Preparation for Delivery

Preparation for delivery

• Preparation of environment for a safe delivery

  • Room should be clean and wipe with antiseptic solution or bleaching solution.

  • Maintain good light and adequate ventilation.

  • Delivery room should be warm to prevent hypothermia of neonate.

  • A  perineal light should be check for proper functioning or not.

  • Mattress should be covered with rubber sheet and then withdraw sheet.

  • Keep ready 2-3 extra pillows, blanket, and mackintosh.

  • Keep Ready of IV stand, IV set, drip, O2 cylinder and tube.

  • Do not allow to enter unnecessary personnel.

  • Delivery bed should have warm leggings.

• Preparation of women

  • Bath especially below the waist to keep the skin clean and to prevent infection.

  • Bladder should be emptied regularly.

  • Clean and trim the perineal region and apply perineal pad.

  • Change the clean hospital gown and apply leggings.

  • Provide glucose water, hot and cold water.

  • Sponging her face and neck by cold water.

  • Extra -ordinary ornament should be removed.

  • Behave with warm friendly manner.

  • Teach women about bearing down effort during contraction and taking long respiration during relaxation period.

  • Proper privacy should be maintained.

• Preparation of self

  • Nails should be short

  • Make the hair tidy.

  • Remove the ring and wrist watch.

  • Familiarize you with women's condition by checking the chart and collecting important information.

  • Wash hand maintaining sterilized technique.

  •  Put on the gloves

  •  Open the delivery set and arrange the equipment in respective place in a proper manner.

  •  Ask your assistance to check FHS, contraction, maternal vitals sign regularly.

  •  Keep the necessary equipment near herself.

• Preparation of equipment for delivery

Episiotomy set

• Episiotomy scissors-1

• Tooth dissecting forceps-1

• Non-tooth dissecting forceps -1

• Small artery forceps -2

• Needle holder -1

• Thread cutting scissors-1

• Round body needle with chromic catgut 2 0-1

• Small gallipot -1

• Another equipment os as in normal delivery.

 Care of women in the 2nd stage of labor.

 Objectives

• To prevent infection of the genital tract by careful attention to asepsis and antiseptic.

• To prevent complication.

• To prevent injury to both women and baby.

• To ensure the delivery of an alive, healthy and undamaged baby.

• To preserve the muscle of the perineum.

• To provide immediate care for a newborn baby for proper thriving.

Care 

Monitoring maternal and fetal condition

1. Maternal condition

• Observation includes the mother's ability to cope emotionally as well as an assessment of her well being.

• Maternal pulse rate is usually recorded every half an hour and blood pressure every hour.

• These should remain within normal limits.

2. Fetal condition

• If the membrane is ruptured, observe the color of liquor, ie.clear, labourmeconium stained or blood stained.
• The midwife should learn to recognize the normal change in fetal heart rate pattern during the second stage.

  • Monitoring progress labor

    • Uterine contraction
    • The strength, length and frequency of the contraction should be assessed continuously by uterine palpation.
    • They are usually stronger and longer than during the 1st stage of labor, lasting up to one minute.
    • Descent, rotation and flexion.
    • For a multiparous woman, birth usually occurs within minutes of complete dilation, perhaps only one push later.
    • But the nulliparous woman usually pushes for 1-2 hours before delivery. The nurse will begin preparation for delivery when a multiparous woman is 6-7 cm dilated because progression through the last few cm of dilation can occur from few minutes to hours.
    • Transfer of nulliparous woman should take place when the presenting part begins to descend the perineum between contraction during the 2nd stage of labor.

Support for birthing position

• There is no single position for childbirth.

• Birth attendants /midwife play a major role in influencing a women's choice of position for birth.

1.  Upright position

• ​​​​​This position reduces the duration of the second stage, the need for forceps or vacuum assisted birth and episiotomy.

2. Squatting

• Is highly effective in facilitating the descent and birth of the fetus.

• It is considered to be the best position for the 3rd stage of labor.

3. Standing position

• The side lying position.
• Is an effective position for the second stage, with the upper part of woman's leg, had a nurse or placed on a pillow.

Management of Delivery

1. Provision of comfort and support

• Nurse should provide emotional support to a woman with labor.

• Encourage her good communication and support by staff.

• Maintain privacy and confidentiality.

2. Prevention of infection

• Hospital is a notorious source of infection.

• Bathroom, sinks, a toilet should be cleaned and disinfected.

• Beds must also be cleaned thoroughly after use.

• Personal hygiene is important.

• The nurse must wash her hands before and after examining the mother.

3. Care of perineum

• Clean the women perineum with an antiseptic solution.

• Place one sterile drape under the woman's buttock.

• As the pressure of the head thin at the perineum control the birth of the head with the finger of one hand applying firm gentle downward pressure to maintain flexion allow natural stretching of perineum tissue.

• Use another hand to support the perineum using a compress or cloth and allow the head the crown slowly.

• Delivery the head in between contraction.

• Performs timely episiotomy when indicated after giving local anesthesia.

• When the axillary crease is seen guide head downward, the mother's abdomen as the posterior shoulder is born over perineum.

• Lift baby's head anteriorly to deliver the posterior shoulder.

• Immediately after birth, the cervix vagina and perineum are inspected for tear.