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METHODS OF

DELIVERY

METHODS OF DELIVERY
Forceps Assisted Delivery
Vacuum Extraction
Cesarean Delivery
Vaginal Birth After
Cesarean
Normal Spontaneous
Delivery

DESCRIPTION
Delivery of the baby
using obstetrical
instruments

1. FORCEPS ASSISTED
DELIVERY
assist the
birth of a
fetus by
providing
the means to
rotate the
fetal head to
an occiputanterior/post
e-rior
position.

Two doublecrossed,
spoon like
articulated
blades that
are used to
assist in the
delivery of
the fetal
head

Indicators
1.FETAL FACTORS
a. second stage of labor fetal

distress
b. abnormal presentation or
arrested descent
c. Preterm labor to protect
fetal head from injuries
d. premature placental
separation

Indicators
2. MATERNAL FACTORS
a. to shorten the second
stage of labor
b. ineffective expulsive
effort/poor
progress
c. exhaustion
d. medical diseases like
cardiac arrest

CRITERIA/PREREQUISITE
1.

Full dilatation of the


cervix
2. Ruptured BOW
3. Engaged head
4. No CPD
5. Episiotomy
6. Anesthesia

TYPES
1.LOW/OUTLET FORCEPS
fetal head on
parietal floor
2. MIDFORCEPS fetal
head at the level of
ischial spines

COMPLICATIONS
1.MATERNAL
a. lacerations
b. hemorrhage
c. uterine rupture
d. uterine prolapse

COMPLICATIONS
1. FETAL
a. facial paralysis (Bells Palsy)
b. increased perinatal
morbidity
and mortality
c. intracranial hemorrhage
d. brain damage
e. skull fracture
f. tissue trauma
g. cord compression

Neonatal Risks
1. ecchymosis and/or edema along
the sides of the face

2. Caput Saccedaneum or cepal


hematoma and subsequently
hyperbilirubinemia may occur
3. Transient facial paralysis
4. Low IQ for children

NURSING IMPLEMENTATION
1.Prepare client and family
2.Provide psychological
support to allay/decrease
anxiety
3.Monitor FHT continuously
4.Assess mother and infant
for complication

INDICATIONS
1. Condition: threaten the mother or
fetus and that can be relieved by
birth
2. conditions: heart dse, acute
pulmonary edema, intrapartal
infection, exhaustion
3. Fetal conditions: premature
placental separation, fetal distress

2. Vacuum extraction
A cap like
suction
device is
applied to
the fetal
head to
facilitate
extraction

3. CESAREAN BIRTH

Cesarean Birth
Birth accomplished through
an abdominal incision into
the uterus.
One of the oldest types of
surgical procedures known.

More hazardous than vaginal


birth
One of the safest types and
one with few complications
when compared with other
surgical procedures.
most
often
used
as
a
prophylactic
measure
to
alleviate problems of birth.

A. MATERNAL FACTORS:
CPD
Active genital herpes or
papilloma
Previous CS by classic
incision
Disabling condition :
Severe HPN of pregnancy
Heart dse that prevent
pushing

B. Placental
Factors:
Placenta previa
Abruptio placenta

C. Fetal Factors:
Transverse lie
presentation
Extreme low birth weight
Fetal distress
Compound conditions
(macrosomic fetus in a
breech lie)

Types of Cesarean Birth


1. Scheduled CS
- there is time for thorough
preparation
2. Emergency CS
- preparation must be done
much more rapidly
EX:
- placenta previa
- abruptio placenta
- fetal distress
- failure to progress

2. Low Segment Incision/


Tranverse
Made horizontally across the
abdomen just above the
symphysis pubis across the
uterus just over the cervix
A.k.a. pfannenstiel or bikini
incision
Most common type of CS

Advantages:
- less likely to rupture in
subsequent labor
- less blood loss
- easier to suture
- decreases postpartal uterine
infections
- less GI complications
Disadvantage:
- it takes longer to perform
impractical for ECS

Types of Cesarean Incisions


1. CLASSICAL CESAREAN INCISION

made vertically through


both the abdominal skin and the
uterus
- The scar could rupture during
labor
- Will not be able to have a
subsequent vaginal birth

4. Vaginal Birth After


Cesarean Birth (VBAC)
Patient who has had a previous
low-transverse cesarean birth.
No medical or obstetric
contraindication to labor
No history of prior uterine
rupture exists
Incidence of dehiscence: 1%

NORMAL SPONTANEOUS
DELIVERY (NSD)
actual event of the
expulsion of the products
of conception from the
maternal body

PURPOSE:
To maintain the physiologic
stability of the woman
throughout the stages of labor
To prevent complications
before, during and after labor
and delivery both the mother
and to the baby

GENERAL
CONSIDERATIONS:
Help the parturient participate
to the extent she wishes in the
delivery of the infant, to meet
the womans goals for herself.

Conserve the womans


energy through helping her
in controlling the
discomforts of labor and
delivery.

Relaxation and reduction of


stress increases womans
ability to cope with labor.

The client should be


assisted in controlled chest
breathing during
contractions and relax
between contractions.

The client is discouraged to


bear until cervical dilation
is complete.

Monitor closely the


progress of labor and be
aware of the warning signs
for the second stage of
labor.

Respect and promote the


woman and her support
persons activities, orient
them with the area.

NORMAL SPONTANEOUS
DELIVERY

MECHANISM OF LABOR
a.k.a. as cardinal movements of
labor are the different
movements or positional
changes that the fetus makes
during the first and second stage
of labor in order to pass
successfully through the
irregular shape of the birth
canal.

EQUIPMENTS/ARTICLES NEEDED
1.
2.
3.
4.
5.
6.
7.
8.

2
1
1
1
1
1
1
2

Peritoneal Forceps Straight


Peritoneal Forceps Curve
Thumb forceps
Tissue Forceps
Needle Holder
Mayo Scissor Straight
Mayo Scissor Curve
Petri Dish

Prepare Delivery Pack


9. Tray with lining
10.Needle ( cutting & round)
11.Kelly Pad
12.Leggings
13.OR Mask
14.OR Cap
15.Pail
16.Green Towel
17.OR gown
18.Hypo tray

2. Maintain Surgical Asepsis

3. Observes warning signs


of the 2nd stage of
labor

4. Scrubs during actual


delivery

5. Give emotional support


to the mother

7. Does procedure in a
systematic manner

PROCEDURE
ACTION
1.Position the woman
in lithotomy on the
delivery table, legs to
be put up slowly at
the same time on the
stirrup. Same should
be done when
straightening the legs
or putting them down
after delivery.

RATIONALE

To prevent
trauma to the
uterine
ligaments,
and
backaches or
leg cramps

Best time
2. Encourage to perform
the woman to strong
push to
do strong
pushing with facilitate
contractions descent of
the fetus

Tell the woman


to use blow
breathing
pattern
between each
contractions

To prevent
pushing
between
contraction

As soon as
the head
crowns,
instruct the
woman not
to push
instead
she is
advised to
pant

To
prevent
rapid
delivery of
the fetus.
To
prevent
dural/subd
ural tears
To
prevent
vaginal or
perineal
lacerations

To prevent
laceration of the
Perform Ritgens
fourchette
maneuver by
To bring fetal chin
supporting with
down the chest so
the palm against that the smallest
the rectum
diameter of the
fetal head is the
one presented at
the birth canal

Assist in episiotomy as needed:


Primarily to prevent
laceration
Prevent prolonged
and severe stitching
of the muscle
supporting the
bladder and rectum
Reduce duration of
the 2nd stage of labor

Enlarge vaginal
outlet in breech
presentation of
forcep delivery
Spare the
infants head from
prolonged
pressure which
may result to
brain damage,
especially in
premature baby.

As soon as the head


is born, suction oralpharynx with small
bulb syringe.
Suction nares next.

To expedite drainage
and prevents
aspiration of amniotic
fluid, mucus and
maternal blood.
To prevent inspiration
following stimulation
of nares before nares
is clear.

As soon as the head


has been delivered,
inspect if a loop of
cord is around the
neck. If present, slip it
down the shoulder; if
too tight, apply 2
clamps an inch apart
before cutting the
cord between the
clamps.

To avoid cord
compression while
the babys body is
being delivered
To prevent accidental
pulling of the cord
resulting to detaching
of the cord from the
base of the placenta
or from the babys
navel.

After external
rotation, give a
gentle steady
downward pull
and then a gentle
upward lift

To deliver the
anterior and
posterior shoulders
Lateral traction to
deliver the shoulder
should never be
done to prevent
nerve injuries.

While supporting
the babys head
and neck with
one hand, glide
the other hand
towards the body
then grasp both
of the babys
ankle.

To prevent
injury as the
babys body is
slippery.

Take note of
the time the
baby is
delivered
.

For proper
documentation.

Immediately
after
delivery, the
baby is held
below the
level of the
mothers
vulva

The blood
from the
placenta
can enter
the
infants
body on
the basis
of gravity
flow.

Place the
baby on
top of
mothers
abdomen

Stimulates
the release
of oxytocin
from the
PG thus
stimulating
uterine
contraction
which aid
in
placental
separation.

Apply 2
clamps to
the
umbilical
cord as its
pulsation
ceases.
Cutting of
the cord is
postponed
until
pulsation
is
stopped

It is
believed
that50-100
mL of
blood is
flowing
from the
placenta
to the NB
at this
time.

Inform the
mother
about the
sex of the
baby and
help to
hold and
inspect
her baby
as she
wishes.

Maternal
and infant
bonding
is initiated
as soon
as the
mother
has eyeto-eye
contact
with her
baby.

Wait for the signs


that placenta has
separated before
attempting to
deliver the
placenta.

May tear the


cord
Separate the
placenta
Invert the uterus

Once placenta is Placental


out it is carefully fragments may
inspected
cause
subsequent
hemorrhage.

Determine the degree To stimulate


of uterine contraction contraction
and perform initial
nursing intervention
for signs of non
contracting or
boggy uterus.
gentle massage
Apply ice cap

Administer oxytocics
as ordered.

To ensure contraction
to prevent
hemorrhage

Assess or monitor BP A common side


effects of oxytocics
of the mother
specifically ergot
derivatives is
HYPERTENSION

Inspect perineum Anytime the


for lacerations.
uterus is firm
and bleeding
comes out in
spurts, suspect
for lacerations.

Assist the
doctor
during the
episiorrhaphy

Laceratio
ns if not
repaired
can lead
to oozing
red blood
from the
lacerated
part of the
perineum.

Evacuate blood
clots and watch
for signs of
placental
fragments.

Non-contraction
of uterus after
placental
delivery may be
caused of either
blood cuts or
retained
placental tissues.

Fundus check To monitor


is done every uterine
15 mins
contraction
Perform
perineal care
aspetically and
applies
peripad
appropriately.

To provide
comfort
Serves as
basis for
monitoring
lochial
discharge.

Keep mother dry, offer


clean clothing/gown and
warm blanket.

To minimize feeling of
chills
To make her more
comfortable

After care of the DR,


instruments and articles

For a more systematic


admission of the next
client for DR procedures

Do charting
comprehensively and
accurately

To maintain the sterility of


the place.
For documentation

A. POSITION
LITHOTOMY POSITION: The legs should be
put up slowly at the same time.
RATIONALE
1. To prevent trauma to the uterine ligaments
2. To Prevent backaches and or legs cramps
The same should be done when putting
the legs down from the stirrups after
delivery

B. BEARING DOWN TECHNIQUE


The second
stage is the
best time to
encourage
strong
pushing
with
contractions.
contractions

PUSHING
Voluntary bearing-down
effort
Secondary power involved in
labor.
Needed to help the primary
power Uterine Contraction
in promoting expulsion of the
fetus

WHEN TO PUSH ?
1. 2ND Stage of Labor or from the
moment the cervix is fully
dilated or 10 cm. open
2. Uterine Contraction

WHEN NOT TO PUSH ?


1. Interval of Contraction
( Period between
contractions) and in
crowning.
2. Before complete cervical
dilatation

CONSEQUENCES
1.
2.
3.

Greater maternal fatigue


Added fetal strain
Possible Injury to the fetal
presenting part
4. Causes more strain to the
diseased heart in women with
cardiac ailment
5. Possible Injury in the cervix

Injury in the cervix


1. CERVICAL EDEMA due to chronic
passive congestion
EFFECTS:
Delay in cervical dilatation
Predisposes to cervical laceration
2. CERVICAL BRUISING / TRAUMA as it is
forced against the symphysis pubis during
pushing

TIPS RELATED TO PUSHING


1. PROPER POSITION:
rose to 45 degrees if not contraindicated
2. HOW TO PUSH?
As woman begins to feel a contraction
take a deep breath and blow it all out
Woman takes a 2nd deep breath which she
holds as she closes her mouth, puts her
chin on her chest and bears & continue
pushing

TIPS RELATED TO PUSHING


Woman runs out of air before the
contraction ends, take another deep
breath and continue pushing
Short pushes are ineffectual, but
prolonged pushing so that woman is
holding her breathes FOR MORE THAN 5
SECONDS IS NOT RECOMMENDED

VALSALVA Maneuver
prolonged breath holding while bearing down

1.Diminished Feto- Placental gas


exchange
2.Diminished perfusion of oxygen
acress the placenta
3.Fetal hypoxia
Encourage the woman to rest or even
snooze a bit between contractions

NO PUSHING IN CROWNING
Instruction should be SIMPLE, CLEAR,
and coming from ONE COACH to avoid
confusion

Normal Spontaneous
Delivery

1. Prepares delivery room,


mother, packs, instruments,
equipments.
2. Maintains surgical asepsis.
3. Observes warning signs in the
second stage of labor.
4. Scrubs during actual delivery
5. Gives emotional support to
mother

6. Does procedure in a systematic manner.


7. Applies Ritgens maneuver at the right
time.
8. After expulsion of the head, check if a
loop of cord is around the neck, if loose
should be done drawn over babys head.
If thigh, it should be clamp and cut
before shoulders are delivered.
9. After external rotation, pull babys head
down and up baby follows.
10. Supports baby by the underarm forearm.

11. Grasp babys feet securely by


thumb and middle finger with
index finger between ankles.
12. Places baby on mothers
abdomen.
13. Milk cord toward baby.
14. Check for pulsation of cord if
absent, place 2 clamps, cut
between the clamp. Give the
baby to the circulating nurse.
15. Inspect for perineal lacerations

16. Observes for signs of placental


separation.
17. After expulsion of placenta,
inspect for completeness.
18. Remove blood clots.
19. Clean perineum, applies
antiseptic.
20. Place perineal pad.
21. After care of instruments,
equipment's.
22. Does charting.

THANK YOU
AND
GOOD LUCK!