A vaginal examination is done to determine position and station of the fetal head; the head is usually the presenting part. When effacement is complete and the cervix is fully dilated, the woman is told to bear down and strain with each contraction to move the head through the pelvis and progressively dilate the vaginal introitus so that more and more of the head appears. When about 3 or 4 cm of the head is visible during a contraction in nulliparas (somewhat less in multiparas), the following maneuvers can facilitate delivery and reduce risk of perineal laceration:
The clinician, if right-handed, places the left palm over the infant’s head during a contraction to control and, if necessary, slightly slow progress.
Simultaneously, the clinician places the curved fingers of the right hand against the dilating perineum, through which the infant’s brow or chin is felt.
To advance the head, the clinician can wrap a hand in a towel and, with curved fingers, apply pressure against the underside of the brow or chin (modified Ritgen maneuver).
Thus, the clinician controls the progress of the head to effect a slow, safe delivery.
This video demonstrates hand maneuvers for assisting with a normal delivery that is taking place in a bed.
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