Midwifery II (Practicum)

Unit 1: Admission of woman in labour

A. Objectives:

• Confirm whether the woman is in true labour by complete history taking and physical examination.
• Perform vaginal examination to assess of pelvic diameters and adequacy and cervical dilatation.
• Admit the woman in labour by performing the admission procedure.

B. Teaching/Learning Activities:

• The students will be assigned to admission room for developing skills in:
• Taking obstetric history of women for admission
• Performing physical examination: General physical examination, Abdominal examination and assessment of foetal condition
• Vaginal examination to confirm the onset of labor and pelvic adequacy
• Recording/Reporting of the findings
• Admitting women in labor.

C. Resources:

• Learning Guide 10.1: Assessment of the Woman in Labor
• Skills Practice Session 10.1: Assessment of the Woman in Labor

D. Evaluation:

• Day to day performance evaluation
• Checklist 10.1: Assessment of the Woman in Labor

Unit 2: Management of Women in First Stage of Labor

A. Objectives:

• Communicate effectively with women and their families.
• Assess the frequency, duration and strength of uterine contractions.
• Monitor the maternal and foetal condition and progress of labour through out labour.
• Record the findings in the partograph.
• Provide physical and psychological care to the woman in labour.
• Utilize alternative methods of relieving labour pain.
• Helping them to maintain their personal hygiene.
• Encouraging them to maintain position as desired.

B. Teaching/Learning Activities:

• Students will be assigned to first stage labour room for providing care to women in labor:
• Communicating with women and family
• Encouraging women to express their concerns and feelings
• Monitoring of FHS, uterine contractions and descend of fetal head every 30 minutes
• Performing vaginal examination to estimate cervical dilatation
• Recording the time of rupture of membranes and color of amniotic fluid
• Plotting the partograph
• Taking appropriate action if condition deviates from normal
• Providing physical and psychological care to the women in labour

C. Resources:

• Learning Guide 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care)
• Skills Practice Session 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care)

D. Evaluation:

• Performance evaluation
• Checklist 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care)
• Conducting Delivery marking key in BSN Evaluation Scheme

Unit 3: Management of Women in Second Stage of Labor

A. Objectives:

• Perform ongoing assessment of maternal and foetal condition and progress of labour.
• Provide supportive care.
• Prepare the equipment, midwife and woman for conducting delivery.
• Take universal precautions and use correct aseptic techniques for preventing infection.
• Perform restricted episiotomy prior to delivery.
• Conduct normal vaginal deliveries skillfully.
• Resuscitate the asphyxiated newborn.
• Provide immediate care to newborn.

B. Teaching/Learning Activities:

• Encouraging them to empty bladder regularly (every 2 hourly)
• Providing nutrition and hydration
• Students will be assigned in the labor ward to develop skills in:
• Monitoring maternal and fetal condition and progress of labor
• Giving supportive care to the mother including bladder care
• Ensuring that all equipment necessary for delivery and care are ready
• Placing the women in comfortable position
• Washing hands and maintaining universal precautions during delivery
• Performing episiotomy as needed by using checklist
• Conducting normal deliveries.
• Placing baby on mother’s chest for maintaining skin to skin contact
• Performing newborn resuscitation as needed
• Providing immediate care to newborn by using eight steps (SNL manual)

C. Resources:

• Learning Guide 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care)
• Skills Practice Session 10.3: Episiotomy and Repair
• Learning Guide 10.3: Episiotomy and Repair
• Skills Practice Session 11.1: Newborn Resuscitation
• Learning Guide 11.1B: Newborn Resuscitation (Bag and Mask ventilation)

D. Evaluation:

• Performance evaluation by using checklist
• Checklist 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care)
• Checklist 10.3: Episiotomy and Repair
• Checklist11.1B: Newborn Resuscitation (Bag and Mask ventilation)
• Conducting Delivery marking key in BSN Evaluation Scheme

Unit 4: Management of Third Stage of Labour

A. Objectives:

• Perform active management of 3rd stage of labor.
• Examine the placenta and membranes for completeness.
• Examine the genital tract for lacerations and tear.
• Repair the episiotomy/second degree perineal tear and low vaginal tear.
• Estimate the loss of blood as accurately as possible.
• Assess the condition of mother and newborn and provide care following delivery.
• Support the mother in case of fetal abnormalities or perinatal death/still birth.

B. Teaching/Learning Activities:

• In the labor ward students will also develop clinical skills on:
• Administering oxytocin
• Delivering placenta by controlled cord traction (CCT)
• Massaging the uterus
• Examining placenta and membranes and disposing them safely
• Examining genital tract for any laceration and tear
• Repairing episiotomies/tears
• Recording and reporting
• Monitoring the maternal conditions: Vital signs, bleeding and checking for contracted uterus
• Providing nutrition and comfort as require
• Providing counseling to the mother and family as needed

C. Resources:

• Learning Guide 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care)
• Skills Practice Session 10.3; Episiotomy and Repair
• Learning Guide 10.3: Episiotomy and Repair

D. Evaluation:

• Performance evaluation using checklist
• Checklist 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care)
• Checklist 10.3: Episiotomy and Repair
• Conducting Delivery, Episiotomy and Repair of the Perineum marking keys in BSN Evaluation Scheme

Unit 5: Management of Abnormal Labour

A. Objectives:

• Administer oxytocic drug for induction and augmentation of labor.
• Provide care to the women receiving oxytocic drip.
• Assist/conduct breech and instrumental delivery.
• Provide the basic emergency obstetric care as needed by using life saving measures.
• Identify and use various instruments used in midwifery.

B. Teaching/Learning Activities:

• In the labor posting students will also develop clinical skills in:
• Administering oxytocic drug for induction and augmentation of labor
• Monitoring and care of women with oxytocic drip
• Diagnosing malpresentations/malpositions and delivering baby with breech presentation.
• Managing cord presentation and cord prolapse.
• Conducting delivery by using vacuum extractor
• Managing shoulder dystocia
• Identification and use of obstetric instruments

C. Resources:

• Skills Practice Session 16.1: Vacuum Extraction
• Learning Guide 16.1: Vacuum Extraction
• Skills Practice Session 17.1: Breech Delivery
• Learning Guide 17.1: Breech Delivery
• Skills Practice Session 18.1: Managing Shoulder Dystocia
• Learning Guide 18.1: Managing Shoulder Dystocia
• Skills Practice Session 20.1: Managing Prolapsed Cord
• Learning Guide 20.1: Managing Prolapsed Cord

D. Evaluation:

• Performance evaluation
• Checklist 16.1: Vacuum Extraction
• Checklist 17.1: Breech Delivery
• Checklist 18.1: Managing Shoulder Dystocia
• Checklist 20.1: Managing Prolapsed Cord

Unit 6: Management of Postpartum Haemorrhage

A. Objectives:

• Manage postpartum hemorrhage by using different modalities.

B. Teaching/Learning Activities:

• In the labor posting students will also develop clinical skills in managing postpartum haemorrhage by:
• Performing manual removal of placenta in retained placenta
• Using bimanual compression of uterus and abdominal aortic comprehension as needed for postpartum hemorrhage
• Diagnosing and managing vulvar hematoma
• Managing inversion of uterus

C. Resources:

• Skills Practice Session 14.3: Manual Removal of Placenta
• Learning Guide 14.3: Manual Removal of Placenta
• Skills Practice Session 14.1: Bimanual Compression of the Uterus
• Learning Guide 14.1: Bimanual Compression of the Uterus
• Skills Practice Session 14.2: Compression of the Abdominal Aorta
• Learning Guide 14.2: Compression of the Abdominal Aorta
• Skills Practice Session 14.4: Vaginal and Cervical Inspection
• Learning Guide 14.4: Vaginal and Cervical Inspection
• Skills Practice Session 14.5: Repair of Cervical Tears
• Learning Guide 14.5: Repair of Cervical Tears

D. Evaluation:

• Performance evaluation
• Checklist 14.3: Manual Removal of Placenta
• Checklist 14.1: Bimanual Compression of the Uterus
• Checklist 14.2: Compression of the Abdominal Aorta
• Checklist 14.4: Vaginal and Cervical Inspection
• Checklist 14.5: Repair of Cervical Tears
• Checklist for Manual Removal of Placenta marking key in BSN Evaluation Scheme

Unit 7: Recording and Reporting about labour and delivery

A. Objectives:

• Record and report all detail of the birth and care given to the mother and baby during labour and delivery.
• Perform postpartum assessment.

B. Teaching/Learning Activities:

• In the labor posting students will also develop clinical skills in:
• Maintaining accurate report and records
• Partograph
• Census
• Nurses record
• Perinatal death audit form

C. Resources:

• Partographs
• Other records and forms

D. Evaluation:

• Performance evaluation
• Performance Evaluation in Labour Unit, Performance Evaluation in Postnatal Ward marking keys in BSN Evaluation Scheme

Unit 8: Care of Postpartum Mother

A. Objectives:

• Perform postpartum assessment of mothers and identify their needs.
• Provide general care to postpartum mothers.

B. Teaching/Learning Activities:

• Students will be assigned in the postnatal ward for assessing the need of women and providing care accordingly by:
• History taking that includes personal information, daily habit, life style, history of present pregnancy, child birth, general well being during postpartum period
• Performing physical examination of the postpartum mother, including checking temperature, blood pressure and breast examination for nipple condition, milk secretion and any abnormalities
• Assessing fundal height, condition of uterus, lochia and sutures
• Providing general care to postpartum mothers that includes: Hygiene/perineal care, suture care, Support for successful breast feeding, Identification of danger signs and complication readiness, Nutritional support including vitamin A.

C. Resources:

• Skills Practice Session 12.1: Postpartum Assessment (History and Physical Examination) and Care
• Learning Guide 12.1: Postpartum Assessment (History and Physical Examination) and Care

D. Evaluation:

• Peer evaluation
• Performance evaluation using procedure checklist
• Checklist 12.1: Postpartum Assessment (History and Physical Examination) and Care
• Postnatal Examination, Perineal Care marking keys in BSN Evaluation Scheme

Unit 9: Breast Feeding

A. Objectives:

• Assist in successful breast feeding to the newborn.
• Assist mothers for alternative feedings techniques with maternal and newborn problems.

B. Teaching/Learning Activities:

• Clinical practice in postnatal ward also includes assisting mothers for successful breast-feeding, i.e.
• Promotion and support for successful breast feeding e.g. latching, positioning, attachment and suckling
• Assisting and teaching mother for:
• Alternative feeding methods
• Prevention of mother to child transmission (PMTCT) for HIV mothers
• Feeding for babies with harelip and cleft palate

C. Resources:

• Skills Practice Session 11.4: Supporting Successful Breastfeeding
• Learning Guide 11.4: Supporting Successful Breastfeeding

D. Evaluation:

• Peer Evaluation
• Performance evaluation
• Checklist 11.4: Supporting Successful Breastfeeding
• Breastfeeding marking key in BSN Evaluation Scheme

Unit 10: Care of women with Abnormal Puerperium

A. Objectives:

• Assess and identify the problems in postpartum mothers and manage appropriately.
• Identify the major problems/ disorders of the mother during post partum period and intervene appropriately.

B. Teaching/Learning Activities:

• Clinical practice in postpartum ward also includes:
• Managing minor problems of postpartum period:
• After pain
• Constipation
• Retention of urine
• Delayed involution of uterus
• Engorged breast/ cracked nipple, plugged milk tube
• Postpartum blues
• Managing the mother with major problems/ disorders:
• Secondary post partum hemorrhage
• Puerperal sepsis
• Deep vein thrombosis
• Postpartum depression/ psychosis
• Post partum eclampsia
• Care of the postnatal woman with HIV/AIDS
• Mastitis and breast abscess
• Fistula (VVF, RVF)
• Sub-involution of uterus

C. Resources:

• Skills Practice Session 12.1: Postpartum Assessment (History and Physical Examination) and Care
• Learning Guide 12.1: Postpartum Assessment (History and Physical Examination) and Care

D. Evaluation:

• Written assignments, observation of clinical performance
• Checklist 12.1: Postpartum assessment (History and Physical Examination) and Care

Unit 11: Newborn Care

A. Objectives:

• Perform daily assessment of the newborn baby and provide care accordingly.

B. Teaching/Learning Activities:

• In the postnatal ward students will also be provided opportunity to care for newborn babies by:
• Assessing the newborn babies in postnatal ward:
• Rapid assessment for colour, respiration, heart rate, cord bleeding and temperature
• Daily assessment: Examination of newborn and recognition of danger signs
• Providing essential care to newborn including eye care, cord and skin care and baby bath.

C. Resources:

• Skills Practice Session 11.3: Assessment of the Newborn
• Learning Guide 11.3: Assessment of the Newborn
• Skills Practice Session 23.1: Assessment of the Newborn with a Problem
• Learning Guide 23.1: Assessment of the Newborn with a Problem
• Skills Practice Session 23.3: Measuring Body Temperature in the Newborn
• Learning Guide 23.3: Measuring Body Temperature in the Newborn
• Skills Practice Session 23.2: Newborn Eye Care
• Learning Guide 23.2: Newborn Eye Care

D. Evaluation:

• Performance assessment
• Checklist 11.3: Assessment of the Newborn
• Checklist 23.3: Measuring Body Temperature in the Newborn
• Checklist 23.2: Newborn Eye Care
• Checklist 23.1: Assessment of the Newborn with a Problem
• Neonatal Examination, Baby Bath marking keys in BSN Evaluation Scheme

Unit 12: Care of Postpartum Women with Special Needs

A. Objectives:

• Provide care to the women with special needs during the postpartum period.

B. Teaching/Learning Activities:

• Students also use the opportunity to care for postpartum women with special needs by Providing care to the postpartum women with special needs:
• Adolescent mother
• Anemic mother
• Burning urination
• Gender based violence
• Women with malaria infection
• Care of mother with vitamin deficiencies
• Newborn death (loss): Perinatal death audit
• Suppression of lactation
• Care of mother with sexually transmitted infections (STI)

C. Resources:

• Skills Practice Session 12.1: Postpartum Assessment (History and Physical Examination) and Care
• Learning Guide 12.1: Postpartum Assessment (History and Physical Examination) and Care

D. Evaluation:

• Case presentation
• Checklist 12.1: Postpartum assessment (History and Physical Examination) and Care
• Case Presentation marking key in BSN Evaluation Scheme

Unit 13: Health Teaching and Counseling

A. Objectives:

• Provide health teaching to mothers and families.

B. Teaching/Learning Activities:

• In the postnatal ward students will have to provide education to postpartum women by:
• Using lesson plan with IEC materials, flip charts, etc
• Providing health teaching to mothers and families on different topics:
• Complication readiness
• Care of mother and neonate at home
• Prevention of infection to mother and neonate
• Preventing STIs, including HIV
• Danger signs of mother and newborn
• Immunization
• Postpartum contraception (FP)
• Postnatal and pelvic floor exercise
• Food and fluid requirement
• Breast feeding
• Postnatal and perineal hygiene
• Stitch care
• Focused postnatal visit

C. Resources:

• Learning Guide 12.1: Postpartum Assessment (History and Physical Examination) and Care
• Learning Guide 11.3: Assessment of the Newborn
• Learning Guide 11.4: Supporting Successful Breastfeeding

D. Evaluation:

• Performance evaluation
• Checklist 12.1: Postpartum assessment (History and Physical Examination) and Care
• Checklist 11.3: Assessment of the Newborn
• Checklist 11.4: Supporting Successful Breastfeeding
• Postnatal Examination, Perineal Care, Breastfeeding marking keys in BSN Evaluation Scheme

Unit 14: Case Presentations

A. Objectives:

(Not specified in the document)

B. Teaching/Learning Activities:

• Students will select a postnatal mother for clinical presentation.

C. Resources:

• Case Presentation marking key in BSN Evaluation Scheme

D. Evaluation:

• Case Presentation marking key in BSN Evaluation Scheme