Materials to be laid out in preparation:
- Monaural stethoscope or foetal doppler.
- Sterile gloves.
- Sterile cloths or washed and ironed cotton nappies.
- Sterile gauzes 5 × 5 cm and 20 × 10 cm.
- Bowl with cotton wall balls soaked in water or disinfectant.
- Bowl or waste bucket.
- 2 Kocher clamps.
- Episiotomy scissors or scalpel.
- Placenta pan or bedpan.
- Umbilical cord scissors.
- Mucus suction device.
- Umbilical cord clamp.
The following materials do not need to be laid out but must be within easy reach:
- Amniotomy instrument.
- Sterile bladder catheter.
- Injection syringes 1 ml, 2 ml, 10 ml, with needles.
- Suture material.
- Local anaesthetic.
- Bag valve mask for oxygen administration.
Procedure
- Monitor the foetal heart sounds after each contraction and note the frequency and rhythm.
- Check the woman’s blood pressure.
- Tell the woman that she can push at will. Give the traditional pushing instructions if required:
- During a contraction, push (bear down) as long and as hard as possible (two to three times).
- Relax and rest in between contractions.
- When a woman giving birth in the supine position feels a contraction coming, she should grab hold of her legs behind the knees and pull her legs back and slightly apart.
- At the peak of the contraction, she should breathe as deeply as possible.
- She should close her mouth and hold her breath.
- She should put her chin down and keep her shoulders flat, or move to the preferred position, for example, half sitting.
- Push/bear down, as if to have a bowel movement, and prevent pressure build up in the head.
- Push calmly and as long as possible, without screaming, until she needs to breathe in again.
- Palpate the uterus to assess the quality of the contractions.
- Wait until the scalp appears.
- Put on the sterile gloves.
- Clean the vulva.
- Tell the woman that in several minutes time when you give the signal, she will have to alternate between pushing and panting.
- Support the perineum with one hand with gauze (20 × 10 cm) so that you can continue to inspect it or keep your hand close to the perineum.
- Once the scalp crowns, instruct the woman to stop pushing and to pant for the rest of the contraction.
- Place your other hand on the visible part of the head or keep your hand close to this [Figure 25].
Figure 25
- If required, facilitate the extension of the head by exerting gentle pressure on it.
- Tell the woman to push carefully in between contractions.
- Gradually allow the head to emerge until the suboccipital is stationed under the pubic arch.
- Allow the head to be born.
- Tell the woman stop pushing.
- Wipe the baby’s mouth with a sterile gauze (5 × 5 cm) and pinch the nose clean [Figure 26].
Figure 26
- Palpate the child’s neck to check if the umbilical cord is wrapped around it (nuchal cord) [Figure 27].
Figure 27
- Wait until the external rotation has spontaneously been completed and allow the woman to carefully push to aid this if necessary.
- Hold the child’s head carefully but firmly with the palms of both your hands biparietally [Figure 28].
Figure 28
- Move the head carefully in the direction of the maternal sacrum [Figure 29].
Figure 29
- Tell the woman to push carefully.
- Wait until the foremost shoulder of the child emerges under the symphysis pubis.
- Tell the woman to stop pushing.
- Carefully move the head in the direction of the maternal symphysis pubis
[Figure 30].
Figure 30
- Wait until the rear shoulder of the child emerges at the height of the perineum.
- Place both of your little fingers under the armpits of the child without letting go of the biparietally held head [Figure 31].
Figure 31
- Extract the child carefully in the extension of the birth canal [Figures 32a-b].
Figure 32a
Figure 32b
- Place the child on the mother’s abdomen (or between her legs in bed).
- Tell their parents the sex of the child.
- Dry the child.
- Record the exact time of birth of the child.