1. The patient has the right to consider and respectful care. information concerning his diagnosis, treatment and progress in terms the patient can be reasonably expected to understand. 3. The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and /or treatment. Where medically significant alternatives for care treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information and to know the name of the person responsible for the procedures and/or treatment. 4. The patient has the right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of his action. 5. The patient has the right to every consideration of his privacy concerning his own medical care program. 6. The patient has the right to expect that all communication and records pertaining to his care should be treated confidential. 7. The patient has the right to expect that within its capacity a lying – in must make reasonable response to the request of a patient for services. 8. The patient has the right to obtain information as to any relationship of his lying – in to other health care and educational institutions in so far as his care is concerned and any professional relationship among individuals, by name, who are treating them. 9. The patient has the right to expect continuity of care. 10. The patient has the right to examine and receive an explanation of his bill regardless of source of payment. 11. The patient has right to know what lying-in rules and regulations apply to his/her contract as patient.

2. The patient has the right to obtain from his physician complete current

1. All patients should be handled by the Midwife/Referring OB. 2. Primigravidas and other gravides requiring episiotomy should be done by the OB, but in case of emergency, skilled Midwife may handle. 3. Always secure consent, maternal history and complete right name of patient for correct documentation and tagging. 4. Upon admission, patients are examined in the labor room. Always take her vital signs, do proper assessment including the FHT and if uncomplicated to do an IE to determine cervix dilatation, presentation and status of BOW. 5. Maintain courtesy and politeness at all times. 6. Always assist mother in labor. NEVER LEAVE THE MOTHER ALONE in the labor and delivery room. 7. Always use the partograph sheet in each patient to determine proper and timely referrals. 8. Make constant round to patients in labor, check for vaginal bleeding, any unusual signs and symptoms and REFER! 9. Mother with 4cms cervical dilation and those requiring close monitoring are admitted in labor room. 10. Infection control policies of DR must be followed at ALL TIMES! 11. Relatives and companions of patients are not allowed to enter Labor and Delivery Room. 12. EiNC or the Essential Intrapartum Newborn Care should always be practiced. 13. Breast Feeding should always be encouraged to all mothers. 14. The skilled Midwife on duty can repair first and second degree perennial lacerations to control bleeding and should be examined by Referring OB. 15. The woman who also undergone epissiorraphy should be checked by the OB prior to transferring her to postpartum unit.

Takes and records vital signs. gives and evaluates nursing care. Identifies nursing needs of patient in labor. Admits patients and if not complicated may do IE to determine cervical dilatation status of BOW. Sees to it that equipment receive with proper care and maintenance. 17. 19. 3. 9. Interprets to the patient and her family their roles in promoting successful delivery. and fetal presentation. Acts as liaison between patients and lying –in personnel. 13. 2. 7. FHT and the partograph. 5. and assists physicians with diagnostic and therapeutic procedure 15. Transfer and endorse patients to postpartum unit. Observes signs and symptoms of labor. Administers and chart medication and patients reactions to medications. . Performs such nursing activities such as bathing and oral hygiene.DUTIES AND RESPONSIBILITIES OF DR STAFF MIDWIVES 1. Plans. Assist physician when examining patients. 18. Gives direct nursing care for all pregnant patients. 4. 8. 10. 11. Teaches and direct nonprofessional nursing personnel. Leopold’s maneuver and fundic height measurement. 6. 14. 22. Observes medical asepsis. 24. monitoring proper alignment of patient’s body especially during labor and utilizing good body mechanics. 23. Prepares patients. Reports observation to the Physician. Carries out Doctor’s order 16. Performs postmortem care. Performs irrigation. gives enemas and IV fluid insertion. catheterization. 20. institutes remedial action when appropriate and record these in chart. Instructs patients and families. Observes and records patient’s emotional and spiritual needs. Acts as a senior nurse when so delegated. 21. Assist patient in moving. 12.

Performs simple procedure as perineal care shaving and SS Enema.25. Attends meetings and conferences. Gives health teaching. 29. 39. Removes all used or discontinued equipment from the labor and Delivery Room. 30. Serves drinking water and nourishment to woman not in active labor. 33. 36. 26. . Interprets hospital. 42. Answers patient’s calls and deliver messages. Tidy Beds and bedside tables. 37. 40. cabinets. Takes and Charts vital signs when delegated. Measure fluid intakes and outputs. 35. 41. Maintains good relationships with other hospital personnel. Maintains cleanliness and orderliness of the Delivery and Labor Room. counters. 32. Charts medications and treatments given accurately. DR policies and procedures. 28. 31. 38. 34. Assists in giving baths to pregnant woman. Checks and receives articles from outgoing midwife. 27. Attend delivery of normal pregnant patients. Attends rounds. Receives and endorses ward equipment and supplies.

As a health professional. the law has provided added skills that the midwife must learn to do her task completely. These include: 1. skills and practice by attending and participating in continuing professional Education (midwifery) activities. Internal examination except when the woman has antepartum bleeding 3. she is duty bound to improve and continuously update and enhance her knowledge. Giving oxytocic drugs after delivery of placenta 5. . Intravenous Fluid infusion during obstetric emergencies 4. Aside from providing care to woman during normal pregnancy and childbirth. Repair of first and second degree perineal lacerations to control bleeding 2. Giving vitamin K to the newborn The Midwife must adhere to her scope of work and training to protect the safety of those who seek her care.A 7392).DUTIES AND RESPONSIBILITIES OF DR STAFF NURSES AND MIDWIVES Philippine Midwifery practice is guided by the Midwifery Act of 1992 (R.

Collect clothing or sheets stained with blood or body fluids and keep them separately from other laundry. wearing gloves or use a plastic bag. Sort or SURIIN b. Always change scrub suit before entering and leaving DR. 7. Delivery packs and instruments are properly cleaned. pails and DR tables should be scrubbed well every after using and cleanse with Lysol Solutions. Kelly pads. weekly cleaning and walling of unit. Proper waste disposal and segregation should be followed AT ALL TIMES. Sanitize or SIGURADUHIN ANG KALINISAN e. mask. packed.LABOR AND DELIVERY ROOM INFECTION CONTROL GUIDELINES 1. autoclaved and should always be ready for use. Needles and sharps are kept in a separate plastic container with cover for proper disposal. and should dry. Always lead the patient to the labor room upon admission and change her slippers use gown before entering. 10. 8. Use bleach for cleaning bowls and buckets. 3. and slippers. All delivery room personnel are required to wear gown. handling delivery and instrument and preparation of the patient. cap. Change curtains every 15 days. Do daily mopping. 5’s should always be implemented: a. 5. 13. Placentas are collected properly in a plastic container kept in freezer for proper disposal. Sweep or SIMUTIN d. 2. soap and water. Set Up or SINUPIN c. and for blood and body fluid spills 14. Do aseptic techniques in doing procedures. 4. DO NOT TOUCH THEM DIRECTLY . 6. Proper hand washing and septic technique in attending/handling deliveries always should be observed. 9. Self-Discipline or SARILING DISIPLINA 12. 11.

SHARPS. Before and after handling patient equipment 7. Handling contaminated waste c. and practice safe sharp disposal 16. repair of episiotomy or tear. BLACK BAG. blood drawing. scalpel. Proper waste disposal and segregation should be followed AT ALL TIMES COLOR CODING OF VARIOUS WASTE CATEGORIES a. Wear gloves. Handling and cleaning instruments b. After use toilet .15. Wear clean gloves when: a. Before preparing medications 5. Wear a long apron made from plastic or other fluid resistant materials. Wear long sterile or highly disinfectant gloves for manual removal of placenta. When coming on duty 2. Before and after patient contact 3.for collection of infective and pathological wet wastes d.for collection of non-infective dry waste b. and other disposable sharp shall be collected using a proof containers and must be properly labeled to avoid accident and health hazard EFFECTIVE HAND WASHING 1.the collection of non-infective wet waste c. cord cutting. Between dirty and clean procedure on the same patient 4. 19. YELLOW BAG. Before and after eating 9. cover needles. Wear sterile or highly disinfectant gloves when performing vaginal examination. 20. After blowing or wiping nose 8. If possible protect your eyes from splashes of blood. delivery. GREEN BAG. and shoes 17. Cleaning blood and body spills 21. abrasions or broken skin with a waterproof bandage. Normal spectacles are adequate eye protection 18. Before and after wearing gloves 10. take care when handling any sharp instruments (use good light). Before performing an invasive procedure 6.

2. To breath normally To be warm To be protected To be feed . 6. Monitor skin to skin contact. Call out time of birth Deliver the baby prone on the mother’s abdomen Dry the newborn thoroughly for a full 30 seconds. Clamp cord 2cm away from newborn skin using sterile plastic cord and apply sterile forceps 5cm from the skin then cut the cord. 10. safer place close to the mother. Delay vitamin K and immunization until after 90 min. 3. 4. 1-3min) 8. 4. Exclude second baby 7. Cover the back with the dry blanket. do not separate baby from the mother until a full breastfeed. Remove wet cloth Check breathing while drying Position newborn prone on the mother’s abdomen in skin to skin contact. BASIC NEEDS OF A BABY AT BIRTH 1. Remove first pair of gloves 9. 11. place newborn in a warmer. 2. Wait for cord pulsation to stop (approx. of uninterrupted skin to skin contact.GUIDELINES IN ESSENTIAL INTRAPARTUM NEWBORN CARE REFERENCES: POGS MDG COUNTDOWN CAPACITY ENHANCEMENT PROGRAM FOR MIDWIVES 2010 OBJECTIVES To describe and carry out the evidence based routine care of a newborn baby at the time of birth and prevent complications DO PROPER HANDWAHING STEPS: 1. Give eye prophylaxis within the first hour. 5. 3. watch for feeding cues. Place identification band in ankle 12. if this is not possible.

attitudes and skills in the residency training program. nurses or midwives from and other lying-in clinic on the job training of the staff. Posters and instructional materials are being posted in the different strategic place to enhance the knowledge of the patient. Management of problematic cases in the clinic 5. Rooming-in practice for all patients except problematic mother or baby 3. 9. Lactation management training program by 2 weeks every 6 months b. 4. Assignment of lactation management program. Monitoring of all breast feeding promotion strategies in the lying-in clinic 10. Incorporation of BF related knowledge. in service physicians.POLICY ON BREASTFEEDING 1. Information dissemination daily through lecture/audiovisual/ demonstration in the OPD and in the rooming-in wards by the lying-in clinic personnel in charge. Formation of lactation brigade-those volunteers who wants to help in the promotion of breast feeding and give assistance to mother during their stay in ward. Formation of lactation management team for: a. 11. Early mother child bonding in the delivery 6. relative and lying-in clinic personnel . 8. 7. No lying-in clinic purchase of milk and confiscation of milk formula from the patient if relative made it available for them. All mothers will practice exclusive breastfeeding 2.

Assessment of fetal well being a. Urine voided 3. Pulse. Cervical dilation b. Color of amniotic fluid Note: Start the partograph only when the woman is in ACTIVE labor (4cm or more) and is contracting enough (3-4 contraction in 10 mins).GUIDELINES OF PARTOGRAPH REFERENCES: POGS MDG COUNTDOWN The partograph is a useful tool for monitoring the progress of labor. temperature. frequency. to interfere in a timely manner to avoid maternal and neonatal morbidity and ensure close monitoring of the woman in labor. Contractions c. woman’s mood and behavior. intensity and duration of contractions. Label patient identifying information. Assessment of maternal well being a. .Perform IE every 4 hours. Fetal heart rate pattern b. Assessment of progress of labor a.This is plotted or recording using X . Note and monitor BP. Use it to avoid unnecessary interventions so maternal and neonatal morbidity is not needlessly increased. Note and monitor every hour the FHT. Or more frequently if necessary 2. Plot the cervical Dilation . USE OF PARTIGRAPH 1. Alert and action lines 2. WHAT TO PLOT? 1. temperature. PR and cervical dilations 3. blood pressure b.

Very short stature 2. Fetal distress 5. VAGINAL BLEEDING (0.+++) 2. Previous Cesarian section 6.++. Severe anemia 7. Color of amniotic fluid “C” membranes are ruptured and amniotic fluid is clear “M” amniotic fluid is stained with meconium “A” amniotic fluid is absent “B” amniotic fluid is bloody 4. Multiple pregnancy 8.OTHER FINDINGS TO RECORDS 1. Malpresentation 9.I if membrane are intact 3. Time membrane ruptured . Obvious obstructed labor . Urine voided (yes or no) The use of PARTOGRAPH is NOT RECOMMENDED to the following risk factors: 1. Antepartum hemorrhage 3. Very premature labor 10. Severe pre-eclampsia and eclampsia 4.

Only during labor 2. Cervical dilatation 2.POLICY ON INTERNAL EXAMINATION (IE) WHENT TO DO AN INTERNAL EXAMINATION 1. INSPECT THE VULVA 5. Every IE may bring INFECTION to that woman and her baby PROCEDURE FOR IE 1. Pelvis (architecture. In the third stage. DO NOT PROCEED 7. is suspected on abdominal examination 4. Explain to the woman what you are going to do 2. WHAT TO NOTE DURING INTERNAL EXAMINATION 1. if there is postpartum hemorrhage caused by retained placenta or suspected laceration 6. blood or pus? 6. When the bow ruptures ( to rule out cord prolapse) 3. adequacy of diameters) . Presenting part 4. Before transferring a woman to mother facility to ensure she is not likely to deliver in journey 5. Rinse vulva with clean water 4. Feel inside the vagina with the middle and index fingers. Bag of water 3. If woman has had vaginal bleeding after 5th month of pregnancy. Take the full aseptic precautions 3.1 5. Never do an IE unless you have a good indication for doing so.2 Is there amniotic fluid? Is it clear or meconium stained? Is there any abnormal discharge. If malpresentation. Wear clean gloves 5.

WHAT IS CERVICAL DILATION  Gradual opening of the cervix  Measured in centimeters  Feel with your 2 fingers  The fully dilated cervix is 10 cm .

Greet the woman and make her comfortable .  Ask for informed consent before examination or any procedure  Respect her privacy  Inform her of results of examination  Reassure 3. Prior Pregnancies and Birth Plan  Assess uterine contractions: intensity. Determine the stage of labor  Explain to the woman that you will perform a vaginal examination and ask for her consent  Respect her privacy  Observe standard precautions (wash hands. FHT between contractions 4. wear gloves)… 2. Assess the woman in labor  Take the history of labor and record on the labor form  Review Homed Base Maternal Record (HBMR) Mother and Child Book which includes: When is delivery expected? Preterm or Term. convulsing  Vomiting  Severe headache with blurring of vision  Vaginal bleeding  Severe abdominal pain  Looks very ill  Fever  Severe breathing difficulty  Do not make a very sick woman wait.CARE OF PREGNANT WOMAN DURING LABOR STEPS TO FOLLOW IN INTRAPARTAL CARE 1. attend to her quickly. Examine the woman for emergency signs  Unconscious.  Perform abdominal exam: Leopold’s maneuver. duration and frequency  Observe the woman’s response to contractions.

 Records findings in labor record or partograph 5.. foul smelling?  Warts. Reassures her. Decide if the woman can safely deliver.  In early labor. contraction are week . Do not give solid food this may take her vomit. FIRST STAGE OF LABOR. If there is indication for referral. cervix is dilated 0-3cm.  Every hour: check for emergency signs. if yes it is meconium stained. Drinking will give her energy for contraction and the sugar will give her energy for her labor. FHR mood and behavior.2 in 10 minutes. Intensity and duration of contraction. Observe the vulva for:    Bulging perineum Any visible fetal parts Vaginal bleeding  Leaking amniotic fluid. frequency. seek permission and discuss findings with the woman and her family  Always maintain privacy when examining the mothers  NEVER LEAVE a woman in labor alone Encourage the woman to:  wash from her waist down or to take a bath on the onset of labor  empty her bladder and bowel. Give supportive care throughout the nabor  Explain procedures. Remind her to empty her bladder every 2 hours (a full bladder may prolong the labor)  move freely ( if BOW is not ruptured.  Every 4 hours: check V/S and cervical dilation . Refer urgently in ACTIVE LABOR 6. keloid tissue or scar that may interfere with delivery  Perform gentle vaginal examination (do not start during contraction)  Explain findings to the woman. Respect and support her choice of a birthing position)  drink as she wishes.period from regular uterine contraction to cervical dilation  first stage: not yet in active labor.

Do not allow the woman to push unless delivery imminent. Do not fundal pressure or push. cervix as well. Woman wants to bear down 3. Do not do IE more frequent for every 4 hours.may cause uterine rupture and fetal death. Mother will become tired. 3. Check every 30 minutes for emergency signs frequency and duration of contractions. REFER  First stage: in active labor. CAUTIONS: 1. Suggest change of position 2. cervix is fully dilated 2. DANGEROUS: may cause trauma to the mother and baby. Strong uterine contractions every 2-3 minutes 4. Do not give medication to speed up labor. Record findings in labor record.  Assess progress of labor: after 8 hours. of contractions are stronger and more frequent but no progress in cervical dilation. On IE. cervix is dilated at 4cm or more. Encourage mobility as comfortable for her 3. Bulging thin perenium fetal head visible during contractions . RELIEF PF PAIN DISCOMFORT 1. REFERENCES: POGS MDG COUNTDOWN: Capacity Enhancement Program for Midwives 2010 SECOND STAGE OF LABOR: the period fully dilation 10cm of the cervix until birth of baby. 4. 2. FHR mood and behavior. Massage her lower back if she finds it helpful. Encourage proper breathing: breathe more slowly make sighing noise and make 2 short breathe follow by a long breathe out.pushing does not speed up labor. The woman is on 2nd stage of labor if: 1.

stay with the woman and encourage her comfortable 3.2 1.1 1. Support the perineum with other hand Discard pad and replace when soiled to prevent infections During delivery of the head. ensure controlled delivery of the head 5. when the birth opening is stretching support the perineum and anus with clean swab to prevent laceration 5. Implement the 3 CLEANS: 1. Wait for external rotation( within 1-2 minutes) head will turn sideways bringing one shoulder just below the symphysis pubis and other facing perineum .1 6. feel heart rate. encourage the mother to bear down when baby’s head is coming down 4. Gently feel if the cord is round the neck: 6. Continue recording in the partograph REMINDERS:  Massaging or stretching the perineum have not been down to be beneficial  DO NOT apply fundal pressure to help deliver the baby.5. keep the head coming out too quickly.2 if it loosely around the neck slip it over the shoulder or head. mood and behavior 2.2 5.1 5.3 5. If it is tight place the finger under the cord clamp and cut the cord unwind the neck 7. Wear double gloves clean delivery surface clean cutting and care of the cord 2.may harm mother and baby 1. Gently wipe the baby’s nose and mouth with a clean gauze or cloth 8. Check uterine contractions.4 keeps one hands on the head as it advances during contraction.3 clean hands. BOW will rupture MONITORING THE SECOND STAGE 1. encourage woman to stop pushing and breathe rapidly with mouth open gently feel if the cord is round the neck 6.

Ask assistant to massage the uterus and provide fundal pressure 3. Exclude 2nd baby by palpating mother’s abdomen. Do not bandage or bind the stamp. Put baby prone on mothers abdomen in skin to skin contact. Give 10 units oxytocin IM to the mother. Thorough dry the baby immediately. Soft tissue like mucosa and muscles 2. 16. Round. If the tear is long and deep through the perineum inspect to be sure there is no third or fourth degree tear a. Leave it open CHOICE OF NEEDLES 1. Maybe done by skilled midwife with supervision of doctor. Sweep the cord and apply Kelly forceps 5cm from the base then cut in between. Wipe eyes 12. 15. Keep the baby warm 14. Gently lift the finger and identify the sphincter .9. When no more cord pulsation is felt on the cord (usually within 3 mins) clamp the cord 2cm from base using sterile plastic cord clamp. Put baby on mother’s abdomen in prone position cover with dry towel 11. Place a gloved finger in the uterus b. Watch for vaginal bleeding 17. Discard wet cloth 13. Apply gentle downward pressures to deliver the shoulder then lift baby up to delivered. Provide emotional support and encouragement 2. Cutting tougher like fascia and skin STEPS IN PERINEAL REPAIR 1. Carefully examine the vagina perineum and cervix 4. Remove first set of gloves 18. 10. Clamp and cut the cord   Feel the cord. Observestump for blood oozing.

8. Check the rectal lumen after repair. Close the deeper perineal tissue with interrupted suture 3. Apply firm pressures on bleeding areas. Avoid tying the suture tight 5. If the tears is deep perform a rectal examination. Removal will help prevent infections as well as formations of an open sinus tract from perineum to rectum 6. Close the vaginal mucosa using continuous inter-locking or simple interrupted 2-0 suture 9. If so. Infiltrate site with local anesthetic Make sure there are no known allergies to Never inject lidocaine if blood is aspirated-the woman can suffer convulsion and death if IV injection of lidocaine occurs. clean the area before and after repair NOTE: skilled midwives or nurses who undergo training are only allowed to repair 1st and 2nd degree laceration and should be checked by OB . Use small caliber suture (chromic 2-0) 4. If the sphincter is not injured proceed with repair 5. Make sure no stitches are in the rectum TECHNIQUES AND TIPS IN PERINEAL REPAIR 1.REFER f. Clean area with anti-septic solutions 6. Close the perineal muscle using interrupted 2-0 suture 10. Close the skin using interrupted (subcuticular) 2-0 sutures starting at the vaginal opening. Repair lacerations in layer 2. Feel the tone and tightness of the sphincter d. Clamp and ligate bleeders 7. they must be removed. If the sphincter is injured. A rectal exam should be performed to check is any of those stitches have been accidentally put through into the rectum. remove the gauze when finished 7.c. Change to clean high level disinfected gloves e.

to repair subcutaneous fascia 2. Continuous suture technique. adequate homeostasis 2. Basc Principles in Repairing Lacerations 1. Lock suture. dexon)  Preferably with needle.are injuries or tears with vaginal canal and the outlet that occurs during delivery of the repair fascia and muscle 3.  3rd degree. adequate anesthesia classification of laceration  1st repair vaginal wall Choice of suture materials:  Must be absorbable: chromic 2-0 polyglocolic derivative (vicryl. Interrupted suture. use minimum suture materials 4. perineal skin. The areas affected by perineal tears are the perineum lateral vaginal walls and areas adjacent to clitoris lateral sulcus tears and others.fourchette.attached to I (atrauma c) THIRD STAGE OF LABOR. and vaginal mucus membrane PLUS the facia and muscles of the perineal body. the fascia and muscles of the perineal body plus the anal sphincter  4th degree.between birth of the baby and delivery of the placenta .involving the fourchette perineal skin and vaginal mucus membrane  2nd degree.extends through the rectal mucosa exposing the lumen of the rectum Different Technique of Suturing 1. abdominal restoration 3.PERINEAL TEARS OR LACERATION. perineal skin vaginal mucus membrane.

check BP PR emergency signs of uterine contractions every 15 minutes 4. no breast problem 4. no pallor 3.s abdomen for 60-90 minutes 5.1. Put the placenta into container for disposal IMMEDIATE POST-PARTUM CARE 1. IV taking or administration set . mother feels well 2. deliver the placenta by controlled cord traction ( with countertraction in the uterus above symphysis pubis 2. check for vaginal bleeding 2. Bottle or bag of IV fluid: D5LR or NSS b. initiate BF within 1 hour when the mother’s ready 5. NORMAL POST PARTUM WOMAN: note the following 1. keep the baby on mother. no perineal swelling GUIDELINES ON INTRAVEMOUS FLIUD 1. make sure the uterus is well contracted with stable V/S before transferring to the postpartum unit. clean the woman and make her comfortable 3. PREPARE MATERIALS TO BE USED a. IV needle/cannula/catheter: gauze 18 or 20 c. check if the placenta and membrabes are COMPLETE. no fever pain 5. normal V/S 7. uterus well contracted and hard 8. no problem with urination 6. massage the uterus over the fundus 3. encourage initiation of breastfeeding . inject oxytocin 10 units IM if not yet given 4.

Explain in simple terms the procedure to the patient and make her comfortable c. CHOOSE THE SITE OF INFECTION a. And expiration of fluid b. Hang the bag on an IV pole. Check the pt. Wear protective gloves f. Remove the plug of protective covering from the bottom of the bag/bottle. Place yourself in comfortable positions sitting if possible 3. Care should be taken out to avoid contaminate the end of the tubing 4.d. Close the flow regulator remove protective covering from the spike of tubing set and insertion of the spike into the port of fliud bag or bottle. PREPARE FOR IV INSERTION a. AVOID -areas of joint flexion -veins close to anterior and deep lying vessels -small visible but impalpable superficials viens -veins irritated by previous use c. Disposable 2. d. Wash hand to prevent infectious or cross-examination e. Check the type clarify. identification b. PERFORMED THE VENIPUNCTURE . PREPARE IV ADMINISTRATION SET a. Organize correct and adequate lighting d. Place the fluid bag/bottle higher squeeze the deep drip chamber to fill 1/3 of it opens the flow regulator to flush the air & bubbles from the rest of the tubing and close the flow regulator. Tourniquet e. USE DISTAL VIENS FIRST d. USE VIENS ON OPPOSITE SIDE TO THE SIDE OF INTENDED PROCEDURE 5. Tape or microsoft f. c. PREFERRED: hand viens b.

Ask the patient to make a fist to maximize vein engorgement c. Management of third stage labor (MTSL): among parturients in the 3rd stage of labor use of oxytocin . Fluid overload INTERVENTIONS DURING DELIVERY THAT ARE RECOMMENDED 1. Tape the catheter in place and adjust the flow rate 6. Hematoma b. Do not repalpatate f. In pregnant woman having vaginal birth restrictive episiotomy(over routine episiotomy) is recommended 2. Air embolism e. Infiltration( pain swelling pallor of site. COMPLICATION OF IV THERAPY a. Thromboembolism d. Phlepitis and septicemia f. Delayed cord clamping 3. Apply gentle pressure over the vein just proximal to the entry site to prevent blood flow and remove the needle from the plastic catheter Connect the plastic catheter to the previous prepared IV tubing set and open the flow regulator k.a. Insert the IV Catheter into the 30-45 angles with the bevel up and the directions of the veins g. Palpate the vein or top help it dilate d. Advance the catheter to enter the vein until blood is visible in the flush chamber of the catheter h. Clean the entry side with alcohol and allow it to dry e. Apply a tourniquet above the choosen site to create an adequate venous filling b. Advance the plastic catheter on into the vein while leaving the needle stationary i. j.IV flow rate decrease or stops observe of back flow or blood into the tubing c.

Routine use of ice packs over the hypogastrium in the immediate post-partum period is not recommended . MTSL: uterine massage after placental delivery 6.4. MTSL: controlled cord traction 5.

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