WEEK 2: CLINICAL SKILLS; CONDUCTING A NORMAL DELIVERY Flashcards
Outline Preparations for delivery
Preparation of the environment- couch,radiant heater etc
Preparation of mother- instructions and reassurance
Preparation of equipment/delivery sets and medications
Preparation of self and assistant- personal protective gear, receiving of the baby
Describe the second stage of labor in Spontaneous vaginal delivery.
Delivery of the head
*The perineum gapes as the head advances
*The encirclement of the widest diameter of the fetal head by the vulvar ring is known as crowning.
*Episiotomy may then be performed as necessary
*The head is delivered slowly as the base of the occiput rotates around the lower margin of the symphysis pubis.
- Describe Conduct of delivery.
*Swab and drape the perineum.
*Support the advancing head and perineum at crowning (Ritgen’s maneuver)
*Upon delivery of the head, feel for presence of a nuchal cord and if present, loosen and flip over the head. Clump and cut it if tight.
*Wipe the face and clear airway
*Wait for restitution and then deliver the anterior shoulder followed by posterior shoulder in AP diameter. Apply gentle traction.
*In most cases, the shoulders appear at the vulva just after external rotation and are delivered spontaneously.
*If not delivered spontaneously, gentle downward traction is applied to deliver the anterior shoulder and then upward traction for the posterior shoulder.
*Excessive traction with extension of the infant’s neck can result in temporary or permanent injury to the brachial plexus- Erb’s palsy.
*The assistant administers oxytocin I0 IU IM Antero lateral aspect of the thigh at delivery of anterior shoulder.
NB: If twins are confirmed or suspected this is administered following delivery of the second twin.
*Deliver the rest of the body follows onto maternal abdomen
*Note the time of delivery
*The cord is then clumped and cut.
*The baby is dried, kept warm and put on maternal chest (skin to skin) if stable.
Skin to skin-kangaroo mother/father care
Describe the Third stage of labor.
The placenta usually is delivered within 5 minutes of the delivery of the infant.
Placenta is considered retained if it is not delivered within 30min
Outline the 4 Signs of placental separation.
*The uterus becomes globular and firm.
*There is often a sudden gush of blood.
*The uterus rises in the abdomen
*The umbilical cord protrudes farther out of the vagina, indicating that the placenta has descended.
Describe the delivery of placenta and membranes
- Support uterus by placing hand on the lower abdomen/suprapubic region cephalad to prevent inversion.
- Apply firm steady downward traction on the cord
- Deliver placenta and membranes slowly by supporting it in both hands.
- Gently twisting the membranes ensures complete delivery.
- Take a quick look at it for completeness and place it in receiver for a more detailed exam later.
- Message the uterus to contract
Describe the 3 ACTIVE MANAGEMENT PLAN OF 3rd STAGE.
Administer IM Pitocin 10IU on anterolateral aspect of the thigh on delivery of the anterior shoulder or immediately after delivery of the baby (or at least with 1 minute of delivery of the baby)
Massage the uterus-myometrial contraction achieves hemostasis.
Deliver the placenta by controlled cord traction (CCT)
Describe Inspection of the perineum and birth canal.
- Explain to the mother what you intend to do and why.
- Inspect as you clean the vulva under a good light source.
- Check for tears/ lacerations, hematomas or oozing.
- Slowly move up fingers on either side of vagina to the cervix while inspecting for bleeding.
A Sims speculum offers adequate exposure vaginal walls.
- Press firmly on the uterine fundus to bring the cervix in closer view.
You may use a speculum and sponge forceps to explore the cervical rim as necessary.
- Expel any clots and estimate blood loss
Describe Examination of the placenta
Lay placenta on a flat surface to check for presence of all cotyledons, calcifications etc.
It may also be assessed under running water.
Lift the placenta by the cord and inspect membranes for completeness.
Inspect cord vessels
Weigh placenta
Outline Ongoing care of mother and baby after delivery.
*Clean mother and make her comfortable
*Provide warm drink
*Take and record vitals.
*WEIGH THE BABY AND COMPLETE THE DELIVERY NOTES.
*Administer routine medications.
During the ‘’4th stage’’, monitor uterine contractility and P/V loss every 15mins.
Initiate lactation as soon as possible unless it’s not her infant feeding option. Early initiation within the first hour of delivery achieves better bonding and facilitates uterine contraction.
Encourage regular voiding.
Continue to put the baby to the breast.
Transfer to the postnatal care
** Ensure proper disposal of placenta and waste and infectious prevention measures throughout the process.
