ANALYSIS OF CASE STUDY Based on data collected and care rendered to Rhoda, the following are the pertinent

issues. At age 26 Rhoda fell in a group of women with the lowest obstetric risk as far as age is concerned (Safe Motherhood 2 !. "ith height of #$$ cm Rhoda was abo%e an a%erage height of #$ cm thus a normal %aginal deli%er& was anticipated. 'here is an association between maternal height and deli%er& outcome. "omen with short stature ha%e an increased risk of cephalo(pel%ic disproportion due to short pel%ic diameter. )n social histor& she said she was the first and onl& wife to her first husband who was working and was gi%ing her ade*uate financial and emotional support. 'his is good because a pregnant woman needs ade*uate support from spouse for her to effecti%el& cope with pregnanc&. She also stated that with the mone& earned b& her husband the& are able to bu& basic essential needs like food and clothes hence fostering mother+s health and proper de%elopment of the foetus. She did her school up to standard eight thus her le%el of understanding was low hence the need for comprehensi%e health education. She was a member of Se%enth ,a& Ad%entist church hence needed guidance on alternati%es to pork and some t&pes of fish the& are not allowed to take. She was a house wife hence needed ad%ice on how she could start a business so that she can e%entuall& become independent financiall& and be able to support herself and her famil&. Both do not smoke nor drink alcoholic be%erages. 'his is good for wellbeing of mother and foetus. -icotine a substance found in tobacco causes interference with o.&gen e.change in lung al%eoli resulting in reduction of o.&gen in circulating blood. Alcohol reduces appetite thus leading to malnutrition in the mother which ma& lead to fetal growth retardation. Rhoda did not suffer from an& hereditar& diseases and no close relati%e she knew e%er suffered from hereditar& diseases such as diabetes, h&pertension, mental illness, epileps& etc. Rhoda weighed 6#kg on initial %isit to antenatal clinic. "eight indicates maternal nutritional status. "ith a height of #$$cm Rhoda had a normal weight for height ratio. According to M&les (2 /!, pregnant women are supposed to gain .$kg weekl& from 2 weeks gestation. )n initial %isit she weighed 6# kg and on second %isit she weighed 60 kg. "eight gain of 2 kg is normal and e.pected in the second trimester. ,uring her third %isit she weighed 6$ kg and on the fourth %isit she weighed 61 kg. Maternal weight gain indicates fetal growth2 thus Rhoda+s bab& was growing normall&.

She had a haemoglobin le%el of ##.3g4dl. 'his indicates that she was not anemic. According to Safe Motherhood (2 ! anaemia in Malawi is defined as haemoglobin le%el of less than # g4dl. 5n pregnanc& there is an increased demand for o.&gen due to increased demand b& the growing fetus. She tested negati%e for proteinuria. 6roteinuria in pregnanc& indicates pregnanc& induced h&pertension, pre(eclampsia and renal failure. She was also tested for 7enereal ,isease Research 8aborator& 'est. 'his is a test conducted to diagnose s&philis in client+s blood. 'he results came out negati%e meaning that she did not ha%e s&philis. S&philis can cause intra(uterine death of foetus or congenital abnormalities hence the need for the test and treatment. She tested negati%e for 957. 957 can be transmitted to the fetus intrauterine, at birth or through breast milk hence the need to single out infected mothers and gi%ing them drugs that reduce the chance of 957 transmission to the foetus. She also tested negati%e for gluconuria meaning she did not ha%e diabetes which is associated with macrosomia which interferes with normal deli%er&. She was gi%en :ansidar 0 tablets as a proph&la.is for malaria in the second and third trimester to pre%ent the mother and the fetus from malaria. Malaria resistance is reduced during pregnanc& (M&les, 2 0!. -eonates born with congenital malaria are well at birth but de%elop fe%er, ;aundice and splenomegall& within # (2 da&s of birth (Ma&es, 2 /!. 5ron tablets 2 mg orall& once a da& was gi%en to Rhoda for one month throughout antenatal period. 5ron tablets impro%e haemoglobin hence pre%enting anaemia. 'etanus 'o.oid %accine was gi%en on initial antenatal %isit and one month later in order to pre%ent the mother and the fetus from tetanus. Assessment on admission confirmed breech presentation. According to Sellers (2 #! there are no known causes of breech presentation. 9owe%er the following factors fa%our breech presentation< preterm babies, multiple pregnanc&, pol&h&dramnios, grand multipart&, contracted pel%is, placenta prae%ia, bicornuate uterus, h&drocephalus and anencephal&. :rom both sub;ecti%e and ob;ecti%e data no predisposing factor was identified. =ltra Sound Scanning was re*uired to rule out some of the pre(disposing factors but it was not done ante(natall&.

'here was normal progress of labour indicated b& progress of contractions from mild to strong. :etal heart rate remained within the normal ranges indicating that there was no fetal distress. Meconium stained li*uor is normal in breech presentation and does not indicate fetal distress (Sellers, 2 #!. As the breech descends into the pel%is, meconium is forced out of the colon and anus. Membranes ruptured spontaneousl& at $pm. A %aginal e.amination was done to assess for cord prolapse which was ruled out. An hour later she deli%ered ruling out need for antibiotics which are indicated when membranes ha%e ruptured for more than 2/ hours before deli%er& (M&les, 2 0!. "hen the loop of the cord appeared, she was discouraged from pushing and the loop was gentl& pulled down and loosened and strong pulsations were present. 8oosening of the cord pre%ents tension on the cord that can block blood suppl& to the fetus. 'ime was noted when loop of the cord appeared and deli%er& of the bab&. 'here was $ minute inter%al. )nl& 1 to # minutes is re*uired before deli%er& if the bab& is to sur%i%e because once the fetal head enters the maternal pel%is blood suppl& is cut from the fetus (Sellers 2 0!. >.tended arms were deli%ered using 8o%set+s manou%re to pre%ent se%ere perineal tears and trauma to the fetus. 'he head was deli%ered using Burn+s Marshall Manou%re because it was fle.ed. After deli%er& the mother was e.amined for an& tears. She sustained first degree perineal tear which was sutured using chromic 2( suture with prior administration of #? lignocaine. 'he bab&+s birth weight was 0# g. 'his was within the normal range of 2$ g to 03 g and was an indication that the bab& was mature (Bennet @ Brown#AAA!. )n discharged at age of 0da&s, the bab& weighed 0 g. "eight loss during the first 0 da&s of life of up to # ? is normal. "eight is regained b& age # da&s. "eight loss is due to inade*uate breast milk in earl& da&s, passing out of meconium, and insensible water loss. "eight is regained later because production of breast milk becomes well established b& da& 0 after deli%er&. 'he bab& was also e.amined for trauma. 'here was no apparent in;ur&. 2/(/3 hours post(deli%er& the bab& had been ha%ing a normal cr&, no con%ulsions and did not de%elop ;aundice. 'his was an indication that the bab& did not sustain an& in;ur& during birth and was adapting well with e.tra(uterine life.

BBC and polio

%accines were administered to the bab& before discharge.

CONCLUSION 9er labour lasted for a normal period i.e. about #$ hours. 8abour e.ceeding 2/hours is classified as prolonged labour. 'he fetus did not distress throughout labour and deli%er& as indicated b& a normal fetal heart rate. =terine contractions progressed well. Mother+s %ital signs remained within normal ranges throughout labour, deli%er& and post(natal periods. ,eli%er& was conducted within recommended time and appropriate manou%res were used. Rhoda adapted %er& well postnatall& and her bab& also adapted well with e.tra(uterine life.

PERSONAL IMPRESSION Rhoda did not e.perience an& significant problems during antenatal, labour, deli%er& and post(natal periods. A good client(care pro%ider rapport was established and maintained throughout her hospital sta&. She was well assessed, monitored and taken care of during her entire hospital sta&. 5 strongl& feel that success of her pregnanc& out come was as a result of indi%idualiDed care 5 pro%ided and support 5 got from other midwi%es and other health care pro%iders who continued pro%iding indi%idualiDed care to Rhoda in m& absence. RECOMMENDATIONS 5t is recommended that haemoglobin test should be done more than once to ensure anaemia is isolated and treated throughout pregnanc& period. 5t is also recommended that albendaDole should be gi%en to all women attending antenatal clinic to pre%ent anaemia that come as a result of worm infestation. 5t is also recommended that all pregnant women should undergo ultrasound scanning antenatall& to isolate an& problems with the fetus. CHALLENGES AND LIMITATIONS 8imitation of resources e.g. sterile packs for cleaning cord, basins to demonstrate bathing of the bab& posed a big challenge to care implementation.

'here was no auditor& pri%ac& because a number of clients were being e.amined in the same room at the same time with onl& co%ering of screens. Rhoda was counseled alone on all topics because her husband was alwa&s at work. LESSONS LEARNT Multiparas women should not be taken for granted that the& know a lot about deli%er& and child care. 'he& need to be taught as much as primigra%idas. 6s&chological preparation of the mother is %er& important as it is the basis for cooperation. Bomprehensi%e hando%er ensures continuit& of indi%idualiDed care pro%ision on patient.