnconates * Case of case book book ‘Antenatal recordin recordings ss