Explaining Questions: Breaking Down Complex Concepts

When questions require explanations, it is essential to break down complex concepts into understandable parts. Start by introducing the topic  you’re discussing and providing a concise definition if necessary. Then, proceed to explain on the key components or factors related to the topic. Use clear and simple language to ensure your explanation is easily understandable.

Example Question: Explain how you would admit a mother who has reported in active phase of first stage?

In response to this question, you can follow the question approach by giving the key points step by step:

• Reception: the mother and the relatives are welcomed; mother is taken to the admission room while the relatives are offered seats. Rapport between the mother, attendants and the midwives is created.
• History taking: if the mother has been attending ANC, her ANC record is obtained; to get the history and any risk factors like multiple pregnancies. If she has not been attending ANC, a full antenatal history is taken, which involves the mother‘s name, address, tribe, religion, husband‘s name and address, her gravida and parity, obstetrical, surgical, social, and medical history, the time and date of admission are entered in the admission forms of the mother.

Then, history of labour under the following headings is recorded:

• Show: the mother is asked if she has seen any blood and mucus, her undergarments examined for any stain, vulva examined for the drainage of show which may appear a few hours before or after beginning of labour.
• Uterine contractions: mother is asked when the regular pains began, how often and if she has backache. Her statement about the length, severity, or expulsive character of the contraction should be confirmed by observation and evaluation then
• Membranes: She is asked whether her water (amniotic fluid) have ruptured or not; if she has noticed a gush or tickling of water → the amount and time are recorded. If in doubt of whether its liquor or urine, litmus paper is dipped into the draining fluid obtained from the vulva to confirm alkalinity or
• Vaginal discharge or bleeding: the mother is also asked if she had any vaginal bleeding/ discharge which should be excluded

• General examination of the mother: her general appearance is noted, that is healthy or ill, colour, any deformities like lame, presence of oedema, infections, varicose veins or enlarged neck veins. Breast examination is carried out to identify their sustainability for breast feeding
• Observations; Vital signs are monitored like temperature, pulse, respiration and blood pressure to rule out eclampsia in She is also asked for bowel action, sleep and rest
• Abdominal Examination: first, the bladder should be empty and this is carried out with the mother lying on the couch on supine position with a pillow under her head and This examination is carried out as follows:
  • On inspection: the shape of the abdomen is noted whether round or oval, the size should be correspond with the weeks of gestation, the foetal movements, skin changes like stria gravidarum and linea nigra and any scar are
  • On palpation: this can be superficial, fundal, lateral, pelvic, height of the fundus and hypochondriac. They are carried out to note the lie whether its longitudinal, transverse, or oblique; the position of the fetus which can be ROA, LOA, ROP, LOP; and engagement plus enlargement of the spleen and the liver.

• On auscultation: the fetal heart is listened, if its heard and regular

• Vulva shave, toilet and examination: the shave is done on women whose cultures allow keeping the vulval area with pubic hair. Any abnormal discharges, oedema, or paleness are noted if present
• Vaginal examination: this is done to mothers who have no history of APH with the current pregnancy under strict asepsis. It‘s done to confirm the onset of labour, the presentation, position, engagement, station of the presenting part, to confirm whether membranes ruptured or intact, exclude cord prolapsed, assess the pelvis if adequate or inadequate and also progress of labour and it‘s the one that determines the admission of a mother on the partograph
• Investigations: routine samples are obtained for example:
  • Blood: for routine counseling and testing (RCT), rapid polymerase reaction (RPR), HBsAg, haemoglobin estimation, Grouping and cross matching → rational to confirm presence of any disease so as to prevent mother to child transmission (MTCT) and for blood transfusion (BT) in case of anaemia
  • Urine: for analysis to test for albumin, sugar, acetone that might complicate labour

• Personal hygiene: a shower is both hygienic and pleasant. If the mother‘s membrane have ruptured or in advanced first stage of labour, she is sponged down on a couch and given a clean

Admission: the mother is then admitted on a partograph, all the necessary information recorded and the continuous observation of the mother takes place accordingly