1) Regularly observe and record the time, interval and intensity of uterine contractions

2) During uterine contractions, the body of the uterus bulges and becomes hard, and relaxes and becomes soft during intermittent periods.

3) As labor progresses, the intensity of uterine contractions gradually increases, the duration becomes longer, and the intermission period becomes shorter.

uterine contraction interval detection

cervical dilation speed

Presentation descent: The sign of fetal head descent is the relationship between the lowest point of the fetal skull and the ischial spine plane.

The fetal head is presented first, and the amniotic fluid is yellow-green mixed with meconium, indicating the presence of intrauterine distress - perform a vaginal examination immediately and pay attention to whether the umbilical cord has fallen off.

The simplest method is palpation

Incubation period: 1 time per hour

Active period: once every 15-30 minutes, 1 minute each time

Abdominal pressure method: The mother puts her feet on the delivery bed and holds on to the handrails with both hands. During contractions, take a deep breath and hold it, and then follow the rhythm of uterine contractions by pushing downwards like defecation to increase abdominal pressure. Be careful not to lift your hips when exerting force. During the interval between contractions, the mother exhales, relaxes her whole body, rests quietly, and does not exert force. The combination of repeated uterine contractions and abdominal muscle pressure can accelerate the delivery of the fetus and shorten the second stage of labor.

Episiotomy should not be performed routinely in first-time mothers. Episiotomy should only be considered when the following conditions occur: the perineum is too tight or the fetus is too large, perineal tearing is expected to be inevitable during delivery, or the mother and child have pathological conditions and urgently need to end delivery. The need for an episiotomy depends on the maternal and fetal conditions and the experience of the surgeon when using forceps or a vacuum suction device to assist the fetus. Generally, the incision is made when the fetal head is crowned to reduce bleeding, or when surgical delivery is decided.

Explain the delivery to the mother and obtain her cooperation. The midwife assists the mother to flex the fetal head during delivery, controls the delivery speed of the fetal head, appropriately protects the perineum, and allows the fetal head to slowly pass through the vaginal opening with the smallest diameter (suboccipital brisket diameter). This is the key to preventing perineal tears and reducing the risk of perineal tearing. Risk of severe perineal laceration

The delivery person stands on the right side of the mother and begins to protect the perineum when the fetal head is exposed and the posterior labia are tense. The method is: cover the perineum with a sterile towel, support the delivery person's right elbow on the delivery bed, separate the thumb of the right hand from the other four fingers, and use the thenar muscle of the palm of the hand to hold the perineum. Whenever there is a contraction, you should press upward and inward, and your left hand should press down on the fetal headoccipital part at the same time to help the fetal head flex and slowly descend. During intermittent contractions, the right hand protecting the perineum should be slightly relaxed to avoid perineal edema caused by excessive pressure for too long. When the occipital part of the fetal head is exposed under the pubic arch, the left hand should assist the fetal head to extend according to the delivery mechanism. If the uterine contractions are strong at this time, the mother should be asked to exhale to eliminate the abdominal pressure. The mother should also be asked to hold her breath slightly downward during the interval of uterine contractions so that the fetal head can be delivered slowly to avoid perineal tears caused by excessive labor force. If the umbilical cord is found to be loose around the neck after delivery, you can use your hands to push the umbilical cord up the fetal shoulders or back away from the fetal head. If the umbilical cord is too tight around the neck or wraps around the neck for two or more weeks, it should be loosened quickly. For the umbilical cord, immediately use two vascular forceps to clamp a section of the umbilical cord and cut it from the middle. Be careful not to injure the fetal neck (Figure 15-23)

After the fetal head is delivered, you should still protect the perineum with your right hand. Do not rush to deliver the fetal shoulder. Instead, use your left hand to squeeze from the root of the nose to the chin to squeeze out the mucus and amniotic fluid in the mouth and nose. This will reduce the risk of the baby sucking in amniotic fluid after the baby's chest is delivered. and blood, and then assists in repositioning and external rotation of the fetal head so that the diameter of the fetal shoulders is consistent with the anteroposterior diameter of the pelvic outlet. The delivery person gently presses the fetal neck downward with his left hand to assist the front shoulder to be delivered from under the pubic arch [Figure 15-22 (3)], and then holds the fetal neck upward to slowly deliver the posterior shoulder from the front edge of the perineum [Figure 15-22 (4)]. After the shoulders are delivered, the right hand protecting the perineum can be relaxed. Then the hands help the fetus and lower limbs to be delivered sideways. Record the time of fetal delivery

Within 1-2 minutes after the fetus is delivered, use two hemostats to cut the umbilical cord between the two forceps at a distance of 15-20cm from the root of the umbilical cord. After the fetus is delivered, a curved plate is placed under the mother's buttocks to collect blood to estimate the amount of bleeding.

1) General situation

2) Placenta

3) Placenta and fetal membranes

4) Soft birth canal examination

5) Assessment of uterine contractions and vaginal bleeding

1) Newborn Apgar/Apgar score

2) General assessment