Preparing for birth Name of presenter: Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project BASICS

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Preparing for birth Name of presenter
Prevention of Postpartum Hemorrhage Initiative
(POPPHI) ProjectBASICS
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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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Small group work

• 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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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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Delivery room

• Make sure that the womans 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).

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Delivery room temperature and lighting

• 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.

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Newborn baby corner

• 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

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Equipment and supplies

• 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

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Maternal and environmental hygiene

• Encourage the woman to wash herself or bathe/
  shower at the onset of labor.
• Place a clean, waterproof sheet under the womans
  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.

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Infection prevention

• Wash hands
• Wear protective clothing
• Sterile/HLD gloves
• Masks
• Gowns and waterproof aprons,
• Caps, eye goggles/face shields

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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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Disadvantages of each type of third stage
management
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.
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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.

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

• 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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Storage of uterotonic drugs

• Check the manufacturers 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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