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Chapter 37

Chapter 37. Emergency Childbirth. Overview. Anatomy Review Normal Childbirth Emergency Childbirth Special Delivery Scenarios Post-Delivery Care. Anatomy Review. During pregnancy, the uterus enlarges The fetus obtains all nutrients from the placenta

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Chapter 37

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  1. Chapter 37 Emergency Childbirth

  2. Overview • Anatomy Review • Normal Childbirth • Emergency Childbirth • Special Delivery Scenarios • Post-Delivery Care

  3. 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

  4. 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

  5. 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

  6. 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

  7. Stop and Review • What are the normal anatomical changes that occur during pregnancy? • Describe the three stages of labor.

  8. The Process of Birth

  9. 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

  10. 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

  11. 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

  12. Emergency Childbirth • Normal delivery • Since field delivery is rare, EMTs may want to review these steps frequently • Most deliveries are completed without complications

  13. 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

  14. 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

  15. 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

  16. Special Delivery Scenarios • Multiple gestation • Delivery of two or more newborns • Usually premature • Second is often in breech presentation • Transport immediately

  17. 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

  18. 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

  19. 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

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