LEVEL 2 NURSING SKILLS LABORATORY MANUAL

JMJ Marist Brothers

NOTRE DAME OF MARBEL UNIVERSITY
Alunan avenue, City of Koronadal, South Cotabato

COLLEGE OF ARTS AND SCIENCES

Nursing Department

ASSISTING AND HANDLING DELIVERY

INTENDED LEARNING OUTCOMES:

At the end of lecture demonstration, the students can:
1. Define labor.
2.Discuss the mechanisms of labor and the four stages of labor.
3. Perform the step-by-step procedure in handling a delivery with 100 % accuracy.
DEFINITION. Labor is a series of continuous, progressive contractions of the uterus
which help the cervix to open (dilate) and to thin (efface), allowing the fetus to move
through the birth canal. Labor usually starts two weeks before or after the estimated
date of delivery.
STAGES OF LABOR
1. First Stage- cervical dilatation stage, from onset of labor until full dilatation of
cervix.
2. Second Stage – expulsion stage, from full dilation of cervix to birth of baby.
3. Third Stage of Labor - placental stage, from birth of baby to expulsion of
placenta.
4. Fourth Stage of Labor - recovery stage, time after birth of immediate recovery;
EQUIPMENT/MATERIALS NEEDED
a. OB pack - Pair of leggings, 1 mayo cover, 4 hypotowels, 1 hand towel, 2 draw
sheets (linen)
b. Xylocaine 2% injection
c. Pair of sterile gloves
d. 6 pcs 4x4 gauze
e. 1 inch plaster
f. 1 withdrawing needle gauge 18
g. KY jelly
h. Straight Catheter
i. 5 cc syringe
j. 1 hypotowel
k. 2 Kelly forceps
l. Bandage scissors
m. Mayo scissors
n. 1 needle holder
o. Tissue forceps
p. Surgical suture with needle
q. Plain NSS for irrigation 1 liter
r. 1 Kidney basin
s. Maternity napkin/ adult diaper
t. 1 Kelly pad
u. 2 ovum forceps
v. 2 jars for the pick up forceps
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 w. 2 waste containers
x. Mayo table

PROCEDURE RATIONALE

KNOWLEDGE
1. Define the procedure.
2. Discuss the purposes of doing the
procedure.
3. State the needed equipment and
materials in doing the procedure

SKILLS
4. Assemble all the equipment. Open the
OB pack. Ensure that principles of
aseptic technique are observed.
5. Do perineal prep prior to surgical hand
scrub.
6. Perform surgical
handwashing/scrubbing.
7. Dry hands with a sterile towel.
8. Don sterile gloves.
9. Arrange linens and instruments in the
mayo table.
10. Put on sterile leggings and sterile
towels on top of the abdomen and
under the buttocks.
11. Aspirate lidocaine (a local anesthetic)
with the assistance of the circulating
nurse this is indicated for primipara for
episiotomy.
12. Assess for the extent of labor, once
the head has crowned, the head is
born by the extension of the face.
13. By the time the head is delivered,
wipe the infant’s face and mouth with
a gauze.
14. Check with 1 (one) finger if the cord is
wrapped around the baby’s neck.
a. If cord is present and loose, deliver
the baby through the loop of the
cord or slip it over the baby’s head.
b. If cord is tight, clamp it on two
sides and cut the cord and unwind
it from around the neck.
Promotes efficiency of work.
Reduces the risk of infection post vaginal
delivery.
Handwashing helps to prevent the spread
of microorganisms.
Dry hands facilitates easy donning of
gloves.
Protects from contaminations from blood
and other secretions.
Maintain the sterility throughout the
procedure.
Facilitates easy access to supplies and
instruments.
Maintains aseptic technique.
Prepares medication for the induction of
anesthesia.
Determines progress of labor, the
descent of the fetus.
Removes secretions from the mouth and
nose to reduce the risk of aspiration.
To ensure the umbilical cord is not around
the neck.
Loose it so it can slip over the baby’s
head or shoulders.
Prevents birth asphyxia (fetal oxygen
deprivation).

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15. Allow the baby’s head to turn
spontaneously and place hand on
each side of the baby’s head, over the
ears, and apply slow, gentle pressure
downward and outward traction.
16. Move the topmost hand from the head
to support the rest of the baby’s body
as it slides out. (Remember that
newborns are wet and slippery be
careful not to drop the baby).
17. Note the time of the delivery and the
gender of the baby.
18. Place the baby on the mother’s
abdomen and thoroughly dry the baby
and cover with a sterile clean, dry
cloth.
19. Wait 1-3 minutes before clamping and
umbilical cord stops pulsating.
20. Assist the physician in delivering the
placenta. Watch for signs of placental
separation.
21. Note for the time of placental delivery,
presentation and inspect for
completeness of the cotyledons.
22. Assist the physician in performing
episiorrhaphy.
23. Apply ice pack over the fundus.
24. Perform perineal care with antiseptic
and sterile water. Removes all traces
of betadine from the patient’s skin. Dry
perineal area.
25. Place maternity pad in patient’s
perineum.
26. Perform aftercare.
27. Removes gloves and dispose in an
appropriate receptacle.
28. Wash hands.
29. Document relevant data.
a. Note the time of delivery.
b. Gender of baby.
c. Placental delivery and
presentation
Facilitates the delivery of anterior
shoulder.
Facilitates the delivery of the baby.
Serves as a legal purpose and for
documentation.
Keep the baby warm.
Leaving the cord attached will help the
baby to have enough iron in his or her
blood, because some of the blood in the
placenta drains along the cord and into
the baby.
Signs of placental separation include a
slight gush of dark blood from the
introitus, change in the uterine contour
from discoid to globular shape, and
lengthening of the cord.
Assessment of any retained placental
fragments results in bleeding and
infection.
Facilitates performance of the procedure.
Promotes contraction of the uterus thus
prevents bleeding.
Removes blood and mucus from the
mother’s perineum – may cause irritation
to the skin.
Maternity pad absorbs blood from the
uterus, thus providing comfort to the
mother.
Prevents the transfer of microorganisms.
Promotes infection control.
Handwashing helps to prevent the spread
of microorganisms.
Documentation provides a record for
communication and evaluation of patient
care.
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ATTITUDE
30. Maintained good nurse patient
interaction.
31. Observe courtesy and tactfulness.
32. Performs the procedure efficiently
33. Appears clean and well groomed.
34. Accept corrections and criticisms
counteractively.
35. Clean organized and systematic in the
entire procedure.
36. Shows calmness and confidence.

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