ORDER OF PERFORMANCE:
1. Preparatory Phase
2. Medical Hand washing
3. Donning and Removing of Sterile Gloves
4. Draping of Mayo Stand
5. Laying of Instruments on the Mayo Tray
6. Vulvar/Perineal-Genital Care
7. Draping of Patient
8. Delivery Technique
9. EINC
(5) Laying of Instruments on the Mayo Tray
1) Straight Forceps - (5cm) used as a ratcheted
hemostat to secure and clamp bleeding vessels.
Also used to grasp delicate tissues
2) Curved Forceps - (2cm) clamping large blood
vessels or manipulating heavy tissue.
3) Scissors (2) - cut cord & suturing
4) Needle Holder - is made from stainless steel and
is used to hold a suturing needle during surgical
procedures.
5) Kidney basin - A kidney dish (British English) or
emesis basin (American English) is a shallow basin
with a kidney-shaped base and sloping walls used in
medical and surgical wards to receive soiled
dressings and other medical waste.
ACCESSORIES
6) 4 Towels - 1 Dry hands, 2-3 drying and cover the
baby, 4 cover the mayo tray
7) Umbilical Clamp - The clamp helps stop bleeding
from the blood vessels in the umbilical cord.
8) Sterile Gauze - Sterile gauze is the basic tool
used to stop bleeding and keep wounds clean. It
treats small to medium cuts, burns, scrapes, and
other wounds. It also protects the area from dirt
and debris that can cause wounds to get infected.
10. 3 pairs of Sterile Gloves - Gloving for peforming
Vulvar/Perineal-Genital Care, delivery (double
gloving - double-gloving is indeed effective in
protecting operating room nurses against bloodborne pathogen exposure.) Sterile gloves help
prevent surgical site infections and reduce the risk
of exposure to blood and body fluid pathogens for
the health care worker.
11. Sutures - Sutures should be placed perpendicular to
the angle of the incision to prevent anatomic
distortion of the perineum and vaginal opening. The
most commonly used suture for the repair of
perineal lacerations is braided absorbable suture or
chromic. Braided absorbable suture is associated
with less pain during recovery and a lower
incidence of wound dehiscence. [9] Depending on
the severity of the laceration, access to an
operating room may be required.
12. 5cc syringe (oxytocin) 10 unit IM after
13. Lidocaine - Lidocaine is a local anesthetic. Local
anesthetics are used to numb areas of the body for
short periods of time. Lidocaine injection is
sometimes used to treat irregular heart
rhythms that may signal a possible heart attack.
Lidocaine injection is also given in an epidural
(spinal block) to reduce the discomfort of
contractions during labor.
14. PREPARE LINEN TO DRAPE THE PATIENT
(6) PERFORMINGVULVAR/PERINEAL-GENITAL CARE
STEPS #6-12
ORDER
1. Mons pubis to Umbilicus
2. Inner thigh (far)
3. Inner thigh (near)
4. L. Majora (far)
5. L. Majora (near)
6. L. Minora (far)
7. L. Minora (near)
8. Clitoris to Anus
9. Umbilicus to Abdomen
(8) DELIVERY TECHNIQUE AND ESSENTIAL IMMEDIATE
NEWBORN CARE
3.
1
5. Our study provides strong evidence that the
environmental temperature of the delivery room has
a direct impact on heat loss in premature infants and
suggests that maintaining a modestly higher delivery
room temperature will reduce the incidence of neonatal
hypothermia.
11. Performs Ritgen’s Maneuver
WHEN?

The Baby is crowning (fetal head focibly extends
the vaginal outlet)
 Encourage the mother to push
1.
2.
3.
4.
5.
6.
Stop ritgen’s maneuver when the baby’s head has
fully came out
Wait for the baby to externally rotate
Maneuver down to deliver the anterior shoulder
Deliver one after the other to fit through the pelvis
Maneuver up to deliver the posterior shoulder
Support with both hands
12. BABY GIRL/BOY OUT! STATE TIME (Loudly)
3 SIGNS FOR PLACENTAL SEPARATION
1. Uterus rises in the abdomen and becomes globular
2. Umbilical cord lengthens
3. Gush of Blood
26. PLACENTA OUT: (Presentation, Time)
 Shiny Schultz (Fetal side), Dirty Duncan (Maternal
side)
EINC (Essential Intrapartum and Newborn Care)
 The Philippines is one of the 42 nations that
account for 90% of global under-five mortality
 37% of these children are newborns less than 28
days old
34.
13. Drying (30 seconds), APGAR (1 minute then 5
minutes after
35. FEEDING CUES: Suckling, tounging, licking
EINC DOH
36.
17-18. Oxytocin prevents excessive postpartum
bleeding by helping the uterus to contract. It is given to
the mother by injection into a vein or into muscle during
or immediately after the birth of her baby. Oxytocin
(Oxytotic hormones, uterotonic action) is the first agent
of choice for PPH prophylaxis because of its high efficacy
and a low incidence of associated side effects.
24. AMTSL: Principles includes to:
1) Enhance separation of placenta
2) Safe and complete delivery of placenta
3) Minimize bleeding
2
deficiency bleeding' (VKDB), also known as
'haemorrhagic disease of the newborn' (HDN).
 Hepa B (1 dose, at birth, 0.5ml): Protects your
child from against hepatitis B, a potentially serious
disease. Protects other people from the disease
because children with hepatitis B usually don't have
symptoms, but they may pass the disease to others
without anyone knowing they were infected.
UPPER RIGHT DELTOID REGION (ID 10-15 degree angle)
 BCG (1 dose, at birth, 0.05ml): BCG (Bacille
Calmette-Guérin) is a vaccine given to babies to
protect them from serious forms of Tuberculosis
(TB) such as TB Meningitis (an infection of the brain)
and Miliary TB (wide spread infection).
 RA 10152 (The Mandatory Infants and Children
Health Immunization Act of 2011) signed by the
Late President Benigno Aquino II in July 26, 2010.
39. PE & AM of the Newborn
a) Weight
b) Height
c) Head Circumference
d) Chest Circumference
38.
 Eye Ointment: Newborns receive erythromycin eye
ointment after birth to prevent pink eye in the first
month of life, also called ophthalmia neonatorum
(ON). The most common cause of ON is chlamydia,
a
sexually
transmitted
infection.
(1cm,
approximately 1/3 inch strip unless indicated
otherwise)
ANTEROLATER THIGH (Vastus Lateralis) IM different
thigh
40. Optional/Delayed Bathing of the Baby for 6 hours:
Prevent hypothermia and promote bonding
 There are times when the newborn bath is
recommended immediately. If the mom is HIV
positive or has a hepatitis a bath is done to limit
transmission to others who come in contact with
the baby. In some facilities a bath is also done with
chorioamnionitis or significant meconium staining.
It is recommended that health care providers use
gloves when handling an unbathed baby.
 CLOTHE THE BABY AND PLACES BACK THE
NEWBORN TO THE MOTHER’S CHEST
41. BREASTFEEDING PER DEMAND/ NUTRITION/CORD
CARE

Vitamin K (1mg/0.5mL):Vitamin K helps the blood
to clot and prevents serious bleeding. In newborns,
vitamin K injections can prevent a now rare, but
potentially fatal, bleeding disorder called 'vitamin K
BREASTFEEDING PER DEMAND
 In the first few weeks of life, breastfeeding should
be "on demand" (when your baby is hungry), which
is about every 1-1/2 to 3 hours. As newborns get
older, they'll nurse less often, and may have a more
predictable schedule. Some might feed every 90
3
minutes, whereas others might go 2–3 hours
between feedings.
NUTRITION
Diet and Exercise After Pregnancy
If you are breastfeeding, the food you eat helps your
baby grow strong and healthy, too. Good eating habits
and exercise will help you lose the weight you gained.
Healthy Eating Tips
Eat a variety of foods. Try to eat a balanced diet of fruit,
vegetables, grains, protein foods and diary each
day. Visit ChooseMyPlate.gov for more information.
Drink plenty of liquids. Your body needs lot of fluid
(about 6-10 glasses a day) especially if you are
breastfeeding your baby. Drink mostly water, milk, and
fruit juice.
Alcohol: Wine, wine coolers, beer, drinks like hard
lemonade and other malt liquor beverages, shots and
mixed drinks contain alcohol that passes to your baby
through your breastmilk and can harm your baby’s brain
and body development.
Caffeine: Caffeine is a stimulant that passes through
breast milk to the baby and may affect growth. Caffeine
is found in tea, coffee, chocolate, many soft drinks and
over-the-counter medicines.
Swordfish, Shark, King Mackerel and Tilefish: These fish
have high levels of a toxin called mercury. Mercury is
harmful to your growing baby’s brain. If you eat tuna, it
is okay to eat up to 6 ounces of canned tuna a week but
make sure to choose light tuna.
Exercise After Pregnancy
Exercise helps you:





Eat foods that have protein such as milk, cheese, yogurt,
meat, fish and beans. Protein rich foods are important
to help you recover from childbirth and keep your body
strong. If you are under 18, or were underweight prior to
pregnancy, you need to eat more protein.
Eat your fruits and vegetables. Try to make half your
plate fruits and vegetables. Fruits and vegetables have
vitamins and minerals that keep you healthy. They also
have fiber, which helps prevent constipation. Make sure
to wash fruits and vegetables under running cold water
before eating them.
Lose weight safely. Talk to your doctor about safely
losing weight after your baby is born. Losing weight too
quickly can affect your breast milk supply. Do not take
diet pills. They contain harmful drugs that can be passed
to your baby through breast milk.
Take prenatal vitamins. If you are breastfeeding, it is a
good idea to continue to take your prenatal vitamins.
Your doctor can prescribe these pills so that your health
insurance will cover a portion of the cost.
Limit junk foods. Soda pop, cookies, donuts, potato
chips and french fries are okay sometimes, but don’t let
them take the place of healthy foods!
Avoid these Foods when Breastfeeding
There are some foods and other substances that can be
harmful to both you and your baby if you are
breastfeeding.
Lose the weight you gained during pregnancy
Reduce backaches, constipation and bloating
Lifts your spirits and improves posture
Helps build muscle tone and strength
Promotes better sleep
Once your doctor says it is okay to start exercising, there
are many ways to be active.
Walking is a great way to exercise because it puts very
little stress on your body. Your baby will probably enjoy
being walked in a stroller too. Try walking briskly for 2030 minutes every day or at least 3 times per week. Meet
with a friend or other new moms to go walking. It’s good
to get out of the house and connect with friends or other
new mothers. You will enjoy the chance to talk about
your baby or to just be with other adults!
Exercise classes are another fun way to get in shape and
sometimes you can find a class that will include your
baby. For example, look for a mom and baby yoga class
in your area.
CORD CARE


Care for your baby's umbilical cord stump:
Wash your hands. Use soap and water. Wash your
hands before and after you clean his stump.

Clean the cord stump. Gently wash the cord stump
and the skin around it with mild soap and warm
water during every bath. Gently pat the stump dry
after your baby's bath.
4

Use rubbing alcohol or water. Your baby's
healthcare provider may suggest you use rubbing
alcohol or water and a cotton swab to clean the
stump. Gently wipe from the base to the top of the
stump with a cotton swab dampened with rubbing
alcohol or water. Clean the stump with each diaper
change.

Clean urine or bowel movement off the stump. If
your baby's stump gets dirty from urine or bowel
movement, wash it off right away with water.
Gently pat the stump dry after you clean it.

Let the cord air dry. After diaper changes or stump
cleaning, fold the front of the diaper down below
the cord stump to let it air dry.

Dress your baby in loose clothing. Loose-fitting
clothes will help the stump dry out faster.

Do not pull or tug at the cord stump. The stump
will fall off on its own.

Do not cover the cord stump. If you want to use a
bellyband on your baby, use only clean, dry gauze.
FOUR (4) CORE STEPS OF EINC
1. Immediate Drying
2. Skin-to-skin Contact
3. Proper Cord Clamping & Cutting
4. Non-separation of Newborn & Mother
1)
2)
3)
4)
IMMEDIATE & THOROUGH DRYING OF THE
NEWBORN
 Immediate and thorough drying for 30
seconds to one minute warms the newborn
and stimulates breathing
EARLY SKIN-TO-SKIN CONTACT BWETWEEN
MOTHER AND NEWBORN
 Early skin-to-skin contact between mother and
newborn and delayed washing for at least 6
hours. This prevents (HIH) Hypothermia,
Infection, and Hypoglycemia.
PROPERLY-TIMED CORD CLAMPING AND CUTTING
 Waiting for the cord pulsations to stop
(between 1 to 3 minutes)
 Prevents anemia and protects against brain
hemorrhage in premature newborns
NON-SEPARATION OF THE NEWBORN FROM THE
MOTHER FOR EARLY BREASTFEEDING INITIATION
AND ROOMING-IN
 Continuous non-separation of newborn and
mother for early breastfeeding protects
infants from dying from infection
 The first feed provides colostrum (Loaded with
immune, growth, and tissue repair factors)
Colostrum provides all the nutrients and
fluid that your newborn needs in the early
days, as well as many substances to protect
your baby against infections. Its color and
thickness are due to the fact that it is higher in
these protective factors.)




-5 to 0 the “presenting” or most palpable part of
the baby is above the woman’s ischial spines.
0 midway between the ischial spines
If the baby’s presenting part is located at zero, it is
considered “engaged”. Aligned with ischial spine.
+4, +5, the baby is held to be born, prepare for
delivery
TRUE LABOR
Contractions are:
 Regular
 Increase Intensity
and
duration
with walking
 Felt in lower
back, radiating to
the lower portion
of the abdomen
 Not relieved by
rest
Bloody Show
Fetus usually engaged
Accompanied
cervical changes
by
FALSE LABOR
Contractions are:
 Irregular
 Often Stop with
walking
 Contractions felt
in
abdomen
above umbilicus
(abdominal
pains)
 Often relieved by
rest
No change in cervix
“Blood show” absent
Fetus is ballotable (If
the head can be
pushed back, the baby
is
still
floating (ballotable). If
the head cannot be
pushed back and is
low in the pelvis, the
head is engaged.)
Not accompanied by
cervical changes
5