ANATOMY AND PHYSIOLOGY OF OBSTETRICS

FOR MIDWIFERY STUDENTS

AND REFERENCE
MANUAL FOR PRACTICING MIDWIVES
IN LOW AND MEDIUM RESOURCES COUNTRIES
 FORWARD

Midwifery Booklets
This is the first of the seventeen [17] booklets for midwifery students and reference manuals
for practicing midwives in low and medium resource countries. The focus of these booklets is to
let the midwifery students have resources that have basic information about midwifery
education and practice in general. This is because for midwives to effectively play their central
role in the management of pregnant, laboring and postpartum mothers and their neonates,
they need to have adequate information regarding all the basics of these areas. The goal of
these booklets therefore is to increase the awareness, knowledge, skills and attitudes of
student midwives, practicing midwives as well as the consumers of midwifery in the areas of
pregnancy labour, postpartum parental-hood and care of the neonate.
Organization of the Contents
The material contained in all the booklets are arranged in sections that will make it easy to
follow and make the contents flow in a logical format. This allows students who are the target
group to focus on the primary concepts that are relevant at beginning level. The experience
gained from using this booklet will therefore assist the student midwives to understand
concepts related to midwifery practice. For practicing midwives it will be a handy reference
manual. Because of that as much as possible and as necessary, each booklet will have both the
normal and pathological information as well as practical skills; exercises/ training sessions and
videos that will support each booklet or and a chapter. This is hoped to assist the students;
consumers and practicing midwives offer and receive better and respectful care to pregnant,
laboring, postpartum mothers; fetal and neonates through early seeking of advice and care.

Cost Effective
These booklets [series] are cost effective solution to providing quality evidence based
information and reference materials to both students and practicing midwives in low and
medium resource countries. This is because in these countries it is difficult for student as well
as practicing midwives to have current materials because of both the cost as well as availability.
It is hoped that these booklets will be updated every few years in order to incorporate current
information. The updates could be conducted by any interested person/s after getting
permission from the author and attribute the updates to the author as well as making the
revised versions to be under Creative Commons

Open Education Resources (OER)

These booklets will use Open Education Resources (OER) in its preparation and will also be
released as new versions of OER under the creative commons license. This means the booklets
are not for sale. The cost paid is towards printing and binding of the booklets and video
production. If anyone would like to modify, translate the booklet should seek permission from
the author and always cite the author whenever it is used and cited.

Accuracy of Information
The author has ensured that the information presented in these booklets is accurate, up to
date, and within acceptable standards.
Thus the author hope that the students, practicing midwives as well as the consumers of
midwifery will find this booklets helpful in studying midwifery and as a reference manual.

TARGET GROUPS
1. Midwifery Students
As a student midwife, knowledge of anatomy and physiology of obstetrics is a vital aspect of the
program in managing and identifying complications during the perinatal period and to provide
quality care. On the other side of the coin practicing midwives need to have a reference manual
that will remind them of certain issues during their day to day practice.
Since the booklets are primarily for student midwives the expected time of studying it will vary
based on the booklet but should be between four to ten [4-10] weeks but longer for
consumers. This is because the booklets provides detailed information covered in specific areas
in a simple easy to follow form.

2. The Consumer
For the consumers of midwifery they will benefit as they will know their bodies better as well as
be able to understand the various changes that occur in their bodies/spouses bodies during the
perinatal period. Therefore be able to seek advice without unnecessary delay.

3. Practicing Midwives
For the practicing midwives however the booklets will use the booklets as a day to day
reference material.
Anatomy and Physiology of Obstetrics Booklet One
This is the first booklet and is on Anatomy and Physiology of Obstetrics as viewed by Midwives.
It has basic information related to male and female reproductive systems, pregnancy including
embryology and the foetus; labour, postpartum; and the neonate.

As stated above there are exercises within each chapter as well as review exercises at the end
of each chapter with an answer key at the end of each booklet which students need to attempt
to answer to test their understanding of the contents of both each chapter as well as the
booklet.
Lastly a DVD is attached containing videos that will assist to illustrate some areas of each either
chapter or booklet and for this booklet that related to anatomy and physiology as viewed by
midwives in areas of male and female sexual and reproductive organs; pregnancy that included
fertilization and pregnancy, labour, puerperium; and the neonate. However more videos will
also be in each booklet specific to that area e.g. antenatal, labour etc.
A list of references and websites to help students, midwives and consumers to get more
information is also included at the end of each booklet.

Images and Pictures

Many images and pictures are from Dr. Bruce Forciea book titled an eText of Human Anatomy
and Physiology and from Wikimedia Commons which is under Creative Commons. Below each
image and or picture is a source from which the image came from and a link is provided where
necessary. Additionally, other authors and booklets that allowed their images and pictures to
be used or and be modified were used. All sources whenever their details were available have
been acknowledged.

Videos
For videos most of them are from Medical Aid Films and Global Health which are also open
videos under Creative Commons, some downloaded from Google but were under CC creative
commons as well. However, some were downloaded from various websites that accepted their
videos to be freely used in this booklet and where possible a source has been acknowledged.
Some of these websites are as listed below:

 https://www.youtube.com/watch?v=I7orwMgTQ5I&index=44&list=PL8dPuuaLjXtOAKed
_MxxWBNaPno5h3Zs8
 https://www.youtube.com/watch?v=R8M0NUJVwoI
 https://www.youtube.com/watch?v=AzrjcVE45SM
 https://www.youtube.com/watch?v=ERZBRqiZD2g
 https://www.youtube.com/watch?v=ZvPVyas68jE
 https://www.youtube.com/watch?v=pNe43KGZTl8

I have enjoyed compiling and modifying these booklets as it was my dream that one day I
should contribute to the midwifery profession with materials in booklets format for midwifery
programs as well as for the consumers of midwifery.
It is therefore my hope that you will enjoy using these booklets. Furthermore I hope it will help
achieve your dream of becoming a quality midwife who will be an advocate for mothers,
neonates and their families in order to reduce the complications of maternal and neonates in
your setting.

Sincerely,

REBECCA CHIKONDI NGALANDE

MSc Public Health; Dip.Edu; MRNM [November, 2016]

ACKNOWLEDGEMENTS
The author would like to thank and appreciate the work done by Original resource of the first
four booklets that was written and adapted by University of Malawi- Kamuzu College of Nursing
Open Education Resources [OER ] Champions from 2009-10. The team with the help from IADP
who acted as mentors and support from the following organizations was able to produce the
resource:

 International Association for Digital Publications (IADP)

 OER Africa / South African Institute for Distance Education

 University of Malawi - Kamuzu College of Nursing (KCN)

Funding for the initial resource was made possible by

 Open Society Initiative for Southern Africa (OSISA)

 Original OER materials supplied by Michigan State University (MSU)

These booklets are licensed as

The photographs and diagrams are from various OER resources; other booklets and resources
whose authors gave permission to be used and modified; all these authors are acknowledged as
attributes to the booklets accordingly at the end of each booklet. Some of the diagrams and
photos are from mothers at antenatal clinic at Ndirande city clinic in Blantyre; Chikwawa and
Nsanje District Hospitals – Malawi who gave permission to be photographed and use the
photos for teaching and learning. These are acknowledged as well as well as where they came
from.

The author wish to acknowledge the use of adapted extracts and illustrations from Safe and
Clean Birth and Newborn Care: A Reference for Health Extension Workers in Ethiopia (2008)
which was based on A Book for Midwives: Care for Pregnancy, Birth and Women’s Health by
Susan Klein, Suellen Miller and Fiona Thompson (2004), published by the Hesperian Foundation,
Berkeley, California, USA.
A book titled an eText of Human Anatomy and Physiology by Dr. Bruce Forciea and from
Wikimedia Commons which is under Creative Commons.

University of Malawi: Kamuzu College of Nursing Open Education Resources [OER] Champions
Team and International Association for Digital Publications [IADP] Mentors

Rebecca Ngalande Faculty Project Coordinator KCN Wyness Gondwe Faculty KCN Blantyre
Blantyre

Dr. Lignet Chepuka Faculty KCN Blantyre

Dr. Elizabeth Chodzaza Faculty then DHOD KCN
Blantyre

Andrew Moore OER Africa / IADP [Mentor]

Chrissie Phiri Faculty KCN Lilongwe

Ephraim Banda ICT KCN Blantyre

Christine Randal OER Africa / IADP [Mentor]

Mary Kamphinda Banda Faculty KCN Blantyre

The author is also thankful for the editors Harry Maliwichi [UNIMA KCN]; and Ms Patricia
Donovan [VSO Seychelles]; for freely use their enabling expertise and time in editing the
anatomy and physiology booklet.
 EDITORS OF THE BOOKLETS:

Patricia Donovan Harry Maliwichi

Add quali ----------------- ------------------------------------------
------------------------------- ------------------------------------------

ABBREVIATIONS

ICT ------------------- Information Communication Technology

IADP ------------------- International Association for Digital Publications
KCN ------------------- Kamuzu College of Nursing
MSU ------------------- Michigan State University
NN ------------------- Neonate
OER ------------------- Open Education Resources
OSISA ------------------- Open Society Initiative for Southern Africa
PNC ------------------- Postnatal Care/Postpartum Care
SAIDE ------------------- South African Institute for Distance Education
UNIMA ------------------- University of Malawi
WHO ------------------- World Health Organization

HOW TO USE THIS BOOKLET

1. Read and study each section carefully

2. Complete each section before attempting the next section
3. Work through the exercises in each section as they come as well as completing review
questions and or exercises at the end of each chapter
4. After going over the exercises; check answers at the end of the booklet to compare the
model answers with your answers and to determine why your response was not correct, if
that is the case

HOW YOU CAN BENEFIT WITH THIS BOOKLET

Each chapter is designed for stand-alone revision, meaning that you need not read from the
beginning to benefit from the booklet. Every chapter begins with a brief introduction covering
the main points of the topic and directing you to some useful resources at the end of the
chapter. The chapter, provide different types of questions that help to test and build knowledge
of the area. These are:
 Labelling Exercise: by identifying different elements on the diagram
 True or False: identify if the statement is true or false
 Multiple Choice: identify which of four-five responses is the best
 Fill in the Blanks: fill in the blanks to complete the statement
 Match the Terms: identify which term matches a statement

The questions have been designed to be slightly more challenging in each section. Do not
ignore a question type just because it is not examinable in that way, because the answer will
contain useful information that could easily be examined in an alternative question format.
Answers are provided at the end of the booklet for each chapter to help you with revision but
can also be used as a learning aid. At the back of the book there is a glossary.
Finally a word of advice for maximum benefits of this booklet is that always apply theory to
practice and how you do it is by always following the problem solving method [PBL].

1. ASK:
 What is wrong? (complaint)
 When did it start?
 Any treatment given?
 Did it help?
2. LISTEN
 Give undivided attention to what client is saying
 Remove distractors
 Stay focussed and don’t assume
 Interpret the client’s silences
 Note any body language
 Be unselfconscious [concentrate]
 Be empathetic
 Be a better hearer
3. LOOK and FEEL:
 Look for the problem.
 Look and feel for anything that is not normal (pain, tenderness
swelling, drainage, discharge, odor, redness)?

4. IDENTIFY THE PROBLEM

5. TAKE APPROPRIATE ACTION according to the protocols of the facility or national protocol
6. EVALUATE / REPEAT THE PROCESS
 Decide the results of the care
 Find out whether there is a change in the problem using the problem solving
process

How to Achieve the Above

1. ASK and LISTEN through comprehensive history taking
2. LOOK and FEEL by conducting a thoroughly physical examination or assessment
3. IDENTIFYING PROBLEMS / NEEDS making decision based on 1-3
4. TAKE APPROPRIATE ACTION manage according to availability of resource but without
compromising care include counselling
5. EVALUATE and REPEAT THE PROCESS based on outcome of point four [4] decide to
review in case something was missed results
Through this format you will be assured that you are offering safe and effective care to women,
their babies and their families.

TABLE OF CONTENTS
CHAPTER 1 INTRODUCTION TO HUMAN BODY

1.0 Over View

1.2 Learning Outcomes
1.3 Facts about the Human Body
1.4 Small Study Groups
1.5 Effective Study Time Periods
1.6 Pictures and Diagrams
1.8 Life
1.9 Homeostasis
1.10 Levels of Organization
1.11 Basic Concepts
 1.12 Overview of Body System
1.13 Anatomical Terminology
1.14 Anatomical Regions
1.15 Division of the Abdomen
1.16 Review Questions for Chapter 1

CHAPTER 2 THE CELL

2.0 Overview
2.1 Learning Outcomes
2.3 The Cell
2.4 Cell Transport
2.5 Cell Cycle
2.6 Mitosis and Meiosis
2.7 Reasons for Cell Division
2.8 Chromosomes and DNA
2.9 Review Questions for Chapter 2

CHAPTER 3 ANATOMY AND PHYSIOLOGY OF MALE REPRODUCTIVE SYSTEM

3.0 Overview
3.1 Learning Outcomes
3.2 Parts of the Male Reproductive Organs
3.2.1 External Organs
3.2.2 Internal Organs
3.3 General Functions of the Male reproductive Organs
3.4 Blood and nerve Supply to the Male Reproductive Organs
3.5. The Physiology of the Male Reproductive Organs
3.5.1 Spermatogenesis
3.5.2 Sperm Cells
3.5.3 Erection and Ejaculation
3.5.4 Testosterone
3.6 Summary of the Male Reproductive System
3.7 Review Questions for Chapter 3

CHAPTER 4 ANATOMY AND PHYSIOLOGY OF FEMALE REPRODUCTIVE SYSTEM

4.0 Overview
4.1 Learning Outcomes
4.2 Parts of the Female Reproductive Organs
4.2.1 External Organs
4.2.3 Internal Organs
4.3 General Functions of the Female reproductive Organs
4.4 The Physiology of the Female Reproductive Organs
4.4.1 Puberty
4.4.2 Menstrual Cycle
 4.5 Anatomy of the female breast
4.6 Physiology of Pregnancy
4.6.1 Major Systems
4.6.2 Other Systems
4.6.3 Common Minor Disorders of Pregnancy
4.7 Physiology of labour
4.7.1 First Stage
4.7.2 Second Stage
4.7.3 Third Stage
4.8 Physiology of Puerperium
4.9 Summary of the Female Reproductive System
4.10 Review Questions for Chapter 4

CHAPTER 5 GENETICS
4.0 Overview
4.1 Genes
4.2 Sex Traits
4.3

CHAPTER 6 EMBROLOGY
6.0 Overview of the Chapter
6.1 Learning Outcomes
6.2 Fertilization
6.4 Stages of Embryology
6.5 The development and function of the placental
6.6 Abnormalities of placenta

CHAPTER 7 ANATOMY AND PHYSIOLOGY OF FETUS AND NEONATE

7.0 Overview of The Chapter

7.1 The Fetal Skull
7.1.1 Bones of the Vault
7.1.2 Regions of the Skull
7.1.3 Land Marks of the Fetal Skull
7.1.4 Diameters of the Fetal Skull
7.1.5 Sutures and Fontanelle
7.2 Fetal Circulation