HANDLING AND ASSISTING DURING DELIVERY

EQUIPMENT:
- Mayo table
- Mayo table drape
- DR Set

o Basin
o Operative sponge (OS)
o Sterile drape
o Instruments
 Multipara Patient:
 2 clamps (Kelly straight and/or curve)
 1 Scissors (Metz, mayo or bandage)
 Ovum forceps (optional)
 Cord clip/clamp or latex band

 Prime Gravida Patient:

 2 clamps (Kelly straight and/or curve)
 2 Scissors (Metz, mayo or bandage)
 Needle holder
 Tissue forceps (optional)
 Ovum forceps (optional)
 5 cc. syringe with needle
 Anesthesia (Lidocaine 2%)
 Suture (Chromic 2/0)
 Cord clip/ clamp

PROCEDURE: Nursing Responsibilities in Handling and Assisting Deliveries

A. Handling a Spontaneous Delivery by a Student Nurse.
STEPS ACTIONS EXCELLENT VERY GOOD FAIR POOR
GOOD
5 4 3 2 1
Labor Room Responsibilities:

 Labor monitoring
- Monitor uterine contractions
- Assess progress of labor (rupture of
BOW, cervical dilatation, effacement &
degree of descent of the fetal head)
 Obtaining Patient’s Data
1  Patient’s identity
 OB History (GTPAL, LMP, AOG)
G = Gavidity
P= Parity (Term, Pre-term, Abortion,
Living)
 Vital signs
 Obtain FHB
 Perform Leupold’s maneuver

 Secure articles needed

For the Mother:
 Adult diaper
2  Maternity napkin
 Underwear
For the Newborn:
 Baby cloth (“lampin”)
 Baby clothing/ layette
 Newborn diaper
 Cord clip
 Bonnet
 Assist in internal examination (IE) as
necessary
 Perform straight catheterization as
3 necessary
 Change patient diaper as necessary
 Secure patient’s comfort and hygiene
 Study patient’s case (Complications,
special procedures, medication given)

Handling:
4 Assist patient to be transported to the
DR
Position patient in lithotomy on
5 the DR table
6 Perform hand hygiene

Perform perineal flashing/ preparation

7
8 Don gloves
Prepare/ arrange instruments/ DR pack
9 Perform straight catheterization
10 Drape patient aseptically
Instruct patient proper breathing
11 technique (baring down or correct
pushing technique)
 Perform/ assist in Ritgen’s maneuver
12 during crowning
Identify and assist in the mechanism of
labor to deliver the newborn
 Descent
13  Flexion
 Internal rotation
 Extension
 External rotation
 Expulsion

14 Assist in episiotomy as necessary

Deliver the newborn’s head, shoulders
15 and the rest of the body safely
Announce the newborn’s delivery, the
16 gender & the time
Place the newborn on mother’s
17 abdomen; initiate skin to skin contact &
breast feeding (latching on)
18 Assist in the cutting of the cord
19 Wait for the sign of placental expulsion
Identify the signs of placental Separation
 Lengthening of the cord
 Sudden gush of vaginal blood
 Change in shape of the uterus
 Firm contraction of the uterus
20
 Appearance of the placenta at the
vaginal opening

Deliver the placenta; examine

21 completeness of cotyledons
Identify mechanism of placental
Separation (2)

 Schultze – “shiny”, clean & fetal

membrane comes out first; separates
from the center
22  Duncan – “dirty”, red, irregular with
ridges of cotyledons and the maternal
side comes out first; separates from the
sides.
Assess the amount of blood loss (normal
23 blood loss = 300 -500 ml)
Assist in the evacuation of blood clots,
24 massage uterus over the fundus
Assist physician in episiorrhaphy or
 suturing of perineal laceration as needed
25  Prepare suturing equipment
 Attached suture to the needle holder
 Prepare Lidocaine 2% (Anesthesia)
Aftercare responsibilities
 Dispose sharps and placenta to
26 respective receptacle
 Wash used instruments at the aftercare
area
 Clean and organize the area as
necessary; refill supplies as necessary

Health teaching (Responsible

parenthood, hygiene, application of ice
27 pack over hypogastrium, massage of
uterus for contraction, report profuse
vaginal bleeding)
28 Documentation

STUDENT COMMENTS CI SIGNATURE ABOVE PRINTED

SCORE NAME/DATE

B. Assisting a Spontaneous Delivery by a Student Nurse

STEPS ACTIONS EXCELLENT VERY GOOD FAIR POOR
GOOD
5 4 3 2 1
Assist patient to be transported to the
1 DR
Position patient in lithotomy on the
2 DR table
Take note of the time of mounting on
3 the DR table
Assist in perineal flashing/ preparation
4
5 Assist in catheterization
Couch patient on proper breathing
6 and pushing technique
Stimulate uterine contraction
7 (massage fundus gently; nipple
stimulation)
Take note of the time of the rupture
8 of the membrane (Bag of water)
Take note of the time of the expulsion
9 of newborn (“Baby Out”)
Take note of the time of the expulsion
10 of placenta (record mechanism)
Take note of the gender of the
11 newborn
Record the newborn’s data/
anthropometric data:
 Weight
12  Head circumference
 Chest circumference
 Abdominal circumference
 Length/ Height
Prepare the newborn’s identification
13 band/ anklet
Check & record the blood pressure of
14 the patient (Mother)
Inject Oxytocin IM or incorporate to
15 the patient’s IVF (if with IVF more
than 500 cc)

 Label IVF properly if incorporation of

oxytocin is done
Assist in episiorrhaphy/ suturing of
16 perineal laceration (offer Lidocaine 2%
to the handling student nurse;
anticipate other needs)
17 Prepare/ apply maternity napkin
Health teaching (Care of the newborn:
exposure to sunlight, hygiene/
18 bathing, care of the cord,
breastfeeding, burping, follow up/
well baby check up, completion of
immunization)
 After care
19 - Clean and organize the area as
necessary
- Refill supplies as needed
20 Documentation

STUDENT COMMENTS CI SIGNATURE ABOVE PRINTED

SCORE NAME/DATE