Intra Natal Care (INC)

Intra Natal Care ( INC) A. Understanding Normal delivery care is care in childbirth that seeks to ensure survival and achieve a high level of health for the mother and baby, through integrated and complete efforts but with minimal intervention so that the principles of safety and quality of service can be maintained at the desired (optimal) level. B. Goals Prevent complications that may occur during labor and after the baby is born to reduce morbidity and mortality for mothers and newborns. C. Preparation of Tools and Materials 1. Instrument Tub 2. Plug hole 3. Thread / Cut Gut 4. Needle Hecting 5. Gloves 6. Metal Catheter 7. Naldfuder 8. Half Coher 9. Slim Seher 10. Anatomical Tweezers 11. Chirugis Tweezers 12. Straight Pean 13. Crooked Pean 14. Episiotomy Scissors 15. Tissue Scissors 16. Bandage Scissors 17. Cut the umbilical cord 18. Umblical / Umbilical Cord Clamp 19. Medline Baby Measuring Tape D. Work Procedures 1. Hearing & Seeing Signs of Second Stage of Labor. 2. Ensure that birth aid equipment is complete, including breaking the oxytocin ampoule & inserting a 2½ ml disposable syringe into the delivery container set. 3. Wear a plastic apron. 4. Make sure your arms are not wearing jewelry, wash your hands with soap & running water. 5. Use DTT gloves on the right hand which will be used for internal examination. 6. Take the syringe with gloved hands, fill it with oxytocin and place it back into the delivery container. 7. Clean the vulva and perineum with wet cotton wool by moving the vulva to the perineum. 8. Do an internal examination - make sure the opening is complete and the amniotic membranes have broken. 9. Dip the right gloved hand into 0.5% chlorine solution, open the glove upside down and immerse it in 0.5% chlorine solution. 10. Check the fetal heart rate after the uterine contractions have finished - make sure the FHR is within normal limits (120 - 160 beats/minute). 11. Tell the mother that the opening is complete and the condition of the fetus is good, ask the mother to push when there is pressure if the mother feels like pushing. 12. Ask for help from the family to prepare the mother's position for menstruation (When there is pressure, help the mother in a half-sitting position and make sure she feels comfortable. 13. Take leadership when the mother has a strong urge to carry out. 14. Encourage the mother to walk, squat or assume a comfortable position, if the mother has not felt the urge to push within 60 minutes. 15. Place a clean towel (to dry the baby) on the mother's stomach, if the baby's head has exposed the vulva with a diameter of 5 ‒ 6 cm. 16. Place a folded clean cloth 1/3 of the way down the mother's buttocks 17. Open the lid of the birth set and pay attention again to the completeness of the tools and materials 18. Wear DTT gloves on both hands. 19. When the fetal head is visible in the vulva with a diameter of 5 ‒ 6 cm, place a clean towel to ring the fetus on the mother's stomach. 20. Check for umbilical cord entanglement in the fetus's neck 21. Wait until the fetal head has completed its spontaneous external rotation. 22. After the head has made an external rotation, hold it biparentally. Encourage the mother to bear down during contractions. Gently move the head downwards and distally until the front shoulder appears below the pubic arch and then move upwards and distally to bring up the back shoulder. 23. After the shoulder is born, slide the lower hand towards the mother's perineum to support the head, lower arm and elbow. Use your top hand to trace and hold your top hand and elbow. 24. After the body and arms are born, the left hand goes along the back towards the buttocks and lower legs of the fetus to hold the lower legs (slip the index finger of the left hand between the knees of the fetus) 25. Carry out a cursory assessment: a. Is the baby crying strongly and/or breathing without difficulty? b. Is the baby moving actively? 26. Dry the baby's body starting from the face, head and other parts of the body except the hands without cleaning the varnish. Replace wet towels with dry towels/cloths. Leaving the baby on the mother's stomach. 27. Check the uterus again to make sure there is no more baby in the uterus. 28. Tell the mother that she will be injected with oxycin so that the uterus contracts well. 29. Within 1 minute after the baby is born, inject 10 units of oxytocin IM (intramascularly) in the distal lateral upper 1/3 of the thigh (do aspiration before injecting oxytocin). 30. After 2 minutes after delivery, clamp the umbilical cord with clamps approximately 3 cm from the center of the baby. Push the contents of the umbilical cord distally (mother) and re-clamp the umbilical cord 2 cm distal to the first clamp. 31. With one hand. Hold the clamped umbilical cord (protect the baby's stomach), and cut the umbilical cord between the 2 clamps. Tie the umbilical cord with DTT or sterile thread on one side then loop the thread back and tie it with a lock knot on the other side. Remove the clamp and put it in the container provided 32. Place the baby so that there is contact between the mother's skin and the baby's skin. Place the baby on his stomach on the mother's chest, the baby's skin in contact with the mother's skin. Straighten the baby's shoulders so that the baby is pressed against the mother's chest/tummy. Try to keep the baby's head between the mother's breasts in a lower position than the mother's nipples. Cover mother and baby with a warm cloth and put a hat on the baby's head. 33. Move the clamp on the umbilical cord until it is 5 -10 cm from the vulva 34. Place one hand on a cloth on the mother's abdomen, at the upper edge of the symphysis, to detect. The other hand tightens the umbilical cord. 35. After the uterus contracts, tense the umbilical cord with the right hand, while the left hand gently presses the uterus towards the doroskrainal direction. If the placenta is not delivered after 30 ‒ 40 seconds, stop tensioning the umbilical cord and wait until the next contraction occurs and repeat the procedure. 36. Do dorsocranial tension and push until the placenta is released, ask the mother to push while the helper pulls the umbilical cord parallel to the floor and then upwards, following the axis of the birth canal (still dorso-cranial pressure). 37. Once the placenta is visible on the vulva, continue to deliver the placenta carefully. If necessary (you feel resistance), hold the placenta with both hands and rotate it in the same direction to help expel the placenta and prevent tearing of the amniotic membranes. 38. Immediately after the placenta is delivered, massage the uterine fundus by rubbing the uterine fundus circularly using the palmar part of 4 fingers of the left hand until the uterus contracts well (the fundus feels hard) 39. Check the maternal and fetal parts of the placenta with the right hand to ensure that all the cotyledons and amniotic membranes have been delivered, and place them in the plastic bag provided. 40. Evaluate possible lacerations of the vagina and perineum. Perform stitches if the laceration causes bleeding. 41. Ensure that the uterus contracts properly and that vaginal bleeding does not occur. 42. Make sure the bladder is empty. If full, do catheterization. 43. Dip hands still wearing gloves into 0.5% chlorine solution, clean blood stains and body fluids, and rinse in DTT water without removing gloves, then dry with a towel 44. Teach the mother and family how to massage the uterus and assess contractions 45. Check the mother's pulse and make sure the mother's general condition is good 46. Evaluation and estimation of blood loss 47. Monitor the baby for signs of danger every 15 minutes. Make sure that the baby is breathing well (40-60 times/minute) and has a normal body temperature (36.5-37.5 °C). If there is rapid breathing, severe lower chest wall retraction, difficulty breathing, moaning, seek referral (see MTBM) 48. Place all used equipment in 0.5% chlorine solution for documentation (10 minutes). Wash and rinse equipment after decommenting 49. Dispose of contaminated materials in appropriate trash receptacles. 50. Clean the mother using DTT water. Clean amniotic fluid, mucus and blood. Help mother wear clean and dry clothes. 51. Make sure mom feels comfortable. Help mother provide breast milk. Encourage the family to provide the drinks and food they want 52. Decontaminate the birthing area with 0.5% chlorine solution 53. Dip dirty gloves in 0.5% chlorine solution turn them inside out and soak in 0.5% chlorine solution for 10 minutes 54. Wash both hands with soap and running water 55. Wear clean gloves to perform a physical examination of the baby 56. Perform a physical examination of the newborn. Make sure the baby's condition is good, breathing is normal (40-60 times/minute) and body temperature is normal (36.537.50C) every 15 minutes 57. After 1 hour of administering Vit K1, give hepatitis B immunization on the right thigh.Place the baby within reach of the mother so that she can breastfeed at any time. Place the baby back on the mother's chest if the baby has not succeeded in breastfeeding. In the first hour and leave it until the baby successfully breastfeeds 58. Remove the gloves upside down and soak them in 0.5% chlorine solution for 10 minutes. 59. Wash both hands with soap and running water then dry them with a clean and dry tissue or personal towel. 60. Complete the partograph (front and back pages), check vital signs and monitor the body IV.