Normal Birth

Assess

• Obstetric history
• Labour progression

Stop

Narcotic analgesics are contraindicated in late second stage labour


Normal birth – not imminent
Reassure
Monitor regularly for change
Transport to obstetric facility using a left lateral position
Provide analgesia as Pain Relief


Imminent normal birth - preparation
Reassure including cultural considerations
Prepare equipment for normal birth
Provide a warm and clean environment
Provide analgesia as per Pain Relief

Imminent normal birth – birth of head

• As head advances, encourage the mother to push with each contraction
• If head is birthing too fast, ask mother to pant with an open mouth during contractions instead
• Place fingers on baby's head to feel strength of descent of head
• If precipitous, apply gentle backward and downward pressure to control sudden expulsion of the head.
• Do not hold back forcibly

Imminent normal birth – umbilical cord check

• Following the birth of the head, check for umbilical cord around neck:
- If Loose, slip over baby's head and check not wrapped around more than once
- If Tight, apply two metal clamps and cut in between as shown right

Normal birth – head rotation

• With the next contraction the head will turn to face one of the mother's thighs
- indicative of internal rotation of shoulders in preparation for birth of body

Normal birth – birth of the shoulders and body

• May be passive or guided birth
• Hold baby's head between hands and if required apply gentle downwards pressure to deliver the top shoulder
• Once top shoulder is visible, if necessary to assist birth, apply gentle upward pressure to birth lower shoulder - the body will follow quickly

• Support the baby
• Note time of birth
• Pass baby to mother, positioning to facilitate breast feed unless baby is non vigorous/requires resuscitation
• Manage the vigorous newborn as per Newborn Baby
• Manage the non vigorous newborn as per Newborn Resuscitation
• If the body fails to deliver in <60 seconds after the head manage as per Shoulder Dystocia

Normal birth – clamping and cutting the cord

• If the newborn is vigorous, the cord can be cut at a convenient time over - 3 minutes. The cord should stop pulsing
• If the newborn requires resuscitation, the cord may need to be cut earlier
• Clamp twice, the first 10 cm from the baby then a second a further 5 cm
• Cut between the two clamps

Normal birth – birthing placenta (third stage)

Passive (Expectant) Management
• Allow placental separation to occur spontaneously without intervention
• This may take from 15 minutes to 1 hou
• Position mother sitting or squatting to allow gravity to assist expulsion
• Breast feeding may assist separation or expulsion
• Do not pull on cord – wait for signs of separation:
    - Lengthening of cord
    - Uterus becomes rounded, firmer, smaller
   - Trickle or gush of blood from vagina
    - Cramping/contractions return

• Placenta and membranes are birthed by maternal effort. Ask mother to give a little pus
• Use two hands to support and remove placenta using a twisting 'see saw' motion to ease membranes slowly out of the vagina.
• Note time of birth of placenta
• Place placenta and blood clots into a container and transfer
• Inspect placenta and membranes for completeness
• Inspect that fundus is firm, contracted and central
• Continue to monitor fundus though do not massage once firm
• If fundus is not firm or blood loss >500mls manage as per Primary Post Partum Haemorrhage