These family-centric interventions should be provided in recognition of the value of inclusion in the birthing process for many women and their families, irrespective of delivery mode. Birthing units should carefully consider adding family-centric interventions that are otherwise not already considered routine care and that can be safely offered, given available environmental resources and staffing models. Obstetrician–gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches, when appropriate, for the intrapartum management of low-risk women in spontaneous labor. For most women, no one position needs to be mandated or proscribed. Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids. Multiple nonpharmacologic and pharmacologic techniques can be used to help women cope with labor pain. The widespread use of continuous electronic fetal monitoring has not been shown to significantly affect such outcomes as perinatal death and cerebral palsy when used for women with low-risk pregnancies. Data suggest that for women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring. Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor. Admission during the latent phase of labor may be necessary for a variety of reasons, including pain management or maternal fatigue. For women who are in latent labor and are not admitted to the labor unit, a process of shared decision making is recommended to create a plan for self-care activities and coping techniques. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. The postdelivery status of the mother and newborn is assessed and recorded.ABSTRACT: Obstetrician–gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that require minimal interventions and have high rates of patient satisfaction. Traction on the cord to hasten placental separation is contraindicated. The patient is assessed for signs of placental separation (small gush of blood, more cord protruding from the vagina, fundal rebound). Standard birthing protocols are then followed, such as using a bulb syringe to suction the newborn as needed, drying the infant, and placing the newborn on the mother's abdomen (skin to skin) in a head-dependent position to facilitate drainage of mucus and fluid. Gentle upward traction assists delivery of the posterior shoulder, and the body emerges as the mother gently pushes. He or she places one hand on either side of the infant's head and gently exerts downward traction to deliver the anterior shoulder. The health care provider unwinds the cord and suctions the infant's nose and mouth. If it is tightly looped, two clamps are used to occlude the cord and cut it between them the clamp is left in place. If the cord loosely encircles the infant's neck, it should be slipped over the infant's head. The health care provider immediately feels for a nuchal cord. The head should be born between contractions and supported as it emerges. If the amniotic sac is intact, the membranes are to be broken. ![]() As crowning occurs, the health care provider uses the dominant hand to gently support the oncoming fetal head and the other hand to support the woman's perineum. ![]() If time permits, the health care provider opens the emergency delivery pack, scrubs, and gloves, and places a sterile drape under the patient's buttocks. To diminish the urge to push, the woman should be encouraged to pant.Įmergency delivery by health care professionals. Signs to be alert for are an accelerating second stage, such as the abrupt onset of strong contractions, an intense urge to bear down, or the patient's conviction that delivery is imminent. ![]() See: precipitate labor Patient careĪlthough primiparas may experience unduly rapid labor and delivery, the event is more common among multiparas. An unexpected birth caused by swift progression through the second stage of labor with rapid fetal descent and expulsion.
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