Podcast
Questions and Answers
What is the primary goal of the Ritgen maneuver during the birth of the fetal head?
What is the primary goal of the Ritgen maneuver during the birth of the fetal head?
- To expedite delivery by applying vacuum pressure
- To control extension of the fetal head and prevent perineal lacerations (correct)
- To administer anesthesia to the mother
- To facilitate the spontaneous birth without assistance
Which approach can decrease the duration of the expulsive phase during delivery?
Which approach can decrease the duration of the expulsive phase during delivery?
- Vacuum extraction
- One-step birth approach (correct)
- Two-step birth approach
- Ritgen maneuver
How long is the mean head-to-body interval using the two-step approach?
How long is the mean head-to-body interval using the two-step approach?
- 24 seconds
- 60 seconds
- 45 seconds
- 88 seconds (correct)
What factor is enhanced by close communication between the midwife and the woman during delivery?
What factor is enhanced by close communication between the midwife and the woman during delivery?
What is true about the Ritgen maneuver in its modified form?
What is true about the Ritgen maneuver in its modified form?
What is one reason the Ritgen maneuver is rarely used today?
What is one reason the Ritgen maneuver is rarely used today?
Which statement best describes the two-step birth approach?
Which statement best describes the two-step birth approach?
What does the combination of uterine contraction and maternal pushing effort lead to?
What does the combination of uterine contraction and maternal pushing effort lead to?
What is a significant consideration when choosing between a one-step and two-step method for facilitating birth?
What is a significant consideration when choosing between a one-step and two-step method for facilitating birth?
What is the primary goal of the first hand placement during birth?
What is the primary goal of the first hand placement during birth?
Which technique has the most evidence for decreasing the incidence of perineal lacerations?
Which technique has the most evidence for decreasing the incidence of perineal lacerations?
When is the two-step physiologic method considered safe to use?
When is the two-step physiologic method considered safe to use?
What is the main purpose of applying warm compresses during childbirth?
What is the main purpose of applying warm compresses during childbirth?
Which positioning is recommended when the fetus is in an occiput anterior position?
Which positioning is recommended when the fetus is in an occiput anterior position?
Which hand technique entails placing one hand on the fetal head to control extension during birth?
Which hand technique entails placing one hand on the fetal head to control extension during birth?
What does the term 'hands off' refer to during the birth process?
What does the term 'hands off' refer to during the birth process?
What is the primary goal when controlling the extension of the fetal head during crowning?
What is the primary goal when controlling the extension of the fetal head during crowning?
Which technique is used by the midwife to control the extension of the fetal head?
Which technique is used by the midwife to control the extension of the fetal head?
What happens when just the fingertips are placed on the fetal head?
What happens when just the fingertips are placed on the fetal head?
How should the midwife apply pressure when using a second hand to support the perineum?
How should the midwife apply pressure when using a second hand to support the perineum?
What is the first step to check for a nuchal cord after the head has emerged?
What is the first step to check for a nuchal cord after the head has emerged?
What should be done if the nuchal cord is determined to be loose?
What should be done if the nuchal cord is determined to be loose?
What technique is used if the nuchal cord is too tight to reduce but has some mobility?
What technique is used if the nuchal cord is too tight to reduce but has some mobility?
Why is controlling the pace of extension important during delivery?
Why is controlling the pace of extension important during delivery?
What should be done if the cord is too tight to perform the somersault maneuver?
What should be done if the cord is too tight to perform the somersault maneuver?
Which position is NOT appropriate for a woman during labor when applying the hand maneuvers for birth?
Which position is NOT appropriate for a woman during labor when applying the hand maneuvers for birth?
What is the main purpose of waiting for the next contraction during the birthing process?
What is the main purpose of waiting for the next contraction during the birthing process?
What is indicated by the rotation of the occiput 90° during birth?
What is indicated by the rotation of the occiput 90° during birth?
What should the midwife avoid doing during the birth of the anterior shoulder?
What should the midwife avoid doing during the birth of the anterior shoulder?
Which hand position should the midwife use while facilitating the birth of the shoulders?
Which hand position should the midwife use while facilitating the birth of the shoulders?
What is the first action to take if the infant's body is allowed to somersault over the perineum?
What is the first action to take if the infant's body is allowed to somersault over the perineum?
During which step of the birth process is suctioning with a bulb syringe deemed unnecessary?
During which step of the birth process is suctioning with a bulb syringe deemed unnecessary?
What position should the woman be in when facilitating the birth of a fetus in an occiput anterior position?
What position should the woman be in when facilitating the birth of a fetus in an occiput anterior position?
What is the first secure grip that a midwife should maintain while facilitating birth?
What is the first secure grip that a midwife should maintain while facilitating birth?
What should be avoided while applying pressure on the fetal head during delivery?
What should be avoided while applying pressure on the fetal head during delivery?
What is a recommended action for preventing tension on the umbilical cord when placing the infant on the mother’s abdomen?
What is a recommended action for preventing tension on the umbilical cord when placing the infant on the mother’s abdomen?
How should the infant be positioned when moved onto the mother’s abdomen?
How should the infant be positioned when moved onto the mother’s abdomen?
What occurs when pulling down on the fetal head alone during delivery?
What occurs when pulling down on the fetal head alone during delivery?
Which hand movements should be performed to ensure the safely emergence of the posterior shoulder?
Which hand movements should be performed to ensure the safely emergence of the posterior shoulder?
What is the purpose of sliding the hand that supports the head down to grasp the infant's thighs?
What is the purpose of sliding the hand that supports the head down to grasp the infant's thighs?
What is the primary focus when handing the newborn to another clinician?
What is the primary focus when handing the newborn to another clinician?
Which method is NOT recommended for supporting the newborn's head during transfer?
Which method is NOT recommended for supporting the newborn's head during transfer?
What adjustment must be made during the birthing process of a fetus in the occiput posterior position?
What adjustment must be made during the birthing process of a fetus in the occiput posterior position?
What condition prevents a vaginal delivery in a face presentation while the mentum is posterior?
What condition prevents a vaginal delivery in a face presentation while the mentum is posterior?
What action should be taken immediately following the birth of a newborn?
What action should be taken immediately following the birth of a newborn?
Which component is NOT part of the initial assessment of the newborn?
Which component is NOT part of the initial assessment of the newborn?
What is the purpose of skin-to-skin contact immediately after birth?
What is the purpose of skin-to-skin contact immediately after birth?
What is the primary objective of delayed cord clamping?
What is the primary objective of delayed cord clamping?
Flashcards
Optimal time for fetal head birth
Optimal time for fetal head birth
The ideal moment for the fetal head to emerge, as it minimizes stress on the perineum and allows for controlled delivery.
Ritgen Maneuver
Ritgen Maneuver
A technique used to guide the fetal head out during birth, involving applying pressure on the chin and occiput to control head rotation.
Original Ritgen Maneuver
Original Ritgen Maneuver
The original Ritgen maneuver, which involved placing fingers inside the woman's rectum. Not commonly used today.
Modified Ritgen Maneuver
Modified Ritgen Maneuver
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Head-to-Body Interval
Head-to-Body Interval
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One-Step Birth
One-Step Birth
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Two-Step Birth
Two-Step Birth
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Mean Head-to-Body Interval (Two-Step)
Mean Head-to-Body Interval (Two-Step)
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Hands-on Technique
Hands-on Technique
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Semi-Sitting, Lateral or Dorsal Position
Semi-Sitting, Lateral or Dorsal Position
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Perineum
Perineum
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Biparietal Diameter
Biparietal Diameter
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Perineal Massage
Perineal Massage
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Warm Compresses
Warm Compresses
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Control of Fetal Head Extension
Control of Fetal Head Extension
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Supporting the Perineum
Supporting the Perineum
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Nuchal Cord Check
Nuchal Cord Check
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Cord Reduction
Cord Reduction
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Birth Through the Cord
Birth Through the Cord
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Cord Loosening
Cord Loosening
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Somersault Maneuver
Somersault Maneuver
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Rubin's Maneuver
Rubin's Maneuver
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Clamp and Cut
Clamp and Cut
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Shoulder Delivery Technique
Shoulder Delivery Technique
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Restitution
Restitution
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External Rotation
External Rotation
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Shoulder Birth
Shoulder Birth
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Shoulder Birth Support
Shoulder Birth Support
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C-Shape Cup
C-Shape Cup
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Upward Pressure on Head
Upward Pressure on Head
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Final Birth Phase
Final Birth Phase
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Newborn Positioning
Newborn Positioning
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Brachial Plexus Risk
Brachial Plexus Risk
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Moving the Newborn
Moving the Newborn
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Secure Newborn Grip
Secure Newborn Grip
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Skin-to-Skin Contact
Skin-to-Skin Contact
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Upward Pressure for Occiput Posterior
Upward Pressure for Occiput Posterior
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Apgar Score
Apgar Score
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Delayed Cord Clamping
Delayed Cord Clamping
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Umbilical Cord Blood Banking
Umbilical Cord Blood Banking
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Study Notes
Fetal Head Birth
- The ideal time for fetal head birth is between contractions.
- The combination of uterine contractions and maternal pushing creates a double force on the perineum, leading to a faster and more abrupt release of pressure.
- Communication between the midwife and the woman is crucial for a team approach, focusing on gentle delivery and perineal integrity.
Ritgen Maneuver
- An older technique where the clinician applies pressure on the fetal chin and occiput to control head birth.
- The fetal chin is palpated, pulled forward, and the opposing hand maintains flexion of the occiput.
- This maneuver pulls the fetal head forward while maintaining flexion.
- It's performed between uterine contractions.
- The initial purpose was to control fetal head extension and prevent perineal tears.
- Rarely used today, as vacuum or forceps are preferred for operative vaginal births.
- The original procedure involved placing fingers in the rectum. The modified procedure places the fingers between the rectum and coccyx.
- The maneuver does not reduce perineal lacerations.
- It may sometimes expedite delivery.
Steps for Ritgen Maneuver
- One hand maintains flexion of the occiput while the other hand palpates the fetal chin.
- The hand on the occiput remains in place until the biparietal diameters are visible.
- The other hand, using a sterile towel, protects the rectum and palpates the fetal chin located between the coccyx and rectum.
- Pressure is applied to the underside of the fetal chin for controlled extension while applying simultaneous pressure on the occiput, managing birth pace.
Head-to-Body Interval and Two-Step Birth
- The midwife can immediately assist in body delivery after head birth (one-step) or wait for the next contraction before guiding the shoulders and body out (two-step).
- The two-step approach is considered physiological.
- The one-step approach may lessen the expulsive phase and prevent neonatal acidemia.
- The average head-to-body interval for a two-step process is around 88 seconds, compared to 24 seconds for the one-step.
- The decision on one step vs two step is based on individual circumstances, and whether or not the fetus is at risk for acidemia.
Hand Maneuvers for Birth
- Initial hand placement prioritizes perineal integrity as the fetus emerges.
- After head emergence, hand placement is crucial for maintaining newborn support throughout delivery.
- Newborns are slippery, and contractions may cause forceful delivery.
- Controlling fetal head extension minimizes perineal tears.
- Techniques include: perineal massage, warm compresses, "hands off" (avoiding touching until biparietal diameter visible), "hands on" (flexion of the fetal head to control extension and supporting the perineum), and Rubin's maneuver.
Hand Maneuvers for Occiput Anterior Position
- The midwife positions herself for clear visibility and access to the perineum.
- A sterile drape is placed near by for instrument and placenta placement.
- To prevent sudden extension of the fetal head, the palmar side of one hand is placed on the occiput.
- If a second hand is used, the other hand supports the perineum, keeping the area between the thumb and finger in line with any possible tear zone.
- The goal is to prevent sudden extension of the fetal head during crowning, which helps lessen tearing of the perineum.
- Nuchal cord (cord around the neck) inspection following the head emergence.
Cord Reduction
- If the cord is loose, the midwife slips it forward over the head before the shoulders are delivered.
Birth Through the Cord
- The method is used when the cord is too tight for reduction but still moveable, permitting birth through the cord.
Somersault Maneuver
- The method is used when the cord is tight but moveable. This method involves using one hand to keep the head close to the mother’s thigh while the other hand rotates / "somersaults" the body over the perineum. Limiting the direct traction of the cord.
Clamp and Cut
- This method is preferred when the other methods aren't possible and the cord is too tight.
Hand Maneuvers for Birth (Continued)
- Wait for the next contraction and restitution/external rotation before proceeding.
- The occiput will rotate 90 degrees
- The midwives might use a modified Rubins maneuver for expediting.
- Positioning for shoulder birth: Position one hand on each clavicle(to control potential shoulder extension issues and injury).
Rubin's Maneuver
- Two fingers are placed over the anterior shoulder and two against the clavicle of the posterior shoulder.
- Pressure is applied to move the infant's head into the oblique diameter of the outlet.
Following Birth
- Skin-to-skin contact with the newborn.
- Clamping and cutting the umbilical cord, perhaps delayed clamping.
- Umbilical cord blood banking is an option.
- Inspection of the perineum and any laceration repair.
- Apgar score to evaluate the newborn's condition.
Hand Skills for Occiput Posterior Position
- The direction of pressure is upward to maintain fetal head flexion, as the occiput (back of head) is closer to the rectum.
- Release upward pressure in a controlled manner once the biparietal diameters are visible to allow extension.
- Used in face presentation, chin (mentum) is under the symphysis, the rest of the head is delivered through neck flexion.
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Description
Explore the techniques and best practices involved in fetal head delivery, focusing on the optimal timing during contractions. Understand the Ritgen Maneuver's historical context and its application in controlling fetal head birth while preserving perineal integrity. Gain insights into modern alternatives in operative vaginal births.
