Delivery of the baby

Conduction of delivery -
It divided into three phases -
                - Delivery of the head
                - Delivery of the shoulders
                - Delivery of the trunk

Delivery of the head - 
The principles to be followed are
- to maintain flexion of the head.
- to prevent its early extension.
- to regulate its slow escape out of the vulval outlet.

General measures -
- The patient is encouraged for the bearing down efforts during uterine contractions.
  This facilitates descent of the head.
- When the scalp is visible for about 5 cm in diameter, flexion of the head is maintained
  during contractions.
- At this stage, the maximum diameter of the head (biparietal diameter) stretches the vulval
  outlet without any   recession of the head even after the contraction is over and it is called
  ''crowning of the head''.
- When the perineum is fully stretched, episiotomy is done.
- Slow delivery of the head in between the contractions is to be regulated.
- The forehead, nose, mouth and the chin are thus born successively over the stretched
  perineum by extension.

Care following delivery of the head -
- Immediately following delivery of the head, the mucus and blood in the mouth and pharynx
  are to be wiped   with sterile gauze piece on a little finger. Alternatively, mechanical or
  electrical sucker may be used.
- The eyelids are then wiped with sterile dry cotton swabs using one for each eye starting
  from the medial to the lateral canthus to minimize contamination of the conjunctival sac.
- The neck is then palpated to exclude the presence of any loop of cord.

Prevention of perineal laceration -
More attention should be paid not to the perineum but to the controlled delivery of head.
- Delivery by early extension is to be avoided.
- Spontaneous forcible delivery of the head is to be avoided.
- To deliver the head in between contractions.
- To perform timely episiotomy.
- To take care during delivery of the shoulders.

Delivery of the shoulders -
- Do not be hasty in delivery of the shoulders. Wait for the uterine contractions to come
  and for the movements of restitution and external rotation of the head to occur.
- External rotation shows that the shoulders are rotating into the antero-posterior diameter
  of the pelvic outlet, which is largest space.
- During the next contraction, the anterior shoulder is born behind the symphysis. If there is
  delay, the head is grasped by both hands and is gently drawn posteriorly until the anterior
  shoulder is released from under the pubis.

Delivery of the trunk -
After the delivery of the shoulders, the fore finger of each hand are inserted under the axillae
and the trunk is delivered gently by lateral flexion.