Makindo Medical Notes

👶 Normal (Spontaneous Vaginal) Delivery – Overview

Normal delivery refers to the natural, spontaneous birth of the baby through the vagina at term (≥ 37 weeks), following spontaneous onset of labour, without the need for operative assistance (forceps, ventouse, or caesarean section). The process occurs in three physiological stages and requires close coordination between the obstetric, midwifery, and neonatal teams. 🤝

🩺 Stage 1 – Cervical Dilatation

• Latent phase: Cervix effaces and dilates to ~4 cm. Contractions mild to moderate. Woman is supported, hydrated, and encouraged to mobilise.
• Active phase: 4–10 cm dilation with strong, regular contractions every 2–3 minutes. Monitor contractions, maternal pulse, BP, and fetal heart (CTG or Doppler). Assess progress by vaginal examination every 4 hours using a partogram. Encourage upright posture, analgesia as needed (TENS, gas & air, epidural if appropriate).

🤰 Stage 2 – Expulsion of the Fetus

• Begins at full cervical dilatation (10 cm) and ends with the birth of the baby.
• Maternal bearing-down efforts coordinated with contractions.
• Delivery sequence: Head engages → flexes → descends → rotates → extends → restitutes → shoulders and body delivered.
• The midwife supports the perineum (“hands-on” or “hands-poised”) to reduce tears.
• Check for nuchal cord (around neck) and deliver shoulders gently.
• Once born: dry and stimulate the baby, clamp and cut the cord after 1–3 minutes (delayed clamping), and place the baby skin-to-skin with mother. 🤱
• Assess Apgar scores at 1 and 5 minutes; handover to neonatal team if concerns.

🩸 Stage 3 – Delivery of the Placenta

• Begins immediately after birth of the baby and ends with expulsion of the placenta and membranes.
• Active management (standard in UK practice):
  • Administer IM oxytocin (10 IU) within 1 minute of birth.
  • Controlled cord traction with counter-pressure on uterus.
  • Inspect placenta and membranes for completeness and cord insertion.
• Physiological management (rarely used) — no uterotonic, placenta delivered spontaneously.
• Check uterus is well-contracted to reduce haemorrhage risk.

👩‍⚕️ Role of the Delivery Team

• 🧑‍🍼 Midwife: Continuous labour support, fetal and maternal monitoring, guiding pushing, delivering baby, assessing perineum, performing active management of third stage.
• 👩‍⚕️ Obstetrician: Present if risk factors arise (fetal distress, malposition, slow progress, bleeding, shoulder dystocia, etc.).
• 👶 Neonatal/Paediatric Team: Standby for high-risk deliveries; immediate newborn assessment, resuscitation if required.
• 🧍 Support partner: Provides emotional support and reassurance to the mother.

✅ After Delivery

• Examine the perineum for tears and repair as needed.
• Record maternal vitals, uterine tone, and vaginal loss.
• Encourage bonding, early breastfeeding, and skin-to-skin contact. 🤱
• Observe for postpartum haemorrhage or retained tissue.
• Document time of delivery, placenta, blood loss, and Apgar scores.

💡 Teaching Tip: Always observe calm, clear communication between the team. Labour is physiological but can become high-risk in minutes — the best teams anticipate rather than react. 🌟