Chapter 37Emergency Childbirth

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Overview

Anatomy Review Normal Childbirth Emergency Childbirth Special Delivery Scenarios Post-Delivery Care

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Anatomy Review

During pregnancy, the uterus enlarges The fetus obtains all nutrients from

the placenta The umbilical cord connects the fetus to

the placenta; both are enclosed in the amniotic sac

Effacement and cervical dilation begin as the pregnancy comes to an end

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Normal Childbirth

Stage 1 of labor– Fetal head moves into pelvis– Cervix thins and dilates– Uterus begins to contract– Can take from a few to up to 30 hours– The amniotic sac ruptures

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Normal Childbirth

Stage 2 of labor– Forceful uterine contractions– Increasing vaginal pressure– The head becomes visible– Mother begins to push– Fetus exhibits the cardinal movements of labor– The newborn is delivered– Usually 30 to 60 minutes

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Normal Childbirth

Stage 3 of labor– Uterus decreases in size– The placenta separates from the uterus and is

expelled – Generally within 30 minutes of delivery

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Stop and Review

What are the normal anatomical changes that occur during pregnancy?

Describe the three stages of labor.

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The Process of Birth

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Emergency Childbirth

History– What is the due date?– Have there been any complications with the

pregnancy?– Note the color of the amniotic fluid– When did contractions begin and how far apart are

they?– Note the number of pregnancies and the number

of live children

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Emergency Childbirth

Assessment– Initial assessment and vital signs– Look for signs of crowning or abnormalities– Maintain privacy and perform assessment in the

presence of another EMT– Only repeat examination if patient’s condition

changes

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Emergency Childbirth

Preparation for delivery– Don appropriate PPE– Prepare supplies– Contact medical control– Two EMTs should facilitate

delivery: one to tend to the mother and one to tend to the newborn

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Emergency Childbirth

Normal delivery– Since field delivery is rare, EMTs may want to

review these steps frequently – Most deliveries are completed without

complications

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Special Delivery Scenarios

Prolapsed umbilical cord– A cord lodged between the birth canal and the

fetus’ head– Can be life threatening– The cord is visible on examination of the vaginal

opening– Place mother on 100% oxygen and place in head

down, buttocks raised position– Push the fetus away from cord

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Special Delivery Scenarios

Breech presentation– Fetus may present buttocks first or limbs first– Increases fetus’ risk of injury– Place mother on 100% oxygen and position head

down with pelvis elevated– Immediately transport to nearest facility– Call medical control

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Special Delivery Scenarios

Meconium– Aspiration can be harmful to the fetus– Can result in infection and injury to the lung tissue– The thicker it is, the more dangerous to the fetus– Suction the nose and mouth to remove the

meconium– Transport immediately and call for ALS backup

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Special Delivery Scenarios

Multiple gestation – Delivery of two or more newborns– Usually premature– Second is often in breech presentation– Transport immediately

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Special Delivery Scenarios

Premature delivery– Early delivery of the newborn– Underdeveloped pulmonary system– Prone to injury and requires extensive

resuscitation– Transport as soon as possible and alert the

hospital you are en route

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22

Post-Delivery Care

Mother– Monitor for bleeding– Stimulate contraction of the uterus via massage– If bleeding is excessive, treat for shock

Newborn– Initial assessment and resuscitation if required

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Stop and Review

What are the signs of a pending delivery? Why is the predelivery history important? Describe the assessment and management

of the following:– Prolapsed umbilical cord– Breech presentation– Multiple births– Meconium