DEFINITION:

Conducting or managing a normal vaginal delivery involves the hand maneuvers used
to assist the baby’s births, immediate care of the newborn, and the delivery of the placenta.

PURPOSES:

1. To have the childbirth event take place in a prepared and safe environment.
2. To conduct delivery with least trauma to mother and baby.
3. To assist mother go through the process without undue stress, injury or complication.
4. To promote smooth and safe transition of new-born to the extra uterine life.
5. To avoid complications.

ARTICLES:

For mother:

1. Articles for cutting an episiotomy:

a. Episiotomy scissors
b. Artery clamps-3
c. Tissue forceps/ thumb forceps - 1
d. Needle holder- 1
e. Syringe and needle for infiltration- 10 ml
2. Scissors for cutting the cord.
3. Bowl for cleaning solution
4. Basin to receive placenta
5. Cotton balls
6. 4 4 gauze pieces
7. Towel/ gauze pad to cover the hand supporting the perineum.
8. Sterile gown.
9. Leggings for the mother
10. Aprons gloves and masks for staff.

For New-born:

1. Baby blanket or flannel cloth- 2; one to receive and dry the baby of excess secretions
and another to wrap the baby.
2. Neonatal resuscitation equipment checked and ready for use.

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 3. Oxygen source with tubing.
4. Suction apparatus and mucus extractor.
5. Cord clamp.
6. Bulb syringe for nasal and oropharyngeal suctioning of the baby.

Other articles:

1. Antiseptic lotions- savlon or Dettol.

2. Suturematerials.
3. Perineal pads for the mother.
4. Oxytocic drugs.
5. Sterile gloves.
6. Methergine
7. Lignocaine 2%.

POINTS TO REMEMBER:

1. Follow strict aseptic technique.

2. Never ask the mother to bear down before full dilatation.
3. Always give episiotomy at the peak of uterine contraction.
4. Check the resuscitation set, suction apparatus, and other equipment are in good
working condition.
5. Record any alteration in uterine contraction or foetal heart rate (FHR). Record the
time of rupture of membranes and colour of amniotic fluid.
6. Note FHR when the uterine contractions are not present.

PREPARATION:

1. Provide local preparation as per agency policy.

2. Administer enema.

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PROCEDURE:

SL.NO NURSING ACTION RATIONALE

.
Before procedure
1. Transfer mother to the delivery room Provides for safe delivery
2. Change her clothing into hospital gown Maintains hygiene.
3. Monitor uterine contraction and PV Helps in assessing progress of labour.
findings
4. Assess the presentation, lie, position, Helps in assessing progress of labour.
attitude, station, cervical dilatation,
effacement, etc.
5. Maintain labour progress chart Helps in determining abnormalities.
(partograph).
6. Note the colour of the liquor if the Meconium stained liquor indicates
membranes rupture. foetal distress.
7. Note the FHR every 10-15 minutes, if not Detects the foetal distress at an early
on continuous foetal monitoring. stage.
8. Avoid giving solid foods. During labour, emptying time of the
stomach is delayed and may cause
regurgitation.
9. Give her fluids in the form of lemon juice Maintains hydration.
or fruit juice (if an operative delivery is
anticipated keep mother on NPO).
10. Instruct her to follow breathing techniques. Ensures more oxygen supply to the
foetus and promotes relaxation.
11. Instruct mother to lie down in left lateral Enhances more blood supply to the
positions. foetus as well as prevents supine
hypotensive syndrome.
12. Give adequate explanation regarding Obtains her cooperation and
breathing, relaxation, and pushing (bearing participation during the process.
down) to mother.
13. Once the onset of second stage has been Gives view to the perineum and to
confirmed, place the woman in dorsal assess the progress clearly.
position with knees bent at lower end of
the delivery bed. Ensure that bladder is
empty.
During procedure
14. Open the delivery pack, arrange the For convenience and timely use.

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 articles, and pour cleansing solution in the
bowl.
15. Perform surgical hand scrub and put on Reduces transfer of microorganisms.
sterile gown and gloves.
16. Drape the mother’s perineum and delivery Obtain a sterile field for delivery.
area
17. Clean the perineum in the following Proper cleansing makes the perineum
manner using one cotton ball separately free from microorganisms.
for each stroke.
Mons pubis zigzag manner from level of
clitoris upward.
Clitoris to fourchette one downward
stroke.
Farther labia minora and then near side.
Labia majora farther side first and then
near side.
Thighs in long strokes away from the
perineum.
Anus in one circular stroke.
18. Delivery of the head: as the head becomes
visible at the introitus, place the pads of
your fingertips on the portion of the vertex
at vaginal introitus.
19. As more of the head is visible, spread your Gives pressure against the foetal head
fingers over the vertex of the baby’s head, to keep it flexed.
with fingertips pointing upward toward the
mother.
20. Cover the hand not used on baby’s head Prevents contamination from the
with a towel and place the thumb in crease anus.
of the groin midway on one side of the
perineum. Place the middle finger in the
same way on the other side of perineum.
21. As the head advances, allow it to gradually Control of the head in this manner
extend beneath hand by exerting control will prevent explosive crowning and
but not prohibitive pressure. pressure on the perineum.
22. With the hand over the perineum, apply This support will prevent rapid birth

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 pressure downward and inward toward of head causing intracranial damage
each other across the perineal body at the to baby and laceration to perineum.
same time.
23. Observe the perineum in the space Detects signs of impending tear, such
between the thumb and middle finger as stretch marks beneath perineal
while offering head control and perineal skin.
support.
24. Give an episiotomy if required when there Avoids injury to the anal spinchter
is bulging, thinned perineum during the and spontaneous laceration of the
peak of a contraction or just prior to perineum.
crowning.
25. As soon as the head is born, during the Feel for cord around the baby’s neck.
resting phase, before the next contraction,
place the fingertips of one hand on the
occiput and slide them down to the level of
shoulders.
26. Sweep the fingers in both directions to feel Detects the presence of nuchal cord
for the umbilical cord. which can prevent the descend of the
foetus and the delivery of the body.
27. If the cord is felt and if it is loose, slip it Prevents the cord from becoming
over the baby’s head. If the cord is tight, tightened around the neck.
apply clamps about 3cm, apart and cut the
cord at the middle of the neck 9mother
must be instructed to pant while clamping,
cutting and unwinding the cord).
28. Wipe the baby’s face and wipe off fluid Facilitates breathing.
from nose and mouth.
29. Suction the oral and nasal passage with a Prevents aspiration of the fluid.
bulb syringe.
30. Delivery of shoulders: Wait for a Allows time for shoulders to rotate to
contraction and watch for restitution and the antero-posterior diameter of the
external rotation of head. outlet.
31. When the shoulders reach the antero-
posterior diameter of the pelvic outlet,
proceed to deliver one shoulder at a time
in the following manner:

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  Place a hand on each side of the head Avoids stretching of the perineum.
over the ears and apply downward
traction to deliver the anterior
shoulder.
 When the axillary crease is seen, guide
the head and trunk in an upward curve
to allow the posterior shoulder to
escape over the posterior vaginal wall.
32. Grasp the baby around the chest and lift This allows the mother to
the baby toward the mother’s abdomen. immediately see her baby and have
close physical contact.
33. Note the time of birth. To document the moment of birth and
birth notification.
34. Place two clamps on the cord about 8- Covering with a gauze while cutting
10cm from the umbilicus and cut it prevents spraying the delivery field
between the two clamps while covering it with blood.
with a gauze.
35. Give the baby to the nursery nurse who Provides for continuity of care.
will place him in the designated area, dry
him, and carry out the assessment and
care.

Fig. Downward traction of foetal head Fig. Delivery of posterior shoulder.

36. Place the placenta receiver against the For receiving the placenta and
perineum. membranes.
37. Place one hand over the fundus to feel the To assess the status of the uterus after
contraction of the uterus. expulsion of foetus.
38. Watch for signs of placental separation: Contraction and placental separation
Lengthening of cord, gush of blood, may occur in 5 minutes.
fundus becoming round, and placenta

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 descending into the vagina.
39. When placental descend is confirmed, ask Bearing down simultaneously with a
the patient to bear down as utyerus contraction aids expulsion of the
contracts, as she did during the second placenta.
stage of labour (controlled cord traction
can be used to deliver placenta).
40. As soon as the placenta passes through the Avoids chances of breaking of
introitus, grasp it in cupped hands. membranes.
41. Twist the placenta round and round with Helps for complete expulsion of
gentle traction so that the membranes are membranes.
stripped off intact. If the length of the
membranes make the movements difficult,
catch the membranes with artery forceps
and give gentle traction till they are
stripped off and expelled intact.

Fig. Controlled cord traction (Brandt-Andrews method)

42. If spontaneous expulsion falls to occur in Gets the membrane stripped off and
20-30 minutes, perform controlled cord expelled completely.
traction or Brandt-Andrews maneuvers.
43. Examine the patient’s vulva, vagina, and
perineum for any laceration.
44. Massage the uterus to make it contract. For expulsion of any retained
products of conception.
45. Suture episiotomy layer by layer if one For adequate healing.
was made.
46. Clean the vulva and surrounding area with Promotes comfort.
antiseptic solution and place perineal pad.
47. Straighten mother’s legs, cross them and Reduces bleeding.
make her comfortable.
48. Clean and replace articles

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49. Removes gloves and wash hands. Prevents spread of micro-organisms.
50. Record the details of delivery and Promotes communication among
condition of the mother and baby in the staff.
patient’s chart.

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BIBLIOGRAPHY:

1. Jacob Annamma, R Rekha, Tarachand Jadhav Sonali. Clinical nursing procedures: the
art of nursing practice. 4th edition. New Delhi: Jaypee Brothers Medcal Publishers.
2020. Page No. 686-691
2. Konar Hiralal. D.C. Dutta’s textbook of obstetrics. 7th edition. New Delhi: New
Central Book agency (P) Ltd.; 2013. Page No.- 211

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 COLLEGE OF NURSING
MEDICAL DIRECTORATE,
LAMPHELPAT

SUBJECT: OBSTETRICS & GYNAECOLOGICAL

NURSING

PROCEDURE
ON
CONDUCT OF NORMAL VAGINAL DELIVERY

Submitted To; Submitted By:

Mrs. N. Bindiya Huirem Anila
nd
Assistant Professor 2 Year M.Sc Nsg
Dept. of Obstetrics & Gynaecological Roll No.- 3
Nursing College Of Nursing
College of Nursing Medical Directorate
Medical Directorate, Lamphelpat Lamphelpat

SUBMITTED ON: 10