RD Manual
RD Manual
RD Manual
To facilitate a successful delivery with least discomfort on the part of the mother.
To safeguard mother and baby against infection.
To prevent maternal hemorrhage.
Equipment
INTRAPARTUM CARE SET
Resuscitation equipment
Identification band (Blue for Baby Boy; Pink for Baby Girl)
Eye Ointment
Stethoscope (to symbolize Physical Examination of the newborn)
Vit K Injection (ampule form)
Hepatitis B Injection (vial form)
2 sterile Tuberculin Syringes with needle
1 sterile aspirating needle
Cotton balls with alcohol
Cotton balls with sterile water or saline water
Digital rectal thermometer
Baby's Diaper
Clean Cloth/ baby's layette
Patient position: Lithotomy position
Procedure Rationale
1. Gather the necessary equipment. Prepare Preparing the equipment saves time and
the birthing instrument set per hospital effort and for assuring the correct and
protocol. Place yellow plastic waste bag completeness of equipment needed.
on the DR table (specifically where the
buttock of the patient is); Prepare The yellow plastic waste bag is used to
Primi/Multipara. dispose bloody and infectious wastes.
Set on the Mayo tray. The room must be set to an environment free
of air draft and regulated temperature in
Check room temperature of the DR must preparation for baby's thermoregulation.
be at 25-28°C and free of air draft.
Notify appropriate staff to assist in the
Check resuscitation equipment
2. Assist the client in lithotomy position and Lithotomy position is a common position of
the ASSISTING NURSE performs childbirth. Perineal prep is best done through
perineal flushing. perineal flushing.
3. 3. Wash hands with clean water and Handwashing is the single and most effective
soap, or scrub hands for at least 40-60 way in deterring the spread of
secs (according to WHO 1- 2-3-4-5) microorganisms.
4. The HANDLE NURSE and the CORD To prevent cross-contamination and assure
CARE NURSE don gown (per protocol) asepsis.
and sterile gloves. Double gloving per
hospital policy. The HANDLE NURSE Oxytocin preparation prior to the delivery
arranges the sterile set in Mayo tray in a will help the assist nurse with ease in the
linear fashion. procedure.
Assisting nurse prepares the Oxytocin IM
in a medication tray.
NOTE: Oxytocin preparation is not a sterile
material.
5. When the perineum bulges, the HANDLE This prevents injury/laceration while the
NURSE protects it with an operating perineum is stretching and to prevent sudden
sponge and applies moderate pressure at expulsion.
the perineum and on the fetal head.
(Ritgen's maneuver)
6. Coach the patient to bear down when Bearing down is effective when there is
there are contractions until the head is contraction.
out, when contraction stops, instruct the
patient to catch up breathe by opening
and breathing through the nose.
7. The HANDLE NURSE places the 1st dry The first sterile and dry linen is used for
sterile linen on top of the abdomen of the drying the baby. Preparing this ahead will
mother. help ease the drying of the baby.
8. Watch for cord coil around the neck of To prevent compression of the cord.
baby. If present, insert finger to ease
pressure, skip coil down baby's shoulder.
9. Wait for external rotation. The HANDLE Forcing the delivery of the baby may cause
NURSE eases the expulsion of the head the laceration of the cervix or the vaginal wall.
by slowly pulling head up and down by
interlocking neck/mandible area of the
baby in between index and middle fingers
of both hands until the anterior shoulder
comes out, then the posterior shoulder
next and the rest of the body.
10. The CORD CARE NURSE calls out and It is important to loudly tell the time of birth-
note for the time of delivery and sex of the this helps in accurate recording of the time
baby. A child is considered born when the and more importantly, alerts other personnel
whole body is delivered. "Baby (Girl/Boy) in case any help is needed.
out! (time)!"
Note during the 1st sec. At the time of drying itself, the baby's
Do not ventilate unless baby is floppy / breathing should be assessed. A normal
limp & not breathing. newborn should be crying vigorously or
Do not suction unless mouth / nose is breathing regularly at a rate of 40-60 breaths
blocked with secretions. per minute. If the baby is not breathing well,
Do not wipe off vernix Do not bath then the steps of resuscitation must be
newborn. carried out.
No slapping.
No hanging upside down. If after 30 seconds of thorough drying
No squeezing of chest. newborn is not breathing or is gasping the
following actions are recommended:
13. When the handle nurse palpates the Oxytocin administration is the 1st step in the
abdomen and ensures that there is no AMTSL to reduce postpartum blood loss, and
second baby, and 1 minute after baby's to enhance detachment of the placenta to the
birth, the ASSISTING NURSE administers lining of the uterus.
Oxytocin 10 units (1mL) IM at the deltoid
of the patient (mother).
14. Meanwhile, the CORD CARE NURSE Delaying cord clamping 1-3 minutes after
wearing sterile gloves waits until cord birth or waiting until the umbilical cord has
pulsation stops or withing 1-3 minutes stopped pulsating has been shown to
after birth while also noting the APGAR increase newborn's iron reserves. It also
Scoring. reduces the risk of iron-deficiency anemia,
improves blood circulation, and prevents
a. Clamp the cord with the sterile plastic cord hemorrhage. APGAR Score describes the
clamp/cord clip (1st clamp), 1 inch (2 cm) newborn health condition after birth
above the umbilical base.
17. Meanwhile, after ensuring that the cord is Breastfeeding within the first hour of life
properly clamped and cut, the CORD prevents neonatal deaths. Delaying the start
CARE NURSE replaces the ASSISTING of breastfeeding makes the newborn prone to
NURSE in supporting the newborn's infection.
back. Ascertain non- separation of
newborn from the mother for early
breastfeeding or "latching on".
The CORD CARE NURSE educates the
mother about breastfeeding.
Note:
leave newborn on SSC to mother's
chest/abdomen.
observe for feeding cues: licking, rooting.
encourage mother to nudge newborn
towards the breast counsel on proper
positioning & attachment minimize
handling by health workers.
Do not give sugar water, formula or other
prelacteals.
Do not give bottles or pacifiers.
Do not throw away colostrums.
Postpone washing until at least 6 hours.
Postpone bathing of baby until at least 6
hours after birth