b. App~y a downward pull steadily but gently, holding higher portions as they come out (like the calves the thighs then the hips).. ' ' 5. 2. 2. Deliver the shoulder using either of these two methods: a. While maintaining the gentle do"'1Tlward pull, slowly tum U1e body such that one shoulder and arm appear at the opening of the birth canal and can tlms be released and delivered first; then turn the baby again so that the other shoulder and acm could be delivered. b. While still maintaining the gentle outward pull, grasp both. feet again in one hand tben gently draw the baby upwards; with the other hand, free the shoulder and am1, then gently pull the baby downward and deliver the other arm and shoulder. 5. 2. 3. Deliver the head. a. After delivering both shoulder, support the hahy's body with one hand. \\Tith the fingers of the other hand, check the neck for cord coil. ff there is cord coil, see if it is loose enough to pass over the ·baby's h~ad as it is delivered. If not. tie the cord twice, with the tics around an incb apart, then cut between the ties. b. lntroduce the left inde. x finger (or that of the right if you are left handed) into the mouili of the baby. c. Hook inde. x and mid die fingers of the other hand over the baby's neck and grasp ilie shoulders. d. While still maintaini ng the pull, elevate tbe baby's body until head is completely delivered. 5. 2. 4. Grasp the baby's feet and hold the baby securely while ensuring drainage of secretions. Stimulate ilie baby if it doesn't cry _5. POntaneou sly. 5. 2. 5 Dry the baby's skin, place him on his mother's chest and cut the cord as expfained in section 2. 11 to 2. l3 of this plan. 5 :J Manage the t J1ircl stage of bboor and th;, t"·o hours immedi,1tely after birth as in Cephalic present:rtion (head first) as explained in items 3. 1 to 4-4 of this plan 6. o Befo1·e leaving the patient, be sure that: 6. 1. The womb is bard and contracted and remains so. 6. 2. There is no excessive bleeding. 6. 3. The placenta is complete. 6. 4. The baby and mother are both in good condition and without any untoward signs and symptoms. PLAN B: 1. 0 Refer the patient immediately to a hospital ( preferably the nearest one). 2..0 Accompa ny 'the patient to the referred level. 3. 0 If the patient hasn't delivered yet, be prepared in case the patient gives birth on the way to the hospital. . 4. 0 Keep her calm. 5. 0 [f tbet"e is shock, do the following: 265 