ACTUAL BIRTH SIMULATION

STERILE PROCEDURE

Sterile procedures are required before and

during specific patient care activities to maintain
an area free from microorganisms and to
prevent infection
STERILE TECHINQUES

Are methods prevent contamination of

organism throughout the surgical procedure
Performing a surgical hand scrub, applying
sterile gloves, and preparing a sterile field are
ways to prevent and minimize infection during
surgeries or invasive procedures.
Application of Sterile Gloves

Sterile gloves are

gloves that are free
from all
microorganisms.
SETTING UP A STERILE FIELD

Aseptic procedures
require a sterile area in
which to work with
sterile objects.
STERILE FIELD

• a sterile surface on which

to place sterile equipment
that is considered free
from microorganisms
STERILE FIELD

• a sterile surface on which to place sterile

equipment that is considered free from
microorganisms
• required for all invasive procedures to prevent
the transfer of microorganisms and reduce the
potential for surgical site infections.
Sterile fields

can be created in the OR

using drapes, or at the
bedside using a
prepackaged set of supplies
for a sterile procedure or
wound care.
STERILE FIELD

• Many sterile kits contain a

waterproof inner drape
that can be set up as part
of the sterile field.
• Sterile items can be linen
wrapped or paper
wrapped, depending on
whether they are single- or
multi-use.
PERINEAL CARE
CONTROLLED DELIVERY OF THE FETAL HEAD

• MECHANISM OF
NORMAL DELIVERY
When the widest
diameter of the fetal
head successfully
negotiates through
the narrowest part of
the maternal bony
pelvis, the fetal head
is considered to be
‘crowning’
Because the shoulders at the
point of the head being
delivered are only just
reaching the pelvic floor they
are often still negotiating the
pelvic outlet and the fetus may
naturally align its head with
the shoulders. This is called
restitution and visually you
may see the head externally
rotate to face the right or left
medial thigh of the mother.
Expulsion

when the head is born, the shoulder &

the rest of the body follows without
much difficulties.
• Every ENGAGEMENT
• Decent DESCENT
• Female FLEXION

• I INTERNAL ROTATION
• Choose to and CROWNING
• Employ EXTENSION
• Rises RESTITUTION
• Extremely EXTERNAL ROTATION
DURATION OF SECOND STAGE
PRIMIS 50 MINS
MULTI 20 MINS
ASSESSMENT: MONITOR FHT Q 15 MINS IN NORMAL
CASE AND EVERY 5 MINS IN HIGH RISK CASES IF NOT
YET DELIVERED

TRANSFER TO THE DR: PRIMIS- CERVIX FULLY

DILATED MULTIS- CERVIX IS 8 CM DILATED
Delivery Position

Lithotomy position
• Dorsal Recumbent
• Left Lateral position
Third Stage of Labor

• Birth of the baby and the delivery of the placenta and

membranes
• Typically 10 to 30 minutes
• If> 30 minutes, considered to be prolonged
• If lasts longer than 18 minutes, with significant risk of
POST PARTTUM HEMORRAGE
MANAGEMENT OF 3RD STAGE OF LABOR

• UTEROTONIC DRUG
• CCT
• MASSAGING THE UTERUS
Uterotonic Drugs

Enhance contraction of the uterus

Facilitate Expulsion of the Placenta
Decrease Blood loss and are;
Given after delivery of the baby, after ruling out presence of
another baby
Uterotonic Route Dosage Onset of Duration Contrain Storage
Agent Action Action of Action dication

Oxytocin IM 10 units 2-4 mins 20 mins Never 15-30

give IV deg.
bolus Celsius

Misoprost Oral 600 mcg 12-15 20-40   Room

ol mins mins temperatu
re
Controlled Cord Traction (CCT)

Technique to assist in expulsion of placenta

Helps to reduce the chances of a retained placenta and
subsequent bleeding.
Uterine Massage

• Immediately after delivery of the placenta, massage the

fundus of the uterus through the woman’s abdomen until it
is well contracted.
• Helps in contraction of the uterus and thus prevents PPH
• Ensure that the uterus does not become relaxed (soft)
after the massage
• Watch for vaginal bleeding
Immediate Essential Newborn Care 

• Time Bounded Interventions

• 1. Immediate and thorough drying
• 2. Early skin-to-skin contact
• 3. Properly timed cord clamping
• 4. non-separation of the newborn and mother for early
initiation of breastfeeding
Time Band: Within 1st 30 secs (Immediate Drying)

• Call out the time of birth

• Dry the newborn thoroughly for at least 30 seconds
• – Wipe the eyes, face, head, front and back, arms and
legs
• Remove the wet cloth
• Do a quick check of breathing while drying
Notes:

• During the 1st secs:

• –      Do not ventilate unless the baby is floppy/limp and
not breathing
• –      Do not suction unless the mouth/nose are blocked
with secretions or other material
Time Band: Within 10-3 mins (Thorough Drying)

Notes:
– Do not wipe off vernix
– Do not bathe the newborn
– Do not do foot printing
– No slapping
– No hanging upside - down
– No squeezing of chest
Time Band: After 30 secs of Drying (Early Skin-
Skin Contact)

• If newborn is breathing or crying:

• Position the newborn prone on the mother’s abdomen or
chest
• Cover the newborn’s back with a dry blanket
• Cover the newborn’s head with a bonnet
Notes:

• Avoid any manipulation, e.g. routine suctioning that may

cause trauma or infection
• Place identification band on ankle (not wrist)
• Skin to skin contact is doable even for cesarean section
newborns
Time Band: 1-3 mins (Properly timed-cord
clamping)

• Remove the first set of gloves

• After the umbilical pulsations have stopped, clamp the
cord using a sterile plastic clamp or tie at 2 cm from the
umbilical base
Clamp again at 5 cm from the base
• ·Cut the cord close to the plastic clamp
Notes:

• Do not milk the cord towards the baby

• After the 1st clamp, you may “strip” the cord of blood
before applying the 2nd clamp
• Cut the cord close to the plastic clamp so that there is no
need for a 2nd “trim”
• Do not apply any substance onto the cord
Time Band: Within 90 mins (non-separation of
newborn from mother to early breastfeeding)

• Leave the newborn in skin-to-skin contact

• Observe for feeding cues, including tonguing, licking,
rooting
• Point these out to the mother and encourage her to nudge
the newborn towards the breast
Counsel on positioning

 – Newborn’s neck is not flexed nor twisted

– Newborn is facing the breast
– Newborn’s body is close to mother’s body
– Newborn’s whole body is supported
Counsel on attachment and suckling

– Mouth wide open

– Lower lip turned outwards
– Baby’s chin touching breast
– Suckling is slow, deep with some pauses
Notes:

– Minimize handling by health workers

– Do not give sugar water, formula or other prelacteals
– Do not give bottles or pacifiers
– Do not throw away colostrum
THANK YOU