Preparing for childbith

Preparing for childbirth involves getting both physically and mentally ready for the process of labour and delivery.

Preparation for mother

Preparation for the mother during labour involves careful considerations for her comfort and safety. The positioning of the woman during labour can significantly impact the process. One approach is to keep the woman in a lateral (side-lying) position, which can help facilitate a smoother labour. Another option is a partial sitting position. Moreover, adopting a dorsal position with a 15⁰ left lateral tilt is commonly favored. This position not only helps avoid compression of the aorta and vena cava but also aids in facilitating the pushing phase of labour.

Hygiene and cleanliness are crucial during this time. Toileting of the external genitalia should be carried out using antiseptic solutions to maintain sterility. Placing a sterile sheet beneath the mother’s buttocks and abdomen helps ensure cleanliness and minimize the risk of infection. Additionally, using sterile leggings is important to maintain a sterile environment.

• It’s advisable to maintain the woman in a lateral position with a 15⁰ left lateral tilt until the pushing efforts commence. This positioning is beneficial for the well-being of both the mother and the baby.
• Never leave the mother alone during labour.
•  Ensure the mother’s bladder is empty, as a full bladder can hinder the progress of labour.
• Use a soaked towel to gently sponge the mother’s face, providing comfort and refreshment.
• Offer oral liquids, including plain water, to keep the mother hydrated during labour.
• Maintain constant monitoring of both fetal and maternal conditions, as well as the progress of labour.
• Place a sterile sheet under the mother’s buttocks to maintain a clean and hygienic environment.
• Perform toileting of the genitalia using antiseptic solutions to ensure cleanliness.
• Provide emotional support and reassurance to the mother throughout the labour process.

Preparation of midwife/ nurse

• Gather essential information from the woman and her chart required for delivery.
• The timing of self-preparation varies based on labour progress rate and the mother’s parity.
• For rapidly progressing multiparous women, scrubbing is done toward the first stage’s end.
• In primigravida cases, scrubbing occurs upon full cervical dilation or head crowning during a contraction.
• Early scrubbing increases contamination risk and infection possibility.
• Prepare a 10-unit oxytocin injection for third-stage management.
• Put a clean and dry plastic apron.
• Shorten nails and ensure tidy hair, removing all ornaments.
• Wash hands using soap and running water.
• After washing or scrubbing hands, air dry or use a sterile towel, keeping palms upwards in the Namaste (pressing the palms together in a prayer-like manner with fingers pointing upward) position.
• Arrange the delivery set and open it.
• Put on sterile gloves.
• Place all required equipment and articles within easy reach.
• Enlist the circulating nurse or health worker to regularly monitor fetal heart sounds, contractions, and maternal vital signs.

Preparation of equipment and supplies for childbirth

• The birthing table is usually set up during the transition phase for nulliparous woman and during the active phase for multigravida. The birthing table is prepared and instruments are arranged on the instrument table.
• The equipment needed for delivery should be sterilized and should be kept ready and in working condition and accessible.
• Keep ready all materials for baby and mother including resuscitation set, oxygen, suction and warm dry clothes as well as needed medicines.

Delivery set

• Sponge holder or forceps for cleaning of vulva-1
• Plain artery forceps for cord clamp-2
• Cord cutting scissors for cord cutting-1
• Galipot for antiseptic solution -1
• Bowl for placenta or collection of blood-1
• Gauze piece and cotton ball for swabbing
• Perineal pad 3-4 pieces
• Sterile clothes- 4 pc (Perineal sheet -2, Baby wrapper-2)
• Sterile gloves and gown for midwife/skill birth attendants
• Antiseptic solution or boiled water

Episiotomy set

• Episiotomy scissors- 1
• Small artery forceps-2
• Tooth dissecting forceps- 1
• Non tooth dissecting forceps-1
• Needle holder-1
• Suture cutting scissors-1
• Small galipot-1
• Chromic catgut no 2-0 -1
• Gauze piece and cotton balls and perineal pads as needed
• Xylocaine injection
• 10 ml syringe-1

Equipment  with medicine which must be available in the labour room

• Different size of syringes; 2cc, 3cc,5cc, 10cc with needles 20, 21 and 18 gauze
• Container with spirit swabs
• Container with dry clean gauze or cotton ball
• IV cannula in different size : 16, 18 gauze for mother and 26 gauze for neonate
• Adult and pediatric IV set
• IV fluids- 5% dextrose, RL, NS and Haemacele
• Tape or Adhesive tape and tourniquet
• Injections- ergometrine, oxytocin, magnesium sulphate, dexamethasone, hydralazine, pethidine, diazepam, morphine, lignocaine, metoclopramide, atropine, adrenaline, calcium gluconate, promethazine or phenergan
• Injection vit-K
• Vitamin A capsule
• Injections. Glucose 25% and 50% ampules
• Cap nifedipine, depin
• Distilled water for dilution of local anesthesia

Equipment preparation

• Baby cot with overhead radiant heater and light
• Suction machine
• Oxygen
• Pre-warmed baby wrapper (soft, dry cloth) and blanket
• Identification hand
• Eye ointment or drop, whatever available
• Cotton ball soaked in sterile Normal saline
• Cord clamp
• Tape measuring and weighing machine

Equipment

• Clean clothes to wear after delivery
• Leggings
• Abdominal binder or supporter
• Hot drink e.g. soup, milk etc.

Neonatal resuscitation set

• Resuscitate with overhead radiant heater (switched on) and light, piped oxygen manometer and suction
• Infant laryngoscope, spare batteries and bulb 
• Neonatal endotracheal tube in different size 2.5, 3.0 and 3.5 mm size and connector and with plastic stylet
• Neonatal airways
• Mucous extractor
• Suction catheter size 6,8, and 10
• New-born size resuscitation bag
• New-born size mask for small baby
• Syringes 2cc, 3cc and 5cc
• Drugs inj. Naloxone hydrochloride 1 ml /ampule (400 microgram/ml)
• Sodium bicarbonate 8.5%, 7.5% and 4.2%
• Dextrose 5% and 25%
• Vitamin K
• Normal saline
• Paediatrics IV set, 26 gauze butterfly needle, spare needles etc.
• Spirit swab
• Cord clamp
• Warmed dry towels
• Adhesive tape

Preparation of delivery room (child birth area)

• Before the onset of the second stage of labour, the delivery room must be readied for childbirth.
• The room should undergo regular cleaning, including mopping the floor with soap, water, and antiseptic solutions.
• Windows, doors, and beds need to be properly dusted during each shift.
• Ensure sufficient and appropriate lighting as well as ventilation.
• Maintain the room temperature within the range of 25-28°C.
• Arrange a perineal light.
• Maintain a safe environment with dry and clean floors, orderly furniture, and well-prepared beds, including those with steps.
• Insure comfort by adjusting the bed with pillows, blankets, and a protective mackintosh for both the bed and floor.
• Have a bucket on hand to collect soiled items and a clean sheet to cover the mattress.
• Keep the episiotomy set prepared.
• Have an IV stand ready, complete with an IV tray containing IV sets, IV drip (RL or NS), 18-gauge IV cannula, spirit swabs, tape, and more.
• Arrange an oxygen cylinder, nasal tubes, emergency medications, and a suction machine.
• Prepare the neonatal resuscitation set, including warm baby clothes, a weighing scale, a room heater, and more.
• Get the patient trolley ready for potential emergency transfers.
• Have a screen, bedpan, and vital signs set prepared.
• Keep sterile pads, gauze pieces, cotton balls, drugs, antiseptic solution, and local anesthetic drugs for perineal infiltration at the ready.

Partner involvement and companion

• During labour and childbirth, many women want to be accompanied by a spouse/ partner, friend, family member, or another community member.
• The  women greatly value and benefit from the presence of someone they trust during labour and childbirth to provide emotional, psychological and practical support and advice .
• The supportive care may include having someone who is continuously present and who reassures and praises her, assists with measures for physical comfort (e.g. providing comforting touch, massage, warm baths and promoting adequate fluid intake and output) and undertakes any necessary advocacy on her behalf (e.g. helping the woman articulate her wishes to health workers and others).
• Supportive care during labour and childbirth also includes the presence of health worker who can advise woman about the progress of labour, coping techniques, and support her in making decisions and expressing her wishes regarding procedures that may need to be undertaken.

Position of the woman

Upon full cervical dilation and entering the expulsive phase of the second stage, encourage the woman to assume her preferred position and prompt her to push. Encourage any non-supine position, side lying, squatting, hands and knees, semi-sitting or sitting. Midwife plays a major role in influencing a woman’s choice of positions for birth

Upright position- facilitates fetal descent and birth by longitudinal axis of birth canal, employing gravity and enlarging the pelvic dimensions.

Squatting position- highly effective in facilitating the decent and birth of fetus. Woman should assume a modified supported squat until the fetal head is engaged.

Standing position- The baby’s head applies even and direct pressure on the cervix, aiding dilation, while contractions intensify and become regular. In this position, the laboring mother can hold her birth support partner, sway, rock, and lean against walls for comfort.

Side lying position- The effective position for the second stage involves the woman’s upper leg being supported by a nurse or placed on a pillow. This position is gravity neutral, lacking the advantages of gravity assistance. However, it can help alleviate pressure on the perineum and decrease the likelihood of perineal trauma.

Breathing technique during labour

1. During the latent phase of the first stage, instruct the woman to maintain a natural, regular breathing pattern.
2. In the early active stage (4-7 cm cervix), encourage abdominal breathing. During contractions, take gradual, deep breaths, ensuring the abdomen, not the chest, rises and falls with each breath. Following each contraction, inhale deeply and exhale slowly, releasing tension and achieving overall relaxation.
3. As the active phase progresses to 8-10 cm, shift to using shallow chest breathing. Breathe in and out at a quicker pace compared to the early active phase, taking shallower breaths. Ensure the chest rises and falls with each breath. Consider the “pant-pant-blow” or “pant-blow-blow-pant” technique, involving shallow breathing followed by a quick exhale before the next shallow inhalation.
4. Second stage : Pushing phase It is important to push only when you feel the urge, even it the cervix is fully dilated. When you feel like pushing, do not hold breath, close your throat or push hard for long time. Rather, push in the manner most natural and comfortable for woman. Make noises while pushing is good because this helps to keep the throat open. Pushing for 5-10 sec. and then taking several breaths before pushing again helps ensure that the baby gets plenty of oxygen. After each contraction, take a deep breath and let it out slowly, relaxing the entire body and letting you go loose all over.
5. During the extension of baby’s head, stop pushing and start panting by breath rapidly through your mouth and throat while your chest goes up and down.

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