A lecture about where babies come from

Richard Beebe MS RN NRP

To be able to handle a routine vaginal delivery in an emergent situation.To recognize that over 90% of pregnancies end in a normal term delivery and that we as healthcare workers are there to assist something that has been going on for millions of years.To be able to recognize potential complications of pregnancy and delivery and be able to administer commonly accepted measures to alleviate the complications.

OvulationMittelschmerzFertilization

ChlamydiaImplantation

PlacentaHormones

Umbilical CordAmniotic SacAmniotic Fluid

175 - 225 mL - 4 monthsPROM

40 weeks in length37 - 42 Weeks

3 trimestersAverage weight

6.6 to 7.9 poundsA missed period is the usual first clue11% of women who say there is “no way” they could be pregnant actually are..

Last Menstrual PeriodTPAL vs GPA

PrimaparaGrandpara

Estimated Due DateAbdominal Assessment

As the uterus grows it rises up out of the pelvis.At approx. 12 weeks the uterus “clears” the pelvis20 weeks = belly button37 weeks = just under xiphoid process.

Are you pregnant? How far along are you?How far apart are the contractions?Any bleeding or discharge? Show? PROM?Do you feel pressure between your legs?How many times have you been pregnant before?How fast were your previous babies born?

Placenta PreviaAbruptio PlacentaEclampsiaFetal Distress (Meconium)Breech PresentationCephalopelvic DisproportionActive Herpes

Always give high flow oxygenBaseline Vital SignsHistory and PhysicalPut mom on side if delivery is not imminent* Locate the OB delivery kit

The pregnant uterus acts like a tourniquet to the vena cava and restricts blood from returning back to the heart.

Treatment: flip them on their side. (preferably left side with high flow oxygen.

Starts out at a rate of 180 in the 1st trimesterAfter 12 weeks, the rate drops to 120-160.Any rate less than 120 signals distress.

Typical OB Kit

A few clean towels, blankets, shirts, etc.clean stringclean sturdy scissors or a knifea clean trash bag Some gauze pads to wipe out the mouthPrayer

check for crowningGet your already located OB kit/supplies out. if you have time, place some folded towels underneath mom’s pelvis with a clean plastic bag opened up and tucked underneath her buttocks.Have your assistant set up another bed/cot near the mom and prepare for baby care.

Position, Dry, Wrap ‘em up. Keep them warm. Keep them level with mom’s body. Keep warm. Check sugar if lethargic or SGA or LGA. Repeat suctioning as needed, keep warm.Note the time of birth and if mobile the county baby was born in. Assess the infant, obtain APGAR’s, keep warmStimulate if not perking up.

Appearance (color)Pulse (> 100)Grimace (vigorous and crying)Activity (good motion in limbs) Respirations

The uterus cannot “clamp down” to control bleeding.Fundal massage is first choice treatment to coax the uterus to firm up.

Explain to mom that this will be uncomfortable, similar to a bad menstrual cramp, but that it MUST be done or she can bleed to death.With your hand flat and perpendicular to the belly, press down anterior to posterior just above the umbilicus until you feel a “ridge” rise up. This “ridge” is the fundus. Begin rubbing the fundus and moving down toward the pubic symphysis until it you no longer see clots and “gushes” from the vagina.

Condition where the cord presents through the birth canal before the head.Life Threatening to baby. Requires aggressive interventions. Knee Chest or ??

“Turtle Sign”High Flow 02Flex mom’s legs as far back as possiblefirm pressure just above the pubic bone