Preparation of environment (delivery room) for a safe

delivery:
1. Room should be cleaned and wiped with antiseptic solution or bleaching solution.
The window, bed, door and floor should be wiped properly.
2. Should have goof light and adequate ventilation.
3. Delivery room should be warm to prevent hypothermia of neonate.
4. Perineal light should be checked if it’s properly functioning of not.
5. Mattress should be covered with rubber sheet and then cover it with draw sheet.
6. Keep ready 2-3 extra pillows, blankets and mackintosh floor bucket etc.
7. Keep ready of I/V stand, I/V set, drip. e.g. 5% dextrose, Ringer, Lactate, O2
cylinder and tube, emergency medicine etc.
8. Do not allow to enter unnecessary personnel.
9. Prepare baby resuscitation set, fetoscope, baby wrapper and blankets, weighing
machine, room heater and trolley antiseptic lotion drum with sterile cotton, gauze
pieces, pads, bowl BPset screen and bedpan, delivery set and episiotomy set.
10. Jug with water feeding cup.
11. All the things should be kept ready and on working conditions.

Preparation of women:
1. Bath especially below the wrist to keep the skin clean.
2. Bladder should be emptied regularly.
3. Provide glucose water hot and cold drink regularly.
4. Sponging her face and neck by cold water.
5. Proper privacy should be maintained.
6. Provide respectful maternity care:
 Behave with warm friendly manner because in this stage she is psychological
ill.
7. Teach the woman about bearing down effort during contraction and taking long
respiration during relaxation period.
 8. Place the woman in proper position.

Nursing care of woman in 1st stage of labor:

1. General care:
- Constant observation is not necessary but need to assess in every 2-4 hourly.
- Periodically engage her in conversation.
- Encourage the birth companion to stay with her.
2. Proper positioning and posture (side-lying position).
3. Diet during labour, only fluid and liquid diet is given by --------- .
4. Attention to the bladder- woman is encouraged to pass urine every 2 hourly. A full
bladder may prevent the head from entering the brim.
5. Attention to the toilet: Emptying the rectum prevent sutting – of the perineum during
2nd stage.
6. Rest and sleep: The woman need adequate rest and sleep for decreasing tiredness
and anxiety.
7. Relief and pain:
- Suggest to change position according to her comfort.
- Give small feed in between the contraction.
- Teach breathing technique during contraction and on relaxation.
- Encourage her visitor to massage her back or hold her hand.
8. Provide comfort and assistance
- Provide care and assistance in daily routine care, toilet dressing, and changing
pad when it is soiled.
- Give her praise, encouragement and reassurance.
- Give detail information about progress of labour.
9. Teaching about bearing down or pushing effort Bearing down should be forbidden
during the 1st stage of labour because when the cerviris not fully dilated, the woman
pushes her uterus downwards and puts great strain on the cervical ligament.
10. Preparation of women for natural child birth.
Preparation of Self
1. Nails should be short.
2. Hair should be tidy.
3. Remove the ring and wrist watch.
4. Wear clean plastic apron and mask.
5. Familiarize yourself with woman’s condition by checking chart and collecting
important information
6. It depends on the rate of advance and whether the woman is multiprae of
primi gravidae. In multiparous woman who is progressing rapidly. Scrub
towards the end of first stage of labour. In primigravidae, when full dilation of
cervix occurs or crowing of the fetal head during contraction.
7. Should not be ‘scrubbed up’ to early because sterility of equipment and
draping will no longer retains and you may become contaminated.
8. After scrubbing, the head should dry on air keeping the palm upwards on
‘Namaste position’.
9. Washed hand should be dried with sterile towel or allow to dry on air.
10. Put on sterile gloves.
11. Request with co-workers for help.
12. Open the delivery set and arrange the equipment in respective place in
proper manner, keep antiseptic solution gallipot.
13. Clean the external genital by antiseptic solution and cotton with sponge
holder.
14. Ask co-workers to check FHS, contraction maternal vital sign regularly.
15. Keep the necessary equipment near herself, such as antiseptic solution,
perineal pad, gauze pieces, cotton, forceps, scissors etc.
Preparation of equipment for delivery
A. Equipment needed for normal delivery
S.N Sterile Equipment Amount Purpose
.
1 Sponge forceps or sponge 2 To clean the external genital by
holder antiseptic solution and cotton
To deliver placenta
2 Plain artery forcep 2 To damp umbilical cord to
prevent bleeding.
3 Cord cutting scissors 1 For cord cutting
4 Grattipot 1 To keep antiseptic solution and
cotton
5 Bowl or kidney tray 1 To receive placenta and blood
6 Rocter forceps 1 To rupture the bag of membrane
7 Perineal sheet 1 To show necessary vulva area
only to prevent contamination of
equipment during suturing----
To prevent contamination of
gloves
8 Perinal pad 3-4 To support perineum during
delivery and apply perineal pad
after delivery
9 Gauze pieces and cotton As To clean external genitalia----
balls necessary
To clean baby’s mouth and nose
after delivery------
10 Sterile gloves 2 pair To war by ------ for delivery and
for sutering--- perineum
11 Antiseptic solution As To clean perineum.
necessary
B. Episiotomy Set:
1. Episiotomy scissors – 1
2. Tooth dissecting forceps – 1
3. Non Tooth dissecting forceps – 1
4. Small artery forceps – 2
5. Needle holders – 1
6. Thread cutting scissors – 1
7. Round body needle with chromic catgut 2 – 1
8. Small gallipot – 1
9. Other equipment is as in normal delivery.
C. Equipment for woman
1. Clean clothes to wear after delivery.
2. Abdominal binder or supporter.
3. Hot drink e.g. milk, soup etc.

D. Equipment for baby

1. Warm baby cotton
2. Warm baby wrapper and blanket
3. Identification band or tag.
4. Sterile water and swabs for eye and nose clearance.
5. Some clean and dry cotton.
6. Cord tying thread.
7. Measuring tape.
8. Gallipot with water.
9. Weighing machine.
Activities performed
1. Assigned duty for all my co-workers and different departments (i.e. admission
room, 1st stage room and 2nd stage room).
2. Prepared delivery room for safe delivery (i.e. maintaining temperature placed
Macintosh over bed, placed buckets, IV stand etc.).
3. Kept ready of I/V stand, I/V set, drip e.g. 5% dextrose, Ringer,
Lactate,---------- O2 cylinder and tube, emergency medicine etc.
4. Arranged the room to provide a comfortable and safe environment for mother.
5. Ensured that sufficient materials, including drugs are available i.e. for the
shift.
6. Prepared delivery set i.e. for primigravidae and multipara.------------
a. Primigravidae set consists of :
i. Sponge holder – 2
ii. Plain artery forcep – 2
iii. Cord cutting scissor – 1
iv. Gallipot – 1
v. Kidney tray – 1
vi. Perineal sheet – 1
vii. Gauze pieces and cotton
viii. Sterile gloves
ix. Antiseptic solution
x. Episiotomy scissors – 1
xi. Needle holder – 1
xii. Round body needle with chromic catgut 1(5) metric lignocaine 7% +
5ml syringe + sterile water.---------
 b. Multipara set consists of:
 Sponge holder – 2
 Plain artery forcep – 2
 Cord cutting scissor – 1
 Gallipot – 1
 Kidney tray – 1
 Perineal sheet – 1
 Perineal pad
 Gauze pieces and cotton
 Sterile gloves
 Antiseptic solution
 Chronic catgut in case of tear
- Needle holder – 1

Injections and medicines were kept ready and checked that all equipments is working
properly or not received mother and visitor courteously and warmly.

1. Took history of woman regarding pregnancy and labour for patient, family chart
and other sources and record accurately.
2. Calculated LMP, EDD and weeks of hestation.
3. Accurately observed and recorded the mothers condition i.e. Temperature, pulse,
blood pressure, respiration, frequency of concentrations and fetal condition (fetal
rate) using partograph.
4. Maintained partograph and monitored contraction and FHS every half and hourly.
5. Prescribed medications were given under the supervision of respected madam.
6. Encouraged mother to empty bladder regularly.
7. Explained progress of labour to the patient and provided psychological support to
obtain their co-operation.
8. Taught patient about pushing and how to breathe relax with contractions.
9. Collaborated with other health team members in the provision of total care.
10. Changed boiled water used for making equipment sterile and placed all the
needed materials and medicine in labour room.
 11. Placed the mother in a safe and comfortable place for delivery.
12. Worked as a circulating nurse during the delivery received to the newborn baby
and cleared the airway.

Conclusion
After performing labour management, I came to know about needed articles, delivery
set, medicines, resusctitatial -------- set for newborn equipment needed in 1 st and 2nd
stage of labour during my labour management, I managed different department such as
labour room (1st stage, 2nd stage and admission room). I ensured that all the articles are
ready or not, maintained partograph and received newborn and cleared the airway,
noted APGAR score and handover of management was given.
Preparation of conducting normal delivery

1. Prepare all equipment needed, delivery set drugs and material for receiving
baby.
2. Place mother in safe and comfortable position and explained about pushing and
proper breathing.
3. Prepared self, put on gloves, plastic apron by scrubbing hands at correct time
(when head is at perineum).

Observations during second stage:

1. Listen and record fetal heart rate frequently after contractions.

2. Assessed progress of labour by observing the descent and advance of the
presenting part with contractions.

Conducting the delivery

1. Opened the delivery set i.e. multiset articles required:

a. Sponge forceps or spongr holder
b. Plain artery forceps – 2
c. Cord cutting scissors – 1
d. Gallipot – 1
e. Bowel of kidney tray – 1
f. Perineal sheet – 1
g. Perineal pad – 3-4
h. Gauze pieces and cotton balls –As necessary
i. Sterile gloves – 2 pair
j. Antiseptic solution – As necessary
2. Episiotomy set:
 a. Episiotomy scissors – 1
b. Tooth dissecting forceps – 1
c. Non Tooth dissecting forceps – 1

d. Small artery forceps – 2

e. Needle holders – 1
f. Thread cutting scissors – 1

g. Round body needle with chromic catgut 2 -1

h. Small gallipot – 1
i. Other equipment is as in normal delivery.
3. Swabbed the vulva area and put on the sterile drayer patient using proper
aseptic technique.
4. Checked for full bladder and took appropriate action.
5. Encourage mother to push with each contractions.
6. Controlled delivery of head, told mother to ---- as head is c
7. Cleared baby’s airway by swabbing mouth and nose.
8. Checked for cord around the neck and there was no cord around the neck.
9. Allowed restitution and external rotation of head.
10. Delivery first anterior shoulder then posterior shoulder and rest of the baby by
lateral flexion.
11. Took all precautionary measures to prevent postpartum heamorrage--------
including giving oxytocin drugs.
12. Noted the APGAR score while establishing respiration.
13. Delivered placenta by controlled cord traction on 2074/11/23 at 5:00 am. Rapidly
uterine massage was done to expel out the clots.
14. Asked the co-workers to check mother vital signs.
15. Checked placenta and membranes for completeness ----- placenta and
membrane were complete.
16. I had conducted SVD with episiotomy checked perineum and vulva for extra tear
except episiotomy cut and repaired under the super-vision of respected madam.
17. Checked mothers fundus making sure its contracted
18. Swabbed vulva area, put on clean pad and kept mother in comfortable position.
19. Measured the blood loss and disposed the placenta safety.
20. Soaked the instrument in chlorine solution for dis-contamination and disposed
used cotton, gauze and needles safety in appropriate area. Provide mother
health teaching on fundal massage, pericare, breast care, hot drinks, nutrition,
breast feeding, and immunization. Record all relevant information in mothers
note and delivery register.
21. Provide fourth stage care to mother and baby as post vital signs were taken,
provide health teaching and importance of it on fundal massage, hot drinks,
nutrition, pericare, breast care, breast feeding, immunization, follow- up, observe
for lochia and bleeding as there was less bleeding and no any foul smell of lochia
and told patient to urinate within 2 hours after having hot drinks timely and patient
had void herself. And I gave proper handover of the case to the PNC ward
friends.