Chapter 25 Childbirth

1. Chapter 25 Childbirth

2. Introduction to Chapter 25 Childbirth is a natural process. One of the main responsibilities of First Responders is to calm the patient and family by responding in a professional manner.

3. First Responders involved in a pre-hospital delivery are treating two patients- the mother and the newborn.

4. The Process of Childbirth (pp. 462-470) • Anatomy • Stages of labor • Patient assessment • Preparing for delivery • Placenta delivery • Care for the Newborn and mother

5. Anatomy of pregnancy (pp. 462-463) • SEE (Fig. 25-1, p. 463) • Uterus – organ containing the infant • Cervix – neck of the uterus • Mucous plug = bloody show • Placenta – provides nourishment and oxygenates the fetus • Umbilical cord – placenta to the fetus • Amniotic sac – fetus floats in sac • Birth canal – Cervix – vagina

6. B. Stages of labor (pp. 463-465) (Fig. 25-2, p. 464) *** 1. First stage: dilation (18 hours?) 2. Second stage: expulsion contractions get closer together and last longer 45 – 90 sec. each, Feeling of bowel movement? Crowning then birth 3. Third stage: placental

7. C. Patient assessment (p. 465) 1. Signs that birth is imminent If there is crowning, the birth is imminent. (p. 465) a. Timing contractions Birth may be imminent when the mother's contractions are two minutes apart. If contractions are between two and five minutes apart, start asking the questions b. Questions to ask : Have you had a baby before? Do you feel the sensation of a bowel movement? Do you feel like the baby is ready to be born? If the mother's answer is "yes" to any of these questions, examine her for crowning.

8. Supine hypotensive syndrome • Before 20 weeks • Heavy vaginal bleeding • Pain below the abdomen • Passage of tissue

9. D. Preparation for delivery (pp. 465-467) 1. Materials and equipment 2. Positioning mother 3. Creating sterile field

10. E. Delivery of baby (pp. 467-469) (Fig. 25-3, pp. 467-468) • From crowning to complete birth (pp. 467-469) • (Fig. 25-4, p. 469) • 2. Baby's first breaths (rub back, flick feet) • 3. Cutting umbilical cord (p. 469) • SEE (Fig. 25-5, p. 470)

11. F. Delivery of placenta (pp. 469-470) The placenta usually delivers within 10 minutes of the infant and almost always within 30 minutes. When it does deliver, wrap it in a sterile towel and place it next to the baby.

12. Wrap the baby and the placenta in another sheet or blanket. If the cord is cut, place the placenta in a plastic bag to be taken to the hospital where a physician can confirm the delivery is complete. Control Bleeding Sanitary napkins over vaginal area Breast feed? Keep mom and baby warm Massage uterus if excessive bleeding

13. G. Newborn care (pp. 469-470) 1. Artificial ventilation (p. 470) If not breathing try tactile stimulation If pulse is below 100 do artificial ventilation 2. CPR (p. 470) Below 60 pulse rate start CPR

14. Complications of pregnancy (pp. 471-472) • Toxemia of pregnancy • High blood pressure • Swelling of extremities • Dramatic weight increase • Blurred vision • Decreased urinary output • Headaches, vomiting, pain in abdomen, seizures • PUT THE PATIENT ON THEIR LEFT SIDE AND TRANSPORT

15. Complications of pregnancy (pp. 471-472) • Spontaneous abortion • Before 20 weeks • Vaginal bleeding • Passage of tissue

16. A. Complications of pregnancy (pp. 471-472) • Ectopic pregnancy • Fertilized egg attaches outside the uterus • Eventually causes ruptured blood vessel, heavy bleeding • Leading cause of death for women in their first trimester

17. A. Complications of pregnancy (pp. 471-472) • Placenta previa • Placenta is positioned low in the uterus, it separates from the uterus • Both mother and baby are in danger

18. A. Complications of pregnancy (pp. 471-472) • Abruptio placenta • Leading cause of death after blunt trauma • Normally implanted egg separates from the uterus • Occurs last 3 months of pregnancy

19. B. Complications of delivery (pp. 472-474)  1. Prolapsed umbilical cord – keep babies head off cord  2. Breech birth –let deliver, protect the airway  3. Umbilical cord around the neck  4. Limb presentation – Get to hospital, nothing you can do  5. Multiple births – same as single, 1 or 2 placentas  6. Premature birth keep warm suction prevent ANY blood loss

20. Study Questions Section 1: The Process of Childbirth

21. Q1. What information must you have in order to decide if a birth is imminent?

22. Q1. What information must you have in order to decide if a birth is imminent? A1. Time between contractions and whether or not there is crowning. Birth may be imminent when the mother's contractions are two minutes apart. If contractions are between two and five minutes apart, ask: Have you had a baby before? Do you feel the sensation of a bowel movement? Do you feel like the baby is ready to be born? If the mother's answer is "yes" to any of these questions, examine her for crowning. If there is crowning, the birth is imminent. (p. 465)

23. Q2. How can you determine how fast and how close together contractions may be?

24. Q2. How can you determine how fast and how close together contractions may be? A2. To time contractions, first place your gloved hand on the mother's abdomen, just above her navel. Feel the involuntary tightening and relaxing of the uterine muscles. Then time these involuntary movements in seconds. Start from the moment the uterus first tightens until it is completely relaxed. Time the intervals in minutes from the start of one contraction to the start of the next. (p. 465)

25. Q3. What can you do to assist a mother in the delivery of the baby? Describe the process briefly.

26. Q3. What can you do to assist a mother in the delivery of the baby? Describe the process briefly. A3. To assist the mother in the delivery of her baby, place the palm of your hand on top of the baby's head to prevent an explosive delivery. Break open the amniotic sac if it has not already broken. If there is meconium staining, clear the baby's airway with a rubber suction syringe. Determine the position of the umbilical cord, and if it is around the baby's neck, dislodge it. Remove fluids from the infant's airway after the head is fully delivered, and support the baby with both hands as the rest of the body delivers. Dry, wrap, and position the newborn. Clean the newborn's mouth and nose and, if breathing does not begin, provide tactile stimulation. Clamp, tie, and cut the umbilical cord when it stops pulsating. Record the time of delivery. Provide basic life support if it is needed. (pp. 467-469)

27. Q4. When does the placenta usually deliver? What should you do with it when it does?

28. Q4. When does the placenta usually deliver? What should you do with it when it does? A4. The placenta usually delivers within 10 minutes of the infant and almost always within 30 minutes. When it does deliver, wrap it in a sterile towel and place it next to the baby. Wrap the baby and the placenta in another sheet or blanket. If the cord is cut, place the placenta in a plastic bag to be taken to the hospital where a physician can confirm the delivery is complete. (pp. 469-470)

29. Section 2: Complications of Childbirth Q1. What would you observe in a breech birth? A prolapsed cord?

30. Q1. What would you observe in a breech birth? A prolapsed cord? A1. In a breech birth, the baby's feet or buttocks are delivered first. When there is a prolapsed cord, the umbilical cord comes out of the birth canal before the infant. (p. 472)

31. .How does a multiple birth differ from a single birth?

32. Q2. How does a multiple birth differ from a single birth? A2. Because multiples are usually smaller than a single baby, delivery is often easier. Identical twins have two umbilical cords coming out of a single placenta. If the twins are not identical, there will be two placentas. (pp. 473-474)

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