Management of a Full-Term Spontaneous Delivery
Vaginal delivery is the preferred mode of delivery for full-term spontaneous labor, with approximately 96% of women with normal pregnancies who enter spontaneous labor at term achieving safe vaginal deliveries for themselves and their infants. 1
First Stage of Labor Management
- Admission Timing: Admit the patient when in active labor (≥6 cm dilation) to decrease unnecessary medical interventions
- Positioning: Encourage walking and upright positions to improve labor outcomes
- Monitoring:
- Use intermittent auscultation for fetal monitoring in low-risk deliveries
- Continuous electronic monitoring for high-risk cases
- Labor Support: Provide continuous emotional support which improves delivery outcomes and birthing experience 2
- Pain Management Options:
- Non-pharmacological: Breathing techniques, position changes, warm compresses
- Pharmacological: Epidural analgesia (does not increase cesarean delivery risk but may prolong labor)
- Systemic opioids or pudendal block as alternatives 2
Second Stage of Labor Management
- Pushing Technique: Allow spontaneous pushing when the woman feels the urge
- Duration: Allow adequate time for pushing before intervening, as research shows labor may progress more slowly than historically reported 2
- Perineal Support: Use warm perineal compresses to reduce trauma 2
- Nuchal Cord Management: If tight nuchal cord is present, it can be clamped twice and cut before delivery of shoulders, or managed with somersault maneuver 2
Third Stage of Labor Management
- Placental Delivery: Active management to prevent postpartum hemorrhage is recommended 2
- Administer oxytocin after delivery of the anterior shoulder or immediately after birth
- Apply controlled cord traction with counter-pressure on the uterus
- Perform uterine massage after placental delivery
Immediate Postpartum Care
- Cord Clamping: Delayed cord clamping is beneficial for neonatal outcomes 2
- Skin-to-Skin Contact: Initiate immediately after birth 2
- Newborn Assessment: Beyond 35 weeks' gestation, there is no benefit to routine bulb suctioning of the nose and mouth 2
- Perineal Repair: Carefully examine for external anal sphincter injuries and use absorbable synthetic suture for second-degree perineal laceration repair 2
Special Considerations
- Episiotomy: Routine episiotomy increases morbidity and should be avoided 3
- Group B Streptococcus: Follow CDC guidelines for prophylaxis in GBS-positive women 2
- Maternal Age: Be aware that advancing maternal age is associated with higher rates of augmentation, operative delivery, and perineal trauma 4
Practices to Avoid
- Discontinuing epidurals late in labor (does not reduce need for operative vaginal delivery) 2
- Routine episiotomy 2, 3
- Unnecessary interventions that may disrupt the natural process of labor
The European Society of Cardiology guidelines emphasize that spontaneous onset of labor is appropriate for women with normal cardiac function and is preferable to induced labor for most women 5. This aligns with evidence showing that the vast majority of women with uncomplicated pregnancies who enter spontaneous labor at term can anticipate safe vaginal deliveries with rare adverse neonatal outcomes 1.