An Evidence-Based Approach to Vaginal Birth

This is a review of evidence-based management of vaginal birth, which is critical to optimizing the outcomes of birthing people and neonates. The current literature supports the use of immediate pushing in the second stage of labor, neuraxial anesthesia administration for vaginal birth for adequate pain control, use of warm compresses in labor to prevent obstetric lacerations, delayed cord clamping for term and preterm neonates, the utility of umbilical cord milking in neonates who require immediate resuscitation, and active management of the third stage of labor with oxytocin administration. In addition, the routine use of episiotomy is shown to increase morbidity without clear evidence of benefit in the setting of spontaneous vaginal delivery or operative vaginal delivery.