Labor and Delivery

Week Week 6

Lesson # RLE RLE 1F

Type Finals

STUFF TO REMEMBER (noots by sundae)

materials needed:

Links for References

LINKS

Title Links Type

Unang Yakap Training (Essential Newborn Care) Training https://www.youtube.com/watch?v=AjcoR2tozyQ Video

Handle(1) https://www.youtube.com/watch?v=oob17XS9j3w Video

Immediate Cord Care(2) https://www.youtube.com/watch?v=RgkRD-Da8sw Video

Assist(3) https://www.youtube.com/watch?v=vXv2siKefh0 Video

Ballard’s Assesment Tool https://www.youtube.com/watch?v=vH4WiqUhQSM&t=165s Video

NEWBORN DELIVERY DEMO (GUIDE) [video references are placed above + refer to proc guide]
!! note: instructions may change during retdem. this guide is for knowing the flow of the procedure !!

A. HANDLE
OB PACK OB SET

Towel kelly curve

Gown kelly straight

Towel needle holder

Gown placental bowl

2 Leggings stainless medicine cup

3 Square Sheets tissue forceps with teeth

Towel

Square Sheet

**green thingy
(leggings)**

Labor and Delivery 1

 **4 square sheets (2 are
colored blue, 2 are
colored green)**

before procedure:

wear cap and mask and OR/DR uni

place woman on lithotomy position on delivery room table

patient is offered with cap and mask

perineal care is performed b4 delivery of baby

Step 1: Do medical handwashing

Step 2:

Remove OB pack using BARE HANDS

make sure that the forceps will not touch the back table

forceps must not touch the table lining which is below waist level (bc it is not sterile)

Step 3:

place the folded part of towel and gown are towards edge of the table (edge away from the delivery room table)

[towel gown towel gown] can be on left side

rest can be on right side [leggings, square sheet, towel, square sheet]
Step 4:

Open OB set away from sterile field

grip the rim of the placental bowl

grab the inner cover of OB set and place it on table (place inner cover under back table)

Step 5:

soak and rinse bandage scissors and surgical scissors before placing them on back table

*make sure uni doesnt touch the sterile field*

[dispense items]

how to open suture book: up → side → fold to the sides → then fold to the back → fold downwards then dispense.

place syringe on placental bowl

suction bulb should be held on the nozzle when dispensing it (round end facing towards bowl)

drop gauze on placental bowl

**ask physician for the size of sterile gloves**

unwrap 2 sterile gloves and drop on back table

* what will be left to dispense is anesthesia/lidocaine**

Step 6:

Do 3 medical handwashing

3 surgical handwashing (pre-medicated brush is used/ ordinary handbrush with antiseptic solution)

after, drop the brush

return to demo room

grab the hand towel using dog-ear (dont forget to lean forward and dry hands properly up until elbows) drop towel
down

Step 7:

grab the gown with thumb facing down

flip the gown and locate for arm hole

insert arms to arm holes

Labor and Delivery 2

 make sure hands dont come out from the sleeve cuffs

have circulating nurse securely tie back of gown at neck part and waist.

*circulating nurse grabs only the tips of the ties.*

closed gloving will be done first on nondominant hand

face nondominant palm up, place palm of glove against it. (thumb of glove rests on thumb of hand)

grasp glove cuff and turn glove cuff over the end of the nondominant hand

* u may fold cuff of sleeve if opening is too wide**

glove the other hand.

fold back the glove wrapper and place it underneath the drapes. (the one with leggings)

Step 8, Step 10 and 11 (combined):

**(10 & 11 goes first)**

ask the circulating nurse to pour anesthesia

remove the needle and cap simultaneously before aspirating the anesthesia

start arranging the instruments according to use: (from the pov of physician; aka left to right)

bandage tissue forceps w/

syringe kelly curve kelly straight surgical scissors needle holder
scissors teeth

* all handles are faced toward the physician and tip towards the nurse **

place the empty glove wrapper underneath the placental bowl (protects back table lining of blood spillage)

arrange the gauze from nurses side to physician in cascading manner (5 sa left, 4 sa right)

*the 10th gauze will be used to wrap the suction bulb**

Step 9:

count gauze agen

open gauze fully including edges then locate centermost

insert the nozzle of the suction bulb then twist and tie the tail end of the gauze (place back the suction bulb sa
placental bowl, then place medicine cup sa upper right)

Step 12:

serve towel to physician

in serving gown, locate neckline then position armholes facing the physician and release the gown as it reaches
his FOREARM

*circulating nurse will tie the strings of the gown**

serve right glove first

unfold the cuff of the right glove

make sure that the thumb side of the glove is facing the physician

*when giving sterile gloves sa doc, 1 foot forward and thumbs up**

do same thing with left glove

fold back the wrapper and set it aside (the one across sa ob pack)

STEP 13:
apply drapes in ff seq:

2 leggings

2 square sheets for abdomen

1 square sheet for buttocks

**green thingy (leggings)**

**4 square sheets (2 are colored blue, 2 are colored green)**

Labor and Delivery 3

 flip leggings and notice the tail slipping out, grab the tail end and form triangular shape towards u (widens opening
of the leggings)

*opening should be towards the patient**

inform patient na mo insert na sha sa leggings

*see to it that sterile gown and gloves will not touch patient**

apply 2nd legging using same technique

take square sheet/top sheet by grabbing the dog ear then apply it to abdomen (2 of them will be placed sa
abdomen)

apply another square sheet for the buttocks

*to protect sterile gloved hand, fold inward part of the square sheet being held*
[“ma’am saka lubot” ]
STEP 14:

push table near the mother

anticipate physician will use syringe

*do not serve and receive the syringe**

*do not remove cap of needle during retdem**

anticipate to serve bandage scissors for episiotomy

*in serving instrument, handle should be towards physician, tip should be towards nurse*
*physician will perform episiotomy (median or mediolateral)**

nurse will now prepare towel drape for perineal support

STEP 15:

grab the blue towel (square sheet)

refold hand towel that is used for perineal support

trifold towel in a way that the side with the flap is folded inward

to support perineum, place right hand inside the hand towel. (so that after refolding, none of the flaps hang at the
back of ur hand)

in supporting perineum, use this part of the palm and apply a forward-upward thrust

handle will position to the left side of physician

apply support to perineum

cover the perineum (lower)

*only apply force when mother already bears down*

[“okay ma’am, the contraction is coming… 1,2,3, push!”]

STEP 17: [PHYSICIAN]

deliver anterior shoulder first by pulling body downward

Labor and Delivery 4

 deliver posterior shoulder by pulling upward

STEP 18: [PHYSICIAN]

the physician will slide his dominant hand at the posterior part of the newborn and grip both legs.

STEP 19: [PHYSICIAN/NURSE]

call out time of birth after baby is out

indicate sex of baby

STEP 21:

after baby is fully out, drop support to rim of bucket

return to back table

STEP 16: [PHYSICIAN]

handle will then serve suction bulb to phys.

physician will suction mouth 1st, then nose

STEP 20 will den be performed by physician or nurse:

1. newborn should be placed on abdomen

2. 1st min. APGAR is done

STEP 22 & 23: [PHYSICIAN]

(1st) curved kelly: 8-10 inches away from base of umbilicus sa baby

(2nd) straight kelly: clamped towards the baby, 1 inch apart from kelly curve

physician will cut the cord in between 2 clamps (dont actually cut it during retdem)

endorse baby to cord care nurse

STEP 24:

Signs of placental separation:

1. Lengthening of umbilical cord

2. Sudden gush of blood

3. Placenta visible at vaginal opening

4. Uterus contracts and feels firm again

anticipate to serve for placental bowl

observe for mechanism of placental expulsion (schultze or duncan)

schultze: the one attached sa cord; baby

duncan: outer part; mother

*in real setting, do not pull the cord and placenta**

place placental bowl on the glove wrapper

STEP 25:

anticipate to serve for operative sponges/gauze b4 episiorrhaphy (used to wipe and absorb blood after placental
delivery)

physician will remove square sheet underneath buttocks and replace w/ another one

anticipate to serve the ff. during episiorrhaphy

Labor and Delivery 5

 needle holder

tissue forceps w/ teeth

surgical scissors

gauze

suture book

needle holder
— used to grasp and clamp the needle during procedure

clamp needle holder

tissue forceps w/ teeth

— used to grasp skin/other tissues

surgical scissors

— used to cut the suture after creating a knot

!! suture and needle: !!

single arm suture or double armed may be used

AFTERCARE/PREPARATION extra:

how to pack square gauze: **don’t forget the dog ear**

Labor and Delivery 6

 how to fold gown:

fold inner → place sa side ( place all inner parts inside) → fold again going to center → trifold

wrapping OB pack (inner part)

Labor and Delivery 7

 B. CORD CARE
before procedure:

ff. must be wrapped:

steel medicine cup

5 swab sticks

umbilical cord clamp

5 pcs gauze or OS (operative sponge)

kidney basin

surgical scissors

STEP 1: perform medical handwashing and open gloving

STEP 2: perform 5th minute apgar scoring

*done while drying the baby*

unwrap the towel of baby

A = appearance

look into the color of baby

P = Pulse

check for heart rate

G = Grimace

check for reflex irritability

*Reflex irritability - term used to describe response of the newborn to stimulation s/a suctioning and slapping
of the foot*
A = Activity

check muscle tone

R = Respiration

check for respiratory effort

*during retdem, the teacher will be the one to tell u findings of APGAR and u will be the one to determine the
score*

Labor and Delivery 8

 STEP 3:
*mouth first then nose*

how to do proper suctioning:

press → insert → release
STEP 4: change the flannel of the baby with a new one
STEP 5: Open necessary materials

open kidney basin

open med glass

STEP 6: Pour Povidone-Iodine in medicine cup and soak cotton swab sticks to antiseptic solution.

place surgical scissor and umbilical cord clamp to kidney basin

*for OS/gauze, do not place it inside sterile kidney basin to not be spilled w/ blood*

wrap the cord with kelly straight

*begin by uncoiling the cord if and when the umbilical cord is twisted*
STEP 7: Twine the cord down using Kelly straight.
*twine the cord towards the centermost part of kelly*

*make sure that you wont pull the cord as u hold it*

STEP 8:
*dip swab sticks on povidone iodine *
1ST SWAB STICK

Labor and Delivery 9

 clean base of cord in sunrays manner

*make sure u wont miss any area*

discard swab stick on waste rec.

2ND SWAB STICK

disinfect from base going up (do it on all sides)

clamp cord 1 inch from the base using plastic cord clamp

*u will hear clicking sound once u have locked the cord clamp well*
how to place gauze:

place gauze on base of the cord

support plastic cord clamp by placing middle and index finger immediately below it

cut on top of umbilical cord clamp (clean cut)

place the cord and kelly straight on kidney basin

remove gauze and discard

3RD SWAB STICK:

disinfect the cord clamp

Labor and Delivery 10

 start with top (start from opening of clamp to the edge) → back of cord clamp → bottom → front of cord clamp →
bottom

4TH SWAB STICK:

disinfect the cord from the clamp to base of cord (front and back)

5TH SWAB STICK:

disinfect base of the cord using sunrays manner agen

cover the baby with flannel

STEP 9:
observe if it has two arteries and one vein (AVA)

STEP 10: Perform 10th minute APGAR as necessary.

C. ASSIST
before procedure:

baby must be wrapped with towel/flannel

STEP 1: Do medical handwashing and open gloving

STEP 2: Suction secretions as needed.

*mouth first then nose*
STEP 3: Apply eye prophylaxis from inner to outer canthus of the eye.

discard ONE squirt first to GLOVED HAND

*in retdem, cap of eye prophylaxis must not be removed*

*make sure that metal or plastic tip of eye prophylaxis will not touch eye of the baby*
STEP 4: Take anthropometric measurements

wrap baby and then place on weighing scale

*make sure that weighing scale is set to 0*

*remove flannel before placing baby on weighing scale*

see to it that balance indicator is aligned to center mark

do reading for weight and wrap baby afterwards

take head, chest and mid-arm circumf followed by abdominal girth

landmarks:

HEAD circumf above eyebrows

Labor and Delivery 11

 CHEST circumf nipple

ABDOMEN above umbilicus

MID-ARM circumf bet. acromion & olecranon process

start with center of forehead → draw around the occiput (posterior portion)

lift baby by supporting head, neck and back

transfer tape measure to chest → align tape measure on nipple line → read chest circumf

transfer tape measure underneath abdomen

*make sure to not include umbilical cord in measuring*

*make sure to lift the baby before pulling the tape measure to avoid abrasions*

take mid arm circumf between acromion and olecranon process

*remember findings for documentation later on*

*head circumf > chest circumf > abdominal girth*
measurements

HEAD circumf 33 - 35.5 cm

CHEST circumf 30-33 cm

ABDOMEN 30 - 33 cm (?)

MID-ARM circumf 12 cm

CROWN TO HEEL 46-54 cm

*if there are unusualities in measuring, reassess the baby*

Labor and Delivery 12

 unwrap baby

take the length by placing baby to side and measure from crown to heel following contour of the body

wrap the baby

STEP 5 & 6:

prepare materials needed for vitamin K and Hep B admin.

disinfection:

AMPULE neck to top

VIAL top to neck

VIT K (ampule)

term newborn 0.1 cc / mL / 1 mg

preterm infant 0.05 cc / ml / 0.5 mg

*based on 10mg/ml dosage of vit k*

HEP B (vial)

0.5 cc / ml / 5 mg

collect vit k from ampule

*dont forget to NOT introduce air to ampule*

*do not remove cap of syringe during retdem*

collect hep b from vial

*for vial, aspirate air equiv to amount of medication that u will withdraw from vial*

inject air to vial and aspirate vial

place the syringes on hypotray

prepare hypoallergenic tape before administration of medication (use bandage scissors)

place cotton ball in between pinky and ring finger

using alcohol swab, disinfect injection site

*injection site is on vastus lateralis*

administer VITAMIN K ON LEFT THIGH
inject → hold hub → aspirate → no blood → inject → cotton → release → tape

place the used syringe temporarily on lined hypotray

administer HEPA B ON RIGHT THIGH

*follow prev steps*

STEP 7:

Apply KY Jelly on thermometer

Labor and Delivery 13

 insert thermometer sa rectum (normal rectal temperature: 36.3-37.9 C)

check for presence of imperforate anus

STEP 8: Apply diaper

*make sure that cord will not be placed inside*
STEP 9: Identification Band

1 on arm; 1 on ankle
*blue for male and pink for female*
STEP 10: Ballard’s Assessment of Gestational Age Criteria

STEP 11:

shirt then bonnet then mittens

Labor and Delivery 14

 *soft side will be touching the baby’s head*

then wrap it with flannel

place baby on crib with crib tag

DOCUMENTATION:

APGAR:
*1st and 5th are req, 10th is optional lang if the prev test jd non-reassuring *
BALLARD’S:
*for maturity rating: if score is not present on given table, place score bet. line and for weeks just insert the
one in bet. those lines*

Labor and Delivery 15