Managing Complications in Pregnancy and Childbirth: - IAWG

C-74 Normal labour and childbirthNote: Episiotomy is no longer recommended as a routine procedure.There is no evidence that routine episiotomy decreases perinealdamage, future vaginal prolapse or urinary incontinence. In fact, routineepisiotomy is associated with an increase of third and fourth degreetears and subsequent anal sphincter muscle dysfunction.DEpisiotomy (page P-71) should be considered only in the case of:• complicated vaginal delivery (breech, shoulder dystocia,forceps, vacuum);• scarring from female genital mutilation or poorly healed thirdor fourth degree tears;• fetal distress.ELIVERY OF THE HEAD• Ask the woman to pant or give only small pushes withcontractions as the baby’s head delivers.• To control birth of the head, place the fingers of one hand againstthe baby’s head to keep it flexed (bent).• Continue to gently support the perineum as the baby’s headdelivers.• Once the baby’s head delivers, ask the woman not to push.• Suction the baby’s mouth and nose.• Feel around the baby’s neck for the umbilical cord:- If the cord is around the neck but is loose, slip it over thebaby’s head;- If the cord is tight around the neck, doubly clamp and cut itbefore unwinding it from around the neck.COMPLETION OF DELIVERY• Allow the baby’s head to turn spontaneously.• After the head turns, place a hand on each side of the baby’s head.Tell the woman to push gently with the next contraction.• Reduce tears by delivering one shoulder at a time. Move thebaby’s head posteriorly to deliver the shoulder that is anterior.