Management
is often referred to midwifery care or obstetric management is a method
of thinking and acting in a systematic and logical in providing
midwifery care , so that both parties benefit both clients and
caregivers . Obstetric management was adapted from a concept developed by Helen
Varney Varney 's Midwifery in the book , the third edition in 1997,
describes the process of midwifery care management which consists of
seven successive steps in a systematic and cyclic .
Step I : Basic data collection
In the first step the assessment is done by collecting all the data is performed to evaluate the patient's condition fully . In the first step of data that must be collected includes data
komporhensif subjective , objective , and results of the examination ,
so as to describe the condition of the actual client and Valid .
A. Subjective Data
1 . Biodata which includes the identity of the patient
a) The name , clear and complete
b ) Age , recorded in the year
c ) Religion , to determine the patient's beliefs in order to guide or direct the patient to pray
d ) Education , to determine the extent of the intellectual level of
the patient , so that midwives can provide counseling in accordance with
education
e ) Tribe / Nation , affect the customs / daily habits - today
f ) Work to identify and measure the economic level . This effect on the level of patient nutrition
g ) address , to facilitate home visits when necessary
h ) No Rmh / Hp , to facilitate communication with patients
2 . The main complaint
To find out the problems faced with regard to puerperal period , for
example, feel stomach ache , pain in the birth canal because of the
presence of sutures on perenium
3 . medical history
a. Past medical history to determine the possibility of a history or acute illness suffered
b . Knowing the health history is now possible illness at this point that has to do with her baby during childbirth and
c . Knowing the family history of disease the possibility of the influence
of the family on the patient's health problems and her baby
4 . History of Marriage : How many times married , married status
5 . Obstetric History
a. History of pregnancy , childbirth and postpartum ago , how many times
inu pregnant , if ever abortion , number of children , the last mode of
delivery , birth attendants , postpartum state ago
b . Labor history now , persalinanjenis date of delivery , sex of the child , the state of the baby ( BB , PB ) birth attendants ,
6 . History KB
To determine whether the patient ever used family planning or not ,
what type , how long , if there are complaints when using it and plan
family planning after childbirth period and what the desired type .
7 . Social and cultural life
To know the patients and families who embrace the traditions that will
favor or disfavor particular patient at the time of parturition ( eg
eating habits )
8 . Psychosocial Data
To study the response of mothers and families of the babies
9 . Data knowledge
To find out how far the development of knowledge about the patient's care after giving birth so profitable during the puerperium
10 . The pattern of daily fulfillment - the
a. Nutrition : On the pattern of eating and drinking , frequency , number , type, food taboos
b . Elimination : About secretory function is bowel and bladder habits , frequency , amount , odor , color , consistency
c . Rest : On rest and sleep patterns of patients ( number of hours )
d . Personal hygiene : Whether mother always maintain the cleanliness of the body , especially in the genital
e . The pattern of activity of the patient's daily activities - day
B. Objective Data
In the face of a patient during childbirth , the midwife must collect data to ensure that the patient is in stable condition . Components are included in the assessment of objective data is
1 . Signs - vital signs
Aimed to determine the state of the mother related to her condition
a. Temperature / temperature
b . Pulse and breathing
c . blood pressure
2 . physical examination
a. State of the breasts and nipples ( symmetric / no , consistency , no swelling / no , puttingmenonjol / no , blisters / no )
b . The state of the abdomen ( normal uterus : sturdy , good contract ,
not when the fundal height above the immediate postpartum period .
Uterus is abnormal : soft , fundal height above the time period
immediately post- parturition )
c . Bladder ( to defecate / no )
d . The state of the genitalia ( Normal :
- Lochea ( red black : lochea rubra , unusual smell , no blood clots
or grains - grains of frozen blood , the amount of light bleeding or
less. Abnormal : bright red , foul odor , frozen bleeds , heavy bleeding
,
- The state of perenium : edema , hematoma , scar episiotomy / laceration , hecting .
- The state of the anus : hemorrhoids .
- The state of ekstreminitas : varicose veins , edema
Step II : Interpretation of the data base
In
this step the identification of the diagnoses or problems based on
accurate interpretation on the basis of the data that has been collected
. Basic data that has been collected , interpreted so as to formulate a diagnosis and specific problem . Diagnosis
and problem formulation , both used because the problem can not be
identified as a diagnosis , but still need to be addressed . The
problem is often associated with things that are being experienced by
women who are identified by the midwife in accordance with assessment
results . The problem is also often accompanies the diagnosis .
a. With regard to the diagnosis Midwifery , abortion , live child , mother's age and state of puerperal basic data include :
1 . Subjective data ( mother's statement about the amount of labor ,
whether or not abortion ever , information about the mother's complaint )
2 . Objective data on TFU and contraction palpation , vaginal examination of expenditures , the results of TTV
b . Constraint problem statement munculberdasarkan patients . Basic data include subjective data (data obtained from the patient
anamneses ) and objective data ( data obtained from the results of the
examination
Step III : Identifying Diagnosis or potential problems
In
this step we identify problems or other potential diagnoses and
diagnoses based on a series of issues that have been identified . This step requires the prevention of anticipation whenever possible
done while observing the patient , the midwife is expected to be
prepared when the diagnosis of potential problems actually occur .
Step IV : Identify and define the needs that require immediate treatment
Identifying
the need for immediate action by the midwife or doctor and or / to be
consulted or dealt with by other health team members in accordance with
the client's condition . The fourth step of the process reflected the continuity of midwifery penatalaksanan earlier . So its management not only in the course of antenatal visits . But continuously until the women maternity and finish times nifasnya safely .
Step V : a comprehensive Care Plan
In this step menyuluruh planned care , determined by the previous steps . This step is a continuation of the diagnosis or management problems that have diindentifiakasi or anticipated . In this step the information / data base that is incomplete can be fitted . In this step midwife task is to formulate a plan of care and make a
deal with patients in accordance with the results of the discussion with
the patient's care plan before melaksanaknnya.adapun things - things
that need to be done yaiyu include :
a. observation :
umu state of the patient , awareness , signs - vital signs , TFU ,
uterine contraction , encourage the mother to urinate immediately ,
early mobilization observation
b . Personal hygiene
1 . Keep your entire body , especially the genital area
2 . Change the bandage every other day , or every time after urinating
c . break
1 . Simply break
2 . Give understanding of the benefits of rest
3 . Back homework a day - day
d . nutrient
1 . Eat nutritious food , quality and enough calories
2 . Drink 3 liters of water a day or a glass after every feed
3 . Drinking tablets Fe / iron ( 40 tabs / day ) and Vit A
e . breast care
1 . Keep a Breast
2 . Give infants exclusively breastfed until 6 months of age
f . sexual intercourse
Give definition of sexual intercourse may be performed anytime
g . family Planning
Instruct the mother to follow the KB according to his
Step VI : Implementing the plan
In this step a comprehensive care plan dilakukankan efficiently and safely . This plan can be carried out entirely by midwives or in part by the patient , or other health care team members . Although the midwife did not do it himself he still bears responsibility for directing .
a. Observed include :
1 . The general state
2 . awareness
3 . TTV ( measuring blood pressure, temperature , pulse and respiration )
4 . TFU , uterine contractions
5 . Encourage the mother to urinate immediately because if a full bladder inhibits uterine involution process
6 . Encourage the mother to mobilasi lochea early to expedite expenditure , accelerate blood circulation
b . personal hygiene
1 . Maintain cleanliness of the entire body , especially the genital area
2 . Changing pads every other day or every time after urinating
c . break
1 . Giving advice to the mother for a nap enough not to be too tired
2 . To alert the mother , if the lack of rest can lead to the production
of less milk production , involusio running slow process that can lead
to bleeding
3 . Advocate the mother to return to work a day job - the
d . nutrient
1 . Consuming nutritious food and enough calories quality mothers should eat foods that contain protein , vitamins and minerals
2 . Drink 3 liters of water a day or after every glass of breastfeeding
3 . Drinking tablets Fe / iron for 40 days after delivery
4 . Drinking vitamin A ( 200 . 000 units ) in order to provide vitamin A to infants through breast milk
e . breast care
1 . Keep a Breast
2 . Give infants exclusively breastfed until 6 months of age
f . Giving Sexual intercourse sense when don'ts
g . Family Planning Advise the mother to immediately follow the KB after childbirth period elapsed in accordance with the wishes
Step VII : evaluation
At
this step to evaluate the activeness of the care that has been given
include the fulfillment of a need for help , whether truly fulfilled in
accordance with the needs which have been identified as the problem and
diagnosis . The
plan can be considered effective if it is really effective in
pelaksannaanya There is a possibility that some of these plans have been
effective while others have not been effective .
