Handling and Assisting Delivery (4) Grasp the glove using your fingers while still
inside the gown and use your left hand whilst
A. Prepare the OB Pack still in the gown to assist in wearing glove on
(1) Ensure that the OB Pack contains the the right hand
complete materials needed (5) Done gloving right hand.
(2) Use your clean hands to open the outer lining (6) Using your right hand, get the left-hand glove
of the OB pack and place it over the palm of your left hand
● This area has been exposed to the (7) Repeat the procedure
numerous surfaces it has been put on, F. Drape the patient
making it unsterile. (1) There is a need to drape the feet and legs of
(3) Using forceps soaked with antiseptic facing the patient because these areas are dirty
down in opening the inner lining of the OB (2) Take the leggings and find the end without
pack. the pocket, hiding your sterile gloves from the
(4) Check if materials inside the OB pack are area
complete (3) Put your hands over this area
B. Prepare the OR Gown Pack (4) Insert the patient’s leg into the pocket
(1) Use your clean hands to open the outer lining (5) Throw the end your hand is holding towards
of the OB pack the patient’s thigh
(2) Using forceps soaked with antiseptic facing (6) Do the same to the other leg.
down in opening the inner lining of the OB (7) Place abdominal drapes by putting half of the
pack. drape over your surgical gloves, hiding it
(8) Throw or release the abdomen drape over the
CIRCULATING NURSE:
patient’s abdomen
(3) Get sterile gloves and open the outer package (9) Place perineal drapes below the perineal area
(4) Drop the inner package of the gloves unto the making sure not to touch the unsterile areas
sterile field G. Arrange instruments
C. Perform Surgical Handwashing (1) Bandage Scissor
(1) Dry your hands using the towel from the OR ● Cuts perineum to create a wider opening
Gown Pack. for the baby
(2) Grasp the center of the towel, step back and (2) Kelly Forceps
let it hang. ● Clamp umbilicus
(3) Find a corner and use it to dry your hand (3) Straight Forceps (optional)
going down to your elbow in a circular patting (4) Umbilical cord scissors (optional)
motion. (5) Surgical Scissor
(4) Take the opposite corner and do the same for (6) Needle Holder
the other hand. ● Repair of perineum
(5) Drop the towel (7) Tissue forceps without teeth
D. Perform Gowning Technique (8) Tissue forceps with teeth
(1) Grasp the center of the gown from the OR
CIRCULATING NURSE:
Gown Pack and step back
(2) Grasp the end and release the rest of the (9) Drop the syringe on the sterile field
gown (10) Drop cord clamp on the sterile field
(3) Using your opposite hand, locate the neck (11) Drop the sterile OS
portion of the gown from the bottom (12) Drop the suture
(4) Use both hands to open up the gown only H. Arrange the materials with the instruments
touching the inside
(5) Put your arms inside the arm holes
(6) Circulating Nurse will assist in tying back of
gown
E. Close Gloving Technique
(1) Use left hand to pick up edge of the
right-hand glove
(2) Place the glove on your palms, with the
fingers of the glove facing towards you
(3) Make sure that the glove thumbs and your
thumbs align
(5) Bandage..Scissors
I. Get Lidocaine from the Circulating Nurse via Vial
(10cc)
(1) Remove Needle Cover
(2) Retract Plunger
(3) Instill in Vial
(4) Get the Lidocaine (10mL)
(5) Recap the Needle ● Clean bandage scissors after with OS
J. Circulating Nurse drops Extra Needle (6) Suction bulb when baby is out
(1) Change the Needle (7) Cord clamp
K. FINALIZE ARRANGEMENT (8) Kelly Curve Forceps
(9) Bandage scissors / Cord cutter
O. Retrieve placenta
(1) Roll the placental cord around the Cord
Forceps
(2) Note for:
● Calkin’s sign
✔ the change of shape of the
uterus from discoid to ovoid,
indicating placental separation
from the uterine wall.
● Gush of blood
● Lengthening of cord
● Change in appearance of uterus (globular
shape)
(3) Method: Brant-Andrews maneuver
● Place hand on hypogastric area
● Pull the forceps in the following order
L. Prepare Suture
(1) Determine dominant hand of doctor ✔ Upward
(2) Open package
✔ Downward
(3) Remove Suture from the package
(4) Get Needle Holder ✔ Left
(5) Clamp the needle at the third teeth of the
needle holder with the needle facing upward ✔ Right
● Round Needle – sutures perineal muscles
✔ Center
● Cutting Needle – sutures skin
(6) Lock the needle holder (4) Place inside placental bowl
(7) Place it back to the tray with pointed end P. Check parts of placenta and presentation
upward (1) Schulz – shiny – fetal side
M. Perineum Support (2) Duncan – dirty – maternal side
(1) Fold the perineal support towel Q. Check BP of patient
(2) Insert it in your dominant hand R. Serve the following:
(3) Hold the patient’s thigh with non-dominant (1) Lidocaine to the Doctor (remove needle cap)
hand (2) OS
(4) Insert the towel under the perineum (3) Return the syringe and scooping technique
(5) Drop towel in the pail when baby is fully out? (4) Needle holder with needle and suture
N. Serve the following: (5) Picking forceps without teeth
(1) Lidocaine to Doctor (remove needle cap) (6) OS
(2) Serve OS (7) Picking forceps with teeth
(3) Recap Needle Syringe with Lidocaine and (8) Surgical scissors
return to tray (9) Clean forceps when returned
(4) Return soiled OS beside placenta bowl S. Suturing the area
(1) Cut the suture with sharp end above and
blunt end below
T. Rinsing perineum
(1) Irrigate perineum
(2) Apply betadine paint to the perineum
● Clitoris down to the sheet
(17) Cut the cord using surgical scissors with sharp end
upward and blunt end downward.
(18) Apply slight pressure on the umbilical cord if bleeding
is present
(19) Put ID band on newborn
● Left ankle (maternity)
● Left and Right Ankle (VSMMC)
b. Gender
Immediate Newborn Care c. Surname of Mother
d. Name of Mother in parenthesis
(1) Prepare the following materials e. Date of birth
a. Cord Clamp f. Time of birth
b. Sterile OS (20) Leave newborn prone on mother’s stomach for
c. Sterile cotton balls skin-to-skin contact
d. Surgical scissors / Cord cutter (21) Observe for feeding ques (tonguing, licking, rooting)
e. Bulb syringe (22) Encourage mother to nudge breasts towards baby for
f. Tape measure feeding
g. Vitamin K ampule (23) Place mother’s hand on the back of the baby
h. Terramycin eye ointment
i. 1 cc syringe
j. Baby diaper (24) After 90 minutes, remove baby from mother’s
k. ID band (blue and pink) abdomen and transfer to Worktable
l. Receiving blanket (25) Hold the back neck of the baby and lower extremity
m. Digital thermometer in transport
n. Baby’s clothes (26) Remove all clothing and weigh newborn
o. Baby blanket a. One hand adjusts weighing scale
p. Weighing scale b. Other hand stays over the baby to prevent
q. Gooseneck lamp falls
(2) Prepare sterile gloves (27) Transfer to worktable holding back of neck and lower
(3) Hand Washing extremity
(4) Double open gloving (28) Do physical assessment and APGAR Scoring
(29) Perform anthropometric measurements
a. Head circumference
(5) Dry newborn thoroughly (>30 secs) ● Above eyebrows
a. Eyes b. Chest circumference
b. Face ● Over nipple line
c. Head c. Abdomen
d. Front ● Over umbilicus
e. Back d. Mid-arm
f. Arms e. Body length
g. Legs ● Occiput to heel
(6) Check breathing while drying (30) Cover newborn’s head with cap and blanket
(7) Do not suction unless blockage is evident (31) Check rectal temperature
(8) Position newborn prone a. Disinfect thermometer (tip to probe)
(9) Cover back with dry blanket b. Locate anus by flexing legs upward
(10) Cover head with bonnet c. Insert thermometer (1/2 or 1 inch)
(11) After 1-3 minutes, properly time cord clamping d. Wait for signal
(12) Remove first set of gloves e. Remove and check temperature
f. Disinfect thermometer (probe to tip)
(32) Vitamin K injections preparation
(13) Check umbilical pulsations if stopped
a. Open 1cc syringe
(14) Clamp the cord 2cm from the based using cord clamp
b. Get and assure the vitamin K ampule
(15) Clamp again at 5 cm from the base using keep forceps
● Dosage and expiration
(16) Place OS under the cord to protect penis/perineum of
c. Break the ampule
baby
d. Get 0.5mg of vitamin K
e. Scooping technique
f. Remove bubbles
g. Prepare cotton with alcohol and dry cotton
(33) Administration of Vitamin K
a. Upper outer portion of
● Right thigh (VSMMC)
● Left thigh (Maternity)
b. Disinfect the area
c. Hold dry cotton between fingers
d. Remove needle cap
e. Hold thigh with non-dominant hand
f. Inject at 90 degrees
g. Hold syringe, aspirate, and administer
h. Mildly pulsate squeeze thigh while
administering
i. Remove
(34) Eye prophylaxis
a. Retract/Open eyes with fingers exposing
conjunctiva
b. Apply from inner canthus to outer canthus
c. Repeat on opposite eye
(35) Put newborn’s diaper
a. Do not cover umbilical cord with diaper
b. Put baby clothes on
c. Wrap baby in blanket
● Place head part/pocket over the baby’s
head
● Tuck the right side into the baby’s arm
and cross its lower end it over to the left
side and place under the left arm. Vice
versa
(36) Check RR and HR
a. Disinfects stethoscope
b. Rub diaphragm of stet to keep warm
c. Check apical pulse (120-160 bpm)
d. Check respiratory rate (chest rise and fall)
