MCN SKILLS/CLINICAL BY:NICOLE HONRADO, BSN 2A

Normal Spontaneous Delivery Technique

LEARNING OBJECTIVES MECHANISMS OF LABOR

a. Definition of Labor and Normal Spontaneous Delivery

b. Overview Stages of Labor and discussing nursing care of
mother during labor and birth
c. Describe how the actions during labor and birth can affect
early breastfeeding.
d. Discuss the evidence for recommended practices during
labor and delivery
e. Explain how certain practices during labor and delivery
hinder breastfeeding

LABOR AND DELIVERY

Labor is the series of events by which uterine contractions and

abdominal pressure expel a fetus and placenta from the uterus.

“A spontaneous vaginal delivery (SVD) occurs when a

pregnant female goes into labor without the use of drugs or
techniques to induce labor, and delivers her baby in
the normal manner, without forceps, vacuum extraction, or a
cesarean section.”

COMPONENTS OF THE BIRTH PROCESS

The Four P’s

 Powers – mother pushing, Uterine Contractions

 Passage – mother’s bony pelvis and soft tissues

 Passenger – fetus, placenta, amniotic membrane and

amniotic fluid

 Psyche – the emotional, mental state of the mother

MECHANISMS OF LABOR

a. Descent – presenting part usually the fetus head

b. Station – level of presenting part to the pelvis
c. Engagement - when presenting part (head) reaches “0”
station
d. Flexion – flex of fetus head to chest
e. Internal rotation – head turns swing anteriorly
f. External rotation – head realigns with shoulders
g. Expulsion – anterior shoulder, then posterior shoulder are
born – then rest of body
h. Mechanisms of labor refer to those physiological changes
in positioning which take place during a normal vaginal
delivery.

BIRTH STATION

 Stage 1 of labor will be where the cervix will dilate (open)

from 0 to 10 cm and will have hundred percent effacement
(thinning).
 During the Latent phase of Stage 1, the cervix will
dilate 1-4 cm, contractions will occur every 5 to 30
minutes and be 30-45 seconds in length.
 During the active phase of stage 1, the cervix will
dilate to 4 to 7 cm and thin (dilation will be 1 cm per
hour), and contractions will be noticeably stronger
and longer (45 to 60 seconds) every 3 to 5 minutes.
 The next phase, which is the transition phase, will be
the shortest but most intense in regards to the strength
and duration of contractions. During the transition
phase, the cervix dilates from 8 to 10 cm and thins
- Station refers to the position of the fetal head relative to the completely. This phase will lead to Stage 2 of Labor.
ischial spines.
MCN SKILLS/CLINICAL
 Stage 2 of labor begins when the cervix has fully dilated
and ends when the baby is fully delivered.
 Stage 3 of labor begins when the baby is fully delivered
and ends when the placenta is delivered.
 Stage 4 of Labor is the first 1-4 hours after the delivery of
the placenta and is the time when the mother is at most risk
for hemorrhage, infection, and other problems.
BIRTHING PRACTICES
What birthing practices may help a woman to initiate
breastfeeding soon after birth?
Practices that may help a woman to feel COMPETENT, IN
CONTROL, SUPPORTED AND READY TO INTERACT
WITH HER BABY who is alert, help to put this Step into action.
INTRAPARTUM CARE
1. Admit to Labor Room when the parturient is already
in the ACTIVE phase
Ask the participants – what is ACTIVE PHASE labor?
- there are 3-4 contractions in 10 minutes
Cervix is 4 cm dilated
↓ Need for CS by 82%
- No difference in need for labor augmentation nor
Apgar score whether admitted in active or latent phase
2. Allow Companion Of Choice To Provide Continuous
Maternal Support
One-to-one intrapartum support:
A. Health provider
Maternal support can be provided by the health worker,
however this may not be continuous one on one intrapartum
support.
B. Companion of choice
The companion of choice should be one identified by
the parturient ….
 Allow a Companion of Choice
• LESS USE OF PAIN RELIEF DRUGS → Increased alertness
of baby
• Baby less stressed , uses less energy
– Reduced risk of infant hypothermia
– Reduced risk of hypoglycemia
• Early and frequent breastfeeding
• Easier bonding with the baby
The health worker can provide emotional support to the laboring
woman by reducing stress:
A. Good communication – use positive words; explain to the
woman her progress of labor. This will help build the mother’s
confidence
B. Respect her privacy
C. Encourage her to move around instead of confining her in
bed in the supine position
D. Allowing her to eat and drink, instead of routine IVF
E. Suggest ways to keep pain and anxiety manageable: provide
massage, cool cloths.
F. Provide adequate and timely pain relief.
3. Allow position of choice during 1st stage of labor, as
upright as possible. Allow mobility during labor.
 There is no evidence supporting strict bed rest in supine
position during the first stage of labor.
BY:NICOLE HONRADO, BSN 2A
 In the absence of complications, women should be
encouraged to change to positions or move around during
labor.
 Most mothers intuitively prefer up-right positions,
ambulation and/or rhythmical movement during labor.
4. Give Oral Fluids and Food during Labor
 Withholding food and drink during labor is an outdated
practice that has been shown to negatively affect birth
outcomes.
 No evidence exists that putting the parturient on NPO
benefits the course of a normal labor
 Intrapartum mothers should be allowed to determine for
themselves what they wish to eat or drink and when they
choose to do so.
Labour and birth needs energy
• Restriction of food and fluid can be distressing
• Increase length of labour
5. NO ROUTINE IVF
 A mother eating and drinking in labor will not require
intravenous
 No evidence exists that suggests the placement of an IV in
the low-risk intrapartum client prevents poor outcomes
 IV fluids need to be used only for a clear medical
indication
 Prophylactic placement of IVF is considered unnecessary
Advantage is to have ready access for emergency meds
Disadvantages:
 Interferes with the natural birthing process
 restricts woman’s freedom to move
 Not as effective as food and fluids in labor to treat/prevent
dehydration, ketosis or electrolyte imbalance
6. RELIEVE Pain & Discomfort during Labor
OFFER NON-MEDICATION METHODS OF PAIN relief
before offering pain medications.
 Labor companion
 Verbal and physical reassurance
 Laboring and birth positions of mother’s choice
 Massage, warm water
 Quiet environment/no bright lights
Again the recurrent themes - all non-pharmacologic
 Photos: acupressure, use of birthing ball,
 An enterprising midwife in Gen Santos City had a walker
in her Lying In clinic.
 A supportive health worker massaging the back of patient
who preferred the “on all fours” position
7. Monitor progress of labor using the WHO Partograph
 No difference in the rate of cesarean section, maternal
infection, and instrumental vaginal delivery.
 Encourages health care providers to diligently monitor the
progress of labor and facilitates early identification of
abnormal progress of labor.
8. Limit total number of IE to 5 or less.
↓ Chorioamnionitis by 72%
↓ Neonatal sepsis by 61%
↓ UTI by 34%
 The number of vaginal examinations is related to the
incidence of infection.
 Women who had vaginal exams during labor were
compared to those who had more than 3 exams: there was
decreased incidence of chorioamnionits and neonatal sepsis.
MCN SKILLS/CLINICAL
Among those who had less than 5 examinations, there was
decreased incidence of UTI altho no statistically significant
decrease in incidence of endometritis.
 Based on these studies, whether we use 3 or 5 internal
examinations as the cut-off for “restricted” number of
internal examinations, limiting the number of IEs on a
woman in labor, results in a decreased risk for both
maternal and neonatal infections.
VAGINAL EXAMS to assess cervical dilatation SHOULD BE
DONE only every 4 hours, or more often as necessary (when
BOW ruptures, when the woman is bearing down)
9. Upright position during delivery
↑ Anterior-posterior and transverse diameters of pelvic outlet
enhances fetal movement through the maternal pelvis in descent
for birth
↑ Efficiency of uterine contractions
↑ Improved fetal alignment
 Being upright (sitting on birthing stools or chairs; squatting)
or lying down - hasadvantages for women delivering their
babies. The benefits of upright positioning may be related
to gravity, less aorto-vagal compression, improved fetal
alignment, and larger anterior, posterior and transverse
pelvic outlets.
 In a Cochrane review on upright vs. supine positioning,
there was a reduction in the incidence of abnormal fetal
heart rate patterns and in the need for episiotomies. There
was an increase in second and third degree perineal tears,
but the incidences of the other morbidities were not found
to be significant.
 Decrease
- Duration of 2nd stage of labor
- Episiotomies
- Abnormal FHR patterns
10. Encourage pushing only when the mother has the urge
to push
 2nd stage of labor redefined as “complete cervical
dilatation” + spontaneous explusive efforts” (Simkin, 1991)
- Pelvic phase of passive descent
- Perineal phase of active pushing
DIRECTED PUSHING (Valsalva pushing)
↓ Venous Return
↓ Perfusion to Uterus, Placenta & Fetus
FHR Changes
Fetal hypoxia & acidosis
INVOLUNTARY BEARING DOWN
Exhalation pushing
Let air out
Parturient-directed
Physiologic: force of bearing down efforts increases as fetal
descent occurs
Avoids hypoxia and acidosis
11. SELECTIVE Episiotomy
 Routine episiotomy is episiotomy done liberally or
intentionally on all women about to deliver to avoid a tear.
(REMINDER: should be performed by doctor; episiotomy
is not a signal function of midwives).
 Selective episiotomy -Episiotomy performed only if there
are indications like:
- Need for instrumental vaginal delivery or a vaginal
breech delivery, Fetal distress
- Shoulder dystocia, Impending laceration (e.g. in big
babies).
BY:NICOLE HONRADO, BSN 2A
↓ Posterior perineal trauma by 12%
↓ 2nd-4th degree tears by 33%
↑ Need for suturing by 29%
↑ Anterior perineal trauma by 84%
No difference in infection rate, urinary incontinence, dysparunia.
w/ or w/o episiotomy
12. Perineal Support and Controlled Delivery of the Head
 Fundal pressure during the 2nd stage of labor refers to the
manual force applied externally to the abdomen at the level
of the uterine fundus to expedite delivery.
 Fundal pressure by an insufflatable belt during the second
stage of labour does not appear to increase the rate of
spontaneous vaginal births in women with epidural
analgesia. There is insufficient evidence regarding safety
for the baby. The effects on the maternal perineum are
inconclusive.Although uterine rupture was not evaluated
by studies, the CPG Panel placed a high value on avoiding
maternal injuries like uterine rupture and fetal death.
A. Keep one hand on the head as it advances during contractions
while the other hand supports the perineum.
B. During delivery of the head, encourage woman to stop
pushing and breathe rapidly with mouth open.
13. Active Management of the Third Stage of Labor
(AMTSL)
 AMTSL consists of interventions to hasten the delivery of
the placenta by increasing uterine contractions and reduce
blood loss.
1. Administration of uterotonic oxytocin within one min of
delivery of the baby.*
2. Controlled cord traction with counter traction on the uterus
3. Uterine massage
 Within one minute after birth of baby, palpate the
mother’s abdomen to exclude a 2nd baby, then give
oxytocin 10 u IM. When the uterus is contracted, deliver
the placenta by controlled cord traction with counter
traction to the uterus (at the suprapubic area). After
delivery of the placenta, massage the uterine fundus.
Summary:
Restricting practices limit a mother’s freedom to move
and/or her position of choice.
1. IV lines
2. Fetal monitoring
3. Absence of support persons to “be with” the intrapartum
client
4. Small labor rooms
5. Epidural placement
6. Labor stimulating medications that require monitoring of
uterine activity
 There is no evidence that continuous electronic fetal
monitoring improves maternal outcomes, and it generally
requires that the mother stays in bed, therefore disallowing
the laboring woman to walk or take the position of her
choice for an easier labor and delivery.
MCN SKILLS/CLINICAL
EINC
Learning Objectives
 know the purpose of EINC
 be familiar on what materials to prepare
 know the step by step standard procedure on DOH EINC
 To define and accomplish the evidence based care of a
newborn baby at the time of birth and prevent serious
complications.
Essential Intrapartum and Newborn Care (EINC) is a package of
evidenced-based practices recommended by the Department of
Health (DOH), Philippine Health Insurance Corporation or
(PhilHealth), and the World Health Organization (WHO).
It is a basic component of DOH’s Maternal, Newborn and Child
Health and Nutrition (MNCHN) strategy. The EINC practices
for newborn care constitute a series of time bound,
chronologically- ordered, strategy procedures that a baby
receives at birth. At the heart of the protocol are four time-
bound interventions; immediate during; skin to skin contact
followed by clamping of the cord after 1-3 minutes; and
breastfeeding initiation.
The Four Core Steps are included in the package of
interventions that comprise Essential Intrapartum and
Newborn Care (EINC)
In advance, prepare decontamination solution by mixing 1 part
of 5 % chlorine bleach to nine (9) parts water to make 0.5 %
chlorine solution. Change chlorine solution at the beginning of
each day or whenever solution is very contaminated or cloudy.
PRIOR TO WOMAN’S TRANSFER TO THE
DELIVERY ROOM
1. Ensure that the mother is in her position of choice, while in
labor.
Freedom of movement:
 distract mothers from the discomfort of labor,
 release muscle tension, and
give a mother the sense of control
Support the woman’s choice of position: left lateral, seated,
squatting, kneeling, standing supported by the companion (or
medicine ball) of choice.
2. Ask mother if she wishes to eat/drink or void.
Labour and birth needs energy
• Restriction of food and fluid can be distressing
• Increase length of labour
BY:NICOLE HONRADO, BSN 2A
 Withholding food and drink during labor is an outdated
practice that has been shown to negatively affect birth
outcomes.
 No evidence exists that putting the parturient on NPO
benefits the course of a normal labor
 Intrapartum mothers should be allowed to determine for
themselves what they wish to eat or drink and when they
choose to do so.
3. Communicate with the mother – inform her of her progress of
labor, give reassurance & encouragement.
WOMAN IS ALREADY IN THE DELIVERY ROOM
PREPARING FOR DELIVERY
1. Check temperature in D.R. area, must be 25-28 degrees
Celsius; eliminate air draft.
2. Ask woman if she is comfortable in the semi-upright position
(The default position of the delivery table).
3. Ensure the woman’s privacy.
4. Remove all jewelries then wash hands thoroughly, observing
the WHO 1-2-3-4-5 procedure.
5. Prepares a clear, clean newborn resuscitation area on a flat
surface. Check the equipment if clean, functional and within
easy reach.
6. Arrange materials/supplies in a linear sequence:
- Gloves, dry linen, bonnet, Oxytocin injection, cord
clamp, instrument clamp, scissors, 2 kidney basins.
7. In a separate sequence, after the 1st breastfeed:
- Eye ointment, (stethoscope for PE), Vitamin K,
Hepatitis B and BCG vaccines (plus cotton balls, etc.)
8. Clean the perineum with antiseptic solution.
How to perform perineal care
A. Gather supplies.
B. Provide privacy for the patient.
C. Wash hands and put on gloves.
D. With the patient on their back, instruct them to open
their legs.
E. Cleanse the perineum, using front to back motions. …
F. Never wash back to front; this causes contamination and
can cause infections.
9. Wash hands and put on two (2) pairs of sterile gloves
aseptically. (If same worker handles perineum and cord).
Sterile gloves help prevent surgical site infections and reduce
the risk of exposure to blood and body fluid pathogens for the
health care worker.
AT THE TIME OF DELIVERY
1. Encourage woman to push as desired.
2. Drape the clean, dry linen over the mother’s abdomen
or arms in preparation for drying the baby.
3. Apply perineal support and do controlled cord traction
(CCT) delivery of the head.
4. Call out time of birth and sex of the baby. Inform the
mother of outcome.
FIRST 30 SECONDS
5. Thoroughly dry the baby for at least 30 seconds,
starting from the face and head, going down to the trunk
and extremities while performing quick check for
breathing.
MCN SKILLS/CLINICAL
1ST CORE STEP: IMMEDIATE AND THOROUGH
DRYING
 Immediate drying:
Stimulates breahing
Prevents hypothermia
 Hypothermia can lead to
Infection
Coagulation defects
Acidosis
Delayed fetal to newborn circulatory adjustment
Hyaline membrane disease
Brain hemorrhage
 If baby is not breathing, STIMULATE by DRYING!
 Do not ventilate unless the baby is floppy/limp and not
breathing
 Routine suctioning not recommended unless the
mouth/nose are blocked
 Vigorous suctioning can create oral aversion (the baby
protects himself by keeping his mouth closed)
1-3 MINUTES
6. Remove the wet cloth.
7. Place baby in skin-to-skin contact on the mother’s abdomen
or chest.
2ND CORE STEP: EARLY SKIN-TO-SKIN CONTACT
 General perception is that it is purely for mother-baby
bonding
 Other benefits:
B – breastfeeding success
L – lymphoid tissue system stimulation
E – exposure to maternal skin flora
S – sugar (protection from hypoglycemia)
T - thermoregulation
 Baby’s frontal contact with mother’s body stimulates both
maternal and baby’s breast-seeking behaviors
 Preterm infants exposed to their mother’s milk odor—a
natural byproduct of skin-to-skin care—suckle for longer
periods of time at each feeding, and consume more milk at
each feeding when they reach 35 weeks post-conceptional
age.
 Touch is the primary sensory trigger for breast-seeking
behavior (along with sight, smell and hearing) Breast
crawl
 In semi-reclined positions primitive neonatal reflexes work
in harmony with gravity, less effort required, less to know
and remember
8. Cover baby with the dry cloth and the baby’s head with a
bonnet.
9. Exclude a 2nd baby (for possible twin) by palpating the
abdomen in preparation for giving Oxytocin.
10. Use wet cloth to wipe the soiled gloves. Gives 1cc Oxytocin,
IM, within one minute of baby’s birth. (before placental
expulsion). Disposes wet cloth properly.
11. Remove 1st set of gloves and decontaminate them properly
(in 0.5% chlorine solution for at least 10 minutes).
12. Palpate umbilical cord to check for pulsations.
BY:NICOLE HONRADO, BSN 2A
13. After pulsations stops, clamp the cord using the plastic cord
clamp, 2 cm from the base.
14. Place the instrument clamp 5 cm from the base.
3RD CORE STEP: PROPERLY TIMED CORD
CLAMPING
 Reduction in anemia
By 80% in term newborns
By 51% in preterm newborns
 Reduction in brain hemorrhage by 41% in preterms
 No significant impact on incidence of post-partum
hemorrhage
15. Cut near plastic clamp (not midway).
16. Perform remaining steps of the AMTSL: Wait for strong
uterine contractions then apply controlled traction and counter
traction on the uterus, continuing until placenta is delivered.
WHO Recommendations for Active Management of the Third
Stage of Labour (AMTSL), 2012 The use of uterotonics for the
prevention of postpartum haemorrhage (PPH) during the third
stage of labour is recommended for all births. Oxytocin (10 IU,
IV/IM) is the recommended uterotonic drug for the prevention
of PPH. In settings where skilled birth attendants are available,
controlled cord traction (CCT) is recommended for vaginal
births if the care provider and the parturient woman regard a
small reduction in blood loss and a small reduction in the
duration of the third stage of labour as important. In settings
where skilled birth attendants are unavailable, CCT is not
recommended. Sustained uterine massage is not recommended
as an intervention to prevent PPH in women who have received
prophylactic oxytocin. Postpartum abdominal uterine tonus
assessment for early identification of uterine atony is
recommended for all women. CCT is the recommended method
for removal of the placenta in caesarean section.
17. Massage the uterus until it is firm. Inspect the lower vagina
and perineum for lacerations and repair lacerations/ tears, as
necessary.
18. Examine the placenta for completeness and abnormalities.
19. Clean the mother, flush perineum and applies perineal
pad/napkin/ cloth.
20. Check the baby’s color and breathing; check that mother is
comfortable, & the uterus is contracted.
21. Dispose placenta in a leak-proof container or plastic bag.
22. Decontaminate (soak in 0.5% chlorine solution) instruments
before cleaning; decontaminate 2nd pair of gloves before
disposal, decontamination lasts for at least 10 mins).
23. Advise mother to maintain skin-to-skin contact. Baby should
be prone on mother’s chest/ in between the breasts with head
turned to side.
MCN SKILLS/CLINICAL BY:NICOLE HONRADO, BSN 2A
15- 90 MINUTES APPLICATION OF EYE OINTMENT
An early first breastfeed seems to help with increased milk
supply in the first days of life 1. Hold the tube with the cap on.
 There is earlier passage of meconium 2. Take the cap off the tube and put the cap on a clean surface
 There is a greater likelihood of continued breastfeeding area.
Delay in the first feed can lead to: 3. Place the newborn in supine position, hold the newborn’s
 Issues of poor milk supply forehead steady with one hand. Raise the upper eye lid of the
 Greater odds of discontinuing breastfeeding eye with the thumb of the same hand. If you are right-handed, it
is easier to be on the right side of your child and steady the
1. Advise mother to observe for feeding cues. forehead with the left hand. If you are left-handed, it is easier to
be on the left side of your child and steady the forehead with the
Early Breastfeeding Initiation right hand.
The timing of initiation of breastfeeding is important as 4. Use the other hand to hold the ointment tube with the thumb
there is a higher risk of death among infants with longer delay in and the index finger.
the initiation of breastfeeding. 5. Position the ointment tube above the eye it is to be applied.
6. Using the little finger of the same hand that is holding the
tube, pull the lower eyelid down gently to form a pocket-like
Breastfeeding Cues/ Feeding Reflexes opening of the eyes.
 Head lifting and bobbing 7. Gently squeeze a small amount of ointment (about 1/2 inch or
 alertness, movements of arms and legs (stepping, the size of a grain of rice) inside this pocket from the inner to
crawling) outer canthus of the eyes.
 Tossing, turning or wiggling 8. Gently release the lower eyelid. Keep holding your child's
 Mouthing, licking, tonguing forehead.
 Rooting 9. Gently release the upper eyelid. Keep holding your child's
 Hand to mouth forehead.
 Changes in facial expression 10. Wipe off any excess ointment around the eye with a separate
 Squeaking noises or light fussing clean tissue.
11. Let go of the newborn’s forehead.
2. Support mother, instruct her on positioning and attachment.
After applying the eye ointment
1. After applying the eye ointment, wipe the tip of the ointment
tube with a clean tissue/cloth.
2. Put the cap back on the ointment tube.
3. Keep the medication in its proper place
4. Wash your hands again

Antropometric Measurements

Weighing scale : Weight

Tape measure: Head Circumference
Chest circumference
Abdominal circumference
Mid-upper Arm circumference
Length

3. Waits for FULL BREASTFEED to be completed.

4. After a complete breastfeeding, administer eye ointment

(first), does thorough physical examination, then does Vitamin
K, Hepatitis B and BCG injection (simultaneously explain
purpose of each intervention).

NEWBORN PROCEDURES
 Eye care, weighing, examinations, injections including the NOT WAITING FOR THE 1ST BREASTFEED
birth dose of the Hepatitis B vaccine should be done only
after the first full breastfeed is completed  Overstimulating the baby (multiple assessment
examinations, suctioning, weighing and measuring,
IDENTIFICATION OF NEWBORN glucose checks, eye treatment, injections) causes the
 After delivery, gender should be determined baby to “shut down”
 Identification is done as soon as possible before the  Leads to a sleepy baby that is difficult, if not impossible, to
newborn is separated from the mother nurse.
 Proper identification of the newborn is the legal and moral  Routinely separating babies from their mothers for
responsibility of the health caregiver evaluation and bathing during the minutes and hours after
 Put on identification band on ankle or on wrist birth disrupts the baby's ability to find the breast and self-
attach
MCN SKILLS/CLINICAL BY:NICOLE HONRADO, BSN 2A
5. Record measurement.
WEIGHT MEASUREMENT
5. Advise optional/delayed bathing of baby (and be able to
 Normal weight ranges from 3.000 to 4.000 kg explain the rationale).
 lowest limit at 2.500 kg
 upper limit at 4.000 kg Harm of Early Bathing
 Removes vernix
1. Remove all clothing including the diaper and place the infant - Vernix is a protective barrier to E.coli and Group B
in the center of the weighing surface. Strep
2. Read the measurement in kgs - Hinders crawling reflex
3. Record the numerical value on the recording sheet - Can lead to hypothermia
- infection, coagulation defects, acidosis, delayed fetal
to newborn circulatory adjustment, hyaline membrane disease,
HEAD CIRCUMFERENCE MEASUREMENT brain hemorrhage
The distance around the baby's head.
 The head is the biggest part of the body about ¼ of the 6. Advises breastfeeding per demand
body length.
 It measures 33-35 cm (13-14 inches). 7. In the first hour, check baby’s breathing and color; check
mother’s vital sign and massages uterus every 15 minutes.
Procedure:
1. Position properly 8. In the second hour, check mother-baby dyad every 30
2. Place the lower edge of the measuring tape just above the minutes to 1 hour.
newborn's eyebrows, above the ears and around the occipital
prominence at the back of the head. 9. Completes all records.
3. Pull the measuring tape snugly to compress the hair. The
objective is to measure the maximal head circumference.
4. Repeat the measurement twice to validate correct
measurement.
5. Record measurement.

MEASURING CHEST & ABDOMINAL

CIRCUMFERENCE

 The chest is almost equal to the abdomen in measurement:

32-33 cm (12-13 inches)
 Measured at the level of the nipples

 Abdominal circumference: 31-33 cm ( 12-13 inches)

 The distance around the baby's belly or abdomen.

Procedure :
1. Remove any clothing covering the newborn’s left arm
2. Calculate the midpoint of the child’s left upper arm:
•Locate the tip of the child’s shoulder with your
finger tips
•Bend the child’s elbow to make the right angle
•Place the tape at zero, which is indicated by two
arrows, on the tip of the shoulder and pull the tape straight down
past the tip of the elbow
•Read the number at the tip of the elbow to the nearest
centimeter
•Divide this number by two to estimate the midpoint
•Mark the midpoint with a pen on the arm

3. Straighten the child’s arm and wrap the measuring tape

around the arm at the midpoint, make sure the tape is not too
tight or too loose
4. Record the measurement in centimeter

LENGTH MEASUREMENT
The measurement from top of head to the heel

 The newborn’s height ranges from 19 to 21 inches, or an

average of 46-54 cm.
 The heel-to-crown measurement is to be taken.

1. The newborn in supine position, straighten the newborns's

legs and hold the ankles together with the toes pointed directly
upward.
2. Move the footboard firmly against the soles of the feet or if
using a measuring tape, hold the tape measure from the head
crown to the heel part.
3. Read the measurement to the nearest 0.1 cm (1/8 in).
4. Repeat the measurement to validate correct measurement