Evolve.

Adapt.
Overcome.
CEFI is now ready.

NORMAL LABOR AND DELIVERY

COURSE CODE: NCM 107 RLE

NURSING
College Name
COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

Your Hospital set up for the

Delivery Room exposure should be
at the Quezon Medical Center,
Lucena City.

But due to the Pandemic COVID

19, we will only have an online
meeting as a method of teaching
delivery of KSA.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

First is, to introduce or show you the DR pack.

1. Kidney Basin (1)
2. Ovum Forcep (1)
3. Surgical Scissors (2)
a. Straight scissors
b. Curve scissors
4. Pick up forcep with teeth/ without teeth
5. Needle holder
Note: numbers 2 to 5 instruments are placed on the kidney basin
then wrapped it and placed on autoclaive for sterilization.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

Kidney Basin or Kidney dish

or Emesis Basin.
It is where the all the
instruments placed
after washing.
Then wrap and packed for
Sterilization at the
Autoclaive machine.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

Ovum Forcep

or

Pick-up Forcep
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

Surgical Scissors:
> Metzenbaum= pointed
tip scissors
> Mayo scissors
> Straight scissors
> Curved scissors
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

Needle Holder with

Chromic Cutting needle,
the thread attached to
the needle is absorbable.
It is used to suture the
Episiotomy.
The other end of thread
Is the round needle.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

Mosquito Curved
and Mosquito straight forcep
used to clamp the umbilical cord after
clamping with asterile umbilical
clamp.
The larger size of mosquito forcep
Is called peritoneals, there is also
straight and curved forcep.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

Pick up forceps:
Tissue forcep with teeth Thumb forcep
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

* Tissue forcep are ideal for grasping

membranes or retrieving small objects.

* Thumb pick up forcep= are spring

forceps used by compression between
your thumb and forefinger and are used
for grasping, holding or manipulating
body tissue
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

To open the sterile pack, we must observe the “sterile

technique”
> Open the pack using an Ovum forcep
> Arrange the instruments at the Mayo Table
> add the following:
1. Sterile syringe with needle (for lidocaine) pudendal
anesthesia
2. Sterile cord clamp
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

1. Show a video on the Instruments

2. Show a video on handling delivery of
baby (unang yakap video)
3. Show
.
the monitoring sheet
(Partograph) after the 3 stages of Labor
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

BEGINNING OF LABOR
Rupture of the chorioamniotic membranes or bloody show is
diagnostic for onset of labor. Bloody show (a small amount of blood
with mucous discharge from the cervix) may precede onset of labor
by as much as 72 hours.
Bloody show can be differentiated from abnormal 3rd-trimester
vaginal bleeding because the amount is small, bloody show is
typically mixed with mucus, and the pain due to abruptio placentae
(premature separation) is absent.
In most pregnant women, previous ultrasonography has been done
and ruled out placenta previa.
However, if ultrasonography has not ruled out placenta previa and
vaginal bleeding occurs, placenta previa is assumed to be present
until it is ruled out. In such cases, digital vaginal examination is
contraindicated, and ultrasonography is done as soon as possible.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

• Labor begins with irregular uterine contractions of

varying intensity; they apparently soften (ripen) the
cervix, which begins to efface and dilate.
• As labor progresses, contractions increase in duration,
intensity, and frequency.
• We nurses must use a partograph to monitor the
progress of labor and contractions.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

THERE ARE 4 STAGES OF LABOR

1. Dilatation stage.
= From the onset of labor (true labor) up to the fully dilatation of
Cervix
2. Fetal Stage
= From fully dilated cervix up to the delivery of the fetus
3. Placental stage
= Fron the delivery of the infant up to the delivery of Placenta
4. Recovery stage
= From the delivery of Placenta up to the fully recovered mother.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

THERE ARE 3 PHASES ON THE FIRST STAGE OF LABOR

Again on the 1st stage of labor (from onset of labor to full dilation of
the cervix (about 10 cm)—has 3 phases: LAT
1. Latent
> During the latent phase, irregular contractions become progressively
better coordinated, discomfort is minimal, and the cervix effaces and
dilates to 4 cm
> The latent phase is difficult to time precisely, and duration varies,
averaging 8 hours in nulliparas and 5 hours in multiparas; duration is
considered abnormal if it lasts > 20 hours in nulliparas or > 12 hours in
multiparas.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

THERE ARE 3 PHASES ON THE FIRST STAGE OF LABOR

Again on the 1st stage of labor (from onset of labor to full dilation of
the cervix (about 10 cm)—has 3 phases: LAT
1. Latent or Prodromal Phase
> During the latent phase, irregular contractions become progressively
better coordinated, discomfort is minimal, and the cervix effaces and
dilates to 4 cm
> The latent phase is difficult to time precisely, and duration varies,
averaging 8 hours in nulliparas and 5 hours in multiparas; duration is
considered abnormal if it lasts > 20 hours in nulliparas or > 12 hours in
multiparas.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

2. Active Phase or Accelerated Phase

> During the active phase, the cervix becomes fully dilated, and the
presenting part descends well into the midpelvis. On average, the
active phase lasts 5 to 7 hours in nulliparas and 2 to 4 hours in
multiparas.
> Traditionally, the cervix was expected to dilate about 1.2 cm/hour
in nulliparas and 1.5 cm/hour in multiparas. However, recent data
suggest that slower progression of cervical dilation from 4 to 6 cm
may be normal
(1). Pelvic examinations are done every 2 to 3 hours to evaluate
labor progress. Lack of progress in dilation and descent of the
presenting part may indicate dystocia (fetopelvic disproportion)
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

2. Transient Transitional Phase

> Contractions become sharp, more intensified and last from 60 to 90
seconds.
> Dilation of cervix is from 8 to 10 cm.
> The parturient may express feelings of frustration, loss of control,
and/or irritability
> She has difficulty comprehending surroundings, event, and
instructions.
> Increase in bloody show due to the rupture of capillary vessels in the
cervix and the lower uterine segment.
> She feels an urge to push or to have a bowel movement and
considered the most severe and difficult phase.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

During the 1st stage of labor,

> maternal heart rate and blood pressure and fetal heart rate
should be checked continuously by electronic monitoring or
intermittently by auscultation, usually with a portable
Doppler ultrasound device (see fetal monitoring).
> Women may begin to feel the urge to bear down as the
presenting part descends into the pelvis. However, they
should be discouraged from bearing down until the cervix is
fully dilated so that they do not tear the cervix or waste
energy.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

The 2nd stage

> is the time from full cervical dilation to delivery of the fetus.
On average, it lasts 2 hours in nulliparas (median 50 minutes)
and 1 hour in multiparas (median 20 minutes).
> It may last another hour or more if conduction (epidural)
analgesia or intense opioid sedation is used.
> For spontaneous delivery, women must supplement uterine
contractions by expulsively bearing down. In the 2nd stage,
women should be attended constantly, and fetal heart sounds
should be checked continuously or after every contraction.
Contractions may be monitored by palpation or electronically.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

2nd stage of labor

> perineal massage with lubricants and warm compresses
may soften and stretch the perineum and thus reduce the
rate of 3rd- and 4th-degree perineal tears. This is not done
anymore.
These techniques are widely used by midwives and birth
attendants. Precautions should be taken to reduce risk of
infection with perineal massage.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

Still on the 2nd stage (in contrast to the 1st stage)

> the mother's position does not affect duration or mode of
delivery or maternal or neonatal outcome in deliveries
without epidural anesthesia.
> Also, the pushing technique (spontaneous versus directed
and delayed versus immediate) does not affect the mode of
delivery or maternal or neonatal outcome. Use of epidural
anesthesia delays pushing and may lengthen the 2nd stage by
an hour.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

The 3rd stage of labor

> Begins after delivery of the infant and ends with
delivery of the placenta. This stage usually lasts only a
few minutes but may last up to 30 minutes.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

Inside the DR unit of Quezon Medical Center, there is a

Labor Room (with 3 beds) where we monitor the FHT
(Fetal Heart Tone or Fetal Heart Beat) of the fetus and
the BP of the Mother. There is a form used to fill up the
data of the parturient (a woman about to give birth, in
labor). It is called a Partograph.
> it is a tool to help in management of labor
> It guides birth attendant to identify women whose
labor is delayed and therefore decide appropriate
action.
 COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.

The line between the green and yellow =shows active

COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.
COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.
COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.
COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.
COLLEGE OF INFORMATION SYSTEM
Calayan Educational Foundation, Inc.
 Nurse-Clinical Instructor (Full Time)
• Dr. Kenneth P. Veluya (Academic Coordinator)
Teaching: Anatomy ad Physiology, Nursing Informatics, Medical
Transcription, Medical and Surgical
Clinical: Operating Room, Medical Ward, and Community

* Dr. Shirley May B. De Gracia (Clinical Coordinator)

Teaching: Biochemistry, Microbiology,Maternal and Child,
Pharmacology, Community
Clinical: NICU, DR, Pediatric, and Community
 Fixed-Full Time (Clinical Instructor)
• Raymund Jose H. De Guzman

Teaching: Skills Laboratory Subjects, Health

Assessment, Theoretical Foundation in Nursing,
Nutrition and Diet Therapy Lab., Care of the Older
Adults
Clinical Area: Operating Room and Medical Ward
 Part Time Clinical Instructors in Nursing
• Dr. Wilma O. Rivadenera
Teaching: Nursing Leadership and Management, Nursing Research, Maladaptive
patterns of behavior.
Clinical: General ward, Special areas like ER and Dialysis, Psychiatric Ward

* Mrs. Analita Seron - SKL subjects and Nutrition Laboratory

* Mrs. Sonia A. Delantar - SKL subjects, OBW d Surgery

* Mrs Rosita Gloria - Pedia, OBW, and Surgery