Cover Image
close this bookCare in Normal Birth (WHO, 1996, 60 p.)
View the document(introduction...)
View the documentACKNOWLEDGEMENTS
close this folder1. INTRODUCTION
View the document1.1 Preamble
View the document1.2 Background
View the document1.3 Risk Approach in Maternity Care
View the document1.4 Definition of Normal Birth
View the document1.5 Aim of the Care in Normal Birth, Tasks of the Caregiver
View the document1.6 The Caregiver in Normal Birth
close this folder2. GENERAL ASPECTS OF CARE IN LABOUR
View the document2.1 Assessing the Well-being of the Woman during Labour
View the document2.2 Routine Procedures
View the document2.3 Nutrition
View the document2.4 Place of Birth
View the document2.5 Support in Childbirth
close this folder2.6 Labour Pain
View the document(introduction...)
View the document2.6.1 Non-pharmacological methods of pain relief
View the document2.6.2 Pharmacological pain relief in labour
close this folder2.7 Monitoring the Fetus during Labour
View the document(introduction...)
View the document2.7.1 Assessment of amniotic fluid
View the document2.7.2 Monitoring the fetal heart rate
View the document2.7.3 Fetal scalp blood examination
View the document2.7.4 Comparison of auscultation and electronic fetal monitoring
View the document2.8 Cleanliness
close this folder3. CARE DURING THE FIRST STAGE OF LABOUR
View the document3.1 Assessing the Start of Labour
View the document3.2 Position and Movement during the First Stage of Labour
View the document3.3 Vaginal Examination
View the document3.4 Monitoring the Progress of Labour
close this folder3.5 Prevention of Prolonged Labour
View the document(introduction...)
View the document3.5.1 Early amniotomy
View the document3.5.2 Intravenous infusion of oxytocin
View the document3.5.3 Intramuscular oxytocin administration
close this folder4. CARE DURING THE SECOND STAGE OF LABOUR
View the document4.1 Physiological Background
View the document4.2 The Onset of the Second Stage
View the document4.3 The Onset of Pushing during the Second Stage
View the document4.4 The Procedure of Pushing during the Second Stage
View the document4.5 Duration of the Second Stage
View the document4.6 Maternal Position during the Second Stage
close this folder4.7 Care of the Perineum
View the document(introduction...)
View the document4.7.1 “Guarding the perineum” during delivery
View the document4.7.2 Perineal tear and episiotomy
close this folder5. CARE DURING THE THIRD STAGE OF LABOUR
View the document5.1 Background
View the document5.2 Prophylactic use of Oxytocics
View the document5.3 Controlled Cord Traction
View the document5.4 Active Versus Expectant Management of the Third Stage
View the document5.5 Timing of Cord Clamping
View the document5.6 Immediate Care of the Newborn
View the document5.7 Care of the Mother Immediately after Delivery of the Placenta
close this folder6. CLASSIFICATION OF PRACTICES IN NORMAL BIRTH
View the document(introduction...)
View the document6.1 Practices which are Demonstrably Useful and Should be Encouraged
View the document6.2 Practices which are Clearly Harmful or Ineffective and Should be Eliminated
View the document6.3 Practices for which Insufficient Evidence Exists to Support a Clear Recommendation and which Should be Used with Caution while Further Research Clarifies the Issue
View the document6.4 Practices which are Frequently Used Inappropriately
View the document7. REFERENCES
View the document8. LIST OF PARTICIPANTS
View the documentSAFE MOTHERHOOD RESOURCE LIST
View the documentBACK COVER

2.8 Cleanliness

Wherever labour and delivery are managed, cleanliness is a first and foremost requirement. There is no need for the form of sterility commonly used in an operating theatre, but nails must be short as well as clean and hands must be carefully washed with soap and water. Attention should be paid to the personal hygiene of birthing women and birth attendants as well as to the cleanliness of the environment and all materials used during birth. In some countries masks and sterile gowns are used traditionally to protect labouring woman from infection. For that purpose they are useless (Crowther et al 1989). However, in regions with a high prevalence of HIV and hepatitis B and C virus protective clothing is useful to protect the caregiver from contact with contaminated blood and other materials (WHO 1995).

WHO has established the contents of a clean delivery kit and its correct, effective use (WHO 1994a). The programmes already in place to advocate the positive effect of the use of the “three cleans” (hands, perineal area, umbilical area) need to be maintained or expanded. The contents of the clean delivery kit may vary from country to country, but they must fit the specific needs of the women giving birth and be easily obtainable at every street corner and in all remote regions of a country. These simple but effective kits can even be assembled at home and include a new, sterile razor blade for the umbilical cord. The clean delivery kit itself and its contents should indeed be clean and need not be sterilized. The disposable materials in the kit should not be reused.

Instruments destined to be reused should be decontaminated appropriately according to guidelines provided by WHO (1995). Equipment which comes into contact with intact skin can be washed thoroughly, instruments which come into contact with mucous membranes or non-intact skin should be sterilized, boiled or chemically disinfected, and instruments which penetrate the skin should be sterilized. These methods serve to prevent the contamination of women and caregivers.

Some measures should be taken during all deliveries, to prevent possible infection of the woman and/or the birth attendant. These measures include the avoidance of direct contact with blood and other body fluids, by the use of gloves during vaginal examination, during delivery of the infant, and in handling the placenta. It is important to reduce the potential for infection by keeping invasive techniques such as episiotomy to the strict minimum and taking additional care with the use and disposal of sharp instruments (for instance during suturing) (ICN 1996).