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Ritgen & perineal protection

Controlled birth of the head.

Source: Williams · NFOG

Technique

  1. Ask her to breathe, not push, at crowning; perineum must be visible.
  2. One hand on occiput slows the head.
  3. Other hand supports perineum (Ritgen: pressure on chin through perineum in front of coccyx).
  4. Allow slow extension of the head.
  5. Feel for nuchal cord: slip over, or clamp and cut if tight.
  6. Gentle downward traction for anterior shoulder, then up for posterior.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.