Normal Delivery Care (APN)

NORMAL DELIVERY CARE (APN) ACTIVITY 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 I. RECOGNIZING SYMPTOMS AND SIGNS OF TIME II 1. Hearing and seeing signs of the second stage of labor  Mother felt a strong and overwhelming urge  The mother feels increasing pressure in the rectum and vagina  The perineum appears prominent.  The vulva and anal sphincter open I. PREPARING DELIVERY AID 2. Ensure complete equipment, materials and essential medicines to assist with delivery and manage maternal and BBL complications. Open the pump for BBL resuscitation → flat, dry and warm resuscitation area, 60 watt lamp at a distance of 60 cm from the baby's body, 3 clean and dry towels/cloths, mucus suction device, tube or balloon and uncover. -Place the cloth over your stomach and the resuscitation area support the baby's shoulders - Prepare 10 units of oxytocin and disposable sterile syringes in the birth set - 3. Wear a plastic apron 4. Remove and store all the jewelry you wear, wash your hands with soap and clean, running water, then dry your hands with a clean, dry tissue or personal towel. 5. Wear DTT gloves on the hand that will be used for internal examination 6. Put oxytocin into the syringe tube (use hands wearing a DTT glove) and sterilize (make sure there is no contamination). III. ENSURE COMPLETE OPENING AND GOOD CONDITION OF THE FETUS 7. Clean the vulva and perineum, wiping them carefully from front to back using cotton or gauze soaked in DTT water. - If the vaginal introitus, perineum or anus is contaminated with feces, clean thoroughly from front to back. - Discard cotton or cleaning gauze (contaminated) in the container provided. - Change gloves if contaminated (decontaminate, remove and in 0.5% chlorine solution →step #9). 8. Do a deep check to ensure complete opening. a. If the amniotic membrane has not broken and the opening is complete, then perform an amniotomy 9. Decontaminate gloves by dipping hands that are still wearing gloves in 0.5% chlorine solution, then remove them and soak them upside down in 0.5% chlorine solution for 10 minutes. Wash both hands after removing both gloves 10. Check the fetal heart rate (FHR) after contraction/relaxation of the uterus to ensure that the FHR is within normal limits (120 ‒ 160x/ minute) IV. PREPARING MOTHERS AND FAMILIES TO HELP WITH THE MENERAN GUIDANCE PROCESS 11. Inform the mother that the opening is complete and the condition of the fetus is good and help the mother find a comfortable position according to her wishes. a. Wait until the urge to push appears, continue monitoring the condition and comfort of the mother and fetus (follow the active phase management guidelines) and document all existing findings. b. Explain to family members how their role is to support and encourage the mother to carry out properly. 12. Ask the family to help prepare the menstrual position. (If there is a feeling of wanting to do menstruation and strong contractions occur, help the mother into a half-sitting position or other desired position and make sure the mother feels comfortable) 13. Carry out breastfeeding guidance when the mother feels a strong urge to push:  Guide the mother so that she can breastfeed correctly and effectively.  Support and encourage her when breastfeeding and correct her  breastfeeding method if it is not appropriate.  Help the mother take a comfortable position according to her  choice (except lying on her back for a long time) Encourage the  mother to rest between contractions  Encourage the family to provide support and encouragement for the mother  Provide sufficient fluid intake orally (drinking)  Assess the FHR after each uterine contraction is completed  Refer immediately if the baby has not or will not be born soon  after 120 minutes (2 hours) of labor (primigravida) or 60  minutes (1 hour) of labor (multigravida) 14. Encourage the mother to walk, squat or take a comfortable position, if the mother has not felt the urge to push within 60 minutes V. PREPARATION FOR BIRTH AID 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 clean cloth folded 1/3 under the mother's buttocks 17. Open the lid of the birth set and look again at the completeness of the tools and materials 18. Wear DTT gloves on both hands VI. PREPARATION FOR THE BIRTH OF A BABY Birth of the Head 19. After you see the baby's head with a diameter of 5-6 cm, open the vulva, protect the perineum with one hand covered with a clean and dry cloth. The other hand holds the baby's head to hold the deflection position and help the birth of the head. Encourage the mother to breathe slowly or breathe quickly and shallowly 20. Check for possible umbilical cord entanglement and take appropriate action if this occurs, and immediately continue the process of giving birth to the baby - If the umbilical cord is loosely wrapped around the neck, remove it from the top of the birth head - If the umbilical cord is tightly wrapped around the neck, clamp the umbilical cord in two places and cut between the two clamps 21. Wait for the baby's head to rotate outward spontaneously Birth of the Fetus 22. After the head makes an external rotation, hold it biparentally. Encourage the mother to bear down during contractions. Gently move downwards and distally until the front shoulder appears below the pubic arch and then move upwards and distally to bring up the back shoulder. The Birth of the Body and Limbs 23. Once both shoulders are born, slide the bottom hand to the head and shoulders. Use your top hand to trace and hold your upper arm and elbow 24. After the body and arms are born, the extension of the upper arms continues to the back, buttocks, legs and feet. Hold both ankles (insert your index finger between your feet and grasp each ankle with your fingers and the other toes) VII. HANDLING NEWBORN BABIES 25. Carry out an assessment of the newborn as follows: - Before the new baby is born a. Is the pregnancy at term? b. Is the amniotic fluid clear, not mixed with meconium (greenish color)? - Immediately after the baby is born -While placing the baby on the stomach, do an assessment (at a glance) c.Is the baby crying or breathing/not gasping? d.Is the baby's muscle tone good/is the baby moving actively? If the baby is full term, the amniotic fluid is not mixed with meconium, is crying or breathing normally/not gasping and is moving actively, do step 26. If the baby is not full term and/or the amniotic fluid is mixed with meconium and/or the baby is not breathing or gasping and/or the baby is limp, manage the baby with asphyxia. 26. Dry the baby's body Dry the baby starting from the head, head and other parts of the body except the hands without removing the varnish. Replace wet towels with dry towels/cloths. Leave it on the mother's stomach. 27. Check the uterus again to ensure there are no more babies in the uterus (singleton pregnancy) 28. Tell the mother that she will be injected with oxytocin so that the uterus contracts properly. 29. . Within 1 minute after the baby is born, inject 10 units of oxytocin IM (intramuscularly) in the distal lateral upper 1/3 of the thigh (do an aspiration before injecting oxytocin) 30. Within 2 minutes after the baby is born, clamp the umbilical cord with clamps approximately 3 cm from the baby's center. Push the umbilical cord distally (mother) and re-clamp the umbilical cord 2 cm distal to the first clamp 31. Cutting and tying the umbilical cord - 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 circle the thread again 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. VIII. ACTIVE MANAGEMENT OF THE III STAGE OF LABOR 33. Move the clamp on the umbilical cord until it is 5-10 cm from the vulva 34. Place one hand on the 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, tension the umbilical cord downwards while the other hand carefully pushes the uterus backwards (dorsocranially) (to prevent uterine inversion). 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 above procedure. - If the uterus does not contract immediately, ask the mother, husband or family member to stimulate the nipples. Removing the placenta 36. Do dorso-cranial tension and push until the placenta is released, ask the mother to push while the helper pulls the central chain parallel to the floor then upwards, following the axis of the birth canal (still dorso-cranial pressure) - If the umbilical cord gets longer, move the clamp until it is about 5-10 cm from the vulva and deliver the placenta. - If the placenta does not separate after 15 minutes of tightening the umbilical cord: 1. Give a repeat dose of oxytocin 10 units IM 2. Perform catheterization (aseptic) if the bladder is full 3. Ask the family to prepare a referral 4. Repeat the umbilical cord tension for the next 15 minutes 5. If the placenta is not delivered within 30 minutes after the baby is born or if it is bleeding, immediately perform a manual placenta procedure 37. When the placenta appears at the vaginal introitus, deliver the placenta with both hands. Hold and rotate the placenta until the amniotic membranes are twisted, then give birth and place the placenta in the container that has been prepared. - If the membranes are torn, use DTT or sterile gloves to explore the remaining membranes, then use your fingers or DTT or sterile clamps to remove the remaining part of the membranes. Tactile stimulation (massage) of the uterus 38. As soon as the placental membranes and amniotic membranes are born, massage the uterus, place the palm of your hand on the fundus and massage with gentle circular movements until the uterus contracts (the fundus feels hard). - Take necessary action if the uterus does not contract after 15 seconds of massage IX. ASSESS BLEEDING 39. Check both sides of the placenta, both mother and baby, and make sure the amniotic membranes are complete and intact. Place the placenta in a plastic bag or special container 40. Evaluate possible lacerations to the vagina and perineum. Perform stitches if the laceration causes bleeding. If there is a tear that causes active bleeding, stitch it immediately X. CARRYING OUT POSTPARTY PROCEDURES 41. Make sure the uterus is contracting well and there is no vaginal bleeding. 42. Make sure the bladder is empty. If full, do catheterization. Evaluation 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, heavy lower chest wall retraction, difficulty breathing, moaning, seek referral (see MTBM). - If the feet feel cold, make sure the room is warm. Return the baby to skin-toskin contact with the mother, cover the mother and baby with one blanket. Cleanliness and security 48 Place all used equipment in 0.5% chlorine solution for documentation (10 minutes). Wash and rinse equipment after decommenting 48 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 mother 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 do 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 (36.5-37.50C) every 15 minutes 57. After 1 hour of administering Vit K1, give hepatitis B immunization to 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 gloves upside down and soak 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. Decontamination 60. Complete partograph (front and back pages), check vital signs and provide IV stage care.