How to do Spontaneous Vaginal Delivery | Merck Manual Professional Version

How to do Spontaneous Vaginal Delivery | Merck Manual Professional Version

Learn how to do routine spontaneous vaginal delivery:

Ensure full cervical dilation before assisting delivery. Feel the fetal suture lines and fontanelles to assess fetal position. Use the dorsal lithotomy position. Feel the uterus or do tocometry if epidural anesthesia is used. Perineal bulging heralds crowning. Control the rate of delivery and help the head clear the pubic symphysis. Avoid episiotomy. Look for nuchal cord. After restitution, grasp the mandible and pull downward. Deliver the shoulders and begin oxytocin infusion. Strip, clamp, and cut the umbilical cord. Bulb suction and nose. If meconium was not passed, stimulate the infant.

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Procedure by Will Stone, MD, and Kate Leonard, MD, Walter Reed National Military Medical Center Residency in Obstetrics and Gynecology; and Shad Deering, COL, MD, Chair, Department of Obstetrics and Gynecology, Uniformed Services University. Assisted by Elizabeth N. Weissbrod, MA, CMI, Eric Wilson, 2LT, and Jamie Bradshaw at the Val G. Hemming Simulation Center at the Uniformed Services University.