Steps of Conducting Normal deliverAssistance required during normal delivery1. Delivery of head2. Prevention of perineal injury3. Relieving cord around the neck4. Delivery of the anterior and posterior shoulder5. Delivery of the trunk and bodySteps of assisting the birthI. Gettingn Ready1.Prepare the necessary equipment.2. Encourage the women to adopt the position of choice and continue spontaneous bearing down efforts during uterine contraction which facilitates the descent of head to stretch the perineum.3. Tell the women what is going to be done, listen to her and respond attentively to her questions and concerns.5. Provide continue emotional support and reassurance as feasible.5. Put on pretective barriers.II. Assisting the birth1. Wash hands thoroughly with soap and water and dry with a clean dry cloth or air dry.2. Put high level disinfected or sterile surgicle gloves on both hands.3. Clean the perineum with a cloth or pad, wet with antiseptic solution, wiping from front to back, use one pad to cover anus.4. Place one sterile drap under womans buttock and one over her abdomen and use the third drape to receive the baby.5. Catheterize the bladder if it is full.

A. Delivery of the head with control6. Ask the woman to give small pushes with contraction as the babys head is born.B. Prevention of perineal injury7.As the pressure of the head thins out the perineum, control the birth of the head with the fingers of one hand, applying a firm gentle downward (but not restrictive) pressure to maintain flexion and allow natural stretching of perineal tissue and prevent tears.This process is repeated during subsequent contractions until the sub-occiput is placed under the symphysis pubis.8. Perform medio-lateral episitomy when the perineum is fully stretched, if it is really needed.Routine episitomy should be abandone.9. Use the other hand to support the perineum using pad or cloth and allow the head to crown slowly and be born spontaneously.10. Sudden delivery of the head during contraction is to be prevented by asking woman not to bear down during extension of the head.11. Slow delivery of the head in between the contractions is to be regulated by pushing the chin with a sterile towel covered fingers of the right hand placed over the anococcygeal region while the left hand exerts pressure on the occiput. The forehead, nose, mouth and the chin are thus born successively over the stretched perineum by extension.12. Once the babys head is delivers ask the women not to push.13. wipe the mucus (and membranes if necessary) from the babys mouth, eye and nose immediately with clean cloth or gauze pieces.C. Relieving cord around the neck14. Feel around the babys neck to ensure the umbilical cord is not around the neck if it is found and if loose enough, it should be sliped over the head or over the shoulders as the baby is being born. But if it is sufficiently tight enough, tie or clamp the cord with two artery forcep in two places 2cm apart and cut the cord between clamp.After cutting the cord expulsion of baby must not be delay otherwise baby will go to hypoxia.IV. Prevention of injury to women Attention should be paid to the controlled delivery of head not to the perineum. Delivery by early extension is to be avoided. Forcible delivery of the head is to be avoided.V. Delivery of the anterior and posterior shoulders15. Wait for the uterine contractions to come and for the movements of restitution and external rotation of head in order to deliver the shoulders safely and to avoid perineal laceration.16. Placed the hand on each side of the babys head like Namaste position after external rotation of the head. Tell the woman to push gently with the next contraction.17. A hand is placed on each side of the babys head over the ears and downward traction is applied. This allows the anterior shoulder to slip bebeath the symphysis pubis while the posterior shoulder remain in the vagina.D. Lateral flexion of the body18. When the axillary crease are seen, guide the head upward towards the womans abdomen as the posterior shoulder born over the perineum.19. Lift the babys head anteriorly to deliver the posterior shoulder.20. Move the top most hand from the head to support the rest of the body as it slides out.21. Place the baby on the mothers abdomen. Dry the baby, wipe the eys and assess the breathing.22. If the baby is crying or breathing(chest rising at least 30 minutes per minute) leave the baby with the mother.23. If the baby is not breathing within 30 seconds. SHOUT FOR HELP and take steps to resuscitate the baby.24.Clamp and cut the umbilical cord.25. Ensure that the baby is kept warm and in skin to skin contact on the mothers chest. Wrap the baby in soft dry cloth and cover with blanket and ensure head is covered to prevent heat loss.26. If the mother is not well ask an assistant to care for the baby.27. Palpate the abdomen to rule out the presence of another baby and procced with active management of third stage.28. Note the time of birth and APGAR score of the baby.29. Draw 5 ml of blood from umbilical cord for coombs test if mothers blood group is negative or O group.30.Keep the baby in lateral position with mother or under warmer after resuscitation.