The management of spontaneous vaginal delivery requires monitoring of maternal and fetal safety. Appropriate clinical personnel and equipment should be available. Patients may be accompanied by their partner or other support person or a doula.
During the second stage of labor, a vaginal examination is done to determine position and station of the fetal head; the head is usually the presenting part. The patient pushes until the fetus crowns, meaning the fetal head (or other presenting part) appears and does not recede between contractions and is firmly applied to the vaginal introitus (see figure Sequence of Events in Delivery for Vertex Presentations).
To minimize maternal perineal injury during the birth, clinicians (or other birth attendants) control how rapidly the head is delivered by communicating with the patient about when to push and when to pause. Clinicians place their hands on the fetal head and mother’s perineum for support and to guide the delivery.
Forceps or a vacuum extractoris used to assist vaginal …