II. Management: Use Gravity and Position Change
- One leg up
- Sit on the toilet and push
- Drape self over an oversized ball
III. Management: Standard Positioning
- Start
- Hips hyperflexed and abducted
- Hands on thighs and knees
- Patient pulls knees towards her
- Maximize abdominal Muscle use with forward curl
- Encourage "Push as if having BM"
- Perineal massage
- No benefit in maintaining intact perineum
- May decrease labor discomfort
- Stamp (2001) BMJ 322:1277-80 [PubMed]
- Patient to hold presenting part down between pushes
- Complete rest "Time Out" between contractions
- Visualization between contractions
IV. Management: Encourage pelvic floor relaxation
- Reassure that Bowel Movement and Urine are normal
- Hydrotherapy
- Warm shower or tub assists in Pelvic Relaxation
V. Management: Towel Trick (Tug-of-war)
- Patient sits in bed with knees adducted
- Patient pulls as hard as can on one end knotted towel
- Clinician pulls
- On other end of towel or
- With sheet tied around her waist
- Helps to relax the perineum
- Create a pelvic curve easier for fetal head to maneuver