Notes
- Assess contractions (regularity, duration, and frequency).
- If birth not imminent: Encourage Pt to take slow, deep breaths during contractions; discourage pushing between contractions.
- If birth imminent: Encourage Pt to push during contractions.
- Head: As head delivers, examine neck for looped cord and gently slip it over baby’s head if present; applying gentle pressure against baby’s head during delivery will help to prevent an explosive delivery and tearing of perineum.
- Be prepared to assist with suctioning: mouth first, then nose, before next contraction (tear away amniotic sac if covering face).
- Shoulders: Position hands on either side of baby’s head and (1) gently guide baby downward until upper shoulder emerges, then (2) guide baby upward as body emerges.
- Keep baby at same level as perineum until cord is cut.
- Hypothermia can occur rapidly in newborns; dry and wrap newborn’s body and head (not face) in dry, warm blankets.
- Reassess airway, and suction mouth and nose as needed.
- Stimulate respirations with vigorous rubbing and drying.
- Cord: Assist in clamping the cord at 8 and 10 in. from newborn.
- Position baby (skin to skin) on mother’s abdomen or chest.
- Do not pull on umbilical cord if placenta has not delivered.
- Encourage breastfeeding or massage mother’s abdomen to stimulate uterine contractions.
- Assess cord vessels: Normally three vessels (one vein, two arteries).
- Document APGAR score at 1 and 5 min postpartum.
- Assess for postpartum complications (e.g., hemorrhage).