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• • Why do you teach the patient proper breathing techniques during labor? Avoid hypertension 
• • Proper breathing technique 

  ·       Inhale ng malalim, then exhale through pursed lips 
• • Mechanism/Cardinal Movement of Labor 

  o   Descent 

  o   Flexion 

  o   Internal Rotation 

  o   Extension 

  o   External Rotation 

  o   Expulsion 
• • Crowning Stage 

  ·       Extension 
• • Anteroposterior Stage 

  ·       External Rotation 
• • Lumabas yung buong katawan ng baby 

  ·       Expulsion 
• • If there is a massive bleeding 

  ·       No need to wait for the pulsations to stop then cut it immediately 
• • Stages of Labor 

  1st: From the onset of true labor to cervical dilatation 

  2nd: From full cervical dilatation to the delivery of fetus 

  3rd: From the delivery of fetus to the delivery of placenta 

  4th: From the delivery of the placenta to 1-4 hours Immediate
• • Vital Sign Checking after labor 
  • q15 for the first 1-2hrs 
  • q30 3rd hr
  • q1 4th hr
• Augment:

  Reinforce (done kapag walang descent na nangyayari) 

  Administering Normal Saline fluid with Oxytocin para mas mapabilis ang pagdescent ng baby 
• • Ischial Spine 

  ·       0 (engaged) 
• • Crowning 

  ·       +3 
• • Paano ang paglabas ng shoulder ng baby? 

  ·       Anterior shoulder first then Posterior Shoulder 
• • After the head is exposed 

  ·       Instruct the mother to STOP pushing to avoid fetal distress 
• • After the head is delivered 

  ·       Check if the nuchal cord (titignan kung may nakapalipot bang cord sa leeg ng bata) 
• • How to deliver the shoulder of the baby? 

  ·       Downward then upward 
• • What can you give the mother in labor? 

  ·       Ice chips ONLY not clear liquid 
• • No Contractions 

  ·       Instruct the mother to stop pushing then rest 
• Emotional Support:

  ·       Came from the mother of the patient or family 

  ·       Pwede din partner (kung meron man) 
• • Kung may nakalimutan kang linisin sa perineal area (example: hindi mo nalinisan ng maayos yung labia majora tapos napahid mo na yung last cotton mo sa anal, gagamitin mo pa ba yung last cotton mo?)
  • NO, you can’t reuse the last cotton ball since it violates the proper cleaning of the perineum 
• • APGAR is done every 

  ·       After 1 minute and after 5 minutes 
• • What is the apperance of the baby when taking the APGAR score during the 1 minute? 

  ·       Acrocyanosis 
• • All the used needles and sharp items are placed in 

  ·       Sharp container 
• • Position of the mother during delivery (Philippine Edition)

  ·       Lithotomy with the foot of the mother placed on the stirrups 
• • Pulsation of the umbilical cord 

  ·       It will stop for about 1-3 minutes 
• Clamping and cutting of cord:

  o   Clamp the cord at 2 cm from the umbilical base 

  o   Clamp again at 5 cm from the base and cut the cord close to the plastic clamp 
• • Milking of the cord 

  ·       Away from the baby and towards you 
• • If the vulva is big, 

  ·       You can get another cotton balls 
• • Vestibule 

  ·       Inner part of the vulva or opening 
• • If there are ONLY 3 COTTON BALLS available for perineal cleaning, 

  ·       Use the 3 cotton balls for Labia Majora and Labia Minora, Vestibule, downward up to the Anus 
• • Kita ang fetal head 

  ·       Crowning 
• • Imminent delivery 

  ·       Crowning (2nd stage of Labor) 
• • Descent 

  ·       It already hit the pelvic muscle due to the amniotic fluid 
• • Ritgen’s Maneuver is done because 

  ·       To prevent tearing or sudden gush of blood 
• • How much blood is loss? 

  ·       250-500ml 
• • Expulsion of the placenta what is the appearance? 

  Duncan or Schultze 
• • Globular Shape 

  ·       Calkin’s Sign 
• Ways to prevent heat loss:

  o   Conduction – Drop Light 

  o   Convection – Drying the infant immediately 

  o   Evaporation – Swaddle / Warm the blanket / Turn off AC 
• • Improve cardiac function and oxygenation 

  ·       Left Side lying Position 

  ·       Back rubbing (Lower back) 

  ·       Effleurage (Tennis Ball (?)) - Hagod (Up and Down motion) 
• • Amniotic fluid color 

  ·       Normal (Clear) 

  ·       Meconium Staining (Greenish – which means in distress si baby)