![]() Women without an epidural who deliver in upright positions have a significantly reduced risk of assisted vaginal delivery and abnormal fetal heart rate pattern, but an increased risk of second-degree perineal laceration and an estimated blood loss of more than 500 mL. Provide continuous support during labor and delivery.ĭo not discontinue an epidural late in labor in an attempt to avoid assisted vaginal delivery.Īllow women to deliver in the position they prefer. Promote walking and upright positions (kneeling, squatting, or standing) for the mother in the first stage of labor. Practices that will not improve outcomes and may result in negative outcomes include discontinuation of epidurals late in labor and routine episiotomy. Postpartum maternal and neonatal outcomes can be improved through delayed cord clamping, active management to prevent postpartum hemorrhage, careful examination for external anal sphincter injuries, and use of absorbable synthetic suture for second-degree perineal laceration repair. Beyond 35 weeks' gestation, there is no benefit to bulb suctioning the nose and mouth. After delivery, skin-to-skin contact with the mother is recommended. A tight nuchal cord can be clamped twice and cut before delivery of the shoulders, or the baby may be delivered using a somersault maneuver in which the cord is left nuchal and the distance from the cord to placenta minimized by pushing the head toward the maternal thigh. ![]() Delayed pushing increases the length of the second stage of labor and does not affect the rate of spontaneous vaginal delivery. Outcomes in the second stage of labor can be improved by using warm perineal compresses, allowing women more time to push before intervening, and offering labor support. Pain management during labor includes complementary modalities and systemic opioids, epidural anesthesia, and pudendal block. Most women with a low transverse uterine incision are candidates for a trial of labor after cesarean delivery and should be counseled accordingly. In the first stage of labor, normal birth outcomes can be improved by encouraging the patient to walk and stay in upright positions, waiting until at least 6 cm dilation to diagnose active stage arrest, providing continuous labor support, using intermittent auscultation in low-risk deliveries, and following the Centers for Disease Control and Prevention guidelines for group B streptococcus prophylaxis. Most of the nearly 4 million births in the United States annually are normal spontaneous vaginal deliveries.
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