Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Delivery, Spontaneous and/or Assisted Vaginal


Related Terms

  • Childbirth
  • Vaginal Birth
  • Vaginal Delivery

Specialists

  • Family Physician
  • Obstetrician/Gynecologist

Comorbid Conditions

Factors Influencing Duration

Length of disability may be influenced by a high-risk pregnancy, complications to mother or infant, or job requirements. Disability may be longer if heavy lifting is a part of the woman's responsibilities.

Medical Codes

ICD-9-CM:
73 - Other Procedures Inducing or Assisting Delivery
73.59 - Delivery, Assisted Spontaneous (Normal Vaginal)

Overview

Spontaneous vaginal delivery involves the birth of a baby and delivery of the placenta from the uterus and through the cervix and the birth canal (vagina). This process results from contractions of the uterus during labor. Most women deliver 38 to 40 weeks after becoming pregnant (conception). In some vaginal deliveries, additional assistance is employed to assist vaginal delivery by using forceps or vacuum extraction applied to the baby's head.

In combination with hormonal changes, the regular muscular contractions of the uterus in labor cause the cervix to soften, thin (efface), and open (dilate) so that the baby may travel from the uterus through the bony pelvis to the vaginal opening. The average labor lasts 12 to 14 hours for a woman having her first baby (nulliparous) and about 6 to 8 hours for subsequent babies (Beers).

Labor occurs in 3 stages. The first stage begins with regular contractions that effect cervical dilation and ends when the cervix dilates to 10 cm. The second stage ends with the baby's birth. The third stage ends with delivery of the placenta, which usually separates from the uterine wall within 5 minutes after delivery. Assisted vaginal delivery can usually occur when the cervix is fully dilated and the baby's head is visible (crowns).

Spontaneous vaginal delivery is the expected outcome for most pregnancies. Assisted vaginal delivery may occur when the second stage of labor is prolonged or when the baby appears to be in distress and delivery time needs to be accelerated.

Source: Medical Disability Advisor



Reason for Procedure

Vaginal delivery proceeds if the maternal pelvis can accommodate the baby's presenting part, usually the head. The pelvis ordinarily widens and softens during labor to allow passage of the baby's head. The decision to proceed with a vaginal delivery may be influenced by the obstetrical history of previous labors, types of deliveries, and estimated infant weight and status of mother and baby.

Assistance using vacuum extraction or forceps delivery may be needed in certain conditions. If the baby appears to be in distress, delivery may need to be facilitated through medical intervention using forceps or vacuum extraction. If pushing continues for a long time once the cervix is fully dilated to 10 cm, both mother and baby may become exhausted. If contractions fade away or if the baby is in an awkward position, such as with the spine against the mother's spine (posterior position), forceps assistance or vacuum extraction may be needed for delivery.

Source: Medical Disability Advisor



How Procedure is Performed

Labor is allowed to progress naturally whenever possible. The mother is encouraged to assume whatever positions are the most comfortable for her during contractions. Lying on either side may both reduce pain and increase maternal blood flow. Vertical positions such as standing or kneeling may be preferable, if tolerated. Walking, showering, and soaking in a hot tub can ease labor pain and allow it to progress more rapidly. Pain medication administered locally, by injection or into the spine (epidural), may be given at the mother's request.

The baby usually presents head first, with its face rotated toward the mother's spine and crowns to spontaneously deliver vaginally with maternal pushing efforts that are coordinated with contractions. If the baby's head does not spontaneously rotate and descend, instruments such as forceps or a vacuum extractor may be used to gently turn or turn and assist with the final expulsion of the baby's head (assisted vaginal delivery). This type of assistance may also be used for more rapid delivery if the mother tires of pushing, or contractions cease prior to delivery, or fetal or maternal distress develops.

For use of either forceps or vacuum extraction, the cervix must be almost completely dilated and the mother's bladder must be empty. The mother's feet/legs are placed in stirrups to maximally expose her perineum. An incision to enlarge the vaginal opening (episiotomy) may or may not be necessary, based on the likelihood of the mother's tissues tearing during delivery. For a vacuum extraction, a soft or metal cup is applied to the crown of the baby's head, and suction traction is applied to the cup while the mother pushes. The traction, combined with maternal pushing, propels the baby from the vagina. The cup is removed once the baby's head is entirely delivered. For forceps assistance, the metal forceps are applied to the sides of the baby's head and can be used to turn or turn and lift the baby's head from the vagina, with the assistance of the mother's contractions and efforts at pushing. Local or regional anesthesia (spinal or epidural) may be used for all types of vaginal deliveries and is more commonly used if assistance with forceps or a vacuum extractor is necessary.

Other techniques that can be used to assist with stimulation of labor include artificially rupturing the bag of amniotic fluid surrounding the baby (amniotomy), inducting (stimulating) contractions, or using the hormone oxytocin to enhance inefficient contractions. Oxytocin is also usually given after delivery of the baby and placenta to contract the uterus and reduce postpartum bleeding.

Source: Medical Disability Advisor



Prognosis

Most spontaneous or assisted vaginal deliveries are uncomplicated. Mother and infant are usually able to leave the hospital within 48 hours.

Because of hormonal and psychological changes associated with delivery, some mothers may experience postpartum blues, usually beginning 2 to 3 days after delivery (postpartum). This usually resolves spontaneously within 2 weeks but may need treatment if prolonged. Lengthy postpartum depression may be a sign of underlying depression and require further consultation and treatment.

Source: Medical Disability Advisor



Rehabilitation

A woman who has had a normal delivery without excessive tearing or pain can begin rehabilitation as soon as a month after the birth. The woman should be pain-free and cleared by her physician before beginning a postnatal exercise regimen.

After checking for separation of the abdominal muscles (diastasis), the first focus of rehabilitation is restoring overall body strength and strengthening the pelvic floor muscles (urethra, vagina, and anus). Should diastasis be present, specialized exercises can be done to decrease the muscle separation, after which other abdominal exercises may be added.

Core strength work can include bridging, abdominal crunches, pelvic tilts, heel slides, gluteal toning exercises, squats, and plies. In addition to core work, the therapist may also initiate a cardiovascular routine to strengthen the core muscles and help the woman regain her pre-pregnant posture. Over time, individuals can add more exercises to the workout.

If the woman is breastfeeding, she may find that some infants dislike the taste of the milk after a workout. Lactic acid produced during the workout can affect the milk. The woman may want to pump her breasts before a workout.

Source: Medical Disability Advisor



Complications

Complications of assisted or spontaneous vaginal delivery affecting the mother include excessive bleeding (hemorrhage), inability to urinate (urine retention), loss of bladder control (urinary incontinence), bruising (hematoma) of the perineum, varying degrees of tearing (laceration) of the perineum, and infection. Pressure on the nerve supplying the genitalia (pudendal nerve) may lead to decreased sensation in this area and/or sexual dysfunction.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Most women recover rapidly from an otherwise uncomplicated vaginal or assisted vaginal delivery. They may have a period of reduced physical activity immediately following delivery due to vaginal bleeding and cramping or episiotomy pain as their uterus/perineum heals from the delivery. The vast majority of women with uncomplicated singleton pregnancies, and spontaneous or assisted vaginal delivery, are physiologically stable enough to return to full-time work within 4 to 6 weeks of delivery. Accommodations for women who are breastfeeding may include additional work breaks and privacy rooms in the workplace where they can breastfeed or pump the breasts. Breastfeeding in and of itself is not a disabling condition.

Source: Medical Disability Advisor



References

Cited

Beers, Mark H., and Robert Berkow, eds. "Management of Normal Labor." The Merck Manual of Diagnosis and Therapy. 17th ed. Merck and Company, Inc., 2004. Merck. Merck & Co., Inc. 1 Jun. 2005 <http://www.merck.com/mrkshared/mmanual/section18/chapter249/249e.jsp>.

Bonni, Aram, and Michael G. Ross. "Forceps Delivery." eMedicine. 27 Aug. 2004. Medscape. 1 Sep. 2005 <http://emedicine.com/med/topic3284.htm. emedicine.com>.

Pope, Christian S., and John Patrick O'Grady. "Vacuum Extraction." eMedicine. 17 Aug. 2004. Medscape. 1 Sep. 2004 <http://emedicine.com/med/topic3389.htm emedicine.com>.

Source: Medical Disability Advisor






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