Fetal Head Birth and Ritgen Maneuver

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

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?

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?

24 seconds

60 seconds

45 seconds

88 seconds (correct)

What factor is enhanced by close communication between the midwife and the woman during delivery?

Team approach for gentle birth Signup and view all the answers

What is true about the Ritgen maneuver in its modified form?

It positions fingers between the rectum and the coccyx Signup and view all the answers

What is one reason the Ritgen maneuver is rarely used today?

There are safer alternative methods available Signup and view all the answers

Which statement best describes the two-step birth approach?

It allows for spontaneous restitution and shoulder delivery Signup and view all the answers

What does the combination of uterine contraction and maternal pushing effort lead to?

Rapid birth of the fetal head Signup and view all the answers

What is a significant consideration when choosing between a one-step and two-step method for facilitating birth?

The fetal heart rate pattern Signup and view all the answers

What is the primary goal of the first hand placement during birth?

To preserve perineal integrity Signup and view all the answers

Which technique has the most evidence for decreasing the incidence of perineal lacerations?

Controlling extension of the fetal head Signup and view all the answers

When is the two-step physiologic method considered safe to use?

When the fetus is not developing acidemia Signup and view all the answers

What is the main purpose of applying warm compresses during childbirth?

To reduce the likelihood of perineal lacerations Signup and view all the answers

Which positioning is recommended when the fetus is in an occiput anterior position?

Semi-sitting, lateral, or dorsal position Signup and view all the answers

Which hand technique entails placing one hand on the fetal head to control extension during birth?

Hands-on technique Signup and view all the answers

What does the term 'hands off' refer to during the birth process?

Avoiding any contact until the biparietal diameter is born Signup and view all the answers

What is the primary goal when controlling the extension of the fetal head during crowning?

To prevent sudden extension of the fetal head Signup and view all the answers

Which technique is used by the midwife to control the extension of the fetal head?

Using the palm of one hand on the occiput Signup and view all the answers

What happens when just the fingertips are placed on the fetal head?

Less control over head extension is present Signup and view all the answers

How should the midwife apply pressure when using a second hand to support the perineum?

Inward towards the middle of the perineum Signup and view all the answers

What is the first step to check for a nuchal cord after the head has emerged?

Palpating the infant's neck with fingertips Signup and view all the answers

What should be done if the nuchal cord is determined to be loose?

Slip it forward over the head before delivery of the shoulders Signup and view all the answers

What technique is used if the nuchal cord is too tight to reduce but has some mobility?

Birth through the cord Signup and view all the answers

Why is controlling the pace of extension important during delivery?

To minimize the risk of maternal injury Signup and view all the answers

What should be done if the cord is too tight to perform the somersault maneuver?

Double-clamp and cut the cord before the infant’s body is born. Signup and view all the answers

Which position is NOT appropriate for a woman during labor when applying the hand maneuvers for birth?

Standing Signup and view all the answers

What is the main purpose of waiting for the next contraction during the birthing process?

To allow restitution and external rotation to occur. Signup and view all the answers

What is indicated by the rotation of the occiput 90° during birth?

The shoulder rotation is beginning. Signup and view all the answers

What should the midwife avoid doing during the birth of the anterior shoulder?

Gripping the fetus's neck. Signup and view all the answers

Which hand position should the midwife use while facilitating the birth of the shoulders?

Little fingers closest to the perineum, thumbs away. Signup and view all the answers

What is the first action to take if the infant's body is allowed to somersault over the perineum?

Ensure a firm hold on the head with one hand. Signup and view all the answers

During which step of the birth process is suctioning with a bulb syringe deemed unnecessary?

While waiting for restitution and external rotation. Signup and view all the answers

What position should the woman be in when facilitating the birth of a fetus in an occiput anterior position?

Semi-sitting, lateral, or dorsal position Signup and view all the answers

What is the first secure grip that a midwife should maintain while facilitating birth?

Gripping the chest and back between thumb and fingers Signup and view all the answers

What should be avoided while applying pressure on the fetal head during delivery?

Laterally flexing the infant's neck Signup and view all the answers

What is a recommended action for preventing tension on the umbilical cord when placing the infant on the mother’s abdomen?

Confirm there is no tension on the umbilical cord Signup and view all the answers

How should the infant be positioned when moved onto the mother’s abdomen?

Head and face slightly lower than the body Signup and view all the answers

What occurs when pulling down on the fetal head alone during delivery?

It widens the angle between neck and shoulder Signup and view all the answers

Which hand movements should be performed to ensure the safely emergence of the posterior shoulder?

Pivot the hand under the fetal head and form a C-shape Signup and view all the answers

What is the purpose of sliding the hand that supports the head down to grasp the infant's thighs?

To create a more secure grip Signup and view all the answers

What is the primary focus when handing the newborn to another clinician?

Providing a secure grip on the neck and shoulders Signup and view all the answers

Which method is NOT recommended for supporting the newborn's head during transfer?

Extending the fingers to support the chest only Signup and view all the answers

What adjustment must be made during the birthing process of a fetus in the occiput posterior position?

Apply upward pressure to support head flexion Signup and view all the answers

What condition prevents a vaginal delivery in a face presentation while the mentum is posterior?

Short neck Signup and view all the answers

What action should be taken immediately following the birth of a newborn?

Immediately clamp and cut the umbilical cord Signup and view all the answers

Which component is NOT part of the initial assessment of the newborn?

Inspection of the perineum Signup and view all the answers

What is the purpose of skin-to-skin contact immediately after birth?

Encourage bonding between the mother and infant Signup and view all the answers

What is the primary objective of delayed cord clamping?

To facilitate blood transfer from the placenta to the newborn Signup and view all the answers

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.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

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.