Spontaneous Vaginal Delivery


Spontaneous Vaginal Delivery, Vaginal Delivery, Vaginal Birth, Normal Spontaneous Vaginal Delivery, NSVD

  • Epidemiology
  1. Vaginal Birth accounts for 70% of deliveries in the United States
    1. Of the 4 million births in the U.S. in 2013, three million were vaginal deliveries
  • Contraindications
  1. Complete Placenta Previa
  2. Active genital Herpes Simplex Virus (or prodromal symptoms) at time of labor
  3. Malpresentation
    1. Non-Frank Breech
    2. Transverse Lie
    3. Face Presentation with mentum anterior
  4. Prior uterine surgery that raises risk of labor-induced Uterine Rupture
    1. History of classic uterine incision (vertical uterine incision)
    2. History of significant transfundal uterine surgery
  5. Untreated HIV Infection
  • Management
  • Vertical Transmission Prevention
  • Management
  • Labor Stage 2
  1. Labor Progression
    1. See Labor Augmentation
    2. See Active Management of Labor
    3. See Labor Coaching
    4. See Fetal Heart Tracing
  2. Assisted Delivery
    1. See Vacuum Assisted Delivery
    2. See Forceps Assisted Delivery
    3. See Manual Rotation in Occipitoposterior Presentation
    4. See Shoulder Dystocia Management
  3. Newborn Care
    1. See Newborn Resuscitation
  4. Other procedures
    1. See Perineal Laceration Repair
  5. Cord Management
    1. Check for nuchal cord as infant's head is delivered
      1. Pull loose nuchal cord's over the infant's head
      2. Tight nuchal cords are associated with increased infant complications
        1. Apply 2 clamps to the nuchal cord and cut the cord between clamps OR
        2. Summersault maneuver
          1. Deliver the anterior and posterior Shoulder
          2. Next, hold infant head by maternal thigh
          3. Next, deliver body by summersault
          4. Remove nuchal cord once body is delivered
    2. Cord clamping
      1. Consider delayed cord clamping in all deliveries not requiring emergent Resuscitation
      2. Wait 1-3 minutes after delivery to clamp cord or until cord stops pulsating
      3. Clamp cord with at least 2-4 cm between the infant and the closest clamp
        1. Allows for umbilical venous catheter
      4. Infant does not need to be below the level of the placenta prior to cord clamping
        1. Vain (2014) Lancet 384(9939): 235-40 [PubMed]
      5. Delayed cord clamping improves infant birth weight, Hemoglobin, iron stores
        1. McDonald (2013) Cochrane Database Syst Rev (7):CD004074 [PubMed]