Birth box and birth/obstetric medicine kit from clinic fridge. Should include
2 sterile metal cord clamps, sterile blunt-ended scissors for cutting cord, 2 plastic
cord clamps
Oxytocin box of 5 (from fridge) — 1 ampoule (10 international units/mL) — needed for
delivery of placenta. Other 4 are needed if she bleeds after birth
Resuscitation equipment for mother (eg oxygen, mask, bag-valve-mask, suction equipment
with adult yankauer sucker)
2 large bore IV cannula
For baby
Warm towels
Oxygen with flow meter (flow rates up to 10L/min)
Infant face mask, oxygen tubing
Bag-valve-mask — sizes 0 and 00
Mechanical suction (low pressure if possible), tubing
Suction catheters, sizes 8–12F
Check
Look at vulva — can you see part of baby (usually the head)
If you can’t see baby but there is bulging of perineum or anus — birth is likely to
be close
If umbilical cord at vulva — see Cord prolapse straight away
If baby’s foot or bottom coming first — see Breech birth
If you can't see baby and perineum not bulging — medical consult — see Labour and birth
If membranes ruptured (waters broken) ask when — look at colour of liquor (waters)
Clear, pink or clear with blood mixed in is normal
Meconium (brown/green) means baby has passed faeces
Put in IV cannula — largest possible, insert 2 if time
Ask helper to do medical consult
Do — if head seen or perineum bulging
Put on goggles and sterile gloves
Support woman to get into a position that feels comfortable — upright position or
kneeling on all fours or semi-sitting propped up on pillows. Do not let her lie flat on her back
Let birth of head happen slowly on its own
Let woman push as she feels like it
When perineum is stretched thin and labia is wide apart as head is being born — ask
woman to 'pant' or puff through contractions — helps baby’s head to be born as slowly
as possible and may help to stop perineum from tearing
Wait for baby’s head to turn and face inside of woman’s leg — you don't need to help
this
Birth of shoulders
Baby usually born with next contraction
After shoulders come out the rest of baby’s body will usually follow
Support baby as it births — it will be slippery so use gentle but firm grip. Can use
warm towel
If not born with next contraction
Put palms of your hands on each side of baby’s head, over ears and temples
Gently ease baby’s head toward woman’s anus as she pushes anterior shoulder out from
underneath pubic bone
Once anterior (front) shoulder born gently ease baby’s head toward woman’s abdomen
as she pushes out posterior (back) shoulder