a. Never leave the patient alone once she has been transferred to the delivery room.

In addition, never turn your back on the perineum because the baby could push through the vaginal opening while your back is turned.

b. Encourage the patient to rest between contractions and to push with contractions.

Only one person should coach. Verbal encouragement and physical contact help reassure and encourage the patient.

c. Position the patient’s legs in the stirrups for the lithotomy position.

This is the most common position for delivery. Facilities using birthing beds have the patient in an upright position. Positioning also depends upon the type of anesthesia to be used and C-section delivery. Each case may be different.

d. Prep the patient’s perineum.

A Betadine® scrub and water are used with 4×4’s. Clean the perineum by washing the pubic area, down each thigh, down each side of the labia, down the perineum, and down the rectal area (see fig. 2-7). Begin cleaning at number 1 and proceed through number 7. Discard used sponges after each step. Rinse area with the remaining solution.

e. Monitor the patient’s blood pressure and the fetal heart tones every 5 minutes and after each contraction.