ROLES AND RESPONSIBILITY AS A NURSE IN A DELIVERY ROOM

“S1”
• Assist of mother
• Transfer mother from labor room to DR
• Position lithotomy
• Perineal preparation
• Take note: baby out time, placental delivery time, PP, BP
• Coach mother during delivery (breathing, pushing)
• Prepare mother’s diaper & clean clothes
• Put diaper and transfer to RR
• Nurse’s notes for mom
ROLES AND RESPONSIBILITY AS A NURSE IN A DELIVERY ROOM
“FLOATER”
• Assist patient coming in and out of DR
o Ask to void
o Open specimen container
• Position patient
• Prep CBG monitoring
• Prep inco. pad on bed
• Check all supplies needed
• Do aftercare
• For admission transfer from IE to labor room
• Arrange materials in the cabinet
o Slippers
o Gowns
o Student logbook
• Secure data
ROLES AND RESPONSIBILITY AS A NURSE IN A DELIVERY ROOM
“S2”
• Assist of baby
• Preparation of baby’s crib
• Secure clothes
o 1 plain
o 1 with hood aside from the bonnet
o Clothes with sleeves or string
• Take note
o Baby out
o Everything S3 gave to the baby (meds)
o Anthropometric measurements
o APGAR & BALLARD
o Nurse’s notes for baby
o Baby’s tag
▪ Baby boy/girl (name of mom & family name)
▪ Gender, time and date
▪ BALLARD & APGAR
▪ Name of pedia (private)
▪ If no specific doctor (Dr. Velez House)
ROLES AND RESPONSIBILITY AS A NURSE IN A DELIVERY ROOM
“S3”
• Handle the baby
• Cord cutting
• Preparation of the baby table
• Secure gooseneck lamp
• Preparation of incontinent pad
• Use paper lining of gloves
• Heat or pre-warm baby table
• Anticipate delivery of the baby
• open gloving
• Secure bulb syringe
• Assist doctor transfer baby to table
• Wipe baby
• Eye ointment
• Vitamin K
• Let document complete anthropometric measurements, APGAR & BALLARD
• Put on clothes for baby
• Vital signs every 15 minutes for 2 hours
ROLES AND RESPONSIBILITY AS A NURSE IN A DELIVERY ROOM
“S4”

• Handle of mother
• Back table
• Gloving
• Arranging instruments
• Preparing of anesthesia, suture and gloves for doctors, sterile water, betadine
• Relay
• Take note:
o Baby out
o Signs of placental separation
o Placenta out
o Anesthesia time
o Episiorrhapy started and end
• Aftercare ~ cleaning of instruments
 NEWBORN CARE
PRINCIPLES OF NEWBORN CARE

1. Preparation for delivery

2. Drying
3. Assessment of state
4. Classifications, precautions
5. Clean the airways as needed
6. Skin to skin contact
7. Cord clamping
8. Early start of breastfeeding
9. Prophylactic activities
10. Observation of mother and newborn
11. Assessment, measuring, examination of newborn
12. Performing rooming-in in daytime and at night
 NEWBORN CARE
4 Time-bound interventions involved in Essential Newborn
1. Immediate and thorough drying
2. Early skin to skin contact followed by,
3. Properly timed clamping and cutting of the cord after 1 to 3 minutes
4. Non-separation of the newborn from the mother for early breastfeeding
initiation and rooming-in

➢ Purpose
o Prevents hypothermia
o Prevents hypoglycemia and sepsis
o Prevents anemia and possibility of developing (intraventricular) hemorrhage in one
of two preterm babies
o Breastfeeding initation within the first hour of life prevents an estimated 19.1 % of
all neonatal deaths.
 NEWBORN CARE
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
 NEWBORN CARE
Time Band: Within 0-3 mins (Thorough Drying)
➢ Do not wipe off vernix

➢ Do not bathe the newborn

➢ Do not do footprinting

➢ No slapping

➢ No hanging upside – down

➢ No squeezing of chest
 NEWBORN CARE
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
➢ Avoid any manipulation, e.g. routine suctioning that may cause trauma
or infection 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
 NEWBORN CARE
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
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

 NEWBORN CARE
Time Band: within 90 mins. (Nonseperation 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
o Newborn’s neck is not flexed nor twisted
o Newborn is facing the breast
o Newborn’s body is close to mother’s body
o 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
 NEWBORN CARE
NON-IMMEDIATE INTERVENTIONS
These interventions are usually given within 6 hours after birth and should never
be made to compete with the time-bound interventions.

1. Give Vitamin K prohylaxis

• Inject a single dose of Vitamin K1 mg IM (if parents decline intramuscular injections,
offer oral vitamin K as a 2nd line).

2. Inject Hepatitis B and BCG vaccinations

• Inject hepatitis B vaccine IM and BCG intradermally.

3. Examine the newborn. Check for birth injuries, malformations or defects.

• Weigh the newborn and record.
• Look for possible birth injury and/or malformations.
• Refer for special treatment and/or evaluation if available.
 NEWBORN CARE
EARLY BATHING/WASHING

• The Association of Women’s Health, Obstetric and Neonatal

Nurses recommends that most newborns receive a
complete sponge bath at least after 6 hours after birth when
their temperature and vital signs are stable.
o There is no need to use an antibiotic cleansers and no
need to remove all vernix
o Babies of mothers with HIV infection should have a
thorough bath immediately to decrease the
possibility of HIV transmission.
o Thereafter, all babies are sponged bathed once a
day, although the procedure may be limited to
 washing only the baby’s face, diaper area and skin
folds.
• Wear gloves when handling newborns until the first bath to
avoid exposing your hands to body secretions such as vernix
• Plan to help a mother, give a first bath before (not after)
feeding to prevent spitting up or vomiting.
• Check to be certain the mother’s room is warm about 24
degrees Celsius to prevent chilling
• Bathing should proceed from the cleanest parts of the body
to the most soiled ones – that is from the eyes and faces to
the trunk and extremities and last to the diaper area
• Wash thoroughly and rinse afterwards then dry the baby
with a soft towel.
 NEWBORN CARE
EARLY BATHING/WASHING

The WHO recommends bathing at least after 6 hours of the

newborn’s life. Bathing the newborn soon after birth causes a drop
in the body’s temperature leading to increased risk of developing
infections, coagulation defects and brain hemorrhage. It also
removes the vernix which is protective against bacteria that cause
neonatal sepsis and removes the crawling reflex.
 NEWBORN CARE
CORD CUTTING & CLAMPING

1. Be sure the cord has stopped pulsing for most births. This is called
delayed cord clamping and provides benefits for your baby.
2. Ensure that there are two clamps on the cord. (The practitioner will be
responsible for this part.)
3. Hold the section of cord to be cut with a piece of gauze under it.
4. Using sterile scissors cut between the two clamps.
5. Dab excess blood. (The amount of blood depends on how long you
wait to cut the cord, the longer you wait, the less blood.)
6. Place scissors away or hand them back to whoever handed them to
you.
 NEWBORN CARE
CORD DRESSING
Follow these precautions when caring for the umbilical cord:

1. Wash your hands.

2. Place cord clamp x 1 approximately 2 cm from skin.
3. If LUSCS or high-risk baby, cord is clamped 4-5 cm from skin
4. Cord is checked for ooze hourly for two hours after birth.
5. Midwife to check cord area daily and record cord status.
6. The area around cord stump is washed carefully with water and dried when bathing the baby. If it is moist,
encourage mothers to fold nappy and plastic under cord area, leaving cord exposed to air.
7. Educate parents to observe and report any signs of infection (redness, stickiness or offensive odour).
8. Clamp the cord with sterile clamps and cut it with sterile scissors.
9. The recommended length of the stump after cutting is 2-5 cm.
10. Use rooming in where possible, with the mother as primary carer.
11. Keep the cord dry and exposed to air.
12. The nappy should allow for the cord to sit out of it.
13. Wash hands before handling the umbilical cord and where possible avoid touching the cord stump.
14. The cord clamp will fall off between days 5-10, you do not need to remove the clamp on discharge from
hospital.
15. Educate parents regarding separation of the cord.
16. Explain there might be slight bleeding at the time of separation of the cord.
 NEWBORN CARE
BILI LIGHT
A type of light of light therapy (phototherapy) that is used to treat newborn
jaundice. Jaundice is a yellow coloring of the skin and eyes. It is caused by
too much substance called bilirubin. Bilirubin is created when the body
replaces old red blood cells with new ones.

Phototherapy involves shining fluorescent light from the bili lights on bare
skin. A specific wavelength of light can break down bilirubin into a form that
the body can get rid of through the urine and stools. The light looks blue.
➢ The newborn is placed under the lights without clothes or just wearing
a diaper.
➢ The eyes are covered to protect them from the bright light.
➢ The baby is turned frequently.
➢ The health care team carefully notes the infant's temperature, vital
signs, and responses to the light. They also note how long the
treatment lasted and the position of the light bulbs.
 ➢ The baby may become dehydrated from the lights. Fluids may be
given through a vein during treatment.
➢ Blood tests are done to check the bilirubin level. When the levels have
dropped enough, phototherapy is complete.
➢ Some infants receive phototherapy at home. In this case, a nurse visits
daily and draws a sample of blood for testing.

Treatment depends on 3 things:

• Gestational age
• Bilirubin level in the blood
• Newborn's age (in hours)
• In severe cases of increased bilirubin, an exchange transfusion may be
done instead.
 NEWBORN CARE
BILI BLANKET

A Bili Blanket is a portable phototherapy device consisting of a

fiber-optic pad and a portable illuminator for the treatment of
neonatal jaundice (hyperbilirubinemia) in the home. The light
emitted from Bili blanket is used to break up bilirubin in the baby’s
blood, reducing the yellowing effect in baby’s skin and whites of
the eyes.
NEWBORN CARE
APGAR SCORING
 NEWBORN CARE
BALLARD SCORING
 NEWBORN CARE
EXPANDED NEWBORN SCREENING
How the test is done:
1. 48 hours or at least 24 hours from birth but not later than 3 days after complete
delivery. A newborn placed in intensive care may be exempted from the 3-day
requirement but must be tested by 7 days of age.
2. A few drops of blood is drawn from pricking the baby’s heel.
3. Then it is blotched on a special absorbent card and dried for at least 4 hours.
4. The procedure may be done by the physician, nurse, midwife, or medical
technologist.
5. If a screening test suggest a problem, the baby’s doctor will follow up with
further testing. If those tests confirm a problem, the doctor may refer the baby
specialist for treatment. Following doctor’s treatment plan can save the baby
from lifelong health-related and developmental problems.
 NEWBORN CARE
EXPANDED NEWBORN SCREENING
Expanded Newborn screening cover six diseases namely:

• Congenital hypothyroidism
• Congenital adrenal hyperplasia
• Galactosemia
• Phenylketonuria
• Maple Syrup Urine Disease
• Glucose-6-Phosphate-Dehydrogenase Deficiency
 POST – PARTUM Assessment
BUBBLE SHE

B - reast (size, shape, enlargement)

U - terus (firm, or boggy)
B - ladder (tender or distended)
B - owel sounds (bowel movement)
L - ochia (amount, odor, color, clots)
E - pisiotomy (location, stitches, edema, redness)

S - urgical incisions (check for bleeding)

H - oman’s signs (positive or negative)
E- emotional stability (status and bonding)
 BREASTFEEDING
PROPER LATCHING
A good latch is vital to successful breastfeeding.
The following techniques plus proper positioning can help ensure a good latch:
• The mother should be in a comfortable chair with great back support to feed the baby.
• Use the breastfeeding support pillow if someone has one. A good breastfeeding pillow
can make a huge difference in getting the baby in a proper position to latch on well.
• Make sure the baby is tummy-to-tummy with you at all times.
• Make sure the mother will bring the baby closer to her, encourage the mother to not try
to lean into the baby. Not only will this cause severe strain on the neck and shoulders,
but it can affect the baby’s position.
• Remember to keep the baby’s ear, shoulder, and hip in alignment, which will make
swallowing easier.
• The baby’s nose should be opposite the nipple.

• The mother might need to hold her breast to help guide the nipple to her baby’s mouth.
Encourage her to grasp the breast on the sides, using either a “C” hold or “U” hold.
 Make sure to keep fingers far from the nipple so she don’t affect how the baby latches
on.
• Aim the nipple toward the baby’s upper lip/nose, not the middle of the mouth. The
mother might need to rub the nipple across the top lip to get your baby to open his/her
mouth.
• The baby’s head should be tilted slightly back.
• When he opens his mouth wide with the chin dropped and tongue down, he should latch
on to the nipple. If he does not open wide, do not try to shove the nipple in and wiggle
the mouth open. It is best to move back, tickle the lip again with the nipple and wait for
a wide open mouth.
• Try to get as much of the lower portion of the areola (the area around the nipple) in the
baby’s mouth.
• The baby’s chin should indent the lower portion of the breast.
• Look to see if the baby’s bottom and top lip are flanged out like fish lips. If they are not,
the mother may use her finger to pull the bottom one down and open up the top one
more.
 BREASTFEEDING
4 PROPER POSITIONING FOR BREASTFEEDING

CRADLE POSITION
The cradle hold is the most common breastfeeding position.
The mum's arm supports the baby at the breast. The baby’s head
is cradled near her elbow, and her arm supports the infant along
the back and neck. The mother and baby should be chest to chest

CROSS-CRADLE POSITION
The cross-cradle position uses the opposite arm
(to the cradle position) to support the infant, with the back of the
baby's head and neck being held in the mother's hand.
Her other hand is able to support and shape the breast if required.
In this position the mum can guide the baby easily to the breast
when they are ready to latch on.
 BREASTFEEDING
4 PROPER POSITIONING FOR BREASTFEEDING

CLUTCH OR FOOTBALL-HOLD POSITION

The baby is positioned at the mother’s side, with their body
and feet tucked under the mum's arm. The baby’s head is
held in the mum's hand. The mum’s arm may also rest on a
pillow with this hold. This position may be advantageous for
mums who have undergone a caesarean section, since it
places no or limited weight on the mum’s chest and abdomen
area. It may also work for low-birth-weight babies or babies that
have trouble latching, since their head is fully supported.

SIDE-LYING POSITION
The mum lies on her side and faces the baby. The baby's mouth is
in line with the nipple. The mum may also use a pillow for back and
neck support. This position may also be advantageous for mums who
have undergone a caesarean section, since it places no or limited
weight on the mum’s chest and abdomen area.
 BREASTFEEDING
SIGNS OF GOOD LATCHING

Signs that confirm a good latch:

• The tongue is seen when the bottom lip is pulled down
• Ears wiggle
• There is a circular movement of the jaw rather than rapid chin movement
• Cheeks are rounded
• You do not hear a clicking or smacking noises
• You can hear swallowing
• Chin is touching the breast
• When the baby comes off the breast, the nipple is not flattened or misshaped
• Any discomfort ends quickly after getting the baby latched on
• The baby ends the feeding with signs of satiety/satisfaction. These signs
include: the baby looks relaxed, “falls” off the breast, has open hands, and/or
falls asleep.
 BREASTFEEDING
BREAST CARE
If The Breasts Become Engorged When Breastfeeding

• Wear a bra with good support 24 hours a day.

• Take a warm shower or apply a warm face cloth to the breasts. The
heat may help milk flow.
• Pump or hand express milk before nursing to soften the breast if the
baby is having trouble latching on because the breasts are engorged.
• Apply a cold compress after feeding. It may help relieve swelling.
• Take Tylenol or Motrin for discomfort.
• Nurse the baby frequently to help the milk supply and reduce
engorgement.
 BREASTFEEDING
BREAST CARE
If the Breasts Becomes Engorged When Bottle Feeding

• Wear a bra with good support 24 hours a day.

• Avoid handling the breasts.
• Do not pump or hand express milk. This will only increase the
engorgement.
• Take Tylenol or Motrin for discomfort.
 BREASTFEEDING
BENEFITS FOR THE BABY

➢ Protects against allergies and eczema

➢ Causes less stomach upset, diarrhea, constipation than formula
➢ Reduces risk of viruses, urinary tract infections, inflammatory bowel
diseases, gastroenteritis, ear infections and respiratory infections.
➢ Lessens the risk of SIDS
➢ Make vaccines more effective
➢ Protects against diseases such as spinal meningitis, type 1 diabetes, and
Hodgkin's lymphoma.
➢ May make the baby smarter
➢ Helps prevent obesity
➢ Brings baby closer to the mother (mother-infant bonding)
 BREASTFEEDING
BENEFITS FOR THE MOTHER

➢ Lowers the risk of breast and ovarian cancer.

➢ Helps lose pregnancy weight.
➢ Triggers the uterus to shrink back to its pre-pregnancy state.
➢ May lower risk of osteoporosis.
➢ Heals the body after delivery
➢ Delays menstruation
➢ Can give some natural birth-control protection
➢ Gives closeness to the baby
➢ Economical (mother can save money when she breastfeeds her baby)