SKILL LABORATORY PRACTICE MODULE

BLOCK
TOPIC

: 7-REPRODUCTIVE SYSTEM
: Normal Labor Procedure

General objectives :
After completion of normal labor procedure obstetrics module,
the students shall be competent in acknowledge the
indication and sign of stage 2 labor, prepared all equipment
needs to delivered a baby, performing physical examination
during labor, performing safe and gentle labor, documenting
-reporting, and developing a good patient-physician
relationship, specifically in obstetrics, in a professional
manners as they will become health care providers in primary
health centers.
Spesific Objectives :
The spesific objectives in normal labor procedure is the
student should be able to performed normal labor procedure
in the primary health care as its trained on Asuhan Persalinan
Normal (APN)/Normal labor care standard used in Indonesia.
Normal Labor Procedure
I. Expected Competency:
a. Students should be able to recognize sign and
symptoms of stage 2 delivery
b. Students should be able to prepare for a normal labor
procedure
c. Students should be able to monitor mother and fetal
condition
d. Students should be able to help mother to push during
bearing down process
e. Students should be able perform head, shoulder, body
and limbs delivery
II. Topic
Determining Stage II of Labor and performing safe and clean
delivery
III. Method
1. Presentation
2. Demonstration

3. Coaching
4. Self practice
5. Evaluation
IV. Laboratory facilities
1. Skill laboratory
2. Trainers
3. Student learning guide
4. Equipment as stated in learning guide
V. Evaluation
1. Nodal point evaluation
2. OSCE
VI. References
1. Cunningham FG, et al. Fetal growth and Development.
Williams Obstetric, 23rd edition. New York:McGraw Hill, 2010.
p.78-104.
2. LeBlond RF, DeGowin RL, Brown DD. DeGowin's Diagnostic
Examination, Ninth Edition The New York : McGraw-Hill
Companies, Inc. ; 2009
3. Bickley LS. Bates' Guide to Physical Examination and
History Taking, 10th Edition Philadelphia :Lippincot
William Wilkins, Ltd.; 2008

VII. LEARNING GUIDE

PROCEDURE
I. ACKOWLEDGE INDICATIONS AND SIGNS OF
STAGE 2
I. Hear and see the stage 2 signs of labor

The mother perceives a strong urge and push.

She perceives the increasing pressure on the

rectum and vagina.

Perineum is protruding.
Vulva and sphincter ani are open
II. PREPARING LABOR HELP
2. Ensure completeness of equipment, materials and
essential medication to help labor and to manage
maternal and newborn complication.
Clean towel or linen 3 pieces
Dry and clean cloth
Fetoscope/Monoural
Sphygmomanometer
0,5% chlorine solution in clean basin
Garbage Bin
Placenta Plate
Kidney Basin
Mucous Vacuum
Apron
Labor set :
1. Surgical Clamp 2 pieces
2. Kocher Clamp for amniotomy 1 pieces
3. Episiotomy Scissors
4. Umbilical Scissors
5. Folleys Urinary Catheter
6. Umbilical Clamp
7. Surgical Glove 2 pieces
8. Spuit 3 mL
9. Oxytocin ampoule 2 pieces
10.
Methyl-ergometrin ampule 1 pieces

SCORE
0
1
2

 Spread

a cloth over the mother's abdomen and the

shoulder padding and infant resuscitation.

Prepare

oxytocin 10 units (1 ampoule) and

disposable sterile syringes in parturition set.

3 . Wear the apron, google, and boots
4 . Remove and keep all the jewelry, wash hands with
seven steps of universal precaution
5 . Wear surgical gloves I on the hand that will be used to
internal examination.
oxytocin into the syringe using the hand wearing

6 . Load

surgical gloves (make sure no contamination in the

syringe)
III. ENSURE THAT THE CERVIX IS FULLY DILATED AND FETUS
CONDITION IS GOOD
7. Clean the vulva and perineum, wipe them carefully
from anterior to posterior by using cotton or
moistened gauze.
If

feces contaminate introitus vagina, perineum or

anus, wipe carefully from anterior to posterior.

Discard

contaminated cotton or gauze into available

container.
Change

contaminated gloves (decontaminate,

remove, and soak in 0.5% chlorine solution step

# 9)
8. Do bimanual examination (internal examination) to
ensure complete opening.
When

the fetal membrane is not rupture and the

opening is complete performed amniotomy.

9.Decontaminating gloves by immersing glove-wearing
hands into 0.5% chlorine solution, take them off and
soak them inversely in a 0.5% chlorine solution for
10 minutes.Wash your hands after gloves taken off.

10.Check

the fetal heart rate (FHR) after contraction

when the uterus is relaxed. This is to ensure that the

fetal heart rate is in the normal range (120-160
times/ minute)

Take appropriate action if FHR is abnormal.

Record the results of the examination,FHR, all
the results of the assessment, and other care on

partograph.
IV. PREPARING THE MOTHER AND HER FAMILY TO HELP IN
GUIDING PUSHING PROCESS.
11. Notify the mother that the

opening

already

completes, fetal condition is good, Help her to find a

comfortable position in accordance with her wants.
a. Wait until the pushing drive emerged. Continue
in monitoring the maternal and fetal condition
(follow guidelines for the management of active
phase) and record all findings
b. Explain to family members how they can play a
role in supporting and encouraging the mother
to push properly.
12. Ask her family to help in preparing push position.(If
there is pushing drive and a strong contraction.Help
the mother to a half-sitting position or any other
position that she want and ensure the mother feels
comfort)
13. Apply pushing guidance when she perceives a
strong urge to push:
A. Guide her to correctly and effectively push.
B. Suggest her to take a rest
between
contractions.
C. Assess FHR by uterine contraction completed.
D. Refer immediately if the fetus has not been
or will not be born after pushing for 120
minutes

(2 hours) (primigravide) or 60

minutes (1 hour) (muItigravide)

E. Give her enough fluid intake

per

oral

(drinking)
Other Things To Apply:

Support and encourage her at the time of pushing

and correct her pushing way if her way is not

proper.
Help her in taking a comfortable position as her
wish (except the position of lying on her back for a

long time)
Suggest her

family

to

give

support

and

encouragement to her.
14. Encourage her to walk, squat, or take a comfortable
position, if the mother does not perceive the pushing
urge in 60 minutes
V. PREPARATION FOR HELPING LABOR
15. Put 2clean towel (to dry the baby) on the mother's
abdomen, if the fetal head already opening vulva in
diameter of 5-6 cm
16. Put a clean cloth folded 1/3 under the maternal
buttock.
17. Open the parturition set covers and check again
completeness of equipment and materials
18. Wear surgical gloves on both hands.
VI. HELPING LABOR
Head delivery
19. Once the baby's head is visible with a diameter of to
5-6 cm vulvas opening, protect the perineum with
right hand covered with a clean dry cloth (prepared
in step #16).The lefthand secures the baby's head to
hold the head deflection position and help the head
delivered.Encourage her to slowly push or
rapid breathing.
swab the babys face, mouth, and nose with

20. Gently

linen or clean gauze

whether the umbilical cord twisted and take an

21. Check

appropriate action if it happened, then immediately

continue the delivery.

If

the umbilical cord wrapped loosely around his

neck, remove through the top of the baby's head

If

the umbilical cord wrapped around his neck tightly,

clamp the umbilical cord in two places and cut

21.

between the two clamps

Wait for the baby's head undertaking the

spontaneous-outer axis-rotation.
Shoulder delivery
22. Once the head performing outer axis rotation, hold it
biparietally. Encourage the mother to push at
contraction. Move the head gently downward and
distallyuntil the anterior shoulder appear under the
pubic archand then move upward and distal to
deliver posterior shoulder. Do not pull the baby in his
axilla.
Delivering the Body and Limbs
23. After delivering both shoulders, slide the helper hand
down to the head and shoulders.Use the helper
upper hand to track and hold the babys upper arm
and elbow.
24.After delivering the babys body and arms, continue
tracing from the babys upper hand to the back,
buttocks, and legs.Grasp the babys ankles (insert
your index finger between fetal legs and hold each
ankles with the thumb and other fingers)
VII. HANDLING OF THE NEWBORNS
25. Assess the newborn
26. Dry the baby's body
From his face, head, and other parts of the body
except the hands without cleaning vernix.Replace
wet towel with a dry towel / cloth. Put the baby one
side on the mother's abdomen.
27. Recheck uterus to ensure no more babies in the
uterus (single pregnancy).
28. Tell her that she would be injected with oxytocin for
good uterine contraction.

29. Within 1 minute after delivery, inject oxytocin 10

units IM (intramuscularly) in 1/3 distal-lateral upper
thigh (do aspiration before injecting oxytocin).
30. Two minutes later after delivery, clamp the umbilical
cord at approximately 3 cm from the center of the
baby with disposable clamp .Push distally content of
the umbilical cord (to mother direction) and clamp
again umbilical cord at 2 cm distal from the first
clamp with arterial clamp.
31. Cutting umbilical cord

By one hand, hold the clamped umbilical cord

(protect

the baby's

tummy), and cut the

umbilical cord between the two clamps.

32. Return back the baby to the mother so that skin-toskin contact occurs. Put the baby on her stomach on
her mother chest. Straighten her shoulders so that
the

baby

adhere

abdomen.Keep

the

inthe
baby's

mother's
head

chest

between

/
the

mother's breast with the lower position of the breast

nipple
33. Cover the mother and her baby with warm blanket
and put a hat on the baby's head.