Vaginal Delivery Assisting

  1. Perform hand hygiene.
  2. Verify the patient's identity using two patient identifiers in accordance with institutional policy.
  3. Assist the practitioner as needed.
  4. Assist with donning personal protective equipment, shoe covers, leggings, OR caps, etc. Tie sterile gown and provide a mask and goggles.
  5. Adjust lighting for delivery.
  6. Provide perineal lubricant if requested.
  7. Provide vacuum or forceps if requested.
  8. Provide assistance with McRobert's maneuver, suprapubic pressure, or repositioning the mother such as in the case of suspected shoulder dystocia.
  9. Notify the practitioner and the patient when contractions are occurring.
  10. Perform hand hygiene and apply clean gloves.
  11. Assist the patient with pushing efforts.
  12. Provide encouragement to the patient and the support person.
  13. Pull up hand holds on birthing bed for the patient to grasp as needed during pushing efforts.
  14. Assist the patient with flexing knees as needed.
  15. Keep the patient informed of progress during delivery.
  16. Continue fetal monitoring and assessment per institutional policy and the practitioner's order.
  17. Auscultate FHR as indicated.
  18. Palpate for uterine contractions as indicated. Nonreassuring FHR patterns or an FHR lower than 100 beats per minute should be reported promptly to the practitioner.
  19. Be prepared to institute emergency measures if a critical situation should arise.
  20. Record time of delivery of the newborn. Birth is the precise time when the entire body is out of the mother.
  21. Remove gloves and discard in proper trash receptacle. Perform hand hygiene and apply clean gloves.
  22. Assist the practitioner with suctioning the infant's nasopharynx or oropharynx in the presence of meconium or as per institutional policy.
  23. Assist the practitioner with repair of episiotomy or lacerations. Supply requested suture for repair. Cleanse perineum after repair.
  24. Remove gloves and discard in proper trash receptacle. Perform hand hygiene and apply clean gloves.
  25. Administer oxytocin or other medications per the practitioner's orders and assist with fundal massage. Label and/or send placenta to the pathology laboratory as per the practitioner's orders or per institutional policy.
  26. Remove gloves and discard in proper trash receptacle. Perform hand hygiene.
  27. Assist with applying the mother's identification band to match those of her infant.
  28. Replace the foot of the bed, remove legs from stirrups, and assist the patient to reposition for comfort.
  29. Obtain maternal vital signs every 15 minutes for the first hour after fourth stage begins and compare with the patient's previous findings.
  30. Using clean technique, assess fundus and lochia every 15 minutes or more frequently if necessary. The fundus should be firm, midline, and below the umbilicus (size of a grapefruit). If the fundus is firm, no massage is needed. If it is boggy or soft, it should be massaged until firm. Saturation of one standard pad within the first hour is a guideline for maximal lochia flow.
  31. Observe perineal and labial areas for hematoma formation. Apply ice pack to perineum for comfort and to reduce edema. Notify the practitioner if a hematoma is observed.
  32. Assess bladder. Encourage the patient to void or catheterize as necessary using aseptic technique.
  33. If the patient had an epidural, remove catheter per institutional policy and assess for returning sensation and movement. Instruct the patient not to get out of bed without assistance. Ensure the patient has adequate strength and movement before ambulation.
  34. Assess the patient's pain scale and medicate as needed.
  35. Keep the patient warm by applying a warm blanket as needed.
  36. Promote early family attachment and assist with breastfeeding as applicable.
  37. Document the procedure in the patient's record