1. Dr. Yin Moe Han
Senior Lecturer
Obstetrics & Gynaecology Department
School of Medicine, UCSI university

2. SECOND STAGE OF LABOUR
full dilatation of the cervix
up to 1 hour
birth of the foetus
7/31/2012 Dr. Yin Moe Han 2

3. MECHANISM OF NORMAL LABOUR
Cardinal movements of labour (LOA)
Head is borned by Extension Restitution
External rotation
7/31/2012 Dr. Yin Moe Han 3

4. Head is borned by EXTENSION
7/31/2012 Dr. Yin Moe Han 4

5. RESTITUTION
7/31/2012 Dr. Yin Moe Han 5

6. EXTERNAL ROTATION
7/31/2012 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 infant
7/31/2012 Dr. Yin Moe Han 7

8. POSITIONING FOR DELIVERY
7/31/2012 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
Arrows
7/31/2012 Dr. Yin Moe Han 9

10. CREATE A STERILE FIELD
AROUND THE VAGINAL OPENING
7/31/2012 Dr. Yin Moe Han 10

11. CROWNING OF THE HEAD
7/31/2012 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
delivers
7/31/2012 Dr. Yin Moe Han 14

15. DELIVERY OF THE HEAD
2nd stage of labour
Head is borned by extension
7/31/2012 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 nose
7/31/2012 Dr. Yin Moe Han 16

17. SUCTION THE AIRWAY
7/31/2012 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 neck
7/31/2012 Dr. Yin Moe Han 18

19. ASSISTING WITH DELIVERY
As the head emerges, the baby
will turn to one side (for easier
passage of shoulders through
birth canal)
Check to see if the umbilical
cord is looped around the
baby’s neck. If so, gently slip
it over the head
Use a clean towel to catch
the baby
Note the time, if possible
7/31/2012 Dr. Yin Moe Han 19

20. DELIVERY OF FETAL HEAD WITH
ROL POSITION
7/31/2012 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 time
7/31/2012 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 abdomen
7/31/2012 Dr. Yin Moe Han 24

25. DELIVERY OF POSTERIOR SHOULDER
7/31/2012 Dr. Yin Moe Han 25

26. BABY DELIVERED
7/31/2012 Dr. Yin Moe Han 26

27. FIRST BODY CONTACT OF MOTHER AND
BABY AND CORD CLAMPING
7/31/2012 Dr. Yin Moe Han 27

28. CLAMPING UMBILICAL CORD
7/31/2012 Dr. Yin Moe Han 28

29. CLAMPING, CUTTING AND TYING
OF
UMBILICAL CORD
7/31/2012 Dr. Yin Moe Han 29

30. 7/31/2012 Dr. Yin Moe Han 30