Ch. 21-Childbirth and Related Emergencies

1. Ch. 21-Childbirth andRelated Emergencies 1

2. Vocabulary • Fetus- The developing unborn baby • Uterus- The organ in which the baby grows • Birth canal- The vagina and lower part of the uterus • Placenta- Structure on the inner lining of the uterus that provides the fetus with nourishment • Umbilical cord- An extension of the placenta that resembles a sturdy rope, through which the fetus is nourished • Amniotic sac- A sac of fluid in which the baby floats • Vagina- The passage for childbirth • Perineum- The area of skin and muscle between the vagina and the anus • Crowning- The emergence of the baby’s head at the vaginal opening • Cervix- The neck of the uterus • Bloody show- Pink-tinged mucus in the vaginal discharge that is evident as labor begins presenting part The part of the baby that emerges first through the birth canal; in a normal birth it is the head. • Miscarriage- Loss of pregnancy before 20 weeks of gestation; also called “spontaneous abortion” • Labor- The process that begins with the first uterine contraction and ends with delivery of the baby and placenta • Dilation- The stage of labor during which the cervix dilates and contractions occur 2

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4. Labor • Labor • Dilation • Crowning and Delivery • Delivery of the Placenta 4

5. First Aid Supplies for Delivery • Surgical scissors (for cutting the cord) • Cord clamps • Umbilical tape or sterilized cord • Bulb syringe • Five towels • 2 X 10 gauze sponges • Sterile gloves • One baby receiving blanket • Two to three sanitary napkins, individually wrapped • Two large plastic bags • Foil-wrapped germicidal wipes 5

6. PROGRESS CHECK 1. The organ that houses a fetus during its development is the ____________. (vagina/perineum/uterus) 2. The ____________ provides nutrients and oxygen to the fetus. (placenta/cervix/amniotic sac) 3. The ____________ often tears during emergency childbirth. (placenta/perineum/vagina) 4. One of the earliest indications of imminent delivery is the ____________. (presenting part/crowning/”bloody show”) 5. Spontaneous delivery of a fetus before 20 weeks of pregnancy is called ____________. (crowning/miscarriage/breech birth) 6. The first stage of labor is called ____________. (crowning/dilation/presentation) 6

7. Miscarriage 1. Ask the woman when her last menstrual period began. If the last period began more than 22 weeks earlier, be prepared for potential delivery of a premature baby. 2. Conduct an initial assessment; monitor vital signs. 3. Provide first aid care based on the woman’s symptoms. Help control vaginal bleeding by placing a sanitary napkin over the vaginal opening; never pack the vagina in an attempt to control bleeding. If the pad becomes soaked with blood, replace it. 4. Save any passed tissue or evidence of blood loss, such as bloody sheets, towels, or underwear. 5. Provide emotional support to the mother and the members of her family; intense grief is normal for both parents. 7

8. Seizure during Pregnancy 1. Treat the woman based on the signs and symptoms, providing the same treatment as you would for any seizure victim. Take care to protect the woman from injuring herself. 2. Position the woman on her left side to allow for drainage of secretions or blood and to keep her tongue from blocking breathing; keep her warm, but do not overheat. 8

9. Vaginal Bleeding in Late Pregnancy 1. Treat the victim according to signs and symptoms, which will usually include shock. Place the victim on her left side (to prevent the baby from pressing on the woman’s inferior vena cava) with her legs and feet elevated. Keep her warm, but don’t overheat. 2. Place a sanitary napkin over the vaginal opening, but do not pack the vagina. Note all soaked pads and other evidence of blood loss. Save any tissue that is passed, for evaluation by a physician. 3. If the bleeding is caused by trauma, control any external bleeding with direct pressure. Care for internal bleeding as described in step 2. 9

10. Ectopic Pregnancy Signs and Symptoms: • Sudden, sharp lower abdominal pain, localized on one side • Vaginal bleeding • Missed menstrual period • Pain under the diaphragm • Pain radiating to one or both shoulders • Tender abdomen • A palpable mass in the abdomen (typically clotted blood) • Lightheadedness or dizziness • Increased pulse • Shock *Activate the EMS system; then place the victim on her back; keep her warm and treat for shock. 10

11. Vocabulary • Placenta previa- A condition in which the placenta is positioned abnormally • Abruptio placenta- A condition in which a normally positioned placenta separates from the uterine wall, usually during the last 3 months of pregnancy • Ectopic pregnancy- A pregnancy in which the fertilized egg is implanted outside the uterus • Preeclampsia- A condition in pregnancy associated with high blood pressure and swelling of the extremities; the first stage of toxemia • Eclampsia- The second stage of toxemia of pregnancy, when life-threatening convulsions or coma occur 11

12. Preeclampsia/Eclampsia 1. Position the victim on her left side to prevent compression of the inferior vena cava, allowing better blood flow to the heart. 2. Keep the victim calm and quiet; while waiting for emergency help, keep the lights dimmed and avoid making loud noises. 3. Care for seizures or coma as you would for any other seizure or coma. 12

13. PROGRESS CHECK 1. To care for vaginal bleeding, you should ____________. (pack the vagina/apply pressure on the abdomen/place a sanitary napkin over the opening) 2. Seizures caused by eclampsia can be aggravated by ____________. (bright lights/movement/pain) 3. The leading cause of first-trimester maternal deaths is ____________. (ruptured uterus/abortion/ectopic pregnancy) 4. An ectopic pregnancy is one in which the fertilized egg implants_______. (near the cervix/outside the uterus/at an angle) 5. A characteristic sign of preeclampsia is ____________. (swelling of the extremities/cyanosis/rash) 6. As many as ____________ percent of the babies of women who suffer ruptured uterus die. (25/50/75) 13

14. Transporting a Woman in Labor 1. Keep the woman lying down during transport; remove any underclothing that could interfere with delivery. 2. Place a folded blanket, sheet, or other clean object under the woman’s buttocks and lower back. 3. Have the woman bend her knees and spread her thighs apart so you can watch for the crown of the baby’s head in the birth canal. 4. Never ask the woman to cross her legs or ankles; never hold the woman’s legs together; and never try to delay or restrain delivery in any way—the pressure can result in permanent injury or the death of the baby. 5. If the woman vomits, turn her head to one side and clean out her mouth. 14

15. Assisting with Delivery • If possible, use appropriate protection (protective gloves, a mask, a gown, and eye protection) against exposure to body substances. • Do not let the woman use the bathroom, even if she feels as if she needs to move her bowels • Do not hold the mother’s legs together or do anything else to delay delivery. • Recognize your own limitations. 15

16. Delivery Procedures 1. If possible, take body-substance isolation precautions 2. Have the woman lie on a firm surface with her knees drawn up and spread apart 3. Support the mother’s head, neck, and shoulders with pillows or folded blankets so she does not feel like she is slipping “downhill” 4. Remove clothing or push it above the mother’s waist 5. As the infant’s head appears in the birth canal place your fingers on the bony part of the infant’s skull and exert very gentle pressure to prevent explosive delivery 6. If the amniotic sac has not ruptured, tear the sac with your fingers 7. As the infant’s head is delivered, determine whether the umbilical cord is around the infant’s neck 8. When the head is delivered, support the head with one hand and suction the mouth and nostrils with a bulb syringe 9. As the torso and full body are born, support the baby with both hands 10. As the feet are born, grasp the feet 11. Continue to suction the baby’s mouth and nose with the bulb syringe 12. Dry the baby and then wrap it in a warm blanket and place it on its back 13. Clamp, tie, and cut the umbilical cord when pulsations cease in the cord 14. Watch for delivery of the placenta 15. When the placenta is delivered, place it in a plastic bag for transport to the hospital 16. Place one or two sterile sanitary napkins over the vaginal opening 17. Record the time of delivery 16

17. Vaginal Bleeding following Delivery 1. Place your hand on the woman’s lower abdomen above the pubis. 2. Using the palm of your hand, your fingers fully extended, the flat of your four fingers cupped around the uterus, massage in a circular motion until you feel the uterus firm up. It should feel like a hard grapefruit. 3. Have the baby suckle on the mother’s breast. This releases a hormone that causes the uterus to contract. 4. If bleeding continues, check your massage technique and continue massage. 17

18. PROGRESS CHECK 1. You should not try to get a woman in labor to a hospital if ____________. (her husband is not present/you have no suitable transportation/ the mother wants a home delivery) 2. ____________ indicates that delivery is imminent. (Contractions more frequent than every 2 minutes/Severe cramplike pains/Shortness of breath) 3. To prevent explosive delivery, exert gentle pressure on the___________. (pubis/vaginal opening/bony part of the baby’s skull) 4. Cut the cord ____________. (before the baby starts breathing/as the baby starts breathing/ after the cord goes limp) 5. Before you cut the cord, it should be clamped or tied in ____________ places. (two/three/four) 6. It is normal for a woman to lose as much as ____________ of blood following birth. (1 cup/2 cups/1 pint) 18

19. Care of a Newborn 1. Immediately dry the infant, paying particular attention to the head, which has a large surface area. 2. Repeat suctioning with the bulb syringe, making sure the infant’s nostrils and mouth are clear. 3. Assess the infant, evaluating the infant’s color, pulse, grimace, activity and ease of breathing. 4. Stimulate the newborn if it is not breathing or the heart rate is less than 100 per minute. 19

20. Resuscitating a Newborn 1. If the infant’s breathing is shallow, slow, gasping, or absent, provide artificial ventilations at the rate of one breath every 1 to 1 ½ seconds. Assess again after 1 minute. 2. If the infant’s heart rate is less than 100 beats per minute, provide artificial ventilations at the rate of one breath every 1 to 1 ½ seconds. Reassess every 30 seconds. 3. If the infant’s heart rate is less than 60 beats per minute and the infant is not responding to the artificial ventilation, start chest compression and ventilation. 20

21. PROGRESS CHECK 1. The first step in caring for the newborn is to ____________ it. (measure/dry/assess) 2. To assess an infant, use the same factors used in the ____________ scoring system. (Apgar/Andrews/Smithson) 3. To encourage an infant to breathe, ____________ the soles of its feet. (pinch/slap/flick) 4. To resuscitate an infant with a low heart rate, deliver artificial ventilation at the rate of ____________ breaths per minute. (30/60/100) 5. If an infant’s pulse rate is less than ____________ beats per minute, deliver chest compressions. (60/80/100) 21

22. 21.5 Abnormal Deliveries • Prolapsed Cord • Breech Birth • Limb Presentation • Multiple Births • Passage of Meconium • Premature Birth 1. Keep the baby warm 2. Use gentle suction with a bulb syringe to keep the baby’s mouth and nose clear of fluid 3. Prevent bleeding from the umbilical cord; a premature infant cannot tolerate losing even minute amounts of blood. 4. Premature babies are highly susceptible to infection. Prevent contamination and do not let anyone breathe into the baby’s face. 22

23. PROGRESS CHECK 1. A ____________ cord is an umbilical cord that presents through the birth canal before the baby. (pulsating/prolapsed/inverted) 2. A ____________ birth occurs when the baby’s buttocks or lower extremities present first. (breech/premature/multiple) 3. During limb presentation, take advantage of ____________. (suction/gravity/force) 4. Meconium indicates that the baby has had a ____________ in the amniotic sac. (seizure/hemorrhage/bowel movement) 5. The primary goal if you see meconium is to ____________ the baby before it takes its first breath. (stimulate/suction/resuscitate) 6. Suspect a multiple birth if ____________ begin after delivery of a baby. (strong contractions/fluid leaks/cyanosis) 7. A premature baby has no ____________. (hair/outer ear cartilage/eyebrows) 23

24. Vocabulary • Vernix caseosa- The white, cheeselike covering on a newborn’s skin • prolapsed cord The presentation of the umbilical cord at the vaginal opening before the baby • breech birth A situation in which the buttocks of the baby present first through the birth canal • Meconium- The feces of the newborn; greenish or brownish-yellow amniotic fluid indicates that the baby had a bowel movement in the uterus before delivery • Premature baby- A baby that weighs less than 51⁄2 pounds and/or is born after less than 36 weeks’ gestation 24