NORMAL VAGINAL DELIVERY
• Call the anesthesiologist/pediatrician
CHECKLIST:
I. Patient preparation
• When the parturient is in the 2nd stage of
labor, transfer the patient to the delivery
room table
• Continue ‘Nothing per orem’ order
II.
• Drape the patient (re –apply the sensors of
the Electronic Fetal Monitor if necessary)
• Get the maternal vital signs every 15 mins,
including the fetal heart rate q 5 mins.
• Monitor the contractions
• Ask the parturient to bear down during the
contractions. You may need to coach the
patient on the correct way to bear down.
• Continue until the fetal head is in the pelvic
floor (fetal scalp is visible without separating
the labia)
• Ask the nurse to prep the perineum and
place the sterile drapes
• Scrub your hands with soap and antiseptic or
hand rub with an alcohol-based antiseptic.
• Open the sterile instrument table
• Don the sterile delivery gown and gloves
Delivery of the Fetal Head
• If episiotomy is be performed, Inject local
anesthesia in along the line of incision.
• Place a sterile towel over the right hand and
cover the anal opening with the thumb and
index finder supporting the perineal body
(modified Ritgens maneuver) to prevent over
stretching and lacerations.
• During the peak of the contraction, perform
the episiotomy
• Guide the fetal head as it extends out of the
introitus
• Wipe the face of the neonate
 • Place both hands on each side of the head
and turn the head with the back towards the
location of the loudest FHT
• Apply downward traction on the head to
deliver the anterior shoulder
• Then upward traction to the deliver the
posterior head
• Continue the traction to assist in the
expulsion of the whole body
III. Observe the “Unang Yakap” principles
• Wipe dry the whole body of the neonate
• Put the neonate on the mother’s abdomen
or anterior chest and cover with
towel/blanket to keep warmth
• Wait for the umbilical cord pulse to
disappear before application of the clamp 2
cms. From the neonate. And another clamp a
few cms from the first clamp, and cut in
between
• Assist for latching
rd
IV. 3 stage of labor
• Observe the signs of placental separation
before application of traction to the
umbilical cord
• Inject Oxytocin
intramuscularly/intravenously
• Deliver the placenta and inspect for
completeness of the cotyledons
• Inspect the vagina for lacerations and repair
accordingly
• Palpate the uterus, and make sure it is well
contracted
• Evacuate blood clots from the vagina
• Monitor for vaginal bleeding
• If repair is performed, do a rectal exam
V. Immediate postpartum care
• Spray with an antiseptic (povidone-iodine)
the perineum
• Monitor vaginal bleeding using sanitary
napkins/diapers
 • Monitor vital signs every 15 mins

• Transfer to room in
VI. Room in instructions

• Diet as tolerated

• Feminine hygiene using feminine antiseptics

e.g. Povidone-iodine, chlorhexidine

• Encourage early ambulation

• Breast feeding instructions

• Medications
VII. Discharge orders

• Care for the perineum

• Care for the neonate

• Diet

• Medications

• Follow up instructions