Silver Cross EMS
EMD CE
November 2011
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This presentation is set up as if you were on
scene, assisting with a delivery.
You will go over the questions to ask, things to
look for, possible complications and assisting
with a delivery. Hopefully this will help you
picture the scene and better understand why
you are asking certain questions and give more
effective instructions.
Your EMDPRS will be updated soon, with
some new information and pre-arrival
instructions.
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Childbirth is a normal, natural part of life.
Your part of the process involves helping, guiding, and
supporting the infant as it is born.
After the birth, you should ensure the infant is breathing
adequately and being kept warm.
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Two indicators of an impending birth:
Frequency of the contractions
Crowning
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As you prepare to assist the mother in the
delivery, keep two things in mind:
Calm the woman: Delivery is a natural process.
Calm yourself: You are there to help or coach.
This lecture has some graphic
pictures of childbirth and
emergency delivery. There will
also be an option to click on a
link to view an actual childbirth
video. Viewer discretion
advised.
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The external opening is
called the birth canal
(vagina).
The developing infant
(fetus) is encased in an
amniotic sac for support
and floats in amniotic fluid.
The placenta is the
organ of exchange
between mother and
child.
The umbilical cord
connects the baby to
placenta.
Opening of the Uterus
is the Cervix.
•Placenta
– develops early in
pregnancy & performs important
functions
Exchanges respiratory gases
– Transports nutrients from mother
to fetus
– Excretes waste
– Transfers heat
– Active endocrine gland produces
several important hormones
– Attached by umbilical cord
•Amniotic
pregnancy
sac – develops early in
Consists of membranes that
surround & protect developing fetus
– Amniotic fluid cushions fetus &
provides stable environment
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Umbilical cord – attaches fetus to
placenta
•
Contains one vein & two arteries
– Vessels in umbilical cord similar to
pulmonary circulation
–
• Arteries carry deoxygenated blood
• Veins carry oxygenated blood
Newborn cord is about two feet
long
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First stage of labor: the pregnant woman’s
body prepares for birth
Characterized by these conditions:
Initial contractions occur.
 The bag of waters breaks.
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The bloody show occurs. (loss of protective mucous
plug from cervix)
The infant’s head does not appear during
contractions.
This is the longest stage but is shorter for each
pregnancy.
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Second stage of labor:
the birth of the infant
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Contractions are close
together, 2-3 minutes
apart.
Mother will have the
urge to push.
You will see the infant’s
head crowning during
contractions.
There is no time for
transport, you will
need to assist with
delivery.
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Third stage of labor: delivery of the placenta
(afterbirth)
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Mom will start to have contractions again and will
usually delivery the placenta within 20-30 minutes.
Your focus should be caring for mom and newborn.
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Is this the woman’s first pregnancy?
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Has the woman experienced a bloody show?
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A woman experiencing her first labor will usually
have more time to reach the hospital.
Loss of mucous plug.
Has the bag of waters broken?
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The bag of waters usually breaks toward the end of
the first stage of labor.
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How frequent are the contractions?
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Contractions less than 2 minutes apart usually
indicate that delivery will occur very soon.
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Contractions are timed from the start of one to the
start of the next.
Does the woman feel an urge to move her
bowels?
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When the infant’s head is in the birth canal, it
presses against the rectum.
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Do not allow her to go to the toilet.
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Is the infant’s head crowning?
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Head is visible in the birth canal
Is transportation available?
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Is the ambulance responding?
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How far is it to the hospital?
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Will bad weather, a natural disaster, or traffic
prevent prompt arrival of transportation?
? What additional information do you want to know?
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You will not be able to maintain sterile
conditions.
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Attempt to be as clean as possible.
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Wash your hands thoroughly.
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If you do not have a sterile delivery kit, use
household items to prepare for delivery.
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Use shoestrings or strips of cloth to tie the cord.
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Have plenty of clean towels ready.
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There will be lots of fluids, so protect yourself.
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Place the patient on a firm surface that is
padded with blankets, folded sheets, or
towels.
Elevate the woman’s hips 2" to 4" with pillows
and blankets.
Place the woman on her back with knees bent
and feet flat on the surface beneath her.
Remove clothing below the waist.
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In a normal birth:
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The infant will turn to its side by itself after the
head emerges.
The rest of the body will be delivered
spontaneously.
The infant will be wet and slippery.
Keep the infant’s head at about the level of the
woman’s vagina.
Encourage the mother to breath deeply
between contractions and push with
contractions.
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Support head with gentle pressure
Check and see if cord is wrapped around baby’s neck— attempt to loosen
(more on that later)
Apply gentle downward pressure on shoulder & head
After anterior shoulder has delivered, apply gentle upward pressure.
Once shoulders are out the rest of body will follow quickly.
Suction or wipe out mouth & nostrils (in that order) when head appears
Once delivered, stimulate infant if it does not breathe (info to follow)
Put two clamps on umbilical cord & cut 6 inches from navel between
clamps, after the cord stops pulsating
Follow this link to a childbirth video, starting
with crowning and ending with stimulation of
the infant and awaiting the afterbirth. This
baby had Nuchal Cord.
http://www.youtube.com/watch?v=80T89vBR_k
•During
first stage of
labor amniotic sac usually
breaks, expelling amniotic
fluid
• If sac is still covering
infant’s head when head
appears, use a finger to
pierce sac
•Very tough membrane
•Note
color & character of
amniotic fluid
• Fluid can be clear or
straw-colored (which is
normal)
• Tainted, discolored,
thick or “pea soup-like”
(which indicates
meconium staining or a
bad intra-uterine
infection)
•Baby
could be in distress
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Once head delivers, have mother to stop pushing
so you can check to see if the cord is wrapped
around infant’s neck
If cord looks like it is wrapped tightly, you will
need to loosen it
Gently slip cord over baby’s head by placing two
fingers under cord at back of neck
Bring cord over shoulders & head
Cord is durable, but it can tear if handled roughly
so don’t use excessive force
Too tight to loosen, clamp cord in two places two
inches apart and cut cord between clamps
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After the baby is out, remember to keep baby level
with birth canal until the cord is clamped and cut
Position infant on it’s side for drainage
Re-suction or wipe out the baby’s mouth & nostrils
Dry & wrap baby in a warm blanket — cover its
head
If baby is not breathing, try to stimulate it by
gently but vigorously rubbing the infant’s back
with you fingertips or flick the soles of it’s feet
If no response
• begin CPR
CPR technique for the infant
that is not breathing, after
stimulation
Place infant on a firm, flat
surface
Find compression site which is
just below nipple line on
middle or lower third of
sternum
Wrap your hands around
upper abdomen with your
thumbs on compression site
Use your thumbs to deliver
gentle pressure against
sternum, pressing ½ to ¾
inch into chest at rate of 100
per minute
30:2 compressions to breaths
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Continue to observe the mother and infant
and keep both warm.
Bleeding should stop after placenta delivers.
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Observe mother for excessive bleeding and treat for
shock
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If baby is doing well and mother wants to
breastfeed, this will help slow bleeding down by
contracting uterus
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Cord presentation
Limb presentation
Breech (buttocks or feet)
Shoulder Dystocia (stuck at shoulders)
Premature or Stillborn
Multiples
Drug or alcohol abuse
Underlying medical problems with mother or
child
Can your questioning help identify possible
problems and better prepare responders?
Most can not be delivered safely in the field.
Elevate mother’s hips to relieve pressure on birth
canal and advise her not to push. Have her
focus on her breathing and wait for responders.
Any bleeding during pregnancy could be the sign
of a serious problem
Ectopic Pregnancy (outside uterus)
Miscarriage
Placenta problems
Uterus rupture
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Some women develop diabetes during
pregnancy (Gestational Diabetes)
Diabetics can have problems maintaining their
blood sugar levels during pregnancy
Supine hypotensive syndrome occurs when
increased weight of uterus compresses inferior
vena cava while a patient is on her back
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Position mother on her left side to avoid this
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Variety of signs and symptoms including:
Hypertension
– Abnormal weight gain
– Edema
– Headache
– Protein in the urine
– Epigastric pain
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If untreated, preeclampsia can progress to
eclampsia
•Eclampsia,
also called
toxemia, most serious
manifestation of
hypertensive disorders of
pregnancy
• Characterized by grand
mal seizures
• Often preceded by
visual disturbances such
as flashing lights or spots
before the eyes
•Eclampsia
patients often
experience swelling of
hands & feet & markedly
elevated blood pressure
• If eclampsia develops,
death of mother & fetus
frequently results
• Treat by lying mother on
her side, maintaining
airway and monitor until
help arrives
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Childbirth is a natural process with a small
percentage of complications.
Follow your scripted protocol for imminent
births.