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LABOUR o Assess membrane; intact or

ruptured, color of fluid
LABOUR o Assess bloody show; amount
 It refers to the physiologic and o Time of onset
mechanical process in which the baby, o Check for cervical changes
placenta, and fetal membranes are o Time of last ingested food
passed through the pelvis and expelled o Fetal Heart Rate
from the birth canal.  Count immediately after rupture
of membrane
MECHANICAL FACTORS INVOLVED IN  Normal: 120 to 160 beats per
LABOUR minute
1. POWERS - It consists of the processes
by which the expulsion of the products STAGE 2: EXPULSION STAGE
of conception is accomplished.  Preparation
o Uterine contractions o Maternal Position (Lithotomy)
o Intra abdominal pressure o Perineal Cleansing
o External pressure  It is often referred as the pushing
2. PASSAGES phase, average 1 to 2 hours in
o Pelvis length.
o Soft parts – cervix and vagina  It begins with complete dilation of cervix
o Pelvic floor (8-10 cm) and ends with delivery of
3. PASSENGERS infant. Contractions severe at 2-3
o Fetus minutes intervals with a duration of 50-
o Placenta 90 seconds and should be completed
o Membranes between 30 minutes to 2 hours.
 Maternal Expulsive Efforts
STAGES OF LABOUR o Bearing down is usually reflex and
spontaneous but in primigravida a
STAGE 1: CERVICAL DILATION degree of coaching is needed.
 It begins with onset of true labour and o The mother is instructed to breathe
ends when cervix is completely dilated normally until the start of the
at 10 cm. contraction then to extent downward
 It consists of 3 phases: pressure as in straining at stool.
o Latent Phase (0-4 cm) o The “push” is sustained as long as
 Frequency: Uterine contraction possible and to breathe slowly
every 15 to 30 minutes expelled as the contraction
 Duration: 15 to 30 seconds disappears.
 Intensity: Mild o No bearing down is done in between
o Active Phase (4-8 cm) contractions to allow both the
 Frequency: Uterine contraction mother and fetus time to recover.
every 3 to 5 minutes o Coaching with constant reassurance
 Duration: 30 to 60 seconds is needed to allay fear and decrease
 Intensity: Moderate anxiety and to ensure coordination
o Transition Phase (8-10 cm) of expulsive efforts and contractions.
 Frequency: Uterine contraction
every 2 to 3 minutes
 Duration: 45 to 90 seconds  Delivery of the Head
 Intensity: Strong o With each contraction, the perineal
 Assessment opening becomes ovoid (egg shape)
to circular with progressive dilation.
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o The perineum is stretched to almost o Feel around the baby’s neck for the
paper-thin, the rectal opening also umbilical cord.
stretches and the rectal mucosa may  If the cord is around the neck,
be visible. attempt to slip it over the baby’s
o The “crowning” stage where the head
fetal head is seen.  If the cord is tight around the
o Pushing is appropriate if the cervix is neck, quickly clamped and cut
fully dilated to 10 cm and the mother o As the head emerges, the baby will
feels the urge to push. turn to one side (for easier passage
o Pushing only when she feels an urge of shoulders through birth canal).
to push. o Allow the baby’s head to turn
o Use abdominal muscles when spontaneously.
bearing down. o After the head turns place a hand on
o Use short pushes of 6 to 7 seconds. each side of the baby’s head.
o Pushing several times with each o Tell the woman to push gently with
contraction. the next contraction.
o Push with slight exhalation. o Following the delivery of the head,
o Continue proper coaching on pushing apply gentle downward traction on
and bearing down. the head for the delivery of the
o Control the delivery of the head to anterior shoulder, and then upward
prevent laceration. movement for the delivery of the
o Episiotomy if required. posterior shoulder.
o Apply Ritgen’s Maneuver o The rest of the body should follow.
o Instruct the mother to focus on her o As the body delivered, one hand
breathing. Have her breathe heavily. remains support the fetal head and
o Ask the mother to pant or give small another hand is slide along the fetal
pushes with contractions as the back to grasp the feet.
baby’s head delivers. o NOTE TIME OF DELIVERY AND
 Ritgen’s Maneuver GENDER of the baby.
o It is an obstetric procedure used to o Airway should be cleared by wiping
control delivery of the fetal head. It the baby face.
involves applying upward pressure o Promote skin to skin contact by
usually as the mother while pushing. putting the baby at the mother’s
It allows the extension of the head abdomen.
and its gradual delivery. It prevents o Dry and wrap the baby, put a bonnet
the contamination of the face with or cap if available.
the anus, and prevention of anal o Assess the baby APGAR first
sphincter injury. minute after birth.
o To control birth of the head, place o Clamp the cord 2 cm from the base
the fingers of one hand against the towards baby after pulsation stops,
baby’s head to keep it flexed. and clamp between mother and the
o Continue to gently support the baby’s umbilicus, then cut between
perineum as the baby’s head clamps.
delivers.  Mechanism of Labour
o Once the baby’s head delivers, ask o Identify the movement in the
the mother not to push. mechanism of labour.
o Cord around the neck (Nuchal Cord A. ENGAGEMENT – when the
– Presence of loops of umbilical cord biparietal diameter of the fetal
around the neck). head if engaged. In primigravida
engagement occurs before the
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onset of labour. In multiparas, it  It is the delivery of the placenta and it is

usually occurs at the onset of the shortest stage. The time it takes to
labour when the head of the deliver your placenta can range from 5
fetus is movable above the inlet to 30 minutes. The contraction signal
and is referred to as “floating.” that the placenta is separating from the
B. DESCENT – after engagement, uterine wall.
futher descent of the fetal head  Mechanism of Placental Separation
(downward passage of the o Schultz mechanism (70%)
presenting through the pelvis)  Separation is in the central in
until the beginning of the second origin and the retroplacental
stage of labour. This movement blood pushes the placenta
is brought about by: downward (shining part).
1. Uterine contractions  Initially there is little gush of
2. Contractions of the blood.
abdominal muscles  Flow of blood is evident after the
3. Bearing down of the delivery of the placenta.
mother which increases o Duncan mechanism (30%)
the abdominal pressure.  The placental separation starts
C. FLEXION – this is brought about at the edge of placenta.
by the resistance of the fetal  Bleeding will be evidenced in the
head by the pelvic floor as it early phase of separation.
descends. The chin of the fetus  The separation is slower and less
is brought to the fetal thorax. complete.
D. INTERNAL ROTATION – the  More blood loss.
fetal head rotates anteriorly from  Maternal edge of the placenta is
its original position towards the first evidence.
symphysis pubis or towards the  Brandt-Andrews Maneuver
hallow of the sacrum. Internal o A technique/method of delivering the
rotation normally occurs when placenta from the uterus during the
the head is at the level of the third stage of labour.
ischial spines resulting in further  Signs of Placental Separation
descents of the resenting parts. o Sudden gush of blood (vulva sign)
E. EXTENSION – after internal o Lengthening of the cord (cord sign)
position, extension follows as a o Changes in shape of the uterus from
result of the resistance offered pear to globular (uterine sign)
by the perineal floor. The head is o The fundal level rises in the
born and becomes visible called abdomen
“crowning.” o Suprapubic bulge may appear
F. RESTITUTION/EXTERNAL
o Be sure to take note the time of the
ROTATION – internal rotation of
delivery of the placenta.
the shoulder follow delivery of
 Inspect the Placenta
the head. Then, the head returns
o Make sure it is complete.
to the oblique position.
o Look for missing pieces or
G. EXPULSION – after external
rotation, the anterior shoulder cotyledons.
become visible, followed by the o Look for malformations.
delivery of the posterior shoulder o Look for areas of adherent blood
and the rest of the body. clot.
o Estimate the blood loss (normal
STAGE 3: PLACENTAL SEPARATION AND blood loss is 500 mL).
EXPULSION
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o Ensure the bleeding is within normal  Place the newborn on the mother’s
limits. abdomen in skin-to-skin contact. Cover
o Check vital signs of the mother. the back with a dry blanket.
o Check if the uterus is well
contracted. With the 1st 30 seconds (Call out the
o Assess for any lacerations. time of birth)
o Perineal flushing after suturing. INTERVENTION
o Clean and assist the mother into a  Dry and provide warmth
comfortable position. ACTION
o Assist with transfer to recovery area.  Use a clean, dry cloth to thoroughly dry
the baby by wiping the face, eyes, head,
STAGE 4: POSTPARTUM front, and back of the trunk, arms, and
 It begins after the placenta is expelled legs.
and last up to 4 hours after birth, during  Do a quick check of newborn’s
which time recovery takes place. breathing while drying.
 During this stage, the woman’s body is  Remove the wet cloth.
beginning to undergo many
physiological and psychological changes DRYING THE NEWBORN
that occur after birth.  Stimulates the newborn to breathe
normally
IMMEDIATE NEWBORN CARE  Minimizes heat loss
(THE FIRST 90 MINUTES)  During the 1st 30 seconds of
drying/stimulation:
At perineal bulging, with presenting o Do not suction unless mouth/nose
part visible (3rd stage of Labour) are obstructed with secretions or
INTERVENTION other material.
 Prepare for the Delivery o Do not ventilate unless the baby is
ACTION floppy and not breathing.
 Ensure that delivery area is draft – free
and between 25 to 28°C using a If after 30 seconds of thorough drying,
thermometer. newborn is breathing and crying
 Wash hands with clean water and soap. INTERVENTION
 Double glove just before delivery.  Skin to Skin (STS) Contact

Preparing to Meet the Baby’s Needs ACTION

 “Good care of the newborn begins with  AVOID any manipulation, such as
good preparation.” routine suctioning.
 Ensure all delivery equipment and  Place the newborn prone on the
supplies, including newborn mother’s abdomen or chest skin-to-skin.
resuscitation equipment, are available.  Cover newborn’s back with a blanket
 Line up materials for delivery according and head with a bonnet.
to sequence of use. NOTE
 Do not separate the newborn from
IMMEDIATE ESSENTIAL NEWBORN CARE mother as long as the newborn does not
 Deliver the baby in prone position on exhibit severe chest in – drawing,
the mother’s abdomen, face turned to grasping, or apnea and the mother does
the side. not need urgent medical stabilization
 Call out time of birth. e.g., emergent hysterectomy.
 Dry, check the baby’s breathing  Do not put the newborn on a cold or wet
while drying the newborn thoroughly. surface.
Remove wet cloth.  Do not wipe off vernix if present.
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 Do not bathe the newborn earlier than 6 INTERVENTION

hours of life.  Palpate the mother’s abdomen. Exclude
 Do not do foot printing. a second baby. If there’s a 2nd baby, get
 If the newborn must be separated from help. Deliver the second newborn.
his/her on a warm surface, in a place Manage as in Multi – Fetal pregnancy.
close to mother. ACTION
 If a baby is crying and breathing
DO NOT REMOVE THE VERNIX normally, avoid any manipulation, such
 Vernix, is the waxy or cheese-like white as a routine suctioning, that may cause
substance found coating the skin of trauma or introduce infection.
human babies.
WHEN should the CORD be clamped
IMMEDIATE SKIN – SKIN CONTACT after birth?
 Skin to skin contact keeps your baby  When the pulsations stop
warm.  Between 1 to 3 minutes
 It helps you calm you and your baby.  Between 30 seconds to 1 minute in
 It encourages bonding between you and preterm
your baby.
 Skin to skin contact regulates baby’s 1 – 3 minutes
breathing. INTERVENTION
 Research shows that skin to skin  Do delayed or non – immediate cord
contact with early feeding promotes clamping
successful breastfeeding. ACTION
 Remove the first set of gloves
SKIN – SKIN CONTACT immediately prior to cord clamping.
 Provides warmth  Clamp and cut the cord after cord
 Improves bonding pulsations have stopped (at 1 to 3
 Provides protection from infection by minutes).
exposure of the baby to good bacteria NOTE
of the mother  Do not milk the cord toward the
 Increases the blood sugar of the baby newborn.
 Contributes to the overall success of
breastfeeding. INITIAL CORD – CARE
 Effect on Immunoprotection  Put ties tightly around the cord at 2 cm
o Colonization with maternal skin flora and 5 cm from the abdomen.
o Stimulation of the mucosa-  Cut between ties with sterile
associated lymphoid tissue system instrument.
o Ingestion of colostrum  Observe for oozing blood.

RISK for HYPOTHERMIA CORD CARE

 Hypothermia can lead to:  Do not apply any substance to the
o Infection stump.
o Coagulation defects  Do not bind or bandage the stump.
o Acidosis  Leave the stump uncovered.
o Delayed fetal to newborn circulatory  Proper and timely clamping and cutting
adjustment of the umbilical cord reduces the risk of
o Hyaline membrane disease anemia in both term and preterm
babies.
o Brain hemorrhage
FROM 90 minutes – 6 hours
If after 30 seconds of thorough drying,
INTERVENTION
newborn is breathing and crying
DR TECH and EINC YEAR 02
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 CORD CARE: The umbilical cord in a full

term neonate is usually about 50
centimeters (20 inches) long and about
2 centimeters (0.75 in) in diameter.
ACTION
 Apply cord clamp ½ to 1 inch from the
abdomen
 Put nothing on the stump
 Fold diaper below stump. Keep cord
stump loosely covered with clean
clothes.
NOTE
 Do not bandage the stump of the
abdomen
 Do not apply any substances or
medicine on the stump ESSENTIAL NEWBORN CARE
 Avoid touching the stump (FROM 90 MINUTES TO 6 HOURS)
unnecessarily.
FROM 90 minutes – 6 hours
Washing (Bathing) should be delayed INTERVENTION
until after 6 hours  Examine the baby
 Washing exposes to hypothermia. ACTION
 The vernix is a protective barrier to  Thoroughly examine the baby
bacteria such as E. coli and Group B  Weigh the baby and record
Strep
 Washing removes the crawling reflex INTERVENTION
 Check for birth injuries, malformations
APGAR SCORING of defects
 Apgar is a quick test performed on a ACTION
baby at 1 and 5 minutes after birth.  Look for possible birth injury:
 The 1-minute score determines how well o Bumps on one or both sided of the
the baby tolerated the birthing process. head, bruises, swelling on buttocks,
 The 5-minute score tells the health care abnormal position of legs (after
provider how well the baby is doing breech presentation), or
outside the mother’s womb. asymmetrical arm movement, or
 This test is done to determine whether a arm that does not move.
newborn needs help breathing or is  If birth injury is present:
having heart trouble. o Explain to parents that this does not
 The APGAR score is based on a total hurt the newborn, is likely to
score of 1 to 10. The higher the score, disappear in a week or two and does
the better the baby is doing after the not need special treatment.
birth. o Gentle handle the limb that is not
moving.
o Do not force legs into different
position.
 Look for malformations:
o Cleft palate or lip
o Club foot
o Odd looking, unusual appearance
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o Open tissue on head, abdomen or cause feeding problems and may block
back the airway.
 If malformation is present:
o Cover any open tissue with sterile NECK
gauze before referral and keep  Examine for swelling, growths, and
warm. twisting, or spasm.
 Refer for special treatment and / or  The mobility is good.
evaluation if available help mother to  It can control the head.
breastfeed. If not successful teach her
alternative feeding, methods. CHEST
 The infant has no supernumerary nipple
PHYSICAL ASSESSMENT or third nipple.
 The clavicle is smooth and straight.
Assess from head to toe to determine if there
is abnormalities or physical deformities. ABDOMEN
 It should be round and symmetric.
HEAD  An asymmetrical abdomen may indicate
 Fontanel is still open (anterior and abdominal mass.
posterior).  Umbilical cord should be dry and intact.
 The suture line is appreciated but will  No bleeding on the base of the umbilical
disappear in time. cord.
 If there is molding, which is normal, but
will disappear. GENITALS
 No presence of swelling and cephalo  Male
hematoma. o The urethral opening is on the tip of
the gland.
EYES o The scrotum should be descended
 Examine the internal and external and has two testes.
structure.  Female
 Structure should be normal (pupil, o The labia are prominent.
sclera, and no other signs of infection or o Mucoid vaginal secretions are normal
bleeding). (pseudomenses).

EARS BACK
 The ears are symmetrical and properly  The spine is inspected for signs of spina
formed. bifida.
 Low set of ears or incorrect formed ears  The spine should be flat in the lumbar
may indicate genetic disorders or and sacral area.
hearing loss.  Look for any bumps or kyphosis.
 Look for presence of skin tags on the
ears. EXTREMITIES
 Examine for deformities, amputations,
NOSE contractures, or mal development due
 Milia or white spots are present. to birth trauma as manifested as limited
 There is no any blockage on the nostrils. or no spontaneous arm movement on
the affected side.
MOUTH  The arms and legs should be
 Mouth is open symmetrically. proportional to the trunk of the baby.
 The tongue is normal, not short or long.  The hands are plumped, which is
 Look for cleft lip or palate, or any normal.
growth on the gums, because it can
DR TECH and EINC YEAR 02
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 The fingernails and toenails are soft and o ABNORMAL FINDINGS: HC less
smooth. than 32 cm is indicative of
 The sole if flat and there is crisscross microcephaly. HC more than 37 is
pattern, which indicate normal. indicative of neurologic involvement
such as hydrocephalus.
PLACEMENT OF IDENTIFICATION BAND
 Identify the sex of the newborn. CHEST
 Write the surname of the newborn.  Chest Circumference
 Date and time of the delivery. o Normal CC is from 30 to 33 (12 to
 Weight of the baby. 13 inch), usually 2 cm less than HC.
 Name of the mother. o It was measured at the level of the
 Fix the identification band on either nipple line.
right or left ankle. o A CC less than 30 cm indicated
prematurity.
FROM 90 minutes – 6 hours
INTERVENTION ABDOMEN
 Give Vitamin K prophylaxis – Vitamin  Abdomen Circumference
K helps the blood to clot and prevent o It is approximately the same as the
neonatal hemorrhage / bleeding during chest circumference.
first few days of life before infant is able o It measures just above the level of
to produce vit K. For full term infants, the umbilicus. It should not be
1 mg IM (0.1 mL) and for pre term measure below level of umbilicus
babies, 0.5 mg (0.05 mL). because a full bladder may interfere
 Inject Hepa B – it protects and prevent with accurate measurement.
the infant from developing liver
diseases and cancer from hepatitis B. LENGTH
Given through IM injection (5 mcg/0.5  The length is measured from the crown
mL) for preterm babies, it should be (top of the head) to the base of the
given one month after birth. spine down to the neonate’s leg to its
fullest extension up to the heel.
 Average length is 45 to 50 cm.
ANTHROPOMETRIC MEASURMENT  Female infants generally ½ inch shorter
than the male infants. The average
HEAD length of boys is 20 to 50 cm, and
 Molding: It is an abnormal head shape female 19 to 49 cm.
that resulting from pressure on the
baby’s head during childbirth. BODY TEMPERATURE
 Caput Succedaneum: It refers to  Initial temperature of the newborn is
swelling, or edema, of an infant’s scalp taken rectally to assess patency of the
that appears as a lump or bump on their anus.
head shortly after the delivery.
 Head Circumference WEIGHT
o Place the tape measure around the  Birth weight of full term newborn
front of the head and the occipital range from 6 to 8.5 lbs. Birth weight
area. should be recorded immediately after
o The tape should be at the level of birth because weight loss occurs rapidly
the eyebrow, which is normally 32 in newborns.
to 35 cm.  The average female infant birth
o The head circumference is usually weight is around 7 lbs, while that of
greater than the chest circumference male infant is around 7.5 lbs. Boys
by 2 cm.
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are usually heavier than girls by 100

grams or 3 ounces.

WITHIN 90 MINUTES OF AGE

INTERVENTION
 EyeProphylaxis/Crede’s Prophylaxis
ACTION
 Administer Erythromycin or Tetracycline
ointment – to protect the baby from
unknown gonorrhea infection in the
mother’s body and reduce the risk of
opthalmia neonatorum (neonatal
conjunctivitis).