Techniques to be professional in vaginal delivery:
1. When you press on the pelvic floor by your fingers, this stimulate uterine contraction.So, press by 2-4 fingers (whatever the volunteer fingers you have) on the posterior vaginal wall just at the level of occiput/ischial spine, you will see more descending of the head.
2. If you did the previous step perfectly & saw your outcome proceed for the most efficient step;
Put your fingers between the head & vaginal wall at the level of ischial spine then swab the fingers you put inside from one side to the other side beneath the occiput i.e. make the head of baby on the dorsum of your fingers & swab the fingers from the lt. side to the rt. side almost at the level of ischial spine while you are pressing on the pelvic floor by the same fingers at the same time. This will help internal rotation.So, by this step you assisted the head descend & the internal rotation.
3. If you become professional in doing the previous steps, do this last one. Do all I mentioned before by fingers from one hand & the other hand pressing on the fundus doing fundal pressure by one hand in the direction of vagina or just correct the axis of uterus over vagina during contractions (sometimes uterus it tilted to one side acc. to position of the baby inside).
3 common techniques are mentioned in obstetric literature
1st. is Anti-Frugsonreflex .
2nd. is modified manual rotation.
3rd. is proper gentle fundal pressure
Tnx for teaching skills.
Recommended vaginal delivery videos for you :
Vaginal delivery techniques PPT(power point presentations):
1. NORMAL LABOUR AND DELIVERY RHEA MARCANO 413003930
2. CONTENTS • 1. Definition of normal Labour • 2. Factors influencing progress of Labour • 3. Diagnosis of Labour • 4. Stages of Labour • 5. Management of Labour
3. LABOUR DEFINITION LABOUR IS DEFINED AS THE ONSET OF REGULAR PAINFUL CONTRACTIONS WITH PROGRESSIVE EFFACEMENT AND DILATATION OF THE CERVIX ACCOMPANIED BY DECENT OF THE PRESENTING PART LEADING TO EXPULSION OF THE FETUS OR FETUSES AND PLACENTA FROM THE MOTHER.
4. FACTORS TO HELP DETERMINE IF LABOUR IS NORMAL • Mature Fetus 37-42 weeks • Spontaneous expulsion • Vertex is the presenting part • Vaginal Delivery • Time ( not < 3hour but not >18 hours) • Complications??
5. INFLUENTIAL FACTORS OF THE PROGRESS OF LABOUR • 3P’s • Power • Passenger • Passage
6. FEMALE PELVIS • Basic framework for the birth canal • True Pelvis- Inlet, cavity and Outlet ( The fetus must pass through all three in order for labour to be sucessful) • Types of Pelvis- Gynaecoid, Anthropoid, Android and Platypelloid
7. THE FETAL SKULL
8. MOULDING The bones of the fetal head can move closer together or overlap to help the head fit through the pelvis. Parietal bones overlap occipital and frontal bones. Moulding can be staged from +1 to +4, +1-+3 being normal and +4 being cause for some concern.
9. DIAMETERS OF THE SKULL
10. INITIATION OF LABOUR
11. CAUSES OF THE ONSET OF NORMAL LABOUR • It is unknown but the following theories are proposed: • Hormonal Factors • Oestrogen Theory • Progesterone withdrawal theory • Prostaglandin Theory • Oxytocin Theory • Fetal Cortisol Theory • Mechanical Factors • Uterine Distension Theory • Stretch of the lower uterine segment
12. Friedman’s Curve
13. DIAGNOSIS OF LABOUR • Signs that can clue you into the onset of Labour • Show- evidence by mucus mixed with blood or mucus plug • Rupture of membranes- look for leaking liquor • panful, regular uterine contractions, atleast (1:10)
14. A D M I S S I O N M A N A G E M E N T
15. • ON ADMISSION: Review antenatal record Complete history if record isn’t available • GENERAL EXAMINATION OF MOTHER General condition- pallor, oedema, abdominal scars, maternal height Vital signs- Blood pressure, Pulse, respiration, temperature (measured and recorded) Heart and Lungs Urinalysis- protein, sugar, ketones
16. • Abdominal Examination: Detail examination, determine fetal presentation, position and engagement Auscultate fetal heart sound Evaluate uterine contractions Attach Carditocography (CTG) for 20 min trace
17. • VAGINAL EXAMINATION Confirm degree of dilatation and effacement Identify the presenting part Fetal head engagement if any doubt Confirm or artificially rupture if necessary (ROM) Exclude cord prolapse • BLADDER/BOWEL CARE Administer an Enema allow to empty bladder ever 1 1/2 – 2 hours
18. • NUTRITION IN EARLY LABOUR No food after labour is established to prevent regurgitation and aspiration Place IV to start administration of fluids • POSITIONING OF LABOURING MOTHER Once everything is well with mom and baby, patient may ambulate or lay in bed as the feel comfortable • MONITORING, PROGRESS OF LABOUR • PAIN RELIEF Opiate drugs- Pethidine given IM q4hrly Epidural analgesia
19. PARTOGRAM • A cartogram is a composite graphical record of key data (maternal & fetal) during labour entered against time on a single sheet of paper. • Relevant measurements such as cervical dilatation, fetal heart rate, duration of labour and vital signs • Monitors progress of Labour
20. COMPONENTS OF A PARTOGRAM • Patient Identification • Time (recorded in 1hr intervals) • Fetal Heart Rate • State of Membranes • Cervical Dilatation • Uterine Contractions • Drugs & Fluids • BP (2hr intervals) • Pulse Rate (30min intervals) • Oxytocin • Urinalysis • Temperature
21. STAGES OF LABOUR
22. First Stage Second Stage Third Stage Begins with the onset of true labour contractions and ends when the cervix is fully dilated (10cm). Cervical effacement and dilatation occurs in this stage 2 Phase: Latent & Active Latent: From diagnosis of labour to 3cm dilatation Active: From 3cm to ful dilatation (10cm) The second stage of labour begins with complete dilatation and ends with the birth of the baby. Approximately 2 hours in a nulliparous and 1 hour in a multiparae woman Begins after birth and ends with the expulsion of the placenta and membranes Shortest stage: After birth, up to 30 minutes
23. FIRST STAGE WHAT HAPPENS AND HOW TO MANAGE!
24. • 1. Contractions • Regular • Increasing Frequency • Stronger • 2. Cervical Dilatation and Effacement • 3. Engagement of the presenting part
25. MANAGEMENT • Continuity of care • Observation of progress of Labour • Monitoring fetal & maternal well-being • Adequate pain relief (according to mothers wishes) • Adequate hydration to prevent Ketosis Lactate ringer solution
26. SECOND STAGE WHAT HAPPENS AND HOW TO MANAGE?
27. SECOND STAGE • First sign of the second stage is the urge to push • Full Dilatation to Delivery of the fetus • Signs to look for:- • (1) Distention of the perineum • (2) Dilatation of the anus • Satisfactory progress:- steady descent of the fetus through the birth canal & onset of the expulsive phase
28. MANAGEMENT • Continuous monitoring during this phase • Maternal Position, usually semi-recumbent or supported sitting position with thighs abducted but any comfortable position expect supine for an uncomplicated pregnancy • Encourage to bear down with the contractions
29. MANAGEMENT (CONT’D) • Maternal condition – BP and PR measured every 15- 30mins and after contractions • Fetal Condition- Fetal heart rate, measured continuously or after contractions • Uterine Contractions- strength, length and frequency continuously assessed • Progress of descent- recorded every 30 mins
30. CONDUCTING THE DELIVERY • position patient • antiseptic solution to clean skin of lower abdomen, vulva, anus and upper thigh, then drape • DELIVERY OF THE HEAD • Control delivery of the head • Perform episiotomy if required • Perform Ritgen’s Maneuver • Clear the airways after delivery of the head
31. CONDUCTING THE DELIVERY (CONT’D) • DELIVERY OF THE SHOULDERS • Anterior shoulder assisted by gentle downward traction of the head • Posterior shoulder is delivered by elevating the head.
32. CONDUCTING THE DELIVERY • DELIVERY OF THE TRUNK • Grasp baby around the chest after shoulders delivered to help with birth of trunk • Baby swept unto mother’s abdomen • Note time of delivery • CUTTING THE UMBILICAL CORD • wait 15-20 seconds then clamp • plastic crushing clip placed 1-2cm above umbilicus and cut 1cm beyond the clamp
33. IMMEDIATE CARE OF THE NEWBORN • Assess baby • Health baby with spontaneous respiration place on mother’s abdomen, dry& cover baby • No spontaneous respiration or respiratory problems then resuscitate baby • APGAR scores
34. EVENTS OCCURRING DURING LABOUR • Flexion and Descent • Internal Rotation of the fetal head • Crowning • Extension • Restitution • Internal rotation of the shoulders • External rotation of the fetal body • Lateral flexion of the body
35. THIRD STAGE WHAT HAPPENS AND HOW TO MANAGE?
36. THIRD STAGE • Begins with fetus delivery and ends with delivery of the placenta/membranes • Two phases: Separation and Expulsion • 30 mins or less • Average blood loss 150-250 mld
37. MANAGEMENT • BIRTH OF THE PLACENTA • Two (2) stages:- • Separation of the placenta from the wall of the uterus and into the lower uterine segment or vagina • Actual expulsion of the placenta out of the birth canal
38. TWO MECHANISMS OF SEPARATION • Mathews-Duncan mechanism (raw surface exposed when delivered) • Schultz Mechanism (placenta inserted at fundus, placenta inverts and covers the raw surface)
39. SIGNS OF SEPARATION • Globular and hard uterus • Sudden gush of blood • Cord Lengthening (Most reliable clinical sign)
40. BIRTH OF THE PLACENTA • Two methods: • Passive Management (wait for spontaneous expulsion of the placenta) • Active Management
41. ACTIVE MANAGEMENT OF THE THIRD STAGE • Help prevent postpartum hemorrhage • Includes:- • Use of oxytocin (given around the time of the anterior shoulder delivery, 10 units) • Controlled cord traction • Uterine massage
42. ACTIVE PLACENTA DELIVERY • Brandt’s Andrew method • Placenta separation • Controlled cord traction • Delivery of the membranes • Examination of the Placenta:- placenta, membranes & umbilical cord for completeness and anomalies
43. • EXAMINATION OF THE PERINEUM • look for lacerations, also vulva outlet, vaginal canal & cervix should be inspected • Repair lacerations or episiotomies immediately
44. IMMEDIATE MANAGEMENT AFTER THE DELIVERY • EARLY POSTPARTUM MANAGEMENT • Monitor for postpartum hemorrhage, keep for atlas 1 hour in delivery suite (bleeding- ask to report any sudden gushes of blood, bp and pulse) • Before discharging from delivery suite • Check uterus frequently to ensure it is firm • Remove intrauterine clots • Look at introitus for NO hemorrhage • Keep bladder empty • Ensure baby is breathing well, pink and well flexed
45. REFERENCES • Obstetrics ten teacher • Various online resources
46. LEARNING RESOURCE • http://intranet.tdmu.edu.ua/data/kafedra/internal/gine cology2/classes_stud/en/nurse/adn/ptn/2/Nursing%2 0Care%20of%20Childbearing%20Family_Practicum /04.%20Labor%20and%20birth%20process..htm
47. QUESTIONS?? Let’s Deliver Babies…………………… THANK YOU!!!
48. • Engagement: The fetus is engaged if the widest leading part (typically the widest circumference of the head) is negotiating the inlet. • Station: Relationship of the bony presenting part of the fetus to the maternal ischial spines. If at the level of the spines it is at “0 (zero)” station, if it passed it by 2cm it is at “+2” station. • Attitude: Relationship of fetal head to spine: flexed, neutral (“military”), or extended attitudes are possible. • Position: Relationship of presenting part to maternal pelvis, i.e. ROP=right occiput posterior, or LOA=left occiput anterior. • Presentation: Relationship between the leading fetal part and the pelvic inlet: cephalic, breech (complete, incomplete, frank or footling), face, brow, mentum or shoulder presentation. • Lie: Relationship between the longitudinal axis of fetus and long axis of the uterus: longitudinal, oblique, and transverse. • Caput or Caput succedaneum: oedema typically formed by the tissue overlying the GLOSSARY
49. Pelvic types Traditional obstetrics characterizes four types of pelvises: • Gynecoid: Ideal shape, with round to slightly oval (obstetrical inlet slightly less transverse) inlet: best chances for normal vaginal delivery. • Android: triangular inlet, and prominent ischial spines, more angulated pubic arch. • Anthropoid: the widest transverse diameter is less than the anteroposterior (obstetrical) diameter. • Platypelloid: Flat inlet with shortened obstetrical diameter.