Emergency vaginal delivery

  1. Describe plan for complicated delivery, including shoulder dystocia, breech presentation, prolapsed cord and perimortem C-section
  2. Call for help: OB and NICU/peds/colleague/ancillary staff
  3. Gather equipment: betadine, sterile gloves, towels, 2 clamps, scissors, newborn warmer and bag. “Born on Arrival” kit if available.
  4. Apply pressure at perineum with left hand covered by a towel
  5. Place right hand on occiput to control delivery of the head
  6. Deliver the head and directs mother to stop pushing
  7. Check back of neck for cord. If present, lift anteriorly over head. If unable, clamp and cut cord and deliver quickly
  8. Exert downward pressure on head and neck to deliver anterior shoulder using “V” shape of index and middle finger of right hand
  9. Exert upward pressure on head and neck to deliver the posterior shoulder using a “C” shape of thumb and index finger of left hand
  10. Deliver the rest of body with left hand around neck and right hand supporting body
  11. Place baby on mother or warmer
  12. Clamp cord twice at least 5 cm from newborn’s abdomen and cut between clamps
  13. Proceed with newborn resuscitation (warm, dry, stimulate)