Normal Spontaneous Vaginal Delivery

DEFINITION
Vaginal delivery is the method of childbirth most health experts recommend

for women whose babies have reached full term, or at least 37 weeks.
Compared to other methods of childbirth, such as a cesarean delivery and
induced labor, it’s the simplest kind of delivery process.
A spontaneous vaginal delivery is a vaginal delivery that happens on

its own, without requiring doctors to use tools to help pull the baby out. This
occurs after a pregnant woman goes through labor, which opens, or dilates,
her cervix to at least 10 centimeters.
Labor usually begins with the passing of a woman’s mucous plug. This
is a clot of mucous that protects the uterus from bacteria during pregnancy.
Soon after, a woman’s water may break. This is also called a rupture of
membranes. As labor progresses, strong contractions help push the baby
into the birth canal.
The length of the labor process varies from woman to woman. Women
giving birth for the first time tend to go through labor for 12 to 24 hours,
while women who have previously delivered a child may only go through
labor from six to eight hours.
There are three stages of labor that signal a spontaneous vaginal delivery is about to occur:
1. Contractions soften and dilate the cervix until it’s flexible and wide enough for the baby
to exit the mother’s vagina.
2. The mother must push to move her baby down her birth canal until it’s born.
3. The mother pushes her placenta (the organ surrounding the baby in the womb) down her
birth canal and out of her vagina.
II. MEDICAL MANAGEMENT
a. Diagnostic Tests
FETAL MONITORING
Fetal status must be monitored during labor. The main parameters are baseline fetal heart rate
(HR) and fetal HR variability, particularly how they change in response to uterine contractions
and fetal movement. Because interpretation of fetal HR can be subjective, certain parameters
have been defined. A normal pattern strongly predicts normal fetal acid-base status at the time of
observation. This pattern has all of the following characteristics:
 HR 110 to 160 beats/min at baseline

 Moderate HR variability (by 6 to 25 beats) at baseline and with movement or contractions
 No late or variable decelerations during contractions
Tests and procedures to diagnose labor include:
 Pelvic exam. Your health care provider might evaluate the firmness and tenderness of
your uterus and the baby's size and position. He or she might also do a pelvic exam to determine if
your cervix has begun to open — if your water hasn't broken and the placenta isn't covering your
cervix (placenta previa).
 Ultrasound. An ultrasound might be used to measure the length of your cervix and
determine your baby's size, age, weight and position in your uterus. You might need to be monitored
for a period of time and then have another ultrasound to measure any changes in your cervix,
including cervical length.
 Uterine monitoring. Your health care provider might use a uterine monitor to measure
the duration and spacing of your contractions.
 Lab tests. Your health care provider might take a swab of your vaginal secretions to
check for the presence of certain infections and fetal fibronectin — a substance that acts like glue
between the fetal sac and the lining of the uterus and is discharged during labor. However, this test
isn't reliable enough to be used on its own to assess the risk of preterm labor.
 Maturity amniocentesis. Your health care provider might recommend a procedure in
which amniotic fluid is removed from the uterus (amniocentesis) to determine your baby's lung
maturity. The technique can also be used to detect an infection in the amniotic fluid.
FOR PAIN CONTROL:
Agents given in intermittent doses for systemic pain control include the following :
 Meperidine, 25-50 mg IV every 1-2 hours or 50-100 mg IM every 2-4 hours
 Fentanyl, 50-100 mcg IV every hour
 Nalbuphine, 10 mg IV or IM every 3 hours
 Butorphanol, 1-2 mg IV or IM every 4 hours
 Morphine, 2-5 mg IV or 10 mg IM every 4 hours
As an alternative, regional anesthesia may be given. Anesthesia options include the following:
 Epidural
 Spinal
 Combined spinal-epidural
b. Drugs x 2-3
Type When/How Advantages Possible Side

Given Effects/Disadvan
tages
Oxytocin Given after Injection or one Cramping.
(Pitocin) delivery of the IV bag usually
placenta usually given after
in IV bag or delivery to
injection if no IV ensure that the
present. uterus remains
contracted and
may prevent
excessive
bleeding.
Causes the
uterus to
contract.
Methergine Given after Given when Cramping and
delivery either excessive nausea.
orally or by vaginal bleeding
injection. Often a occurs. Contraindicated if
series of six pills. high blood
Stronger than pressure
Oxytocin.
problematic.
III. SURGICAL MANAGEMENT ( if needed )
EPISIOTOMY
-.An episiotomy is a minor surgery that widens the opening of the vagina during childbirth. It is a
cut to the perineum -- the skin and muscles between the vaginal opening and anus.
IV. Five Nursing Responsibilities for Three Phases
A. PRENATAL CARE
1. Assess the health status of the client

2. Identify and manage high risk cases
3. Estimate EDD accurately
4. Teach the mother the elements of childcare, proper nutrition, personal hygiene, and
environmental sanitation
5. To start the regular dose of folic acid during the first trimester as prescribed by the doctor
B. INTRANATAL CARE
1. Provide comfort of the mother

2. Monitor Vital Signs of the mother
3. Monitor fetal contraction and fetal heart rate
4. Position the mother in her left side
5. Monitor positive attitude about fetal outcome
C. POSTNATAL CARE
1. Encourage sitz baths and early ambulation

2. Instruct the proper perineal care
3. Monitor vital signs
4. Assess pain and administer analgesics as prescribed by the physician
5. Promote rest, relaxation, bonding with infant if separated
V. PROGNOSIS
A. Ideal
Normal Spontaneous Vaginal Delivery a.k.a. Vaginal Birth, Spontaneous Vaginal Delivery (SVD),
Normal Vaginal Delivery, is the term used to describe any delivery of the baby through the vagina. The
baby typically comes through head first. If the baby is not head first, (e.g., breech) it may need to be
delivered by c-section .
B. Actual
GOOD FAIR POOR JUSTIFICATION

Duration ✔  The baby is 38 weeks gestation
Onset of Illness ✔ The fetus inside the womb was

already in full term upon
admission.
Compliance of ✔ The patient is struggling with
Medication finances.
Family Support ✔ Her family was always there to
support her.
Environment ✔ Due to poor ventilation and
noisy environment of the ward.
Age ✔ Patient’s age is 20 and is within
childbearing age.
Precipitating ✔
Factors
GOOD > 4/7 x 100 = 57.14
FAIR > 2/7 x 100 = 28.57
POOR >1/7 x 100 = 14.29
VI.REFERENCES
http://gynaeonline.com/cpd.htm
https://en.wikipedia.org/wiki/Oxytocin
https://www.drugs.com/cdi/methergine.html
https://www.google.com.ph/?gfe_rd=cr&ei=bonsV9WZConmugSsq7noCA&gws_rd=ssl#q=nsvd

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DEFINITION

Vaginal delivery is the method of childbirth most health experts recommend

A spontaneous vaginal delivery is a vaginal delivery that happens on

 HR 110 to 160 beats/min at baseline

Tests and procedures to diagnose labor include:

FOR PAIN CONTROL:

Type When/How Advantages Possible Side

III. SURGICAL MANAGEMENT ( if needed )

IV. Five Nursing Responsibilities for Three Phases

1. Assess the health status of the client

1. Provide comfort of the mother

1. Encourage sitz baths and early ambulation

GOOD FAIR POOR JUSTIFICATION

Onset of Illness ✔ The fetus inside the womb was

FAIR > 2/7 x 100 = 28.57

POOR >1/7 x 100 = 14.29

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