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College of Nursing, Christian University of Thailand

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topics: Evolution, concepts, and theories related to midwifery
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 29/08/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Evolution concepts and theories related to midwifery

Behavioral
Objectives of each
teaching topic
1. Define
midwifery.
2. Discuss the
evolution of
midwifery.
3. Explain the
concepts and
theories related to
midwifery.
4. Identify and
describe the roles
and responsibilities.
*1.5,2.2,5.3

Content of Each Teaching Topic (in


brief)
1. Midwifery
Introduction
Defined as the practice of assisting in
childbirth.
Midwifery- meant with woman.
France- "wise woman," or "sage
femme.
Content
1.1Evolution of midwifery
Ancient civilizations of the Westmidwives were women with some
medical training.
By the Middle Ages, though,
midwives basically used the
knowledge acquired through their own
experience to assist in deliveries.
In the 16th century, childbirth was
placed squarely in the realm of
physicians for the first time.
Contemporary Midwives
Midwives of today work in hospitals,
homes and birthing centers and have
different programs for training and
certification.
1.2
Concepts and theories related
to midwifery
Theory is the acknowledged
foundation to practice methodology,
professional identity and growth of
formalized knowledge. It has been

Teaching and
Learning
Activities
-Lecture
Discussion
-Video
Presentation
about the
history of
Midwifery and
methods of
ancient times
birth and
delivery.
-Questions
about the
evolution of
midwifery.

Teaching
Aides

Evaluation
Methods

Evaluation
results

-PowerPoint
presentation
-Board and
marker
-Video clip
about the
history of
midwifery and
methods of
ancient times
and birth and
delivery

Class
Participation
and answering
questions
about the
evolution of
midwifery
-Class
feedback about
the video
presentation on
the history of
midwifery and
methods of
ancient times
birth and
delivery.

-The students
were able to:
- distinguish
and
comprehend
the topics
discussed.
-showed great
enthusiasm in
learning the
topics
discussed.
-defined
midwifery.
-distinguish
the evolution
of midwifery.
-understand
the concepts
and theories
related to
midwifery.

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic (in


brief)
noted that practice must not only be
evidence-based but also theory-based.
Hence, midwifery must be theory
based because theories serve as a
broad framework for practice and may
also articulate the goals of a profession
and core values. In this paper, an
evolving theory on the empowerment
of childbearing women is introduced,
where the midwifes professionalism is
central. The theory is synthesized from
nine datasets and scholarly work, and
then more than three hundred studies
were reviewed for clarication and
conrmation. According to the theory,
the midwifes professionalism is
constructed from ve main aspects:
The professional midwife cares for the
childbearing woman and her family.
This caring within the professional
domain is seen as the core of
midwifery. The professional midwife
is professionally competent. This
professional competence must always
have primacy for the sake of safety of
woman and child.
1.3
The roles and responsibility of
midwives
1.3.1 Certified Nurse Midwife

Teaching and
Learning
Activities

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Aides

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Methods

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results

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic (in


brief)
Have atleast a bachelors degree or
doctoral degree.
Have completed both nursing and
midwifery training.
Have passed national and state
licensing exams to become certified.
May work in conjunction with doctors.
1.3.2 Certified Midwife- is not a
registered nurse but otherwise meets
the same qualifications as a certified
nurse-midwife. Because this
certification has only existed since
1996, there are few CMs. Currently,
only some states recognize this
certification as sufficient for licensing.
1.3.3 A lay or direct-entry midwife
may or may not have a college degree
or a certification. Direct-entry
midwives may have trained through
apprenticeship, workshops, formal
instruction, or a combination of these.
Not all states require them to work in
conjunction with doctors, and they
usually practice in homes or nonhospital birth centers. But not every
state regulates direct-entry midwives
or allows them to practice.
Summary
World Health Organizationdistinguishes midwifery for its

Teaching and
Learning
Activities

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Aides

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Methods

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results

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic (in


brief)

Teaching and
Learning
Activities

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Aides

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Methods

Evaluation
results

continual health care of women and


infants worldwide.
Hence, midwifery must be theory
based because theories serve as a
broad framework for practice and may
also articulate the goals of a profession
and core values. In this paper, an
evolving theory on the empowerment
of childbearing women is introduced,
where the midwifes professionalism is
central.

Reference:
1. Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2. Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3. Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4. Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.
Overview Assessment
After learning this topic, the students were able to answer the questions raised by the lecturer and they showed a very high
participation in the class discuss

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Fetal Assessment
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 05/09/2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Fetal Assessment

Behavioral
Objectives of each
teaching topic
1.Identify typical
signs
of normal and
abnormal fetal heart
rate patterns.
2. Identify and discuss
different types of fetal
assessment.
3. Compare FHR
monitoring performed
by intermittent
auscultation with
external and internal
electronic methods.
4. Explain the
baseline
FHR and evaluate
periodic changes.
5. Discuss and
demonstrate
abdominal
Assessment/Leopold
maneuver using the
correct sequence of
the procedure with
emphasis on
professional code of
ethics
*1.5,2.2,5.3

Content of Each Teaching Topic


(in brief)
Fetal Assessment
Introduction
Fetal monitoring during pregnancy
is used to prevent fetal death.
Content
1 Fetal movement counting
Fetal movement refers to motion of
a fetus caused by its own muscle
activity. Locomotor activity begins
during the late embryological
stage, and changes in nature
throughout development. Muscles
begin to move as soon as they are
innervated. These first movements
are not reflexive, but arise from
self-generated nerve impulses
originating in the spinal cord. As
the nervous system matures,
muscles can move in response to
stimuli.
Generally speaking, fetal motility
can be classified as either elicited
or spontaneous, and spontaneous
movements may be triggered by
either the spine or the brain.
Whether a movement is
supraspinally determined can be
inferred by comparison to
movements of an anencephalic
fetus.

Teaching and
Learning
Activities
-Lecture
Discussion
-Questions
about types of
fetal
assessment.
-Video
presentation
about nonstress test,
amniocentesis
and ultrasound
-Demonstration
On Leopolds
Maneuver

Teaching
Aides

Evaluation
Methods

Evaluation
results

-Powerpoint
presentation
-Board and
marker
-Video clip
on non-stress
test,
amniocentesis
and ultrasound

-Quiz about
types of fetal
assessment and
the nursing
management.
-Class
participation
and answering
questions about
types of fetal
assessment.
-Class feedback
about the video
presentation on
non-stress test,
amniocentesis
and ultrasound.
-Return
Demonstration
on Leopolds
Maneuver

The students
are able to:
-differentiate
and identify
the types of
fetal
assessment.
-distinguish
and
comprehend
the topics
discussed.
-showed great
enthusiasm in
learning the
topics
discussed.

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic


(in brief)
Although the heart begins to beat
on the 23rd day after conception,
this article primarily deals with
voluntary and reflex movements.
Ages are given as age from
fertilization rather than as
gestational age.
Some sources contend that there is
no voluntary movement until after
birth. Other sources say that
purposive movement begins
months earlier.3D ultrasound has
been used to create motion pictures
of fetal movement, which are
called "4D ultrasound
2. Non-stress test
A nonstress test (NST) is a
screening test used in pregnancy. A
cardiotocograph is used to monitor
the fetal heart rate.
3. Contraction stress test
A contraction stress test (CST) is
performed near the end of
pregnancy to determine how well
the fetus will cope with the
contractions of childbirth. The aim
is to induce contractions and
monitor the fetus to check for heart
rate abnormalities using a
cardiotocograph. A CST is one

Teaching and
Learning
Activities

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Aides

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results

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic


(in brief)
type of antenatal fetal surveillance
technique.
4.Ultrasound
Ultrasounds are sound waves with
frequencies higher than the upper
audible limit of human hearing.
Ultrasound is no different from
'normal' (audible) sound in its
physical properties, except in that
humans cannot hear it. This limit
varies from person to person and is
approximately 20 kilohertz (20,000
hertz) in healthy, young adults.
Ultrasound devices operate with
frequencies from 20 kHz up to
several gigahertz.
5.Amniocentesis
Amniocentesis (also referred to as
amniotic fluid test or AFT) is a
medical procedure used in prenatal
diagnosis of chromosomal
abnormalities and fetal infections,
and also used for sex determination
in which a small amount of
amniotic fluid, which contains fetal
tissues, is sampled from the
amniotic sac surrounding a
developing fetus, and the fetal
DNA is examined for genetic
abnormalities. The most common

Teaching and
Learning
Activities

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Aides

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Methods

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results

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic


(in brief)
reason to have an "amnio" is to
determine whether a baby has
certain genetic disorders or a
chromosomal abnormality, such as
Down syndrome. Amniocentesis
(or another procedure, called
chorionic villus sampling (CVS))
can diagnose these problems in the
womb. Amniocentesis is usually
done when a woman is between 14
and 16 weeks pregnant.
6. Foams test
Amniotic fluid samples were
obtained from 203 pregnant
women who delivered within 72
hours after amniotic fluid
collection. Each sample of
amniotic fluid was taken to
perform both foam stability index
(FSI) test and simple shake test
immediately. The both tests are
functional test to evaluate amount
of lung surfactants in amniotic
fluid to predict the development of
respiratory distress syndrome in the
newborns.
7. Biophysical Profile
A biophysical profile (BPP) is a
prenatal ultrasound evaluation of
fetal well-being involving a scoring

Teaching and
Learning
Activities

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Aides

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Methods

Evaluation
results

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic


(in brief)

Teaching and
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results

system,[1] with the score being


termed Manning's score. It is often
done when a non-stress test (NST)
is non reactive, or for other
obstetrical indications.
The "modified biophysical profile"
consists of the NST and amniotic
fluid index only.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.

Overview Assessment
1. After learning this topic, the students can answer the questions accordingly and they can participate in the class discussion.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Fetal Assessment
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 05/09/2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Fetal Assessment

Behavioral
Objectives of each
teaching topic
1. Identify the
different types of
indirect method of
fetal assessment
2. Discuss cord
blood analysis at
birth.
*1.5,2.2,5.3

Teaching and
Learning
Activities
Fetal Assessment
-Lecture
Discussion
Content
8. Indirect fetal assessment
-Questions
A general term which can refer to any about scalp
maneuver used to evaluate the fetus'
stimulation test
status during pregnancyeg,
and cord blood
measurement of heartbeat and visual
analysis
examination of the amniotic sac;
-Video
however, as used, FM usually refers to presentation
the use of electronic devices during
about indirect
L&D to assess the baby's heartbeat and fetal
uterine contraction.
assessment,
9. Scalp stimulation
scalp
Fetal scalp stimulation test is a
stimulation
diagnostic test used to detect fetal
and cord blood
metabolic acidemia. It can be used as a analysis
non-invasive alternative to fetal scalp
blood testing.
10. Cord blood analysis at birth
Cord blood refers to a sample of blood
collected from the umbilical cord when
a baby is born. The umbilical cord is
the cord connecting the baby to the
mother's womb.
Content of Each Teaching Topic (in
brief)

Teaching
Aides

Evaluation
Methods

Evaluation
results

-Powerpoint
presentation
-Board and
marker
-Video clip on
indirect fetal
assessment
Scalp
stimulation test
and cord blood
analysis

-Class
participation
and answering
questions about
scalp
stimulation test
and cord blood
analysis.
-Class
feedback on
the video
presentation
about indirect
fetal
assessment,
scalp
stimulation test
and cord blood
analysis.

The students
were able to:
-identify and
distinguish
indirect
method of fetal
assessment.
-discuss cord
blood analysis
and scalp
stimulation
test.
-distinguish
and
comprehend
the topics
discussed.
-showed great
enthusiasm in
learning the
topics
discussed.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.

Overview Assessment
The students need are meet according to the objectives and plans of the topic.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Mechanism of labor
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 19/09/2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Mechanism of labor

Behavioral
Objectives of each
teaching topic
1. Discuss about
theories of labor.
2. Describe and
discuss physiologic
forces of
labor.
3. Identify the
premonitory signs
of labor
4. Differentiate
between true and
false labor.
5. Enumerate the
cardinal
movements of
birth.
6. Define induction
of labor.
*1.5,2.2,5.3

Teaching and
Learning
Activities
Mechanism of labor
-Lecture
Discussion
Introduction
The mechanisms of labor, also known -Questions
as the cardinal movements, involve
about the
changes in the position of the fetuss
theories of
head during its passage in labor.
labor and
premonitory
Content
Mechanism of labor
signs of labor
1. Theories of labor
-Video
a. Uterine Stretch theory
presentation
The idea is based on the concept that
about the
any hollow body organ when
mechanism of
stretched to its capacity will inevitably labor
contract to expel its contents.
-Demonstration
b. Oxytocin theory
of the
Pressure on the cervix stimulates the
mechanism of
hypophysis to release oxytocin from
labor
the maternal posterior pituitary gland.
As pregnancy advances, the uterus
becomes more sensitive to oxytocin.
c. Progesterone deprivation theory
Progesterone is the hormone designed
to promote pregnancy. It is believed
that presence of this hormone inhibits
uterine motility.
d. Prostaglandin theory
In the latter part of pregnancy, fetal
membranes and uterine decidua
increase prostaglandin levels. This
Content of Each Teaching Topic (in
brief)

Teaching
Aides

Evaluation
Methods

Evaluation
results

-Powerpoint
presentation
-Board and
marker
-Video clip on
mechanism of
labor

-Class
participation
and answering
questions about
the theories of
labor and
premonitory
signs of labor
-Class feedback
on the video
presentation
about the
mechanism of
labor.
-Return
demonstration
on the
mechanism of
labor.

The students
were able to:
-discuss
theories of
labor.
-differentiate
between true
and false labor
-distinguish
and
comprehend
the topics
discussed.
-showed great
enthusiasm in
learning the
topics
discussed.

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic (in


brief)
hormone is secreted from the lower
area of the fetal membrane (forebag).
e. Theory of Aging Placenta
Advance placental age decreases
blood supply to the uterus. This event
triggers uterine contractions, thereby,
starting the labor.
2. Possible causes of labor onset
Normal Causes. While no one knows
the exact cause of labor, several
factors come into play during this
final stage of pregnancy. First, the
level of prostaglandin, a hormone,
increases, causing the cervix to soften.
Second, the levels of the hormone
oxytocin increase, triggering
contractions
3. Premonitory signs of labor
o A feeling of activity and lightness
on the part of the patient
o A diminution of the abdominal
protuberance
o An increased vaginal secretion
o Frequently a sympathetic
irritability of the bladder, and
sometimes of the rectum also.
o Lightening: the mother would feel
the descent of the fetus and changes
the abdominal contour.

Teaching and
Learning
Activities

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Aides

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Methods

Evaluation
results

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic (in


brief)
o Braxton hicks contraction: painless
irregular contractions
o Bloody show
o Sudden rush of energy: due to
change in levels of estrogen and
progesterone
o Increased backache and sacroiliac
pressure
o Ripening of cervix: soft (as butter)
feeling of the cervix
o Rupture of the membrane: bag of
water
4. Differences between true and false
labor
Before "true" labor begins, you might
have "false" labor pains, also known
as Braxton Hicks contractions. These
irregular uterine contractions are
perfectly normal and might start to
occur from your fourth month of
pregnancy.
False labor: Intermittent nonproductive muscular contractions of
the womb (uterus) during pregnancy,
most commonly in the last two
months before full term. These
contractions are non-productive in the
sense that they do not produce any
flattening (effacement) or dilation
(opening up) of the cervix.

Teaching and
Learning
Activities

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Aides

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Methods

Evaluation
results

Behavioral
Objectives of each
teaching topic

Content of Each Teaching Topic (in


brief)

Teaching and
Learning
Activities

Teaching
Aides

Evaluation
Methods

5. Cardinal movements of labor


The seven cardinal movements of
labor are: engagement, descent,
flexion, internal rotation, extension,
external rotation and expulsion.
6. Induction of labor
Labor induction also known as
inducing labor is a procedure used
to stimulate uterine contractions
during pregnancy before labor begins
on its own. Successful labor induction
leads to a vaginal birth.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.

Overview Assessment
The students demonstrate knowledge and understand the content.

Evaluation
results

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Nursing care on Stages of labor and birth
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 26/09/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Stages of labor and birth

Behavioral
Objectives of
each teaching
topic
1. Describe the
ongoing
assessment of
maternal progress
during the
first, second, third
and
fourth stages of
labor.
2. Identify the
physical and
psychological
findings indicative
of maternal
progress during
labor.
3. Identify signs of
developing
complications
during
labor and birth.
*1.5,2.2,5.3

Content of Each Teaching Topic (in


brief)
Nursing care on Stages of Labor
Introduction
Childbirth, labour, delivery, birth,
partus, or parturition is the culmination
of a period of pregnancy with the
expulsion of one or more newborn
infants from a woman's uterus. The
process of normal childbirth is
categorized in three stages of labour:
the shortening and dilation of the
cervix, descent and birth of the infant,
and the expulsion of the placenta.
Each year about 0.5 million women
die due to pregnancy and childbirth, 7
million have serious long term
complications, and 50 million have
negative outcomes following delivery.
Most of these issues occur in the
developing world.
Content
1.First Stage of Labor
From the beginning of labor to the full
opening (dilation)of the cervix(about
4inches or 10cm).
1.1 Three phases

Teaching and
Learning
Activities
-Lecture
Discussion
-Questions
about the
nursing care on
the four stages
of labor.
-Video
presentation
about birth and
delivery.
-Demonstration
on assisting
birth and
delivery

Teaching
Aides

Evaluation
Methods

Evaluation
results

-PowerPoint
presentation
-Board and
marker
-Video clip on
birth and
delivery

-Class
participation
and answering
questions on
nursing care of
the four stages
of labor.
-Class feedback
on the video
presentation on
birth and
delivery.
- Return
demonstration
on assisting
birth and
delivery.

- The students
were able to:
-describe the
stages of labor.
-identify
physiological
signs.
-give correct
answers to
questions
-distinguish
and
comprehend
the topics
discussed.
-showed great
enthusiasm in
learning topics
discussed.

1.1.1 Latent Phase


-cervix dilates at 0-3cm
-mild contractions
-duration of 20-40sec
-frequency of every 510min
1.1.2 Active Phase
-cervical dilatation
reaches 4-7cm
-moderate contractions
-duration of 40-60sec
-frequency of 3-5min
1.1.3 Transition Phase
-cervix at 8-10cm
-strong contractions
-duration of 60-90sec
-frequency of 2-3min
1.2 Nursing interventions
Hospital admission: a. personal data
b. obstetrical data, Vital Signs, FHRnormally 120-160/min, Laboratory
routine: CBC, Hgb, Hct, Enema,
Perineal Shaving, Provide emotional
and psychological support, Timing of
uterine contractions, Assisting the
doctor in giving meds or analgesia and
Giving local anesthesia (lidocaine)
when in DR table.
2. Second Stage of Labor

From the complete dilatation of the


cervix to delivery of the baby.
- CROWNING hallmark of 2nd stage
-PRIMI50 minutes
-MULTIGRAVID-20minutes
2.1 Nursing interventions
Position legs into stirrups at the same
time, when the head crowns, instruct
mother not to push but to pant and
assist in episiotomy.
3. Third Stage of Labor
From delivery of the baby to delivery
of the placenta.
3.1 Types of placental delivery
3.1.1 SCHULTZ fetal surface,
bluish and shiny.
3.1.2 DUNCAN-uterine surface,
reddish and rough.
3.2 Signs of placental separation
Lengthening of the cord, sudden gush
if blood
Change in the shape of the uterus of
Calkins sign and firm contraction of
uterus
3.3 Nursing interventions
Just watch for the signs of placental
separation
Take note of the time of placental
delivery

Inspect for the completeness of the


cotyledons
Check for the condition of the fundus
-massage carefully
-apply ice cap over abdomen to help
contract the uterus
-injection of Methergin or Syntocinon
(IM) to maintain uterine contraction
and prevents hemorrhage.
Inspect the perineum for laceration
Make mother comfortable
Position the newly delivered mother
flat on her back without pillows
Give initial nourishment (milk, soup,
tea)
Allow patient to sleep
4. Fourth Stage of Labor
Critical period for the mother on the
1st 1-2hrs after delivery
4.1 Nursing interventions
Monitor VS every 15 minutes
Fundus should be checked every 15
minutes x 1 hr then every 30 minutes
for the next 4 hours
Check for the amount of bleeding
Check for bladder distention
Encourage rooming-in
Summary

The process of having a baby occurs in


several stages over many hours or even
a few daysfrom early labor through
delivering the baby and the placenta.
During labor, contractions in your
uterus open your cervix and move the
baby into position to be born.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.
Overview Assessment
The students need is meet according to the objectives and plans of the topic. The topic has been interesting to the students and
students are able to exhibit a very high cooperation.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Maternal systemic response to labor
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 03/10/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Maternal systemic response to labor

Behavioral
Objectives of each
teaching topic
1. Identify the
maternal anatomic
and physiologic
adaptations to
labor.
2.Identify nonpharmacologic
strategies to
enhance relaxation
and decrease pain
and discomfort
during
labor.
*1.5,2.2,5.3

Content of Each Teaching Topic (in


brief)
Physiological changes during
pregnancy
Introduction
Maternal physiological changes in
pregnancy are the normal adaptations
that a woman undergoes during
pregnancy to better accommodate the
embryo or fetus. They are
physiological changes, that is, they are
entirely normal, and include
cardiovascular, hematologic,
metabolic, renal and respiratory
changes that become very important in
the event of complications.
Content
1. Cardiovascular System
Cardiac outputincreases about 12 31% in the 1st stage. -Increases about
50% in the second stage. Heart rate
increases slightly
2. Blood Pressure
Systolic increases in 1st stage
Systolic and Diastolic increase in 2nd
stage. Rises with each contraction. May
rise further with pushing.

Teaching and
Learning
Activities
-Lecture
Discussion
-Questions
about the
maternal
physiological
changes.

Teaching
Aides
-Powerpoint
presentation
-Board and
marker

Evaluation
Methods

Evaluation
results

-Class
Participation
and answering
questions about
maternal
physiological
changes

The students
were able to:
-identify the
maternal
anatomic and
physiological
changes to
labor.
- distinguish
and
comprehend
the topics
discussed.
- showed great
enthusiasm in
learning the
topics
discussed.

3. Fluid and Electrolyte Balance


Increase in renin, plasma renin activity,
and angiotensinogen.
Edema may occur at base of bladder
due to pressure of fetal head.
4. Respiratory System
Respiratory rate increases. Increase in
oxygen demand and consumption.
Mild respiratory acidosis usually
occurs by time of birth.
5. Renal System
Nephrology findingsslight
proteinuria may occur; polyuria; GFR
increased due to increased CO.
6. Gastrointestinal System
Gastric Motilitydecreased
Gastric emptying is prolonged.
Gastric volume remains increased.
7. Immune System and other
blood values
WBCincrease due to stress
Tempmay slightly increase
especially if mom is dehydrated, Blood
glucosedecreases
8. Pain
In the first stage: arises from dilatation
of cervix, stretching of lower uterine
segment, pressure, and hypoxia of

uterine muscle cells during


contractions.
In the second stage: arises from
hypoxia of contracting uterine muscle
cells, distention of the vagina and
perineum, and pressure.
In the third stage: arises from
contractions and dilatation of cervix as
placenta is expelled.

Summary
The body must change its physiological
and homeostatic mechanisms in
pregnancy to ensure the fetus is
provided for. Increases in blood sugar,
breathing and cardiac output are all
required. Levels of progesterone and
estrogens rise continually throughout
pregnancy, suppressing the
hypothalamic axis and subsequently
the menstrual cycle. The woman and
the placenta also produce many
hormones.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.

3.
4.

Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.

Overview Assessment
1. After learning this topic, the students can answer the questions raised by the lecturer and they were able to comprehend the
topic discussed.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Fetal response to labor
Name of Instructor: Dr. Punyanut Phimchaisai
Day/Month/Year: 10/10/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Fetal response to labor

Behavioral
Objectives of
each teaching
topic
1. Identify and
discuss the fetal
anatomic and
physiologic
adaptations to
labor.
*1.5,2.2,5.3

Content of Each Teaching Topic (in


brief)
Fetal Heart rate adaptations to labor
Introduction
Although the fetus experiences
mechanical and hemodynamic changes
during pregnancy and birth, the full
term infant can withstand these changes
without adverse effects.
Content
1. Heart rate changes
The presence of fetal heart rate
accelerations is one of the most
important signs of well-being during
labor. Accelerations are defined as
short-term rises in the heart rate of at
least 15 beats per minute, which last at
least 15 seconds. In many cases, they
last longer.
1. Acid base Status in Laboratory
Care provider sometimes need to
employ additional methods to further
assess fetal oxygenation and acid base
status.
2. Hemodynamic Changes
Plasma volume increases 45% at term,
RBC volume increases 20%, thus while

Teaching and
Learning
Activities
-Lecture
Discussion
-Questions
about the
hemodynamic
changes during
pregnancy and
birth

Teaching
Aides
-Powerpoint
presentation
-Board and
marker

Evaluation
Methods

Evaluation
results

-Class
Participation
and answering
questions on
hemodynamic
changes during
pregnancy and
birth
-Midterm quiz
On the history,
evolution of
midwifery, fetal
assessment,
mechanism of
labor, stages of
labor, maternal
and fetal
response to
labor.

The students
were able to:
-identify the
fetal
adaptations to
labor.
-distinguish
and
comprehend
the topics
discussed.
-showed great
enthusiasm in
learning the
topics
discussed.

pregnant patients have increased RBC


mass, they appear anemic. Normal
hemoglobin is 12 g/dL. During labor,
contractions squeeze blood into the
systemic circulation, and after delivery,
uterine involution autotransfuses 500
cc/blood.
Summary
Changes in the fetal heart rate(FHR)
reflect fetal response to the labor
process. Assessment of the FHR is a
critical nursing responsibility.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.
Overview Assessment
1. After learning this topic, the students can answer the questions raised by the lecturer and they were able to comprehend the
topic discussed.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Maternal Assessment
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 24/10/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1. Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Maternal Assessment

Behavioral
Objectives of
each teaching
topic
1. Discuss
prenatal
record.
2. Discuss highrisk
screening and
intrapartal
assessment of
maternal
physical and
psychosociocultural
factors.
3. Discuss
methods
used to evaluate
the
progress of
labour
*1.5,2.2,5.3

Content of Each Teaching Topic


(in brief)
1. Prenatal Record
Introduction
Prenatal care is often the primary
way young women access basic
health care. The prenatal record
and the initial prenatal evaluation
are so closely linked that they
must be discussed together.
Content
1 Intrapartal High-Risk Screening
Screening for intrapartal high-risk
factors is an integral part of
assessing the normal laboring
woman. As the history is
obtained,note the presence of any
factors that may be associated with
a high-risk condition.For
example,the woman who reports a
physical symptom such as
intermittent bleeding needs further
assessment to rule out abruptio
placentae or placenta previa before
the admission process continues. It
is also important to recognize the
implications ofa highrisk condition

Teaching and
Learning
Activities
-Lecture
Discussion
-Questions about
intrapartal high risk
screening, physical
and
psychosociocultural
Assessment

Teaching
Aides
-Powerpoint
presentation
-Board ands
marker

Evaluation
Methods

Evaluation
results

-Class Participation
And answering
question on
intrapartal high risk
screening, physical
and
psychosociocultural
Assessment

The students
were able to:
-discuss
prenatal
record.
-discuss
methods used
to evaluate
progress of
labor
- distinguish
and
comprehend
the topics
discussed.
-The students
are able to
showed great
enthusiasm in
learning the
topics
discussed.

for the laboring woman and her


fetus.For example,if there is an
abnormal fetal presentation,labor
may be prolonged,prolapse of the
umbilical cord is more likely, and
the possibility of a cesarean birth
is increased.
2 Intrapartal Physical and
Psyhosociocultural Assessment
The physical assessment portion
includes assessments performed
immediately on admission as well
as ongoing assessments.When
labor is progressing very
quickly,there may not be time for a
complete nursing assessment. In
that case the critical physical
assessments include maternal vital
signs, labor status, fetal status, and
laboratory findings. The cultural
assessment portion provides a
starting point for this increasingly
important aspect of assessment.
Individualized nursing care can
best be planned and implemented
when the values and beliefs of the
laboring woman are known and
honored. It is sometimes
challenging to achieve a balance

between cultural awareness and


the risk of stereotyping because
cultural responses are influenced
by so many factors. Nurses are
most effective when they combine
an awareness of the major cultural
values and beliefs of a specific
group with the recognition that
individual differences have an
impact.Developing Cultural
Competenceprovides examples of
selected beliefs of some Native
American women.
4 Evaluating Labor Progress
The nurse assesses the womans
contractions and cervical dilatation
and effacement to evaluate labor
progress.
Contraction Assessment Uterine
contractions may be assessed by
palpation or continuous electronic
monitoring. Palpation. Assess
contractions for frequency,
duration, and intensity by placing
one hand on the uterine fundus. It
is important to keep the hand
relatively still because excessive
movement may stimulate
contractions or cause discomfort.

Determine the frequency of the


contractions by noting the time
from the beginning of one
contraction to the beginning of the
next.

Summary
During the initial prenatal visit, the
practitioner collects most of the
information that will be used to
evaluate obstetrical risks and
determine what special
interventions, if any, are needed.
This visit establishes the
foundation for the physician
patient relationship, particularly
when the patient is new to the
physician.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.

Overview Assessment
1. The students need are meet according to the objectives and plans of the topic. The topic has been interesting to the students
and students are able to exhibit a very high cooperation.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: High risk pregnancies
Name of Instructor: Mrs. Nongnaphat Wongchantorn
Day/Month/Year: 31/10/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1. Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Nursing therapeutics for high risk and complicated pregnancies

Behavioral
Objectives of each
teaching topic
1. Identify high risk
and complicated
pregnancies
2. Discuss the
nursing
management.
*1.5,2.2,5.3

Content of Each Teaching Topic (in


brief)
High risk pregnancies
Introduction
A high-risk pregnancy is one of greater
risk to the mother or her fetus than an
uncomplicated pregnancy. Pregnancy
places additional physical and
emotional stress on a womans body.
Health problems that occur before a
woman becomes pregnant or during
pregnancy may also increase the
likelihood for a high-risk pregnancy.
Content
1. Fetal anomalies
Congenital anomalies are also known
as birth defects, congenital disorders or
congenital malformations. Congenital
anomalies can be defined as structural
or functional anomalies (e.g. metabolic
disorders) that occur during intrauterine
life and can be identified prenatally, at
birth or later in life.
2. Dead fetus
Fetal death" means death prior to the
complete expulsion or extraction from
its mother of a product of human
conception, irrespective of the duration

Teaching and
Learning
Activities
-LectureDiscussion
-Questions
About fetal
anomalies,
dead fetus,
teenage
pregnancy and
elderly
gravida

Teaching
Aides
-Powerpoint
presentation
-Board and
Marker

Evaluation
Methods

Evaluation
results

-Class
participation
and answering
questions on
fetal
anomalies,
dead fetus,
teenage
pregnancy and
elderly gravida

The students
were able to:
-evaluate high
risk and
complicated
pregnancies
-give correct
answers to
questions
- distinguish
and
comprehend
the topics
discussed.
-showed great
enthusiasm in
learning the
topics
discussed.

of pregnancy and which is not an


induced termination of pregnancy.
3. Elderly gravida
The elderly primigravida is defined as a
woman who goes into pregnancy for
the first time at the age of 35 years or
older. Progressively, this has become
more common in our contemporary
society and traditionally such
pregnancy is regarded as high risk.
4. Teenage pregnancy
Teenage pregnancy is defined as a
teenage girl, usually within the ages of
13-19, becoming pregnant. The term in
everyday speech usually refers to girls
who have not reached legal adulthood,
which varies across the world, who
become pregnant.
5. Unwanted pregnancy
Unintended pregnancy is a core concept
that is used to better understand the
fertility of populations and the unmet
need for contraception (birth control)
and family planning. Unintended
pregnancy mainly results from not
using contraception, or inconsistent or
incorrect use of effective contraceptive
methods.

6. Drug addiction during


pregnancy
Substance abuse during pregnancy is
more prevalent than commonly
realized, with up to 25% of gravidas
using illicit drugs.1 In fact, substance
abuse is more common among women
of reproductive age than among the
general population.2 The average
pregnant woman will take four or five
drugs during her pregnancy, with 82%
of pregnant women taking prescribed
substances and 65% using
nonprescription substances, including
illicit drugs.1 Substance abuse during
pregnancy is difficult to detect because
the signs and symptoms of this
behavior are often subtle, self-reports of
substance use may be misleading or
infrequently elicited, physicians may
fail to routinely screen for use, and
substance abusing pregnant women
may seek little or no prenatal care.
7. Abuse during pregnancy
Abuse, whether emotional or physical,
is never okay. Unfortunately, some
women experience abuse from a
partner. Abuse crosses all racial, ethnic
and economic lines. Abuse often gets

worse during pregnancy. Almost 1 in 6


pregnant women have been abused by a
partner.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.
Overview Assessment
The students need are meet according to the objectives and plans of the topic.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: High risk pregnancies
Name of Instructor: Ms.Nongnaphat Wongchantorn
Day/Month/Year: 07/11/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1. Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. High risk pregnancies

Behavioral
Objectives of each
teaching topic
1. Identify the risk
factors, etiology,
medical and nursing
management of
hyperemesis
gravidarum and PIH.
2. Compare
hydramnios and
oligohydramnios.
3. Identify the risks
factors,
classification,
medical and nursing
managements and
the complications of
twin pregnancy
*1.5,2.2,5.3

Content of Each Teaching Topic (in


brief)
Nursing therapeutics for high risk and
complicated pregnancies
Introduction
A high-risk pregnancy is one of
greater risk to the mother or her fetus
than an uncomplicated pregnancy.
Pregnancy places additional physical
and emotional stress on a womans
body. Health problems that occur
before a woman becomes pregnant or
during pregnancy may also increase
the likelihood for a high-risk
pregnancy.
Content
1.Hyperemesis Gravidarum
gravidarum (HG) is a complication of
pregnancy characterized by intractable
nausea, vomiting, and dehydration
and is estimated to affect 0.52.0% of
pregnant women. Malnutrition and
other serious complications, such as
fluid or electrolyte imbalances, may
result.
Hyperemesis is considered a rare
complication of pregnancy, but
because nausea and vomiting during

Teaching and
Learning
Activities
-Lecture
Discussion
-Questions
about
hyperemesis
gravidarum
and
hydramnios
-Case study
about
hyperemesis
gravidarum
and
hydramnios

Teaching
Aides
-Powerpoint
presentation
-Board and
Marker

Evaluation
Methods

Evaluation
results

-Class
participation
and answering
questions about
hyperemesis
gravidarum
and
hydramnios.
-Case study
evaluation
On
Hyperemesis
gravidarum
and
Hydramnios

-The students
were able to:
-differentiate
hyperemesis
gravidarum,
PIH and
hydramnios.
-give correct
answers to
questions.
-distinguish
and
comprehend
the topics
discussed.
-showed great
enthusiasm in
learning the
topics
discussed.

pregnancy exist on a spectrum, it is


often difficult to distinguish this
condition from the more common
form of nausea and vomiting
experienced during pregnancy known
as morning sickness.
1.1 Nursing care
Dry bland food and oral rehydration
are first-line treatments. Due to the
potential for severe dehydration and
other complications, HG is treated as
an emergency. If conservative dietary
measures fail, more extensive
treatment such as the use of
antiemetic medications and
intravenous rehydration may be
required. If oral nutrition is
insufficient, intravenous nutritional
support may be needed. For women
who require hospital admission,
thromboembolic stockings or lowmolecular-weight heparin may be
used as measures to prevent the
formation of a blood clot.
2. PIH
Gestational hypertension or
pregnancy-induced hypertension
(PIH) is the development of new
hypertension in a pregnant woman

after 20 weeks gestation without the


presence of protein in the urine or
other signs of preeclampsia.
Hypertension is defined as having a
blood pressure greater than 140/90
mm Hg.
3.Polyhydramnios and
Oligohydramnios
Polyhydramnios (polyhydramnion,
hydramnios, polyhydramnios) is a
medical condition describing an
excess of amniotic fluid in the
amniotic sac. It is seen in about 1% of
pregnancies. It is typically diagnosed
when the amniotic fluid index (AFI) is
greater than 24 cm.There are two
clinical varieties of polyhydramnios:
Chronic polyhydramnios where
excess amniotic fluid accumulates
gradually
Acute polyhydramnios where excess
amniotic fluid collects rapidly.
Oligohydramnios is a condition in
pregnancy characterized by a
deficiency of amniotic fluid. It is the
opposite of polyhydramnios.
The common clinical features are
smaller symphysiofundal height, fetal
malpresentation, undue prominence of

fetal parts and reduced amount of


amniotic fluid.
4.Twins
Twins are two offspring produced by
the same pregnancy. Twins can either
be monozygotic ("identical"),
meaning that they can develop from
just one zygote that will then split and
form two embryos, or dizygotic
("fraternal"), meaning that they can
develop from two different eggs, each
are fertilized by separate sperm cells.
In contrast, a fetus which develops
alone in the womb is called a
singleton, and the general term for one
offspring of a multiple birth is
multiple.
Summary
Complications of pregnancy are
problems that are caused by
pregnancy. There is no clear
distinction between complications of
pregnancy and symptoms and
discomforts of pregnancy. However,
the latter do not significantly interfere
with activities of daily living or pose
any significant threat to the health of
the mother or baby. In contrast,
pregnancy complications may cause

both maternal death and fetal death if


untreated. Still, in some cases the
same basic feature can manifest as
either a discomfort or a complication
depending on the severity.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.
Overview Assessment
The students need are meet according to the objectives and plans of the topic.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Complicated pregnancies
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 14/11/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Unit
1. Complicated pregnancies

Behavioral
Objectives of each
teaching topic
1. Describe common
illnesses such as
diabetes mellitus,
heart
disease, asthma,
anemia and
Thallasemia that can
result in
complication when
they exist with
pregnancy.
2. Discuss the
medical and nursing
care for a woman
with diabetes
mellitus,heart
disease, asthma,
anemia and
thallasemia during
pregnancy.
Hyperemesis
gravidarum.
3. Identify the risks
factors,
classification,
clinical

Teaching and
Learning
Activities
Nursing therapeutics for high risk and
-Lecture
complicated pregnancies
Discussion
-Questions
Introduction
Some disorders and conditions can
about DM and
mean that pregnancy is considered high- heart disease.
risk (about 6-8% of pregnancies in the
- Case study
USA) and in extreme cases may be
presentation
contraindicated. High-risk pregnancies
About DM
are the main focus of doctors
and heart
specialising in maternal-fetal medicine. disease during
pregnancy.
Content
1.DM
Gestational diabetes (or gestational
diabetes mellitus, GDM) is a condition
in which women without previously
diagnosed diabetes exhibit high blood
glucose (blood sugar) levels during
pregnancy (especially during their third
trimester). Gestational diabetes is
caused when insulin receptors do not
function properly. This is likely due to
pregnancy-related factors such as the
presence of human placental lactogen
that interferes with susceptible insulin
receptors. This in turn causes
Content of Each Teaching Topic (in
brief)

Teaching
Aides
-Powerpoint
presentation
-Board and
marker

Evaluation
Methods

Evaluation
results

-Class
participation
and answer
questions
about DM and
heart disease.
-Case study
evaluation on
DM during
pregnancy and
heart disease
during
pregnancy.

-The students
were able to:
-describe and
differentiate
DM, heart
disease,
asthma,
anemia and
thallasemia.
-distinguish
and
comprehend
the topics
discussed.
-showed great
enthusiasm in
learning the
topics
discussed.

manifestations, and
medical and nursing
management
thallasemia.
1.1,2.1,2.2,2.3,3.2
3.3

inappropriately elevated blood sugar


levels.
1.1 Management
The goal of treatment is to reduce the
risks of GDM for mother and child.
Scientific evidence is beginning to show
that controlling glucose levels can result
in less serious fetal complications (such
as macrosomia) and increased maternal
quality of life. Unfortunately, treatment
of GDM is also accompanied by more
infants admitted to neonatal wards and
more inductions of labour, with no
proven decrease in cesarean section
rates or perinatal mortality.
2. Heart Disease
Mechanical artificial heart valves also
pose serious risks during pregnancy due
to the need to adjust use of blood
thinners and the potential for lifethreatening clotting (thrombosis) of
heart valves. Congestive heart failure.
As blood volume increases, congestive
heart failure can get worse. Congenital
heart defect. Pregnancy stresses your
heart and circulatory system. During
pregnancy, your blood volume increases
by 30 to 50 percent to nourish your
growing baby. The amount of blood

your heart pumps each minute also


increases by 30 to 50 percent. Your
heart rate increases as well. These
changes cause your heart to work
harder.
Labor and delivery add to your heart's
workload, too. During labor
particularly when you push you'll
experience abrupt changes in blood flow
and pressure. When your baby is born,
decreased blood flow through the uterus
also stresses your heart
3. Asthma
Asthma is a fairly common health
problem for pregnant women, including
some women who have never had it
before. During pregnancy, asthma not
only affects you, but it can also cut back
on the oxygen your fetus gets from you.
But this does not mean that having
asthma will make your pregnancy more
difficult or dangerous to you or your
fetus. Pregnant women who have
asthma that is properly controlled
generally have normal pregnancies with
little or no increased risk to themselves
or their developing babies.
4. Anemia

During pregnancy, your body produces


more blood to support the growth of
your baby. If you're not getting enough
iron or certain other nutrients, your
body might not be able to produce the
amount of red blood cells it needs to
make this additional blood.
It's normal to have mild anemia when
you are pregnant. But you may have
more severe anemia from low iron or
vitamin levels or from other reasons.
Anemia can leave you feeling tired and
weak. If it is severe but goes untreated,
it can increase your risk of serious
complications like preterm delivery.
4.1 Types of anemia
4.1.1 Iron-deficiency anemia.
This type of anemia occurs
when the body doesn't have
enough iron to produce
adequate amounts of
hemoglobin. That's a protein in
red blood cells. It carries
oxygen from the lungs to the
rest of the body.
In iron-deficiency anemia, the
blood cannot carry enough

oxygen to tissues throughout the


body.
Iron deficiency is the most
common cause of anemia in
pregnancy
1.1.2 Folate-deficiency
anemia. Folate, also
called folic acid, is a
type of B vitamin. The
body needs folate to
produce new cells,
including healthy red
blood cells.
1.1.3 Vitamin B12 deficiency.
The body needs vitamin
B12 to form healthy red
blood cells
5. Thallasemia
The thalassemias are a group of genetic
blood diseases that cause a reduction of
the production of normal hemoglobin in
the red blood cells. Hemoglobin is a
protein carried by the red blood cells,
which brings oxygen to all the parts of
the body
Summary
Serious pre-existing disorders which
can reduce a woman's physical ability to
survive pregnancy include a range of

congenital defects (that is, conditions


with which the woman herself was born,
for example, those of the heart or
reproductive organs, some of which are
listed above) and diseases acquired at
any time during the woman's life.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.
Overview Assessment
1. The students need are meet according to the objectives and plans of the topic. The topic has been interesting to the students
and students are able to exhibit a very high cooperation.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Complicated pregnancies(cont.)
Name of Instructor: Ms. Nongnaphat Wongchantorn
Day/Month/Year: 21/11/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Complicated pregnancies

Behavioral
Objectives of each
teaching topic
1.Describe
common
illnesses such as
urinary tract
infection, thyroid
disorders,
appendicitis, and
uterine myoma that
can result
complications
when they exist
with pregnancy.
2. Discuss the
medical
and nursing care
for a woman
infection, thyroid
with urinary tract
disorders,
appendicitis, and
uterine myoma
during pregnancy
*1.5,2.2,5.3

Content of Each Teaching Topic (in


brief)
Nursing therapeutics for high risk and
complicated pregnancies
Introduction
For the vast majority of women,
pregnancy follows a routine course.
Some women, however, have medical
difficulties related to their health or the
health of their baby. These women
experience what is called a high-risk
pregnancy.
Content
1. Urinary Tract Infection
A urinary tract infection (UTI), also
called bladder infection, is a bacterial
inflammation in the urinary tract.
Pregnant women are at increased risk
for UTIs starting in week 6 through
week 24. UTIs are more common
during pregnancy because of changes in
the urinary tract. The uterus sits directly
on top of the bladder. As the uterus
grows, its increased weight can block
the drainage of urine from the bladder,
causing an infection.
2. Thyroid disorders

Teaching and
Learning
Activities
-Lecture
Discussion
-Questions
about
UTI,thyroid
disorders, and
appendicitis
during
pregnancy
-Case study
presentation
about uterine
myoma

Teaching
Aides
-Powerpoint
presentation
-Board and
marker

Evaluation
Methods
-Class
participation
and answering
questions
about UTI,
thyroid
disorders, and
appendicitis
during
pregnancy
-Case study
evaluation
on Uterine
myoma

Evaluation
results
The students
were able to:
-describe and
differentiate
the common
illnesses
during
pregnancy.
- showed a
high
enthusiasm
regarding the
content.
-distinguish
and
comprehend
the topics
discussed.

Pregnancy has a profound impact on


the thyroid gland and thyroid function
since the thyroid may encounter
changes to hormones and size during
pregnancy.
3. Appendicitis
Appendicitis in pregnancy is a
relatively common phenomenon. Rates
of between 1 in every 1000 to 1 in 2000
pregnancy have been reported.
Pregnant mothers thus do develop
appendicitis too. Not uncommonly,
attending physicians and patients
develop a lot of anxiety about the
occurrence of appendicitis during
pregnancy and as to what is the best
way to manage this condition.
4. Uterine myoma
Uterine fibroids are large masses made
up of tissue cells from your uterus.
Actually a type of non-cancerous
tumor, fibroids can grow in and around
your uterus, distorting the shape and
size of this organ. Fibroids typically
range in size, from just a few
centimeters in length to up to 15
centimeters or more. Fibroid tumors
often grow in clusters, so if you have
one uterine fibroid, it is likely that you

may also have more. Fibroids are


actually quite common - between 50%
and 80% of all women have at least
one. For the most part, these fibroids
cause no symptoms, though they can be
problematic for about 20% of women.
Between 10% and 30% of pregnant
women also have fibroids. Uterine
fibroids are usually discovered during
your annual pelvic exam
Summary
High-risk complications occur in only 6
percent to 8 percent of all pregnancies.
These complications can be serious and
require special care to ensure the best
possible outcome.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.
Overview Assessment
1. After learning this topic, the students can answer the questions raised by the lecturer and they were able to comprehend the
topic discussed.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Pregnancy with bleeding
Name of Instructor: Ms. Rungaroon Pumcharoen
Day/Month/Year: 28/11/ 2015 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.

Teaching Units
1. Pregnancy with bleeding

Behavioral
Objectives of each
teaching topic
1. Define abortion.
2. Identify and
discuss the causes
and types of
abortion.
3. Identify the
clinical
manifestations of
abortion.
4. Explain the
medical and nursing
management of
abortion.
5. Define molar
pregnancy.
6. Explain the
causes
of molar
pregnancy.
7. Identify the
clinical
manifestations of
molar pregnancy.
8. Explain the
medical and nursing

Content of Each Teaching Topic (in


brief)
Nursing therapeutics for high risk and
complicated pregnancies
Introduction
A high risk pregnancy is one in which
some condition puts the mother, the
developing fetus, or both at higherthan-normal risk for complications
during or after the pregnancy and birth.
Content
1.Abortion
Abortion is the ending of pregnancy by
the removal or forcing out from the
womb of a fetus or embryo before it is
able to survive on its own. An abortion
can occur spontaneously, in which case
it is often called a miscarriage.
1.1.
Types of abortion
1.1.1. Induced.
Reasons for procuring induced
abortions are typically characterized as
either therapeutic or elective. An
abortion is medically referred to as a
therapeutic abortion when it is
performed to save the life of the
pregnant woman; prevent harm to the
woman's physical or mental health;

Teaching and
Learning
Activities
-Lecture
Discussion
-Questions
about the types
of abortion,
molar
pregnancy,
ectopic
pregnancy.
-Case study
presentation
about abortion,
ectopic and
molar
pregnancy.

Teaching
Aides
Powerpoint
presentation
Board and
marker

Evaluation
Methods

Evaluation
results

Class
participation
and answering
questions on
the types of
abortion, molar
pregnancy,
ectopic
pregnancy.
Case study
evaluation on
Abortion,
ectopic and
molar
pregnancy.

The students
were able to:
-define and
identify types
of abortion.
-differentiate
molar between
ectopic
pregnancy.
- distinguish
and
comprehend
the topics
discussed.
- showed great
enthusiasm in
learning the
topics
discussed.

management of
molar pregnancy.
9. Discuss the
causes of ectopic
pregnancy.
10. Identify the
clinical
manifestations of
ectopic pregnancy.
11. Explain the
medical and nursing
management of
ectopic pregnancy.
12. Compare
abruption placenta
and placenta previa
in terms of causes,
Clinical
manifestations,
medical and nursing
management.
*1.5,2.2,5.3

terminate a pregnancy where


indications are that the child will have
a significantly increased chance of
premature morbidity or mortality or be
otherwise disabled; or to selectively
reduce the number of fetuses to lessen
health risks associated with multiple
pregnancy.
1.1.2 Spontaneous
Spontaneous abortion, also known as
miscarriage, is the unintentional
expulsion of an embryo or fetus before
the 24th week of gestation A
pregnancy that ends before 37 weeks of
gestation resulting in a live-born infant
is known as a "premature birth" or a
"preterm birth". When a fetus dies in
utero after viability, or during delivery,
it is usually termed "stillborn".
Premature births and stillbirths are
generally not considered to be
miscarriages although usage of these
terms can sometimes overlap.
2. Molar Pregnancy
Molar pregnancy is an abnormal form
of pregnancy in which a non-viable
fertilized egg implants in the uterus and
will fail to come to term. A molar
pregnancy is a gestational trophoblastic

disease which grows into a mass in the


uterus that has swollen chorionic villi.
These villi grow in clusters that
resemble grapes. A molar pregnancy
can develop when fertilized egg had
not contained an original maternal
nucleus. The products of conception
may or may not contain fetal tissue. It
is characterized by the presence of a
hydatidiform mole (or hydatid mole,
mola hydatidosa). Molar pregnancies
are categorized as partial moles or
complete moles, with the word mole,
being used to denote simply a clump of
growing tissue, or a growth.
3. Ectopic Pregnancy
An ectopic pregnancy, or eccyesis, is a
complication of pregnancy in which the
embryo is implanted outside the uterine
cavity.With rare exceptions, ectopic
pregnancies are not viable.
Furthermore, they are dangerous for
the mother, since internal bleeding is a
life-threatening complication. Most
ectopic pregnancies (93-97%) occur in
the distal Fallopian tube (so-called
tubal pregnancies), but implantation
can also occur in the cervix, ovaries,
and abdomen. An ectopic pregnancy is

a potential medical emergency, and, if


not treated properly, can lead to death
4. Abruptio Placenta
Placental abruption (also known as
abruptio placentae) is a complication of
pregnancy, wherein the placental lining
has separated from the uterus of the
mother prior to delivery. It is the most
common pathological cause of late
pregnancy bleeding. In humans, it
refers to the abnormal separation after
20 weeks of gestation and prior to
birth. It occurs on average of 0.5% or 1
in 200 deliveries. Placental abruption is
a significant contributor to maternal
mortality worldwide; early and skilled
medical intervention is needed to
ensure a good outcome, and this is not
available in many parts of the world.
Treatment depends on how serious the
abruption is and how far along the
woman is in her pregnancy
5. Placenta Previa
Placenta praevia (placenta previa AE)
is an obstetric complication in which
the placenta is inserted partially or
wholly in the lower uterine segment. It
is a leading cause of antepartum
haemorrhage (vaginal bleeding). It

affects approximately 0.4-0.5% of all


labours.
In the last trimester of pregnancy the
isthmus of the uterus unfolds and forms
the lower segment. In a normal
pregnancy the placenta does not
overlie. If the placenta does overlie the
lower segment, as is the case with
placenta praevia, it may shear off and a
small section may bleed.
Summary
A pregnancy can be considered a highrisk pregnancy for a variety of reasons.
Factors can be divided into maternal
and fetal. Maternal factors include age
(younger than age 15, older than age
35); weight (pre-pregnancy weight
under 100 lb or obesity); height (under
five feet); history of complications
during previous pregnancies (including
stillbirth, fetal loss, preterm labor
and/or delivery, small-for-gestational
age baby, large baby, pre-eclampsia or
eclampsia); more than five previous
pregnancies; bleeding during the third
trimester; abnormalities of the
reproductive tract; uterine fibroids;
hypertension; Rh incompatability;

gestational diabetes; infections of the


vagina and/or cervix; kidney infection;
fever; acute surgical emergency
(appendicitis, gallbladder disease,
bowel obstruction); post-term
pregnancy; pre-existing chronic illness
(such as asthma, autoimmune disease,
cancer, sickle cell anemia, tuberculosis,
herpes, AIDS, heart disease, kidney
disease, Crohn's disease, ulcerative
colitis, diabetes). Fetal factors include
exposure to infection (especially herpes
simplex, viral hepatitis, mumps,
rubella, varicella, syphilis,
toxoplasmosis, and infections caused
by coxsackievirus); exposure to
damaging medications (especially
phenytoin, folic acid antagonists,
lithium, streptomycin, tetracycline,
thalidomide, and warfarin); exposure to
addictive substances (cigarette
smoking, alcohol intake, and illicit or
abused drugs). A pregnancy is also
considered high-risk when prenatal
tests indicate that the baby has a
serious health problem (for example, a
heart defect). In such cases, the mother
will need special tests, and possibly
medication, to carry the baby safely

through to delivery. Furthermore,


certain maternal or fetal problems may
prompt a physician to deliver a baby
early, or to choose a surgical delivery
(cesarean section) rather than a vaginal
delivery.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4.
Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.
Overview Assessment
1. The students need are meet according to the objectives and plans of the topic. Students exhibit a high participation.

Teaching Plan (Theory)


Semester 1 Academic Year 2558

Course code: INUR 3314 Course Title: Midwifery I


Teaching topic: Pregnancy with infectious diseases
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 15/12/ 2014 Time: 9:00-11:00
Venue: Christian University Room 401
Year of Students: Third Year

Course Behavioral Objectives:


1. Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.

Teaching Units
1. Pregnancy with infectious diseases

Behavioral
Objectives of each
teaching topic
1. Differentiate the
signs and symptoms
diagnoses and
medical and nursing
management among
common infectious
diseases such as
hepatitis B, herpes,
syphilis, rubella, and
HIV.
2. Identify the causes
of infectious
diseases during
pregnancy.
3. Explain the effects
of on and
management of
pregnant women
who have human
immunodeficiency
virus (HIV) infection
and AIDS.
4. Describe the
prevention of

Content of Each Teaching


Topic (in brief)
Pregnancy with infectious
diseases
Introduction
Most common maternal
infections (eg, UTIs, skin and
respiratory tract infections) are
usually not serious problems
during pregnancy, although some
genital infections (bacterial
vaginosis and genital herpes)
affect labor or choice of delivery
method. Thus, the main issue is
usually use and safety of
antimicrobial drugs. However,
certain maternal infections can
damage the fetus (for congenital
cytomegalovirus or herpes
simplex virus infection, rubella,
toxoplasmosis, hepatitis, or
syphilis
Content
1.Hepatitis B Virus
Hepatitis B (also referred to as
hep B) is a highly infectious virus
that's spread through blood,

Teaching
and
Learning
Activities
-Lecture
Discussion
-Question
about
Hepatitis B,
herpes,
syphilis and
rubella
during
pregnancy.

Teaching
Aides
-Powerpoint
presentation
-Board and
Marker

Evaluation Methods
Class participation and
answering questions
on Hepatitis B, herpes,
syphilis and rubella
during pregnancy
-Final Quiz on
Nursing therapeutics
for high risk and
complicated
pregnancies,pregnancy
with bleeding and
pregnancy with
infectious diseases.

Evaluation
results
The students
were able to:
-differentiate
the common
maternal
infections
affecting
labor and
choice of
delivery
method.
-give correct
answers to
questions
-showed a
high
enthusiasm
regarding the
content.

infectious diseases in semen, and other bodily fluids. If


women.
you're a carrier, you may have
*1.5,2.2,5.3
contracted the virus:
Through sexual contact with
another carrier
At birth, if your mother was a
carrier
By sharing needles or getting
stuck by a needle accidentally
By using a toothbrush or razor
that has even a small trace of a
carrier's blood on it (even one
you can't see)
By getting a body piercing or
tattoo at a place where good
health practices aren't followed
1.1 Signs and symptoms
you contract hepatitis B, you may
feel very tired. You may also
have abdominal pain, nausea and
vomiting, a loss of appetite, joint
pain, or jaundice (your eyes and
skin take on a yellow tinge). But
many people have no symptoms
and never even know they've
been infected.
About 10 to 15 percent of people
who are 5 years of age or older
when they contract HBV end up

as hepatitis B carriers meaning


that their body never gets rid of
the virus. About a quarter of
those with a chronic HBV
infection will eventually end up
with a life-threatening liver
disease, and about 20 percent of
those with liver disease develop
liver cancer. An estimated 5,000
people in the United States die
every year from illness caused by
HBV.
2. Herpes
The biggest concern with genital
herpes during pregnancy is that
you might transmit it to your
baby during labor and delivery.
Newborn herpes is relatively rare
(about 1,500 newborns are
affected each year), but the
disease can be devastating, so it's
important to learn how to reduce
your baby's risk of becoming
infected.
You can transmit herpes to your
baby during labor and delivery if
you're contagious, or "shedding
virus," at that time. The risk of
transmission is high if you get

herpes for the first time (a


primary infection) late in your
pregnancy.
3. Syphilis
Syphilis is a sexually transmitted
infection (STI) that's caused by a
type of bacterium. If left
untreated, syphilis can have very
serious long-term consequences.
Fortunately, if caught in time, it
can be treated with antibiotics.
Syphilis is transmitted by direct
contact with a sore on an infected
person. The most common way
to get syphilis is through vaginal,
anal, or oral sex, but it's also
possible to get it by kissing
someone with a syphilitic sore on
or around the lips or in the mouth
or by exposing an area of broken
skin to a sore.
Syphilis can be transmitted to
your baby through the placenta
during pregnancy or by contact
with a sore during birth.
The infection is relatively rare
among women in the United
States, with 1 case per 100,000
women in 2011. The rates are

significantly higher in
communities with high levels of
poverty, low levels of education,
and inadequate access to health
care.
4. Rubella
Rubella, also known as German
measles, is a short-lived
infectious disease of childhood
caused by a togavirus. German
measles and so-called red
measles, or rubeola, are not
directly related to each other,
though both are covered by the
common MMR (measles,
mumps, rubella) vaccine. Most
women of childbearing age either
have had the disease or have been
immunized against it as a child.
Even if you're not immune, the
risk that you might contract
rubella is practically nil since the
disease has been eliminated in
this country and most people are
immune and unlikely to come
down with it in the first place.
However, since rubella is
contagious and since it hasn't
been eliminated abroad, a

nonimmune person is at risk of


getting the illness if she comes
into contact with someone who is
infected. The rubella virus is able
to cross the placenta and is most
dangerous early in pregnancy,
when babies exposed to the virus
are at risk of a condition called
congenital rubella syndrome,
characterized by eye defects,
heart defects, and mental
retardation. The risk of
miscarriage or stillbirth also
increases if a pregnant woman
contracts rubella. Exposure after
20 weeks of pregnancy rarely
results in such defects

Summary
Getting prenatal care is crucial.
For example, simple blood tests
can tell you whether you're
immune to certain infections,
such as chicken pox and rubella..
Basic measures like washing
your hands, not sharing drinking
glasses or utensils, not changing
cat litter, using gloves when

gardening, and staying away


from anyone with a contagious
disease will reduce your risk of
getting sick.
Practicing safe sex will help
prevent many sexually
transmitted infections. And you
can take measures to avoid foodborne infections too such as
not eating certain foods, washing
fruits and vegetables, and making
sure that your meat, fish, and
eggs are well cooked and your
work surfaces aren't
contaminated.

Reference:
1.
Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.
2.
Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3.
Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women Health Care.8th ed.

4.

St. Louis : Mosby-Year. Book, Inc.


Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and womens Health Care. 8th ed. Missuri.
Mosby.

Overview Assessment
1. After learning this topic, the students were able to answer the questions raised by the lecturer and they showed a very high
participation in the class discussion.