CONDUCTION OF NORMAL VAGINAL DELIVERY

Definition

Systematic process of enabling a woman to safely deliver foetus, placenta and membranes
through birth canal

Purposes

To help her deliver baby Safe environment

To detect and prevent complication during delivery

Equipment

1. Delivery bundle consisting

Surgeon gown 2

Delivery sheet1

Leggings 2

Surgical towel 2

2. Delivery instrument set consisting

Large size k- basin

Small bowel of cotton and gauze

Kelly clamp

Curved Kelly clamp 1

Small cord cutting scissors and sterile pad 1

Cord clamp

3.Episiotomy set consisting of

K-basin

Bowl of gauze

Needle holder

Thumb forceps
Artery forceps straight

Round body and cutting needle

LP needle and 2-0 cotton suture material

4. Other equipment

Injection tray with

20cc syringe

20G, 22G needles

Lignocaine 1%( local anaesthetic )or lignocaine 2% with water for injection

Injection methergine0.2 mg/inj

Pitocin 10 units

Mucus sucker

1-0 chromic catgut

Tampoon and extra gauze pieces

Episiotomy scissors

Sterile gloves

Cleansing solution

Spot light

Linen for mother and baby

Voveran suppository

Placenta cover

Procedure

Steps Rationale

Explain procedure to the women and offer Helps in establishing rapport with patient
encouragement

Provide privacy Wins patient co operation

 Bring her to edge of bed or keep in middle of For ease of visualization
cot and position in lithotomy

Assemble equipment to right side, and keep

neonatal area also ready with warmer, suction
and oxygen

Wear mask, apron and scrub hand for 5 To prevent cross infection
minutes

Wear sterile gown and gloves To maintain aseptic technique

Clean perineum with antiseptic solution

Drape the woman with delivery sheet under

buttocks, legging to legs and towel over
abdomen

Ensure that the bladder is empty Full bladder can delay delivery

Encourage her to bear down when she get

expulsive contraction

If episiotomy is necessary, do so when head Episiotomy give space to the baby’s arrival
Crowns, after infiltrating perineum with
lignocaine

Turn off fan while delivering baby

Support perineum with dominant hand using

towel and control extension with non dominant
hand when head is being delivered

Clear Airway of baby by suctioning Opens airway

Wipe eyes with sterile cotton Prevents infection

Feel for presence of cord around the neck And

if cord is tight, clamp and cut immediately ( if
Cord is loose, flip it over the baby's head )

Wait for restitution and internal rotation off

shoulders to take place

Hook neck by applying two fingers over neck

and Two under neck and deliver anterior
shoulder by giving download traction. Then
deliver posterior shoulder by upward traction

Deliver body by lateral flexion ( towards

women's abdomen )

Hold baby's head to the angle of 45 degree

with head low position

Note time of birth

Evaluate baby's condition at birth

Code is clamped near vulva by an assistant.

Milk cord and apply Second clamp 5cm away
from first one. If baby is asphyxiated or
amniotic fluid is meconium stained, apply one
more clamp towards baby's side you take blood
for ABG

Cover cord with gauze pieces cut umbilical

cord in between the two clamps

Administer injection pitocin 10 units i m after

the delivery of the baby. If she bleeds
administer injection methergine0. 2 mg IV, if
there are no contraindications (PIH, cardiac
disease )

Receive baby dry sheet,clear Airway, wipe

and wrap baby

Wait for placenta to separate Prevents unnecessary bleeding

Confirm placental separation

Deliver placenta by modified brand Andrew

method using controlled cord traction. Clamp
cord near vulva and hold clamp with two
fingers of dominant hand. Keep non dominant
hand just above symphysis pubis and
compresse fundus. Deliver placenta with slight
rotatory movement
 After the delivery of the placenta, massage the
uterus and empty the blood clots to enhance the
tonicity of the uterus

Massage uterus after it is completely empty Massaging improves uterine contraction

Tie identification tag on mother and baby.

Show baby to mother and relatives and ask
them to identify.

Examine for para urethral, perineal or vaginal

tear

Insert a tampon and Secure one end with an

artery clamp

Suture episiotomy and perineal tear with 1-0

catgut, cervical,para urethral vaginal tear with
2-0 catgut

Clean perineum insert voveran suppository,

fix pads, change linen and make mother
comfortable

Provide warmdrink

Measure cord length by hand span and check

with inch tape

Examine placenta for any abnormality

weigh placenta at earliest and dispose

according to hospital policy

Document details of delivery and flat sandal

examination

Aftercare

Replace items in respective place

Watch for bleeding from vagina and episiotomy site

Check vital sign every 30 minutes for next 2 hours

Encourage mother to eat normal food and drink fluids

Initiate breastfeeding within an hour of delivery

Encourage voiding

Check fundal height after voiding

Check baby's cord for bleeding

Transfer to ward after voiding. Make sure postnatal orders, transfer order and prescription are
written.