After delivery
- If the baby is delivered in good condition, then he or she should be handed over to the mother as soon as possible to encourage skin-to-skin contact.
- Double-clamp the cord and take paired cord blood samples.
- Deliver the placenta by controlled cord traction when signs of placental separation occur.
- Check for perineal damage with particular attention for the integrity of anal sphincter and anal mucosa.
- Repair the perineal tears.
- Once the repairs are completed, a vaginal and rectal examination should be performed to confirm restoration of anatomy.
- Check the swabs, sharps and instruments counts are correct.
- Examine the baby's head to confirm that the position of the instrument used was correct for self-audit.
- Document clearly. Refer to the
RCOG proforma for recording instrumental vaginal deliveries. - Prescribe analgesia/thromboprophylaxis as needed.
- Provide advice on bladder care.
- Debrief the woman and the team.
- Individualise care for women with third- and fourth-degree tears.