II. Epidemiology
- Vaginal Birth accounts for 70% of deliveries in the United States
- Of the 4 million births in the U.S. in 2013, three million were vaginal deliveries
III. Contraindications
- Complete Placenta Previa
- Active genital Herpes Simplex Virus (or prodromal symptoms) at time of labor
- Malpresentation
- Non-Frank Breech
- Transverse Lie
- Face Presentation with mentum anterior
- Prior uterine surgery that raises risk of labor-induced Uterine Rupture
- History of classic uterine incision (vertical uterine incision)
- History of significant transfundal uterine surgery
- Untreated HIV Infection
IV. Management: Vertical Transmission Prevention
V. Management: Labor Stage 1
- See First Stage of Labor
- See Fetal Heart Tracing
- Labor Progression
- Pain management
VI. Management: Labor Stage 2
- Labor Progression
- Assisted Delivery
- Newborn Care
- Other procedures
- Cord Management
- Check for nuchal cord as infant's head is delivered
- Pull loose nuchal cord's over the infant's head
- Tight nuchal cords are associated with increased infant complications
- Apply 2 clamps to the nuchal cord and cut the cord between clamps OR
- Summersault maneuver
- Deliver the anterior and posterior Shoulder
- Next, hold infant head by maternal thigh
- Next, deliver body by summersault
- Remove nuchal cord once body is delivered
- Cord clamping
- Consider delayed cord clamping in all deliveries not requiring emergent Resuscitation
- Wait 1-3 minutes after delivery to clamp cord or until cord stops pulsating
- Clamp cord with at least 2-4 cm between the infant and the closest clamp
- Allows for umbilical venous catheter
- Infant does not need to be below the level of the placenta prior to cord clamping
- Delayed cord clamping improves infant birth weight, Hemoglobin, iron stores
- Check for nuchal cord as infant's head is delivered
VII. Management: Labor Stage 3
- See Third Stage of Labor
- See Postpartum Hemorrhage
- See Retained Placenta
- See Uterine Inversion