Delivery Room
Home » Our Services » Medical Services » Obstetrics and Gynecology »
Delivery Room
At Makati Medical Center, we welcome babies with the exceptional care. At
our delivery room, we provide the highest standards of quality care for both
mothers and their babies. We are committed to providing the safest and
most comfortable delivery experience possible.
Our Delivery Room encompasses
 5 state-of-the-art operating rooms
 4 labor rooms
 2 Lamaze rooms
 2 Birthing suites
We are fully equipped to provide the appropriate response to whatever
healthcare demands mothers or babies may require.
Our operating rooms and Lamaze rooms are equipped with:
 the latest Doppler studies equipment
 3D ultrasound
 incubators
 surgical rooms
These fetal monitor equipment allow our specialists to closely watch the
progress of labor and the well-being of our babies.
All delivery rooms are equipped with state-of-the-art Hill-Rom Affinity III
Birthing Beds that accommodate virtually any birthing position a laboring
mother chooses to make.
To meet a growing demand for quality but less expensive care, Makati Med
launched a Maternity Package Program. Packages include:
 Spontaneous vaginal delivery with or without tubal ligation
 Cesarean section for singleton and multiple gestations
 Hysterectomy
 Adnexal surgery
 Dilatation and curettage
At Makati Med, we fully appreciate the miracle of birth, which is why we
have several programs, which include:
 Bonding programs for mothers and babies. Here, we even provide
tips on breast feeding and the proper care and handling of babies.
 Rooming-in programs that encourage mothers to keep their
babies with them throughout their stay, on certain hours only,
depending on their own preferences and on the health of both
mother and baby.
 Continuous wellness programs for babies
 A 19-week care program for babies – more about this
 Special programs for diabetic mothers, premature babies that
need more care
 History  Back to top
 The Department of Obstetrics and Gynecology (Delivery Room)
had its beginning together with the hospital on August 15,
1956. It was then chaired by Manila Doctors Hospital (MDH)
Founder, Dr. Constantino P. Manahan. Ever since it was
accredited for residency training in 1984, the department has
continued to expand both in its training program and its
services to the community. With the expansion of the Hospital,
the Delivery Room Complex, in 1993, was moved from its small
niche at the fourth floor Operating Room to its spacious area,
occupying about half of the former 3A wing.
 Within the Delivery Room Complex are six (6) Labor Rooms,
three (3) Delivery Rooms Suites, two (2) Operating Room
suites and one (1) Recovery Room, all constructed in a way
that there is rapid ease in transferring patients from Labor
Room to the delivery or operating suites. Moreover, there are
other amenities which have been added or improved, namely
the cozy OB Lounge, the Conference Room, the Ultrasound
Room, Urogynecology Room, all possible through the kind of
support of the hospital administration.
 At the helm of all these modest undertakings is the ever
energetic department chairman, Dr. Nora I. Silao, whose
dynamism has inspired the residents to pursue no less than
excellence in residency training which started in 1977.
Delivery room also takes pride in all its Nurses, who had
undergone rigorous trainings before deploying them to the
area thus making them efficient and effective nurses.
 At the present, the department chairperson, Dr. Marilyn David
Rubio continued all the programs with the help of the team of
Training Officers.
Technology
Many medical centers in the country claim to have world-class equipment of
one kind or another for certain medical applications. St. Luke's paces them all
with the most comprehensive range of the latest and most sophisticated
technologies for diagnosing and treating diseases from the simplest to the
most complex.
Known for its aggressive acquisition of top-of-the-line equipment, St. Luke’s
is better equipped than 95% of hospitals in the United States. St. Luke’s
continuously acquires the latest technologies to enhance its capabilities and
deliver superior results in pursuit of its mission of healing.
* 3-Tesla Magnetic Resonance Imaging (MRI)
* 3D Echocardiography
* 4D Ultrasound
* 64-Slice CT Scanner
* Electron Microscopy
* Endovenous Laser Therapy
* Extracorporeal Shockwave Lithotripsy
* High Dose Rate Brachytherapy
* Hyperbaric Oxygen Therapy (HBOT)
* Picture Archiving and Communications System (PACS)
* Photodynamic Therapy for Age-Related Macular Degeneration
* Positron Emission Tomography (PET) Scanner & Cyclotron
* Radiofrequency Ablation (RFA)
* SIRT
Abbreviations: BPD, bronchopulmonary dysplasia • DR, delivery room •
CPAP, continuous positive airway pressure • PEEP, positive end-expiratory
pressure • FIO2, fraction of inspired oxygen
Despite dramatic improvements in survival rates of preterm infants over the
last 50 years, there have been no significant further improvements in survival
or morbidity rates over the most recent 10 years.1,2 Survival rates among
infants with a birth weight of 500 to 1500 g in participating centers of the
Eunice Kennedy Shriver National Institute of Child Health and Human
Development Neonatal Research Network of the United States were 84% in
1995–1996 and 85% in 1997–2002; the survival rate without major neonatal
morbidity (which included bronchopulmonary dysplasia [BPD],
intraventricular hemorrhage, and necrotizing enterocolitis) was unchanged
(70%) between these 2 time periods.1 Similar findings were observed in
epidemiologic data from Norway and Germany, which were published almost
coincidentally.2,3 New paradigms for addressing care of extremely preterm
infants may be necessary to achieve further improvements in outcome.
Before the last decade, increased survival rates of preterm infants had been
attributed to regionalization of high-risk pregnancies, use of prenatal
corticosteroids, and an aggressive approach to perinatal therapy.4 Birth in a
high-risk perinatal center with a higher level of neonatal care is associated
with better survival rates than birth in a center that provides a lower level of
care,5 and mortality and morbidity rates are increased for the most
immature infants who require transport after birth.6 Some of the major
morbidities associated with extreme prematurity such as BPD and
intraventricular/periventricular hemorrhage could potentially be affected by
management in the first minutes of life. However, the principles of care that
occur in the NICU are not always used in the delivery room (DR). Care of the
smallest preterm infants in the DR has received very little attention in
newborn-resuscitation protocols. It is only with the most recent edition of
the Neonatal Resuscitation Program textbook7 that a chapter dedicated to
preterm infants was introduced.
The tools used during newborn resuscitation are generally rudimentary, and
monitoring is traditionally based on clinical examination alone, which can
have substantial subjectivity.8 Recent surveys have revealed that even in the
most developed countries, equipment used for newborn resuscitation is
frequently not any more advanced than in less developed countries.9–12
Conversely, adult-resuscitation protocols incorporate advanced monitoring
from the first moments of resuscitation.13 It seems that use of the best
available tools and principles of preterm infant care in the DR would help
achieve a stable transition from fetal life, minimizing risks of serious
morbidity.
As many as 7% of delivery services in the United States admit infants directly
into a bed in an adjacent NICU, immediately providing an appropriate,
monitored environment.12 However, most existing facilities cannot create
such a proximal relationship between the DR and the NICU. Equipping the
existing DR resuscitation space with supplies that are currently used routinely
in the ICU will allow a higher level of care from the first moments of life.
Therefore, we suggest that incorporation of an intensive care environment
into the DR could enhance survival rates and reduce morbidity of extremely
preterm infants.
FREQUENCY OF NEWBORN RESUSCITATION AMONG EXTREMELY
PRETERM INFANTS
TOP
FREQUENCY OF NEWBORN...
VENTILATION IN THE DR...
OXYGEN, OXIDATIVE STRESS, AND...
TEMPERATURE CONTROL IN THE...
ADDITIONAL MONITORING
APPLYING AVAILABLE TECHNOLOGY IN...
REFERENCES
Although only ~10% of all infants require some resuscitative interventions
during the immediate transition from fetal life,7 decreasing gestational age is
associated with increasing need for resuscitative interventions. We reviewed
DR interventions over a 5-year period from the University of California San
Diego Medical Center and found that 92% of such infants received positive
pressure ventilation, 61% were intubated in the DR, 10% received chest
compressions, and 1.5% received epinephrine.14 In another study, 40% of
the infants at the threshold of viability had a temperature of <35°C on
admission to the ICU.15
VENTILATION IN THE DR HAS SHORT-TERM AND-LONG-TERM
CONSEQUENCES
TOP
FREQUENCY OF NEWBORN...
VENTILATION IN THE DR...
OXYGEN, OXIDATIVE STRESS, AND...
TEMPERATURE CONTROL IN THE...
ADDITIONAL MONITORING
APPLYING AVAILABLE TECHNOLOGY IN...
REFERENCES
Ventilation is the most common resuscitative intervention performed in the
DR and may influence the development of BPD.16 Barotrauma and/or
volutrauma are responsible in experimental animals for the activation of
specific genes and the subsequent release of proinflammatory mediators
that trigger this cascade of events.17–19 In experimental animals it has been
shown that significant pathologic changes in the lung, including epithelial
damage, protein leak into the alveolar spaces, and inhibition of surfactant
function, may be induced by administering only a few inflations with high
tidal volumes immediately after birth and thereafter may be exacerbated by
the use of mechanical ventilation.20–23
The occurrence of BPD varies widely according to center, and the use of early
continuous positive airway pressure (CPAP) has been associated with low
rates of BPD.24,25 In addition, positive end-expiratory pressure (PEEP) is
considered essential during mechanical ventilation for any respiratory
problems of the newborn.25 However, tools for providing manual ventilation
do not all have the ability to provide PEEP and CPAP. Self-inflating bags are
the most commonly used resuscitation devices worldwide and are used in
40% of the DRs in the United States. These devices do not provide CPAP, and
they provide inconsistent PEEP even with a PEEP valve.26 Flow-inflating bags
have the ability to provide both CPAP and PEEP but require significant
training and experience to be used effectively.26 The T-piece resuscitator
may be desirable because pressures, including CPAP and PEEP, can be set
and delivered at target levels easily without a significant chance of
unintended overshoot of pressure.27 For infants who require positive
pressure inflations, the goal is to deliver a pressure and tidal volume that will
lead to adequate lung inflation without inducing additional lung injury. Tracy
et al28 have shown that hyperventilation occurs frequently in the intubated
ventilated preterm infant during resuscitation when chest rise is used as a
marker for determining the level of pressure delivered.
Mask ventilation can be difficult in the first minutes of life with frequent
occurrences of obstructed inflations. Additional methods of monitoring
ventilation can be used to ensure the presence of a patent airway, such as
use of a colorimetric carbon dioxide detector or an end-tidal carbon dioxide
detector.29 Measurement of tidal volume can be accomplished with flow
sensors with manual ventilating devices30 or with the use of mechanical
ventilators to provide consistent inflations. Further evaluation using these
monitoring devices may enable a more informed approach to ventilation
with the intention of limiting associated lung injury.
OXYGEN, OXIDATIVE STRESS, AND LUNG INJURY
TOP
FREQUENCY OF NEWBORN...
VENTILATION IN THE DR...
OXYGEN, OXIDATIVE STRESS, AND...
TEMPERATURE CONTROL IN THE...
ADDITIONAL MONITORING
APPLYING AVAILABLE TECHNOLOGY IN...
REFERENCES
Studies in human neonates have shown that the use of pure oxygen during
resuscitation may cause oxidative stress,31,32 damage the myocardium and
kidney,33 and/or negatively influence survival.34–37 Two recent prospective
randomized clinical trials were performed to evaluate the effectiveness of
variable oxygen concentration during newborn resuscitation of preterm
infants.38,39 These trials demonstrated that successful resuscitation of
preterm infants can be achieved by using a low initial fraction of inspired
oxygen (iFIO2 = 0.30) but not air (iFIO2 = 0.21) as the initial gas admixture.
The average oxygen concentration used to achieve target oxygen saturations
within the first 5 to 10 minutes of life and avoid bradycardia was 30% to 40%
in both studies. In addition, the use of a low iFIO2 allows an achievement of a
target saturation of 85% at 10 minutes after cord clamping with lower
oxygen load.38 To provide adequate oxygenation during initial transition by
using a targeted oxygen saturation protocol in the DR, pulse oximeters,
blenders, and a source of compressed air are essential. Because the average
duration of DR care is >20 minutes, these tools are also critical for avoiding
hyperoxia after the initial transition.14
TEMPERATURE CONTROL IN THE DR
TOP
FREQUENCY OF NEWBORN...
VENTILATION IN THE DR...
OXYGEN, OXIDATIVE STRESS, AND...
TEMPERATURE CONTROL IN THE...
ADDITIONAL MONITORING
APPLYING AVAILABLE TECHNOLOGY IN...
REFERENCES
Efforts to limit heat loss of preterm infants in the DR during resuscitation and
transport have been broadly recommended by most of the national
resuscitation programs worldwide.40 Minimizing heat loss is extremely
difficult because of high evaporative heat loss exacerbated by a large
temperature gradient from the skin to the ambient air and physical
characteristics of the premature infant.41 The use of polyethylene occlusive
skin wrapping used without drying has been shown to reduce temperature
loss in the DR.42 It is probably most sensible to use this practice in
conjunction with skin-temperature probes and servo control of radiant-
warmer output to avoid hyperthermia and a drop in the heater output when
in full-power manual mode for >15 minutes. An increase in the DR
temperature will also greatly facilitate the maintenance of adequate core
temperatures in the extremely low birth weight infant. Admission
temperatures that are in the hypothermic range have been associated with
increased risk for mortality and late-onset sepsis.43 Therefore, every effort
should be made to keep the preterm infant's temperature within normal
limits during resuscitation and transport.
ADDITIONAL MONITORING
TOP
FREQUENCY OF NEWBORN...
VENTILATION IN THE DR...
OXYGEN, OXIDATIVE STRESS, AND...
TEMPERATURE CONTROL IN THE...
ADDITIONAL MONITORING
APPLYING AVAILABLE TECHNOLOGY IN...
REFERENCES
One of the most important signs of successful transition is maintenance of a
normal heart rate. The occurrence of bradycardia is most frequently a
reflection of inadequate lung inflation, and heart rate is an important
decision point in the resuscitation protocol. Auscultation is the most accurate
clinical method of determining the heart rate but remains difficult in some
situations and occupies 1 individual during the resuscitation.44 The
continuous demonstration of heart rate allows the resuscitation team to
continuously reevaluate interventions. This can be facilitated by the use of a
monitor, such as a pulse oximeter or electrocardiography monitor, which
frees an individual to perform other tasks. Electrocardiography leads can be
applied quickly and can provide an electrographic heart rate display within
30 seconds.45 Pulse oximeters applied immediately can provide a reliable
heart rate within 90 seconds and are also useful for monitoring
oxygenation.46 Both monitors can be used as ongoing indicators of the
adequacy of resuscitation interventions.
APPLYING AVAILABLE TECHNOLOGY IN THE DR: A FUTURE
PERSPECTIVE
TOP
FREQUENCY OF NEWBORN...
VENTILATION IN THE DR...
OXYGEN, OXIDATIVE STRESS, AND...
TEMPERATURE CONTROL IN THE...
ADDITIONAL MONITORING
APPLYING AVAILABLE TECHNOLOGY IN...
REFERENCES
Accumulated evidence suggests that resuscitation of extremely preterm
infants should be individually adjusted and gentle. To achieve this goal, we
propose the following.
1. High-risk pregnancies should be referred, when possible, to high-risk
perinatal centers at which a sufficient number of trained caregivers
(minimum of 3 per delivery: 1 team leader and 2 assistants) are available
around the clock.
2. Every referral center should have at least 1 DR bed equipped as if it were
a NICU bed ("DRICU") to allow titrating FIO2 according to the infant's needs
and should continuously monitor for clinical variables (heart rate, pulse
oxygen saturation, and temperature).
3. Ventilation equipment that can provide CPAP and PEEP and consistent
pressure delivery and/or tidal volume monitoring should be used. This may
be most effective in the form of a neonatal ventilator or T-piece resuscitator.
Intensive care of newborns at the highest risk begins antenatally and should
be continued with equal or greater attention throughout transition, in the
DR, and into the NICU. Instituting such practices may help achieve further
improvements in outcome for the most preterm infants.
Giving birth is one of the most precious times in our lives. This miracle is one
that many women are choosing to share with their families or friends. Having
the comforting presence of those you love can enhance the experience and
make you feel more relaxed. The problem is that many of the people who are
invited have no idea about how to act or behave during this moment of great
joy. Here are some ideas of things not to do!
* Make room! In general try to stay out of the way of the medical staff. If
the nurse, midwife or doctor comes in the room to do an exam or talk to the
laboring mother, offer to leave the room. If that's not required or requested
be sure to move to the outskirts of the room to allow the medical staff access
and room to the mom in labor to make their job easier.
# Privacy, please. While it's tempting to go to the waiting room to share
every little detail, remember mom may not want every little detail shared.
Always ask her before sharing any information, no matter how minute the
issue seems.
# Watch the food! Don't go bring food back to the room. The lingering odors
can cause nausea or remind mom that her choices of food are limited. This is
cruel and unusual punishment. If you do slip out for food, remember to
brush your teeth to remove lingering odors.
# Watch the Monitor. Watching the monitor is fine to help you get a sense of
her labor pattern. You can even ask a nurse, in the hall, to show you how to
read the monitor. Be careful about making comments about the
contractions, particularly comparing them to other rooms (if you can see
other monitors), comparing them to her pain level ("Gee that was a big
one!"), and comparing them to each other ("That one wasn't nearly as big as
the ones last hour.").
# Chatter Be mindful and respectful of what the laboring mom needs. If she
wants to talk she'll talk. Chances are there will be parts of labor where quiet
and darkness are what she needs most. Be respectful of her needs. Avoid
unessecessary chatter with others in the room. Bring a book to read in the
corner or nap if you can. Also remember that everything you say she will
remember in great detail. She is very sensitive at this time and even well
meaning jokes may miss their mark. Instead remind her of what a great job
she is doing and how you are grateful to have been invited to experience her
miracle.
# Photos Ops While you may want to snap great photos of the on goings of
the birth, be sure you have her permission and know the rules of the hospital
or birth center. Let her preferences guide your camera's lens.
# Steal the thunder! Be sure to allow the new parents or mom to be able to
tell everyone the good news. If you are asked to go fetch someone from the
waiting room, play a game and refuse to tell them anything, not even how
big the baby is, not even if it's a boy or girl! This allows the new parents to
get to see the looks of joy in others faces. The line I always use is, "They'd
love you to join them to welcome their baby." Then I tight lip it back to the
room with the anxious guest.
In the Delivery Room
Picture of a newborn's footprintsThe birth of a baby is one of life's most
wondrous moments. Few experiences can compare with this event. Newborn
babies have amazing abilities, yet they are completely dependent on others
for every aspect - feeding, warmth, and comfort.
Amazing physical changes occur with birth. When the baby is delivered, the
umbilical cord is cut and clamped near the navel. This ends the baby's
dependence on the placenta for oxygen and nutrition. As the baby takes the
first breath, air moves into the lung airways. Before birth, the lungs are not
used to exchange oxygen and carbon dioxide, and need less blood supply.
The fetal circulation sends most of the blood supply away from the lungs
through special connections in the heart and the large blood vessels. When a
baby begins to breathe air at birth, the change in pressure in the lungs helps
close the fetal connections and redirect the blood flow. Now, blood is
pumped to the lungs to help with the exchange of oxygen and carbon
dioxide.
Some babies have excess amounts of fluid in their lungs. Stimulating the baby
to cry by massage and stroking the skin can help bring the fluid up where it
can be suctioned from the nose and mouth.
Providing warmth for the newborn:
A newborn baby is wet from the amniotic fluid and can easily become cold.
Drying the baby and using warm blankets and heat lamps can help prevent
heat loss. Often a knitted hat is placed on the baby's head. Placing a baby
skin-to-skin on the mother's chest or abdomen also helps keep the baby
warm.
Immediate care for the newborn:
Health assessments of the new baby begin immediately. One of the first
checks is the Apgar test. The Apgar test is a scoring system designed by Dr.
Virginia Apgar, an anesthesiologist, to evaluate the condition of the newborn
at one minute and five minutes after birth. The physician and nurses will
evaluate the following signs and assign a point value:
A Activity; muscle tone
P Pulse rate
G Grimace; reflex irritability
A Appearance; skin color
R Respiration
A score of seven to 10 is considered normal. A score of four to six may
indicate that the baby needs some resuscitation measures (oxygen) and
careful monitoring. A score of 3 or below indicates that the baby requires
immediate resuscitation and lifesaving techniques.
Physical examination of the newborn:
A brief physical examination is performed to check for obvious signs that the
baby is healthy. Other necessary procedures will be done over the next few
minutes and hours. These may be done in the delivery room or in the
nursery, depending on several factors, including the condition of the baby.
Some of these procedures include the following:
* temperature, heart rate, and respiratory rate
* measurements of weight, length, head circumference
These measurements help determine if a baby's weight and
measurements are normal for the number of weeks of pregnancy. Small or
underweight babies as well as very large babies may need special attention
and care.
* cord care
Cleansing of the umbilical cord stump may include treatment with a
purple antiseptic dye which helps prevent infection.
* bath
Once a baby's temperature has stabilized, the first bath can be given.
* footprints
Footprints are often taken and recorded in the medical record.
Before a baby leaves the delivery area, identification bracelets with identical
numbers are placed on the baby and mother. Babies often have two, on the
wrist and ankle. These should be checked each time the baby comes or goes
from your room.
After a Vaginal Delivery
Healthy babies born in a vaginal delivery are usually able to stay with the
mother. In many cases, immediate newborn assessments including weight,
length, and medications, and even the first bath are performed right in the
mother's room. As quickly as possible, a new baby is placed in the mother's
arms.
In the first hour or two after birth, most babies are in an alert, wide awake
phase. This offers a wonderful opportunity for parents to get to know their
new baby. A baby will often turn to the familiar sound of the mother's voice.
A baby's focus of vision is best at about eight to 12 inches - just the distance
from baby cradled in a mother's arms to her face.
This is also the best time to begin breastfeeding. Babies have an innate ability
to begin nursing immediately after they are born. Although some
medications and anesthesia given to the mother during labor and delivery
may affect the baby's sucking ability, most healthy babies are able to
breastfeed in these first few hours. This initial feeding helps stimulate breast
milk production. It also causes contraction of the mother's uterus which can
help prevent excessive bleeding.
After a Cesarean Delivery
If your baby is born by a cesarean delivery, chances are good that you can be
awake for the surgery. Only in rare situations will a mother require general
anesthesia for delivery. This means she is not conscious for the birth. Most
cesarean deliveries today are done with a regional anesthesia such as an
epidural or spinal. With this type of anesthesia, only part of the body is
numbed for surgery. The mother is awake and able to hear and see her baby
as soon as he/she is born.
Babies born by cesarean are usually checked by a nursery nurse or
pediatrician right after delivery. This is often done right near you in the
operating room. Because babies born by cesarean may have difficulty
clearing some of the lung fluid and mucus, extra suctioning of the nose,
mouth, and throat are often needed. Occasionally, deeper suctioning in the
windpipe is required.
Once a baby is checked over, a nurse will wrap the baby warmly and bring
the baby to you to see and touch. In some cases, babies born by cesarean will
first need to be watched in the nursery for a short time. All of the usual
procedures such as weighing and medications are performed there. Usually,
your baby can be brought to you while you are in the recovery area after
surgery.
Many mothers think that they will not be able to breastfeed after a cesarean
delivery. This is not true. Breastfeeding can begin in the first hours right in
the recovery room, just as with a vaginal delivery.
If Your Baby Has Problems
Picture of a newborn in the neonatal intensive care unit
All the baby's body systems must work together in a new way after birth.
Sometimes, a baby has difficulty making the transition. Health assessments,
including the Apgar test performed right after birth, can help determine if a
baby is doing well or having problems.
If there are signs the baby is not doing well, treatment can be given right in
the delivery room. The physician and other members of the healthcare team
work together to help the baby clear excess fluid and begin breathing.
Babies who may have difficulty at birth include those born prematurely,
those who experienced a difficult delivery, or those with birth defects.
Fortunately for these babies, special care is available. Newborn babies who
need intensive medical attention are often admitted into a special area of the
hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines
advanced technology and trained healthcare professionals to provide
specialized care for the tiniest patients. NICUs may also have intermediate or
continuing care areas for babies who are not as sick but need specialized
nursing care. Some hospitals do not have trained personnel or an NICU and
babies may need to be transferred to another hospital.
Having a sick baby can be distressing. Few parents expect complications with
pregnancy or their baby to be sick or premature. It is quite natural for
parents to have many different emotions as they try to cope with the
difficulties of a sick baby. But, it is reassuring that today's advanced
technology is helping sick babies get better and go home sooner than ever
before. And it helps to know that although separation from a baby is painful,
it does not harm the relationship between the mother and baby.