PROCEDURE RATIONALE

I. OPENING A STERILE PACKAGE

Check bedside equipment: Organization promotes efficient time

management.
1. Flushing Can
- opened in a fanfold
manner for perineal
flushing
2. Betadine Spray
- cleaning the perineal area
and final preparation
3. Cotton Balls
4. Pickup Forceps
- ovum forceps, teeth inside
5. Hypotray
- working forceps; lift the
fold, hand inside fold to
get the working forcep.

1. Washes hands. To deter the spread of microorganisms.

- Perform medical handwashing

and remove all jewelry, including
wedding bands/rings.

2. Obtains package and reads

directions for opening.

- Obtain the package and read

directions for opening.

- Opening of the OB Pack is only

done when the px is showing
imminent signs of delivery
(SUBIRBA).

- Look for the tape with the date To check for the expiry date of the OB
Pack.

3. Plans adequate workspace. To observe aseptic technique.

- Position yourself at least an inch

away from the edge of the table.
 4. Opens package, working away To observe aseptic technique.
from body.

- Open the first cover according to

its fold direction; can be done
with bare hands; make sure to
open the cuff that is away from
you first and insert your hand
under the cuff. Lift then drop.

- The second cover of the OB Pack

will be opened the same way
except we use the pickup forceps
now. Lift then drop.

5. Touches only outside surface of To maintain sterility.

wrapper.

- Ensure to only touch the outside

surface of the wrapper.

II. PUTTING STERILE INSTRUMENTS /

EQUIPMENTS ON STERILE AREA

1. Gets the pick-up forceps

aseptically.

- Get the pick-up forcep to use it To maintain sterility.

in getting the materials inside
the OB Pack.

2. Removes and places the cover of

the tray upside down on a clean
surface.

3. Gets the needed instruments To ensure proper arrangement form

carefully. bottom to top.

- Check and arrange the contents - 1 towel

of the OB Pack. - Bonnet
- Flannel
- 2 drapes
- 2 leggings
- Sterile gown

4. Put back the tray cover without

touching the inside-part after
 using.

5. Put sterile eqipments on the sterile

field without touching it with clean
hands.

Reminders on opening and To observe aseptic technique.

handling sterile packs:
1. One step backward
2. Make sure to peel open
facing sidewards, not
infront of the sterile field.
3. Use banana peeling
method in opening the
instruments.
4. Maintain your hold to
avoid instruments from
falling or making them
unsterile.
5. Do not make too much
noise in preparing, as in,
avoid the clanking sound
of the metal instruments
so as to not startle and
increase the anxiety of the
patient
6. Throw the packaging on
the garbage bin assigned
for it (usually under the
table)

➔ STERILE BASIN To maintain sterility.

- Banana peel

➔ ALLIS FORCEPS To maintain sterility.

- Banana peel or may use
pick-up forceps.

➔ SYRINGE To maintain sterility.

- Banana peel or may use
pick-up forceps.

➔ BLADE To maintain sterility.

- Banana peel then drop on
sterile table.

➔ MAYO SCISSORS To maintain sterility.

 - Banana peel or may use
pick-up forceps.

➔ PRIMISET/NSVD To maintain sterility.

- Banana peel or may use
pick-up forceps.

➔ PLACENTAL CURETTE To maintain sterility.

- Banana peel or may use
pick-up forceps.

➔ UMBILICAL CORD CLAMP To maintain sterility.

- Banana peel or may use
pick-up forceps.

➔ OS To maintain sterility.
- Banana peel or may use
pick-up forceps.

➔ COTTON BALL To maintain sterility and to prepare it

- Banana peel and place it later in placing the needed solution.
in the sterile bowl.

➔ SUCTION BULB To prevent it from bouncing and falling

- Banana peel then drop on of the table.
the bigger basin.

➔ SUTURE To maintain sterility.

- Banana peel then drop on
sterile table.

Prepare 3 sterile gloves for the

obygyne, resident, and nurse and
make sure that it is the right
size.

Banana peel from first packaging, Donning the sterile gloves, dominant
drop it on the on the sterile with hand comes first.
its second packaging and
arrange it on the table

Make sure to know what is the

handedness of the consultant
and the resident/s so as to know
what side should be on top when
they open the package
 6. Arranges the instruments and
equipments if complete before
working.

Arrange the instruments on the table;

from left to right, with at least an inch
of allowance:
1. Allis forceps
2. Syringe 5cc
3. Blade holder
4. Mayo Scissors (can be curved or
straight; tetht down if curved)
5. Umbilical Cord Clamp
6. 3 clamps (can be curved)
7. Needle holder
8. Tissue forceps with teeth
9. Placental Curette
10. Ovum Forceps
11. Blade (Alinged on top of the
holder)
12. Suture (above needle holder,
below big basin)

III. WORKING WITHIN A STERILE FIELD

1. Arranged adequate work space

with work surface at waist height

- Arrange adequate work space

with work surface at waist
height

2. Avoids touching sterile items

against 1” border at edge of sterile
field

- Avoid touching sterile items

against 1” border at edge of
sterile field

3. Keeps sterile field in view at all

times

- Keep sterile field in view at all

times

4. Avoids talking, coughing, sneezing,

 or reaching over sterile area

- Avoid talking, coughing,

sneezing, or reaching over sterile
area

5. Avoids touching items in sterile

field with bare hands

- Avoid touching items in sterile

field with bare hands

6. Adds only sterile items to sterile

field

- Add only sterile items to sterile

field

7. Dons gloves aseptically

- Arrange the sterile gloves Order (from nearest to farthest) →

according to the order of use consultant, resident/s, then yours
(this is aligned on top of the (which is already near the top most
farthest right instruments) part)

- Arrange the OS (right side,

starting on top of the clamps) in To avoid getting doubles and possible
cascading manner contamination when instruments come
in contact with the sterile OS
- Perform surgical handscrubbing
after the preparation To maintain sterility.

- Perform proper donning of

sterile gloves and place its To maintain sterility.
wrapper under the basin (make
sure to hold it on its sterile side
since you’re already wearing the
sterile gloves).

8. Withdraws 5-10cc of lidocaine

correctly and aseptically

- With assistance, aspirate 5cc of To be used for the patient during

local anesthesia (lidocaine) episiotomy

9. Mounts the surgical blade correctly

 - Mount the surgical blade on the To be used for episiotomy
blade holder using the needle
holder / clamp Note: Check for
blade number and holder
number; even on even, odd on
odd.

10. Threads the prescribed length of

suture to the round needle

- Open the Chromic 2.0 pack over To ensure sterility in the work place.
the basin

- Cut the round needle (2/3) , and Round needle is for the deep tissues
the cutting needle (1/3) length. and muscles which means it needs
more suture length than the cutting
needle which is used for the skin.

11. Mounts the round needle correctly

to the needle holder

- Secure the round needle in the To be used to suture the skin.

needle holder, and the cutting
needle on an OS

- Note: Needle should form a smile

with the tip on the opposite
direction of the MD’s
handedness, and then when you
put it in the table, it should form
a frown

Place OS over the ovum forceps: For easier access when it’s time to
1. Form OS in a triangle then wrap clean the uterus
the OS on the ovum forceps
2. Make sure to lock the forceps to
keep in place

Ask for assistance to pour water and To be used to clean the patient during
betadine on sterile bowl with cotton the procedure
balls.

IV. DELIVERY

When patient is fully dilated, place the To ensure ease of access of tools
table near the client

While waiting for the doctor to start To ensure sterility

the procedure, place hands on the table

Before starting the operation, do final To prepare the client and to ensure
preparation by cleaning the perineal sterility
area with perineal flushing and
betadine spray

1. Drapes the leggings aseptically

Put in mind the proper way of folding Place the leggings over the patient's
and also opening the leggings. Place legs, starting from the foot to the groin
your hands on the cuff then open.
Note: Start on the leg farther from you
Note: Do not fix so that you will and do not fix it because the assist will
maintain your sterility. do that

2. Lays aseptically the strike draping

towel under the buttocks

Place a drape under the patient’s To ensure sterility.

buttocks

Note: Make sure you are touching the

side of the folded triangle and cover
the dorsal part of your gloved hand too

When there is crowning and there is To help encourage dilatation of cervix.

still a bag of water, perform ARM
(artificial rupturing of the membrane)
of the bag of water using the allis
forceps

Once the client is still pushing, hand To prepare patient for eppisiotomy.
over the 5 cc local anesthetic to the
doctor

[EPISIOTOMY START] So that the doctor will have an easier

access to the handle of the instruments
When handing equipment /
instruments, make sure to touch the
teeth / the tip of the instruments

Give the blade to the doctor by This is to be used by the doctor for
touching the neck of the blade, episiotomy (median / midlateral
together with an OS episiotomy)

Offer the mayo scissors to the doctor This is for the cutting of perineal tissue
and muscles for Ritgen’s Manuever

Use Ritgen’s Maneuver to support To prevent perineal tearing or

perineal area laceration

3. Assists the doctor in the delivery of

the newborn with proper
observation of the principles in the
newborn care (including correct
performance of Ritgen’s
Maneuver)

a. Proper placement of hand

on the head of the baby,
and feeling for the cord in
case of cord coils
b. Pull down to facilitate the
delivery of the anterior
shoulder

Assist the head of the baby by using a

scissor-like method and pull the neck
of the baby down to let the upper
shoulder out
c. Pull up to facilitate the
delivery of the posterior
shoulder

Pull the neck up to let the lower

shoulder out
d. Slide the dominant hand
following the contour of the
baby’s back while the
non-dominant hand is
supporting the head and
neck of baby

Externally rotate the baby and support

the neck with your nondominant hand,
while your dominant hand will support
the back of the baby - Facilitate the
delivery of the fetal body parts and
catch the feet
When the head of the baby is out, wipe To remove any debree
the mouth and nose of the baby using
OS

When there are secretions in the mouth To facilitate the airway of the baby
and nose, use suction to remove
secretions starting from the mouth
(press first then place in mouth/nose)

4. Call out time of delivery, including

gender

Announce time of delivery (baby out), To identify time of delivery and gender
and gender of the baby

5. Place baby on mother’s abdomen

and perform thorough drying

Directly place baby over the mother’s To ensure child and mother connection
abdomen (around the breast area) (pwde sabihin to ensure skin to skin of
the baby and the mother)

Place a drape on the abdomen of the To provide a sterile workplace.

mother (under the baby)

Place layette and bonnet on baby To ensure warmth for the baby and to
prevent hypothermia

6. Feel for the pulsation of the

umbilical cord

Feel for the pulsation of the umbilical

cord

7. If pulsation stops, applies the

plastic clamp 1 inch from the
abdomen of the baby

Wait for pulsation of the cord to stop To lower risk of anemia and iron
before placing umbilical cord clamp deficiency

Give the umbilical clamp to the doctor

and apply 1 inch from the base.

8. Milk the umbilical cord towards the

mother at least 2 cm from the first
clamp and maintain the hold

Milk the umbilical cord towards the To prepare for cutting of the cord.
mother at least 2 cm from the first
clamp and maintain the hold.

9. Applies the second clamp an inch

from the first clamp

Apply the 2nd clamp 1-2 inches from To prepare for cutting of the cord.
the umbilical cord clamp

10. Cuts in between the two clamps

and return the scissors to the
sterile field

Give the mayo scissors to the doctor To cut the cord.

Place the cut cord over the drape on To prepare for the changing of the
the abdomen buttocks drape

11. Lays the second sterile draping

towel aseptically on the
hypogastric area

Get another drape and change the To change the soiled drape on the
drape on the mother’s buttocks by buttocks to a cleaner one
holding the new drape on your
dominant hand, and removing the old
drape under the patient with the other
hand, and asking the patient to lift
their buttocks to change the drape

12. Correct application of Brandt

Andrew’s and Crede’s Maneuver

Using the Brandt Andrew’s Maneuver, coil To facilitate the delivery of the placenta
the umbilical area

Watch for signs of placental separation This means that the placenta is almost
such as rising of the fundus, globular ready for delivery.
shape of the abdomen, sudden gushing
of blood, and lengthening of the umbilical
cord

When resistance is felt while performing To facilitate delivery of the placenta

Brandt Andrew’s maneuver, perform
Crede’s Maneuver by placing your
dominant hand on the patient’s
symphysis pubis to push the placenta out,
while pulling the cord with your
nondominant hand

When placenta is near the vaginal area, To ensure that the placenta is delivered
position the basin near the buttocks just properly
on top of the anus

13. Delivers the placenta correctly,

including time of placental delivery

Deliver the placenta correctly, including

time of placental delivery

14. Recognizes the type of placental

delivery

When delivering the placenta, identify To identify if the placenta is Schultz or

the placental presentation Duncan

15. Inspects the placenta for

completeness

When the placenta is delivered, make To make sure that the clamp is not
sure to remove the clamp that is on the thrown away
cord and placing it on the table

While doctor is checking for placental The normal number of cotyledons is

fragments, break the membrane and around 15-20/25
count for the cotyledon on the Duncan
side, and announce to the doctor if
cotyledon is complete
 Clean gloves using OS To remove blood in gloves and to
maintain sterility

16. Lays the third/last sterile draping

towel under the buttocks

17. Assists the doctor during

episiorrhaphy

a. Give lidocaine
To prepare for episiorrhaphy
Offer the syringe with lidocaine to the
doctor to start episiorraphy.

b. Hand over the needle older

with round needle, and
tissue forceps
To clamp the arteries and veins.
Hand out the tissue forceps and needle
holder with the round needle to the
doctor

When there are bleeders, offer clamps

c. Hold mayo scissors with OS

(position on the side of
patient, facing the doctor)

[EPISIORRAPHY START] To assist the doctor while performing

To assist the doctor in suturing, hold episiorrhaphy
the mayo scissors and OS, while
positioning yourself from away from
the doctor’s back and beside the
mother’s hips and legs

During suturing, you can assist by To help the doctor during suturing and
putting the OS first on the drape, then locking the suture
support the needle to make the suture
straight

d. Change the round needle to

a cutting needle

Make sure to watch out for the doctor For ensure efficiency during the
to tell you when to cut, or when the procedure
doctor will position themselves for you
to cut

When cutting, make sure to open only

the tip of the scissors, and to support To ensure accurate cutting of the
the scissors by placing it on top of your suture, and to clear the site from blood
2 fingers, and cutting on top of the
knots that the doctor has made, and to
tap the area with your OS to clean any
blood

After the doctor is done suturing the In preparation for suturing the skin
deep tissue and muscle, secure the
cutting needle to the needle holder

Offer the needle holder with the cutting To prepare for suturing of the skin
needle and tissue forceps to the doctor,
and hold the mayo scissors and OS

Prepare cotton balls with betadine to To clean the suture site

squeeze over the site

When the doctor tells you to cut or To clean and disinfect the area
when the doctor will position
themselves for you to cut, open only
the tip of the scissors, and to support
the scissors by placing it on top of your
2 fingers, and cutting on top of the
knots that the doctor has made, and
tap the area with OS for to clean off
blood, and clean the area with the
cotton balls with betadine

18. Assist in the cleansing of the

uterus (hand over the placental
curette, then ovum forceps with
OS)

When the episiorrhaphy is done, hand To clean out the lining of the uterus
out the placental curette and ovum
forcep with the OS

When the OS on the ovum forcep is To facilitate the cleaning of the uterus
bloody, place another OS until there is
less blood is on the OS when used

19. Does aftercare like:

a. Remove the drapes

Remove the leggings and the drapes To create a better view of the perineal
that is on the buttocks of the patient area
and over the abdomen of the patient,
and drop them on the floor

b. Perineal flushing (7 cotton

balls)

Perform external douche using cotton To clean the genital area of the patient
balls lined with betadine and water of blood and any other liquid from the
● 1st CB: Clitoris going up to the operation
symphisis pubis
● 2nd CB: Groin towards the thigh
(far leg) 3rd CB: Groin towards
the thigh (near leg) 4th CB: Far
Labia (1 direction)
● 5th CB: Near Labia (1 direction)
● 6th CB: Clitoris, then vaginal
opening, down to the perineum
● 7th CB: Clitoris, then vaginal
opening, down to the perineum,
then to the anus

Perform perineal flushing and use To wash off excess liquid and to
betadine spray maintain attain sterility

c. Perineal pad application

With assistance, raise the hips of the To protect the genital area of the
patient and apply diaper Note: The patient
part with the plaster is the one that
goes under the buttocks

d. Straightening the legs (at the

same time)

With assistance, position the legs of the To provide comfort on the legs of the
client from lithotomy to supine position patient due to holding the lithotomy
position for a long time
e. Change patient’s gown,
 make the patient
comfortable (regulate IV,
blanket)
Change the gown of the client, provide
a blanket, and make the patient To ensure the comfortability of the
comfortable and ask for any patient
discomforts

f. Monitor VS every 15
minutes for 2 hours
Regulate IV

g. Palpate fundus (contracted)

palpate the fundus
To check if the uterus is contracted or
h. Washing of instruments not, if not contracted inform ci and
staff
Separate and secure the sharps
- Remove the needle on the
syringe
- Remove the blade on the blade To ensure proper disposal of waste
holder
- Remove the extra sutures from
the round and cutting needles

And place them in the sharps

container

i. Proper disposal of waste

materials, soiled linens,
sharps, and needles used

OS, CBs, and syringe will go on the pail

To ensure proper disposal of waste

Count your instruments - 10
instruments - Suction bulb over the CB
basin To ensure that tools are complete and
no instrument is missing

Dispose placenta in the proper To ensure proper disposal of placenta

placental waste bin (placental pail)
unless told otherwise by the patient
(religion i.e. Islam – in that case, place
it inside a cellophane with formalin and
label it with the surname and mother’s
name)

When returning the basin, wash the it To loosen dried up blood from the
first and put all the instruments on the instruments
basin and go to the sink in the delivery
room and soak and open all the
instruments

Bring the mop from the back of the To ensure proper waste disposal
delivery room and grab the things on
the floor such drapes and leggings

- Use the leggings as a hamper for

the dirty drapes
- Wrap the leggings used as
hamper in the cloth of the sterile
table

Secure the plastic inside of the pail that To ensure proper waste disposal
contains waste from the procedure
such as the urine and feces of the
patient by removing the air inside and
closing it properly

Then bring the pail and the yellow bin

at the back of the delivery room

Mop the floor by using the proper type To ensure proper disinfection of the
of mop depending on the situation and floor
then get all the things in the floor

- Red: for blood

- Yellow: for infectious (i.e. HepB,
STDs, HIV/AIDS)
- White: for rinsing and
disinfecting

Rinse mop after use and dry them To ensure that the mop is clean and
ready for use

Clean your table by spraying with To ensure proper disinfection

disinfectant and then wipe
After 2 hours, the patient will be To ensure proper disinfection
brought to the ward From there, clean
the bed by removing the covers and
spraying disinfectant on the bed, and
cover the bed after cleaning

In washing the instruments, make sure To ensure proper disinfection

to brush the teeth of the instruments
and rinse afterwards, and place them
in the disinfectant solution for 30-45
minutes

After placing the disinfectant solution, to facilitate drying on the instruments

rinse them again and place them to dry

Ask the CI if there are no more To ensure that no steps are forgotten
remaining tasks before removing
gloves

To ensure aseptic technique.

Remove gloves ensuring aseptic
principles and discard in yellow bin

20. Remove gloves and wash hands To deter the spread of microorganisms

21. Document the necessary data