Part 1 will be on normal vaginal delivery.
Normal Delivery
1) Preparation
a. Call for help!! OB/GYN, NICU, pediatrics
b. Place patient in dorsal lithotomy position. You can have the patient push their feet against your upper arm if the bed is not equipped for this (like in our ED)
c. Put on PPE
d. Get suction, warmer, airway equipment, sterile gloves/clamps/scissors
2) Delivery – NORMALLY the head should be the presenting part
a. Gentle countertraction once the head emerges prevents expulsive delivery and reduces tears and lacerations.
b. Check for nuchal cord
i. If present, attempt to place finger between cord and neck to slip over baby’s head
ii. If that fails, clamp and cut cord
c. Gentle downward force to deliver anterior shoulder first
d. Gentle upward force to deliver posterior shoulder
e. Clamp and cut cord ~2-3cm from baby
f. Suction, dry, warm and stimulate baby in warmer. If baby is well can give to mother.
3) Placental delivery – don’t forget! This will occur soon after delivery. Prolonged placental delivery increases risk of postpartum hemorrhage (>18-20min)
a. Maintain manual suprapubic pressure
b. Using clamps, provide very gentle cord traction. There will be a gush of blood and abrupt lengthening as the placenta separates. Have a bucket ready to catch the placenta.
c. Inspect for missing parts. An easy way the OB/GYNs told me is to check for any tears in the lining of the placenta (it looks like it’s in a bag)
d. Check the perineum for any tears
e. Start oxytocin (10U IM)
4) Check frequently within first hour of delivery. Highest risk of postpartum hemorrhage is in this first hour.
Sounds easy. What can go wrong? 😰