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Delivery of head
Prevention of perineal injury
Relieving cord around the neck
Delivery of the anterior and posterior shoulder
Delivery of the trunk and body
pressure to maintain flexion and allow natural stretching of perineal tissue and
prevent tears.This process is repeated during subsequent contractions until the subocciput is placed under the symphysis pubis.
8. Perform medio-lateral episitomy when the perineum is fully stretched, if it is
really needed.Routine episitomy should be abandone.
9. Use the other hand to support the perineum using pad or cloth and allow the
head to crown slowly and be born spontaneously.
10. Sudden delivery of the head during contraction is to be prevented by asking
woman not to bear down during extension of the head.
11. Slow delivery of the head in between the contractions is to be regulated by
pushing the chin with a sterile towel covered fingers of the right hand placed over
the anococcygeal region while the left hand exerts pressure on the occiput. The
forehead, nose, mouth and the chin are thus born successively over the stretched
perineum by extension.
12. Once the babys head is delivers ask the women not to push.
13. wipe the mucus (and membranes if necessary) from the babys mouth, eye and
nose immediately with clean cloth or gauze pieces.
C. Relieving cord around the neck
14. Feel around the babys neck to ensure the umbilical cord is not around the neck
if it is found and if loose enough, it should be sliped over the head or over the
shoulders as the baby is being born. But if it is sufficiently tight enough, tie or clamp
the cord with two artery forcep in two places 2cm apart and cut the cord between
clamp.
After cutting the cord expulsion of baby must not be delay otherwise baby will go to
hypoxia.
IV. Prevention of injury to women
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16. Placed the hand on each side of the babys head like Namaste position after
external rotation of the head. Tell the woman to push gently with the next
contraction.
17. A hand is placed on each side of the babys head over the ears and downward
traction is applied. This allows the anterior shoulder to slip bebeath the symphysis
pubis while the posterior shoulder remain in the vagina.
D. Lateral flexion of the body
18. When the axillary crease are seen, guide the head upward towards the womans
abdomen as the posterior shoulder born over the perineum.
19. Lift the babys head anteriorly to deliver the posterior shoulder.
20. Move the top most hand from the head to support the rest of the body as it
slides out.
21. Place the baby on the mothers abdomen. Dry the baby, wipe the eys and
assess the breathing.
22. If the baby is crying or breathing(chest rising at least 30 minutes per minute)
leave the baby with the mother.
23. If the baby is not breathing within 30 seconds. SHOUT FOR HELP and take steps
to resuscitate the baby.
24.Clamp and cut the umbilical cord.
25. Ensure that the baby is kept warm and in skin to skin contact on the mothers
chest. Wrap the baby in soft dry cloth and cover with blanket and ensure head is
covered to prevent heat loss.
26. If the mother is not well ask an assistant to care for the baby.
27. Palpate the abdomen to rule out the presence of another baby and procced with
active management of third stage.
28. Note the time of birth and APGAR score of the baby.
29. Draw 5 ml of blood from umbilical cord for coombs test if mothers blood group
is negative or O group.
30.Keep the baby in lateral position with mother or under warmer after
resuscitation.