[NURSING UGM] Keterampilan Keperawatan - Pertolongan Persalinan (Intranatal)

Main ideas / lessons conveyed

The video demonstrates intranatal (childbirth assistance) nursing skills, emphasizing:

• Continuous monitoring of labor progress, especially during the transition into the 2nd and 3rd stages
• Strict infection prevention, using appropriate PPE and sterile technique
• Standard assisted delivery steps for:
  • The 2nd stage (birth of the baby)
  • Active management of the 3rd stage (delivery of the placenta)
  • 4th stage monitoring (uterine tone/contractions, bleeding, bladder, and overall condition)

It also highlights how to use clinical assessment criteria, such as:

• Fetal heart rate range
• Cervical dilation/position
• Amniotic fluid status
• Signs of placental separation
• Bleeding estimation

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Methodology / step-by-step instructions presented

1) Preparation and setup (before assisting delivery)

• Explain purpose:
  • Assist the mother to deliver the baby and placenta
  • Monitor up to the 4th stage (noted as within ~2 hours postpartum in the intro)
• Prepare materials:
  • Partus set (delivery instruments kit)
  • Supplies for mother and baby
  • PPE for the assistant
• Confirm patient information and comfort:
  • Check the mother’s bracelet/history (example shown: gestational details, number of children)
  • Ask about complaints and pain

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2) Identify signs of labor and prepare for the 2nd stage

• Assess whether labor has entered the 2nd stage by observing:
  • Urge to push
  • Pressure on anus
  • Perineum protrusion
  • Vulva and anus opening
• Prepare medication and tools:
  • Check completeness of the delivery set
  • Prepare oxytocin (example described: ampoule + measured volume into a sterile container/tub)
  • Break/separate the ampoule as needed
• Infection control:
  • Perform hand hygiene
  • Put on sterile gloves

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3) Cleanse and perform internal assessment

• Position mother:
  • Ask mother to bend legs
• Place underpad for cleanliness
• Perform vulva hygiene:
  • Use cotton swabs in a structured sequence (examples described: right/left labia majora/minora, then toward anus/meatus)
• Perform internal examination:
  • Insert fingers appropriately (described: middle then index)
  • Determine:
    • Whether dilation is complete
    • Whether amniotic fluid is intact or has broken
      • If intact: proceed to rupture/break the membranes
      • If already broken: proceed with readiness for birth

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4) Fetal assessment and readiness for pushing

• Monitor fetal heart rate:
  • Example given: ~140 bpm
  • Normal range stated: 120–160 bpm
• Confirm overall readiness:
  • Cervical dilation complete
  • Head descended
  • Amniotic fluid status
  • Fetal condition good
• Coaching mother:
  • Encourage continued pushing
  • If “fast labor” is happening, instruct rest when needed
  • Positioning guidance:
    • Encourage left tilt
  • Family support allowed:
    • Family may assist with drink/massage
  • Comfort measures:
    • Lower back support

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5) Baby delivery technique (2nd stage)

• Set up delivery field:
  • Place towel/clean cloth near delivery area
• Assist crowning and perineal protection:
  • Use one hand to support/perineal protection (holding perineum to reduce tearing)
  • Use the other hand to stabilize the top of the baby’s head
• During pushing:
  • Guide repeated pushes until the head becomes visible and delivers fully
• After head delivery:
  • Clean eyes, nose, mouth
• Check umbilical cord status:
  • Look for whether the cord is wrapped around the neck
• Facilitate rotation:
  • Allow “rotate spontaneously” when appropriate
• Deliver shoulders and body:
  • Hold parietal area; deliver upper shoulder, then lower shoulder
  • Guide body downward and assist legs/buttocks delivery as needed
• Newborn immediate care:
  • Dry and massage/tactile stimulation
  • Avoid drying hands/palms initially (mentioned in an IMD context)
• Assess condition:
  • Check Apgar score concepts described (reddish skin, active movement, cry)
  • If satisfactory, no additional “suction” step described (explicitly says no need for “Saken”)
• Cover and prepare for cord cutting:
  • Change to a clean blanket after drying
  • Cut umbilical cord:
    • Identify ~3 cm from base of navel
    • Twist before cutting to prevent blood spurting
    • Use clamps/then scissors (described as first and second clamp distances)
• Prepare for Immediate Mother-Baby Contact (IMD):
  • Disinfection steps mentioned with povidone iodine (petadin)
  • Place baby skin-to-skin with mother, with head covered and hat/cover in place
  • Wait about 1 hour for IMD

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6) Active management of the 3rd stage (placenta delivery)

• Before giving oxytocin:
  • Confirm fetal status in the uterus (example: check fundus to ensure only one fetus/confirm fundal height)
• Give oxytocin injection:
  • Inject into outer third of the thigh
  • Aspirate first, then inject
  • Purpose stated: prevent bleeding
• Controlled umbilical cord traction (C-U C T):
  • Perform controlled umbilical cord traction (described as stretching without excessive pulling)
• Use landmarks and technique:
  • Left hand above symphysis
  • Apply “dorsocranial skills” to support/guide cord traction
• Recognize signs of placental separation (3 signs mentioned):
  1. Blood comes out suddenly/spontaneously
  2. Uterus becomes rounded
  3. Umbilical cord lengthens
• If signs present:
  • Deliver placenta by pulling down and then guiding up according to the birth canal direction
• After placenta delivery:
  • Assess completeness:
    • Check insertion site (middle) and ensure membranes/cotyledons are intact
    • If incomplete: perform manual placental removal
• Uterine massage and bleeding assessment:
  • Massage uterus clockwise
  • Check for clots and estimate bleeding:
    • Collect clots into a measuring cup to quantify blood loss
• Perineal/birth canal check:
  • Inspect for perineal tears
  • If none, document no tear

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7) Clean-up, mother dressing, and 4th-stage monitoring

• Clean mother and birth area:
  • Clean around birth canal/groin area
  • Dry with cloths (described as using multiple washcloths)
• Prepare mother:
  • Provide sanitary napkin
  • Assist mother to wear pants/underwear
• 4th stage monitoring (active observation):
  • Monitor uterine contractions and uterine tone
  • Teach mother self-massage/stimulation
  • Monitor:
    • Bleeding
    • Bladder status
• Infection prevention for tools:
  • Soak used tools in 0.5% chlorine solution

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8) Postpartum counseling and follow-up instructions (as shown)

• Manage comfort:
  • Explain that stomach pain may help uterus shrink; wrinkles shrink
• Confirm no need for stitches in this case:
  • States contractions/pushing were good and “no stitches needed”
• Encourage recovery care:
  • Encourage eating, drinking, nutrition, and breastfeeding support
• Plan follow-up within ~2 hours postpartum:
  • Recheck blood pressure, pulse, and “tension” (likely pulse/vitals)
  • Ask about bleeding

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Speakers / sources featured

• Wiwin lismidiati — Department of Child and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, UGM (speaker/demonstrator)
• Mother/patient (appears as “Ma’am”) — patient being coached and assisted
• Erwati / Ernawati — other women addressed in the video (likely patient family/participants or staff introductions)