Fetal Welfare During Pregnancy and Childbirth

Fetal Welfare During Pregnancy and Childbirth Monitor fetal welfareThis can be done by health workers or pregnant women themselves. It is very important for midwives to teach mothers how to monitor the welfare of their fetus because midwives or health workers cannot always monitor the welfare of the fetus at all times. So that the fetus is immediately known if there are signs of danger, pregnant women must monitor their fetus every day. 1)Monitoring Fetal Welfare by Health Workers. - Ultrasound is performed by a doctor to determine gestational age, monitor the condition of the fetus, check the length of the fetal head buttocks (CRL: Crown - Rumplength). - Calculating the fetal heart rate (djj) using a monocular stethoscope or leanec stethoscope, can also be done with a - Doppler, usually done by midwives by: attaching the stetoscope / dopller to the mother's stomach at the punctum maximum, distinguishing djj from the mother's pulse by feeling the pulse on the wrist mother, then count the fetus's heart rate for a full minute. - Non Stress Test (NST) / Non-Stress Test. Indications for NST: 1. Suspected IUGR 2. History of IUGR in previous pregnancies 3. DM 4. Hypertension 5. Multiple gestation 6. Ologohydramnios 7. Bypassing HPL 8. PROM (Premature rupture of membranes) / premature rupture of membranes 9. Decreased fetal movement 10. History of stillbirth Nonstress Test (NST) Procedure. 1. Place the patient on his side (left or right) 2. Initiate external electronic fetal monitoring (FHR and contractions) 3. Identify the FHR (Fetal Heart Rate) limit of at least 3 minutes. 4. Continue monitoring for at least 20 minutes 2)Monitoring fetal well-being by pregnant women. By counting fetal movements (FMC: Fetal Movement Counting). FMC simple method: 1. Ask mother to put 10 coins in a bowl 2. Take a coin every time the fetus moves 3. If you don't take all the coins within two hours, then pregnant women should immediately see a midwife or doctor. The daily FMC carried out by pregnant women can vary. Ask the pregnant woman to determine a time of day when the fetus is usually active and the pregnant woman has time to focus on fetal movements. For example, at 8 am when the mother has eaten breakfast, fetal movements are usually active and the mother can rest while reading the newspaper so she can focus on paying attention to fetal movements. Every day at the same time, namely 8 am, start counting fetal movements and record in a small book how long it takes to identify 10 fetal movements. If at any time it takes longer than usual to reach 10 fetal movements or there are no movements, the pregnant woman should immediately see a midwife or doctor. 3)Regular Visits During the remaining pregnancy after the first examination, pregnant women are expectedto come for examination to a clinic or health facility. The pregnancy check-up schedule is set as follows; at 28 weeks of gestation, examinations are carried out every 4 weeks; after entering 28 weeks to 36 weeks of pregnancy, check every 2 weeks; and after 36 weeks of gestation until delivery, the examination becomes more intensive, namely once a week. If there are complications or abnormalities, it is hoped that you will come for an examination immediately and not wait for the next scheduled examination. Things that need to be done on a return visit are: 1. Current pregnancy history includes: - Asking how the client feels since their last visit - Ask if the client has any questions or concerns since their last visit - Ask about fetal movements in the last 24 hours. - Ask whether there are any problems or signs of danger that the client may have experienced since the last visit. - Ask whether there are any complaints that have been commonly experienced since pregnancy. Ask the mother about nutritional status, iron supplements and Tetanus Toxoid (TT) immunization. 2. General approaches to inspection include: - Observe the client's appearance, emotional mood and body posture during the examination - Explain all inspection procedures - Continuing questions that need to be clarified while conducting the inspection 3. Laboratory tests and danger signs include: - Ask BAK clients to check for proteinuria and urine glucose if necessary - Measuring blood pressure 4. Physical examination includes: - Measure the height of the uterine fundus by hand if the gestational age is > 12 weeks, or with a tape measure if the gestational age is > 22 weeks - Perform abdominal palpation to detect multiple pregnancies if the gestational age is > 28 weeks - Perform abdominal palpation to determine the location, presentation, position and descent of the fetal head if the gestational age is > 36 weeks - Counting DJJ with a fetoscope if the gestational age is > 18 weeks 5. Counseling and preparation for childbirth/complication preparedness includes: - Explain to the mother about the normal discomfort experienced. - According to the gestational age, teach the mother about breastfeeding, birth control, light exercise, rest, nutrition and fetal growth. - Discuss birth/emergency preparation plans. - Teach mothers about danger signs, make sure mothers understand what to do if they encounter danger signs. - Schedule the next return visit Document the results of the visit in a SOAP note