|Full abdominal and vaginal examination||Head is ≤1/5th palpable per abdomen|
Cervix is fully dilated and the membranes ruptured.
Exact position of the head can be determined so proper placement of the instrument can be achieved.
Assessment of caput and moulding.
Pelvis is deemed adequate. Irreducible moulding may indicate cephalo–pelvic disproportion.
|Preparation of mother||Clear explanation should be given and informed consent obtained.|
Appropriate analgesia is in place for mid-cavity rotational deliveries. This will usually be a regional block.
A pudendal block may be appropriate, particularly in the context of urgent delivery.
Maternal bladder has been emptied recently. In-dwelling catheter should be removed or balloon deflated.
|Preparation of staff||Operator must have the knowledge, experience and skill necessary.|
Adequate facilities are available (appropriate equipment, bed, lighting).
Back-up plan in place in case of failure to deliver. When conducting mid-cavity deliveries, theatre staff should
be immediately available to allow a caesarean section to be performed without delay (less than 30 minutes).
A senior obstetrician competent in performing mid-cavity deliveries should be present if a junior trainee is
performing the delivery.
Anticipation of complications that may arise (e.g. shoulder dystocia, postpartum haemorrhage)
Personnel present that are trained in neonatal resuscitation