Normal Delivery (Delivery Technique)
Definition
Normal delivery, often referred to as natural childbirth
or spontaneous vaginal delivery (NSVD), is the process
of giving birth through the vaginal canal without surgical
interventions.
Goal
To assist the patient to give birth spontaneously.
Positioning
(Patient position)
Equipments Assemble the equipment in a linear
arrangement:
[ ] 2 pairs of sterile gloves
[ ] Cord clamp
[ ] Curve forceps
[ ] Mayo scissor
[ ] Tissue forceps with teeth
[ ] Needle holder
[ ] 2 sterile cloth
[ ] Baby's bonnet
[ ] 1pc 1ml syringe
[ ] 1pc 3ml syringe
Stages of Labor
1st stage - onset of labor until complete cervical dilation
2nd stage - complete dilation after delivery of infant
3rd stage - delivery of infant until delivery of placenta
Observe for the Mechanism of Labor:
Observe for the second stage of labor (from full cervical
(10cm) dilation to delivery of the baby). If the presenting
part is seen.
Crowning - means the widest part of the baby's head
(the crown) has passed the bony pelvic outlet. In
between contractions, the protruding foetal head
throught the vaginal introitus does not recede. (If
second stage labor is already seen put on sterile gloves)
Delivery of Head, Shoulders, and Body
Head
- as head crowns, one hand is used to keep neck flexed
preventing precipitous expulsion
- Ritgen's maneuver or Modified Ritgen's Manueve -
when it distends the vulva and perineum enough to
open the vaginal introitus to a diameter of 5cm or more
a sterile towel used to apply upward pressure on fetal
chin through perineum at the tip of the maternal coccyx
to facilitate extension of the head held against the
symphysis. ( the baby facing the anus of the mother)
- Suction mucous from mouth and nose if present
Shoulder
- the external rotation occur. (The baby facing the
mother's thigh)
- using a downward traction towards mother sacrum
with mother pushing, deliver the anterior shoulder
under pubis symphysis
- Check for the nuchal cord or cord around the neck - to
assess if the umbilical cord is wrapped around the fetal
neck, gently run a finger along the neck. If a loop of cord
is detected and it feels loose, carefully slip it over the
head. However, if it's tightly secured, cut the loop
between two clamps for safe delivery.
- Immediate upward traction is then used to deliver
posterior shoulder
Body
- Delivery of body then occurs spontaneously or with
assisted pushing from mother
- Allow the baby to rest at or just below the vaginal
opening for 3 minutes to ensure that the fetoplacental
circulation remains uninterrupted before clamping the
umbilical cord.
- Then the baby dried (immediate thorough drying) and
placed on top of the mother's abdomen for skin to skin
contact.
Third Stage
1. Cord clamping and cutting the umbilical cord - Palpate
the umbilical cord for pulsation, if pulsation stops clamp
the cord 1 inch (2-3cm) from the base and instrument
clamp 5 inches from the base. Cord is cut 1cm from the
cord clamp.
2. Delivery of the Placenta After the birth of the baby,
the placenta's detachment usually occurs within a brief
window of 1 to 5 minutes.
3 Signs of Placental Separation
- Uterine Sign The uterus may firm up and rise in the
abdomen
- Vulva Sign There may be a noticeable increase in
vaginal bleeding
- Lengthening of the cord (Cord Sign) The umbilical cord
might lengthen, indicating that the placenta is detaching
Delivery of the Placenta
The delivery of the placenta typically takes 5 to 15
minutes, though it can extend up to an hour. It's
important not to force the expression of the placenta. To
assess the uterus's contraction, gently grasp the
mother's abdomen below the navel. As the placenta
approaches the perineum, lift the cord to assist in its
exit. Rotate the placenta slowly while lowering your
hands to avoid tearing the membranes and ensure
nothing is retained in the birth canal. Note for check for
the completeness of the placenta
- Examine placenta for
[ ] Intactness
[ ] Succenturiate lobes
[ ] Number of vessels - Estimate blood loss Should be
<500ml
500ml = postpartum hemorrhage
- Inspection of perineum for trauma and need for repair
Examine for lacerations
[ ] Cervix
[ ] Vagina
[ ] Perineum If none clean the mother with anti-septic
solution, flush perineum and apply perineal
pad/napkin/cloth.