Normal Midwifery( maternity for nursing)
NursesCatalysts

Step-by-Step Guide to Spontaneous Vaginal Delivery: Preparation, Implementation, and Completion

Step-by-Step Guide to Spontaneous Vaginal Delivery: Preparation, Implementation, and Completion.

A comprehensive guide for midwives on performing a safe spontaneous vaginal delivery—covering preparation, indications, contraindications, equipment, active third stage management, and essential newborn care

COMPETENCES

• To conduct the normal delivery

• To be able to interpret the partograph.

To manage the third stage of labor with engagement and attentiveness.

• To help the baby breathe

INDICATIONS

• Term pregnancy

• Vertex presentation

• Frank or complete breach presentation

• Adequate maternal pelvis

CONTRA INDICATIONS:

• Cephalopelvic Disproportion (CPD)

• Malposition and malpresentation

• Complete placenta previa and vasa previa

• Pulsating cord prolapse and cord presentation

PREPARATION

Midwifery

    • Wear a clean and fitting uniform.

    • Use closed shoes with a short heel.

    • Tie back hair and wear a head cap.

    • Keep nails trimmed and unpainted.

    • Avoid makeup and jewelry.

  • Environment (ensure privacy, ventilation, and well-lit).

  • Infection control (handwashing, waste management).


Client

  • Introduce the client and request informed consent.

  • Explain the delivery process to the client and their guest. Listen attentively to their questions and concerns. Respond to their needs.

  • Respect dignity and the privacy (respectful maternity care).

  • Ask the client to empty her bladder and explain why; assist her if necessary.

    Equipment

• Disinfection set (sterile packet with a gall pot, five swabs, and Kocher forceps)

• Set for episiotomy (Kocher, scissors, surgical forceps, anatomical forceps, hold needle)

• 1 sterile amnihook in case of need.

• 1 sterile urinary catheter in case of need.

• Non-irritant solution for disinfection.

• Gloves (examination gloves, sterile gloves)

• Tray or trolley

• Mackintosh and sterile drapes

• Material of protection: plastic apron, boots, glasses, hat, and mask.

• A folding screen if no curtains are available.

• Bucket with a solution for decontamination.

• Local anesthesia (lidocaine 2%)

• Syringe of 10 mL and two needles.

• Syringe of 2 ml and 2 needles (1 for aspiration and 1 for IM injection)


• 1 ampoule of 10 IU oxytocin.

• Gauzes

• Fetoscope, Doppler

• Ensure the newborn resuscitation equipment is ready and working.

Check the following items:

  • Suction catheters

  • Aspirator machine

  • Oxygen

  • Ambu bags

  • Masks

  • Resuscitation table with an overhead heater.

• Material for taking vital signs.

• Container for placenta, dustbin.

• Bucket for decontamination with a solution of disinfection (chlorate solution 0.5%).

• Client records.


IMPLEMENTATION

  • Give her continuous emotional support and reassure her.

  • Choose the delivery position with the woman. Options include:

    • Squatted position

    • Knee position

    • Lateral position

    • Gynecological position with cushions or pillows for support.

  • Let the client push on her own after full dilation. This is best when the baby is well positioned in the pelvis.

  • Listen to the FHR after each contraction.

  • Make sure that the bladder is empty; if not, empty the bladder by inserting a urinary catheter.

  • Put on the materials for protection (plastic apron, boots, glasses, hat, and mask).

Wash and dry your hands.

  • Put on the examination gloves.

  • Clean the vulva and the perineum with five gauzes dipped in a solution of disinfection. Clean from the top to bottom, either with examination gloves or Kocher’s forceps.

  • Decontaminate examination gloves before discarding them in the dustbin.

  • Disinfect your hands with alcohol. If not, wash them well with soap and water. Then, dry them with a sterile towel from the table or let them air dry.

  • Slide the sterile drape under the woman's buttocks. Make sure not to touch her or the table.

  • Put on the sterile gloves that are on the table.

  • Take a folded sterile drape/tissue from the table and put it on the abdomen of the client to receive the baby.

Delivery of the head

  • Place one hand’s fingers on the advancing head. This keeps it flexed to help control the delivery.

  • Use the other hand to support the perineum with gauze.

  • Evaluate for episiotomy if necessary (see the checklist for the episiotomy procedure).

  • Maintain a firm but delicate pressure on the head to maintain its flexion.

  • Ask the client to blow with a soft force to avoid pushing in the absence of a contraction.

  • Once you deliver the head, use your hand to receive it.

  • Wipe the mouth and nose of the baby with sterile gauze and remove any mucus.

  • Verify that the cord is not around the baby’s neck: if the cord does not tighten, make it slip over the head of the baby. If the cord tightens, apply two Kocher forceps and cut the cord between the two clamps.

  • Allow the head to rotate in a natural manner.

  • Delivery of the shoulders

  • Place a hand on each side of the baby’s head over the ears.

  • Pull down with a light touch to assist the front shoulder in sliding under the pubic symphysis.

  • When you see the axillary crease, lift the head and trunk. This helps the posterior shoulder move over the perineum.

  • Hold the baby around the chest to help deliver the trunk. Then, lift the baby onto the client’s abdomen and cover the baby.

  • Memorize the hour and the date of birth.

  • Inform the client about the sex of the baby and congratulate her.

  • Wait 2 to 3 minutes before clamping the umbilical cord. Also, check the umbilical pulse first.

  • Apply Kocher’s forceps to the umbilical cord 20 cm from the baby’s abdomen. Then, place the second forceps 25 cm from the baby.

  • Cut the cord between the two Kocher's forceps. Use the baby scissors and a gauze. This will help stop blood from spurting.


COMPLETION

Put the material used in the bucket of decontamination solution.

  • Leave the area tidy.

  • Wash and dry hands

    • Teach immediate breastfeeding.

    • Check the umbilical cord for bleeding.

    • Keep the baby warm.

    • Discuss immunization.

    • Cover family planning.

    • Talk about nutrition.

    • Emphasize hygiene.

    • Explain danger signs for mothers and babies.

  • Document the findings obtained in her file using the partograph

Further Reading

Back to Article List