Maternal and Newborn Health Nursing
This domain spans the antenatal, intrapartum, postpartum, and neonatal periods, and questions often hinge on recognising deviation from normal. Understand antenatal care: dating and estimated due date, routine screening, danger signs (bleeding, severe headache with visual disturbance, reduced fetal movement, fever, draining membranes), and health promotion including nutrition, iron and folate, and malaria prevention where relevant.
For labour and birth, know the stages, the expected pattern of contractions and cervical change, fetal monitoring (baseline rate, variability, accelerations, decelerations - variable decelerations suggest cord compression, late decelerations suggest uteroplacental insufficiency), and the major emergencies: postpartum haemorrhage (uterine atony is the commonest cause - massage the fundus, empty the bladder, escalate), pre-eclampsia and eclampsia (hypertension with proteinuria; magnesium sulphate for seizure prophylaxis with monitoring for toxicity), obstructed labour, and shoulder dystocia.
Postpartum and newborn care includes involution, lochia assessment, breastfeeding support, thermoregulation (the newborn loses heat by evaporation, conduction, convection, and radiation), hypoglycaemia, jaundice, and newborn resuscitation principles (warm, dry, stimulate, position, then ventilate if not breathing).
Traps: attributing heavy bleeding to 'normal lochia'; missing that a severe headache in pregnancy is not benign; confusing magnesium toxicity signs (loss of deep tendon reflexes, respiratory depression) with other causes; and choosing a neonatal action that skips warming and drying. Also watch 'expected versus abnormal' wording.
Rule of thumb - the postpartum haemorrhage sequence: call for help and massage the fundus while assessing tone, tissue, trauma, and thrombin ('the four Ts'). Worked example: a woman one hour after birth has a boggy uterus and heavy bleeding - massage the fundus firmly, empty the bladder, and escalate, rather than simply changing pads.