Ch 27 Labor and Delivery

A woman pregnant for the first time is dilated 3 cm, with contractions every 5 minutes. She is groaning and perspiring excessively and states that she did not attend childbirth classes. What is the most important nursing action? 1. Notify the woman's health care provider. 2. Administer the prescribed narcotic analgesic. 3. Ensure that her labor will be overseen. 4. Give simple breathing and relaxation instructions.

4. Give simple breathing and relaxation instructions.

The nurse has just reviewed the fetal heart rate on an assigned laboring patient. What finding indicates the need to notify the charge nurse? 1. Accelerations 2. Early decelerations 3. Average FHR of 126 bpm 4. Late decelerations

4. Late decelerations

To determine fetal lie, presentation, and position, the caregiver uses which assessment technique? 1. Abdominal ultrasound scan 2. Fetal heart tone auscultation 3. Palpation of contractions 4. Leopold's maneuvers

4. Leopold's maneuvers

Tocotransducer (TOCO)

- placed on fundus; Measures & Records the frequency & duration of contractions

Suctioning With a Bulb Syringe

-the bulb syringe should always be kept in the infant's crib -the mouth is suctioned first to prevent the infant from inhaling pharyngeal secretions when gasping as the nares are touchede -nasal passages are suctioned one nostril at a time -the bulb is compressed and the tip is inserted into one side of the mouth. The center of the mouth is avoided because the gag reflex can be stimulated -when the infant's cry does not sound as though it is through mucus or a bubble , suctioning can be stopped -the parents should be given demonstrations on how to use the bulb suyringe and asked to perform a return demonstration

The nurse assesses a laboring client's cervix to be dilated to 4 cm. Which stage of labor would the nurse record? 1 First 2 Second 3 Prodromal 4 Transitional

1 First

Fetal position

Relationship of the landmark on the presenting fetal part to the front, sides, or back of the maternal pelvis.

External rotation

Rotation of a joint away from the middle of the body.

Molding

Shaping of the fetal head by overlapping of the cranial bones to facilitate movement through the birth canal during labor.

Flexion

The back is bowed outward, the chin is touching the sternum, the arms are crossed on the chest, and the thighs are flexed on the abdomen.

Lightening

The process or time during late pregnancy when the fetal head begins to descend into the mother's pelvis, resulting in a lessening of pressure on the diaphragm

Attitude

The relationship of fetal body parts to one another

Which body structure supports the uterus and fetus during the late months of pregnancy.

The superior portion of the pelvis (iliac segment of the innominate bones)

The three causes of transverse line in pregnancy?

Weaken abdominal walls maternal pelvic contracture placenta previa

What can make uterine contractions less frequent and intense?

When the woman receives narcotic analgesic medication or epidural analgesia early in labor.

What time frame does the delivery of the baby have to occur after the amniotic sac has ruptured?

Within 24hrs after membrane raptures

Apgar score

a scale of 1-10 to evaluate a newborn infant's physical status at 1 and 5 minutes after birth

Primiparas

a woman having her first baby

Candidates for VBAC include the following:

• A woman with one or two low transverse uterine scars but none from removal of fibroid tumors or uterine rupture • A woman whose pelvis is adequate for estimated fetal size

What occurs in Cord prolapse?

Can put pressure on the vessels in the cord can restrict blood flow to the fetus.

How to measure contractions?

Frequency: the time from the beginning of one contraction to the beginning of the next Duration: length of individual contraction Intensity: strength of contraction

What indicates the end of the first stage of labor?

Full cervical dilation

Methylergonovine maleate (Methergine),

Given for postpartum hemorrhage Causes uterine contracitons. Contraindicated for clients with hypertension and cardiac disease. Check B/P prior to administration

What happens when attempts to deliver a breech presentation vaginally?

may result in fetal head entrapment.

Multiparous

means a woman who has given birth two or more times

Which are the most commonly used analgesics when in labor?

meperidine hydrochloride (Demerol) and butorphanol tartrate, which may be given intramuscularly or intravenously.

Oligohydramnios

not enough amniotic fluid

Oxytocic (Pitocin)

oxytocin is a hormone produced by the pituitary gland) is a drug that stimulates uterine contractions and works to prevent postdelivery hemorrhage.

Which medications are given in early labor to promote relaxation and rest?

pentobarbital (Nembutal sodium) and secobarbital (Seconal sodium)

Fetal lie

relationship of the long axis of the fetus to the long axis of the mother

Complete breech

the buttocks present and the thighs are well flexed on the abdomen.

Meconium

the greenish material that collects in the intestine of a fetus and forms the first stools of a newborn

Fetal presentation

the manner in which the fetus appears to the examiner during delivery

Expulsion

the process of driving or forcing out

Longitudinal

the spine of the fetus is parallel to the spine of the mother.

Transverse line

the spine of the fetus is perpendicular to that of the mother.

Effacement

thinning of the cervix during labor

Which medication is given to relief moderate to severe pain during labor?

butorphanol tartrate (Stadol)

What are the precipitous labor fetal complications?

hypoxia from decreased periods of uterine relaxation between contractions and intracranial hemorrhage related to rapid birth.

When are Vaginal deliveries of breech infants may be allowed?

if the fetus is preterm or the mother is multiparous.

Ultrasound transducer or doppler

uses high-frequency sound waves to reflect movement of the fetal heart ventricles.

What are the precipitous labor maternal complications?

uterine rupture lacerations of the birth canal amniotic fluid embolism postpartum hemorrhage.

The nurse notes accelerations with fetal movement. The nurse correctly recognizes that heart accelerations most commonly: 1. Are reassuring. 2. Are caused by umbilical cord compression. 3. Warrant close observation. 4. Are caused by uteroplacental insufficiency.

1. Are reassuring.

The major maternal indications for cesarean delivery are

1. Cephalopelvic disproportion (the head of the fetus is larger than the pelvic outlet), so that the fetus is unable to pass through the maternal pelvis 2. Previous cesarean delivery 3. Breech presentation 4. Medical conditions that endanger the mother's health, such as cardiac complications 5. Abnormal conditions of the placenta, such as placenta previa 6. Infections of the vaginal canal 7. Pelvic abnormalities

The nurse is caring for a patient in labor who has had meperidine (Demerol) for pain relief. Which side effects are commonly associated with this drug? (Select all that apply.) 1. Dry mouth 2. Hypotension 3. Bradycardia 4. Pruritus 5. Tachypnea

1. Dry mouth 2. Hypotension 3. Bradycardia 4. Pruritus 5. Tachypnea

The major fetal indications for cesarean delivery are

1. Fetal oxygen deprivation (hypoxia) 2. Prolapse of the umbilical cord 3. Breech presentation 4. Malpresentations, such as transverse 5. Congenital anomalies

When planning care for a woman whose membranes have ruptured, the nurse recognizes that the woman's risk for what has increased? 1. Intrauterine infection 2. Hemorrhage 3. Precipitous labor 4. Supine hypotension

1. Intrauterine infection

The fetal position is ROA. Where is the fetal presenting part in relation to the maternal pelvis? 1. The occiput is facing the right side and the front of the maternal pelvis. 2. The mentum is facing the right side and the front of the maternal pelvis. 3. The occiput is facing the left side and the back of the maternal pelvis. 4. The sacrum is facing the right side and the front of the maternal pelvis.

1. The occiput is facing the right side and the front of the maternal pelvis.

At which week of gestation would Rho(D) immune globulin be administered to a pregnant client who is Rh negative? 1 12 weeks 2 28 weeks 3 36 weeks 4 40 weeks

2 28 weeks

Which would be included in the plan of care for an obstetrical client who has been taking carbamazepine throughout the first trimester of pregnancy? 1 Evaluation for fetal hydramnios 2 Evaluation for a neural tube defect 3 Evaluation for cardiac malformation 4 Chromosomal assessment for Down syndrome

2 Evaluation for a neural tube defect

Which is the action of a tocolytic? 1 Termination of a pregnancy 2 Inhibits labor and maintains a pregnancy 3 Induces abortion when taken during pregnancy 4 Stimulates uterine contractions during pregnancy

2 Inhibits labor and maintains a pregnancy

A client is diagnosed with placenta previa. Where is the placenta located in this pregnancy complication? 1 Infarcted 2 Low-lying 3 Immaturely developed 4 Separating prematurely

2 Low-lying

Which depression medication is considered safe to use for the breastfeeding mother? 1 Fluoxetine 2 Paroxetine 3 Valproic acid 4 Methotrexate

2 Paroxetine

Rho(D) immune globulin is prescribed for a Rhesus (Rh)-negative client who has just given birth. Before giving the medication, the nurse verifies the newborn's Rh factor and reaction to the Coombs test. Which combination of newborn Rh factor and Coombs test result confirms the need to give Rho(D) immune globulin? 1 Rh positive with a positive Coombs result 2 Rh positive with a negative Coombs result 3 Rh negative with a positive Coombs result 4 Rh negative with a negative Coombs result

2 Rh positive with a negative Coombs result

A client at 7 weeks' gestation reports to the prenatal nurse that she is sick every morning with nausea and vomiting and that she does not think she can tolerate it throughout her pregnancy. The nurse assures her that this is a common occurrence in early pregnancy and will probably disappear by the end of which month? 1 Fifth month 2 Third month 3 Fourth month 4 Second month

2 Third month

As the woman's labor progresses, which assessment finding indicates that the second stage of labor has begun? 1. Passage of a mucous plug 2. Bearing-down reflex 3. Dilation of the cervix to 7 cm 4. Change in shape of the uterus

2. Bearing-down reflex

Which maternal cardiovascular finding is expected during labor? 1. Increased cardiac output 2. Increased pulse rate 3. Decreased white blood cell count 4. Decreased blood pressure

2. Increased pulse rate

A woman tells the nurse she thinks her membranes have ruptured. What action by the nurse best validates rupture of membranes? 1. Feeling the draw sheet for wetness 2. Performing a nitrazine test 3. Inserting a Foley catheter into the bladder 4. Performing an ultrasound

2. Performing a nitrazine test

To assess the frequency of regular labor contractions, what should the nurse record? 1. The interval between the peaks of the contractions 2. The start of one contraction to the start of the next 3. The end of one contraction to the start of the next 4. How many contractions she has in 15 minutes.

2. The start of one contraction to the start of the next

A pregnant woman reports nausea and vomiting during her first trimester of pregnancy. The nurse explains to the client that an increase in which hormone is the precipitating cause of the nausea and vomiting? 1 Estrogen 2 Progesterone 3 Luteinizing hormone 4 Chorionic gonadotropin

4 Chorionic gonadotropin

A pregnant woman is being induced because she is past her due date. Which drug would be administered to the client to soften the cervix and promote labor? 1 Clomiphene 2 Menotropins 3 Dinoprostone 4 Choriogonadotropin alfa

3 Dinoprostone

Which position increases cardiac output in the obstetrical client with cardiac disease? 1 Trendelenburg 2 Low semi-Fowler 3 Lateral positioning 4 Supine with legs elevated

3 Lateral positioning

A newly arrived Russian immigrant attends the prenatal clinic for the first time. Although she states that she has had immunizations, she does not know which ones. Which immunization would the nurse recommend? Select all that apply. One, some, or all responses may be correct. 1 Mumps 2 Measles 3 Diphtheria 4 Hepatitis B 5 Chickenpox

3 Diphtheria 4 Hepatitis

A pregnant woman is attending childbirth classes. She asks the nurse teaching the class when she can have an internal fetal monitor applied. What is the best nursing response? 1. "Because you have had a low-risk pregnancy, you are not considered a candidate for internal monitoring." 2. "Your health care provider decides when to apply the internal monitor." 3. "Your cervix must be 2 to 3 cm dilated and your membranes ruptured before an internal monitor can be applied." 4. "We can apply the internal monitor at any time after your membranes rupture."

3. "Your cervix must be 2 to 3 cm dilated and your membranes ruptured before an internal monitor can be applied."

A woman has progressed through her labor without difficulty. However, the fetal heart rate has been decreasing with each contraction for the past 15 minutes. The rate decreases from 150 to 125 bpm after the peak of the contraction and returns to 150 bpm 15 seconds after the contraction is finished. What phenomena do the clinical manifestations most support? 1. Variable decelerations. 2. Early decelerations. 3. Late decelerations. 4. Combination decelerations.

3. Late decelerations.

Oxytocin

A hormone released by the posterior pituitary that stimulates uterine contractions during childbirth and milk ejection during breastfeeding.

If the nitrazine paper comes out blue, what's the fluid discharge?

Amniotic fluid.

Birthing Centers

Birthing centers are family focused and are considered ideal only for those women with low-risk pregnancies. These facilities are viewed as desirable, because they allow the mother to experience labor and delivery in a more homelike setting.

Multiparas

woman who has delivered more than one viable infant

Uterine inertia

absence or weakness of uterine contractions

Descent

an action of moving downward, dropping, or falling

nulliparas.

women who have no borne children

What are the sign and symptoms of complications of Oxytocin (Pitocin)?

changes in FHR bradycardia tachycardia arrhythmias, or excessive frequency duration, or pressure of contractions. In addition, if hypertonic labor patterns result, administer oxygen.

Surfactant

chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing

Cephalopelvic disproportion

condition preventing normal delivery through the birth canal; either the baby's head is too large or the birth canal is too small

Complications of an episiotomy

include infection, blood loss, pain, and painful sexual intercourse

Hypoxia

deficiency in the amount of oxygen reaching the tissues

Cardinal movements of labor

descent, flexion, internal rotation, extension, restitution, external rotation, expulsion engagements

Internal rotation

enables the fetal head to progress through the maternal pelvis. The largest diameter of the fetal head aligns with the largest diameter of the pelvis.

Footling breech

extension of one or both thighs and legs so that one or both feet are presenting

Cephalocaudal

from head to tail

Latent phase of labor

(0 to 3 cm dilation) Contractions occur 5 to 8 minutes apart and last 20 to 35 seconds. Dilation at this point is about the size of a penny. The woman generally is alert and talkative. The nulliparous woman may feel anxious about childbirth. This phase is ideal for teaching and establishing rapport. The nurse or a significant other may be the coach, reviewing techniques learned in prenatal classes. Pain tends to be mild and easily controlled. Backache is common. Many women, particularly multiparas, prefer to remain home during this stage. If the bag of waters has not ruptured, many women walk during this stage. Women should be advised that if the membranes rupture, they should seek care to be evaluated.

Active phase of labor

(4 to 7 cm dilation) Contractions occur at 3-to 5-minute intervals and last 40 to 60 seconds. The woman becomes less talkative and focuses on breathing techniques learned during prenatal classes. If she has not learned breathing techniques already, teach them to her during labor. The intensity of the pain increases but still may be manageable without medication.

Transitional phase of labor

(8 to 10 cm dilation) Contractions occur at 2-to 3-minute intervals and last up to 90 seconds. The woman is focused deeply and may not wish to communicate with the nurse or significant other. She may be irritated easily by distractions. If the woman has not requested pain medication earlier, she may desire it at this time. Nausea is common.

The patient delivers an 8-lb, 1-oz boy. Ten minutes later, there is a sudden gush of blood from her vagina. At the same time, the woman's uterus becomes globular in shape and the umbilical cord lengthens. What do these findings most likely indicate? 1. Separation of the placenta 2. Uterine hemorrhage 3. Cervical or vaginal laceration 4. Uterine involution

1. Separation of the placenta

The nurse is preparing a patient for a scheduled cesarean section. The nurse will administer medications to reduce gastric acidity. Which medications may be used? (Select all that apply.) 1. Sodium citrate (Bicitra) 2. Ranitidine (Zantac) 3. Cimetidine (Tagamet) 4. Famotidine (Pepcid) 5. Glycopyrrolate (Robinul)

1. Sodium citrate (Bicitra) 2. Ranitidine (Zantac) 3. Cimetidine (Tagamet) 4. Famotidine (Pepcid)

A 23-year-old primigravida arrives at the labor unit in early labor. Which assessment finding indicates that labor has begun? 1. Decreased vaginal secretions 2. Weight gain of 1 to 3 lb 3. Cervical dilation 4. Increased fetal movement

3. Cervical dilation

On the second postpartum day, the nurse is evaluating the rate of involution of a client's uterus. Where would the nurse expect the fundus to be located? 1 At the level of the umbilicus 2 One fingerbreadth above the umbilicus 3 Above and to the right of the umbilicus 4 One or two fingerbreadths below the umbilicus

4 One or two fingerbreadths below the umbilicus

When the woman enters the transition phase to active labor, which behaviors should the nurse expect to see? 1. A desire for personal contact and touch 2. Sleepiness and quietness, with a desire for touch 3. Responsiveness to teaching 4. Irritability, resistance to touch, withdrawal

4. Irritability, resistance to touch, withdrawal

If the nitrazine paper comes out no reactive, what the fluid discharge?

Probably urine

Frank breech

The fetal legs are flexed at the hips and extend toward the shoulders; this is the most common type of breech presentation. The buttocks present at the cervix

What happen in a Neural tube defects?

birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn't close completely

Extension

increases the angle of a joint occurs when the occiput passes under the symphysis pubis. This bony structure acts as a stable point and provides leverage, which enables the head to leave the pelvis. The actual delivery of the head is done by extension.

Braxton Hicks contractions

intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses false labor

How to administer Oxytocin (Pitocin)?

is administered intravenously with a piggyback procedure

Dilation of the cervix

is the enlargement of the cervical opening and the cervical canal that occurs once labor has begun. The diameter of the cervix increases from less than 1 cm to full dilation (approximately 10 cm) to allow birth of a term fetus.

Precipitous labor

labor that lasts less than 3 hours from the onset of contractions to the time of birth

The most common position for delivery is?

left occiput anterior (LOA), in which the occiput of the fetus points toward the left anterior segment of the maternal pelvis.

Episiotomy

surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth

First nursing intervention right after birth?

the baby's airway is established and the umbilical cord is clamped with two clamps and then severed between the clamps. If there are no complications, show the baby to the parents. Then either give the infant to the mother to hold or position the infant in a warming unit that allows for close observation and care.

What happens after a pregnant women experiences "lighting"

the woman often notices that urinary frequency returns. She may be able to breathe more normally because the abdominal cavity has more space.

What position is the baby placed to promote fluid drainage?

turned to right side and supported in this position to facilitate drainage from mouth and to promote emptying of stomach contents into the small intestine.

Placental separation

• A firmly contracting fundus • A change in the uterus from discoid (disklike) to globular ovoid (egg-shaped) as the placenta moves to the lower segment • A sudden gush of dark blood from the introitus (the entrance into the vagina) • Apparent lengthening of the umbilical cord as the placenta gets closer to the introitus • A vaginal fullness (the placenta) noted on vaginal or rectal examination or fetal membranes seen at the introitus

Nitrazine Test for Rupture of Membranes

• Explain the procedure to the woman or the couple. • Perform the procedure. • Wash hands. • Put on sterile gloves. • Use nitrazine test paper, a dye-impregnated test paper for determination of pH (differentiates amniotic fluid, which is slightly alkaline, from urine and purulent material [pus], which are acidic). • While wearing a sterile glove lubricated with water, place a piece of test paper on the cervical opening. or • With a sterile, cotton-tipped applicator, dip deep into the vagina to pick up fluid; touch applicator to test paper. (Procedure may be done during speculum examination.) • Read results: • Membranes probably intact: identifies vaginal and most body fluids that are acidic: Yellow, pH 5.0 Olive-yellow, pH 5.5 Olive-green, pH 6.0 • Membranes probably ruptured: identifies amniotic fluid that is alkaline: Blue-green, pH 6.5 Blue-gray, pH 7.0 Deep blue, pH 7.5 • False test results are possible because of presence of bloody show, insufficient amniotic fluid, or semen. • Provide pericare as needed. • Remove gloves and wash hands. •Document results (positive or negative).

The 5 p's

•Passageway: The pelvis and soft tissues • Passenger: The fetus • Powers: Contractions • Position of mother: Standing, walking, side lying, squatting, on hands and knees • Psyche: Psychological response

Nursing intervention to prevent hypothermia in new born?

immediately dry the infant to help reduce heat loss from evaporation. Then, place the baby in contact with the mother's skin, especially if she wishes to breast-feed, or transfer the baby to a radiant warming unit.

Amniotomy

incision into the amnion (rupture of the fetal membrane to induce labor; a special hook is generally used to make the incision)

Restitution

As soon as the head is delivered, it moves to realign with the body and shoulders.

How are most breech pregnancies delivered?

Cesarean Delivery

How is true labor defined?

Contractions follow a regular pattern. Contractions come closer together, are stronger, and tend to last longer. Contractions get stronger with ambulation. Contractions seem to start in the lower back and then travel to the lower abdomen. Contractions usually are not stopped with controlled breathing, sedation, or other relaxation interventions. The cervix softens, effaces, and dilates. he fetus continues descent into the pelvis.

What nursing intervention should implemented when a woman may have seepage or sudden of fluid from the vagina.

Evaluation should be performed to determine what the fluid is. A simple test with nitrazine paper can distinguish between fluids

What occurrences may happen days for women go into labor?

Some women notice a slight loss of weight (1 to 3 pounds) a few days before labor. Reports of nausea and diarrhea are not uncommon during this period. An energy burst often is experienced. Expectant mothers report cooking, cleaning, and preparing for the baby's arrival with renewed energy.

Ferguson's reflex.

Spontaneous urge to push during labor that occurs when the presenting part (of the fetus) reaches the pelvic floor; may occur without full cervical effacement (Shortening and thinning of the cervix). Woman is discouraged from pushing until the cervix has dilated completely to prevent damage to the cervix.

Benefits of hospital births

The greatest is the availability of trained personnel in the event complications occur. Within the hospital facility, a variety of rooming options are available. Some facilities offer single-room LDRP (labor, delivery, recovery, postpartum) units. This type of arrangement allows for the labor, delivery, and birth to take place in a single location.

Which Antianxiety medications given when in labor?

hydroxyzine (Vistaril) and diazepam (Valium) may be administered to reduce apprehension and anxiety. These medications also potentiate the effects of narcotics.

Management of women who plan VBAC includes the following considerations.

• External cephalic version may be as successful for women with a prior cesarean as for women with an unscarred uterus. • Epidural analgesia and anesthesia may be used. • Induction and augmentation of labor with oxytocin may be done. Use of prostaglandin gel appears to be safe. Misoprostol (Cytotec) currently is contraindicated. • Most authorities recommend electronic fetal monitoring. • A physician, anesthesia, and personnel must be immediately available during active labor in case an emergency cesarean is needed

Which are the several methods for evaluation of the size of the true pelvis?

• Palpation: Externally, the health care provider can use a pelvimeter to determine the distance between the ischial tuberosities. This measurement helps estimate the distance between the ischial spines, which otherwise can be obtained only with pelvic x-ray examination. Internally, additional bony prominences are evaluated to determine pelvic adequacy. • Pelvimetry: With x-ray films from different views, the health care provider can measure accurately the bony prominences. This type of assessment may be done for a woman who is not currently pregnant but is seeking preconception care. The diagnostic measurement may be performed for women who have had an injury or known developmental problem, such as • Ultrasound scan: Sound waves above the range of human hearing also can be used to estimate pelvic adequacy. Because ultrasound scanning does not involve the use of radiation, it generally is regarded as safe for the fetus. An ultrasound scan can show soft tissue and helps gather information regarding fetal growth, multiple pregnancy, placental location, and abnormal presentation that may complicate delivery.

Measures to reduce the risk of maternal aspiration (or of lung injury, if aspiration occurs)

• Restrict intake to clear fluids or maintain nothing-by-mouth status if surgery is expected, such as with a scheduled cesarean birth. • Administer drugs to raise the gastric pH and make secretions less acidic, such as sodium citrate and citric acid (Bicitra), ranitidine (Zantac), cimetidine (Tagamet), or famotidine (Pepcid). • Administer drugs to reduce secretions, such as glycopyrrolate (Robinul).

Standard Precautions During Childbirth

• Wash hands before donning gloves and after performing procedures and removing gloves. • Wear gloves (clean or sterile, as appropriate) when performing procedures that require contact with the woman's genitalia and body fluids, including bloody show (e.g., during vaginal examination, amniotomy, hygienic care of the perineum, insertion of an internal scalp electrode and intrauterine pressure monitor, and catheterization). • When assisting with a birth, wear a cover gown and a mask with a shield or protective eyewear. Cap and shoe covers are worn for cesarean birth but are optional for vaginal birth in a birthing room. The primary health care provider who is attending the birth should wear a sterile gown with a waterproof front and sleeves. • Drape the woman with sterile towels and sheets as appropriate. Explain to the woman what can and cannot be touched. • Help the woman's partner put on appropriate coverings for the type of birth, such as cap, mask, gown, and shoe covers. Show the partner where to stand and what can and cannot be touched. • Wear gloves and gown when handling the newborn immediately after birth. • Use an appropriate method to suction the newborn's airway, such as a bulb syringe, mechanical wall suction, or DeLee oral suction device.