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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.
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
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.
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)
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
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.
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
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
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
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.
To expedite drainage
and prevents
aspiration of amniotic
fluid, mucus and
maternal blood.
To prevent inspiration
following stimulation
of nares before nares
is clear.
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.
Administer oxytocics
as ordered.
To ensure contraction
to prevent
hemorrhage
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.
To provide
comfort
Serves as
basis for
monitoring
lochial
discharge.
To minimize feeling of
chills
To make her more
comfortable
Do charting
comprehensively and
accurately
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
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
CONSEQUENCES
1.
2.
3.
VALSALVA Maneuver
prolonged breath holding while bearing down
NO PUSHING IN CROWNING
Instruction should be SIMPLE, CLEAR,
and coming from ONE COACH to avoid
confusion
Normal Spontaneous
Delivery
THANK YOU
AND
GOOD LUCK!