Page 70 - 33Elctronic Book (3) Normal Labor

• Knowledge deficit related to physiological changes of normal labor, newborn care,

and self-care.
• High risk of infection secondary to episiotomy during delivery.

Planning and Implementations
• Apply two forceps on umbilical cord and cut in between.
• Carefully inspect vagina, perineum, and labia for lacerations and tears.

• Inspect vulva for bleeding, edema, and hematoma.
• Make sure that the uterus is well contracted. Flabbiness or enlargement of the

uterus indicates bleeding.
• Palpate the height of the fundus. Feeling the fundus above the umbilicus may be
due to presence of another fetus, blood clots, big placenta, or full bladder.

• Avoid vigorous uterine massage because it may lead to irregular contractions, and
cause retained placental parts or membranes.

• Observe signs of placental separation.
• Evacuate the bladder by a catheter if the placenta is not separated within 20
minutes.

• The placenta is expelled by controlled cord traction and use of oxytocic drugs. It is
then received in the hands, and turned through a circle. This method reduces blood
loss and shortens the third stage.

• Examine the placenta and membranes for general appearance, completeness, cord
vessels, and weight.

• Estimate the average blood loss (200-600 ml).
• Clean and dry the vulva, buttocks and thighs and then apply a sterile pad.
Evaluation (Expected Outcome)

• The placenta is expelled without difficulty.
• The physiological status of the woman remains normal.

Care of the newborn include:

Care of the newborn include:

1- Clearance of the air passages (nose, mouth, and pharynx) by a mucus cather or suction
pump.

2- Apgar score is determined 1 and 5 minutes after delivery of the infant

3- Aplastic clamp is applied 5cm from fetal abdomen to avoid umbilical hernia. The cord is
th
inspected for bleeding and painted with alcohol. The cord usually falls on the 6 day. If the
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