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Normal labour,second stage by Dr Yin Moe
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Normal labour,second stage by Dr Yin Moe

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  • 1. Dr. Yin Moe Han Senior LecturerObstetrics & Gynaecology Department School of Medicine, UCSI university
  • 2. SECOND STAGE OF LABOUR full dilatation of the cervix up to 1 hour birth of the foetus7/31/2012 Dr. Yin Moe Han 2
  • 3. MECHANISM OF NORMAL LABOUR Cardinal movements of labour (LOA) Head is borned by Extension Restitution External rotation7/31/2012 Dr. Yin Moe Han 3
  • 4. Head is borned by EXTENSION7/31/2012 Dr. Yin Moe Han 4
  • 5. RESTITUTION7/31/2012 Dr. Yin Moe Han 5
  • 6. EXTERNAL ROTATION7/31/2012 Dr. Yin Moe Han 6
  • 7. NORMAL CHILDBIRTH Positions that a woman may General methods of adopt during childbirth supportive care during labour are most useful in helping the woman tolerate labour pains Once the cervix is fully dilated and the woman is in the expulsive phase of the second stage, encourage the woman to assume the position she prefers and encourage her to push There must be enough room in front of mom to care for the infant7/31/2012 Dr. Yin Moe Han 7
  • 8. POSITIONING FOR DELIVERY7/31/2012 Dr. Yin Moe Han 8
  • 9. PERINEAL CLEANSING Need 6 swab balls Clean sequentially as shown by the numbers Clean according to the direction shown by the Arrows7/31/2012 Dr. Yin Moe Han 9
  • 10. CREATE A STERILE FIELD AROUND THE VAGINAL OPENING7/31/2012 Dr. Yin Moe Han 10
  • 11. CROWNING OF THE HEAD7/31/2012 Dr. Yin Moe Han 11
  • 12. EPISIOTOMY Note:  Considered only in:  Not a routine procedure  complicated vaginal delivery  Do not decrease  breech  perineal damage  shoulder dystocia  future vaginal prolapse  forceps  urinary incontinence  vacuum  Associated with  scarring from female  an increase of 3rd & 4th genital mutilation or degree tears poorly healed third or fourth degree tears  subsequent anal sphincter muscle dysfunction.  fetal distress.7/31/2012 Dr. Yin Moe Han 12
  • 13. ASSISTING WITH DELIVERY As crowning occurs, place a hand on the top of the baby’s head and apply light pressure Instruct the mother to focus on her breathing. Have her “pant like a dog” to help her stop pushing and prevent a forceful birth.7/31/2012 Dr. Yin Moe Han 13
  • 14. DELIVERY OF THE HEAD Ask the woman to pant or give only small pushes with contractions as the baby’s head delivers To control birth of the head, place the fingers of one hand against the baby’s head to keep it flexed (bent) Continue to gently support the perineum as the baby’s head delivers7/31/2012 Dr. Yin Moe Han 14
  • 15. DELIVERY OF THE HEAD 2nd stage of labour Head is borned by extension7/31/2012 Dr. Yin Moe Han 15
  • 16. SUCTION THE BABY’S MOUTH AND NOSE Once the baby’s head delivers, ask the woman not to push Suction the baby’s mouth and nose7/31/2012 Dr. Yin Moe Han 16
  • 17. SUCTION THE AIRWAY7/31/2012 Dr. Yin Moe Han 17
  • 18. CORD AROUND THE NECK Feel around the baby’s neck for the umbilical cord If the cord is around the neck, attempt to slip it over the baby’s head If the cord is tight around the neck, doubly clamp and cut it before unwinding it from around the neck7/31/2012 Dr. Yin Moe Han 18
  • 19. ASSISTING WITH DELIVERYAs the head emerges, the babywill turn to one side (for easierpassage of shoulders throughbirth canal)Check to see if the umbilicalcord is looped around thebaby’s neck. If so, gently slipit over the headUse a clean towel to catchthe baby Note the time, if possible7/31/2012 Dr. Yin Moe Han 19
  • 20. DELIVERY OF FETAL HEAD WITH ROL POSITION7/31/2012 Dr. Yin Moe Han 20
  • 21. DELIVERY OF ANTERIOR SHOULDER Anterior shoulder wedged behind the pubic symphysis 7/31/2012 Dr. Yin Moe Han 21
  • 22. DELIVERY OF ANTERIOR SHOULDER Direction of traction - should be in the direction of the axis of the body 7/31/2012 Dr. Yin Moe Han 22
  • 23. COMPLETION OF DELIVERY Allow the baby’s head to turn spontaneously. After the head turns, place a hand on each side of the baby’s head. Tell the woman to push gently with the next contraction.  Move the baby’s head Reduce tears by delivering posteriorly to deliver the shoulder that is anterior one shoulder at a time7/31/2012 Dr. Yin Moe Han 23
  • 24. DELIVERY OF POSTERIOR SHOULDER Lift the baby’s head anteriorly to deliver the shoulder that is posterior Support the rest of the baby’s body with one hand as it slides out Place the baby on the mother’s abdomen7/31/2012 Dr. Yin Moe Han 24
  • 25. DELIVERY OF POSTERIOR SHOULDER7/31/2012 Dr. Yin Moe Han 25
  • 26. BABY DELIVERED7/31/2012 Dr. Yin Moe Han 26
  • 27. FIRST BODY CONTACT OF MOTHER AND BABY AND CORD CLAMPING7/31/2012 Dr. Yin Moe Han 27
  • 28. CLAMPING UMBILICAL CORD7/31/2012 Dr. Yin Moe Han 28
  • 29. CLAMPING, CUTTING AND TYING OF UMBILICAL CORD7/31/2012 Dr. Yin Moe Han 29
  • 30. 7/31/2012 Dr. Yin Moe Han 30