Self-Assessment Questions (SAQs) for Study Session 3
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the questions below Case Study 3.1. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.
First read Case Study 3.1 and then answer the questions that follow it.
Case Study 3.1 Woizero Almaz
Woizero Almaz is a full term pregnant woman who came to the Health Post with pushing down pain and blood stained vaginal discharge which began five hours earlier. This is her first pregnancy and she is very anxious about it. On examination you found she is in first stage of labour.
SAQ 3.1 (tests Learning Outcomes 3.2 and 3.3)
What support can you give her to alleviate Woizero Almaz’s fear about her condition?
To reassure Almaz, be kind and respect her and her culture and norms. Show interest in her. Explain what is happening and how the labour will progress. Encourage her to ask questions and express her ideas and worries. Tell her about the condition of her baby. Allow a trusted support person to be with her. Explain each procedure before you do it.
SAQ 3.2 (tests Learning Outcome 3.4)
What assessment tools and means will you use to assess the progress of Almaz’s labour? How will these assessments help you?
Measuring Almaz’s blood pressure, temperature and pulse helps you to know about her condition. By checking the fetal heartbeat it is possible to identify the presence of fetal distress. Monitoring the contractions, cervical dilatation and descent of the baby’s head all help to assess the progress of labour. (When you have learned about the partograph in Study Session 4, you will know that it is the best tool to follow the progress of labour and to detect any abnormality on time).
SAQ 3.3 (tests Learning Outcomes 3.5 and 3.6)
During the first stage of labour, what type of food will you recommend to her? And how often will you try to get her to eat something?
During the first stage of labour, a high calorie fluid diet is recommended. Some examples are tea, soft drinks, soup, and fruit juice. Almaz should drink at least one cup every hour.
SAQ 3.4 (tests Learning Outcomes 3.5 and 3.6)
When you are providing care to Almaz during her labour, how do you prevent infection being transmitted to her and her baby?
Adopt standard precautions and infection prevention procedures during vaginal examinations and conducting the delivery. Wash your hands before and after each procedure for at least 2 minutes, using soap and clean water or an alcohol hand cleaner. Wear clean protective clothing such as an apron, goggles, mask, gloves and shoes. Use safe waste disposal methods (burying or burning). Scrub, decontaminate and sterilise metal or glass instruments using a 0.5% chlorine solution for 10 minutes, then cleaning with soapy water and boiling or using a sterilisation machine.
SAQ 3.5 (tests Learning Outcome 3.4)
What will you assess (and how often) to check whether Almaz’s labour is progressing normally?
You would measure vital signs in the mother: blood pressure and temperature every 4 hours, pulse every 30 minutes.
You would monitor the frequency, length and strength of her contractions every 30 minutes; in normal labour, as the labour progresses, contractions become faster, stronger and more frequent.
Cervical dilatation is assessed by doing a vaginal examination every 4 hours; in normal labour the average rate for cervical dilatation is at least 1 cm per hour.
You would measure the descent of the presenting part every 2 hours by abdominal palpation of the fetal head in relation to the pelvic brim, or by vaginal examination.
SAQ 3.6 (tests Learning Outcome 3.4)
What would indicate that Almaz’s baby is showing signs of fetal distress?
The presence of dark-green meconium in the amniotic fluid leaking from Almaz’s vagina during labour suggests fetal distress; meconium is the baby’s first stool and it does not normally pass stool until after the birth. The fetal heart rate in a distressed baby during labour and delivery could either be significantly above or below the normal range of 100–180 beats per minute.
SAQ 3.7 (tests Learning Outcomes 3.1, 3.2 and 3.6)
Which of the following statements is false? In each case explain what is incorrect.
A Maternal preference means respecting how the mother wants to give birth.
B In the first stage of labour the mother should not drink anything in case she vomits.
C The frequency of contractions refers to how painful the contractions become.
D Meconium discharging from the vagina is a sign of fetal distress.
E The ‘three cleans’ are clean hands, clean surface for the delivery and clean equipment.
A is true. Respecting maternal preferences includes how she wants to give birth.
B is false. During the first stage of labour the mother should drink at least one cup of fluid every hour to prevent dehydration.
C is false. The frequency of contractions refers to how often they come in every 10 minute period during the labour; it does not refer to how painful they become, which is the strength of contractions.
D is true. Meconium discharged from the vagina is a sign of fetal distress.
E is true. The ‘three cleans’ are clean hands, clean surface for delivery and clean equipment.
Summary of Study Session 3