Normal vaginal delivery basics( Them).pptx

Basics of normal vaginal delivery

1. Normal vaginal delivery Presented by: SL. Lhingneithem

2. 1. Normal vaginal delivery is a systematic process of enabling a woman to safely deliver fetus,-------------- and ---------------through the birth canal. 2.Ensure to empty the bladder before delivery to prevent from a) PPH b) Vesico vaginal fistula c) Perineal tear d) Both a and b 3.What is the full form of DCC and CCT: i ) DCC : ii) CCT : 4.Episiotomy if necessary should be performed: a) when there is no contraction b) During contraction c) When the head crown d) Both b and c PRE-POST TEST QUESTION

3. DEFINITION: Systematic process of enabling a woman to safely deliver fetus, placenta and Membranes through the birth canal. PRINCIPLES: 1.A safe environment is provided. 2.Asepsis is maintained throughout. 3.Injury to mother and fetus is prevented. 4.Deviation from normal is identified and prompt action is taken. 5.The mother is supported physically and psychologically.

4. PURPOSES: 1.To help her delivered baby in a safe environment. 2.To detect and prevent complications during delivery. EQUIPMENTS: A.Trolley with following items ➢ NVD set ➢ Small bowl-2 ➢ Sponge holder-2 ➢ Sims speculum-2 ➢ Kockers forcep-2 ➢ Tissue scissors-1 ➢ Episiotomy scissor’s -1

5. ➢ Cord cutting scissor-1 ➢ Artery forcep’s -2 ➢ Needle holder-1 ➢ Thumb forcep (plain)-1 ➢ Thumb forcef (toothed)-1 ➢ Tampons ➢ Gauze piece,pads ➢ Placenta bowl (big)-1 ➢ Syringe 5cc -1 ➢ Chromic catgut/ ethilon ➢ Sterile gloves ➢ Inj.Ceftriaxone 1gm (if prescribe) ➢ Inj.Lignocaine 1%/2%

6. ➢ Liquid paraffin/Xylocaine jelly ➢ Betadine solutions ➢ Napkins B.DELIVERY DRAPE SET: -Surgeons gown -Delivery sheet -Leggings 1 pair -Towel-2 -Under pad -Linen -Baby sheet- 1 and Mother’s cloth.

7. PROCEDURE: SL.NO. STEPS RATIONALE 1 Explain procedure to the woman and offer encouragement throughout the delivery process. Reduces anxiety and promotes support to the woman 2 Provide privacy Provides security to the mother 3 Keep in the middle of cot and position in modified lithotomy position Gives view to the perineum and to assess the progress clearly. 4. Assemble equipment to right side,and keep neonatal area readywarmer , suction and oxygen. For convenience and timely used

8. 5 Wear mask,apron and performed surgical hand scrub Maintains sterility 6 Wear sterile gown and gloves Maintains sterility 7 Clean perineum with antiseptic solution Prevents infection 8 Drape the woman with delivery sheet placing it under buttocks and help to wear the leggings Obtains a sterile field for delivery 9 Ensure that the bladder is empty, catheterize if full Prevents post partum hemorrhage and vesicovaginal fistula.

9. 10 Encourage her to bear down when she gets expulsive contractions Helps in descent of the fetal head 11 Perform episiotomy during contractions, if necessary when head crowns, after infiltrating perineum with 1% lignocaine. Avoids injury to the anal sphincter and spontaneous laceration of the perineum 12 Turn off fan while delivering baby Prevents hypothermia. 13 Support perineum with dominant hand using towel and control extension of baby’s head with the nondominant hand when head is being delivered Assist in delivery of the head 14 Wipe eyes with sterile cotton, if necessary Prevents infection 15 Feel for presence of cord around neck and if cord is tight, clamp in two places and cut immediately ( if cord is loose, flip it over the baby’s head) Prevents asphyxia and distress

10. 16 Wait for restitution and internal rotation of shoulders to take place naturally Promotes delivery of the shoulders 17 Hook neck by applying two fingers over neck and two fingers under the neck using both hands and deliver anterior shoulder by giving downward traction. Then deliver posterior shoulder by giving upward traction. During this time, ask the assistant to give perineal support to prevent tear. Promotes delivery of both the shoulders 18 Deliver body by lateral flexion ( towards woman’s abdom en) Promotes delivery of the trunk 19 Place the baby on the mother’s abdomen with head low position at the angle of 45 degree Prevent aspiration and avoid pressure over the spine 20 Note time of birth. For proper documentation 21 Evaluate baby’s condition at birth Detects any abnormal findings and correct intervention at the right time.

11. 22 Delayed cord clamping (DCC) : Clamp the cord after 1 minute ( maximum 3 minutes) near vulva. Apply second clamp 5cm away from the first one. DCC prevents anemia, necrotizing enterocolitis , hypothermia in newborn. Enhances bonding 23 Cover cord with gauze piece and cut umbilical cord in between the two clamps Prevents splashing of blood 24 Keep the mother and baby together if possible Enhances bonding and initiate early breastfeeding 25 Collect cord blood as per the order Detect the blood group and Rh factor 26 Tie identification tag on mother and baby Prevents confusion and provide safety of the child

12. 27 Show the baby to the mother and ask her to identify and repeat the sex of the baby for 2-3 times Provides safety of the child as well as the staffs 28 Keep the baby on the mother’s abdomen ( if hospital policy allows) till the placenta is delivered Creates mother and child bonding as well as initiation of early breastfeeding. 29 Show the baby to other significant relatives and ask them to identify and repeat the sex of the baby. Prevents legal issue 30 Administer inj. Pitocin 10 units IM after the delivery of the baby. If active bleeding is present, administer inj. Methergin 0.2 mg IV, if there are no contraindications ( PIH< cardiac disease and Rh – ve mother ) Active management of the third stage of labor AMTSL 31 Receive baby in dry sheet, clear airway, wipe and wrap baby Prevents hypothermia

13. 32 Wait for placenta to separate. Watch for signs of placental separation Prevents inversion of uterus 33 Confirm placental separation Bulging over the supra pubic region, gush of fresh blood, permanent lengthening of cord indicates placental separation 34 Deliver placenta by Modified Brand Andrews (MBA) method using controlled cord traction (CCT). Clamp cord near vulva and hold clamp with two fingers of dominant hand. Keep non dominant hand just above symphysis pubis and exert pressure over the fundus in an upward direction Active management of the third stage of labour (AMTSL) Enhance contraction of the uterus 35 Deliver placenta giving downward and backward traction till the placenta is delivered. As the placenta comes out hold it on the palm of the hand and rotate gently to deliver the membranes Prevents inversion of the uterus 36 After the delivery of the placenta, massage the uterus and empty the blood clots to enhance the tonicity of the uterus Active management of the third stage of labor (AMTSL). Enhance contraction of the uterus

14. 37 Examine for para urethral, perineal or vaginal tear Detect any complication 38 Insert a tampon and secure one end with an artery clamp Prevents excessive bleeding 39 Suture episiotomy or perineal tear with 1-0 catgut; cervical para urethral and vaginal tear with 2-0 catgut/ vicryl / ethilon Assist in good stitching 40 Clean perineum, fix pads from front to back Prevents bleeding and infection 41 Change linen and make mother comfortable Promote comfort

15. 42 Provide warm drink Provide strength to the mother 43 Examine placenta for any abnormalities Detects retained placenta and other complication 44 Place placenta in a plastic cover and weight the placenta. Dispose the placenta as per hospital policy Normal placenta weight is 500gm 45 Observe the mother and baby in labor room for one hour Early detection of problems and prompt actions 46 Document all the details of delivery of the baby, placenta and suturing of episiotomy For records

16. ENGAGEMENT :

17. DESCENT:

18. INTERNAL ROTATION OF THE HEAD:

19. CROWNING:

20. Thank you