Preparing for birth

Name of presenter:

Prevention of Postpartum Hemorrhage Initiative (POPPHI) ProjectBASICS

Objectives

By the end of this session, participants will be able to describe:

• How to prepare the delivery room for the birth.

• How to prepare for care of the baby at birth.

• How to prepare the newborn corner in the delivery room.

• Offer and obtain permission for skin-to-skin contact and AMTSL .

• Selection and storage of uterotonic drugs for AMTSL.

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Tasks: See the Reference Manual and review how to prepare the following for birth:

• Group 1: Client care areas

• Group 2: Woman

• Group 3: Newborn corner

• Group 4: Equipment / medications / supplies

Reading / Discussion time: 5 minutes

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Small group work

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Human resources

• If possible, have two providers at each birth (one provider may be less qualified than the other)—one to care for the woman and one to care for the newborn.

• Where one provider is less qualified, the more competent person should deal with the more complex tasks for the mother and baby.

• Encourage the woman to have a companion with her who can provide support for her during childbirth.

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• Make sure that the woman’s bodily privacy is protected, e.g., by placing curtains or dividers between delivery beds.

• Ensure that all surfaces the woman and baby come in contact with are clean (with some being covered by sterile linen), warm, and dry.

• Check that the necessary items for infection prevention are available: water, soap, injection safety box, bucket with a decontamination solution, etc. (details in the session on preventing infection).

Delivery room

• Make sure that the room is warm (around 25-28 °C/ 77.0-82.4 °F) and free from drafts from open windows and doors, with fans and air conditioning being adjusted as needed.

• If the temperature of the room is less than optimal, turn the heater on, if one is available, at the place where special care of the baby will be carried out.

• Where a heater is available, place the baby linen under/near it for warming before delivery.

• Make sure the room is well-lit.

Delivery room temperature and lighting

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Make sure the table/surface where newborn resuscitation and special care will be provided:

• Is clean, warm, dry, and without air drafts

• Has a clean mattress that can be decontaminated or washed between babies and covered with a clean, preferably sterile cloth

• Is well-lit

• Has a heat source where possible

• Has all of the necessary equipment, supplies, and medications for essential newborn care and newborn resuscitation

Newborn baby corner

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Check that all needed equipment and instruments for delivery care, essential maternal and newborn care, newborn resuscitation, and adult resuscitation are:

• Available

• In good working order

• Clean, sterile/HLD

• Ready and accessible

Equipment and supplies

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• Encourage the woman to wash herself or bathe/ shower at the onset of labor.

• Place a clean, waterproof sheet under the woman’s bottom.

• Wash hands with soap before and after each examination.

• Clean the vulval and perineal areas before each examination.

• Ensure cleanliness of laboring and birthing area(s).

• Clean up all spills immediately.

Maternal and environmental hygiene

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• Wash hands

• Wear protective clothing:

– Sterile/HLD gloves

– Masks

– Gowns and waterproof aprons,

– Caps, eye goggles/face shields

Infection prevention

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Discussions with the woman regarding special care - AMTSL

During the first stage of labor, before contractions become very intense, explain AMTSL to the woman to obtain her informed consent:

•Review advantages of AMTSL and physiologic management of the third stage of labor.

•Review disadvantages of AMTSL and physiologic management of the third stage of labor.

•Assist the woman in making an informed choice for management of the third stage of labor.

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Advantages of each type of third stage management

Physiologic (expectant) management

Active management

Does not interfere with normal labor process.

Does not require special drugs/supplies.

May be appropriate when immediate care is needed for the baby (such as resuscitation) and no trained assistant is available.

May not require a birth attendant with injection skills.

Decreases the length of the third stage.

Decreases the likelihood of prolonged third stage.

Decreases average blood loss.

Decreases the number of PPH cases.

Decreases the need for blood transfusion.

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Physiologic (expectant) management

Active management

The length of the third stage is longer compared to AMTSL.

Blood loss is greater compared to AMTSL.

Increased risk of PPH.

Requires uterotonic drugs and items needed for injection/injection safety.

Requires a birth attendant with experience and skills giving injections and using CCT.

Disadvantages of each type of third stage management

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Discussions with the woman regarding special care – skin-to-skin

During the first stage of labor, before contractions become very intense, explain to the woman:

•The benefits to the baby of skin-to-skin contact with the mother.

• That immediately after birth the newborn will be placed first on her abdomen and then on her chest, and obtain her permission to do this.

• That basic care will be provided while the baby is in skin-to-skin contact and obtain her permission to do this.

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Preparation of a uterotonic drug for AMTSL

• Prepare the uterotonic drug as soon as the woman is fully dilated.

• If an injectable uterotonic, load the syringe and prepare the needle.

• If misoprostol, get the tablets and drinking water ready.

• Wherever possible, have an assistant who can give the uterotonic drug to the woman after you have excluded the presence of another baby.

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Selection of a uterotonic drug for AMTSL

Oxytocin is the uterotonic of choice for AMTSL because:

• It is fast-acting, acts within 2-3 minutes after IM injection.

• It is inexpensive.

• In most cases, it has no side effects or contraindications for use during the third stage of labor.

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Recommendations for selection of a uterotonic drug for prevention of PPH (1)

In the context of active management of the third stage of labor, if all injectable uterotonic drugs are available:

• Skilled attendants should offer oxytocin to all women for prevention of PPH in preference to ergometrine/methylergometrine.

• Skilled attendants should offer oxytocin for prevention of PPH in preference to oral misoprostol (600 mcg).

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Recommendations for selection of a uterotonic drug for prevention of PPH (2)

In the context of active management of the third stage of labor, if oxytocin is not available but other injectable uterotonics are available:

• Skilled attendants should offer ergometrine/methylergometrine or the fixed drug combination of oxytocin and ergometrine to women without hypertension or heart disease for prevention of PPH.

• Skilled attendants should offer 600 micrograms (mcg) misoprostol orally for prevention of PPH to women with hypertension or heart disease for prevention of PPH.

Verify and keep within MOH recommendations.18

In the context of prevention of PPH, if birth attendants’ skills are limited, misoprostol or oxytocin should be administered soon after the birth of the baby.

• Administer misoprostol 600 micrograms (mcg) orally or oxytocin 10 IU IM after the birth of the baby.

• Apply controlled cord traction ONLY when a skilled attendant is present at the birth.

• Massage the uterus after the delivery of the placenta.

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Recommendations for selection of a uterotonic drug for prevention of PPH (3)

Storage of uterotonic drugs

Check the manufacturer’s label for recommendations on how to store injectable uterotonic drugs outside the refrigerator. In general:

• Oxytocin may be kept outside the refrigerator at a maximum of 30 °C (warm, ambient climate) for up to three months and then discarded.

• Ergometrine and Syntometrine vials may be kept outside the refrigerator in closed boxes and protected from the light for up to one month at 30 °C and then discarded.

• Misoprostol should be stored at room temperature away from excess heat and moisture.

To ensure the longest life possible of injectable uterotonics, keep them refrigerated at 2-8 °C.

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Review session objectives

By the end of this session, participants will be able to describe:

• How to prepare the delivery room for the birth.

• How to prepare for care of the baby at birth.

• How to prepare the newborn corner in the delivery room.

• Offer and obtain permission for skin-to-skin contact and AMTSL .

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Learning activities

• Please complete learning activities found in the Participant’s Notebook for Session 3.

• You may work individually or in groups on the learning activities during breaks, in the evening, or in the clinical area when there are no clients.

• You may correct your answers individually or with another participant or the facilitator.

• See a facilitator if you have questions.

Learning activities

• Please complete learning activities found in the Participant’s Notebook for Session 3.

• You may work individually or in groups on the learning activities during breaks, in the evening, or in the clinical area when there are no clients.

• You may correct your answers individually or with another participant or the facilitator.

• See a facilitator if you have questions.22