Midwifery I (Practicum)

Unit 1: Antenatal Assessment

A. Objective:

• Communicate effectively with the pregnant woman during the antenatal assessment.
• Set up the antenatal clinic in the health facility.
• Take health history of the pregnant woman in detail.
• Calculate expected date of delivery (EDD) and period of gestation (POG).
• Perform head to toe examination including abdominal exam of the pregnant woman and monitor fetal growth.

B. Teaching/Learning Activities:

Students will be assigned in antenatal clinic (ANC) and in the community health facility for:

1. Communicating effectively
2. Setting up of Antenatal clinic
3. Taking health history in detail
4. Calculating EDD and POG
5. Conducting head to toe and obstetric examination of pregnant women including identification of lie, presentation and position, and monitoring of fetal growth

C. Resources:

• MNH LRP Modules 6, 9
• Learning Guide 6.1: Basic Counseling Skills
• Skills Practice Session 6.1: Basic Counseling Skills
• Skills Practice Session 9.1: Antenatal Assessment and Care
• Learning Guide 9.1: Antenatal Assessment (History and Physical Examination) and Care
• Skills Practice Session 9.2: Pelvic Examination
• Learning Guide 9.2: Pelvic Examination
• Skills Practice Session 9.3: Antenatal Physical Examination
• Reference Manual: Basic Maternal and Newborn Care. Chapters 3,3
• National Maternity Care Guidelines, Chapter 1, 2 and 3

D. Evaluation:

• Performance evaluations using checklist
• Checklist 6.1 Basic Counseling Skills
• Checklist 9.1: Antenatal Assessment History and Physical Examination and Care
• Checklist 9.2: Pelvic Examination
• Assessment of Pregnant Woman marking key in BSN Evaluation Scheme

Unit 2: Antenatal Screening Tests

A. Objective:

• Prepare for/ perform antenatal screening tests.

B. Teaching/Learning Activities:

1. Students will prepare the pregnant women for/ carry out various screening tests:
   • Hemoglobin and blood grouping
   • Urinalysis for albumin and sugar
   • VDRL
   • Rapid HIV test with confirmation
   • Bedside clotting test
   • Others (according to facility level)

C. Resources:

• MNH LRP Module 9
• Skills Practice Session 9.4: Hemoglobin Test
• Learning Guide 9.4: Hemoglobin Test
• Skills Practice Session 9.5: Urine Test for Protein
• Learning Guide 9.5: Urine Test for Protein

D. Evaluation:

• Performance evaluation using checklist
• Checklist 9.4: Hemoglobin Test
• Checklist 9.5: Urine Test for Protein
• Assessment of Pregnant Woman marking key in BSN Evaluation Scheme

Unit 3: Health Education

A. Objective:

• Give health teaching to the pregnant women and family members regarding care during pregnancy and preparation for childbirth.
• Provide HIV counseling to pregnant women.

B. Teaching/Learning Activities:

1. Students will select appropriate topics and provide health teaching to the pregnant women in ANC
   • Nutrition support
   • Birth preparedness and complication readiness plan
   • Self care and other health practices (food taboos and beliefs)
   • Immunization and other preventive measures
   • Return visits (4 minimum visits in total)
   • Danger signs of pregnancy
2. Students will provide HIV counseling for PMTCT

C. Resources:

• MNH LRP Module 7
• WHO Safe Motherhood Midwifery Module-Session 10-The Midwife in the Community
• Government of Nepal National HIV/AIDS Strategic Plan 2006-2011

D. Evaluation:

• Performance evaluation using checklist after discussion of key topics
• Health Teaching marking key in BSN Evaluation Scheme

Unit 4: Management of Vaginal Bleeding During Pregnancy

A. Objective:

• Provide nursing care to pregnant women with vaginal bleeding (early as well as late bleeding), including:
• Perform/assist in manual vacuum aspiration (MVA)
• Provide assist in post abortion care and comprehensive abortion care

B. Teaching/Learning Activities:

1. Students will manage pregnant women with vaginal bleeding
   • Rapid initial assessment
   • Establishment of I/V line
   • Management of women with vaginal bleeding in early pregnancy.
   • Post abortion care (PAC) and comprehensive abortion care (CAC)
   • Ectopic pregnancy
2. Students will manage bleeding in late pregnancy: Placenta previa & abruptio Placenta
   • Rapid initial assessment
   • Blood transfusion
   • Bedside clotting test
   • Life saving skills

C. Resources:

• MNH LRP Module 13
• Learning Guide 13.5: Postabortion care (Manual Vacuum Aspiration [MVA])
• Learning Guide 13.6: Postabortion Family Planning Counseling

D. Evaluation:

• Peer practice with learning guide
• Evaluation using checklist
• Checklist 13.5: Postabortion care (Manual Vacuum Aspiration [MVA])
• Checklist 13.6: Postabortion Family Planning Counseling

Unit 5: Management of Pregnancy Induced Hypertension (PIH): Pre-eclampsia and Eclampsia

A. Objective:

• Identify and take appropriate action for the management of PIH, pre-eclampsia -and eclampsia.

B. Teaching/Learning Activities:

• Students will recognize and manage PIH /pre-eclampsia / Eclampsia
• Use of anti convulsive and antihypertensive drugs
  • Magnesium sulfate
  • Diazepam (if magnesium sulphate not available)
  • Nifedepine
  • Hydralazine
• First line management

C. Resources:

• MNH LRP Module 15
• Skills Practice Session 15.1: Management of Severe Pre-Eclampsia and Eclampsia
• Learning Guide 15.1: Management of Severe Pre-Eclampsia and Eclampsia
• Learning Guide for Antihypertensive Drugs
• Reference Manual: Managing Complications in Pregnancy and Childbirth, S-35 to S-56

D. Evaluation:

• Performance evaluation
• Checklist 15.1: Management of Severe Pre-Eclampsia /Eclampsia

Unit 6: Medical Disorders during Pregnancy

A. Objective:

• Identify and manage the pregnant women with medical complications.

B. Teaching/Learning Activities:

1. Students will recognize and manage women with:
   • Severe anemia, cardiac diseases, diabetes, jaundice and urinary tract infections and others

C. Resources:

• (No resources listed in the document for this unit)

D. Evaluation:

• Performance evaluation

Unit 7: High Risk Pregnancies

A. Objective:

• Identify the risk cases and make referrals.

B. Teaching/Learning Activities:

1. Students will identify and refer for:
   • Rh incompatibility
   • Multiple pregnancy
   • Malpresentations / malpositions
   • Previous uterine surgery- scarred uterus
   • Other infections which may need higher level of care including active Hepatitis B or HIV/AIDS
   • Associated medical disorders

C. Resources:

• Reference Manual: Managing Complications in Pregnancy and ChildbirthC, -79-C-80

D. Evaluation:

• Performance evaluation

Unit 8: Documentation of Care

A. Objective:

• Maintain proper documentation of the related cases.

B. Teaching/Learning Activities:

1. Students will record and report the gynecological and prenatal care provided.

C. Resources:

• Midwifery I and II Clinical Logbook
• ANC Cards and Registers

D. Evaluation:

• Performance evaluation

Unit 9: Clinical Case Presentations

A. Objective:

• (No objectives listed in the document for this unit)

B. Teaching/Learning Activities:

1. Students will select one high-risk pregnant woman for clinical presentation.

C. Resources:

• Clinical Case Presentation marking key in BSN Evaluation Scheme

D. Evaluation:

• Clinical Case Presentation marking key in BSN Evaluation Scheme