MCN MIDTERMS_UNIT 2 LESSON 5 (1).pdf

Unit 2 (Lesson 5): Conducting a Normal Delivery Conducting a Normal Delivery and Immediate Postpartum Care Signs of the Second Stage of Labor: The second stage of labor starts when the cervix is fully dilated (10 cm) and ends with the bir...

Unit 2 (Lesson 5): Conducting a Normal Delivery Conducting a Normal Delivery and Immediate Postpartum Care Signs of the Second Stage of Labor: The second stage of labor starts when the cervix is fully dilated (10 cm) and ends with the birth of the baby. This phase is intense but often shorter than the first stage, requiring the mother to push actively. Common signs indicating the second stage: Stronger and longer contractions: Contractions become more intense and frequent, helping push the baby through the birth canal. Urge to push: The mother feels a powerful urge to push, similar to the feeling of needing to pass stool. Crowning: The baby’s head appears at the vaginal opening, signaling that birth is imminent. Maternal Responses: As the baby moves down the birth canal, the mother experiences intense physical sensations, including shaking, sweating, and sometimes nausea. Her emotions may vary from focus and determination to exhaustion and anxiety. The healthcare team provides encouragement and guides her in effective pushing techniques. Preparing for Delivery: Before delivery begins, the healthcare team prepares the room, ensuring that all equipment is sterile and infection control measures are followed. Unit 2 (Lesson 5): Conducting a Normal Delivery 1  Infection Control Protocols: Three cleans – clean hands, clean surfaces, and clean equipment are essential to prevent infections. Sterile tools: Sterilized gloves, towels, and instruments such as forceps and scissors are used to minimize the risk of contamination. The delivery room is kept warm (around 25-28°C) to prevent hypothermia in the newborn, free from drafts, and well-lit for clear visibility during delivery. Required Equipment for Delivery: Waterproof covers to protect surfaces. Sterile gloves, surgical scissors, clamps, and towels. Perineal care tools: Cotton balls soaked in antiseptic solutions, gauze, and sterile drapes. Delivery Procedure: 1. Positioning the Mother: The lithotomy position (legs in stirrups) is often used in hospitals, but alternatives like squatting can help the baby descend more easily due to the use of gravity. 2. Perineal Cleaning: The healthcare provider cleans the perineal area with antiseptic solutions before the baby is delivered to prevent infections. Unit 2 (Lesson 5): Conducting a Normal Delivery 2  3. Guiding the Baby Out: As the mother pushes, the healthcare provider supports the perineum and the baby’s head to reduce the risk of tearing. Delivery of the Baby: Crowning: When the baby’s head crowns, the healthcare provider supports the head to guide it out safely. Nuchal Cord (Cord Around the Neck): If the umbilical cord is wrapped around the baby’s neck, it will either be gently loosened or clamped and cut if necessary. Ritgen’s Maneuver: Helps a fetus achieve extension. This technique involves applying pressure to the baby’s head from the perineum (the area between the vagina and anus) with one hand while controlling the speed of the baby’s head with the other hand on the occiput (the back of the baby’s head). This helps control the baby’s descent, minimizing the risk of perineal tearing. Unit 2 (Lesson 5): Conducting a Normal Delivery 3  Shoulders and Body: After the head is delivered, the shoulders and body typically follow smoothly. The healthcare provider may guide one shoulder at a time to avoid injury or excessive tearing. After the baby is delivered, the pediatrician assesses the baby's APGAR score within the first minute after birth. If the score is 8-10, the baby is healthy enough to stay with the mother for at least 90 minutes for skin-to-skin contact and breastfeeding initiation. Vernix caseosa is a white, cheese-like creamy substance that covers a newborn's skin at birth. It protects the baby’s skin from amniotic fluid, helps retain moisture, and has antimicrobial properties to reduce infection risk. Some vernix is often left on the baby’s skin after birth for its protective benefits. Immediate Postpartum Care: After delivery, care is provided to ensure both the mother and baby are stable and healthy. Cutting the Umbilical Cord: After the cord stops pulsating, it is clamped and cut. Delayed cord clamping allows more blood to flow to the baby, boosting the newborn’s iron levels. Clamp the umbilical cord 5 cm from the baby's abdomen with an instrument clamp, then apply a plastic clamp 2.54 cm (1 inch) from the abdomen. Cut the cord near the plastic clamp using surgical scissors, with gauze underneath to catch any blood. A cord cut too long increases the risk of infection. The cord is then inspected to ensure it has two arteries and one vein (AVA check). Active Management of the Third Stage of Labor (AMTSL): Unit 2 (Lesson 5): Conducting a Normal Delivery 4  Active management helps prevent excessive bleeding after the baby is born. The key steps include: 1. Oxytocin Administration: Within one minute after birth, 1 mL of oxytocin is injected IM into the mother’s deltoid muscle. This promotes uterine contractions, helping to expel the placenta and reduce postpartum bleeding. Purpose: To stimulate uterine contractions and reduce the risk of postpartum hemorrhage. 2. Controlled Cord Traction (CCT): The healthcare provider gently pulls on the umbilical cord while applying counterpressure to the uterus to help guide the placenta out. Brandt-Andrews Maneuver: This technique is used to help deliver the placenta by applying controlled traction on the umbilical cord while simultaneously applying counter-pressure above the mother’s pubic bone. This prevents uterine inversion and helps remove the placenta safely. 3. Uterine Massage: After the placenta is delivered, the uterus is massaged to ensure it remains firm and continues contracting, which helps minimize bleeding. Postpartum Medications and Prophylaxis for the Newborn: After birth, newborns receive a series of prophylactic treatments to ensure their health. Crede's Prophylaxis: Tetracycline or Erythromycin Eye Ointment: Applied to the baby’s eyes from inner canthus to outer canthus to prevent neonatal conjunctivitis (ophthalmia neonatorum), an eye infection that can be caused by bacteria in the birth canal. Purpose: Prevent blindness or severe eye infections caused by exposure to bacteria like gonorrhea or chlamydia during birth. Vitamin K Administration: Unit 2 (Lesson 5): Conducting a Normal Delivery 5  1 mg or 0.1 ml of Vitamin K (if more than 2000g, 0.05 if less) is injected IM into the baby’s anterolateral aspect of left thigh (accdng to ma’am Rhea) shortly after birth. Purpose: Prevents Vitamin K deficiency bleeding (VKDB), which can cause dangerous internal bleeding in newborns. Babies are born with low levels of Vitamin K, a crucial factor for blood clotting. Hepatitis B Immunization: 0.5 mL Hepatitis B Vaccine (if more than 2000g, do not administer unless ordered if less) is administered IM into baby’s anterolateral aspect of right thigh within the first 24 hours of life. Purpose: Prevent the baby from contracting Hepatitis B, a serious liver infection. The vaccine provides long-term protection against this virus. Postpartum Monitoring: After delivery, the mother’s condition is closely monitored to ensure her recovery is smooth. Vital Signs: The mother’s blood pressure, pulse, and bleeding (lochia) are checked frequently (every 15 minutes in the first hour). Lochia is the vaginal discharge that occurs after childbirth, as the uterus sheds the remaining tissue and blood after the placenta is delivered. 1. Lochia Rubra: Color: Bright red. Duration: Usually lasts for the first 3-5 days postpartum. 2. Lochia Serosa: Color: Pinkish-brown. Duration: Occurs around days 4 to 10 postpartum 3. Lochia Alba: Color: Yellowish-white. Unit 2 (Lesson 5): Conducting a Normal Delivery 6  Duration: Begins around day 10 and can last for up to 2-4 weeks postpartum. Fundal Palpation: The healthcare provider checks the firmness of the uterus. If the uterus is soft or “boggy,” it may indicate blood or clots, requiring immediate uterine massage to firm it up and stop excessive bleeding. Special Procedures: Episiotomy: In some cases, the healthcare provider may make a small incision in the perineum (episiotomy) to help the baby pass through more easily. This incision is repaired after delivery. There are two main types of episiotomy: 1. Midline Episiotomy: Cut direction: A straight incision made from the vaginal opening toward the anus. Advantages: Heals faster, less painful. Disadvantages: Higher risk of extending into the anal area, causing more severe tearing. 2. Mediolateral Episiotomy: Cut direction: An angled incision made from the vaginal opening, directed sideways away from the anus. Advantages: Less risk of severe tearing toward the anus. Disadvantages: More painful and takes longer to heal than midline. These cuts are made to enlarge the vaginal opening and aid delivery when necessary. Pain Management: Postpartum pain from uterine contractions or perineal trauma can be managed with cold packs, pain relievers, and exercises like Kegel exercises to strengthen the perineal muscles. Amniotomy: Artificial popping of amniotic sac Unit 2 (Lesson 5): Conducting a Normal Delivery 7  Baby Breastfeeding FAQs How often should the baby nurse? In the first few weeks, 8-12 times a day. As the baby grows and starts eating solid foods (around 6 months), nursing frequency gradually decreases. How to know the baby is hungry? Signs include head turning, sucking on hands, and searching for the breast. Crying is a late sign, so nurse before the baby starts crying. How to know the baby is latched correctly? The baby is close to the mother, with the chin tucked in and the areola mostly inside the baby’s mouth. Nursing should be painless, with slow, deep sucking. How to know the baby is getting enough milk? 3-4 yellow bowel movements and 5-6 wet diapers daily in the first six weeks. The baby should be relaxed after feeding and regain birth weight within 10-14 days. Should the baby nurse from both breasts? Start with one breast until the baby lets go, burp them, then offer the second. Alternate breasts at each feeding. Wash the breasts with water only; avoid soap. Unit 2 (Lesson 5): Conducting a Normal Delivery 8