Nueva Ecija University of Science and Technology: Activity

NUEVA ECIJA UNIVERSITY OF SCIENCE AND
TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines
COLLEGE OF NURSING
NORMAL DELIVERY
ACTIVITY
Like all areas of medicine, pregnancy and childbirth has a number of

specialised terms, many of which you will
hear during your own pregnancy and labour
and the birth of your baby. Identify the
following Medical terminologies.
1. Abortion
2. amniotic fluid
3. amniotic sac
4. antenatal
5. antepartum haemorrhage
6. birth canal
7. breaking of water
8. cervix
9. Contraction
10. crowning
11. dilation
12. epidural
13. false labour
14. full term
15. gestation
16. haemorrhage
17. labour
18. neonate
19. newborn
20. perineum
21. perineal haematoma
22. placenta
23. postnatal
24. postpartum haemorrhage
25. premature
26. prenatal
27. first trimester
28. second trimester
29. third trimester
30. ultrasound
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ABSTRACTION-
LECTURE
Labour
 Labour is defined as the onset of regular painful contractions with

progressive effacement and dilatation of the cervix accompanied by
decent of the presenting part leading to expulsion of the fetus or fetuses
and placenta from the mother.
Child Birth
 Childbirth, also known as labour and delivery, is the ending of

pregnancy where one or more babies leaves the uterus by passing
through the vagina or by Caesarean Section. In 2015, there were about
135 million births globally. About 15 million were born before 37 weeks
while age of gestation 3 and 12 percent were born after 42 weeks. In the
developed world most deliveries occur in hospitals, while in the developing
world most births take place at home with the support of a traditional
birth attendant.
 The most common way of childbirth is a vaginal delivery. It involves three

stages of labour: the shortening and opening of the cervix, descent
and birth of the baby, and the delivery of the placenta.
Signs and symptoms
 The most prominent sign of labour is strong repetitive uterine

contractions. The distress levels reported by labouring women vary
widely. They appear to be influenced by fear and anxiety levels,
experience with prior childbirth, cultural ideas of childbirth and
pain, mobility during labour, and the support received during labour.
Personal expectations, the amount of support from caregivers, quality of
the caregiver-patient relationship, and involvement in decision-making are
more important in women's overall satisfaction with the experience of
childbirth than are other factors such as age, socioeconomic status,
ethnicity, preparation, physical environment, pain, immobility, or medical
interventions.
Descriptions
 Pain in contractions has been described as feeling similar to very strong

menstrual cramps. Women are often encouraged to refrain from
screaming. However, moaning and grunting may be encouraged to help
lessen pain. Crowning may be experienced as an intense stretching and
burning. Even women who show little reaction to labour pains, in
comparison to other women, show a substantially severe reaction to
crowning (the appearance of the baby's head).
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 Back labour is a term for specific pain occurring in the lower back, just
above the tailbone, during childbirth.
Vaginal birth
 Humans are bipedal with an erect stance. The erect posture causes the
weight of the abdominal contents to thrust on the pelvic floor, a complex
structure which must not only support this weight but allow, in women,
three channels to pass through it: the urethra, the vagina and the rectum.
The infant's head and shoulders must go through a specific sequence of
maneuvers in order to pass through the ring of the mother's pelvis.
Labour and Delivery
Factors that influence progress of labour
Five P’s
1. Passenger
2. Passage
3. Powers
4. Placenta
5. Psychology
1. Passenger (Fetus).
(a) Presentation of the fetus (breech, transverse).
(b) Position of the fetus (ROP, LOP).
(c) Size of the fetus.
2. Passage (Birth Canal).
(a) Parity of the woman, if she has ever delivered before.
(b) Resistance of the soft tissues as the fetus passes through the birth
canal.
(c) Fetopelvic diameters.
3. Powers (Contractions).
(a) Force of the uterine contractions.
(b) Frequency of the uterine contractions.
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4. Placenta.
(a) Site of implantation.
(b) Whether it covers part of the cervical os.
5. Psychology (Psychological State of the Woman).
(a) Patient extremely anxious.
(b) Emotional factors related to the patient.
(c) Amount of sedation required for the patient.
Stages of Labour
Labour has three stages:
 The first stage is when the neck of the womb (cervix) opens to 10cm
dilated.
 The second stage is when the baby moves down through the vagina and
is born.
 The third stage is when the placenta (afterbirth) is delivered.
Important relationship to be considered:
 Fetal Lie
 Fetal presentation
 Fetal attitude or posture
 Fetal position
Fetal Lie
 refers to the relationship between the long axis of the fetus with respect

to the long axis of the mother.
The possibilities include:
 a longitudinal lie,
 a transverse lie, and,
 on occasion, an oblique lie.
Fetal presentation is a reference to the part of the fetus that is overlying the

maternal pelvic inlet.
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Fetal Presentation
 Fetal presentation is a reference to the part of the fetus that is overlying

the maternal pelvic inlet. The most common relationship
between fetus and mother is the longitudinal lie, cephalic presentation.
 A breech fetus also is a longitudinal lie, with the fetal buttocks as

the presenting part.
Fetal Presentations
Fetal Attitude or Posture
 This describes the relationship of fetus' body parts to one another.
 Normal fetal attitude is when the head is tucked down to the chest with its
arms and legs drawn in towards center of chest.
Fetal Position
Refers to the relationship of an arbitrary chosen portion of the fetal

presenting part to the right or left side of the birth canal.
May be directed anteriorly, transversely or posteriorly.
 LOA- Left Occiput Anterior (most frequent)
 LOT- Left Occiput Transverse
 LOP- Left Occiput Posterior
 ROA- Right Occiput Anterior
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 ROT- Right Occiput Transverse
 ROP- Right Occiput Posterior
Fetal Positions
Cardinal Movements of Labour
 Refer to the varying head positions a fetus undergoes throughout the

labor process. These positions help the fetus successfully navigate the
maternal pelvis and birth canal. Learn about these positions and quiz
yourself at the end.
The Seven Cardinal Movements of Labor
 Engagement
 Descent
 Flexion
 Internal rotation
 Extension
 External rotation
 Expulsion
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Engagement
 Engagement is a medical term often referred to as “baby dropping.” This

means that the infant's head or buttocks have settled into the pelvis prior
to labor. If this is your first pregnancy, engagement will usually occur
about two or three weeks prior to the onset of labor.
Descent
 This occurs as a result of active forces of labor. Internal Rotation: This

occurs as a result of impingement of the presenting part on the bony and
soft tissues of the pelvis. Extension: This is the mechanism by which the
head normally negotiates the pelvic curve.
Flexion
 During flexion, uterine contractions push the fetus downward against the

cervix. Its chin becomes tucked, touching its chest as if preparing to do a
forward roll. This position allows for the smallest head diameter to pass
through the pelvis.
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INTERNAL ROTATION
 Usually, the baby will be face down toward your spine. Sometimes, the
baby will rotate so it faces up toward the pubic bone. As your baby's head
rotates, extends, or flexes during labor, the body will stay in position with
one shoulder down toward your spine and one shoulder up toward your
belly.
Extension
 The curve of the hollow of the sacrum favors extension of the fetal head
as further descent occurs. This means that the fetal chin is no longer
touching the fetal chest.
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External Rotation
 After the head of the baby is born, there is a slight pause in the action
of labor. During this pause, the baby must rotate so that his/her face
moves from face-down to facing either of the laboring woman's inner
thighs.
Expulsion
 Expulsion, stage of: The second stage of labor, lasting from the full
dilation of the cervix until the baby is completely out of the birth canal.
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The vagina is called a 'birth canal' when the baby enters this passage.
Station refers to the relationship of the fetal presenting part to the level of the
ischial spines. When the presenting part is at the ischial spines the station is 0
(synonymous with engagement). If the presenting fetal part is above the spines,
the distance is measured and described as minus stations, which range from −1
to −4 cm. If the presenting part is below the ischial spines, the distance is
stated as plus stations ( +1 to +4 cm). At +3 and +4 the presenting part is at
the perineum and can be seen.
The fetal head may temporarily change shape substantially (becoming more
elongated) as it moves through the birth canal. This change in the shape of the
fetal head is called molding and is much more prominent in women having their
first vaginal delivery.
Cervical ripening is the physical and chemical changes in the cervix to prepare
it for the stretching that will take place as the fetus moves out of the uterus and
into the birth canal. A scoring system called a Bishop score can be used to judge
the degree of cervical ripening in order to predict the timing of labor and
delivery of the infant or for women at risk for preterm labor. It is also used to
judge when a woman will respond to induction of labor for a postdate pregnancy
or other medical reasons. There are several methods of inducing cervical
ripening which will allow the uterine contractions to effectively dilate the cervix.
Onset of labour
There are various definitions of the onset of labour, including:
 Regular uterine contractions at least every six minutes with evidence of

change in cervical dilation or cervical effacement between consecutive
digital examinations.
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 Regular contractions occurring less than 10 minutes apart and progressive
cervical dilation or cervical effacement.
 At least three painful regular uterine contractions during a 10-minute

period, each lasting more than 45 seconds.
The first stage of labour is divided into "latent" and "active" phases, where the
latent phase is sometimes included in the definition of labour, and sometimes
not.
Common signs that labour, commonly spelled as labor, is about to begin may
include "lightening". Lightening is the process of the baby moving down from
the rib cage with the head of the baby engaging deep in the pelvis. The
pregnant woman may then find breathing easier, since her lungs have more
room for expansion, but pressure on her bladder may cause more frequent need
to void (urinate). Lightening may occur a few weeks or a few hours before
labour begins, or even not until labour has begun.
Some women also experience an increase in vaginal discharge several days

before labour begins when the "mucus plug", a thick plug of mucus that blocks
the opening to the uterus, is pushed out into the vagina. The mucus plug may
become dislodged days before labour begins or not until the start of labour.
While inside the uterus the baby is enclosed in a fluid-filled membrane called
the amniotic sac. Shortly before, at the beginning of, or during labor the sac
ruptures. Once the sac ruptures, termed "the water breaks", the baby is at risk
for infection and the mother's medical team will assess the need to induce
labor if it has not started within the time they believe to be safe for the infant
First stage
 The first stage of labor and birth occurs when you begin to feel regular
contractions, which cause the cervix to open (dilate) and soften, shorten
and thin (effacement). This allows the baby to move into the birth canal.
The first stage is the longest of the three stages.
The first stage of labor has three parts:
1. Early labor
Your cervix opens to 4 centimeters. You will probably spend most of early
labor at home. Try to keep doing your usual activities. Relax, rest, drink clear
fluids, eat light meals if you want to, and keep track of your contractions.
2. Active labor
Your cervix opens from 4 to 7 centimeters. This is when you should head
to the hospital. When you have contractions every 3 to 4 minutes and they each
last about 60 seconds, it often means that your cervix is opening faster (about 1
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centimeter per hour). As your labor progresses, your bag of waters may break,
causing a gush of fluid. After the bag of waters breaks, you can expect your
contractions to speed up.
3. Transition to second stage
Your cervix opens from 7 to 10 centimeters. For most women, this is the
hardest or most painful part of labor. This is when your cervix opens to its
fullest. Contractions last about 60 to 90 seconds and come every 2 to 3
minutes.
Phases of the first stage of labour
Divided into:
 Latent phase – The start of labour is called the latent phase. This is when
your cervix becomes soft and thin, and starts opening for your baby to be
born.
 Active phase - During active labor, your cervix will dilate from 6

centimeters (cm) to 10 cm.
During effacement, the cervix becomes incorporated into the lower segment of
the uterus. During a contraction, uterine muscles contract causing shortening of
the upper segment and drawing upwards of the lower segment, in a gradual
expulsive motion. The presenting fetal part then is permitted to descend. Full
dilation is reached when the cervix has widened enough to allow passage of the
baby's head, around 10 cm dilation for a term baby.
A standard duration of the latent first stage has not been established and can
vary widely from one woman to another. However, the duration of active first
stage (from 5 cm until full cervical dilatation) usually does not extend beyond
12 hours in first labours ("primiparae"), and usually does not extend beyond 10
hours in subsequent labours ("multiparae"). The median duration of active first
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stage is four hours in first labours and three hours in second and subsequent
labours.
 Dystocia of labor, also called "dysfunctional labor" or "failure to

progress", is difficult labor or abnormally slow progress of labor, involving
progressive cervical dilatation or lack of descent of the fetus.
Second stage
Your baby moves through the birth canal
 The second stage of labor begins when the cervix is completely dilated
(open), and ends with the birth of your baby. Contractions push the baby
down the birth canal, and you may feel intense pressure, similar to an
urge to have a bowel movement.
 Your health care provider may ask you to push with each contraction. The
contractions continue to be strong, but they may spread out a bit and give
you time to rest. The length of the second stage depends on whether or
not you've given birth before and how many times, and the position and
size of the baby.
 The intensity at the end of the first stage of labor will continue in this
pushing phase. You may be irritable during a contraction and alternate
between wanting to be touched and talked to, and wanting to be left
alone. It isn't unusual for a woman to grunt or moan when the
contractions reach their peak.
Third stage
Afterbirth
 After the birth of your baby, your uterus continues to contract to push out
the placenta (afterbirth). The placenta usually delivers about 5 to 15
minutes after the baby arrives.
Fourth stage
Recovery
 Your baby is born, the placenta has delivered, and you and your partner
will probably feel joy, relief, and fatigue. Most babies are ready to nurse
within a short period after birth. Others wait a little longer. If you are
planning to breastfeed, we strongly encourage you to try to nurse as soon
as possible after your baby is born. Nursing right after birth will help your
uterus to contract and will decrease the amount of bleeding.
Delivery of the Fetus
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A vaginal examination is done to determine position and station of the fetal
head; the head is usually the presenting part. When effacement is complete and
the cervix is fully dilated, the woman is told to bear down and strain with each
contraction to move the head through the pelvis and progressively dilate the
vaginal introitus so that more and more of the head appears. When about 3 or 4
cm of the head is visible during a contraction in nulliparas (somewhat less in
multiparas), the following maneuvers can facilitate delivery and reduce risk of
perineal laceration:
 The clinician, if right-handed, places the left palm over the infant’s head
during a contraction to control and, if necessary, slightly slow progress.
 Simultaneously, the clinician places the curved fingers of the right hand
against the dilating perineum, through which the infant’s brow or chin is
felt.
 To advance the head, the clinician can wrap a hand in a towel and, with
curved fingers, apply pressure against the underside of the brow or chin
(modified Ritgen maneuver).
An episiotomy is not routinely done for most normal deliveries; it is done only
if the perineum does not stretch adequately and is obstructing delivery. A local
anesthetic can be infiltrated if epidural analgesia is inadequate. Episiotomy
prevents excessive stretching and possible irregular tearing of the perineal
tissues, including anterior tears. An episiotomy incision that extends only
through skin and perineal body without disruption of the anal sphincter muscles
(2nd-degree episiotomy) is usually easier to repair than a perineal tear.
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 The most common episiotomy is a midline incision made from the
midpoint of the fourchette directly back toward the rectum. Extension into
the rectal sphincter or rectum is a risk with midline episiotomy, but if
recognized promptly, the extension can be repaired successfully and heals
well. Tears or extensions into the rectum can usually be prevented by
keeping the infant’s head well flexed until the occipital prominence passes
under the symphysis pubis.
 Another type of episiotomy is a mediolateral incision made from the

midpoint of the fourchette at a 45° angle laterally on either side. This type
usually does not extend into the sphincter or rectum, but it causes greater
postoperative pain, is more difficult to repair, has increased blood loss,
and takes longer to heal than midline episiotomy. Thus, for episiotomy, a
midline cut is often preferred.
Episiotomy
Delivery of the Placenta
 After delivery of the infant and administration of oxytocin, the clinician

gently pulls on the cord and places a hand gently on the abdomen over
the uterine fundus to detect contractions; placental separation usually
occurs during the 1st or 2nd contraction, often with a gush of blood from
behind the separating placenta. The mother can usually help deliver the
placenta by bearing down.
 If the placenta has not been delivered within 45 to 60 minutes of delivery,

manual removal may be necessary; appropriate analgesia or anesthesia is
required. For manual removal, the clinician inserts an entire hand into the
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uterine cavity, separating the placenta from its attachment, then extracts
the placenta.
 The placenta should be examined for completeness because fragments left

in the uterus can cause hemorrhage or infection later. If the placenta is
incomplete, the uterine cavity should be explored manually.
Management of Labour
Aims in the Management of labour
 To achieve delivery of a normal healthy child
 To anticipate, recognize and treat potential abnormal conditions before

significant hazard develop for the mother or the fetus.
Principles In The Management Of Labour
 Diagnosis of Labour
 Monitoring the progress of labour
 Ensuring maternal well-being
 Ensuring fetal well-being.
Management of the First Stage of Labour
 On Admission:
When the women presents at hospital, the woman’s antenatal record is

reviewed to discover whether there have been any abnormalities during her
pregnancy. When there are no records of antenatal care a complete history
must be taken.
General examination of the mother
a) General conditions – evaluate the mother’s general health condition. Look

for pallor, edema, abdominal scar (LSCS) and maternal height.
b) Vital signs – Blood pressure, pulse, respiration and temperature are taken
and recorded.
c) Heart and lungs
d) Urine analysis – for protein, sugar and ketones
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Abdominal examination:
a) A detailed abdominal examination should be carried out and recorded.
b) Determine the presentation and position of the fetus and also the
engagement.
c) Auscultate the fetal heart
d) Evaluate the uterine contraction
Vaginal examination – the purpose is to
a) To make a positive diagnosis of labour
b) To make a positive identification of presentation
c) To determine whether the fetal head is engaged in case of doubt.
d) To determine whether the fore waters have ruptured or to rupture them

artificially.
e) To exclude cord prolapse after rupture of the fore waters.
f) To confirm the degree of cervical dilatation and position of the presenting

part.
g) To assess progress of labour
h) To assess the adequancy of the pelvis.
Bowel preparation:
 If there has been no bowel action for 24 hours or the rectum feels loaded
on vaginal examination an enema is given.
Bladder care
 A full bladder may initially prevent the fetal head from entering the pelvic
brim and later impede descent of the fetal head. It will also inhibit
effective uterine action.
 The woman should be encouraged to empty her bladder every 1 ½ - 2

hours during labour.
 The quantity of urine passed should be measured and recorded and a

specimen obtained for testing.
Nutrition in early labour
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 No food is permitted after labour is established – to prevent regurgitation
and aspiration.
 It is important to maintain adequate hydration – via intravenous routes.
 Position of labouring mother:
As long as the patient is healthy, the presentation normal, the presenting

part engaged, and the fetus in good condition, the patient may about or may be
in bed, as she wishes.
 Monitoring the progress of labour
Once labour has become established, all events during labour should be
recorded on a partogram.
a) The well-being of the fetus
b) The well-being of the mother
c) The progress of the labour
Pain relief
When the pain are severe an analgesic preparation may be given
a) Optate drugs – e.g. Pethidine given intramuscularly every 4 hour
b) Ing
c) Halational analgesia – e.g. Entomox
d) Epidural analgesia
Normal Labour and Delivery
 Labour Pain – cause
Pain in labour
The pain experienced by the woman in labour is caused by the:
1. Uterine contractions and uterine ischaemia
2. Cervical dilatation. Dilatation and stretching of the cervix and lower

uterine segment stimulate nerve ganglia and a major source of pain.
3. Distention of the vagina and perineum. Marked distention of the vagina

and perineum occurs with fetal descent, especially during the second
stage.
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Labour Pain – causes
Pain Relief in Labour
 Three methods are in common use during labour
1. Analgesic drugs – (narcotics e.g. pethidine) which are given by

intramuscularly injection.
2. Inhalation analgesia – (e.g. Entonox)
3. Regional anaesthesia – (e.g. epidural, spiral) that blocks the sensory pain
pathways.
Monitoring Fetal Heart
Uterine contractions can affect fetal heart rate by increasing or decreasing that
rate in association with any given contraction.
The three primary mechanisms by which uterine contractions can cause a

decrease in fetal heart rate are
1. Fetal Heart
2. Umbilical cord
3. Uterine myometrial vessels
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Immediate Postpartum Care
The cervix and vagina are inspected for lacerations, which, if present, are
repaired, as is episiotomy if done.
 Then if the mother and infant are recovering normally, they can begin
bonding. Many mothers wish to begin breastfeeding soon after delivery,
and this activity should be encouraged. Mother, infant, and father or
partner should remain together in a warm, private area for an hour or
more to enhance parent-infant bonding.
 For the first hour after delivery, the mother should be observed closely to
make sure the uterus is contracting (detected by palpation during
abdominal examination) and to check for bleeding, blood pressure
abnormalities, and general well-being.
ANALYSIS
o:
-y/o gravida 3, para 2, who was admitted at term at 6:30 a.m. She stated that she had
been having contractions at 7 to 10 minute intervals since 4 a.m. They
lasted 30 seconds. She also stated that she had been having "a lot of
false labor" and hoped that this was "the real thing". Her membranes
were intact. Mrs. G.'s temperature, pulse and respirations were normal
and her blood pressure was 124/80. The fetal heart tones were 134 and
regular. The nurse examined Mrs. G. and found that the baby's head was
at +1 station, and the cervix was 4 cm. dilated and 80 percent effaced.
She reported her findings to the doctor and he ordered Demerol 50 mg.
with Phenergan 25 mg. to be given intravenously when needed.
Mrs. G. is in false labor? Give reasons for your answer.

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was getting into bed, her membranes ruptured. What is the first thing that you would do
after this occurs? Why?
embranes ruptured, her contractions began coming every 4 minutes and lasted 45 to 55
seconds. They were moderately strong. Why is it important for Mrs. G. to
relax during her contractions? How can you help her to relax?
ou think Mrs. G. should be given the medication ordered by the doctor? What safety
measures should be taken at the time the medication is given? What
observations should be made after it is given? Why? What observations
would you report to the doctor?
ou know that Mrs. G. has entered the transition phase?
am revealed that Mrs. G. is complete and +2. What should be the nursing interventions
at this time?
e her a pudendal block and did a midline episiotomy. At 8:05 a.m. Mrs. G. gave birth to
a 7 lbs., 5 oz. (3.317 gm.) boy in the L.O.A. position. The nurse put
medicine in the baby's eyes and placed an identifying bracelet on his
right wrist and ankle. A matching bracelet was placed on the mother's
wrist. The baby was shown to his mother and then taken to the newborn
nursery. At 8:08 a.m. the placenta was expelled.
medicine put in the baby's eyes?
portant to put identification on the baby in the delivery room?
hould Mrs. M. receive before she is transferred to the recovery room.
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punishable
Telefax No.by(044)
Law” - NEUST
463-0226
neustmain@yahoo.com
www.neust.edu.ph
TECHNOLOGY
COLLEGE OF NURSING
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punishable
Telefax No.by(044)
Law” - NEUST
463-0226
neustmain@yahoo.com
www.neust.edu.ph
TECHNOLOGY
COLLEGE OF NURSING
APPLICATION
NURSING PROCEDURE:
Assessment
 Assess the responses of the mother towards the intensity and duration
of the contractions.
 Assess the comfortability of the mother with her birthing position.
 Assess her breathing techniques if they are effective or could add to the
difficulty that the mother might be experiencing.
 Assess the ability of the support person to assist the mother
during labor and birth.
 Assess the fetal heart sounds to make sure that there is no occlusion in
the cord that could hinder fetal circulation.
 Assess if the environment is comfortable for both the mother and the
baby.
Nursing Diagnosis
Examples of nursing diagnoses are:
• Pain related to intensity of uterine contractions

• Deficient knowledge related to the child bearing down.
Outcome Identiﬁcation and Planning
 The place of birth must be prepared prior to delivery.

 For multigravidas, preparation of the room could start when the cervix
has dilated to 9 to 10 cm.
 For primiparas, preparation of the birth place should start when the
head has crowned to the size of a quarter.
 The newborn care area must also be prepared within the same room
and include supplies for eye care, suction and resuscitation equipment,
radiant heat warmer, sterile towels, and identification of the newborn.
 The mother should choose a position that will be most comfortable for
her during birth.
 Alternative birthing positions today are the dorsal recumbent position,
the lateral Sim’s position, squatting, and semi-sitting.
 A health care provider must be situated at the foot of the birthing table
already so that the infant would not fall off if birth happened
precipitously.
punishable
Telefax No.by(044)
Law” - NEUST
463-0226
neustmain@yahoo.com
www.neust.edu.ph
TECHNOLOGY
COLLEGE OF NURSING
Equipment Needed:
 Kelly pad
 Drainage pail
 Sterile OB pack (gown, OB sheet)
 Drape towels with or without instruments
 Sterile gloves
 Normal Delivery Set (arrange according to order use)
 Sterile pads
 Suction bulb
 Two straight forceps
 One surgical pair of scissors
 Placental bowl
 Syringe (5-10cc)
 Hypodermic needles
 Aspirating Gauge 19-21
 Injecting Gauge 21-23
 Chromic
 Needle holder
 Thumb forceps
 Tissue forceps
Client Education Needed:
 If the client has a birth plan, make sure all health care providers are
aware of her individual preferences.
 Encourage the mother to void before delivery to reduce the discomfort.
 Allow client to take ice chips or hard candies for relief of dry mouth.
 Provide a comfortable environment for both the mother and the baby.
 Allow the client to assume a birthing position of her choice as long as it
is not contraindicated.
 Assist the client in venting out any emotions with regards to her
delivery experience.
Implementation :
ASSESSMENT
1.  Ensure the privacy and dignity of the woman. Make her
feel comfortable. A male doctor needs a female assistant
while performing the examination. Ask if she has
understood what is going to be done and ask her
permission before undertaking the examination
 All equipment, medicine, and disposables should be
made ready before the pregnant women are brought into
the delivery room
 The woman is to be moved to the labor table in the
active stage of labor
punishable
Telefax No.by(044)
Law” - NEUST
463-0226
neustmain@yahoo.com
www.neust.edu.ph
TECHNOLOGY
COLLEGE OF NURSING
 Unnecessary pushing in between contractions should be
avoided
 Ensure the woman is hydrated and the bladder is empty
before encouraging the woman to push
 All neonatal equipment for ENBC and resuscitation should
be pre-checked and kept ready until the pregnant woman
is brought in
 The room temperature should be maintained in the range
26–28°C in the Labour Room and chilly areas will need
heaters during winter
 Provide emotional support and reassurance, as feasible
 Encourage the presence of a birth companion
PLANNING
1.  Prepare the equipment and materials:
 Kelly pad
 Drainage pail
 Sterile OB pack (gown, OB sheet)
 Drape towels with or without instruments
 Sterile gloves
 Normal Delivery Set (arrange according to order use)
 Sterile pads
 Suction bulb
 Two straight forceps
 One surgical pair of scissors
 Placental bowl
 Syringe (5-10cc)
 Hypodermic needles
 Aspirating Gauge 19-21
 Injecting Gauge 21-23
 Chromic
 Needle holder
 Thumb forceps
 Tissue forceps
IMPLEMENTATION
1. Change into a DR suit.
2. Put on personal protective attire (wear goggles, mask, cap,
shoe covers, plastic apron)
3. Palpate the suprapubic region to ensure that the woman's
bladder is not full. If it is full, encourage her to empty the
bladder or catheterize
4. Wash hands and put on sterile gloves
5. Clean the woman’s perineum with sterile swabs
6. Talk to the woman and encourage her to take breaths through
her mouth after every contraction
7. When the head is visible, encourage her to bear down during
contractions
8. Support the perineum with one hand using a clean pad and
control the Birthhead's Birth with the fingers of the other hand
to maintain flexion, allowing natural stretching of the perineal
tissue to prevent tears.
9. Feel around the baby’s neck for the cord and respond
appropriately if the cord is present
10. Allow the baby's head to turn spontaneously, then, with the
hands-on either side of the baby's head, deliver anterior
shoulder by gently moving head a little downward which allows
the shoulder to drop down the symphysis pubis
punishable
Telefax No.by(044)
Law” - NEUST
463-0226
neustmain@yahoo.com
www.neust.edu.ph
TECHNOLOGY
COLLEGE OF NURSING
11. When the axillary crease of the anterior shoulder is seen,
deliver the posterior shoulder, lifting the baby upwards towards
the mother's abdomen.
12. Support the rest of the baby's body with one hand as it slides
out and Says "Baby Out" note the baby's time of birth and sex
and show the mother. Place the baby on the mother's
abdomen over a clean, dry, prewarmed towel in a prone
position with the head turned to one side.
13. Quickly dry the baby with a prewarmed towel, discard the wet
towel. Wrap the baby loosely in the second prewarmed dry
towel. Delay cord clamping for 1-3 mins if the baby is crying or
breathing well
14. Palpate the mother's abdomen to rule out an additional
baby/babies and proceed with active management of the third
stage (AMTSL) and ENBC
15. Look for any vaginal or perineal tears; if present, assess the
degree of tear and manage accordingly*
For third-degree perineal tears, refer the woman immediately
for higher specialized care with proper, sterilized perineal
dressing.
EVALUATION
1. Maintain aseptic technique throughout the procedure Cleaning
of the labor table should be done immediately after the
transfer of mother to the postnatal/observation ward.
DOCUMENTATION
1. Do the Charting.
Outcome Evaluation
A care plan would not be complete if no evaluation was done to test the
effectiveness of your plan.
 Client will be able to manage her discomfort using nonpharmacologic

methods.
 Client will be able to identify other pain relief measures.
 Client has no signs of bladder distention and can void every 2 hours.
 Client states that she has reduced or no mouth discomfort.
 Client states that the environment is comfortable enough.
 Client reports that the delivery is a tolerable and highly meaningful part
of her life.
punishable
Telefax No.by(044)
Law” - NEUST
463-0226
neustmain@yahoo.com
www.neust.edu.ph

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NUEVA ECIJA UNIVERSITY OF SCIENCE AND

Like all areas of medicine, pregnancy and childbirth has a number of

 Labour is defined as the onset of regular painful contractions with

 Childbirth, also known as labour and delivery, is the ending of

 The most common way of childbirth is a vaginal delivery. It involves three

Signs and symptoms

 The most prominent sign of labour is strong repetitive uterine

 Pain in contractions has been described as feeling similar to very strong

Labour and Delivery

Factors that influence progress of labour

(a) Presentation of the fetus (breech, transverse).

(b) Position of the fetus (ROP, LOP).

(c) Size of the fetus.

2. Passage (Birth Canal).

(a) Parity of the woman, if she has ever delivered before.

(c) Fetopelvic diameters.

(a) Force of the uterine contractions.

(b) Frequency of the uterine contractions.

(a) Site of implantation.

(b) Whether it covers part of the cervical os.

5. Psychology (Psychological State of the Woman).

(a) Patient extremely anxious.

(b) Emotional factors related to the patient.

(c) Amount of sedation required for the patient.

Labour has three stages:

 The third stage is when the placenta (afterbirth) is delivered.

Important relationship to be considered:

 Fetal attitude or posture

 refers to the relationship between the long axis of the fetus with respect

The possibilities include:

Fetal presentation is a reference to the part of the fetus that is overlying the

 Fetal presentation is a reference to the part of the fetus that is overlying

 A breech fetus also is a longitudinal lie, with the fetal buttocks as

Fetal Attitude or Posture

 This describes the relationship of fetus' body parts to one another.

Refers to the relationship of an arbitrary chosen portion of the fetal

May be directed anteriorly, transversely or posteriorly.

 LOA- Left Occiput Anterior (most frequent)

 LOT- Left Occiput Transverse

 LOP- Left Occiput Posterior

 ROA- Right Occiput Anterior

 ROP- Right Occiput Posterior

Cardinal Movements of Labour

 Refer to the varying head positions a fetus undergoes throughout the

The Seven Cardinal Movements of Labor

 Engagement is a medical term often referred to as “baby dropping.” This

 This occurs as a result of active forces of labor. Internal Rotation: This

 During flexion, uterine contractions push the fetus downward against the

There are various definitions of the onset of labour, including:

 Regular uterine contractions at least every six minutes with evidence of

 At least three painful regular uterine contractions during a 10-minute

Some women also experience an increase in vaginal discharge several days

The first stage of labor has three parts:

3. Transition to second stage

Phases of the first stage of labour

 Active phase - During active labor, your cervix will dilate from 6

 Dystocia of labor, also called "dysfunctional labor" or "failure to

Your baby moves through the birth canal

Delivery of the Fetus