Checklist for Student

Actual

Prepared By: Analisa L. Pepito RN, MN

PROCEDURE
Drapes needed:
1. Gather materials needed for delivery. 1. One set of leggings
A. Mother- adult diaper and patient’s gown 2. 1 bottom sheet
B. Newborn- Baby’s layette ( shirt, diaper, booties, mittens, 3. 1 top sheet
blanket, bonnet) 4. 2 receiving blanket for
C. DR set and instruments: Newborn

1 Mayo scissor – this is used to cut the cord and the perineum.
1 Kelly clamp – used to clamp the cord towards the placenta
1 needle holder – used to hold the needle (sutures)
1 tissue forceps,
15 pcs 4 x 4 or sponge,
1 cord clip ,
1 kidney basin – for placenta
Sutures – Commonly used : Chromic 2-0, Vicryl
(Ask for physician’s preference)
1pc -5 cc syringe and Lidocaine for local anesthesia
Mayo table- all instruments are placed.

Rationale: Certain procedures requires a specialized

set and instruments for organization.
2. Assess uterine fundus by
palpating contractions (frequency,
duration, interval and intensity)
Rationale: To determine whether a
contraction pattern is typical of true
labor and identify abnormal
contractions that may jeopardize the
health of the mother and fetus.
Pattern of contractions:
1. Frequency – is the period from the
beginning of one uterine contraction to
the beginning of the next. Expressed in
minutes and fractions of min (such as
“contractions 3 1/5 to 4 min apart”.
2. Duration – is the length of each
contraction from beginning to end.
Expressed in seconds. Ex: “her UC’s last
55-65 seconds.
3. Intensity – is the strength of the
contractions. Described as mild (like the
tip of your nose), moderate (touch your
chin) and strong (touch your forehead)
4. Interval – the period between the end of
one contraction and the beginning of the
next. Most fetal exchange of oxygen ,
nutrients, and waste products occurs in
the placenta at this time.
• 3. Monitor progress of
labor using the partograph.

• Rationale:
• This records the vital
observations to assess
progress during labor
using a graph and to
recognize deviation from
the norm and decide on
timely referral.
4. Wash hands, wear sterile
gloves and apply lubricant.

• Rationale: This prevents

transmission of
microorganisms. Applying
lubricant gel reduces pain
during vaginal examination.
5. Perform vaginal examination
using your index and middle
fingers of the dominant hand. (The
thumb and other fingers are kept
out of the way to avoid carrying
microorganisms into the vagina)

Rationale: To determine cervical

dilatation, effacement, fetal
position, presentation, station and
whether the membranes have
ruptured.
6. Do perineal prep aseptically using 6
sponges. Take one sponge to begin each
new area and do not return to a clean area
with a used sponge. (24 pts 1-6)

The proper order and motions are as

follows.
1. Use a zigzag motion from mons pubis
to lower abdomen just above the
symphysis pubis.
2 & 3. Use a zigzag motion on the inner
thigh from the labia majora to about
halfway between the hip and knee. Repeat
for the other inner thigh.
4 & 5 – Apply a single stroke on one side
from clitoris over labia minora, perineum,
and anus. Repeat for the other side.
6. Use a single stroke in the middle from
the clitoris over the vulva and perineum.
Rationale: Prevents contamination or
cross contamination of an area which is
already clean.
7. Apply sterile drapes
(depending on agency practice) -
2 leggings, I bottom sheet and 1
top sheet.

Rationale:
Provides effective fluid
collection with easy clean-up and
disposal, while reducing the risk
of staff and patient contact with
blood and body fluids.
8. BIRTH OF THE HEAD
(28 pts A-G)

A. If an episiotomy is needed, perform it when the

head is well crowned.
Rationale: Minimizes blood loss from episiotomy.

B. As the vaginal orifice encircles the fetal head,

apply pressure on the woman’s perineum with one
hand while applying counterpressure to the fetal head
with the other hand (Ritgen’s maneuver)
Rationale: Controls the exit of the head so that it is
born gradually rather than popping out; this
minimizes trauma to the maternal tissues.

C. Wipe secretions from the infant’s face and suction

the mouth and nose with a bulb syringe.
Rationale: Removes blood and secretions, preventing
the infant from aspirating them with the first breath.
8. BIRTH OF THE HEAD

D. If there is a cord around the fetal neck(Nuchal cord), if it is

loose, slip over the head. If it is tight, it is clamped and cut
between two clamps before the rest of the baby’s body is born.
Rationale: Allows the rest of the birth to occur and prevents
stretching or tearing the cord.

E. After external rotation, apply gentle traction on the fetal

head in the direction of the mother’s perineum.
Rationale: External rotation allows the shoulders to rotate
internally and aligns their transverse diameter with the
anteroposterior diameter of the mother’s pelvic outlet. Traction
on the head in the direction of her perineum allows the
anterior fetal shoulder to slip under the symphysis pubis.
F. Lift the head toward the mother’s symphysis pubis.
Rationale: Permits the posterior fetal shoulder to be eased over
the perineum minimizing trauma to the maternal tissue.

G. Pull out rest of the infant’s body after the shoulders are
born and place on the mother’s abdomen. Maintain the infant
in a slightly head-dependent position while suctioning excess
secretions using bulb syringe (If needed).
Rationale: Gravity aids in spontaneous drainage of secretions
and prevents aspiration of oral mucous and secretions.
9. DELIVERY OF THE PLACENTA
(shortest stage lasting up to 30 min with an average
length of 5-10min)
(12 pts A-C)
A. Identify signs of placental separation.

1. Firmly contracting fundus- after the birth of the fetus , strong

uterine contractions cause the placental site to shrink markedly.
2. A change in the uterus from discoid to globular ovoid shape as the
placenta moves into the lower segment.
3. A sudden gush of dark blood from introitus.
4. Apparent lengthening of the umbilical cord as the placenta draws
closer to the introitus.
Rationale: The goal in the management of the 3rd stage of labor is
the prompt separation and expulsion of the placenta, achieved in the
easiest, safest manner.
Pressure should never be applied in a noncontracted state because
doing so could cause the uterus to evert( turn inside out)
accompanied by massive bleeding.

B. Apply controlled traction on the umbilical

cord and gentle massage when signs of
separation are noted.
Rationale: This facilitates delivery of the placenta and
amniotic membranes. Excessive traction on the cord may
cause it to break.

C. Inspect the placenta for completeness.

Rationale: To be certain it is intact and part of it was not
retained preventing the uterus from fully contracting and
lead to hemorrhage and infection.
10. Assist in Episiorrhaphy as needed. Take
note of the types of episiotomy done
( midline/median or mediolateral episiotomy)
(8 pts)

Two types of Episiotomy Incisions:

• 1.Midline/median incision- this is done
vertically, easy to repair, but it has a higher
risk of extending into the anal area.
• 2.Mediolateral Incision – this is done at an
angle. This offers the best protection from
an extended tear affecting the anal area,
but it is often more painful and is more
difficult to repair.

Rationale:
Routine episiotomies are no longer
recommended, but still, the procedure is
sometimes needed to prevent laceration or
unnecessary tear of the perineum. The pain
and discomfort resulting from episiotomies
can interfere with mother-infant interaction,
breastfeeding, reestablishment of sexual
relationship with partner, and even
emotional recovery after birth.
11. Do perineal care and place adult diaper.

Rationale:
To provide comfort and easy assessment of the
amount of lochia

12. Check DR instruments, clean and soak per

agencies policy.

Rationale:
This is done to check for completeness of instruments
used, for sterilization of instruments ready for next
deliveries. Instruments are generally presoaked or pre-
rinsed to prevent drying of blood and tissue.
13. Disinfect Delivery room and DR
table.

Rationale:
Disinfecting the delivery room and table
prevents cross contamination and spread
of microorganisms.

14. Record the procedure done,

assessment and data of the client.
Rationale:
Documentation provides an accurate
nursing skills done and pertinent patient
information support the
multidisciplinary team to deliver quality
care.