OB PACK, DELIVERY, & POSTPARTUM CARE

Check bedside equipment 1. Flushing Can – opened in a fanfold manner

for perineal flushing
2. Betadine Spray – cleaning the perineal
area and final preparation
3. Cotton Balls
4. Pickup Forceps – ovum forceps, teeth
inside
5. Hypotray – working forceps; lift the fold,
hand inside fold

Perform medical handwashing and remove To deter the spread of microorganisms

all jewelry, including wedding bands / rings

Opening of the OB Pack

- Only done when px is showing imminent signs of delivery (SUBIRBA)

Check equipment 1. OB Pack

2. Sterile Bowl
3. Allis Forceps
4. Mayo Scissors
5. Primiset
- (1) Needle Holder
- (3) Straight and/or Curved Clamps
- Tissue Forceps with teeth
- Blade Holder
- Ovum Forceps
6. Sterile Cotton Balls
7. Sterile OS (Operating Sponge)
8. Blade
- Check for the number to verify the
holder
9. Umbilical Cord Clamp
10. Placental Curette
11. Suction Bulb
12. Sterile Gloves (4)
- You
- OB Resident
- Pedia Resident
- OB Consultant
13. Lidocaine – serve as local anes.
14. Syringe (5cc)
15. Chromic 2.0 Double Arm – the suture

Look for the tape with the date To check for the expiry date of the OB Pack

Position yourself at least an inch away from To observe the aseptic technique
the edge of the table

Open the first cover according to its fold To observe the aseptic technique
direction; can be done with bare hands; make
sure to open the cuff that is away from you first
and insert your hand under the cuff

The second cover of the OB Pack will be

opened the same way except we use the
pickup forceps now

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Check and arrange the contents of the OB Arrangement from bottom to top:
Pack
— based on Ma’am Domanais (vid demo):
- 3rd Towel / Drape
- Layette
- Bonnet
- 2nd Towel / Drape
- 1st Towel / Drape
- 1 Pair of Leggings

— based on Ma’am Operario, Zehender, and

Medidas (f2f lecture; nakasulat sa whiteboard):
- 3rd Towel / Drape
- 2nd Towel / Drape
- Layette
- Bonnet
- 1st Towel / Drape
- 1 pair of leggings

Note: fold the corner of the drape (triangular)

Reminders on opening and handling sterile packs

- Make sure to peel open facing sidewards, not infront of the sterile field
- Do not let the peeling / opening side draw back because that will be considered unsterile;
do this by holding the closed side of the pack firmly together with its peeled side
- Do not make too much noise in preparing, as in, avoid the clanking sound of the metal
instruments so as to not startle and increase the anxiety of the patient
- Throw the packaging on the garbage bin assigned for it (usually under the table)

Open sterile small bowl To observe the aseptic technique

Banana Peel + use the pickup forceps to

remove it from the packaging and prevent the
packaging from touching the content

Open Primiset To observe the aseptic technique

Banana Peel + pick it up one by one from the

packaging using pickup forceps

Open other instruments To observe the aseptic technique

- Allis Forceps
- Mayo Scissors
- Placental Curette

Banana Peel + pick it up one by one from the

packaging using pickup forceps

Open sterile suction bulb To prevent it from falling off the table

Banana Peel + drop it to the bigger basin

Open the sterile CB To prepare it later in placing the needed solution

Banana Peel + place it in the sterile bowl

Open the OS pack To observe the aseptic technique

Banana Peel + drop to the sterile table

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Open the syringe pack and suture To observe the aseptic technique

Banana Peel + drop to the sterile table

Open the Umbilical Cord Clamp To observe the aseptic technique

Follow the arrow direction, peel halfway, and

drop to the sterile table

Open the blade To observe the aseptic technique

Banana Peel + drop to the sterile table

Prepare the sterile gloves and make sure that

it is the right size

— Method 1 (Ma’am Operario; on F2F demo) —

Banana Peel from first packaging + use the
pickup forceps to take it out of the second
packaging

Make sure that the one on top is the glove that This is because in donning the sterile gloves,
is right for the person’s handedness dominant hand comes first

— Method 2 (Ma’am Domanais; on vid demo) —

Banana peel from first packaging, drop it on the
on the sterile with its second packaging and
arrange it on the table

Make sure to know what is the handedness of

the consultant and the resident/s so as to know
what side should be on top when they open the
package

Arrange the instruments on the table; from left

to right, with at least an inch of allowance
- Allis Forceps Allis Forceps not necessary when bag of water
is not intact anymore

- Syringe 5cc For local anes.

- Blade Holder
- Blade (aligned on top of the holder)
- Mayo Scissors (can be curved or Episiotomy and cutting of umbilical cord
straight; teeth down if curved)
- Umbilical Cord Clamp
- 3 clamps (can be curved or straight; One for cord clamping, the other two for
teeth down if curved) bleeders (which are the cut arteries and veins
during episiotomy)

- Needle holder
- Suture (above needle holder, below big For episiorrhaphy
basin)
- Tissue forceps with teeth Used to hold the site / tissue that will be sutured
on episiorraphy

- Placental Curette For the cleaning and scraping uterine lining

- Ovum Forceps Wrapped with OS to clean the uterus

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Arrange the sterile gloves according to the Order (from nearest to farthest) → consultant,
order of use (this is aligned on top of the farthest resident/s, then yours (which is already near the
right instruments) top most part)

Arrange the OS (right side, starting on top of To avoid getting doubles and possible
the clamps) in cascading manner contamination when instruments come in
contact with the sterile OS

Perform surgical handscrubbing after the To maintain sterility

preparation

Perform proper donning of sterile gloves and To maintain sterility

place its wrapper under the basin (make sure to
hold it on its sterile side since you’re already
wearing the sterile gloves)

With assistance, aspirate 5cc of local To be used for the patient during episiotomy
anesthesia (lidocaine)

Mount the surgical blade on the blade holder To be used for episiotomy
using the needle holder / clamp

Note: Check for blade number and holder

number; even on even, odd on odd

Open the Chromic 2.0 pack over the basin To ensure sterility in the work space

Cut the round needle (2/3) , and the cutting Round needle is for the deep tissues and
needle (1/3) length muscles which means it needs more suture
length than the cutting needle which is used for
the skin

Secure the round needle in the needle holder, To be used to suture the skin
and the cutting needle on an OS

Note: Needle should form a smile with the tip

on the opposite direction of the MD’s
handedness, and then when you put it in the
table, it should form a frown
- ex. if right handed si doc, dapat yung tip
ng needle is nasa left direction

Place OS over the ovum forceps For easier access when it’s time to clean the
- Form OS in a triangle then wrap the OS uterus
on the ovum forceps
- Make sure to lock the forceps to keep in
place

Ask for assistance to pour water and betadine To be used to clean the patient during the
on sterile bowl with cotton balls procedure

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Delivery of the Baby

When patient is fully dilated, place the table To ensure ease of access of tools
near the client

While waiting for the doctor to start the To ensure sterility

procedure, place hands on the table

Before starting the operation, do final To prepare the client and to ensure sterility
preparation by cleaning the perineal area
with perineal flushing and betadine spray

Place the leggings over the patient's legs, To maintain sterility

starting from the foot to the groin

Note: Start on the leg farther from you and do

not fix it because the assist will do that

Place a drape under the patient’s buttocks

Note: Make sure you are touching the side of To ensure sterility
the folded triangle and cover the dorsal part of
your gloved hand too

When there is crowning and there is still a bag
of water, perform ARM (artificial rupturing of
the membrane) of the bag of water using the
allis forceps
To help encourage dilation of cervix
(since ma pop ang water, maka apply ng force
ang ulo ng bata tas ma encourage dilation of
cervix)

Hand over the 5 cc local anesthetic to the To prepare the patient for episiotomy
doctor

[EPISIOTOMY START]

When handing equipment / instruments, So that the doctor will have an easier access to
make sure to touch the teeth / the tip of the the handle of the instruments
instruments

Give the blade to the doctor by touching the This is to be used by the doctor for episiotomy
neck of the blade, together with an OS (median / midlateral episiotomy)

Offer the mayo scissors to the doctor This is for the cutting of perineal tissue and
muscles for Ritgen’s Manuever

Use Ritgen’s Maneuver to support perineal To prevent perineal tearing or laceration

area

When the head of the baby is out, wipe the To remove any debree
mouth and nose of the baby using OS

When there are secretions in the mouth and To facilitate the airway of the baby (pwede mo
nose, use suction to remove secretions rin sabihin na mauna dapat sa mouth kasi diyan
starting from the mouth (press first then place in ga hinga ang bata if mag iyak –
mouth / nose) oronasopharyngeal suctioning)

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Mechanism of Labor and Delivery (Fetal Ascend, Flexion, Internal Rotation, Extension, External
Rotation, & Expulsion)
- Assist the head of the baby by using a scissor-like method and pull the neck of the baby
down to let the upper shoulder out
- Pull the neck up to let the lower should out
- Externally rotate the baby and support the neck with your nondominant hand, while your
dominant hand will support the back of the baby
- Facilitate the delivery of the fetal body parts and catch the feet

Announce time of delivery (baby out), and To identify time of delivery and gender
gender of the baby

Directly place baby over the mother’s To ensure child and mother connection (pwde
abdomen (aorund the breast area) sabihin to ensure skin to skin of the baby and
the mother)

Place a drape on the abdomen of the mother To provide a sterile workplace

(under the baby)

Place layette and bonnet on baby To ensure warmth for the baby and to prevent
hypothermia

Wait for pulsation of the cord to stop before To lower risk of anemia and iron deficiency
placing umbilical cord clamp

Place the umbilical clamp 1 inch from the To prepare for cutting of the cord
base, and apply the 2nd clamp 1-2 inches
from the umbilical cord clamp

Give the mayo scissors to the doctor To cut the cord

Place the cut cord over the drape on the To prepare for the changing of the buttocks
abdomen drape

Delivery of the Placenta

Get another drape and change the drape on To change the soiled drape to a cleaner one
the mother’s buttocks by holding the new
drape on your dominant hand, and removing the
old drape under the patient with the other hand,
and asking the patient to lift their buttocks to
change the drape

Using the Brandt Andrew’s Maneuver, coil the To facilitate the delivery of the placenta
umbilical area

Watch for signs of placental separation such This means that the placenta is almost ready for
as rising of the fundus, globular shape of the delivery
abdomen, sudden gushing of blood, and
lengthening of the umbilical cord

When resistance is felt while performing To facilitate delivery of the placenta

Brandt Andrew’s maneuver, perform Crede’s
Maneuver by placing your dominant hand on
the patient’s symphysis pubis to push the
placenta out, while pulling the cord with your
nondominant hand

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When placenta is near the vaginal area, To ensure that the placenta is delivered properly
position the basin near the buttocks just on
top of the anus

When delivering the placenta, identify the To identify if the placenta is Schultz or Duncan
placental presentation

When the placenta is delivered, make sure to To make sure that the clamp is not thrown away
remove the clamp that is on the cord and
placing it on the table

While doctor is checking for placental The normal number of cotyledons is around
fragments, break the membrane and count for 15-20/25
the cotyledon on the Duncan side, and
announce if cotyledon is complete

Clean gloves using OS To remove blood in gloves and to maintain

sterility

Hand out the tissue forceps and needle To prepare for episiorrhaphy
holder with the round needle to the doctor

When there are bleeders, offer clamps To clamp the arteries and veins

[EPISIORRAPHY START]

To assist the doctor in suturing, hold the To assist the doctor while performing
mayo scissors and OS, while positioning episiorrhaphy
yourself from away from the doctor’s back and
beside the mother’s hips and legs

During suturing, you can assist by putting the To help the doctor during suturing and locking
OS first on the drape, then support the needle to the suture
make the suture straight

Make sure to watch out for the doctor to tell For ensure efficiency during the procedure
you when to cut, or when the doctor will
position themselves for you to cut

When cutting, make sure to open only the tip To ensure accurate cutting of the suture, and to
of the scissors, and to support the scissors by clear the site from blood
placing it on top of your 2 fingers, and cutting
on top of the knots that the doctor has made,
and to tap the area with your OS to clean any
blood

After the doctor is done suturing the deep tissue In preparation for suturing the skin
and muscle, secure the cutting needle to the
needle holder

Offer the needle holder with the cutting To prepare for suturing of the skin
needle and tissue forceps to the doctor, and
hold the mayo scissors and OS

Prepare cotton balls with betadine to squeeze To clean the suture site
over the site

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When the doctor tells you to cut or when the To clean and disinfect the area
doctor will position themselves for you to
cut, open only the tip of the scissors, and to
support the scissors by placing it on top of your
2 fingers, and cutting on top of the knots that
the doctor has made, and tap the area with OS
for to clean off blood, and clean the area with
the cotton balls with betadine

When the episiorrhaphy is done, hand out To clean out the lining of the uterus
the placental curette and ovum forcep with
the OS

When the OS on the ovum forcep is bloody, To facilitate the cleaning of the uterus
place another OS until there is less blood is on
the OS when used

Postpartum Care

Remove the leggings and the drapes that is To create a better view of the perineal area
on the buttocks of the patient and over the
abdomen of the patient, and drop them on the
floor

Perform external douche using cotton balls To clean the genital area of the patient of blood
lined with betadine and water and any other liquid from the operation
- 1st CB: Clitoris going up to the
symphisis pubis
- 2nd CB: Groin towards the thigh (far
leg)
- 3rd CB: Groin towards the thigh (near
leg)
- 4th CB: Far Labia (1 direction)
- 5th CB: Near Labia (1 direction)
- 6th CB: Clitoris, then vaginal opening,
down to the perineum
- 7th CB: Clitoris, then vaginal opening,
down to the perineum, then to the anus

Perform perineal flushing and use betadine To wash off excess liquid and to maintain attain
spray sterility

With assistance, raise the hips of the patient To protect the genital area of the patient
and apply diaper

Note: The part with the plaster is the one that

goes under the buttocks

With assistance, position the legs of the client To provide comfort on the legs of the patient due
from lithotomy to supine position to holding the lithotomy position for a long time

Change the gown of the client, provide a To ensure the comfortability of the patient
blanket, and make the patient comfortable
and ask for any discomforts

Regulate IV and palpate the fundus To check if the uterus is contracted or not, if not
contracted inform ci and staff

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After doing patient care, move on to instruments

Separate and secure the sharps To ensure proper disposal of waste

- Remove the needle on the syringe
- Remove the blade on the blade holder
- Remove the extra sutures from the
round and cutting needles

And place them in the sharps container

OS, CBs, and syringe will go on the pail To ensure proper disposal of waste

Count your instruments To ensure that tools are complete and no

- 10 instruments instrument is missing
- Suction bulb over the CB basin

Dispose placenta in the proper placental To ensure proper disposal of placenta

waste bin (placental pail) unless told otherwise
by the patient (religion i.e. Islam – in that case,
place it inside a cellophane with formalin and
label it with the surname and mother’s name)

When returning the basin, wash the it first To loosen dried up blood from the instruments
and put all the instruments on the basin and
go to the sink in the delivery room and soak
and open all the instruments

Bring the mop from the back of the delivery To ensure proper waste disposal
room and grab the things on the floor such
drapes and leggings
- Use the leggings as a hamper for the
dirty drapes
- Wrap the leggings used as hamper in
the cloth of the sterile table

Secure the plastic inside of the pail that To ensure proper waste disposal
contains waste from the procedure such as the
urine and feces of the patient by removing the
air inside and closing it properly

Then bring the pail and the yellow bin at the

back of the delivery room

Mop the floor by using the proper type of To ensure proper disinfection of the floor
mop depending on the situation
- Red: for blood
- Yellow: for infectious (i.e. HepB, STDs,
HIV/AIDS)
- White: for rinsing and disinfecting

Rinse mop after use and dry them To ensure that the mop is clean and ready for
use

Clean your table by spraying with To ensure proper disinfection

disinfectant and then wipe

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 After 2 hours, the patient will be brought to the To ensure proper disinfection
ward

From there, clean the bed by removing the

covers and spraying disinfectant on the bed,
and cover the bed after cleaning

In washing the instruments, make sure to To ensure proper disinfection

brush the teeth of the instruments and rinse
afterwards, and place them in the
disinfectant solution for 30-45 minutes

After placing the disinfectant solution, rinse To facilitate drying on the instruments
them again and place them to dry

Ask the CI if there are no more remaining To ensure that no steps are forgotten
tasks before removing gloves

Remove gloves ensuring aseptic principles and To ensure aseptic principles

discard in yellow bin

Other Notes:
Handle (sterile until after the episiorrhaphy)
- DR room prep
- will give stuff to assist and/or OB i.e. drapes, leggings, layette, bonnet
- open the placenta and aftercare of the placenta (will also be the one to give updates
to the physician)
- aftercare of the DR
- will do the suctioning if institution allows it (for SPH, only the physician is allowed to
suction)

Assist (unsterile)
- tighawak atong lidocaine tas ang handle ang mag withdraw
- tig arrange atong mga ginahatag na gamit sa iyaha sa handle
- mag wipe sa baby using the layette
- assigned sa newborn care

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 NEWBORN CARE
Immediate newborn care is activities that will prevent the occurrence of untoward
effects in the newborn including hyperthermia, infection, and bleeding.

Purposes:
● To prevent bleeding from the cord
● To prevent infection of the cord and eyes
● To prevent hyperthermia

Preparation

Disinfect and prepare the crib before the To prevent infection of the newborn
delivery of the newborn

Prepare the two (2) drop lights To provide warmth for the newborn

Do the medical handwashing To deter the spread of microorganisms

Assemble all equipment For efficient time management

Layette (folded neatly, side of your

nondominant hand)

from bottom to top, on the side of your

dominant hand
- Layette
- Booties and Mittens
- Bonnet
- Diaper
- Baby’s dress

Binder (not necessary, but for binding the knee

for applying medication)

Prepare the hypotray To attain ease of acquirement

- Cotton Balls (2 dry & 2 soaked with
alcohol)
- Tape measure
- Eye Ointment
- Vitamin K Ampule
- Tuberculin Syringe
- Thermometer
- Comb / Brush

Prepare a kidney basin as waste receptacle To attain proper waste management

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Prepare stethoscope, alcohol, and sharps To check for CR, disinfect, and observe proper
container waste disposal

Prepare your jotdown notebook

- Name of Institution
- Name of Patient: Baby (gender) (family name)
- Name of Mother
- Date of Delivery
- Time of Delivery
- Medications Given
- Name of ophthalmic ointment and time given
- Vit K: dosage / route / time given
- VS
- Time, CR, RR, Temp
- Anthropometric Measurements
- Weight
- Head C., Chest C., & Abdominal C.
- Length

Prepare medications (terramycin ointment; To make sure that the correct medication is
Vitamin K) administered
- Read medication name before and after
preparation
- Check for manufacturing date and
expiration date, dosage, characteristic
of drug
Note: Disinfect ampule using CB with alcohol,
open ampule with the CB; remember fish hook
technique for the syringe

Receiving the Newborn

Wash hands and don a pair of working To maintain aseptic principles

gloves

Upon receiving the newborn, check the ID To identify any unusualities with the newborn
band (attached to the leg part of the baby);
pedia will weigh the baby, provide warmth, Record weight on jotdown notebook
check for bruises and deformities ● Weight: 2.35-4 kg

Take Vital Signs for 1 full minute (RR, CR, Taking of RR is first since there is less
rectal Temp) stimulation of the baby and would lessen the
● RR: 30-40 cpm likeliness of the baby crying
● CR: 120-160 bpm
● Temp: 36.7 - 37.8 C The rectal route for the temperature taking is
Note: Do not forget to disinfect the thermometer only done to check for anal perforation
bulb to stem, insert only up until the bulb tip in a
twisting motion; and place it to waste receptacle
immediately after; warm diaphragm of steth

Takes the Anthropometric Measurements To see if the baby falls within the normal ranges
accurately and record it of measurements for newborns
- Head, Chest, and Abdomen ● Head C.: 33-35 cm
Circumference ● Chest C.: 31-33 cm
- Length ● Abdomen C.: 20-30 cm
Note: Align with eyebrows for Head C., align ● Length: 49-53 cm
with the nipple for Chest C. and above umbilical
cord for Abdominal C.; heel to head for length

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Restrain the upper extremities by tucking the To prevent movement of the baby when
layette administering medications

- Tuck under baby arms then tuck under

baby’s butt

Restrain lower extremities using the binder

(optional pero sabihin pa rin)
- On the knees, front to back then criss
cross, bring to front and knot

Perform Crede’s Prophylaxis properly from To protect the newborn against newborn
inner to outer canthus blindness or ophthalmia neonatorum caused by
Neisseria gonorrhoeae
Note: Check the name again and expiry date if
available; allow some medicine to stick out first
and into the eye without touching the tip

Get 1 sterile cotton ball with alcohol and To prepare for the Vitamin K administration
disinfects the site for intramuscular injection

Note: Inner to outer in circular motion

Inject the Vitamin K correctly into the left To provide protection against bleeding that
vastus lateralis, and applying light pressure could occur due to low levels of this essential
using dry CB after injecting vitamin
- Full Term: 0.1 cc/ml
- Preterm: 0.05 cc/ml
Note: Lock baby’s knees by placing little
pressure on the knees; don’t forget cushion
fashion; inject like holding a pen, hold the hub,
aspirate, check for blood backflow, plunge down
when there is no backflow, choose another site
if there is backflow

Releases the restraints from the upper and To make the baby comfortable
lower extremities

Take the Vital Signs (RR, CR, axillary Temp) To record any unusualities after the medications
are given

Clean the newborn using a towel and comb To clean newborn and remove excess blood

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Dress the Newborn To provide warmth for the newborn
- Put on the newborn’s sterile dress
- Provide a clean bonnet Diaper is should not be on top of the cord to
- Put on the diaper, mittens, and booties avoid contamination of the cord
- Change the newborn’s layette
- Fold from the over the arms to
the sides, tuck to the back,
bring bottom up , then fold over
the arms once again

Swaddle the baby and place it on the crib To provide warmth and comfort; and to prevent
with its head elevated the increase of intercranial pressure

Do aftercare
- Start with the sharps (needle, ampule) To prevent accidents
- Disinfect the thermometer (stem to bulb)
- Disinfect diaphragm of stethoscope
- Return hypotray
- Remove gloves
- Do handwashing To deter the spread of microorganisms

Document accurately
- Patient’s Chart
- Medication Sheet (as STAT med, with date, name of drug, dosage, route or site,
time, and nurse’s initials)
- VS Sheet
- Medication notebook in the NICU

Monitor the vital signs every 15 minutes until stable. Then, every 30 minutes x 4 takes

PERSONAL ATTRIBUTES (mga stuff na tignan ng CI sa iyo)

- Performed procedure with ease and confidence
- Showed interest in his/her work
- Attentive while doing the procedure
- Analyzed the importance of personal hygiene and good grooming
- Accepted constructive criticism and suggestions with a positive attitude
- Performed procedure with honesty
- Handled the newborn with tender loving care

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