Emergency vaginal delivery

Steps

1. Call for help: OB and NICU/peds/colleague/ancillary staff.

2. Place the patient on her back with hips and knees flexed, anticipating delivery when crowning occurs (the fetal head will be visible at the vaginal introitus).

3. Apply pressure at perineum with left hand covered by a towel.

4. Deliver head: Place one hand over occiput to control, use opposite hand to exert pressure on the chin of the fetus through the perineum.

5. Deliver the head and direct mother to stop pushing.

6. Check the back of the neck for cord: If present, lift anteriorly over head (If unable, clamp and cut cord and deliver quickly).

7. Deliver anterior shoulder: Apply gentle downward (posterior) traction on head and neck using "V" shape of index and middle finger of one hand.

8. Deliver posterior shoulder: Gently lift the head and neck upward using a "C" shape of thumb and index finger of the opposite hand.

9. Deliver the rest of the body. Support neck with left hand and body with the right.

10. Clamp the cord twice 4-5 cm from infant's abdomen and cut between clamps.

11. Proceed with newborn resuscitation (warm, dry, stimulate).

12. Deliver the placenta (placental separation usually occurs within 5 minutes after delivery, but can be delayed up to 30 minutes; ask the mother to bear down to aid in delivery).

13. May exert gentle downward pressure on umbilical cord and fundal massage to aid in placental delivery.