ESSENTIAL

INTRAPARTUM CARE

MARIAN MENDOZA RN MAN

ASSISTING IN A DELIVERY
 Assisting in a Delivery
Purpose: To support and assist the mother
during the delivery.

Equipment:
Sterile drapes (gyne sheet)
Sterile gloves
Antiseptic solution
Mask
Steps: ASSISTING NURSE DELIVERY
In advance:
 prepare decontamination solution by mixing 1 part 5% chlorine
bleach to 9 parts of water to make 0.5% chlorine solution.

 Change chlorine solution at the beginning of each day or whenever

solution is very contaminated or cloudy.

(A bleach and water solution should be mixed daily to preserve its

strength • Leave the solution on the surface for a minimum of one
minute • Cleaning must be done prior to disinfecting When chlorine —
sold as a granular powder, liquid or sometimes in its elemental form as
a gas — is added to water, it forms a weak acid called hypochlorous
acid. This acid is very proficient of killing bacteria such as salmonella
and E. coli, and it also knocks out many viruses .Jun 4, 2013)
Prior to woman’s transfer to the DR:
 Ensure that mother is in her position of choice
while in labor.
 Ask mother if she wishes to eat/drink or void.
 Communicate with the mother – informed her
of progress of labor; give reassurance and
encouragement
Woman already at the DR: Preparing for delivery
 Check temperature in DR area to be 25-28˚C; eliminate
air draft
 Notes the time the mother enters the DR; ushers mother
to the DR table.
 Administers oxygen (per doctor’s order)
 Positions the mother in semi-upright (default position of
the DR table)
 Provide privacy
 Places both legs in the stirrups at the same time*.
Secures mother’s legs with the straps of the stirrups.
 Takes vital signs, FHT and notes progress of labor
 Note time membranes ruptured
spontaneously (take note of the color)
 Allow mother to push/bear down during
contraction as desired and encourages mother
to breathe out during a pushing effort.
 Notes the time when the baby is born and the
sex of the baby.
 Excludes a second baby by palpating the
abdomen in preparation for giving oxytocin.
• Administers
Oxytocin* 10 units
IM (intramuscular)
within 1 minute of
baby’s birth.
• Date: Into:

Name: Initial BP:

Case #: Final BP:
Age: Oxytocin:
BOW: Started:
Baby Out: Ended:
Gender: Nubain:
P.O. Midazolam:
Cord clamping:
Remarks: (cord loop, meconium stained, perineal support, episiotomy
 Notes the time of placental delivery and presentation.
Signs of placental separation
• The most reliable sign is the lengthening of the umbilical cord
as the placenta separates and is pushed into the lower uterine
segment by progressive uterine retraction. ...
• The uterus takes on a more globular shape and becomes
firmer. ...
• The uterus rises in the abdomen. ...
• A gush of blood occurs
• lying longer than 1 hour in a lithotomy position leads to
intense pelvic congestion because blood flow to the lower
extremities is impeded. Pelvic congestion may lead to
thrombophlebitis in the postpartal period.
 Removes straps from the mother’s legs and lowers legs from
the stirrups.
 Palpates the mother’s uterus if firm and contracted; palpates
fundus by supporting the lower segment with the non
dominant hand
 Offers a clean gown and blanket
 Transfers mother and baby to the DR recovery room
maintaining skin to skin contact; baby should be on prone on
mother’s chest / in between the breasts with head turned to
one side.
 Does after care
 Obtain vital signs and massage uterus every 15 minutes for
the 1st hour then every 30 mins to 1 hour for the second hour.
 Document
ESSENTIAL INTRAPARTUM
CARE
ATTENDING A DELIVERY
 Attending a Delivery
Purpose:
 To ensure the expectant mothers to have normal and safe
delivery.
 WHO - Arrange materials/ supplies in a linear sequence
(Gloves, dry linen, bonnet, oxytocin injection, plastic cord
clamp, instrument clamp, metz scissors, 2 kidney basin
 In a separate sequence after the full breastfeed (eye
ointment, stethoscope to symbolize PE) vit. K, hepatitis B
and BCG vaccines (plus cotton balls)
STEPS: ATTENDING DELIVERY
 Wears head cap, mask; Washes hands using the WHO 1-2-3-4-5
procedure; puts on 2 pairs of sterile gloves.
 Positions in front of mother, in close proximity to the birth outlet.
 Cleans the perineum with antiseptic applying the 177 principle;
include a wide area (vulva, upper inner thighs, mons pubis, and
anus)
 Rinses the perineum with designated solution
 Assesses for a full bladder, catheterizes mother using French 12
catheter and inserts it between contractions; careful aseptic
technique is observed.
 Places sterile drapes around the perineum.
 Places a sterile towel over the perineum as soon as the head of
the baby is prominent. (Perineal support)
 STEPS: ATTENDING DELIVERY
 Supports baby’s head as it emerges, preventing too rapid
delivery with gentle pressure. (Controlled delivery of the
head)
 During delivery of the head, Encourages woman to stop
pushing and breathe through the mouth.
 Passes fingers along the occiput. If a loop is felt, gently
loosens and draws down over the fetal head. If too
tightly coiled, clamps and cuts cord before the shoulders
are born.
 Delivers the shoulder after external rotation* and
provides support for baby’s body as it is delivered.
 STEPS: ATTENDING DELIVERY
 Calls out the time of birth and sex of the baby.
 Informs the mother of the outcome.
 Lays the baby on the sterile abdominal drape of
the mother.
 Removes 1st set of gloves and decontaminates
them properly (in 0.5% chlorine solution in10
minutes).
 Palpates umbilical cord to check for pulsations.
 STEPS: ATTENDING DELIVERY
 After cord pulsations stopped, Clamps cord
using plastic cord clamp 2 cm from the base.
 Places the instrument clamp 5 cm from the
base
 Cuts near the plastic clamp (not midway).
 Holds and rolls the cord over instrument
clamp.
 STEPS: ATTENDING DELIVERY
 Performs the remaining steps of AMTSL
(Active management of the third stage of
Labor):
 Waits for strong contractions then applies
controlled cord traction and counter
traction on the uterus until placenta will be
delivered
 Massages the uterus until firm and
contracted.
 Holds placenta as it is delivered, announces
placenta out, places in placental bowl and
checks completeness of cotyledons.
 Inspects the lower vagina and perineum for
lacerations/tears and repairs lacerations as
necessary.
 STEPS: ATTENDING DELIVERY
 Checks mother for excess bleeding* and
fundal firmness. Supports the lower segment
of the fundus; with dominant hand massages
uterus in rotating motion until firm and
contracted
 Cleans the mother, flushes perineum and
applies perineal pad/diaper.
 Disposes placenta in a leak-proof container
or plastic bag.
 STEPS: ATTENDING DELIVERY
 Decontaminates (soaks in 0.5% chlorine
solution) instruments before cleaning;
Decontaminates 2nd pair of gloves before
disposal, stating that decontamination lasts
for at least 10 minutes.

 Does proper documentation

Mechanisms of labor / Cardinal
movements
 Mechanisms of labor / Cardinal
movements
• 1. DESCENT
• 2. FLEXION
• 3. INTERNAL ROTATION
• 4. EXTENSION
• 5. EXTERNAL ROTATION (RESTITUTION)
• 6. EXPULSION
Second Stage of Labor: Expulsion of Fetus
Maternal changes:
• Perineum bulges
• Contractions are severe at 2 to 3 minute intervals with
duration of 50 to 60 seconds
• Pushing w/ contractions
• Grunting sounds
• Behavior changes from great irritability to great involvement
& work
• Sleep & relaxation occur between contractions
• Leg cramps
• The new born exits the birth canal
 Third Stage of Labor:
Expulsion of Placenta
• Placental separation:
• Globular formation of uterus
• Lengthening of umbilical cord
• Gush of blood
• Oxytocin drugs are administered to help the
uterus contract
• 3RD stage of labor commences with the
delivery of the fetus and ends with delivery of
the placenta and its attached membranes
Duration
• Normally 5 to 15 minutes
• 30 minute have been suggested if there is no
evidence of significant bleeding
METHODS OF PLACENTAL
SEPARATION
FOURTH STAGE: RECOVERY AND BONDING

• Last from 1 to 4 hours after birth

• Mother and newborn recover from the physical
process of birth
• The maternal organ undergo initial readjustment to
the nonpregnant state
• the mother’s blood pressure will return to pre-labor
level, pulse is decrease than that of the labor pulse.
• The fundus remains contracted; this is normal and
essential. Fundus is midline 1 – 2 fingerbreadths
below the umbilicus (belly button).
• Lochia is scant and red. (Lochia is a discharge from the
vagina after birth to 6 weeks and progresses as
follows: mostly blood, followed by a more mucous
fluid that contains dried blood, and later a clear-to-
yellow discharge
• Maternal Changes
• Fundus firm in the midline & at or slightly above the
umbilicus
• Moderate, bloody vaginal discharge (lochia rubra)
• Fatigue, thirst, chills, nausea
• Excitement & intermittent dozing