Definition of terms

1. Handling Delivery
- Actual handling of the delivery of the fetus.
2. Assisting Delivery
- Handling the instruments to the one handling
the delivery.
3. Episiotomy
- Surgical incision of the perineum made to
prevent tearing of the perineum with birth
and to release pressure of the fetal head
during delivery.
4. Episiorraphy
- Repair tear of the episiotomy with the use of
sutures.
5. Laceration
- Tearing of the vulvar, vagina and sometimes
rectal tissue during birth.

CARDINAL MOVEMENTS
1. Delivery Engagement
- Occurs when the widest part of the fetal head
has passed below the maternal pelvic inlet.
2. Descent
- Downward movement of the biparietal
diameter of the fetal head to within the pelvic 3. Flexion
inlet.
- baby moves further downward and then head
•
meets obstruction at the pelvic floor causing
o Fetal presenting part is not engaged in
flexion.
pelvic inlet.
• 4. Internal Rotation
o Fetal presenting part has entered pelvis. - the fetal occiput rotates anteriorly from its
• original position toward the symphysis.
o Fetal presenting part (usually biparietal - The ischial spines project into the midpelvis
diameter of fetal head) has passed causing the fetal head to rotate anteriorly to
through pelvic inlet. accommodate to the available space.
- With further descent, the occiput rotates
anteriorly and the fetal head assumes an
oblique orientation. In some cases, the head
may rotate completely to the occiput anterior
position.
5. Extension
- the as the fetal head descends further it
meets resistance from the perineal muscles
and is forced to extend.
- The fetal head becomes visible at the vulvova
ring. (crowning)
6. External Rotation / Restitution Second Stage of Labor
- When head emerges, the shoulders are (Stage of Expulsion)
undergoing internal rotation as they turn in Complete Dilation to Expulsion of the Baby
the midpelvis to accommodate to the
projection of the ischial spines. The head, now
✓
born, rotates the shoulders undergo this
- Denotes extracting the fetal head
internal rotation.
- Using one hand to pull the fetal chin from
7. Expulsion between the maternal anus and the coccyx,
- Following delivery of the infant’s head and and the other on the fetal occiput to control
internal rotation of the shoulders, the anterior speed of delivery.
shoulder rests beneath the symphysis pubis. - It is performed during uterine contraction.
The posterior shoulder is born, followed by
the anterior shoulder and the rest of the body.

✓ Palpate for cord coil.

✓ Suction baby’s mouth and nose using bulb syringes.
✓ Deliver the shoulder, wait for the external rotation
where one shoulder is up and the other shoulder is
down.
Stages of labor ✓ With one hand at the back of the neck, the other one
grasping the extremities and put the baby in the
First Stage of Labor
mother’s abdomen and suction secretions.
(Stage of Dilation)
Onset of true labor to full cervical dilation
Third Stage of Labor
❖ (Placental Stage)
- Longest and least intense phase of labor. Birth of baby to Expulsion of Placenta
- Contractions are more frequent • Dangerous time because of possible hemorrhaging.
(5-20 minutes apart) and stronger
- The cervix dilates 3-4 cm and effaces
Placental separation
❖
- signaled by dilatation of the cervix from
4 to 7 cm. ➢
- Contractions become longer, more severe, and 1. Uterus becomes globular in shape and firmer,
frequent discoid to avoid, indicating placental separation
(3-4 mins apart) from the uterine wall.
2. Gushing of Blood
❖
3. Lengthening of Cord
- Cervix dilates from 8- 10 cm.
4. Uterus rises in the abdomen
- Contractions are very strong lasting 60-90
seconds and occurring every few minutes.
➢
- A method of expressing the placenta in which
body uterus is vigorously squeezed in order to
produce placental separation

➢
- a mechanism or technique for delivery with the
maternal rather than the fetal side surface
presenting the dirty or rough side.

Placental Expulsion
➢
- a method of expressing the placenta by
grasping the umbilical cord with one hand and
placing the other hand on the abdomen,
application of the traction on the cord by
OVERVIEW:
moving the forceps up, down, left, right.

➢
- a mechanism or technique for the delivery with
the fetal rather than the maternal side surface
presenting the shiny and glistening side of the
fetal membrane

Fourth Stage of Labor

(Stage of Physical Recovery)
Delivery of Placenta up to 1-4 hrs. after Delivery
 •
Contents of OB Pack Umbilical cord scissor - used to cut the umbilical
cord.
CPCMHI VSMMC • Surgical scissors - used to cut the umbilical cord.
3 gowns Digital thermometer • Needle holder - used to hold the round needle with
2 leggings Adult diaper suture.
• 1 tissue forceps with teeth - used to hold the soft
3 drapes Sterile gloves
tissues in the perineal area during Episiorraphy.
1 perineal support 1 bottle of 70% alcohol
1 bottle Betadine Solution Steps: handling delivery
Pack cotton ball
Baby diaper PREPARATION:
Bonnet a. Do medical and surgical hand washing
b. Perform gowning (per institution protocol) and
ID bracelet
gloving (per institution protocol)
c. Do draping (per institution protocol)
Contents of Instruments set
ACTION:
CPCMHI 1. DRAPE the patient accordingly.
Bandage scissor a. Leggings (left and right)
Kelly curve b. Abdominal drape
c. Perineal drape
Kelly straight
d. Baby drape
Surgical scissor e. perineal support
Needle holder 2. Encourage the woman to push/ bear down once
Tissue forceps uterus is at the height of its contraction and to do
Placental bowl breathing exercises when it is not.
3. Ensure controlled delivery of the head of the
VSMMC MULTI SET VSMMC PRIMI SET baby.
Bandage scissor Bandage scissor 4. Keep one hand on the head as the head of the
Kelly curve/straight Surgical scissor baby advances. To keep the head from coming
out too quickly.
Needle holder Kelly curve/straight
5. Support the perineum with the other hand. To
Tissue forceps with teeth Needle holder
prevent perineal lacerations.
Tissue forceps without teeth Tissue forceps with teeth 6. Discard the pad when soiled. To prevent infection
Tray Tissue forceps without 7. During the delivery of the head encourage the
teeth woman to stop pushing and breath rapidly with
10 cc disposable syringe Tray mouth open.
Needle and Suture 10cc disposable syringe 8. Sliding your hands into the neck of the baby,
Sterile 4x4 OS 5-10 pcs. Needle and Suture gently feel if the cord is around the neck.
2 leggings (optional) Sterile 4x4 OS 5-10 pcs. a. If it is loosely around the neck, slip it over
the shoulders or the head
4 Sterile OP towels
b. If it is tight, place a finger into the cord,
2 leggings (optional)
clamp and cut the cord, and unwind it
from around the neck.
Instruments 9. Gently wipe the baby’s mouth and nose with
clean gauze.
• 10cc disp. Syringe with lidocaine anesthesia + 10. Wait for external rotation (within 1-2 min) the
bandage scissors are used during episiotomy. head of the baby will turn sideways bringing one
• 2 Kelly Forceps – used to clamp the umbilical cord shoulder just below the symphysis pubis and the
of the baby other facing the perineum
 4. Apply betadine antiseptic solution, sanitary
pad/adult diaper and clean maternity duster.
11. Apply downward pulling motion to deliver the top
5. Do after care:
shoulder then lift the baby up to deliver the lower
• Position the mother comfortably (closed
shoulder. Gently deliver the rest of the baby.
legs)
12. Place the baby to the mother’s abdomen in prone
• Removed stained drapes
position.
• Take vital signs immediately
13. Cover the baby with dry towel. Thoroughly dry the
• Check the instruments if complete
baby immediately. Wipe the baby’s eyes.
• Wash the instruments if complete and let
14. Discard wet cloth.
it dry
15. Put the baby in prone position, in skin-to-skin
contact on the mother’s abdomen. Keep the baby • Pack clean equipment and auto-clave
warm.
16. Palpate mother’s abdomen to determine if there
is a second baby.
17. Remove gloves (first set of gloves) or change to
new ones.
18. Deliver the placenta by controlled cord traction
(with counter traction on the uterus above the
symphysis pubis). This is a supervision checklist for Emergency
19. Massage uterus over the fundus. Obstetric and Newborn Care sites to help monitor:
20. Once delivered, place the placenta on the bowl
(1) the infrastructure and environment
and inspect for completeness of its parts.
(2) equipment and material
21. Document the placental presentation.
(3) management of antenatal care clients,
patients during labor and delivery, as well
Steps: Assisting delivery as postnatal mothers and babies,
(4) family planning
PREPARATION: (5) postabortion care
a. Do medical and surgical hand washing
b. Perform gowning (per institution protocol) and
gloving (per institution protocol)
c. Prepare the materials, ob pack and instruments
set to be used in the delivery.
• materials include: to be obtained from the
accompanying (per institutional policy)
- maternity duster
- adult and newborn
- baby clothes and flannel
• instruments set needs to be anticipated
whether to use primi/multi set (per
institutional policy)
d. Anticipate the amount of anesthetic agent to be
use. Prepare the agent in the syringe.

ACTION:
1. Serve the instruments to be used to the physician
in appropriate manner.
2. Assist in suturing the episiotomy. Anticipate
doctor’s need during suturing
3. After suturing of the perineum is done, flush the
operative site with normal saline.
 9. A baby should undergo a Newborn Screening
Quiz 3 (NBS) within how many hours from birth?
Topic: Handling and Assisting Delivery
Date: March 17 • 24 hrs.
Score: 30/30 10. After the umbilical pulsations have stopped
student nurse Carla clamps the cord using a sterile
1. Student Nurse Sophia was assigned in handling a
plastic clamp at ___ from the base of the
delivery, she recalls that the following signs of
newborn?
placental separation, EXCEPT?
• 2 cm
a. The uterus rises in the abdomen
11. Vitamin K injection should be administered at
b. None of the choices
what particular site?
c. Sudden gush of blood
• Vastus Lateralis
d. Lengthening of the cord
12. A term wherein the fetal presenting part is not
2. This stage of labor is the period from the birth of
engaged in pelvic inlet?
the baby through the delivery of placenta?
• Floating
• Placental stage
13. True or False. Do not suction unless the
3. Based on the procedure, what should you do
mouth/nose are blocked with secretions or other
FIRST before handling a delivery?
materials?
• Do Medical and Surgical Handwashing
• True
4. After the OB physician sutured the perineum
14. Contractions during this phase are usually very
area, the operative site must be flush with what
strong that would last 60-90 seconds and
kind of solution?
occurring every few minutes?
• Normal Saline
• Transition Phase
5. Infants with mothers tested positive for HepB
15. Upon the delivery of the placenta, Student Nurse
surface antigen (HBsAg) should also receive an
Carla noticed that the placenta is presenting the
immunization called?
shiny and glistening side of the fetal membrane.
• Hep B immunoglobulin (HBIG)
She is correct if she states that the placenta being
6. It denotes the extraction of the fetal head, using
delivered was a __?
one hand to pull the fetal chin from between the
• Schultze
maternal anus and the coccyx and the other on
16. Student Nurse Tom understands that in Assisting
the fetal occiput to control speed of delivery?
a Delivery his MAJOR nursing responsibility is to?
• Ritgen’s Maneuver
• Prepares the materials (OB pack and
7. During the birthing process, Massaging the uterus
instruments set to be used in the delivery)
over the fundus promotes uterine ___
17. In an Apgar test, the healthcare provider
• Contractions
examines following category, EXCEPT for?
8. It is a surgical incision of the perineum made to
• Neuromuscular Maturity
prevent tearing of the perineum with the birth
18. True or False. In Handling procedure, Do we
and to release pressure of the fetal head during
encourage the patient to push/bear down once
delivery?
uterus is at the height of its contraction?
• Episiotomy
• True
19. Nurse Ryan performs cord care to the newborn. 28. A patient was in Labor. Upon initial assessment of
He recalls that a newborn should be thoroughly the OB physician, it has an I.E of 5-6cm.
dry for atleast? Contractions becomes longer, more severe and
• 30 seconds frequent in what phase of the 1st stage of labor
20. In assisting a normal spontaneous vaginal does the patient is experiencing?
delivery, student nurse Mia must anticipate the • Active Stage
use of what anesthetic agent? 29. A quick test performed on a baby at 1 and 5
• Lidocaine minutes after birth?
21. When the face and the head of the baby is • Apgar Scoring
delivered, what would nurse Mia initially DO? 30. All of the instruments below are commonly used
• gently wipe the baby’s mouth and nosee during the delivery, EXCEPT?
with clean gauze • Army Navy Retractor
22. Student nurse Chloe noticed that secretions is
evident upon the delivery of the newborn, what is
the BEST nursing intervention she should do?
• Check breathing, do not ventilate unless
not breathing and do not suction unless
with secretions but first suction the mouth
23. Which is the correct sequence of Cardinal
Movements of the newborn upon delivery?
• Engagement, Descent, Flexion, Internal
roation, Extension, External rotation,
Expulsion
24. A method of expressing the placenta by grasping
the umbilical cord with one hand and placing the
other hand of the abdomen, application of the
traction on the cord by moving the forcep up,
down, left, right?
• Brandt Andrews Maneuver
25. A medication instilled to the both eyes of the
newborn to prevent ophthalmia neonatorum?
• Crede’s prophylaxis
26. A process of rating the infant’s physical and
neuromuscular maturity?
• Ballard Scoring
27. Initially the newborns temperature should be
taken at?
• Rectum