2. 0 J. 6. 1. 7. over yom· haods). If available, use an apron. If true labor pains have just started, adv. ise the patient to urinate since a full bladder may delay progress of labor. lf sterile gloves are available, do an internal exam and determine how wide the opening of the cervix is. Do the following during the second stage oflabor (from complete opening of the cervb, up to the birth of the baby): 2. 1. lfyou arrive during tl1is stage, do the following: 2. 1. 1. Wash hanlls willi soap and warm, previously boiled water. using the pouring method for rinsing. 2. 1. 2. Spread on the working area at least the following thiogs or ask somebody to spread tbem out while you assist in the delive. ry of the baby: a. dean cloth tu dry the baby, blanket and bonnet h. :. i pai 1· of scissors or a blade soaked in 70% alcolwl c. :. howl or bnsin with warm previously boil<. :<l water d. basin for the placenta c. lwo sterile 11mbilical clamps 01· cord tics f. pack of cotton balls )!.. p:qwr waste bnskct h dc:,n rl1JI h 1r, s11pport Lhe perineum ., d1nt1i:?,c of clo1·hing for I he mother 2. 2. Clean the perinea] area of the palient using cot1:on balls and warm water every time fecal material comes out when the patient bears down. 2. 3. Wear a pair of sterile gloves. Make sure to change the· gloves if it gets in contact with any fecal material. 2-4. Instruct the patient to bear down properly. 2. 6. 2. 4. 1.. Mouth must be closed and the force directed to the perinea) 2. 4. 2. 2. 4. 3. 2-4. 4. area. Bearing down must be done only while the womb is contracting. Patient must rest between contractions. Patient must continuously bear down during the whole time the uterus is contracting. Watch for ruphue of the bag of water and wait for the crowning of the baby's bead. Support the area just below the opening of the birtl1 canal with the palm of the hand (either left or right) using a piece of clean cloth or diaper as lining. Deliver the baby's head: 2. 7. 1. Extend the baby's head up gently to prevent it from getting io contact with the anus. 2. 7. 2. As soon as the baby"s head comes out, pass the fingers of one hand to the baby's neck to check if there is one or more coils of the umbilical cord, support the baby's l,ead with the other hand. 2..7. 3. If there i. s a cord coiled around the neck, do the following: a. If the coil is loose, slip it over the bead. b. If the coil is tight or not loose enough to slip over the head, quickly tie the co;rd twice (the ties should be around one inch apart), then cut the cord bel:\'lleen the two ties; deliver the baby promptly. 2. 7. 4. Instruct the patient to stop bearing down and breathe thrn the mouth after the baby's head bas been delivered. 263 