HANDLING

AND
ASSISTING
DELIVERIES
 GENERAL OBJECTIVES
• After the discussion and demonstration,
the BSN 2 students will able to develop
positive attitude, acquire basic knowledge
and skills in handling and assisting
deliveries.
SPECIFIC OBJECTIVES
The BSN 2 Students will be able to:
1. Recognize the importance of assisting and handling safe
delivery to prevent maternal and child morbidity and
mortality.
2. Define related terminologies correctly.
3. Arrange instruments needed in handling and assisting
deliveries according to its use.
4. Practice the procedure following the steps written in RLE
Manual.
5. Prepare the materials needed in Handling and Assisting
Deliveries before a procedure.
6. Return Demonstrate Handling and Assisting Deliveries
utilizing the steps written in RLE Manual.
• Handling delivery- is the actual handling of the
delivery of the fetus
• Assisting delivery- handling the instruments to
the one handling the delivery
• Episiotomy- a surgical incision of the perineum
made to prevent tearing of the perineum with birth
and to release pressure of the fetal head during
delivery.
• Episiorraphy- repair tear of the episiotomy with
the use of sutures.
• Laceration- refers to the tearing of the vulvar,
vagina and sometimes rectal tissue during birth.
 CARDINAL
•
MOVEMENTS
ENGAGEMENT- occurs when the widest part of the fetal
head has passed below the maternal pelvic
inlet.Essentially, the baby's head has officially entered its
mother's pelvis.

• DESCENT- downward movement of the biparietal diameter

of the fetal head to within the pelvic inlet.

– Floating- fetal presenting part is not engaged in pelvic

inlet
– Fixed- fetal presenting part has entered pelvis
 
– Engagement – fetal presenting part
(usually biparietal diameter of fetal
head) has passed through pelvic inlet
– Station 0- presenting part has reached
level of ischial spines
– Stations -1,-2,-3- presenting part is 1,2,3
above the level of ischial spines
– Stations +1, +2, +3- presenting part is
1,2,3 below level of ischial spines. A
station of +4 indicates that presenting is
on the pelvic floor.
FLEXION- baby moves further downward and then head meets
obstruction at the pelvic floor causing flexion.
-while descending through the pelvis, the fetal head flexes so that
the fetal chin is touching the fetal chest. This functionally creates a
smaller structure to pass through the maternal pelvis. When flexion
occurs, the occipital (posterior) fontanel slides into the center of the
birth canal and the anterior fontanel becomes more remote and
difficult to feel. The fetal position remains occiput transverse
INTERNAL ROTATION- in accommodating the birth canal, the fetal
occiput rotates anteriorly from its original position toward the
symphysis. The movement results from the shape of the fetal head,
space available in the midpelvis and contour of the perineal
muscles. The ischial spines project into the midpelvis causing the
fetal head to rotate enteriorly to accommodate to the available
space.

With further descent, the occiput rotates anteriorly and the fetal
head assumes an oblique orientation. In some cases, the head may
rotate completely to the occiput anterior position.
EXTENSION- as the fetal head descends further it meets
resistance from the perineal muscles and is forced to extend.
The fetal head becomes visible at the vulvova ring; its largest
diameter is encircled (crowning) and the head then emerges
from the vagina.
The curve of the hollow of the sacrum favors extension of the
fetal head as further descent occurs. This means that the fetal
shin is no longer touching the fetal chest.
•EXTERNAL ROTATION/RESTITUTION- When head emerges, the
shoulders are undergoing internal rotation as they turn in the
midpelvis to accommodate to the projection of the ischial
spines. The head, now born, rotates the shoulders undergo this
internal roatation
The shoulders rotate into an oblique or frankly anterior-
posterior orientation with further descent. This encourages the
fetal head to return to its transverse position.
EXPULSION- Following delivery
of the infant’s head and internal
rotation of the shoulders, the
anterior shoulder rests beneath
the symphysis pubis. The
posterior shoulder is born,
followed by the anterior shoulder
and the rest of the body.
 STAGES OF LABOR:

FIRST STAGE OF LABOR

(Stage of DILATATION)
-Onset of true labor to full
cervical dilatation
•LATENT PHASE- The first phase of the first stage of labor when contractions
are becoming more frequent (usually 5 to 20 minutes apart) and somewhat stronger.The
cervix dilates (open approximately three or four centimetres and effaces (thins out).Is usually
the longest and least intense phase of labor.

•ACTIVE STAGE- the second phase of the first stage is signalled by dilatation of
the cervix from 4 to 7 cms. Contractions become longer, more severe, and frequent (usually 3
to 4 mins. Apart)

•TRANSITION PHASE- the third phase and the last phase. Cervix dilates
from 8 to 10 cms. Contractions are usually very strong lasting 60-90 seconds and occurring
every few minutes.
  
SECOND STAGE OF
LABOR
( stage of EXPULSION)
Complete dilatation to expulsion
of the baby
Ritgen’s Maneuver
1.Denotes extracting the fetal head, using
one hand to pull the fetal chin from between
the maternal anus and the coccyx, and the
other on the fetal occiput to control speed of
delivery. It is perform during the uterine
contraction.
Ritgen’s Maneuver
2. Palpate for cord coil.

•Suction baby’s mouth and nose using bulb syringes.

•Deliver the shoulder, wait for the external rotation where

one shoulder is up and the other shoulder is down.

•With one hand at the back of the neck, the other one
grasping
the extremities and put the baby in the mothers abdomen
and suction secretions.
 THIRD STAGE
(PLACENTAL STAGE)
-Birth of the baby-expulsion of the placenta
-This stage of labor is the period from birth of the
baby through delivery of the placenta.
-This is considered a dangerous time because of
the possibility of hemmoraging
Placental separation

Calkin’s sign
1.1.The uterus becomes globular in shape and firmer, discoid to avoid,
indicating placental separation from the uterine wall.

1.2.Gushing of blood
-2nd sign
-or sudden glush of blood

1.3. Lengthening of the cord

-3rd sign
-the umbilical cord descends three (3) inches or more further out of the
vagina
1.4.The uterus rises in the abdomen

 
 Crede’s Maneuver
A method of expressing the
placenta in which body uterus is
vigorously squeezed in order to
produce placental separation
 
Placental Expulsion
Brandt- Andrews Maneuver- a method of expressing the
placenta by grasping the umbilical cord with one hand and
placing the other hand on the abdomen, application of the
traction on the cord by moving the forcep up, down, left,
right.

Schultze’s mechanism- Shiny (fetal side)- a mechanism or

technique for the delivery with the fetal rather than the
maternal side surface presenting the shiny and glistening
side of the fetal membrane

Duncan mechanism- dirty or rough (maternal side)- a

mechanism or technique for delivery with the maternal
rather than the fetal side surface presenting the dirty or
rough side.
FOURTH STAGE
(stage of PHYSICAL
RECOVERY)
- Delivery of the
placenta up to 1-4 hrs.
After delivery
 CONTENTS OF OB PACK
• VSMMC ( OB KIT)
• CPCMHI – Digital thermometer
– 3 gowns – Adult diaper
– 2 leggings – Sterile gloves
– 3 drapes – 1 bottle of 70% alcohol
– 1 perineal support – 1 bottle Betadine
solution
– Pack cotton ball
– Baby diaper
– Bonnet
– ID bracelet ( white and
pink / blue)
 CONTENTS OF INSTRUMENT SET
• VSMMC
• CPCMHI PRIMI SET

– 1 bandage scissor -1 bandage scissor

-1 surgical scissor
– 1 kelly curve
-1 kelly curve/straight forcep
– 1 kelly straight - 1 needle holder
– 1 surgical scissor -1 tissue forcep with
teeth/without teeth
– 1 needle holder -1 tray
– 1 tissue forcep – 10cc disposable syringe
– for lidocaine hcl 2% (to be
1 placental bowl added)
– Needle and Suture (to be
added)
– Sterile 4x4 OS 5-10 pcs. (to
be added)
– 4 sterile OP towel
– 2 leggings (optional)
 CONTENTS OF INSTUMENT SET
• VSMMC
MULTI SET
-1 bandage scissor
-1 kelly curve/straight forcep
- 1 needle holder
-1 tissue forcep with teeth/without teeth
-1 tray
-10cc disposable syringe for 2 % lidocaine hcl
(to be added)
– Needle and Suture
(to be added)
– Sterile 4x4 OS 5-10 pcs. (to be added)
– 2 leggings (optional)
 INSTRUMENTS
• 10cc disp. Syringe with lidocaine anesthesia + bandage
scissors are used during episiotomy.
• 2 kelly forceps – used to clamp the umbilical cord of the
baby
• Umbilical cord scissor- used to cut the umbilical cord.
• surgical scissors used to cut the umbilical cord.
• needle holder used to hold the round needle with
suture.
• 1 tissue forceps with teeth used to hold the soft tissues
in the perineal area during episiorraphy
 STEPS IN HANDLING DELIVERY
PROCEDURE
PREPARATION

 
a. Do medical and surgical hand washing
b. Perform gowning (per institution protocol) and gloving
(per institution protocol)
c. Do draping (per institution protocol)
ACTION:
1. DRAPE the patient accordingly.

a. Leggings (left and right)

b. Abdominal drape
c. Perineal drape
d. Baby drape
e. perineal support
2. Encourage the woman to push/ bear down once uterus is at the
height of its contraction and to do breathing exercises when it is not.
Assisting
Delivery
 Basic Emergency Obstetric and Newborn
Care (BEmONC ) or Comprehensive
Emergency Obstetric and Newborn Care
(CEmONC) Site Supervision Checklist

• This is a supervision checklist for Emergency

Obstetric and Newborn Care sites to help
monitor: (1) the infrastructure and environment,
(2) the equipment and material, (3) the
mananagement of antenatal care clients,
patients during labor and delivery, as well as
postnatal mothers and babies, (4) family
planning, and (5) postabortion care.
Universal access to EmONC is considered essential
to reduce maternal mortality and requires that all
pregnant women and newborns with complications
have rapid access to well-functioning facilities that
include a broad range of service delivery types and
settings A set of seven key obstetric services, or
“signal functions,” has been identified as critical to
basic emergency obstetric and newborn care
(BEmONC): administration of parenteral antibiotics;
administration of parenteral anticonvulsants;
administration of parenteral uterotonics; removal of
retained products (manual vacuum aspiration);
assisted vaginal delivery; manual removal of the
placenta; and resuscitation of the newborn [5].