ACTION
Planning – Prior to DR transfer
Ensures that mother is in her position of choice
while in labor
Asks mother if she wishes to eat/drink or void.
Communicates with the mother - inform her of
progress of labor, gave reassurance and
encouragement.
Planning – Already in the DR
Checks temperature in DR area to be 25-28 degrees
Celsius; eliminates air draft.
Asks woman if she is comfortable in the semiupright position (the default position of delivery
table).
Prepares a clear, clean newborn resuscitation area.
Checks the equipment if clean, functional and
within easy reach.
Ensures the woman's privacy.
Removes all jewelry then wash hands thoroughly
observing the WHO 1-2-3-4-5 procedure
Arrange materials/supplies in a linear sequence:
Gloves, 2 dry linen, bonnet, oxytocin injection,
plastic clamp, instrument clamp, scissors, 2 kidney
basins.
In a separate sequence, to be used after the 1st
breastfeed: Eye ointment, stethoscope to symbolize
PE, vit.K, hepatitis B and BCG
Cleans the perineum with antiseptic solution.
Wash hands and put on 2 pairs of sterile gloves
aseptically. (If same worker handles perineum and
cord).
Implementation – at delivery
Encourages woman to push as desired.
Drapes the clean, dry linen over the mother's
abdomen or arms in preparation for drying the
baby.
Applies perineal support and did controlled delivery
of the head.
(done as soon as fetus’ head is prominent at VO
~8cm)
Calls out time of birth and sex of baby.
Informs the mother of outcome
Thoroughly dried baby for at least 30 seconds,
starting from the face and head, going down to the
trunk and extremities while performing a quick
check for breathing. 1-3 MINUTES
Removes the wet cloth.
Places baby in skin-to-skin contact on the mother's
abdomen or chest.
Covers baby with the dry cloth and the baby's head
with a bonnet.
Excluded a 2nd baby by palpating the abdomen in
preparation for giving oxytocin.
RATIONALE
effective positioning = speed labor + reduce discomfort by aligning the baby
properly, and reducing area-specific pressure and unnecessary muscular effort
properly nourished + hydrated = prevent exhaustion in a pregnant woman;
exhaustion = prolongs labor + lead to fewer contractions that are less effective.
constant communication = reduce anxiety of the mother who is in labor
ensures appropriate environment for baby’s adjustment outside from the
uterine cavity of the mother
helps get your baby into the best position for birth. baby gets pushed down to
cervix due to gravity
ready at all times, in cases of emergency during delivery and for high-risk
newborn
gives comfort to the client
single most effective method of preventing infection spread. must be performed
thoroughly, properly, and consistently
materials are arranged according to the order of usage. this is for easy
accessibility of the health care provider
once the mother is positioned for birth, the vulva and perineum are cleansed.
hospital protocols and the preferences of primary health care providers for
cleansing may vary
preventing infection spread
coach and encourage the woman to push once there is contraction.
used to dry the baby
help achieve extension and allow the smallest head diameter to present; place a
sterile towel over the rectum and do Ritgen’s maneuver. ❌apply pressure to
uterus fundus = uterine rupture
ask woman to continue pushing until occiput is firmly at the pubic arch. head is
born between contractions
TOB is the precise time when the entire body is out of the mother
show the baby to her and let her be aware of the baby’s sex
help prevent heat loss. keep baby at the same level as the mother’s uterus until
the end of the cord stops pulsating to prevent baby’s blood from flowing to or
from the placenta and the resultant hypovolemia or hypervolemia. ❌milk the
cord
prevents hypothermia
elevates maternal oxytocin levels, strengthening the uterine contraction that
will help the placenta to separate and the uterus to contract to prevent
hemorrhage
further reduce heat loss after drying
This is done to ensure that there is a single pregnancy
Uses wet cloth to wipe the soiled gloves. Give IM
oxytocin within one minute of baby's birth.
Disposes wet cloth properly.
Removes first set of gloves and decontaminates
them properly (in 0.5% Cl solution for > 10
minutes).
Palpates umbilical cord to check for pulsations.
After pulsation stops, clamp cord using the plastic
clamp or cord tie 2 cm from the base.
Places the instrument clamp 5 cm from the base.
Cuts near plastic clamp (not midway).
Performs the remaining steps of the AMTSL (Active
Management of the Third Stage of Labor:
Waits for strong uterine contractions then applies
controlled cord tractions and counter traction on
the uterus, continuing until placenta is delivered.
Massage the uterus until firm.
Inspects the lower vagina and perineum for
lacerations/tears and repair them as necessary
Examines the placenta for completeness and
abnormalities.
oxytocin = uterine contraction and it decreases bleeding
preparation of the cutting of the umbilicus + prevent infection.
wait for the pulsation to stop before cord clamping
delayed umbilical cord clamping appears to be beneficial for term and preterm
infants. In term infants. increases hemoglobin levels at birth and improves iron
stores in the first several months of life = better developmental outcomes
drain the cord of blood. hold the remaining cord that is still attached to
placenta.
cord stump = not too long after the cord clamp
to prevent postpartum hemorrhage. includes administering oxytocin/Pitocin,
clamp + cutting the umbilical cord within 3 minutes after birth, gently controlling
cord traction following uterine contraction and separation of the placenta
wait for the placenta to separate, ❌ tug the cord = tear the cord, separate the
placenta, or invert the uterus. signs of placental separation include a slight gush
of dark blood from introitus, lengthening of the cord, and change in the uterine
contour (discoid → globular shape)
prevent or minimize hemorrhage; demonstrate to mother to do independently
episiotomy = suture. immediate repair promotes healing, limits residual damage
and decreases possibility of infection
shiny fetal surface (Schultze mechanism) or dark roughened maternal surface
(Duncan mechanism). after the placenta and amniotic membranes emerge,
examines intactness to ensure that no portion remains in the uterine cavity
Cleans the mother; flush perineum and applies
make the mother feel comfortable
perineal pad/napkin or cloth.
Checks baby color and breathing; checks that
perform a brief assessment of the newborn immediately: APGAR score at 1 and 5
mother is comfortable and uterus is contracted.
minutes after birth.
Disposes the placenta in a leak-proof container or plastic bag.
prevent the spread of infection
Decontaminates (soaked in 0.5% chlorine solution) instruments before cleaning; decontaminates
2nd pair of gloves before disposal stating that decontaminations last for at least 10 minutes
Advises mother to maintain skin-to-skin contact.
promoting thermoregulation and M ↔ NB interaction = place the naked newborn
Baby should be prone on mother's chest in between on the mother’s bare’s chest and cover both with blanket. SSC reduces
the breasts with head turns to one side.15-90
conductive and radiant heat loss and enhances newborn temperature control
MINUTES
and maternal infant interaction
Advises mother to observe for feeding cues and
mother needs to understand infant behaviors re: breastfeeding + recognize that
cites example of feeding cues.
the baby is ready to feed via readiness cues or early signs of hunger. ex. H-M or
H-H movements, suckling motion, rooting reflex
Supports mother, instructs her on positioning and
encourage + assist the mother to breastfeed in semi-reclining position with the
attachment.
newborn lying prone, S-S on mother’s bare chest. her body supports the baby.
Waits for FULL BREASTFEED to be completed.
Advises delay bathing of baby (After 24 hours of
life).
Advises breastfeeding per demand and about
Danger signs for referral.
Evaluation
1st hour: check baby's breathing + color, and check
mother's VS and massage uterus every 15 mins
In the 2nd hour: check mother-baby dyad every 30
minutes to 1 hour.
Complete all records
milk production = supply meets demand system. (i.e as milk is removed from the
breast, more is produced). incomplete removal of milk from = decreased milk
supply.
WHO advises delaying the bath for 24 hours = VC contains antimicrobial proteins
that are active against group B strep, E. coli etc.+ increased BF rates (less stress)
breast milk contains vital antibodies that are passed from the mother that help
protect the infant against certain infections. promoting BF needs to be a priority.
ensure that the baby is in good condition and at the same to check the mother’s
status on hemorrhage
constant checking will ensure the good condition of both mother and child
documentation served as a monitoring on the condition of the baby and the
mother as well as the management given to the patient