Normal labour,second stage by Dr Yin Moe

Dr. Yin Moe HanSenior Lecturer

Obstetrics & Gynaecology Department School of Medicine, UCSI university

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SECOND STAGE OF LABOUR

full dilatation of the cervix full dilatation of the cervix

up to up to 1 hour1 hour

birth of the foetusbirth of the foetus

22Dr. Yin Moe HanDr. Yin Moe Han

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MECHANISM OF NORMAL LABOUR

Cardinal movements of labour (LOA)

Head is borned by Extension

Restitution

External rotation


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Head is borned by EXTENSION


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RESTITUTION


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EXTERNAL ROTATION


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NORMAL CHILDBIRTH

General methods of General methods of supportive care during supportive care during labour are most useful labour are most useful in helping the woman in helping the woman tolerate labour pains tolerate labour pains

Once the Once the cervix is fully cervix is fully dilated dilated and the woman is and the woman is in the expulsive phase in the expulsive phase of the second stageof the second stage, , encourage the woman to encourage the woman to assume the assume the positionposition she she prefers and encourage her prefers and encourage her to push to push

Positions that a woman may Positions that a woman may adopt during childbirthadopt during childbirth

There must be enough room in front of mom to care for the infant


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POSITIONING FOR DELIVERY


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PERINEAL CLEANSING

Need 6 swab balls

Clean sequentially asshown by the numbers

Clean according to the direction shown by the Arrows


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CREATE A STERILE FIELDAROUND THE VAGINAL OPENING


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CROWNING OF THE HEAD


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EPISIOTOMY NoteNote::

Not a routine Not a routine procedureprocedure

Do not decreaseDo not decrease perineal damageperineal damage future vaginal future vaginal

prolapseprolapse urinary incontinenceurinary incontinence

Associated withAssociated with an increase of 3an increase of 3rdrd & &

44thth degree tears degree tears subsequent anal subsequent anal

sphincter muscle sphincter muscle dysfunction. dysfunction.

Considered only in:Considered only in:

complicated vaginal complicated vaginal deliverydelivery

breechbreech shoulder dystociashoulder dystocia forcepsforceps vacuumvacuum

scarring from female scarring from female genital mutilation or genital mutilation or poorly healed third poorly healed third or fourth degree or fourth degree tears tears

fetal distress.fetal distress.


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ASSISTING WITH DELIVERY

As crowning occurs, As crowning occurs, place a hand on the top place a hand on the top of the baby’s head and of the baby’s head and apply light pressureapply light pressure

Instruct the mother to Instruct the mother to focus on her breathing. focus on her breathing. Have her “pant like a Have her “pant like a dog” to help her stop dog” to help her stop pushing and prevent a pushing and prevent a forceful birth.forceful birth.


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DELIVERY OF THE HEAD

Ask the woman to pant or Ask the woman to pant or give only small pushes give only small pushes with contractions as the with contractions as the baby’s head delivers baby’s head delivers

To control birth of the To control birth of the headhead, place the fingers of , place the fingers of one hand against the one hand against the baby’s head baby’s head to keep it to keep it flexed (bent) flexed (bent)

Continue to Continue to gently support gently support the perineum as the baby’s the perineum as the baby’s headhead delivers delivers


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DELIVERY OF THE HEAD

Head is borned by extension

2nd stage of labour


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SUCTION THE BABY’S MOUTH AND NOSE

Once the baby’s Once the baby’s head delivers, ask head delivers, ask the woman not to the woman not to pushpush

Suction the baby’s Suction the baby’s mouth and nosemouth and nose


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SUCTION THE AIRWAY


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If the cord is around the neck, attempt to slip it over the baby’s

head

CORD AROUND THE NECK

Feel around thebaby’s neck

for the umbilical cord

If the cord is tight around the neck, doubly clamp and

cut it before unwinding it from around the neck

If the cord is tight around the neck, doubly clamp and

cut it before unwinding it from around the neck


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ASSISTING WITH DELIVERY

Use a clean towel to catch the baby

Note the time, if possible

Check to see if the umbilical cord is looped around the baby’s neck. If so, gently slip it over the head

As the head emerges, the baby will turn to one side (for easier passage of shoulders through birth canal)


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DELIVERY OF FETAL HEAD WITH ROL POSITION


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DELIVERY OF ANTERIOR SHOULDER

Anterior shoulder wedged

behind the pubic symphysis


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DELIVERY OF ANTERIOR SHOULDER

Direction of traction- should be in the direction of the axis of the body


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COMPLETION OF DELIVERY

Allow the baby’s head Allow the baby’s head to turn spontaneously. to turn spontaneously.

After the head turns, After the head turns, place a hand on each place a hand on each side of the baby’s side of the baby’s head. Tell the woman head. Tell the woman to push gently with to push gently with the next contraction. the next contraction.

Reduce tears by delivering

one shoulder at a time

Move the baby’s head Move the baby’s head posteriorly to deliver posteriorly to deliver the shoulder that is the shoulder that is anterior anterior


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DELIVERY OF POSTERIOR SHOULDER

Lift the baby’s head anteriorly to deliver the shoulder that is posterior

Support the rest of the baby’s body with one hand as it slides out

Place the baby on the mother’s abdomen


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DELIVERY OF POSTERIOR SHOULDER


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BABY DELIVERED


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FIRST BODY CONTACT OF MOTHER AND BABY AND CORD CLAMPING


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CLAMPING UMBILICAL CLAMPING UMBILICAL CORDCORD


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CLAMPING, CUTTING AND TYING

OFUMBILICAL CORD


04/13/2304/13/23 3030Dr. Yin Moe HanDr. Yin Moe Han

Normal labour,second stage by Dr Yin Moe

Health & Medicine

Transcript of Normal labour,second stage by Dr Yin Moe