University of Pangasinan

PHINMA Education Network

NORMAL SPONTANEOUS DELIVERY

Procedure/Skill Rationale
1. Prepare the necessary equipment.
2. Encourage the patient to adopt the
position of choice and continue
spontaneous bearing down efforts.
3. Tell the patient what is going to be done,
listen to her, and respond attentively to her
questions and concerns.
4. Provide continual emotional support and
reassurance, as feasible.
5. Put on personal protective barriers.
ASSISTING THE BIRTH
1. Wash thoroughly with soap and water
and dry with a clean, dry cloth or air dry.
2. Put sterile gloves on both hands.
3. Place one sterile drape under the
patient’s buttocks, one over her
abdomen, and use the third drape to
receive the baby.
BIRTH OF THE HEAD
4. Clean the patient’s perineum with a
cloth, wet with antiseptic solution and
water, wiping from front to back.
5. Ask the patient to pant or give only
small pushes with contractions as the
baby’s head is born.
6. As the pressure of the head thins out
the perineum, control the birth of the
head with the fingers of one hand,
applying a firm, gentle downward (but
not restrictive) pressure to maintain
flexion, allow natural stretching of the
perineal tissue, and prevent tears.
7. Use the other hand to support the
perineum using a cloth or compress and
allow the head to crown slowly and be
born spontaneously.
8. Wipe the mucus (and membranes, if
necessary) from the baby’s mouth and
nose with a clean cloth.
9. Feel around the baby’s neck to ensure
the umbilical cord is not around the
neck:
 If the cord is around the neck but
 is loose, slip it over the baby’s
head.
 If the cord is loose but cannot
reach over the baby’s head, slip
it backwards over the shoulders.
 If the cord is tight around the
neck, clamp the cord with two
artery forceps, place 3 cm apart,
and cut the cord between the
two clamps.
COMPLETING THE BIRTH
10. Allow the baby’s head to turn
spontaneously.
11. After the head turns, place a hand on
each side of the baby’s head, over the
ears, and apply slow, gentle pressure
downward (toward the mother spine)
and outward until the anterior shoulder
slips under the pubic bone.
12. When the arm fold is seen, guide the
head upward toward the mother’s
abdomen as the posterior shoulder is
born over the perineum.
13. Lift the baby’s head anteriorly to deliver
the posterior shoulder.
14. Move the topmost hand from the head
to support the rest of the baby’s body as
it slides out.
15. Place the baby on the mother’s
abdomen (if the mother is unable to
hold the baby, ask her birth companion
or an assistant).
16. Thoroughly dry the baby and cover with
clean, dry cloth:
 Assess breathing while drying
the baby and if he/she does not
breath immediately, begin
resuscitative measures.
17. Clamp and cut the umbilical cord:
 Clamp the cord at about 3 – 5
cm from the umbilicus.
 Cut the cord between the
clamps.
18. Ensure the baby is kept warm and in
skin-to-skin contact on the mother’s
chest and cover the baby with a cloth or
blanket, including the head.
19. Palpate the mother’s abdomen to rule
out the presence of additional baby and
proceed with active management of the
third stage.
ACTIVE MANAGEMENT OF THIRD STAGE OF
LABOR
1. Give Oxytocin 10 units IM.
 2. Clamp the cord close to the perineum and
hold the clamped cord and the end of the
clamp in one hand.
3. Place the other hand just above the pubic
bone and gently apply counter traction
(push upward on the uterus) to stabilize
the uterus and prevent uterine inversion.
4. Keep light tension on the cord and wait for
a strong uterine contraction (two to three
minutes).
5. When the uterus becomes rounded or the
cord lengthens, very gently pull downward
on the cord to deliver the placenta.
6. Continue to apply counter traction with the
other hand.
7. If the placenta does not descend during 30
to 40 seconds of controlled cord traction,
relax the tension, and repeat with the next
contraction.
8. As the placenta delivers, hold it with both
hands and twist slowly so the membranes
are expelled intact.
 If the membranes do not slip out
spontaneously, gently twist them
into a rope and move up and down
to assist separation without tearing
them.
9. Slowly pull to complete delivery.
10. Massage the uterus if it is not well
contracted.
EXAMINATION OF PLACENTA
11. Hold placenta in palms of hands, with
maternal side facing upwards, and check
whether all lobules are present and fit
together.
12. Hold cord with one hand and allow
placenta and membranes to hang down:
 Insert fingers of other hand inside
membranes, with fingers spread
out, and inspect membranes for
completeness.
 Note position of cord insertion.
13. Inspect cut end of cord for presence of two
arteries and one vein.
EXAMINATION OF VAGINA AND PERINEUM
FOR TEARS
14. Gently separate the labia and inspect
lower vagina for lacerations/tears.
15. Inspect the perineum for lacerations/tears.
16. Gently cleanse the perineum with warm
water and clean cloth.
17. Apply a clean pad or cloth to the vulva.
POST-PROCEDURE TASKS
1. Place any contaminated items in a
 plastic bag or leakproof, covered waste
container.
2. Decontaminate instruments by placing
in a container filled with 0.5% chlorine
solution for 10 mins.
3. Decontaminate needles and/or
syringes:
4. Immerse both gloved hands briefly in a
container filled with 0.5% chlorine
solution, then remove gloves by turning
them inside out.
5. Wash hands thoroughly with soap and
water and dry with clean, dry cloth or air
dry.