![]() ![]() This is to slow the head and reduce the likelihood of significant tears. Some providers will support the perineum with one hand and maintain the head in flexion, often using a warm towel. Once the chin is delivered, the head drops downward.Īdvise the mother to push gently as the head crowns. Crowning occurs as the maximal head circumference is present at the vaginal opening. The head progressively stretches the perineum and vaginal opening, and the occiput, forehead, nose, and chin progressively pass through. These combine to produce a main force in the direction of the vaginal opening. ![]() Pressure from the uterus acts posteriorly, and pressure from the symphysis acts anteriorly. This may also be a good time to offer a pudendal block.Įxtension occurs with progression of the head to the vulva. Other providers adopt a 'hands off' approach, citing evidence that massage does not improve outcomes ( Stamp et al, 2011). Some providers will gently stretch the perineum. Normally the occiput is turned towards symphysis pubis (OA, occiput anterior position), but in approximately 20% of cases, the head rotates occiput posterior (OP). Internal Rotation occurs as the head descends through the pelvis in the majority of cases. It is further encouraged during labour by resistance from cervix, walls of pelvis, and pelvic floor. It is present before labour to some degree due to natural muscle tone. Monitor cervical change throughout labour, as described here.įlexion is the movement of the chin towards to thorax, and is important to optimize the presenting diameter of the head. It is brought about by pressure of the amniotic fluid, pressure from the uterus on the fetus, maternal efforts of bearing down, and elongation of the fetus. Descent occurs at greater rate during latter part of the 1st stage and 2nd stage. This normally occurs 2-3 weeks before labour in nulliparous women and may occur any time before or after onset of labour in multiparous women.ĭescent occurs prior to onset and then throughout labour. newborn supplies: suction, bag-valve mask, oxygenĮngagement is the descent of the widest part of the fetus through the pelvic inlet.clamps/sterile string, scalpel for the umbilical cord.There are many ways of learning how to deliver an infant we recommend praticing with a Laerdal MamaNatalie trainer, available for use in low-resource settings. It is critical for the health care team to regularly practice and be prepared for these situations. While the majority of deliveries are joyful and otherwise uneventful, there are a few true emergencies, including shoulder dystocia, postpartum hemorrhage, and neonatal apnea that can quickly arise. Regardless of the steps taken, care is required to maintain a low risk of infection to mother and baby. In most centres, routine episiotomy is no longer used, and some allow the mother and baby to accomplish the work of delivery with very little guidance. Others take a much more 'hands-off' approach. Many physicians take an active role in guiding the infant out, in the interests of minimizing trauma to the birth canal. Different health providers approach delivery in different ways. ![]()
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