ESSENTIAL INTRAPARTUM AND NEWBORN CARE

PRIOR TO PATIENT’S TRANSFER TO THE DR

Ensure that mother is on her position of choice when in labor.

Ask mother if she wishes to eat/drink.
Communicate with the mother- inform her of progress of labor, give reassurance and
encouragement.

PATIENT ALREADY IN THE DR

Preparing for Delivery

Check temperature in DR area, check for air draft.
Ask patient if patient is comfortable in the semi-upright position which is the default position.
Remove all jewelry.
Wash hands thoroughly observing the proper procedure.
Arrange things in a linear fashion:
Gloves, dry linen, bonnet, oxytocin injection, plastic clamp, instrument clamp, scissors, 2 kidney
basins
Clean the perineum with antiseptic solution.
Wash hands.
Put on 2 pairs of sterile gloves aseptically. (if same worker handles perineum and cord).
At the time Delivery
Encourage woman to push as desired.
Apply perineal support and do controlled delivery of the head.
Call out time of birth and sex of baby.
Inform the mother of outcome.
First 30 seconds
Place the baby on a clean, dry cloth/towel on the mother’s abdomen.
Thoroughly dry baby for at least 30 seconds, starting from the face and head, going down to the
trunk and extremities.
1-3 minutes
Remove wet cloth.
Place baby on skin-to-skin contact on the mother’s abdomen.
Cover the baby with a clean, dry cloth/towel.
Cover baby’s head with a bonnet.
Exclude a 2nd baby by palpating abdomen. Use the wet cloth to wipe the soiled gloves. Give IM
oxytocin within one minute of baby’s birth. Dispose off the wet cloth properly.
Remove the 1st set of gloves.
Decontaminate these properly (by soaking in 0.5% chlorine solution for at least 10 minutes)
Palpate umbilical cord to check for pulsations.
After pulsations stopped, clamp cord using the plastic cord clamp at 2 cm from base.
Place the instrument clamp 5 cm from the base.
Cut near plastic clamp (not midway).
Perfom the remaining steps of the Active Management of Third Stage of Labor:
Wait for strong uterine contractions then apply controlled cord traction and counter traction on
the uterus, continuing until placenta is delivered.
Massage the uterus until it is firm.
Inspect the lower vagina and perineum for lacerations/tears and repaired lacerations/tears if
necessary.
Examine the placenta for completeness and abnormalities.
Clean the mother: flush perineum and apply perineal pad/napkin/cloth
Check baby’s color and breathing; check that mother is comfortable, uterus contracted.
Dispose off the placenta in a leak-proof container or plastic bag.
Decontaminate (soaked in 0.5% chlorine solution) instruments before cleaning; decontaminate 2nd
pair of gloves before disposal.
Advise mother to maintain skin-to-skin contact. Baby should be prone on mother’s chest/in between
the breasts with head turned to one side.
15-90 minutes
Advise mother to observe for feeding cues (cited examples)
Support mother, instruct her on positioning and attachment.
Wait for FULL BREASTFEED to be completed.
After a complete breastfeed, administer eye ointment (first), do thorough physical examination, give
Vit. K, hepatitis B and BCG (simultaneously explain purpose of each intervention).
Advise OPTIONAL/DELAYED bathing of baby (and is able to explain the rationale).
Advise breastfeeding per demand and about Danger Signs for early referral
In the first hour: check baby’s breathing and color; and check mother’s vital signs and massage uterus
every 15 minutes.
In the second hour: check mother-baby dyad every 30 minutes to 1 hour.
Complete all RECORDS: administer eye ointment, vitamin K, hepatitis B and BCG.