Midwifery II (Theory) Syllabus
Also Read: Midwifery I (Practicum) – BSN 18 Syllabus
Course Description
This course enables students to acquire in-depth knowledge about the care of women with normal and abnormal labor and puerperium including the life saving measures.
Course Objectives
At the end of this Midwifery II (Theory) course, the student will be able to:
Unit 1: Introduction to Labor
- Define the terminologies used in labor and puerperium.
- Discuss labor in terms of its onset, signs, normal course and duration.
- Explain the factors that affect labor.
- State the different landmarks of foetal skull and their effect on labor.
- Describe the pain relief measures during labor.
Unit 2: Physiology and Management of First Stage of Labor
- Discuss the procedure for admitting a woman in labor.
- Describe the physiological changes during the first stage of labor.
- Describe the management of first stage of labor.
- Discuss the ongoing assessment during labor including vaginal examination.
- Discuss partograph and its importance in monitoring labor.
- Describe maternal and fetal distress and actions to be taken including referral.
Unit 3: Physiology and Management of Second Stage of Labor
- Describe the physiological changes during the second stage of labor and its signs and symptoms.
- Explain the mechanism of the passage of foetus through the pelvis and birth canal.
- Describe the management of woman during the second stage of labor.
- Describe the preparation to be made for delivery.
- Describe the steps of conducting the vaginal delivery of baby.
- Describe the concept of restricted episiotomy and its indications and methods.
- Describe the care of the neonate at birth.
- Explain the extra-uterine adaptation of newborn.
- Discuss the essential care of newborn at birth.
- Describe the process of resuscitation of an asphyxiated newborn.
- Describe the correct technique of bag and mask ventilation.
Unit 4: Physiology and Management of Third and Fourth Stages of Labor
- Explain the physiology of third stage of labor.
- Demonstrate active management of third stage of labor.
- State the importance of examination of genital tract and placenta and membranes method of estimating blood loss.
- Demonstrate the technique of repairing episiotomy and/or perineal and vaginal tear.
- Discuss the care of mother and newborn in the labor room following delivery.
Unit 5: Drugs used in Labor
- Discuss the various drugs used in labor including their route, actions, side effects and nursing considerations.
Unit 6: Malpositions & Malpresentations
- Discuss the malpositions and malpresentations of the fetus and their management.
- State the technique of conducting a breech delivery.
Unit 7: Obstetric Emergencies
- Discuss the concept of essential and emergency obstetric care.
- Describe the various obstetric emergencies and their life saving measures.
- Describe the steps to be used in manual removal of retained placenta.
- Explain the procedure of evacuating a hematoma.
Unit 8: Abnormal Labor
- Describe abnormal labor.
- Explain the pre-term and post-term labor and responsibility of the midwife in their management.
- State the risks associated with premature rupture of membranes.
- Describe the abnormal uterine contractions and their effect on labor.
- Discuss the causes and effects of prolonged and obstructed labor.
- Discuss the management of abnormal labor.
- Describe the procedure of vacuum delivery.
Unit 9: Normal Puerperium
- Define puerperium.
- Discuss the physiological and psychological changes that take place in the body during puerperium.
- Discuss the assessment of mother during the early puerperal period and at six weeks after childbirth.
- Discuss management of normal puerperium.
- Discuss the risk of infection and measures to be taken to prevent infection in the mother and newborn.
- Teach and counsel the mother and family about care of mother and neonate, including postpartum contraception.
Unit 13: Breastfeeding
- Explain the physiology of lactation.
- Explain the initiation and management of breastfeeding.
- Describe the measures for promotion of successful breastfeeding.
- Describe the technique of counseling HIV positive mothers regarding breastfeeding.
Unit 14: Problems in Breastfeeding the Newborn
- Explain various breast problems and their management.
- Explain the artificial feeding and its implications.
Unit 15: Newborn Problems
- Describe the management of minor problems of newborn.
- Describe the major problems of newborn baby and their management.
- Describe the common birth injuries including their management.
- Describe the characteristic of low birth weight babies and their management.
- State the danger signs of newborn and their management.
- State the common congenital anomalies and describe the technique of counseling the mother and family with malformed newborn and still birth.
Unit 16: Domiciliary Midwifery
- Describe the concept, principles and components of domiciliary midwifery.
Syllabus Table of Contents
Quickly navigate to any unit in the Midwifery II (Theory) Syllabus using the links below.
Course Content Details
Unit 1: Introduction to Labor 2 hrs
1.1 Terminologies used in labor and puerperium.
1.2 Definition and identification of labor:
1.2.1 True labor
1.2.2 False labor
1.2.3 Duration of first, second and third stage of labor
1.3 Factors affecting labor: Power, passage and passenger (foetal skull, its landmarks and moulding during labour).
1.4 Physiology of labor.
1.5 Relief of labor pain:
1.5.1 Physiology of labor pain
1.5.2 Psychological response to pain
1.5.3 Reduction of pain
1.5.4 Psychological support and midwife’s responsibilities
1.5.5 Alternative methods of pain relief
1.5.6 Drugs used for relief of labor pain
Activities: Interactive lectures and discussion.
Resources: MNH LRP Module 10. Reference: Maternal and Newborn Care, Chapters 6. Supplementary Material: Pelvic model to demonstrate normal female pelvis and movements of the fetal head during normal labor.
Evaluation: Students response to questions. Pretest Questionnaire Answer Sheet and Key: Module 10 Labor and Childbirth Care.
Unit 2: Physiology and Management of First Stage of Labor 10 hrs
2.1 Admission of woman in labor:
2.1.1 Admission procedure
2.1.2 History of pregnancy and labor
2.1.3 Physical examination
2.1.4 Obstetrical examination
2.1.5 Vaginal examination
2.1.6 Investigations
2.1.7 Assessment of fetal condition
2.1.8 Infection prevention (review)
2.1.9 Danger signs of labor
2.2 Physiological changes during the first stage of labor.
2.3 Management of first stage of labor using nursing process:
2.3.1 Psychological and cultural issues
2.3.2 Prevention of infection
2.3.3 Positioning and mobility
2.3.4 Nutrition and fluids
2.3.5 Bowel and bladder care
2.3.6 Monitoring maternal and fetal wellbeing and progress of labor through abdominal and vaginal examination
2.3.7 Partograph recording
2.3.8 Identification and management of deviations from normal
2.3.9 Danger signs of first stage of labor
2.3.10 Maternal and fetal distress
2.3.11 Appropriate action including referral
Activities: Interactive lecture, Role play, Exercise.
Resources: MNC-LRP Module-10. Reference Manual: Basic Maternal and Newborn Care, Chapter 6. IMPAC-WHO Manual: Section 1, C-57 to C-59. Role Play 10.1: Reassuring the Woman in Labor. Exercise 10.1 and Answer Key: Using the Partograph.
Evaluation: Students response to questions. Post-test Knowledge Assessment. Questionnaire: Labor and Childbirth Care Module 10.
Unit 3: Physiology and Management of Second Stage of Labor 14 hrs
3.1 Physiological changes of second stage of labor:
3.1.1 Uterine action
3.1.2 Soft tissue displacement
3.1.3 Signs and symptoms of second stage of labor
3.2 Mechanism of labor.
3.3 Management of second stage of labor:
3.3.1 Comfort and support
3.3.2 Continuation of partograph recording: Monitoring maternal and fetal condition and progress of labor
3.3.3 Preparation of mother, midwife, equipment and place of delivery
3.3.4 Infection prevention measures (review)
3.3.5 Process of conducting delivery of baby (step by step)
3.3.6 Episiotomy: Concept of restricted episiotomy, its indications, types and method
3.3.7 Danger signs and complication of second stage of labor and their management
3.3.8 Recording reporting
3.4 Care of the neonate at birth:
3.4.1 Physiological adaptation of newborn to extra-uterine life: Breathing, Heart rate, Color, Thermoregulation
3.4.2 Essential care of newborn:
3.4.2.1 Definition and purpose
3.4.2.2 Eight steps of immediate newborn care
3.4.3 Newborn resuscitation:
3.4.3.1 Overview of fetal hypoxia, asphyxia & meconium aspiration
3.4.3.2 Steps of newborn resuscitation
3.4.3.3 Care after resuscitation
Activities: Interactive lecture and discussion, Demonstration and return demonstration, Role play, Case study.
Resources: MNC-LRP Module-10. Skills Practice Session 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care). Learning Guide 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care). MNC-LRP Module-11. Role play 11.1: Parent education and support for care of the newborn at birth. References Care of the Newborn Reference manual SCF 2004 Chapter 4, pages 93-107. Case Study 11.1 Newborn Resuscitation.
Evaluation: Questionnaire: Labor and Childbirth Care Module 10. Peer evaluation. Pretest Questionnaire. Answer Sheet and Key: Module 11: Newborn Care. Knowledge Assessment Questionnaire. Answer Sheet and Key: Module 11: Newborn Care.
Unit 4: Physiology and Management of Third and Fourth Stages of Labor 10 hrs
4.1 Physiological changes during third stage of labor.
4.2 Active management of third stage of labor:
4.2.1 Use of oxytocics
4.2.2 Clamping and cutting the cord
4.2.3 Controlled cord traction
4.3 Examination of birth canal, placenta and membranes and blood loss.
4.4 Repair of episiotomy and second degree perineal and low vaginal tear.
4.5 Care after childbirth:
4.5.1 Assessment of mother and newborn
4.5.2 Meeting basic needs
4.5.3 Observation for danger signs of third stage of labor
4.5.4 Recording and reporting
Activities: Simulation in model, Practice in model, Case study, Skills practice, Skills Practice Session 14.4: Vaginal and Cervical Inspection, Skills Practice Session 14.5: Repair of Cervical Tears.
Resources: MNC-LRP Module-10. PCPNC. Reference Manual: Basic Maternal and Newborn Care. Chapter 6. Supplementary Material: Physiology and Management of the Third Stage of Labor. Case Studies 10.1 and 10.2 and Keys: Supporting the Woman During Childbirth. Reference Manual: Basic Maternal and Newborn Care, Chapters 9 and 10. Skills Practice Session 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care). Learning Guide 14.4: Vaginal and Cervical Inspection. Learning Guide 10.2: Assisting Normal Birth (Including Immediate Newborn and Postpartum Care). Learning Guide 14.5: Repair of Cervical Tears.
Evaluation: Students’ response to questions. Pretest Questionnaire Answer Sheet and Key: Module 10: Labor and Childbirth Care.
Unit 5: Drugs used in Labor 2 hrs
5.1 Drugs used in labor:
5.1.1 Sedatives
5.1.2 Anticonvulsants
5.1.3 Analgesics
5.1.4 Oxytocics
5.1.5 Respiratory stimulants
5.1.6 Others, e.g. Buscopan
Activities: Interactive lecture.
Resources: Normal Birth (Including Immediate Newborn and Postpartum Care).
Evaluation: Students response to questions.
Unit 6: Malpositions & Malpresentations 8 hrs
6.1 Common malpositions and malpresentations and their diagnosis and management:
6.1.1 Occipito-posterior position
6.1.2 Face, brow, breech and shoulder presentation
6.1.3 Unstable lie
6.1.4 Multi-foetal pregnancy
6.1.5 Compound presentation
6.2 Technique of delivering baby with breech presentation.
Activities: Illustrated lecture and demonstration.
Resources: MNC-LRP module 17. Myles 13th & 14th edition. Case Studies 17.1 and Key: Malpositions. Case Studies 17.2 and Key: Malpresentations. Skills Practice Session 17.1: Breech Delivery. Learning Guide 17.1: Breech Delivery.
Evaluation: Return demonstration. Pretest Questionnaire Answer Sheet and Key: Module 17: Malpositions and Malpresentations.
Unit 7: Obstetric Emergencies 10 hrs
7.1 Concept of essential obstetric care (EOC) and emergency obstetric care (EmOC).
7.2 Obstetric emergencies and their life saving management:
7.2.1 Intrapartum and post-partum haemorrhage
7.2.2 Placenta previa
7.2.3 Cord presentation and prolapse
7.2.4 Shoulder dystocia
7.2.5 Rupture of uterus
7.2.6 Inversion of the uterus
7.2.7 Shock
7.2.8 Retained placenta
7.2.9 Manual removal of placenta
7.2.10 Bimanual and aortic compression
7.2.11 Placenta accrete/ adherent placenta
7.2.12 Vulval hematoma
7.2.13 Severe vaginal and cervical tear
Activities: Illustrated lecture, clinical protocol, practice on model. Clinical skill lab.
Resources: MNC-LRP modules 13, 14, 18, 19, 20. Reference Manual: Managing Complications in Pregnancy and Childbirth. Case Study 20.1 and Key: Fetal Distress in Labor and Case Study 20.2 and Key: Prolapsed Cord. Skills Practice Session 20.1: Managing Prolapsed Cord. Learning Guide 20.1: Managing Prolapsed Cord. Skills Practice Session 18.1: Managing Shoulder Dystocia. Learning Guide 18.1: Managing Shoulder Dystocia. Case Study 18.1 and Key: Shoulder Dystocia. Clinical Simulation 13.1: Management of Shock (Hypovolemic or Septic Shock). Skills Practice Session 14.3: Manual Removal of Placenta. Learning Guide 14.3: Manual Removal of Placenta.
Evaluation: Not specified in the syllabus.
Unit 8: Abnormal Labor 9 hrs
8.1 Abnormal labor:
8.1.1 Pre-term and post-term labor and their management
8.1.2 Premature rupture of membranes
8.1.3 Abnormal (hypo and hypertonic) uterine contractions
8.1.4 Precipitated labor
8.1.5 Prolonged labor
8.1.6 Obstructed labor
8.1.7 Cephalo-pelvic disproportion
8.1.8 Maternal and fetal distress
8.2 Management of abnormal labor:
8.2.1 Trial labor
8.2.2 Induction and augmentation of labor
8.2.3 Instrumental Delivery: Vacuum delivery and forceps delivery
8.2.4 Operative delivery: Caesarean section
8.2.5 Destructive operations: Embryotomy, craniotomy, evisceration, decapitation and cleidotomy
Activities: Illustrated lecture. Practice in model. Practice in skill lab.
Resources: Myles text book 13th & 14th edition. Case Study 22.4 and Key: Pre-labor Rupture of Membranes. Case Study 16.1 and Key: Unsatisfactory Progress of Labor. Skills Practice Session 16.1: Vacuum Extraction. Learning Guide 16.1: Vacuum Extraction.
Evaluation: Students’ response to questions. Pretest Questionnaire Answer Sheet and Key: Module 16: Unsatisfactory Progress of Labor. Pretest Questionnaire Answer Sheet and Key: Module 22: Other Complications in Pregnancy and Childbirth.
Unit 9: Normal Puerperium 6 hrs
9.1 Definition of puerperium.
9.2 Physiological and psychological changes during puerperium.
9.3 Postnatal assessment of mother:
9.3.1 Physical health
9.3.2 Psychological health
9.3.3 Detection of actual and potential problems
9.4 Management of normal puerperium:
9.4.1 Physical care
9.4.2 Psychological support
9.4.3 Prevention of infection
9.4.4 Complication readiness
9.4.5 Health education and counseling on self care, care of the newborn, postpartum contraception and management of minor problems of puerperium
Activities: Interactive lecture, Case studies, Interactive lecture and Role play.
Resources: MNC-LRP module 12. Reference Manual: Basic Maternal and Newborn Care, Chapter 9 and 10. Case Studies: 12.1 and 12.2 and Answer Keys: Postpartum Assessment and Care. Role play 24.1 Communicating about FP choices. Skills Practice Session 24.1: Family Planning Counseling and Assessment. Learning Guide 24.4: Counselling, Assessment, and Clinical Skills for.
Evaluation: Students’ response to questions. Pretest Questionnaire Answer Sheet and Keys: Module 12: Postpartum Care and Module 24: Family Planning. Checklist 24.1: Family Planning Counseling and Assessment.
Unit 10: Care of the Newborn
10.1 Care of the Newborn (First 24 hours):
10.1.1 History taking
10.1.2 Physical examination.
10.1.3 Danger signs of newborn
10.1.4 Essential care
10.1.5 Teaching and counseling mothers and family about newborn care at home
10.2 Essential newborn care 2-28 days (Follow-up newborn care)
Activities: Discussion. Demonstration by using the learning guide on initial history and physical examination of new born care.
Resources: Checklist 11.3: Assessment of the Newborn. MNC-LRP module-6 Newborn Care Guide, Trainer’s SC US. Role play 11.1: Parent education and support for care of the newborn at birth.
Evaluation: Peer group practice with learning guide.
Unit 13: Breastfeeding 6 hrs
13.1 Physiology of lactation (review).
13.2 Initiation and management of breast feeding: Benefits to mother and baby.
13.3 Promotion of successful breastfeeding:
13.3.1 Baby friendly hospital
13.3.2 Exclusive breastfeeding
13.3.3 Technique of breastfeeding
13.3.4 Support and advice to mother
13.3.5 Expressing and storing breast milk
13.3.6 Cup and spoon feeding
13.4 Breastfeeding among HIV positive or HIV unknown mothers:
13.4.1 Risk of HIV transmission through breastfeeding (PMTCT)
13.4.2 Benefits of exclusive breastfeeding for the first six months
13.4.3 Role of the health care provider in counseling an HIV positive mother
13.4.4 Post-exposure prophylaxis with ARVs for the HIV exposed infant and HIV testing in infants
Activities: Brain storming. Interactive lecture and demonstration. Demonstration.
Resources: Newborn Care: Trainer’s guide. SC US. Skills Practice Session 11.4- Supporting Successful Breastfeeding. Learning Guide 11.4-Supporting Successful Breastfeeding.
Evaluation: Students response to questions. Pretest Questionnaire Answer Sheet and Key: Module 11: Newborn Care. Pretest Questionnaire Answer Sheet, and Key: Module 7: STI/HIV and Safe Motherhood. Peer evaluation.
Unit 14: Problems in Breastfeeding the Newborn 8 hrs
14.1 Problems in breast feeding and their management:
14.1.1 Depress/inverted/flat nipple
14.1.2 Sore/Cracked nipple
14.1.3 Plugged milk tube
14.1.4 Engorged breasts
14.1.5 Inadequate breast milk
14.1.6 Mastitis
14.1.7 Breast abscess
14.1.8 Suppression of lactation (chemical and mechanical)
14.2 Artificial Feeding:
14.2.1 Alternative/artificial feeding
14.2.2 Feeding of the newborn with the cleft palate/cleft lip
Activities: Illustrative lecture. Group work/ discussion.
Resources: Myles. CS dawn & SNL reference manual. RH protocol & IMPAC.
Evaluation: Students response to questions.
Unit 15: Newborn Problems 12 hrs
15.1 Minor problems of newborn:
15.1.1 Feeding problems
15.1.2 Sticky eyes
15.1.3 Sore buttock (diaper rashes)
15.1.4 Skin rashes
15.1.5 Umbilical infection
15.1.6 Thrush
15.1.7 Dehydration fever
15.1.8 Physiological jaundice
15.1.9 Vomiting
15.1.10 Engorged breast
15.1.11 Pseudo-menstruation
15.2 Major problems of newborn:
15.2.1 Pneumonia
15.2.2 Birth asphyxia
15.2.3 Respiratory distress syndrome
15.2.4 Meconium aspiration syndrome
15.2.5 Convulsion
15.2.6 Jaundice within 24 hrs
15.2.7 Sepsis
15.2.8 Hypothermia/ hyperthermia
15.3 Common birth injuries:
15.3.1 Skull injuries
15.3.2 Soft tissue injuries
15.3.3 Nerve injuries
15.3.4 Fracture bone
15.4 Low birth weight babies:
15.4.1 Characteristics of prematurity and dysmaturity and their management
15.4.2 Kangaroo mother care (KMC)
15.5 Newborn danger signs and referral.
15.6 Congenital malformations (review) and Still birth.
Activities: Illustrative lecture & discussion. Case studies. Role play. Demonstration by using NB care learning guide/ film show.
Resources: Skills Practice Session 23.1: Assessment of the Newborn with a Problem. Learning Guide 23.1: Assessment of the Newborn with a Problem. Case Study and Key 23.1: Breathing Difficulty. Case Study and Key 23.2: Convulsions or Spasms. Role Play and Key 23.1: Communicating with parents of a Newborn with a Problem. Reference Manual: Basic Maternal and Newborn Care, Chapter 8. Skills Practice Session 23.2: Newborn Eye Care. Learning Guide 23.2: Newborn Eye Care. Case Study and Key 23.3: Jaundice. Case Study and Key 23.4: Low Birth Weight Baby. Case Study and Key 23.5: Vomiting. Skills Practice Session 23.3: Measuring Body Temperature in the Newborn. Learning Guide 23.3: Measuring Body Temperature in the Newborn.
Evaluation: Students response to questions. Pretest Questionnaire Answer Sheet and Key: Module 23: Managing Newborn Problems.
Unit 16: Domiciliary Midwifery 6 hrs
16.1 Domiciliary midwifery; Concept, principles and components:
16.1.1 Antenatal care
16.1.1.1 Birth preparedness and complication readiness
16.1.2 Intrapartum
16.1.2.1 Domiciliary kit-bag
16.1.2.2 Six cleans
16.1.2.3 Delivery by single person
16.1.2.4 Complication readiness
16.1.3 Postpartum
16.1.3.1 Postpartum care
16.1.3.2 Danger sign: Mother and baby
Activities: Interactive lecture. Video show/ role play. PCPNC.
Resources: Not specified in the syllabus.
Evaluation: Not specified in the syllabus.
References
- Beck, D., Ganges, F., Goldman, S., and Long, P. (Eds.). (2004). Care of the Newborn, Reference manual. USA; Save the Children Federation.
- Benett, V. R. and Brown, L. K. (Ed.) (2003), Myles Textbook for Midwives, 14th ed, Churchill: Livingston
- Bobak and Jensen, (1994). Maternity Nursing, 4th ed. St. Louis: Mosby Company.
- Bobak and Jensen, (1993). Maternity and Gynecologic Care, 15th ed, St.Louis: Mosby Company.
- Dickson J.E. (1994). Maternal and Infant Nursing Care. St.Louis: Mosby Company
- DoHS/MOH (2007) Maternal and Newborn Care Learning Resource Package for Skilled Birth Attendants, Kathmandu: The Author
- Dutta D.C. (2004). Textbook of Obstetrics 6th ed New Central Book agency.
- FHD (2004). Basic Emergency Obstetric Care and Comprehensive Emergency Obstetric Care: Inservice Training Handbook. Kathmandu: The Author
- FHD (2007) National Medical Standards for Reproductive Health, Volume II & III. Kathmandu: The Author.
- Indirani T.K., (2003). Textbook of Midwifery. New Delhi: Jaypee Brothers, Medical Publishers P. LTD.
- Jacob, A., (2005). A Comprehensive Textbook of Midwifery. JAPEE BROTHERS medical Publishers (P.) Ltd, New Delhi.
- JHPIEGO, (2000) Post abortion Care: A Reference Manual for Improving Quality of Care., Kathmandu: The Author
- Kinzie, B. & Gomez, P. (2004). Basic Maternal and New Born Care: A Guide for Skilled Providers. Baltimore: JHPIEGO.
- MOHP (2006) National Policy on Skilled Birth Attendance. Kathmandu: Author
- Shirish, N., Daftary, S. & Chakravak, B. (2002). Manual of Obstetrics. Edinburgh: Churchill Living stone
- Shakya S., (2003). Garvabastha Ra Sutkeri (Nepali Version) Kathmandu: Educational Publishing House.
- Sweet B.R.(1998). Mayes Textbook for Midwives. 11th ed, ELBS
- WHO (2003). Standards for Midwifery Practice for Safe Motherhood, Volume, 1, 2, 3 & 4, New Delhi.
- WHO, UNFPA, UNICEF and World Bank, (2000). Integrated Management of Pregnancy and Childbirth, (IMPAC)
- WHO, UNFPA, UNICEF and World Bank, (2003), Pregnancy, Childbirth, postpartum and Newborn Care (PCPNC): Guide for Essential Providers