CMG 26 - OBSTETRICAL & GYNAECOLOGICAL EMERGENCIES
(Revised: January 2010)
Unscheduled Normal Field Birth
The most important ambulance role in a field delivery is to appear calm!
The preferred management is birth at a hospital – but if birth is imminent, reassure the mother & help her to a comfortable position.
 Ensure full history
 Oxygen
 Pain relief as required
Provide support and guidance during birth of baby’s head while encouraging gentle “grunty” pushes or controlled breathing to
ease the head out slowly and gently. As the head is born have your hand close to the top of the baby’s head – you do not need
to touch it unless the woman gives an uncontrolled push and the baby would otherwise ‘shoot’ out (especially important if the
baby is preterm < 37 weeks).
Observe for cord around the baby’s neck. If present the baby may be born through the loop of cord. If the cord is loose, it may
be slipped forward over the head, taking care not to stretch it or tear it. Rarely the cord is so tight that it stops the baby’s descent
and in this situation it may need to be clamped in two places and cut between the clamps. Great care is necessary not to injure
the baby or woman while doing this.
Place the baby straight up on to the mother’s chest noting time of birth. Dry baby and maintain warmth by keeping the baby
close to the mother’s skin. Place warm blankets over the baby and mother.
Assess the baby’s Apgar score at 1 and 5 minutes after birth.
Cord should not be routinely cut but, if necessary, apply plastic clamp (x2) at 3cm from the umbilicus, milk the cord gently back
from the clamp 3cm, taking care not to pull on the umbilicus. Apply plastic clamp (x2) then cut the cord using clean scissors.
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ACT Ambulance Service Clinical Management Manual
Uncontrolled when printed. The latest version of this document is available on the ACT Ambulance Service internet site.
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Complicated Birth
P.V. Haemorrhage
Prolapsed cord:
Not pregnant / early pregnancy:
Posture in the knee to chest position
(often easier in the all fours knee to chest position)
100%Oxygen
Advise hospital early
Urgent transport
Do not encourage pushing
Manage as per perfusion status
Breech presentation:
Normal, unassisted birth may not always be possible.
Where possible, do not encourage the woman to push but to breathe
through her contractions.
Notify and urgently transport to hospital.
Once legs and body have been born, support the baby’s body
as it hangs downward while waiting for the gentle, slow birth of the head.
(Do not apply downward traction). Encourage the mother to ‘breathe’ her
baby’s head out.
If head is not born with the next contraction, encourage her to push whilst
gently supporting the baby as it hangs downward.
Other presentations:
Recognise!
Normal, unassisted delivery may not always be possible.
Notify and urgently transport to nearest appropriate hospital.
Advanced pregnancy
Manage as per perfusion status
Left lateral position
Do not attempt to massage the fundus of the uterus
Notify and prompt transport to nearest appropriate
hospital
Seizures due to eclampsia
5g MgSO4 IV
Cardiac arrest in advanced pregnancy
Position with wedge under right hip to obtain
25 – 30o leftwards tilt.
Give fluid bolus early.
Urgent transport as soon as backup has arrived.
If performing CPR, increase CPR compression force due
to the chest wall compliance secondary to breast
hypertrophy.
Ensure hospital is notified as early as possible that the
patient is pregnant.
Women in more advanced pregnancy (approx 20+ weeks gestation) are generally best treated/transported in
the left lateral position, regardless of the problem.
ACT Ambulance Service Clinical Management Manual
Uncontrolled when printed. The latest version of this document is available on the ACT Ambulance Service internet site.
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