الفهرس 
Vaginal delivery: State of art.Only 14 pages are availabe for public view
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Abstract
Introduction: The basic physiology of birth remains unchanged despite “advances” in maternity care. What has changed is the increase in technology and interventions in the birthing process. While childbirth is a natural, normal, and healthy process, many interventions have become routine in maternity care. Many interventions either directly or indirectly interfere with the normal birth process. Continuous labor support is beneficial as it result in a reduction in maternal anxiety and a related decrease in stress hormones, a higher likelihood of spontaneous vaginal birth, lower likelihood of cesarean surgery and vaginal instrumental delivery, fewer requests for intra partum analgesia and improved postpartum perception of the childbirth experience. The normal laboring woman need not be confined to bed early in labor, freedom of movement in labor may result in shorter labors, increased uterine contractility, greater comfort, reduced need for pharmacologic pain relief and decreased risk for operative delivery (including operative vaginal delivery and cesarean surgery. Elective induction of labor increases the need for analgesia, epidural anesthesia, and neonatal resuscitation, it results in more cesarean surgeries, and may increase the likelihood of instrumental vaginal delivery, intra partum fever, shoulder dystocia, and admission to the neonatal intensive care unit. Eating and drinking in labor provides essential nutrition and energy for the laboring woman. There was no evidence of benefit in restricting food or fluids in labor. In addition, laboring women preferred to eat and drink rather than fast. Intravenous lines prevent women from moving freely, may raise stress levels, may cause fluid overload in both mothers and babies, and do not provide adequate nutrient and fluid balance for the demands of labor. Intermittent auscultation of the fetal heart sound is better than continuous electronic fetal monitoring for healthy women with no complications. The partogram (or partograph) is a simple, inexpensive tool to provide a continuous pictorial overview of labor. It is considered as one of the most important advances in modern obstetric care and is a necessary tool in the management of labor. Aim of work: To review the different opinions about the mode vaginal delivery (either spontaneous or by aid) in different parts of the world late in the last century and in the recent years. Also to review the circumstances when vaginal delivery is permitted and when it is condemned. Conclusions: Most women prefer vaginal delivery as vaginal delivery is associated with high degree of maternal satisfaction including personal control over delivery, improved maternal infant interaction at the time of delivery, better birth experience, increase safety of vaginal delivery in well equipped hospital. The rate of instrumental deliveries decreased in the last years due to less training on forceps and vacuum devices and increased maternal and neonatal complications with instrumental deliveries. The rate of cesarean section increased in the last years due to many reasons example: increased maternal age and increased maternal request for cesarean section to avoid pain during labor.