Republic of the Philippines

City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

College of Allied Health Studies

Detailed Learning Module

Program: Graduate in Midwifery

Course Code: Clinical Practicum 102(MDW 101)

Title: Essential Intrapartum Newborn Care

Assisting Normal Birth with Active Management of Third Stage of Labor
Identification of instrument, supplies and other equipment used in assisting normal birth

Module No. 1

I. Introduction: Midwives are expected to perform a variety of procedures in the course of caring for a patient
throughout pregnancy, delivery and the postpartum period. Most of them are learned in the undergraduate
program. However, some would need further enhancement as mastery of these skills would greatly affect their
ability to respond critically and effectively under pressure. This module will focus on developing skills in
assessing normal birth with active management of third stage of labor. It is also includes the familiarization of
different instrument, supplies, medications, proper attire used in attending the normal spontaneous delivery.

II. Learning Objectives: At the end of the module, the participants will be able to perform basic essential
midwifery skills. The participants will be able to:
o Outline the step-by-step procedure in assessing normal birth with active management of third stage
of labor.
o Know the different instrument, supplies, medication, the proper attire used in attending the normal
spontaneous delivery.
o Analyze the possible complications by practicing the active management of third stage of labor. o
Correlate and anticipate to manage the complications that may happen throughout the procedure

III. Topics and Key Concepts

Discussion:
Topic 1: Identification of instrument, supplies and other equipment used in assisting normal birth

Principles: Sterile persons have scrubbed and are

gowned and gloved. Unsterile person have not.

Only Sterile items are used within the sterile field.

Proper packaging, sterilizing, and handling should provide such assurance. If you are in doubt about the
sterility of anything consider it not sterile. Known or potentially contaminated items must not be transferred
to the field.
For example:
1. If sterilized packaged is found in a non sterile workroom.
2. If uncertain about actual timing or operation of sterilizer. Items processed in suspect load are unsterile.
3. If unsterile person comes into close contact with a sterile table and vice versa.
4. If sterile table or unwrapped sterile items are no under constant observation.
5. If sterile package falls to the floor; it must be discarded.
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
 Olongapo City Sports Complex, East Tapinac, Olongapo
City Tel. No. (047) 224-2089 loc. 314
and at or above waist level. Gowns protected by cuffing drape over
are considered sterile only from them.
waist to shoulder level in front and
the sleeves
Circulating nurse pouring sterile
solution in to a sterile basin. Note
that only the tip of bottle is over
the basin. Non sterile person
avoids reaching over a sterile field.
Sterile scrub nurse draping the
mayo table. Sterile person avoid
reaching over a non sterile field.
Therefore drapes nonsterile table
first toward self, then away. Gown
is protected by distance. Hands are
Sterile person keeps hands in sight

Gowns are considered sterile only from the waist to shoulder level in front and the sleeves. When wearing a
gown, consider only the area you can see down to the waist as the sterile area.
Scrub midwife holds the sterile fan non sterile table and unfolds drape
folded non sterile drape and unfolds first toward self. Note that hands
drape first toward itself. Note that are inside cover to protect them.
the hands are inside sterile cover to Scrub midwife continuing to
protect them. unfold sterile drape. Hands are
inside sterile cover for
Tables are sterile Only at table protection. Midwife may now
Level: move closer to the table, since
Scrub midwife unfolds sterile the first part of unfold drape
drape. Midwife stands back from now protects gown.
Draping a large non sterile table.

1. Only the top of a table with sterile drape is considered sterile. Edges and sides of drape extending below
table level are considered unsterile.
2. Anything falling or extending over table edge such as a piece suture, is unsterile. Scrub midwife does not
touch the part hanging below the table.
In unfolding sterile drape, the part that drops below the table surface is not brought back up to table level.
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

DELIVERY ROOM-It is called a labor, delivery, and recovery room (LDR). This is the type of room that some
hospitals and almost all birth centers use for their care. Once you are placed in a room, this is the room that
you will use for your labor and birth, including the initial hours of recovery.
DELIVERY ROOM ATTIRE- consists of the scrub dress, head cover, mask and shoes cover. Sterile gown and
gloves are added for scrubbed team.
The purpose is to provide effective barriers that prevent the dissemination of microorganisms to the patients
and to protect personnel from infected patients.
operating suite
Head Cover-is used to cover hair
completely
Shoes-should be clean and
conducive washable and soft-soled
covered by she covers

Scrub Dress-worn only in the

Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo
City Tel. No. (047) 224-2089 loc. 314
before coming into the operating team members.
room and must be worn over nose
and mouth

HANDWASHING BY WHO
Sterile gown-are worn over scrub
attire
Sterile gloves- are worn to
complete the attire for scrubbed
Mask- is put on by all personnel

Hand washing is one of the simplest and most effective means of preventing the spread of flu and other infectious
diseases.

Regular handwashing is one of the best ways to remove germs, avoid getting sick, and prevent the spread of
germs to others. Whether you are at home, at work, traveling, or out in the community, find out how
handwashing with soap and water can protect you and your family.

Hand washing is one of the simplest and most effective means of preventing the spread of flu and other infectious
diseases.
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

GLOVING BY OPEN GLOVE TECHNIQUE

This method of gloving uses a skin-to-skin, glove-to-glove technique. The hand, although scrubbed, is not
sterile and must not contact the exterior of sterile gloves. The everted cuff on the gloves exposes the inner
surfaces. The first glove is put on with skin-to skin technique, bare hand to inside cuff. The sterile fingers of
that gloved hand then may touch sterile exterior of the second glove, i.e. glove-to-glove technique.

1. With the left hand, grasp the cuff of the right glove on the fold. Pick up the glove and step back from
the table. Look behind you before moving.
2. Insert right hand into glove and pull it on, leaving the cuff turned well down over hand. 3. Slip finger of
the gloved right hand under the everted cuff of the left glove. Pick up the glove and step back.
4. Insert hand into the left glove and pull it on leaving the cuff turned down over the hand. 5. With
fingers of the right hand, pull cuff of the left glove over cuff of the left sleeve. If the stockinet is not
right, fold a pleat, holding it within right thumb while pulling the glove over the cuff. Avoid touching the
bare wrists.
6. Repeat step 5 for the right cuff, using the left hand, and thereby completely gloving the right hand.

INSTRUMENT, SUPPLIES, EQUIPMENT USED IN ATTENDING THE NORMAL SPONTANEOUS DELIVERY

hold the needles during the tips have "teeth" to used for cutting the
surgical operations, securely hold a tissue. umbilical cord.
clamping the needle Clamp Forcep-securely
firmly. hold/clamp the umbilical
Tissue Forcep- for cord
grasping tissue. Often, Umbilical Cord scissors-
Needle holder- used to
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
 Olongapo City Sports Complex, East Tapinac, Olongapo
City Tel. No. (047) 224-2089 loc. 314
umbilical cord and/or povidone
sutures iodine solution
Kidney basin- used for
the collection of
placenta
Cord clamp- used to
hold the cord in place
when the cut is made
Surgical scissor-used to cut Cotton ball with

Sanitex Chromic/sutures Lidocaine Oxytocin ampule

Vitamin K Hepatitis B vaccine BCG vaccine Syringes (3 cc, 1cc) OS stethoscope Mayo tray and stand

Baby's bonnet/cap Linen Kelly pad Surgical gloves (2 set) pail DR table stretcher Stool Ambu bag

Republic of the Philippines

City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

Oxygen tank and regulator Suction apparatus and tip IV stand, IV fluid Doppler

What is the Essential Newborn Care Protocol?

o Series of time bound chronologically ordered, standard procedures that a baby receives from birth
 o Simple, to-the-point, user-friendly, globally accepted evidence-based protocol to essential newborn
care focusing on the 1st week of life
o Doable even by a single health worker caring for both mother and newborn

The First 90 Minutes

o Immediate Essential Newborn Care

Time band: 2nd stage of labor

o At perineal bulging, with presenting part visible
Intervention: Prepare for the delivery
Action:
o Ensure that delivery area is draft-free and room temperature between 25–28oC.
o Wash hands with clean water and soap.
o Double glove just before delivery.
Preparing to Meet the Baby’s Needs “Good care of the newborn begins with good preparation” o Ensure all
delivery equipment and supplies, including newborn resuscitation equipment, are available. o Line up
materials for delivery according to sequence of use

Prepare for Delivery

o 2 sets of sterile gloves
o Two clean and warm towels or cloth
o Self inflating bag and mask (normal and small
newborn)
o Suction device
o Sterile cord clamp or ties
o Sterile forceps and scissors
o Rolled up piece of cloth
o Bonnet
o Clean dry warm surface
Broken equipment is dangerous

✔ Equipment must be checked daily and well before a

delivery takes place.
✔ Resuscitation equipment should always be close to
the delivery area
✔ Health workers must know how to use the equipment.
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

STANDARD PRECAUTIONS
o Always remember the importance of observing precautions to help protect the mother and baby and
ourselves from infections with bacteria, viruses including HIV

o Deliver the baby in prone position on the mother’s abdomen, face turned
to the side
o Call out time of birth.
o Dry the newborn thoroughly. Check the baby’s breathing while drying.
Remove wet cloth.
o Place the newborn on the mother’s abdomen in skin-to-skin contact.
Cover the back with a dry blanket.

Time: WITHIN THE 1ST 30 SECS

Intervention: Dry and provide warmth.
Action:
o Use a clean, dry cloth to thoroughly dry the baby by wiping the face, eyes, head, front and back of the
trunk, arms and legs.
o Do a quick check of newborn’s breathing while drying.
 o Remove the wet cloth.
o Drying The Newborn

■During the 1st 30 seconds of drying/stimulation:

o Do not suction unless mouth/nose are obstructed with secretions or other material
o Do not ventilate unless the baby is floppy and not breathing
✔ 10% asphyxiated
✔ 90 % normal
o Do not remove the vernix!!!

Time band: If after 30 secs of drying, newborn is breathing or crying

Intervention: Skin -to-skin (STS) contact
Action:
o Avoid any manipulation, such as routine suctioning.
o Place the newborn prone on the mother’s abdomen or chest skin-to-skin.
o Cover newborn’s back with a blanket and head with a bonnet.
o Place identification band on ankle

Immediate skin-to-skin contact

o Provides warmth
o Improves bonding
o Provides protection from infection by exposure of the baby to good bacteria of the mother
o Increases the blood sugar of the baby
o Contributes to the overall success of breastfeeding

Skin-to-Skin Contact
o Effect on Immunoprotection
✔ Bacteria Colonization with maternal skin flora
✔ Stimulation of the mucosa-associated lymphoid tissue system.
✔ Ingestion of colostrum

Risks of Hypothermia
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

Hypothermia can lead to :

o Infection
o Coagulation defects
o Acidosis
o Delayed fetal to newborn circulatory adjustment
o Hyaline membrane disease
o Brain hemorrhage.

Time band: If after 30 secs of drying, newborn is NOT breathing or is

gasping Intervention: Re-position, suction and ventilate
Action:
o Clamp and cut the cord immediately
o Call for HELP
o Transfer to a warm firm surface
o Inform the mother

o Start resuscitation protocol

Time Band: 1 – 3 minutes

Intervention: Delayed or non-immediate cord clamping
Action:
o Remove the first set of gloves immediately prior to cord clamping.
o Clamp and cut the cord after cord pulsations have stopped ( at 1 to 3 minutes)

ADVANTAGE OF DELAYED CLAMPING OF THE CORD

Action: Initial Cord care
✔ -Put ties tightly around the cord at 2 cm & 5 cm from the
abdomen.
✔ -Cut between ties with sterile instrument.
✔ -Observe for oozing blood.
o Do not apply any substance to the stump
o Do not bind or bandage the stump
o Leave the stump uncovered

Washing should be delayed until after 6 hours

o Washing exposes to hypothermia
o The vernix is a protective barrier to bacteria such as E. coli and Group B Strep
o Washing removes the crawling reflex

Time: WITHIN 90 min of age

Intervention: Provide breastfeeding support for initiation of breastfeeding
Action:
o Leave the baby on the mother’s chest in skin-to-skin contact.
o Observe the newborn.
o Place identification tag / bracelet on the baby’s ankle

Maintain skin-to-skin contact

- uninterrupted for at least 90 minutes after birth and until the first thorough breastfeed is complete

Monitor the mother and baby during the first hour after complete delivery of the placenta

Republic of the Philippines

City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

o Never leave the woman and newborn alone

o Keep the mother and baby in the delivery room
o Record findings, treatments and procedures in the labor record
o Monitor every 15 minutes:
Baby
✔ Breathing
✔ warmth

SKIN TO SKIN CONTACT & INITIATION OF BREASTFEEDING

SIGNS OF READINESS TO BREASTFEED

✔ OPENING OF THE MOUTH,
✔ ROOTING,
✔ Tonguing,
✔ LICKING

Help the mother and baby into a comfortable position

Initiation of breastfeeding
o Health workers should not touch the newborn
unless there is a medical indication.
o Do not give sugar water, formula or other prelacteals.
o Do not give bottles or pacifiers.
o Do not throw away colostrum.
 o If the mother is HIV-positive, counsel the mother on breastfeeding

The first breast feed

o Keep the mother and baby together for as long as possible after delivery o
Delay tasks such as weighing, immunizations, etc. until after the first feed

HIV and Immediate Newborn Care

o If the mother has HIV/AIDS:
✔ universal precautions must be followed as with any other delivery and after care.
✔ Her baby can have immediate skin-to-skin contact
✔ Breastfeeding can begin when the baby is ready after delivery
✔ Do not give the baby any other food or drink
✔ Good attachment and positioning are vital
✔ If replacement feeding, prepare formula for the mother for the first few feeds

Time: WITHIN 90 min of age

Intervention: Do eye care
Action:
o Wipe the eyes
o Apply an eye antimicrobial within 1 hour of birth:
✔ 1% silver nitrate drops (EFFECTIVE, MOST
POTENT) or
✔ 2.5% povidone iodine drops or
✔ 1% tetracycline ointment or erythromycin eye
drops
o Do not wash away the eye antimicrobial

II. Essential Newborn Care

Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

FROM 90 Min – 6 HRS

Time: FROM 90 Min – 6 HRS
Intervention: Give Vitamin K prophylaxis and Hepatitis B and BCG vaccinations at birth
Action:
o Wash hands.
o Inject a single dose of Vitamin K 1 mg IM.
o Inject Hepatitis B vaccine IM and BCG intradermally.
o Record.

Time: WITHIN 90 min of age

Interventions:
o Examine the baby
o Check for birth injuries, malformations or defects
Action:
o Thoroughly examine the baby.
o Weigh the baby and record.
o Look for possible birth injury and/or malformation

Time: WITHIN 90 min of age

Interventions: Cord care
Action:
o Wash hands before and after cord care.
✔ Put nothing on the stump.
✔ Fold diaper below stump. Keep cord stump loosely covered with clean clothes.
✔ If stump is soiled, wash it with clean water and soap. Dry it thoroughly with clean cloth.
Time: WITHIN 90 min of age
Interventions: Provide additional care for a small baby or twin
Action:
o If the newborn is delivered 2 months earlier or weighs <1500 grams,
o refer to a hospital
o If the newborn is delivered 1 month early of is visibly small (1501 – 2499g)
o Special support for breastfeeding
o Discharge planning

ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR

- The third stage of labor- has traditionally been defined as the time between the birth of the baby and the
delivery of the placenta and membranes. It is the third stage that is the most perilous for the woman because
of the risk of postpartum hemorrhage (PPH). The third stage of labor typically lasts between 10 and 30
minutes; if the placenta fails to separate within 30 minutes after childbirth, the third stage is considered to be
prolonged. If the third stage of labor lasts longer that 18 minutes, it is associated with a significant risk of
PPH; and there is a six-fold increase in PPH when the third stage of labor lasts longer than 30 minutes.

- Management of the third stage of labor:

1. The third stage of labor may be managed expectantly or actively. In expectant (physiological) management,
uterotonic drugs are not given prophylactically, the cord may or may not be clamped early, and the placenta is
delivered by maternal effort.
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

2. In active management, = uterotonic drugs are given before delivery of the placenta, the cord is usually cut
2–3 minutes after birth, and the placenta is delivered by controlled cord traction (CCT).

COMPONENTS OF AMTSL

(1)Administration of a uterotonic drug within 1 minute after the baby’s birth and after ruling out the
presence of another baby;

(2) Clamping and cutting the cord after cord pulsations have ceased or approximately 2–3 minutes after birth
of the baby, whichever comes first;

(3) CCT during a contraction with counter traction to support the uterus, including gently turning the
placenta as it is delivered to prevent tearing of the membranes; (4) Massaging the uterus immediately after
delivery of the placenta

The EINC practices are evidenced-based standards for safe and quality care of birthing mothers and their
newborns, within the 48 hours of Intrapartum period (labor and delivery) and a week of life for the
newborn.

- Recommended EINC practices for newborn care are time-bound interventions at

the time of birth (1)Immediate and thorough drying of the newborn(2)Early skin
to-skin contact between mother and the newborn(3)Properly-timed cord clamping
and cutting(4)Unang Yakap (First Embrace) of the mother and her newborn for early
breastfeeding initiation
- The unnecessary interventions during labor and delivery, which do not improve
the health of mother and child, are eliminated. These are
(1)enemas and shavings,
(2) fluid and food intake restriction, and
(3)routine insertion of intravenous fluids.
(4)Fundal pressure to facilitate second stage of labor is no longer practiced,
because it resulted to maternal and newborn injuries and death.
- The unnecessary interventions in newborn care which include
(1) routine suctioning,
(2)early bathing,
(3) routine separation from the mother,
(4)foot printing,
(5)application of various substances to the cord, and
(6)giving pre-lacteals or artificial infant milk formula or other breast-milk substitutes.

ESSENTIAL INTRAPARTUM NEWBORN CARE (EINC) DELIVERY

1. In advance, prepare decontamination solution by mixing 1 part 5%
chlorine bleach to 9 parts water to make 0.5% chlorine solution. Change
chlorine solution at the beginning of each day or whenever solution is very
contaminated or cloudy.

PRIOR TO WOMAN’S TRANSFER TO THE DR

Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo
City Tel. No. (047) 224-2089 loc. 314

2. Ensure that mother is in her position of choice while in labor.

3. Asked mother if she wished to eat/drink or void.

4. Communicated with the mother-informed her progress of labor, gave
reassurance and encouragement.

WOMAN ALREADY IN THE DR------ PREPARING FOR DELIVERY

5. Checked temperature in DR area to be 25-28 ˚Celsius; eliminated air
draft.

6. Asked woman if she is comfortable in the semi-upright position(the

default position of delivery table).
7. Ensured the woman’s privacy.
8. Removed all jewelry then washed thoroughly observing the WHO
1-2-3- 4-5 procedure.

9. Prepared a clear, clean newborn resuscitation area on a firm and flat

surface. Checked equipment if clean, functional and within easy reach.

10. Arranged materials/supplies in a linear sequence: Gloves, dry linen,

bonnet, oxytocin injection, plastic clamp, instrument clamp, scissors, 2
kidney basins.
In a separate sequence, for after the 1st breastfeed: Eye
ointment,(stethoscope to symbolize PE), Vit K, and BCG vaccines (plus
cotton balls etc)
11. Cleaned the perineum with antiseptic solution.

12. Washed hands and put on 2 pairs of sterile gloves aseptically.(if same
worker handles perineum and cord)

AT THE TIME OF DELIVERY

13. Encourage woman to push as desired.
14. Draped the clean, dry linen over the mother’s abdomen or arms
in preparation for drying the baby.
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo
City Tel. No. (047) 224-2089 loc. 314

15. Applied perineal support and did controlled delivery of the

head. 16. Called out time of birth and sex of baby.
17. Informed the mother of outcome.

FOR 1ST 30 SECONDS

18. Thorough dried baby for at least 30 seconds, starting from the face and
head, going down to the trunk and extremities while performing a quick
check for breathing.

1-3 MINUTES
19. Removed the wet cloth.
20. Placed baby in skin-to-skin contact on the mother’s abdomen or
chest 21. Covered baby with dry and the baby’s head with a bonnet.

22. Excluded a 2nd baby by palpating the abdomen in preparation for giving
oxytocin.
23. Give IM oxytocin within one minute of baby’s birth after wiping the
soiled gloves with the wet cloth. Disposed of wet cloth properly.

24. Removed 1st set of gloves after positioning the baby for cord clamping,.
Decontaminated the gloves properly(in 0.5% chlorine solution for at least
10 minutes).

25. Palpated umbilical cord to check the pulsations.

26. After pulsations stopped, clamped cord using the plastic cord tie 2 cm
from the base.
27. Placed the instrument clamp 5 cm from the base.
28 Cut near plastic clamp (not midway).

29. Performed the remaining steps of the AMTSL:

30. Waited for strong uterine contractions then applied controlled cord
traction on the uterus,
31. continuing until placenta was delivered
32. Massage the uterus until it is firm.
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo
City Tel. No. (047) 224-2089 loc. 314

33. Inspected the lower vagina and perineum for lacerations/tears and
repaired lacerations/tears, as necessary.

34. Examined the placenta for completeness and abnormalities.

35. Cleaned the mother, flushed perineum and applied perineal

pad/napkin/cloth.
36. Checked baby’s color and breathing; checked the mother was
comfortable, uterus contracted.
37. Disposed of the placenta in a leak-proof container or plastic bag. 38.
Decontaminated (soaking in 0.5% chlorine solution) instruments before
cleaning; decontaminated 2nd pair of gloves before disposal, stating that
decontamination lasts for at least 10 mins.
39. Advised mother to maintain skin-to skin contact. Baby should be prone
on mothers chest/in between the breasts with head turned to one side.

15-90 MINUTES
40. Advised mother to observe for feeding cues and cited examples of
feeding cues.

41. Supported mother, instructed her on positioning and

attachment. 42. Waited for FULL BREASTFEED to be completed.

43. After a complete breastfeed, administered eye ointment(first), did

thorough physical examination, then did Vit. K, hepatitis B and BCG
injections (simultaneously explained purposes of each intervention).

44. Advised OPTIONAL/DELAYED bathing of baby (and was able to explain

the rationale).
45. Advised breastfeeding per demand.
46. In the first hour, checked baby’s breathing and color; and checked
mother’s vital signs and massaged uterus every 15 minutes.
 47. In the second hour, checked mother-baby dyad every 30 minutes to 1
hour
48. Completed all RECORDS
TOTAL:
Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo
City Tel. No. (047) 224-2089 loc. 314

Oxytocin Ergometrine/
Methyl-ergometrine

Maximum dose Not more than 3 L of IV fluids

containing oxytocin
IM or IV (slowly): 0.2 mg

Repeat 0.2 mg IM after 15 minutes If required, give

0.2 mg IM or IV (slowly) every 4 hours

5 doses (Total 1.0 mg)

Dose and route IV: Infuse 20 units in 1 L IV fluids at Precautions

60 drops per minute Contra-indications
IM: 10 units Do not give as an IV bolus Pre-eclampsia,
Continuing dose IV: Infuse 20 units in 1 L IV fluids at hypertension, heart disease
40 drops per minute

IV. Teaching and Learning Materials and Resources

- Reference book
- Midwifery Skills Procedure Checklist
-White pad and pen