Conducting A Childbirth

CHECKLIST FOR CONDUCTING CHILDBIRTH
GETTING READY
1. Prepare the necessary equipment.
2. Allow the woman to push spontaneously.
3. Allow the woman to adopt the position of choice.
4. Tell the woman (and her support person) what is going to be done, listen to her and respond
attentively to her questions and concerns.
5. Provide continual emotional support and reassurance, as feasible.
CONDUCTING THE CHILDBIRTH

1. Put on a clean plastic or rubber apron, rubber boots and eye goggles.
2. Use antiseptic hand rub or wash hands thoroughly with soap and water and dry with a sterile cloth or
air dry.
3. Put high-level disinfected or sterile surgical gloves on both hands.
4. Clean the perineum with a cloth or compress, wet with antiseptic solution or soap and water, wiping
from front to back.
5. Place one sterile drape from the delivery pack under the woman’s buttocks, one over her abdomen and
use the third drape to receive the newborn.
Delivery of the Head

6. Place fingers of one hand on the advancing head to sustain flexion and control birth of the head.
7. Use the other hand to support the perineum with a pad, cloth, or compress.
8. As the perineum distends, decide whether an episiotomy is necessary (e.g., if the perineum is very
tight). If needed, provide perineal infiltration with lignocaine and perform an episiotomy.
9. Maintain firm but gentle pressure on the head to encourage flexion.
10. Ask the woman to gently blow out each breath in order to avoid pushing.
11. After crowning, allow the head to gradually extend under your hand.
12. Using a clean cloth, wipe the mucus (and membranes if needed) from the baby’s mouth and nose.
13. Gently feel around the newborn’s neck for the cord:
 If the cord is around the neck but loose, slip it over the baby’s head.
 If the cord is loose but cannot reach over the head, slacken the cord so that it can slip backwards
over the shoulders as the shoulders are born.
 If the cord is tightly wound around the neck, clamp the cord with two artery forceps, placed 3 cm
apart, and cut the cord between the two clamps.
14. Allow restitution and external rotation of the head to occur.
Delivery of the Shoulders

15. Place one hand on either side of the newborn’s head, over the ears.
16. Apply gentle downward traction to allow the anterior shoulder to slip beneath the symphysis pubis.
17. When the axillary crease is seen, guide the head and trunk in an upward curve to allow the posterior
shoulder to escape over the perineum.
18. Grasp the newborn around the chest to aid the birth of the trunk and lift the newborn toward the
woman’s abdomen.
19. Note the time of birth.
Immediate Care of the Newborn

20. Dry the newborn quickly and thoroughly with a clean, dry towel/cloth immediately after birth.
21. Wipe the newborn’s eyes with a clean piece of cloth.
22. Place the newborn in skin-to-skin contact on the mother’s abdomen and cover with a clean, dry
towel/cloth.
23. Observe the newborn’s breathing while completing steps 21 and 22:
 If the newborn is not breathing, begin resuscitation measures.
 If the newborn is breathing normally, continue with the following care.
Clamping and Cutting the Cord
24. Place two clamps on the cord with enough room between them to allow for easy cutting of the cord.
25. Cut the cord, using sterile scissors under cover of a gauze swab to prevent blood spurting.
26. Tie the cord tightly 2.5 cm from the newborn’s abdomen.
27. Leave the newborn in skin-to-skin contact on the mother’s abdomen or chest, covered by a clean, dry
towel/cloth.
28. Palpate the mother’s abdomen to rule out the presence of another baby.
29. Give 10 IU oxytocin intramuscularly.
ACTIVE MANAGEMENT OF THE THIRD STAGE
Getting Ready
1. Tell the woman (and her support person) what is going to be done, listen to her and respond
attentively to her questions and concerns.
2. Provide continual emotional support and reassurance, as feasible.
3. Ask an assistant to place a sterile receptacle (e.g., kidney basin) against the woman’s perineum.
Delivering and Examining the Placenta

4. Clamp the cord close to the perineum with forceps.
5. Wait for the uterus to contract.
6. Use one hand to grasp the forceps with the clamped end of the cord.
7. Place the other hand just above the level of the symphysis pubis, on top of the drape covering the
woman’s abdomen, with the palm facing toward the mother’s umbilicus and gently apply counter-
traction in an upward direction.
8. At the same time, firmly apply traction to the cord, in a downward direction, using the hand that is
grasping the forceps.
9. Apply steady tension by pulling the cord firmly and maintaining pressure (jerky movements and force
must be avoided):
 If the maneuver is not successful within 30–40 seconds, stop pulling, wait for the next contraction
and repeat.
REMEMBER – Traction on cord must be applied only when uterus is contracted otherwise
it can cause inversion of uterus.
10. When the placenta is visible at the vaginal opening, hold it in both hands.
11. Use a gentle upward and downward movement or twisting action to deliver the membranes.
12. Immediately and gently massage the uterus through the woman’s abdomen until it is well contracted.
13. Hold the placenta in the palms of the hands, with maternal side facing upward.
14. Check whether all of the lobules are present and fit together
15. Now hold the cord with one hand and allow the placenta and membranes to hang down.
16. Insert the other hand inside the membranes, with fingers spread out.
17. Inspect the membranes for completeness.
18. Note the position of insertion of the cord.
19. Inspect the cut end of the cord for the presence of two arteries and one vein.
20. Place the placenta in the receptacle (e.g., kidney basin) provided.
21. Show the mother how to massage her uterus to maintain contractions.
Examining the Birth Canal

22. Ask assistant to direct a strong light onto the perineum.
23. Gently separate the labia and inspect the lower vagina for lacerations/tears.
24. Inspect the perineum for lacerations/tears.
25. Repair episiotomy (if one was performed) (see Learning Guide for Episiotomy and Repair).
26. Wash the vulva and perineum gently with warm water or an antiseptic solution and dry with a clean,
soft cloth.
27. Place a clean cloth or pad on the woman’s perineum.
28. Remove soiled bedding, make the woman comfortable, and cover her with a blanket.
29. Before removing gloves, place soiled linen in 0.5% chlorine solution for 10 minutes for
decontamination.
POST-BIRTH TASKS
1. Before removing gloves, dispose of waste materials in a leak proof container or plastic bag and
dispose of the placenta by incineration (or place in a leak proof container for burial), after consulting
with the woman about cultural practices.
2. Place all instruments in 0.5% chlorine solution for 10 minutes for decontamination.
3. To dispose of needle and syringe, flush needle and syringe with 0.5% chlorine solution three times,
then place in a puncture-proof container.
4. Immerse both gloved hands in 0.5% chlorine solution. Remove gloves by turning them inside out.
 If disposing of gloves, place them in a leak proof container or plastic bag.
 If reusing surgical gloves, submerge them in 0.5% chlorine solution for 10 minutes for
decontamination.
5. Use antiseptic handrub or wash hands thoroughly with soap and water and dry with a clean, dry cloth
or air dry.
6. Record all findings on woman’s record.

Conducting A Childbirth

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Conducting A Childbirth

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CHECKLIST FOR CONDUCTING CHILDBIRTH

CONDUCTING THE CHILDBIRTH

Delivery of the Head

Delivery of the Shoulders

Immediate Care of the Newborn

ACTIVE MANAGEMENT OF THE THIRD STAGE

Delivering and Examining the Placenta

Examining the Birth Canal

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