c. Assist With the Actual Delivery of the Head. This should be accomplished
between contractions to slow the force of expulsion.
d. Coach the Patient to Pant/Blow. This should be done as the head delivers.
However, she may be required to bear down slightly to assist with delivery of the large
diameter of the head. Panting and blowing helps to avoid pushing after delivery of the
head to allow time to bulb suction amniotic fluid from the infant's mouth.
e. Bulb Suction Amniotic Fluid from the Infant's Mouth. Place your finger
into the infant's mouth to allow insertion of the syringe.
f. Allow Rotation. Allow the infant to spontaneously accomplish external
g. Check for a Nuchal Umbilical Cord. Slide one or two fingers along the
anterior side of the infant's head and neck to the shoulder to assess for the presence of
a nuchal (around the neck) umbilical cord.
(1) If there is a loosely wrapped cord, the cord should be lifted and slid over
the infant's head. This is known as "reducing" the cord.
(2) If there is a tight nuchal cord, the cord must be clamped twice and cut
between the clamps.
(3) If the cord is loose, but cannot be lifted over the infant's head, it may be
slid over the delivering body.
A nuchal cord occurs in about 25 percent of all deliveries.
h. Allow Infant to Complete External Rotation. After complete rotation, place
your hands so that the palms are flat against the sides of the infant's head.
i. Coach the Patient to Push and to Pant/Blow. Tell the patient when to push
and when to pant/blow. This will assist with a controlled delivery of the shoulders.
(1) The nurse applies gentle downward pressure on the head until the
anterior shoulder delivers from under the pubic arch and becomes visible.
(2) Support the infant's head and neck. The infant is gently pushed or lifted
upward to facilitate delivery of the posterior shoulder.
j. Assist With Delivery of the Posterior Shoulder. After the delivery of the
posterior shoulder, the infant's body is generally expelled rapidly. However, if the infant
is large, the mother may have to assist by pushing.