MANAGEMENT OF THE 2ND STAGE OF LABOUR

REQUIREMENTS #

1. A trolley containing the following:
   1. Top Shelf (Sterile)
      1. Delivery bowls (Two, one with cotton swabs and the other for antiseptic lotion)
      2. Gallipot with swabs
      3. Kidney dish to receive placenta
      4. Delivery set (two artery forceps, cord scissors)
      5. Towels and clips
      6. Dissecting forceps (non-toothed) for lifting or picking up sterile items
      7. Cord clamp
      8. Mucus trap or suction bulb
      9. Amniotic forceps
      10. Sponge holding forceps (Two)
      11. Linen pack containing: abdominal sheet, perineal sheet, leggings, sheet for receiving the baby, sheet to spread on the edge of the table
2. Bottom Shelf (Sterile)
   1. Rubber mackintosh apron
   2. Goggles
   3. Catheter
   4. Sanitary pad
   5. Blood pressure apparatus (manual and digital) and stethoscope
   6. Thermometer (digital)
   7. Sterile gloves in a pack
   8. Sterile gown in a pack for midwife’s use
   9. Sharps container
   10. Antiseptic lotion (Savlon and Dettol)
   11. Identification tag
   12. Episiotomy pack
   13. A tray containing the following medication: Vitamin K, Ergometrine, Syntocinon/Oxytocin, Syntometrine
   14. Resuscitation tray

STEPS #

1. Establish rapport (refer steps)
2. Explain procedure to client (refer steps)
3. Provide privacy
4. Allow a companion of choice to be with client where applicable
5. Observe and maintain infection prevention techniques throughout procedure
6. Set delivery trolley and infant resuscitation tray ready in the delivery room
7. Inform client and companion about her condition
8. Allow client to adopt birth position of her choice
9. Ensure bladder is emptied and ask assistant to be with client
10. Scrub, put on protective clothing, clean client’s upper thighs and vulva
11. Drape client and confirm full dilatation of cervical os
12. Apply clean pad to anal region and instruct assistant to check F.H. with each contraction
13. Instruct client to bear down with each contraction and rest in between
14. Continue reassuring client and companion
15. Maintain flexion as head advances
16. Infiltrate perineum and make timely episiotomy if necessary
17. Instruct patient to pant when head crowns and deliver the rest of the head by extension
18. Feel for the presence of cord around baby’s neck
19. Clean baby’s eyes and suck mouth and throat
20. Remind mother that baby will be delivered unto her abdomen as the midwife waits for restitution and external rotation of the foetal head to take place
21. Deliver anterior shoulder first and then posterior shoulder
22. Deliver rest of the body through lateral flexion unto the mother’s abdomen
23. Note time of delivery and assess condition of baby at first and fifth minute
24. Dry baby and maintain skin to skin
25. Check for undiagnosed twin
26. Give oxytocin within one minute of delivery of baby
27. Clamp cord and separate baby
28. Clear airway if necessary and provide warmth
29. Show baby to mother and congratulate her
30. Apply identification band and keep baby comfortable in a cot