Per Gabbe’s Obstetrics, the goals of clinical assistance at spontaneous vaginal delivery are:

Reduction of maternal trauma
Prevention of fetal injury
Initial support of the newborn

In this epiode, you'll learn how to assist with and perform a vaginal delivery—from pre-delivery preparation to delivering the placenta and everything in between.

I’ll walk you through what to do before, during, and after the delivery, as well as what instruments to expect on your delivery cart. Whether you're a med student attending your first delivery or an intern refining your skills, this step-by-step guide will help you feel more confident and prepared.

✳️ Before You Begin: A Free Resource for Incoming OB/GYN Interns

If you just matched into OB/GYN and are starting residency this July, check out my free guide:
"OB/GYN Residency Starter Pack: A 5-Step Guide for Incoming Interns"
It’s designed to help you feel less overwhelmed and more prepared as you get ready for day one.
👉 Download it here

What to Expect on the Delivery Cart

When you enter the delivery room, you should see two things: the patient and the delivery cart.

Typical items on the delivery cart include:

Gowns and under-buttock drape (with plastic pocket to catch fluids)
Abdominal drape (optional, for fundal massage. Alternatively, you can use a blue towel.)
Two basins (one for the placenta, one with water for cleaning)
Laps (white spongy towels for wiping blood)
Blue towels (for cleaning post-procedure and/or fundal massage)
Allis clamps
Smooth pickups (e.g., Russian or tissue forceps)
Ring forceps
Needle driver
Scissors (one pair for you, one for cord cutting)
Plastic umbilical cord clamp (for the baby’s side)
Two cord clamps (Kochers or other artery clamps for the placental side)
Cord blood collection cup and vacuum container

Note: Although the delivery tray is sterile, vaginal delivery itself is not a sterile procedure. However, clean technique is recommended to minimize infection risk.

Step-by-Step: How to Assist with a Vaginal Delivery

Step 1: Confirm Full Dilation

Check the cervix to ensure the patient is completely dilated. Don’t gown and glove until you’re sure—patients are sometimes called "ready" when they still have a ways to go. If the baby is visibly crowning, skip the check and proceed.

Step 2: Prepare the Patient

If a Foley catheter is in place, request it be removed.
Position the patient appropriately. Dorsal lithotomy is most common in the hospital setting, especially with epidurals, but whatever position both the patient and you feel comfortable with is acceptable.
Slide the under-buttock drape into place.
Break down the bottom of the bed.

Step 3: Coach the Patient on Pushing

Coach your patient with a method like:

“Take a deep breath, curl over your belly, and push while pulling your thighs back. We’ll do three pushes for 10 seconds each with every contraction.”

Open vs. closed glottis pushing: Studies show no significant difference in outcomes. Go with whatever works best for the patient.

The Delivery Itself

As the fetal head crowns, place fingers on the head to apply gentle downward pressure to minimize rapid extension and injury to the urethra, clitoris and perineum .
Allow the head to restitute (rotate) naturally.
Use gentle downward traction to deliver the anterior shoulder.
Apply upward and outward traction to deliver the posterior shoulder.
Deliver the rest of the body and place the baby on the mother’s abdomen.

Delayed Cord Clamping

ACOG recommends delaying cord clamping by 30–60 seconds for vigorous term and preterm infants. Hand scissors to the chosen person and allow them to cut the cord after delay.

Delivering the Placenta

Active management of the third stage includes:

Administering uterotonics (Pitocin)
Applying gentle cord traction using one of the clamps on the cord
Applying suprapubic pressure to prevent uterine inversion

As the placenta delivers:

Gently twist the placenta to reduce tearing of the membranes.
Place it in a basin for inspection.

Signs of placental separation:

Gush of blood
Cord lengthening
Fundal firmness (a balled-up uterus)

Final Steps

Inspect for lacerations and repair them as needed.
Clean the patient.
Count all laps, instruments, and needles.

Quick Tips for Medical Students

Introduce yourself to the patient before delivery. Ask the team which patients to speak to.
Introduce yourself to the nurses and ask where to find a gown and gloves.
If invited to a delivery, act fast—students often miss deliveries because of slow prep.
Practice gowning and gloving quickly.
Memorize the 3 signs of placental separation—this will likely come up when you're assisting.

That’s it! You’ve now got a step-by-step overview of the vaginal delivery procedure.
Stay tuned for the next episode, and don’t forget to grab the free OB/GYN intern guide if you haven’t already.