Maternity Care Basics

APGAR Score

• The APGAR score is a quick assessment of a newborn's health.
• It's given at 1 minute and 5 minutes after birth.
• Scores are given for appearance, pulse, grimace, activity, and respiration.
• A score of 7-10 is normal, 4-7 requires some resuscitative measures, and 3 or below requires immediate resuscitation.

Birth Weight

• Full-term babies are born between 37 and 41 weeks of pregnancy.
• The average weight for full-term babies is about 7 pounds (3.2 kg).
• Very small and very large babies are at greater risk for problems.

The Transition Phase

• Contractions reach their peak intensity every 2-3 minutes, lasting 60 to 70 seconds.
• Cervical dilation reaches 8 to 10 cm.
• Intense discomfort, nausea, vomiting, and loss of control may occur.
• The urge to push usually begins.

The Second Stage

• From full dilatation and cervical effacement to birth of the infant.
• Contractions change to an uncontrollable urge to push.
• The fetal head pushes against the vaginal introitus, causing it to open.
• Fetal scalp appears at the vaginal opening and enlarges from the size of a dime to a half-dollar, known as "crowning".

The Third Stage

• Known as the placental stage.
• Begins with birth of the infant and ends with the delivery of the placenta.
• The uterus can be palpated as a firm, rounded mass below the umbilicus.
• Uterine contractions begin again, and the uterus contracts to a discoid shape.

Placental Separation

• Occurs approximately 5 minutes after birth.
• Signs include lengthening of the umbilical cord, sudden gush of blood from the vagina, placenta visible at the vaginal opening, and uterus contracting and feeling firm again.

Placental Expulsion

• The fetal side of the placenta is shiny due to the apposed amniotic membrane (Schultze mechanism).
• The maternal side is dull and subdivided into as many as 35 lobes (Duncan mechanism).

Puerperium (Postpartum Period)

• Refers to the 6-week period after childbirth.

Fourth Stage

• Refers to the first 4 hours after delivery, during which the focus is on maternal stabilization and recovery, including vital signs monitoring, uterine contraction assessment, and postpartum bleeding management.

Psyche-Emotional State During Birth

• Childbirth classes, anticipatory guidance, and continuous labor support can aid psychological adaptation to labor.

Subcutaneous Implants

• Non-biodegradable implants filled with synthetic progesterone, embedded under the skin of the upper arm.
• Slowly release progestin over 3 years.
• Suppress ovulation, thicken cervical mucus, and change the endometrial lining, making implantation difficult.

Transdermal Patch (Estrogen/Progesterone)

• Worn on the skin, releases estrogen and progestin into the bloodstream.
• Thickens cervical mucus and suppresses ovulation.
• A safe and convenient birth control method if used correctly.

Intramuscular Injections (Depo-Provera)

• Single injection every 12 weeks inhibits ovulation.
• Advantages include long-term reliability.
• Disadvantages include weight gain, headache, depression, irregular menses, and loss of bone mineral density.

Intrauterine Devices (IUDs)

• Small T-shaped device inserted into the uterus through the vagina.
• May contain copper or progesterone.

Barrier Methods

• Place a chemical or latex barrier between the cervix and sperm to prevent fertilization.

Spermicides

• Agents that kill spermatozoa before they can enter the cervix.

Vernix

• Thick, waxy substance that covers the skin of newborns, protecting them in amniotic fluid.
• Washes off during the first bath.

Neuromuscular System

• Newborns demonstrate neuromuscular function by moving extremities, controlling head movements, exhibiting a strong cry, and displaying newborn reflexes.

The Blink Reflex

• Protects the eye from objects coming near it by rapid eyelid closure.
• Elicited by shining a strong light into the eye.

The Rooting Reflex

• A basic survival instinct that helps a baby find and latch onto a bottle or breast to feed.
• Elicited by gently stroking the corner of the baby's mouth.

The Sucking Reflex

• Elicited by touching the roof of the baby's mouth.
• Starts around the 32nd week of pregnancy and is fully developed by 36 weeks.
• Premature babies may have a weak sucking reflex.

The Swallowing Reflex

• Initiated when food, liquid, or saliva reaches the baby's throat.
• Integrated by 12-18 months.
• Serves as a defensive airway reflex.

The Extrusion Reflex

• Pushes solid food out of the mouth using the tongue.
• Protects the baby from new textures.
• Fades at 4 months.

The Palmar Grasp Reflex

• Present at birth and persists until 4 to 6 months of age.
• When an object is placed in the infant's hand, their fingers close tightly around it.
• The grip is strong but unpredictable.

Carbohydrates

• Provide energy for a growing baby.
• The primary energy source for babies.
• Found in breast milk and foods like rice, bread, and sweet potato.

Protein

• Building blocks of muscles and helps build and repair tissues.
• Responsible for the production of hormones for growth and development.
• Found in breast milk, eggs, legumes, lean meat, chicken, and fish.

Fat

• Supplies energy, allows the absorption of fat-soluble vitamins, and helps with brain development.
• Found in breast milk, butter, vegetable oil, and fatty fish.
• Limit intake as excess fat can cause problems.

Vitamins A, D, E, and C

• Important vitamins that regulate body functions and promote growth and development.
• Vitamin A is critical for vision, healthy skin, and a healthy immune system.
• Vitamin D is essential for bone formation and calcium and phosphorus absorption.
• Vitamin E protects vitamin A and prevents tissue breakdown.
• Vitamin C forms collagen for bone, cartilage, blood vessel, and connective tissue development.
• Found in breast milk, fruits, and vegetables.

B Vitamins

• Include vitamin B1, B2, B6, B12, niacin, thiamine, and folate.
• Important for various metabolic processes, including energy production, cell growth, and nervous system function.
• Found in breast milk, meat, poultry, fish, eggs, dairy products, whole grains, and leafy green vegetables.