RESPONSIBILITIES OF ASSIST

The unsterile student/ wears clean gloves

Assistant to the sterile handle student
1. Do labor watch
Monitor Fetal Heart Beat(should not be uterine soufile)
* Not during uterine contractions
* Any abnormal action abnormality in FHB initial action is to change the
* Mothers position
* Latent phase: every hour
* Active phase: every 30 minutes
* Transitional phase: every 15 minutes
Monitor BP of mother every 30 minutes
2. If still in the latent and active phase of stage 1 (up to 7cm dilation), assist
patient in ambulating in the area. But now allowed if there is PROM
3. If in the transitional phase (8cm-10cm), do squatting. one student will
stand in front of the patient will the patient puts her hands on his shoulder,
while another student will stay at the back will squat together with the
mother
4. Let the patient remove panties before mounting to DR table assist. wear
clean gloves and put Kelly pad on DR table
5. Ask watcher to buy ice and wrap in cloth
6. if parturient is already mounted to DR table, assist in positioning
(lithotomy)
In lithotomy, put both legs up in stirrups at the same together with the
ungloved
Handle (to prevent injury to the uterine ligament)
7. Do Perineal Flushing
Use 3 or more cherry ball with betadine feminine wash and working
Forceps
Slowly flush the perineum using tap water
8. If no signs of bulging perineum. Assist client to a left lateral decubitus
position.
Upon washing Instruct, mother not to push to pant (rapid and shallow
Breathing) Instead to prevent rapid expulsion of the baby
9. Get BP and PHB every 30 minutes especially during active labor
10. If head of neonate is delivered. Stay beside the woman
11. If the expulsion occurs, note the time and say baby out (what time)
12. Handle student/doctor will place the baby on the abdomen while
Suctioning and
The staff will take the baby and put it in nearby crib

13. Get the BP of the mother immediately after expulsion

14. Palpate the uterus to determine degree of contraction
15. Wait for placental separation. Observe the 3 signs of placental separation
(Rising of the fundus to the level of the umbilicus, lengthening of the cord
sudden gush of vaginal blood). Take note of the time of placental
Separation placenta out: what time
16. Get immediately the BP of the mother right after separation
17. Put ice over abdomen, or massage uterus
18. Assist in giving lidocaine holding only the vial and not the syringe (assist
will run errands because he is unsterile. He can also do IVF follow ups)
19. Help handle after care
20. Check fundus characteristics and level q 15 minutes for 1 hour q 30
minutes for the next 4 hours
21. Monitor lochia . immediately after delivery, a perennial pad can be
saturated after 30 minutes
22. The mother should void within 5-8 hours post delivery
23. Chck mothers BP q 15 minutes
RESPONSIBILITIES OF ACTUAL NURSE
The sterile student
Assistant to the midwife/doctor
1. Do labor watch. Help assist in monitoring BP and FHB
2. Make sure to study and familiarize the stage 4 o labor mechanism of labor,
5 Ps, placental expulsion presentation etc
3. Always observe sterile technique
4. Check the mayo table. Complete the instrument needed for delivery
One kelly curved
One kelly straight (sometimes 2 kelly curved are used)
One needle holder
One ovum foreceps
One mayo scissors
One metz scissors
One tissue forceps
Two sterile leggings
Two hypo towel
One kidney basin
Four pieces OS
One suction bulb
1 chromic suture
1 10-cc syringe (for lidocaine) dont open yet: assist student will
open sterile field When the doctor ask

3 cherry balls with betadyne

5. Set aside gloves for doctors (5 for female doctors 7 for male doctors)
6. When the parturient is mounted to the DR table, assist in lithothomy
position then do the following
Handwashing
Air dry hands
7. Watch out for crowning
8. If this occurs, do surgical gloving, then place sterile hypo towel over
mothers abdomen (one that was used to cover on the mayo table)
9. Drape the patient using sterile leggings found in the mayo table. Then put
another hypo towel under the buttocks, making sure not to contaminate
your gloved hads
10. Wait for the head to be delivered hold suction bulb with one hand
11. When the heads is delivered suction the mouth 1 st then suction the nose
Handle can perform the ritgens maneuver (use sterile cloth or OS)
1 hand= ritgens
other hand=suction
Episiotomy-may be done
EPISIOTOMY- surgical incision of the perineum and to release
Pressure of The Fetal head with birth
Advantages
A) Substitutes a clean cut for a rugged tear
B) Minimizes pressure on the fetal head
C) Shortens the last portion of the second stage of labor
12. Maintain ritgens while the body is being delivered. After being delivered
stop the ritgens and drop the cloth on the floor
13. When the baby placed on the abdomen of the mother by the doctor
continue to suction the mouth of the nose
14. Give 1 kelly forcep to the doctor the doctor will clump the cord then
another Kelly forcep doctor will clamp again then the mayo scissors cord
doctor will cut (sometimes the doctors will get the forceps themselves)
15. the staff will take the baby crib
16. Handle continues to assist while the doctor/midwife will do the Brandt
Andrew maneuver. Wait for the placenta to come out by observing the
3signs of placental separation (rising to the fundus to the level of the
umbilicus, lengthening of the cord sudden qush of vaginal blood )
17. Once placenta is out get the kidney basin and the doctor will put the
placenta there. Some doctors will use the kidney basin to catch the
placenta. Note the time of placental expulsion and identify if Duncan or
Schultz placenta should be delivered within 20 minutes
18. Inspect cotyledons of placenta. Normal-20 cotyledons
19. Assist doctor/midwife in their needs like offering instruments
20. Assist epistorraphy if to be done
Let assist open syringes chromic then drop on the sterile field
Remove needle with cap of syringe, the withdraw lidocaine from the
offered
Vial by the assist, making sure to touch only the hub and not the vial.

Then
Reconnect to original needle with cap
Knowing what hands is to be used by the doctor
Placing suture in the needle holder, offer in the right way, wile
Holding the Thread
Dominant hand will hold scissor non-dominant will hold 1 OS for
sponging
Cutting suture (long: half inch short: close to knot
Sterile shopping
21. After episiorraphy do not removes your glover yet
22. Do perineal care, wipe off blood strains around the vulva with OS apply
betadyne to suture line position mother flat on bed without pillows
23. Provide blankets to keep her warm if complained of chills
24. Do after care. Scrub all instruments with soap and water, dry in towel then
soak in deconex solution
25 Carry pail-containing placenta and Kelly pad to the washing area, dispose
sharps in one hole and the placenta in another one. Make sure to flush
placenta with 5 pails of water
26. Scrub Kelly pad hang it dry
27. Do charting of DR note. Follow format provided
RESPONSIBILITIES OF CORD CARE
1.
2.
3.
4.

Do labor watch. Get FHB and BP

Watch out for crowning. Do clean gloves
prepare a sterile ahead of tome
get an OB set (sterile)
umbilical scissors/ mayo scissors
cord clamp (dont open yet unless baby has been delivered)
3 cotton balls with alcohol
3 cotton balls with betadyne
Sterile gloves
5. should be available at he other corner of the table
Rectal thermometer
Dry cotton
Tape measure
Vitamin k ampule
1 cc syringe with needle
Credes prophylaxis
ID bracelet
Drop light on crib cord dress area
Weighing scale
2 Os (to wipe baby during bath)
1 baby bath tub

6. Prepare bath of baby. Mixed it with baby Johnsons Baby shampoo. Check
if temperature is appropriate (use elbow wrist)
7. Ask clothes baby from parents, and prepare them
* Infant shirt
* Diapers
* Bornet / cloth to wrap baby
8. make sure that the fan is turned off in cord dressing room
9. When neonate is delivered, wait for it to be transferred to the crib with the
drop light applied place in side-lying position and stimulate to cry by
rubbing and wiping the back then the staff will transport the baby to the
cord dressing area
10. Weight baby and say it out loud average 6.5-7.5lbs (3-3.4kgs)
make sure to lift the forcep
low birth weight 5.5 lbs (2kgs)
11. bath baby
* Support the head always, buttocks can stay submerged
* Cephalocadual approach last woud be geitalia
* Can use OS to wipe the vernix in the head
* Dont mind if the forcep is soaked in the tub
* Dry the baby
When carrying the baby use a football hold
9. Back to the crib wipe to dry then do the measurements. Get
measurements head chest, abdomen circumference length
Head 33cm-35cm (slip under the head) (write value immediately in
small Notebook)
Then slip the tape measure into the abdomen
Abdomen: 31cm-33cm (umbilical level)
Turn the baby to the side (side lying position) then measure from
the Posterior fontanel down to the feet (follow curvature of the
baby)
Length 45.7cm-53 75cm (average 50 cm)
13. Dress up the baby but expose the umbilical area for cord dressing
14. Do surgical gloving then perform cord care
15. STEPS IN CORD CARE
(PUPOSE TO PREVENT TETANUS NEONATORUM)
A) Get one cotton ball with alcohol then wipe from base in rotating
motion
then up the cord with upward sticks (70% alcohol to prevent
drying up)
use opposite side of cotton ball for another upward strike then use
cotton
ball with betadyne following the same manner Oserve if
1vein:2arteries
B) Milk the cord to return blood and nutrient to the body
C) Camp the cord 1 inch form the base (make sure that cord is in the
center of the clamp)

D) Cut cord inch above the clamp (or every close to the clamp)
E) Wipe stump with another cotton balls with alcohol from the top to
the base then finally cotton ball with betadyne
16. Insert rectal thermometer into anus by lifting both legs with one hand
(insert only bulb then wait for 1-2 minutes to get the reading (2reasons to
check for imperforated anus and is the most accurate route of taking
temp) read it loud if-temp is more than 37.5 degrees Celsius turn off the
drop light. Must be maintained between 35.5-36.5 degrees Celsius
17. Put on clothes neonate diaper must cover cord stump
18. Administer standing order of media like vitamin k (to prevent bleeding due
to deficient clotting factor vitamin k)
Best site: vastus lateralis left side (more developed muscle) (follow
IM
Technique)
<2.5 kg = 0.05 ml of vit k
>2.5 kg = 0 1 ml of vit k
Hold cotton ball against injection sites and press for a while
If with heap B give 0.5 ml on opposite leg
Dont throw remaining vitamin k just cover with the plaster and put
together with garamycin
19. Administer credes prophylaxis to both eyes
To prevent opthalmia neonatorum due to gonorrhea
Make sure that the drop light is away from the face
Apply general appearance sulfate/ gramycin
1 drop in each conjunctival sac
If ointment apply in inner cornea to outer canthus (make sure not to
touch the Eye)
20. Mummify the baby. Then give to family identifying the sex while giving
21. Do aftercare (no need to remove sterile gloves after cord care since this
will be Used to clean the instruments)
22. Wash instruments with soap and water, then let it dry
23. Do DR notes. Follow format Provide
24 Complete Dr forms Complete CER