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    F NB Thirdfourthstage

    Uploaded by

    Manisha Thakur

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    F NB Thirdfourthstage

    Uploaded by

    Manisha Thakur
    24 views1 page

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    f-nb-thirdfourthstage

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    Copyright:

    © All Rights Reserved
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    24 views1 page

    F NB Thirdfourthstage

    Uploaded by

    Manisha Thakur

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Queensland Health

    Normal birth—Third and fourth stage


    Care is woman centred and includes informed choice, consent, privacy and respectful
    communication. Contemporaneous documentation is essential.
    · Environment that promotes newborn physiological
    adaptation
    Third and fourth stage · Uninterrupted skin to skin contact for at least 1 hour or
    in the low risk mother after first feed
    and baby · Woman and baby are not separated or left alone
    · Minimal interference in maternal/baby bonding
    · Support to breastfeed (if method of choice)

    Third stage Baby


    From birth of baby to birth of placenta/membranes Initial assessment
    · Breathing, HR, colour, reflex irritability, tone,
    Management
    o Apgar score at 1 and 5 minutes
    · Modified active: recommend for all births

    http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au


    · Initial brief newborn examination
    o Oxytocin 10 IU IM after birth of baby
    o Wait at least 1–3 minutes after birth or for cord Supportive care
    pulsation to cease and then clamp and cut cord · Maintain warmth with:
    o Controlled cord traction and uterine guarding o Clear visibility and optimal airway position
    after signs of separation o Adequate lighting for observation of colour
    o Prolonged after 30 minutes
    Ongoing assessment
    · Physiological
    · Respiratory rate, colour, positioning for patent
    o Suitable for well women without risk factors
    airway every 15 minutes for first 2 hours
    o Placenta birthed by maternal effort/gravity
    · Temperature and HR within 1 hour of birth
    o Oxytocin not administered
    o Clamp cord after pulsation ceased Non-urgent care (after first feed)
    o No controlled cord traction · Weight, length and head circumference
    o Prolonged after 60 minutes · Recommend phytomenadione (vitamin K/
    · If concern with cord integrity or FHR: Konakion® ) 1 mg IM
    o Clamp and cut the cord · Offer Hepatitis B vaccine (as per local policy)
    Ongoing care
    · Encourage upright position
    · Ensure bladder empty

    State of Queensland (Queensland Health) 2017


    · Maintain calm, warm and relaxed environment
    · Support privacy and reduce interruptions Discuss, consult, refer, manage
    · Encourage to focus on physiological process
    as per professional# and
    · Observe general physical condition
    Queensland guidelines

    Fourth stage
    First 6 hours after birth of placenta/membranes
    Yes
    Supportive care
    · Encourage mother to eat, drink and rest
    · Discuss and offer pain relief (if indicated)
    · Consider personal hygiene needs Indications
    · Assess emotional and psychological wellbeing for additional
    care?
    · If RhD negative blood group, review indications
    for RhD immunoglobulin

    Assessment (for the first two hours) No


    Alter frequency of observations/assessment as
    indicated.
    · Temperature: within the first hour
    · Pulse, RR, BP: after birth of the placenta Routine care
    · Fundus and lochia: after birth of the placenta, then
    every 15‒30 minutes
    · Perineum: with first maternal observations
    · Pain and discomfort
    · Urine output: monitor voiding postpartum
    · Examine placenta, membranes and cord

    BP: blood pressure, FHR: fetal heart rate, HR: heart rate, IM: intramuscular, IU: international units, RR: respiratory rate, VE: vaginal
    examination, #Australian College of Midwives: National Midwifery Guidelines for Consultation and Referral. 3rd Edition, Issue 2. 2015

    Queensland Clinical Guidelines: Physiological birth Flowchart version F17.25-4-V2-R22

    Queensland Clinical Guidelines


    www.health.qld.gov.au/qcg

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