Vaginal Delivery

Chapter 11 Vaginal Delivery



Common indications


A vaginal delivery begins with the second stage of labor, which begins when the cervix is fully dilated. Confirm that the cervix is fully dilated by performing a cervical examination. During the second stage, uterine contractions and maternal pushing efforts move the fetus down from the pelvis to the introitus (Figure 11-1). The patient can begin pushing or is allowed to labor down for a period of time. The patient has several positions that she can use during the second stage. She can push in the squatting, supported supine, or side position.


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FIGURE 11-1 A-E. Cardinal movement of the fetus during the second stage of labor.



Equipment


The key equipment needed for a routine vaginal delivery includes a bulb suction, gauze, two hemostats for cord clamping, scissors for cutting the cord, and ring forceps to extract membranes or to aid in the examination after delivery. Instruments for suturing a laceration should also be included in the delivery kit (Figure 11-2). While the patient is pushing, prepare your equipment for delivery. Make preparations for the active management of the third stage of labor and immediate newborn care after delivery. Prepare the administration of pitocin for either 10 mg IM, 5 mg IV, or 20 mg IV in a liter of normal saline over 1 to 2 hours.


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FIGURE 11-2 Equipment.



Key steps



1. Preparation: The patient can lie on her back during the delivery, squat, or use stirrups, depending on her comfort with the position and the clinical situation. The squat position does not allow the physician to intervene easily, so it should be reserved for low-risk deliveries only.

2. Anesthesia: The patient may elect for no anesthesia, epidural, pudendal, or local blocks.

3. Delivery of head: As the infant’s head begins to crown, use one hand to apply light pressure to the head. Control the delivery of the head with minimal contact, and do not resist the maternal forces that are pushing out the infant (Figure 11-3). There is no evidence that suggests supporting the perineum reduces the incidence of perinea1 lacerations.

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Dec 12, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Vaginal Delivery

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