Universal Safety Precautions during Deliveries

Why Universal Precautions Matter in Maternity Care

Childbirth involves massive exposure to body fluids, making infection control non-negotiable for every practicing midwife in Nigeria. Universal precautions mean treating every woman's blood, amniotic fluid, vaginal secretions, and other body fluids as potentially infectious, regardless of her known HIV or hepatitis status. Midwives face daily occupational risks from needle-stick injuries and accidental splashes during rapid deliveries. Routine application of these safety rules protects both the healthcare worker and the newborn baby from preventable hospital-acquired infections like puerperal sepsis and neonatal tetanus.

Mastering Hand Hygiene Before and After Childbirth

Handwashing remains the single most effective intervention to stop the spread of pathogenic microorganisms in any delivery suite. Midwives must perform hand hygiene before touching a pregnant woman, before any clean or aseptic procedure such as vaginal examination or catheterization, and immediately after body fluid exposure.

• Social handwashing: Using plain soap and running water to remove visible dirt and transient flora.
• Aseptic hand hygiene: Using an alcohol-based hand rub or antimicrobial soap before surgical procedures like episiotomy repair or Cesarean section assist.
• Post-delivery hand hygiene: Washing thoroughly after removing gloves to eliminate any micro-organisms that penetrated microscopic tears in the glove barrier.

Proper Personal Protective Equipment for the Midwife

During childbirth, the midwife acts in a high-splash environment requiring full barrier protection.

• Examination and surgical gloves: Sterile gloves are mandatory for vaginal examinations in active labor, artificial rupture of membranes, and delivery. Non-sterile gloves suffice for general cleaning or handling soiled linens.
• Plastic aprons and gowns: Waterproof aprons prevent amniotic fluid and blood from soaking through uniforms onto the midwife's skin or clothes.
• Face masks and eye protection: Goggles or face shields protect the conjunctiva of the eyes from sudden spurts of amniotic fluid, blood, or lochia during second stage push or perineal repair.

Safe Handling and Disposal of Sharp Instruments

Episiotomy scissors, suture needles, and disposable scalpel blades pose severe blood-borne infection risks, particularly for hepatitis B, hepatitis C, and HIV. Midwives must never recap used needles under any circumstances, as this action causes a high percentage of accidental puncture wounds. Sharps must be dropped immediately after use into a puncture-resistant safety box placed close to the point of care. Never overfill a sharps container beyond the designated fill line, and ensure it is sealed and disposed of through safe incineration protocols.

Managing Blood and Amniotic Fluid Splashes

Accidents happen quickly in bustling maternity wards, and fluid splashes to skin or mucous membranes demand prompt, calm action. If blood or amniotic fluid splashes into the eyes, rinse immediately with copious amounts of clean running water or normal saline while keeping the eyes open. If fluid splashes onto unbroken skin, wash the area thoroughly with soap and running water without scrubbing aggressively. For accidental punctures or cuts, encourage bleeding gently under running water, wash with soap and water, and report the incident immediately for post-exposure prophylaxis evaluation.

Decontamination and Processing of Delivery Instruments

Reused instruments like metal needle holders, speculums, and artery forceps require meticulous processing before they touch another patient.

• Decontamination: Immediately submerge used instruments in a 0.5% chlorine solution for 10 minutes to neutralize blood-borne viruses and bacteria.
• Cleaning: Wash the instruments thoroughly with brush, soap, and clean water to remove all remaining organic matter, blood clots, and tissue.
• Sterilization or High-Level Disinfection: Process cleaned instruments through autoclaving, dry heat sterilization, or boiling to ensure complete destruction of all microbial life.