UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
MEDICAL CENTER

PROCEDURE

 PROCEDURE:                        125
EFFECTIVE:                        12/91
REVISION:                        8/05
APPROVED:                        8/05

PROCEDURE FOR CIRCULATING A VAGINAL DELIVERY

PURPOSE: To provide care to mother and baby while observing aseptic technique.

EQUIPMENT:

  1. Patient Chart

NURSING ACTION:

PROCEDURE STEPS:

  1. Place patient in lithotomy position on the birthing bed. Place her feet on the foot rests and adjust to comfortable position.
  2. Remove the end of the bed and position the patient for delivery.
  3. Prep the perineum. The nurse will stay at the perineum until the M.D. is present.
  4. Obtain vital signs with fetal heart rate. Obtain FHR every 5 minutes until the infant is delivered.
  5. Assist the physician with gown.
  6. Obtain any supplies the physician needs, i.e., vacuum, forceps, 4X4's.
  7. Note the time of delivery.
  8. Care of the infant:
  1. Dry the infant off.
  2. Assess the infant according to the APGAR scoring system at one and five minutes.
    NOTE: If pediatricians are present, they will give the scores.
  3. Obtain infant footprints and maternal fingerprint, place I.D. bands, and administer prophylactic antibiotic (erythromycin) to both eyes.  Place infant security band.
  4. Place cap on infant, cleanse feet with surplus eye ointment. Then place infant in clean, warm sterile sheet and give infant to the mother.
  5. Continue monitoring the infant especially for warmth and color.
  1. Complete the footprint sheet and the delivery summary sheet.
  2. Note the time of delivery of the placenta and administer Pitocin as ordered.
  3. Assist the physician to clean the patient and return birthing bed to normal position. Change linen and patient gown, as needed.
  4. If infant is admitted to nursery, send a copy of the delivery summary, footprint sheet, mother's physical and history, newborn flowsheet, Hepatitis B Vaccine, Hearing Screen Consent, and Infant Security form.
  5. If normal newborn, the infant remains with the mother. Pediatricians will come to L&D to assess the infant. If newborn has complications, the pediatricians will determine if the infant is to remain on L&D or be taken to IL2 or ICN.
  6. Assure that all supplies are replaced and the infant warmer is clean.

KEYPOINT: Call for pediatricians on M.D. order or at any time that the infant is compromised. When pediatricians are present, the nurse will assist them with the care of the infant.

KEYPOINT: If the patient has an epidural or has twins, the anesthesia resident must be called for delivery. If present, he/she will assume the care of the mother, the nurse continues to monitor the fetus.

KEYPOINT: Sterile technique is to be used when giving supplies to the M.D. or assisting with procedures.

REFERENCES:
 Maternal-Newborn Nursing: Theory and Practice. Francine Nichols and Elaine Zwelling, W.B. Saunders Co.,                      Philadelphia,    1997, pp. 748-788.
"Maternal Nursing Care Plans", Karla Luxner, RNC, MSN, 1999, Skidmore-Roth Publishing, Inc.
"Alexander's Care of the Patient in Surgery", Margaret Meeker & Jane Rothrock, 11th Ed., 1999, Mosby, Inc.

RESOURCE PERSON(S):  Marie Patterson, RN, MA; Shirley Jones, RN; Gail Fresh, RN


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