CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107

HANDLING AND ASSISTING DELIVERY

DEFINITION OF TERMS MEASUREMENTS OF PELVIC INLET

HANDLING DELIVERY
• It is the actual handling of the delivery of the fetus
ASSISTING DELIVERY
• Handling the instruments to the one handling the delivery
EPISIOTOMY
• A surgical incision of the perineum made to prevent tearing of
the perineum with birth and to release pressure of the fetal
head during delivery.
EPISIORRAPHY
• Repair tear of the episiotomy with the use of sutures.
LACERATION
• Refers to the tearing of the vulvar, vagina and sometimes
rectal tissue during birth.
CARDINAL MOVEMENTS
• ENGAGEMENT
o Occurs when the widest part of the fetal head has passed
below the maternal pelvic inlet.
o Essentially, the baby's head has officially entered its
mother's pelvis.
• DESCENT
o Downward movement of the biparietal diameter of the
fetal head to within the pelvic inlet.
FLOATING
• Fetal presenting part is not engaged in pelvic inlet
FIXED FLEXION
• Fetal presenting part has entered pelvis • Baby moves further downward and then head meets
obstruction at the pelvic floor causing flexion.
ENGAGEMENT • While descending through the pelvis, the fetal head flexes so
• Fetal presenting part (usually biparietal diameter of fetal head) that the fetal chin is touching the fetal chest.
has passed through the pelvic inlet o This functionally creates a smaller structure to pass
STATION 0 through the maternal pelvis.
• Presenting part has reached level of ischial spines • When flexion occurs, the occipital (posterior) fontanel slides
STATIONS -1, -2, -3 into the center of the birth canal and the anterior fontanel
becomes more remote and difficult to feel.
• Presenting part is 1, 2, 3 above the level of ischial spines
• The fetal position remains occiput transverse.
STATIONS +1, +2, +3
• Presenting part is 1, 2, 3 below level of ischial spines. A station
of +4 indicates that presenting is on the pelvic floor

INTERNAL ROTATION
• In accommodating the birth canal, the fetal occiput rotates
anteriorly from its original position toward the symphysis.
o The movement results from the shape of the fetal head,
space available in the midpelvis and contour of the
perineal muscles.
• The ischial spines project into the midpelvis causing the fetal
head to rotate enteriorly to accommodate to the available
space.
• With further descent, the occiput rotates anteriorly, and the
fetal head assumes an oblique orientation.
• In some cases, the head may rotate completely to the occiput
anterior position.

LAMAGON | BSN 2A
 CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107
HANDLING AND ASSISTING DELIVERY
EXTENSION
• As the fetal head descends further, it meets resistance from
the perineal muscles and is forced to extend.
• The fetal head becomes visible at the vulvova ring; its largest
diameter is encircled (crowning) and the head then emerges
from the vagina.
• The curve of the hollow of the sacrum favors extension of the
fetal head as further descent occurs.
o This means that the fetal shin is no longer touching the
fetal chest.
EXTERNAL ROTATION/RESTITUTION
• When the head emerges, the shoulders are undergoing
internal rotation as they turn in the midpelvis to
accommodate to the projection of the ischial spines.
• The head, now born, rotates the shoulders undergo this
internal rotation.
• The shoulders rotate into an oblique or frankly anterior-
posterior orientation with further descent.
o This encourages the fetal head to return to its transverse
position.
EXPULSION
• Following delivery of the infant’s head and internal rotation of
the shoulders, the anterior shoulder rests beneath the
symphysis pubis.
• The posterior shoulder is born, followed by the anterior
shoulder and the rest of the body.
STAGES OF LABOR
FIRST STAGE OF LABOR
(STAGE OF DILATATION)
• Onset of true labor to full cervical dilation.
LATENT PHASE
• The first phase of the first stage of labor when contractions are
becoming more frequent (usually 5 to 20 minutes apart) and
somewhat stronger.
• The cervix dilates (open approximately three or four
centimetres and effaces (thins out).
• Is usually the longest and least intense phase of labor.
ACTIVE PHASE
• The second phase of the first stage is signaled by dilatation of
the cervix from 4 to 7 cms.
• Contractions become longer, more severe, and frequent
(usually 3 to 4 mins. apart).
TRANSITION PHASE
• The third phase and the last phase.
• Cervix dilates from 8 to 10 cms.
• Contractions are usually very strong, lasting 60-90 seconds and
occurring every few minutes.
SECOND STAGE OF LABOR
(STAGE OF EXPULSION)
• Complete dilatation to expulsion of the baby.
RITGEN’S MANEUVER
1. Denotes extracting the fetal head, using one hand to pull the
fetal chin from between the maternal anus and the coccyx, and
the other on the fetal occiput to control speed of delivery.
• It is performed during uterine contraction.
2. Palpate for cord coil.
• Suction baby’s mouth and nose using bulb syringes.
• Deliver the shoulder, wait for the external rotation where
one shoulder is up, and the other shoulder is down.
• With one hand at the back of the neck, the other one
grasping the extremities and put the baby in the mother’s
abdomen and suction secretions.
THIRD STAGE OF LABOR
(PLACENTAL STAGE)
• Birth of the baby – expulsion of the placenta
• This stage of labor is the period from birth of the baby through
delivery of the placenta.
• This is considered a dangerous time because of the possibility
of hemorrhaging.
PLACENTAL SEPARATION
• Calkin’s sign
1.1. The uterus becomes globular in shape and firmer, discoid
to avoid, indicating placental separation from the uterine
wall.
1.2. Gushing of blood
o 2nd sign
o Or sudden glush of blood
• 1.3. Lengthening of the cord
o 3rd sign
o The umbilical cord descends three (3) inches or more
further out of the vagina
• 1.4. The uterus rises in the abdomen
CREDE’S MANEUVER
• A method of expressing the placenta in which body uterus is
vigorously squeezed in order to produce placental separation.
LAMAGON | BSN 2A
 CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107
HANDLING AND ASSISTING DELIVERY

PLACENTAL SEPARATION CONTENTS OF OB PACK

• Brandt–Andrews Maneuver CPCMHI VSMMC (OB KIT)
o A method of expressing the placenta by grasping the • 3 gowns • Digital thermometer
umbilical cord with one hand and placing the other hand • 2 leggings • Adult diaper
on the abdomen, application of the traction on the cord • 3 drapes • Sterile gloves
by moving the forceps up, down, left, right. • 1 perineal support • 1 bottle of 70% alcohol
• Schultze’s Mechanism • 1 bottle Betadine
o Shiny (fetal side)
• solution
o A mechanism or technique for the delivery with the fetal
• Pack cotton ball
rather than the maternal side surface presenting the shiny
• Baby diaper
and glistening side of the fetal membrane.
• Bonnet
• ID bracelet (white and
• pink / blue)
CONTENTS OF INSTRUMENT SET
CPCMHI VSMMC
• 1 Bandage scissor PRIMI SET
• 1 Kelly curve • 1 Bandage scissor
• Duncan Mechanism • 1 Kelly straight • 1 Surgical scissor
o Dirty or rough (maternal side) • 1 Surgical scissor • 1 Kelly curve/straight
o A mechanism or technique for delivery with the maternal • 1 Needle holder forceps
rather than the fetal side surface presenting the dirty or • 1 Tissue forceps • 1 Needle holder
rough side. • 1 Placental bowl • 1 Tissue forceps with
teeth/without teeth
• 1 Tray
• 10cc Disposable syringe
for
• Lidocaine HCL 2% (to be
added)
• Needle and Suture (to be
• added)
• Sterile 4x4 OS 5-10 pcs.
(to be added)
• 4 Sterile OP towel
• 2 Leggings (optional)
MULTI SET
• 1 Bandage scissor
• 1 Kelly curve/straight
forceps
• 1 Needle holder
• 1 Tissue forceps with
teeth/without teeth
• 1 Tray
• 10cc Disposable syringe
for 2 % Lidocaine HCL (to
be added)
• Needle and Suture (to be
added)
• Sterile 4x4 OS 5-10 pcs.
(to be added)
• 2 Leggings (optional)
FOURTH STAGE OF LABOR
(STAGE OF PHYSICAL RECOVERY) INSTRUMENTS
• Delivery of the placenta up to 1-4 hrs. after delivery 10cc disp. Syringe with lidocaine anesthesia + bandage scissors
• Used during episiotomy.
2 Kelly forceps
• Used to clamp the umbilical cord of the baby.
Umbilical cord scissors
• Used to cut the umbilical cord.

LAMAGON | BSN 2A
 CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107
HANDLING AND ASSISTING DELIVERY

Surgical scissors 18. Deliver the placenta by controlled cord traction (with counter
• Used to cut the umbilical cord. traction on the uterus above the symphysis pubis). Make sure
Needle holder the bladder is empty.
19. Massage uterus over the fundus.
• Used to hold the round needle with suture.
20. Once delivered, place the placenta on the bowl and inspect for
1 tissue forceps with teeth completeness of its parts.
• Used to hold the soft tissues in the perineal area during 21. Document the placental presentation.
episiorraphy. STEPS IN ASSISTING DELIVERY PROCEDURE
STEPS IN HANDLING DELIVERY PROCEDURE PREPARATION
PREPARATION a. Do medical and surgical hand washing.
a. Do medical and surgical hand washing. b. Perform gowning (per institution protocol) and gloving
b. Perform gowning (per institution protocol) and gloving (per institution protocol).
(per institution protocol). c. Prepare the materials, OB pack and instruments set to be
c. Do draping (per institution protocol). used in the delivery.
ACTION - Materials include: to be obtained from the
1. Drape the patient accordingly accompanying.
a. Leggings (left and right) ✓ Maternity duster (per institutional policy)
b. Abdominal drape ✓ Adult and newborn (per institutional policy)
c. Perineal drape ✓ Baby clothes and flannel (per institutional
d. Baby drape policy)
e. Perineal support - Instruments set needs to be anticipated whether to
2. Encourage the woman to push/bear down once uterus is at the use primi/multi set (per institutional policy)
height of its contraction and to do breathing exercises when it d. Anticipate the amount of anesthetic agent to be used.
is not. Prepare the agent in the syringe.
WHEN THE BIRTH OPENING IS STRETCHING AND THE HEAD OF THE ACTION
BABY IS CROWNING 1. Serve the instruments to be used by the physician in
3. Ensure controlled delivery of the head of the baby. appropriate manner.
4. Keep one hand on the head as the head of the baby advances. 2. Assist in suturing the episiotomy. Anticipate doctor’s need
- To keep the head from coming out too quickly. during suturing.
5. Support the perineum with the other hand. 3. After suturing of the perineum is done, flush the operative site
- To prevent perineal lacerations. with normal saline.
6. Discard the pad when soiled. 4. Apply betadine antiseptic solution, sanitary pad/adult diaper
- To prevent infection and clean maternity duster.
7. During the delivery of the head encourage the woman to stop 5. Do after care:
pushing and breath rapidly with mouth open. ✓ Position the mother comfortably-closed legs
✓ Removed stained drapes
DELIVERING THE BABY
✓ Take vital signs immediately
8. Sliding your hands into the neck of the baby, gently feel if the
✓ Check the instruments if complete
cord is around the neck.
✓ Wash the instruments if complete and let it dry
- If it is loosely around the neck, slip it over the shoulders or
✓ Pack clean equipment and auto-clave
the head.
- If it is tight, place a finger into the cord, clamp and cut the
cord, and unwind it from around the neck.
WHEN THE FACE AND HEAD OF THE BABY IS DELIVERED
9. Gently wipe the baby’s mouth and nose with clean gauze.
10. Wait for external rotation (within 1-2 min) the head of the
baby will turn sideways bringing one shoulder just below the
symphysis pubis and the other facing the perineum.
11. Apply downward pulling motion to deliver the top shoulder
then lift the baby up to deliver the lower shoulder. Gently
deliver the rest of the baby.
12. Place the baby to the mother’s abdomen in prone position.
13. Cover the baby with dry towel. Thoroughly dry the baby
immediately. Wipe the baby’s eyes.
14. Discard wet cloth.
15. Put the baby in prone position, in skin-to-skin contact on the
mother’s abdomen. Keep the baby warm.
16. Palpate mother’s abdomen to determine if there is a second
baby.
17. Remove gloves (first set of gloves) or change to new ones.

LAMAGON | BSN 2A